Tag Archives: KO Project Round Table Members

An Athlete’s Story of Re-ordered Expectations in The Wake of Multiple Concussions

By Kate Parhiala

kateshotIn 2010, the UCI Mountain Bike World Cup announced that it would have an event in the United States, at Windham Mountain in New York. This same year was my first as a professional mountain bike racer and I had the opportunity to participate in the four-cross event at this race. Four-cross is a downhill event where four racers at a time go head-to-head down a track with flat and banked turns, jumps, rocks, drops, and whatever obstacle the course builder decides to throw in. In each round the top two racers move on and the third and fourth are eliminated. To determine groups everyone takes a timed seeding run.

containerdropSuccessfully navigating the jump where I ended up having problems later on.

I never got that far. Before the race there is an allotted time during which riders can take practice runs on the course. Everything about this course was huge, especially the jumps. I had been carefully inspecting and attempting the course bit by bit. By my third practice run I attempted to string the whole thing together. As I approached the big step-down jump I was much farther left than where I had been hitting it previously. There were two landings to this jump: I had been aiming for the closer one, same as in the other runs, but was carrying a bit more speed this time around. I ended up landing on the flat area between the close landing and the far one. All that I remember as I began to fall off the back of the bike was thinking “Wow, this is embarrassing.” About an hour later I woke up in an ambulance.

windham_crash

The big crash at Windham. The medics are trying to free my leg. I don’t remember any of this.

There is a considerable chunk of time that I don’t remember. I have been told that I was physically unconscious for about 30 seconds but mentally I was completely blacked out for at least an hour. The medics were asking me questions to check on my cognition. I knew my name and what my bib number was but couldn’t remember signing up for the race or how I had gotten there. Apparently my left foot had not come unclipped from the pedals and my left leg had become pinned between the rear wheel and the seat. The medics had to let the air out of the tire to extract my leg, which they thought was definitely broken. I was carted down the mountain and into ski patrol where they put an IV in and eventually an ambulance came to bring me to the trauma center in Albany, about an hour away. We were almost there when I finally came to, strapped to a backboard and very nauseous.

brokenhelmet

 My helmet after concussion #2. I should have bought a new one instead of just replacing the visor.

I remember very little of my stay in the emergency department at Albany Medical Center. I think they got me in right away for a brain scan and x-rays. Luckily no bleeding in the brain and only two badly sprained ankles. I don’t believe I was given any instructions on how to care for a concussion after I was discharged because I spent the next few days doing things I shouldn’t have been doing. With two more days booked at the World Cup, my boyfriend (now fiance) and I wanted to stick around and watch the races. I was hobbling around the mountain on my crutches in the bright sunlight with the loud crowds drinking the occasional beer.

jumpThe day after the crash – concussed and sore in front of the jump that took me out.

It took until going to work the Monday after for me to realize what a mess I was. I just remember sitting at my desk staring blankly at my computer not being able to think. It hurt to think. I couldn’t remember a lot of things that I had previously been working on. My speech was a little slurred and it was difficult to come up with words. By mid-day I finally told my boss that I had to go to the doctor. After taking the subway and the bus home I got in my car to drive to the doctor’s office. Very quickly I discovered that I could barely control the car. My reaction time was so delayed that I kept almost crashing every time a car was stopped in front of me. The doctor told me that I needed to take it easy for a while after a bad concussion and should take at least a week off from work. I left my car at my parents’ house so I wouldn’t try to drive it.

It took at least a month or two for me to start recovering from the most acute symptoms. It was such a relief when I could finally concentrate for most of a workday. I still have trouble remembering anything from that general timeframe. In addition, something strange happened with my memory: things got rearranged. Memories from 10 or 15 years ago were suddenly vivid like they had occurred yesterday while more recent events felt like the distant past. I began having extremely vivid dreams as well (more so than usual) and started remembering little things that were long forgotten. These strange memory issues are still affecting me today.

This was not my first concussion, it was my third. My first happened during a BMX race in 2003. I crashed going over the first jump and hit the left side of my head really hard. There was a bright flash of light and an immediate headache. This was described to me as a mild concussion and I did not notice any residual symptoms. My second concussion actually went undiagnosed. I didn’t realize that I had one. In July of 2010 I was at a downhill mountain bike race and crashed during practice. It was one of those crashes where I went over the bars and the first thing to hit the ground was my face because it happened way too fast to get my hands off the bars. My full-face motocross helmet actually dug some rocks out of the dirt as my head plowed through. I hit so hard that I felt like I should have blacked out. I was definitely out of it and a little confused but I chalked it up to being shaken by the crash. I didn’t think this was a concussion because there was no loss of consciousness and no flash of light. In retrospect it definitely was. I just did not feel right for weeks afterwards but I replaced the shattered visor on my helmet and was back in action the next weekend. This was only a little over a month before the big crash at Windham.

Fast-forward to the 2011 season: I ended up suffering a fourth minor concussion over the summer and a fifth in October, both practicing for downhill bike races (even with a new helmet). The cumulative effect of this, in addition to the memory changes that I still deal with, includes mood changes and migraine headaches. I became significantly depressed and anxious after having 4 concussions in 15 months. In addition I started getting migraine headaches so bad that I would throw up (luckily only a few times a month). Still, it was difficult for me to realize how all of this fit together but I finally decided that I needed help when none of it was improving during the 2012 season.

I began seeing a new doctor who referred me for neuro-psych evaluation. Most of the testing done was negative but a brain MRI actually revealed mild atrophy in the temporal and parietal lobes of my brain. It was strongly suggested that I quit anything that put me in significant risk of further head trauma because further injury could be devastating. This especially meant no more downhill and no more BMX. This was very difficult news for me. I had focused my life around these things for quite some time and it was hard to go from thinking about what World Cup races I wanted to enter the next season to selling my downhill bike and letting my sponsorships expire. I really miss that life but I had no other choice.

It’s a very strange feeling to have an injury that I can never recover from. Even though the symptoms are somewhat managed with medications the physical damage is irreparable. Even before the doctors advised that I stop racing downhill I knew that things weren’t quite right. It is always difficult to get back in the saddle after a bad injury because you’re shaken and anxious. But with time one can usually overcome this. Because I’ve injured the very part of me that controls those thoughts and emotions I was never able to recover my confidence in the two years before I finally quit. I was getting faster and developing better technique but becoming more and more scared and anxious. I know that before continuously landing on my head this wasn’t the case but it’s hard to remember what that felt like.

Since the brain scan results I’ve had to dial the excitement back a quite a bit. Being an adrenaline junkie causes my happiness and sanity to be dependent on doing active and exciting things. At this point I’ve tried to create a balance between acceptable risk and not being bored and miserable. I continue to alpine ski and still race (while wearing a great helmet, of course). While there is still risk, I have not suffered a head injury in the 26 years that I have been skiing (and I hope to continue this trend). On the biking side I have been doing more cross country mountain biking and have started racing cyclo-cross. In addition I am becoming more involved in mountain bike coaching. I still do easy jumps and drops but try to stick to a controlled environment and will not ride beyond my ability.

When it comes to mountain biking I firmly believe that fewer injuries of all types would be sustained if people sought professional instruction, specifically on bike handling, rather than the trial and error method. This is part of the reason I have become more involved with coaching. If a rider learns solid fundamental skills before attempting larger obstacles he or she will be able to more safely progress. Many riders, including myself, did not have this opportunity. To paraphrase my friend and fellow coach, former pro Karen Eagan, if you feel lucky that you just landed that drop DO NOT go bigger; Practice it again and again until you are completely comfortable and then you can progress to the next one. Mountain bike instruction has only recently become more widely available and is something that this sport has been severely lacking. Downhill racing can never be made completely safe, and it shouldn’t be (that’s part of the allure), but riders can at least be equipped with the skills to sufficiently tackle any course they are confronted with.

Having this experience has caused a significant change in mindset. I’ve become comfortable with backing down from certain challenges like drops or jumps if I don’t feel completely comfortable. I can always try another day when the conditions are right. Why go for it now? Is it really worth it? Some things I will probably never attempt and now I’m ok with that. I would rather be riding my bike and skiing for many more years than possibly risk it all because I couldn’t tell myself no. As written of world-renowned steep skier Andreas Fransson in a recent issue of Powder Magazine, “He is most proud of the runs he didn’t take, because backing off is harder than dropping in.”

Sara Birkholz, on Post Concussion Syndrome, From the Trenches

imagesaraThe past several months I have picked up and read books about personal accounts of survival. The authors have amazed me with their strength and their new outlook on life once they have emerged from whatever dark tunnel or trial was placed in their life. As I finished reading each story, however, I could not help but wonder what their story would look like if they had written it in the midst of their battle. I have struggled to write this article because I do not yet have the insight of seeing the light at the end of the tunnel. I do not know how my “crisis” so to speak, will turn out. I decided in a way this is a good thing because the purpose of The Knockout Project is to educate people on what the ramifications of a concussion can be. Stepping into the life of someone who is currently living day in and day out with the consequences of a concussion can shed a lot of light on why it is so important to protect ourselves and those we love from being injured.

First I would like to start with the definition of concussion. A concussion is a traumatic brain injury that alters the way your brain functions. In the past when I heard someone had suffered from a concussion, I did not think much of it. My first reaction was NEVER “Bobby received a traumatic brain injury today during football practice.” Instead I thought, “whew, Bobby had his bell rung a bit at football practice and should be fine.” I am sure that is the way the majority of people feel about concussions. I thought this way about concussions until last August.

On August 7, 2012, our family decided to end a fun three day trip to Duluth, MN by going on the new Alpine Coaster at Spirit Mountain. After all, it was on the way out of town and the kids were pretty pumped about riding it. I hopped on the sled like contraption with my daughter. As we left the boarding station the employee told us “go as fast as you can, the sled is attached to the tracks and you cannot be thrown off.” Of course once my 10 year old heard that great news, we were full steam ahead. As I saw the first turn approaching I felt like we were going much too fast and leaned forward to grab the brake. I was too late, and because I had not leaned into the turn and was in an awkward position, I got whipped to the right. I actually felt my head snap and was dazed the rest of the way down the mountain. At the bottom I told my husband and kids that I did not feel well and that I was jarred on the first turn. We all just laughed and talked about mom being a wimp and getting too old to go on rides.

Within 48 hours from my ride down the mountain, I started having dizzy spells.

Within 72 hours I ended up in the emergency room because I could not stop throwing up. I did not even initially associate my symptoms with anything that had happened at Spirit Mountain. I thought to have a concussion, you had to be knocked out. Many tests were ordered to figure out what was going on with me and why I was suddenly having a “neurological event” (that is what the doctors described it as on those first few days). Eventually, I was sent home with the “good” news that my CT and MRI were both clear.

It was not until about 10 days after the accident, and continued nausea, vomiting and dizziness, that I called the neurologist to tell him about the Alpine Coaster ride. He confirmed that I did not need to be knocked unconscious to have a concussion and that I was indeed having concussion symptoms. He told me to continue as I was and all my symptoms should clear on their own within 6 weeks.

Fast forward to today, February 26th, 2013. I am almost 7 months post accident, and as I sit and type this article I am wearing sunglasses because the back light from the computer screen is excruciating for me. I have not had one moment since August without nausea, dizziness, light sensitivity, and disequilibrium. Up until Christmas, I was still vomiting almost daily. Even bending over to get laundry out of the dryer makes me feel like I am spinning so much I have to rush to a toilet. Every time I am in the car and we go from moving to a stop I have a wave of nausea come over me that is so severe that I have to prepare and have bags in the car. Entering into a big box store, like Target, makes me feel even more off balance and dizzy. I try to wear a baseball cap and sunglasses into stores but even that does not take away the increased nausea and disequilibrium that the fluorescent lighting causes. From the moment my feet hit the floor and my eyes open this is my current “normal”.

Before this accident I was an avid runner, taught spinning classes at the local gym, practiced law part time, helped coach my kids in various sports, spent tons of time with my girlfriends and family and absolutely loved and embraced every day. Today I struggle to even get through a day. I have prayed to die over and over because my physical symptoms are so horrendous. I cry myself to sleep many nights because I know in the morning I am facing another day like this. I feel awful 100% of the day. I have severe nausea 100% of the day. I am dizzy from the moment I stand up. I feel off balance 100% of the day. Grabbing milk and juice quick from a grocery store is excruciating with all the lights and stimulation.

People do not understand what it is like to live this way. I have gotten everything from “what is your problem, you just have a concussion” to “certainly you can’t still be having symptoms?!” But the worst was recently when I retrieved my file from the clinic and the doctor had written “hypochondriac” and “health anxiety” as his conclusions to my problems. ARE YOU KIDDING ME??!! I could not make up these symptoms if I tried. And frankly, I would be living my life to the fullest not spending time at a clinic. That is all I want and pray for…..my old life back. It is a very scary moment when you are still sick and miserable every second of the day and the doctor who was in charge of “helping” you does not even understand concussions and doesn’t even believe you.

I am now seeing a new set of doctors in Minneapolis, MN who truly understand post concussion syndrome. Every time I leave their offices, I feel even more educated about brain injuries. In two short visits, they have gotten to the bottom of the dizziness and nausea. Apparently, my whole ocular system was knocked out of whack in the accident and each eye is focusing on a different objects and sending different messages to my brain. The scary part is about 50% of the brain is devoted to visual processing. So, I know I am still facing a long road to recovery with my therapists. I am also undergoing vestibular therapy to get my balance back. I never realized that one small, or what I thought was small, whiplash event could damage so many centers in my brain.

Finally, living with PCS is a very lonely journey. I have learned that as your symptoms persist, everyone moves on with their lives. Every once in awhile they throw you a “how are you?” Sometimes I tell people things are a little bit better only because I do not want to go through the process of trying to describe my symptoms. Sometimes I tell them I am little bit better because I wish so badly they were getting a little bit better. But the honest answer is “I am the same.” I have not seen any recovery in over half a year. PCS is a time when you really learn who your friends and loved ones are, and you learn that health, above anything else, is a true blessing you took for granted every day.

As you can see, when you are in the midst of a dark tunnel the story is not exactly inspiring but it is real! This is a very frank look at my current life with post concussion syndrome. In addition, you get to see how absolutely devastating a head injury can be. I do not have a history of concussions. This is my story after just one concussion event. All it takes is one event to have lingering, debilitating post concussion symptoms. I want people to realize that risking your brain to go back into a game is not a good decision. Riding a bike or going skiing without a helmet should be unthinkable. I could go on, but ultimately I want to educate others as much as possible, because even though I was in a freak accident, other people have the chance to step away from a sport or event before more damage is done. Also, I want to emphasize how important it is to find the right doctors and therapists if you are having lingering symptoms from a head injury. Trust your gut. The doctors are working for you and this is your brain not a cut that needs stitches.

I know in the end, God never gives us a challenge we cannot handle. With the help of my husband and two wonderful kids, current doctors and therapists, and the love of all my other PCS pals, I know this has to get better and I can continue to persevere. I plan to continue to update all of you on my progress in therapy and hope I can help anyone who is currently going through this. I hope someday I can write again with the insight of recovering from this monster. People with head injuries have an invisible injury. We look healthy on the outside, but deal with very real, disabling, miserable side affects every day. Concussions are not something to take lightly. As Sir Francis Bacon said, “Knowledge is power.” And now you know.

Mental Toughness: The Role of the Athletic Mindset in Perpetuating the Concussion Crisis

By Jay Fraga

raceConcussion is a funny thing. As an “invisible” injury, the odds that it will be dismissed by any number of people in a position to do something about it, including the player, are high. It’s difficult to quantify a concussion visually. It is not difficult to quantify a compound fracture of a leg. A concussed person can look you in the eyes and say, “Hey, I’m fine to play. Put me back into the game” and many people will believe them at face value because they don’t have much visual evidence to the contrary.  A player with a compound fracture of the leg could look you in the eyes and say, “Hey, I’m fine to play. Put me back into the game”, and you would instantly know that they’re out of their mind. “Uh, apparently, you didn’t see the gore that is your leg. Forget it”.

So, why is there a difference in reactions among players, coaches, and even many medical personnel between the two injuries?

In terms of long-term ramifications, I’d take a compound fracture of the leg over a concussion any day. Before someone calls me a maniac, I should point out that I’ve suffered badly broken legs as well as multiple concussions and the aftermath is not even close. Brain injuries of any kind need to be avoided at absolutely all costs. This is coming from a man who once thought that learning how to walk again after breaking both legs was the toughest thing that he ever had to do and would ever have to endure again. I was wrong on that one.

On top of the strange denials that invisible injuries like concussions evoke from society at large, the condition also has to contend with athletes who have been trained, many since an early age, to prevail over any obstacle. I’ve read many articles recently where the authors can’t seem to comprehend why players can’t grasp the enormity of concussions and they express shock at such instances. “Football players? They knew what they were signing up for. How could anyone not know that football is a dangerous game?” Right?

Not so fast.

Why can’t athletes grasp the severity of concussions, pull themselves from games, and allow themselves to be properly treated? Take money out of the equation. It’s still pretty simple: Athletes are conditioned mentally to succeed. Successful athletes understand that mind over matter isn’t just a cliché; it’s truly the Law of the Land. Mental toughness is probably the most important ingredient to success in sports. Could there be any other reason why professional team franchises employ sports psychologists to build up their players?

Mental toughness, the very same ingredient that is essential to success in sports, is responsible for the majority of pervasive denial by athletes of the severity of concussions.

As a young, impressionable amateur athlete, the mental toughness that was ingrained in me by my Mother afforded me success. As I won more, the more ingrained that concept became in me. Putting in more effort than my competitors (along with the belief that I was just plain faster than they were) created a little boy that believed that he could surmount any obstacle in front of him simply by willing himself to succeed. That little boy grew up to be a man, and he carried that ethic with him. It served me well in athletics, and it served me well in life; right until the point where I denied the obvious severity of my concussions. To me, they were an annoyance; just another hurdle to get over so that I could prepare for the next race.

Digging into it, I never was consciously aware that there was a problem, or that I was injured beyond something minor. I feel that my mindset allowed me to gloss over details that were serious warning signs as opposed to knowing full well that I was hurt and making a conscious decision to go out and race hurt, further imperiling my health. My friend Kevin Saum wrote about his blurred vision (on top of a host of other symptoms) in a football game where he convinced himself that sweat running into his eye was responsible for it. Further that, I’ve had situations where I’ve been completely knocked out and woken up surrounded by EMT’s who ask, “Are you OK?”, and I’ve reflexively blurted out, “Yes, I’m fine” without even knowing what planet I was on. What’s important is that I wasn’t making a conscious effort to deceive anybody in any of those cases, but there was absolutely some mechanism that was leading to me to speak authoritatively when I had absolutely no clue what I was talking about.

Instances like those lead me to ask the question: As motivated athletes, are our brains tricking us?

As concussion awareness advocates, our mission is two-fold: Along with raising awareness of symptoms and ramifications of concussion, we must also find a way to address the mental toughness conundrum with regard to dismissal of concussion symptoms.  We can’t look expressly to coaches, because coaches were once players too. As such, they’re wired the same way as the athletes are.

It is incredibly hard to teach new dogs new tricks. It’s even harder to teach old dogs new tricks.