Sudden Impact

Albuquerque Journal
Dec. 14, 2008

When the dizziness and fatigue hit, Volcano Vista defensive back Daniel Gassoway figured he was simply out of shape. He was, after all, playing in his first game since missing most of football practice the previous two weeks after a concussion.

But, as that Oct. 17 game against Del Norte progressed, he made a tackle in which his head absorbed much of the blow.

The feeling in his legs faded.

Watching from the Wilson Stadium stands, Gassoway’s mother, Lori, noticed that Daniel seemed uncoordinated.

Soon he collapsed and tried to crawl off the field.

“I can’t feel my legs,” Daniel told the athletic trainer.

Don Gassoway ran onto the field to check on his son.

Eyes open, Daniel didn’t respond.

He didn’t squeeze his father’s hand.

He just lay there, twitching.

Weeks later, those details remain sharp in the Gassoways’ minds as Daniel and his parents talk about the brain hemorrhage he suffered that night, two weeks after suffering a mild concussion.

A thought lingers in Lori’s head.

“I look back now, and I wish there was something I could have done differently to prevent the second (injury),” she said. “We did everything we were supposed to. … There was nothing we could have done differently. I wish there would have been. I wish there was another test we could have run. Or a feeling that we had. Or a sign from him that he wasn’t ready. There was nothing.”

Daniel Gassoway’s rare, yet frightening, combination of head injuries and the unusually high number of concussions suffered this season by Cibola’s football team underscore the mystery and danger shrouding youth head injuries.

They also serve as examples of why local medical personnel treat concussions, especially among young athletes, so carefully. And they explain why those officials say dealing with these concussions is a community responsibility.

So, what was done between Gassoway’s Oct. 3 concussion and his more serious injury on Oct. 17?

Plenty.

For the Gassoways, that’s the scary part.

A concussion is widely described as a blow to the head resulting in impairment of neurologic function. It doesn’t require loss of consciousness, a common myth.

Once diagnosed, the National Athletic Trainers’ Association position statement — which state and Albuquerque Public Schools athletic trainers follow — says concussed athletes under age 18 should be managed more conservatively. They should follow stricter return-to-play guidelines than adults because damage to developing brains can be catastrophic.

This could include deadly conditions, such as second impact syndrome, during which the entire brain swells in response to multiple, even mild, concussions within a short window. But there are serious questions within the medical community as to whether this condition exists.

For Daniel Gassoway, all prescribed precautions were taken. He was evaluated by the school athletic trainer — each APS high school staffs one, full time. Because of further concerns, Gassoway saw his doctor. As he was monitored, Gassoway sat out more than a week of practice. Eventually, he passed all the return-to-play progressions, which take athletes through increasing levels of physical activity every 24 hours. If concussion symptoms, such as dizziness, headaches, amnesia, nausea or blurred vision, occur, the athlete must start from the beginning.

Said Dr. Tom Pascuzzi of MD Urgent Care, one of several physicians volunteering at local high school football games: “You need about five to seven days to clear someone.”

The return-to-play aspect of concussion management is critical. Doctors do not and may never know if Gassoway’s concussion and subsequent brain hemorrhage were linked.

However, the concern exists. In its most recent annual survey, the National Center for Catastrophic Sports Injury Research notes that many football players who suffered fatal brain trauma had concussions or complained of headaches just before their deaths.

But determining if an athlete is ready to play begets obstacles.

In many milder concussions, the symptoms are noticeable only to the athlete. If he or she doesn’t report it, the injury could remain veiled. And, once treatment starts, athletes can lie their way past tests.

Two days after Gassoway’s collapse, a high school player in New Jersey died from a similar injury. But Ryne Dougherty had been cleared to play after a concussion in part because he reportedly hid from doctors his ongoing headaches.

“I think some kids do hide it,” said Missy Archibeck, Eldorado High’s athletic trainer. “… There is this drive among athletes; they want to compete. They don’t like telling people they’re injured.”

David Vargas, a running back for Cibola High, suffered a concussion early this season. He reported it, received treatment and returned to play. But he had thoughts of deceiving medical personnel. As an experienced player, he knows pain management is part of the game.

“You think, ‘Maybe I’ll be fine,’ ” Vargas said. “Then, the doctor finally explained it to me. He said ‘You might have a slight concussion now, but if you go out there and play too soon, it could be fatal next time you go out there and hit.’ That was when I was like, ‘I better take care of it.’ “

Data from the American College of Sports Medicine suggests that up to 85 percent of concussions go unreported.

Because concussions can be so mysterious on so many levels, APS athletic trainers rely on a community-management approach.

Officials say vigilance is crucial for all: Athletes. Coaches. Teachers. Parents. Athletic trainers.

To that end, the New Mexico Activities Association created a Sports Medicine Advisory Committee last year. The NMAA, which governs the state’s high school sports, wanted a means to educate coaches on sports medicine issues.

In October, the NMAA conducted a Web-based seminar on concussions, with information provided by a doctor. NMAA Executive Director Gary Tripp was satisfied with the seminar, but noted that only “10 or 11” people participated, including no coaches and two parents.

“It’s something that’s just starting,” Tripp said. “So it’s going to have to get caught on.”

University of New Mexico medical personnel have put together monthly lectures on different issues.

Said APS athletics director Kenny Barreras: “I’m very happy with the way our athletic trainers assess (athletes) right now. It’s a continuing education thing. We have continual conversations about, ‘How can we do this better?’ “

Some claim computer-based programs can better determine when an concussed athlete can safely return to play. They test athletes before the season to establish a baseline score. After a concussion, a player’s score must return to the baseline before clearance. Neuropsychological testing is also available.

But doctors say these options haven’t been proven conclusively — and Sandia athletic trainer Robert Evers said “neuropyschological tests are very expensive.”

Barreras places his faith in the athletic trainers. He said APS is reviewing the various computer programs.

“I feel very comfortable right now with all of our athletic trainers — in the training they have, in the education and knowledge that they have and knowing their kids. They can assess a concussion.”

Pascuzzi, the volunteer sideline doctor, endorses APS’s current, community-management model of handling concussions.

“It’s very effective,” he said. “That’s the best you can do. Having parents involved and other kids involved. Having community awareness and respect for it. The proof of that is that there aren’t that many (severe) head injuries compared to the number of concussions we see.”

Don Gassoway was happy about the way his son’s injuries were handled.

“The (athletic) trainers, the school, they were extremely supportive,” he said. “The doctors on-field were great.”

Daniel Gassoway just hopes to get back on the football field.

His headaches faded recently. He progressively returned to school. As of Friday, Gassoway had been attending full-time for two weeks. The family’s unsure if his abilities in math, which were an academic strength, will be affected. Walking is the most strenuous exercise he can safely do.

“I doubt it sometimes, with the injuries,” Gassoway said. “But I really want to go back.”