Shedding light on the realities of Second Impact Syndrome.
The mountains are magnets for the risk-taker in all of us. As biking, skiing, snowboarding, kiting, and climbing enthusiasts, we are likely cracking our melons at a rate higher than some of the less adrenaline-addicted populations out there. If nothing else, the fact that we spend most of our free time strapped into helmets says something about the inherent recklessness of our more risky habits.
So, with all of this head-banging going on, how much do you really know about head injuries or about the people who suffer from them?
In February 2010, Mike Robertson, a Canmore, AB-based snowboard cross national team athlete, stood on the Olympic podium in Vancouver with a silver medal around his neck. But, as a result of ensuing snowboarding-related head injuries, and a lack of knowledge regarding recovery-management, it turned out to be the last time he would compete on the circuit.
If Mike’s story teaches us anything, it’s that most of us don’t quite understand the impact of multiple concussions and Second Impact Syndrome. It’s about time we get schooled.
Mike Robertson’s Story
Mike’s story began with his first diagnosed concussion in 2008, which kept him out of competition and training for about two weeks. The second undiagnosed concussion occurred in 2009. He “toughed it out” and didn’t complain about his aches and pains, so no one else thought to mention to Mike that he should take it easy. He competed the following weekend.
In March of 2010, two weeks after the Vancouver Olympics, he experienced another concussion that required about a month of recovery. Almost six months later at a summer training camp, he hit his head again – this time very lightly – but the result was the same: another concussion with all the accompanying side effects. After a four-month recovery, and only a few weeks back into snowboarding, he had another “light-impact” fall, this one in deep backcountry powder in February 2011.
Despite the apparently minor impact, as of this writing, he still suffers from the effects of this last concussion. “I have now experienced the whole range of concussion symptoms: headaches, dizziness, loss of memory, depression and generally feeling not myself,” Mike says.
His ongoing physical, mental and emotional recovery from these symptoms has been plagued by the struggle to find answers. Directly following the impacts, he wanted to know when he would be able to get back to competition, but like most people who suffer head injuries, he found himself swimming in a sea of “maybes” and “we don’t really knows.”
With the support of his family and friends, and through the arduous process of seeking help from a number of sources (including a neuropsychologist), Mike was eventually diagnosed with Second-Impact Syndrome. Having learned about SIS and the potential for irreversible damage, Mike feels lucky to have only the minor symptoms he lives with today. It could have been much worse.
In retrospect, he can see that his recovery might have been mismanaged, both by himself and by the system.
“Having had success and failure, I now know
that success doesn’t happen overnight.
Patience is definitely a virtue.”
– Mike Robertson, Olympic Silver Medalist – Snowboard Cross
What’s Going on in There?
The brain is a complex system that interprets messages being sent to and from the body. A concussion occurs when the brain moves suddenly inside the skull, rattling, shaking or colliding with the hard surface. Everything in the body is connected to the brain, so injuring it may affect anything from mobility, vision, hearing, touch and smell to cognitive, emotional and social functions, depending on the extent of the injury and the part of the brain that has been affected.
Because no two crashes are exactly alike, understanding the intricacies of brain injury becomes quite challenging.
Second Impact Syndrome occurs when an athlete returns to sport too soon after suffering from an initial concussion. The athlete does not have to receive a major second blow to the head to set the effects in motion. What testing has found is that when this second impact occurs, the brain’s ability to self-regulate the amount of blood volume to the brain is damaged. This can result in increased cerebral blood volume and, in turn, the possibility of brainstem herniation or even death.
Research indicates that as individual cells die because they have been damaged, they release chemical substances which can cause nearby cells to become poisoned and die. This may take some time to occur and is why some symptoms may actually get worse rather than better even weeks or months after an injury.
Just how long it will take for a brain injury to completely heal is unclear. But, what is known is that the brain is much more vulnerable to concurrent and more severe injury within the period during which it is recovering (and thus not functioning normally) from a previous impact. The focus is now on extensive and purposeful healing time to avoid a second impact.
How Does It Feel?
The uniqueness of each brain injury can be one of the most frustrating challenges for those who are seeking help. Despite the many differences, the Brain Injury Association of Canada (BIAC) lists a handful of symptoms that do seem to appear across the board.
- nausea or vomiting
- light headedness
- seeing bright lights or stars
- and the feeling of being stunned
Consistent long-term effects:
- impaired reasoning skills
- and a tendency towards one-track thinking
In addition, subtle social skills may be lost due to difficulty controlling emotions, making decisions, remembering ideas and communicating coherently and logically during a conversation. Combined, these factors often lead to depression.
“The hardest [symptom] to accept and deal with is depression,” Mike says. “I am a happy guy…my job is to snowboard.” And like many, Mike found it difficult to ask for help. After all, no one, especially not a twenty-something extreme athlete, wants to be labelled with a mental health issue. But, being able to stare down the social stigma and face his depression head-on is, undeniably, the principal turnaround in his journey to wellness.
Sadly, because of their lack of emotional control, many SIS sufferers report losing friends and having difficulty cultivating and maintaining new friendships. This is not only a challenge for the injured to deal with, but also for those who support the injured person. Even relatively “mild” evidence of a brain injury can lead to job loss, divorce and other social isolation, as a result of a lack in understanding of, and compassion for, the injured person’s seemingly unpredictable actions. Any loss of customary ability to compete, to work, to play or to socialize normally will often lead to a sense of lost identity, which in turn compounds the feelings of depression.
How Can You Help?
After a head injury, the active involvement of family members and friends is essential to the achievement of optimal rehabilitation during both the short term and long term recovery process. The focus is now on extensive and purposeful healing time to avoid a second impact.
If you witness a crash, and if the person is conscious, you can help immediately by assessing whether he has had a concussion by asking Maddock’s questions. This is a standard list of questions that were created to diagnose football-related concussions, but the questions can be altered to suit the situation. Ask the questions, and if the injured person gets even one answer wrong, suspect that he has had a concussion, and insist that he takes a breather and finishes up the day early. Don’t let him continue to ride or play. In fact, he should not continue with activity until he has been properly diagnosed by a professional, so be sure the injured person sees their doctor if there is any question of concussion (see below).
Then watch for symptoms of nausea or vomiting, dizziness, confusion, fatigue, light-headedness, headaches, irritability, disorientation and depression. Some of the effects of brain injury may not be apparent for some time after the incident because they affect the cognitive, emotional and social capabilities of the brain without demonstrating external signs of change or injury. These “invisible” symptoms, however, can be socially and physically devastating and do require the attention of trained professionals.
A person with a brain injury is not always the most reliable source for determining whether or not he is “fine” so it is often up to the support system to encourage him to rest and to know where to get help. Keep an eye out and listen carefully.
Mike’s biggest mistake was going back to competition before he was ready, thus risking permanent damage by taking minor blows while still in recovery. “The greatest and most difficult lesson for me was that, unlike other injuries, you can’t “tough it out” with a brain injury,” Mike explains. “I guess I can also be stubborn and didn’t want to admit to myself that I was depressed. It took someone else to book me in to see a psychologist, and this has been the biggest help to me in my recovery so far.”
Arrange for yourself or your loved one to see a family doctor who can set you on the right path to recovery. There are a number of new diagnostic technologies that he or she may suggest, including MRIs and CT scans. While these will help you to understand the extent of the injury, they only measure structural damage to the brain and don’t always help with making a recovery plan. If the injury occurred as a result of sport, doctors will also most likely have you fill out a SCAT (Sport Concussion Assessment Test) with them.
BEAM (Brain Electrical Activity Mapping) is another diagnostic tool that is available to measure the actual electrical activity of the brain and provides a more comprehensive diagnosis. BEAM allows doctors to pinpoint the aspects of your brain that are not functioning properly, which can guide them in their use of cognitive behaviour therapy involved in rebuilding the damaged sections.
If a concussion has been diagnosed and the mental, emotional, and psychological symptoms of SIS persist long-term, most doctors will also suggest anti-depressants or cognitive behaviour therapy with a psychologist, or both. Doctors should begin to wean the patient off of the drugs as symptoms improve, so be sure to follow up.
After being diagnosed by a professional, the next step is to become familiar with the rest and recovery guidelines at stopconcussions.com. These guidelines reflect cutting-edge medical knowledge and are the current gold standard for treatment.
As always, proper rest is the key to overcoming any injury. With head injuries, though, it is vital. Encourage the injured person to take more time to rest, relax and recover. Chill out with them and let them know that you are there if they need you.
Light at the End of the Tunnel
In order to truly heal, Mike encourages people in his shoes to be honest with themselves and to pay close attention to the symptoms of headaches, nausea and depression. He also says that if you are not receiving the support you need, you should not hesitate to actively search it out for yourself. “There are a lot of specialists who are eager to help,” he says. “It is just a matter of finding the right people.”
Elite athletes can find a great source of support through the Canadian Sport Institute Calgary. Mike eventually found his way there and says the support of knowing that other athletes were on a similar journey was a real comfort in a time of such uncertainty.
“I have suffered physically as a result of my concussions, but the worst of that suffering has been related to the struggle to get support and answers,” Mike says. “So I truly hope that my story will bring increased awareness to the severity and lesser-known effects of multiple concussions, and that I can make it easier for others who come after me to find help.”
If we can take charge of our understanding of the risks and realities of Second Impact Syndrome, we will be a stronger support for those dealing with post-concussion life in the mountains. Perhaps a community can actually lead a change in the culture of brain injury, making the long overdue switch from the old “tough it out” mentality to a compassionate “rest and recover” approach.