January 19, 2021 // Perspective

Considering the danger of concussions

Dr. David Kaminskas

The Catholic Doctor Is In

When I was a sophomore in college, I participated in a flag football league. Even though it was flag football, it got physical at times. If you could not pull the flag, a tackle was acceptable. 

I was a running back and toward the end of a game they called my number. I broke into the clear and thought I was about to be the hero as I sprinted toward the goal line. The next thing I remember is waking up face down choking on the turf in my mouth. By the time I began to regain consciousness both teams had circled around me, hoping I would begin to move. I had been tackled from behind and evidently hit my head hard enough on the ground to be knocked out. 

That night, I had the worst headache of my life as I tossed and turned in bed, fighting back nausea. It was days before I thought I had all my faculties again. I had no clue at the time, but I had just experienced a significant concussion.

A concussion is a traumatic brain injury. The estimate is that 4 million of these occur in the United States every year. If you are male, your best opportunity to have a concussion is in football, hockey, lacrosse and rugby. Girls have their best chance playing soccer. I have a godchild who took a full year to recover from a concussion that occurred during a competitive soccer game.

If you watch the NFL, you no doubt have seen many concussions occur. If the player experiences loss of consciousness even for a few seconds, the diagnosis of a concussion is clear. Getting knocked out, though, is not necessary to be diagnosed with a concussion. 

The symptoms of a concussion include headache, dizziness, confusion, amnesia, slurred speech, forgetfulness, nausea, drowsiness, insomnia, photophobia and blurred vision; but the list does not stop there. Allow me to go a little deeper into the pathophysiology of what happens to the brain. 

After the trauma, some of the brain neurons develop abnormal activation. Affected areas of the brain can have accumulation of a harmful substance called lactic acid, the same chemical that builds up in the muscles of marathon runners. Reduced blood flow to the brain can occur for days or weeks after a traumatic brain injury. 

The brain is fed by glucose carried in the blood, and if there is reduced blood flow there may not be enough “food” for the brain to function properly. This is one suspected cause of the cognitive dysfunction that may occur following a concussion.

There are protocols designed to treat concussions that occur during sports. The NFL has an extremely strict protocol for diagnosis and treatment before a player can return to game play. All protocols include an immediate suspension of participation in the sport. 

Studies have shown that some level of activity during the first few days post-concussion such as walking or stretching exercises is a good thing. Students usually are counseled to take a few days off from school, but if they return to school and experience recurrent symptoms and difficulty concentrating, they need more time off. It is recommended to avoid loud music, avoid video games and minimize screen time, even though your child may not appreciate the importance of this. 

When to allow a player to return to his or her sport can be a difficult decision. Once the original symptoms resolve, the athlete can begin light exercise. It turns out using a stationary bike is a good place to start, then proceeding with more vigorous exercise is allowed. The next step is to practice with the team and, if that goes well, then back to full competition.

If there is another concussion in the weeks to come the medical team, and usually a neurologist or sports medicine specialist, will be more aggressive in protecting the athlete and he or she will not be cleared to participate again for a long time. 

There have been multiple high-level athletes who have been advised to quit their sport because of multiple concussions, which can lead to long-term brain dysfunction. Some of the retired NFL players who have sustained multiple traumatic brain injuries — not necessarily just concussions — before the current strict protocols were developed have gone on to develop Chronic Traumatic Encephalopathy. This can lead to depression, dementia and suicide.

Participation in school sports has been shown to have great value for children. They make friends, learn about teamwork, get physically conditioned and learn how to gracefully win and lose. But there are also risks that must be considered. Parents have a great responsibility in making this decision. Guiding your children to make the best choices takes prayer and some help from the Holy Spirit. 

Dr. David Kaminskas is a board-certified cardiologist and member of the Dr. Jerome Lejeune Catholic Medical Guild of Northeast Indiana, www.fortwaynecma.com.