By Patricia Guthrie
WebMD Health News
Reviewed by Hansa D. Bhargava, MD
Oct. 21, 2015 -- Zackery Lystedt doesn't want others to end up like him.
At 22, he walks with a looping gait, leaning heavily on a metal cane. He peers through thick glasses, specially designed to help his peripheral (side) vision. It takes him a moment to gather his thoughts before he speaks in a strained, thick voice. He struggles to remember his schedule day to day, and often relies on his mother to be his short-term memory schedule.
A concussion can cause a range of short- or long-term complications that affect thinking, language, sensation, or emotions. You may have memory and communication problems, headaches, depression, or personality changes.
Recovery involves physical and mental rest. It includes:
- No sports or physical exertion
- No activities that involve concentration, including reading, texting, using a computer, and playing video games
As your symptoms improve, doctors recommend shortened school or work days.
Zack's daily challenges stem from a traumatic brain injury he received while playing football when he was 13. In 2006, Zack nearly died after he got two concussions in a single football game, something called second impact syndrome.
Although it's not easy for him to get around, he's spent the last 9 years speaking to lawmakers, coaches, athletic directors, trainers, health care workers, and parents about the dangers of concussions and what happens when they aren't given time to heal.
That's why it was especially painful for Zack to watch the news about Kenney Bui. The 17-year-old high school football player from Seattle died earlier this month, 3 days after he received a head injury during a game.
After his death, school officials revealed that Bui, a wide receiver and defensive back, had suffered a concussion in September and had been cleared to play by health care professionals following the CDC's guidelines.
It's the kind of injury Zack believes he was left alive to help prevent.
"It makes me mad, it makes me sad," he says of Bui's death. "These are preventable injuries."
Had Zack sat out the rest of the game on Oct. 12, 2006, he most likely would be doing normal 22-year-old activities, like "out driving picking up chicks," as he likes to joke.
On that day, Zack suffered a concussion in the second quarter of the game when he made a tackle and hit the ground hard. He sat out for a while, but returned to the game in the second half.
Zack took more hits but finished the game. As he walked off the field with his father, he collapsed and started to convulse. He was flown to Seattle's Harborview Medical Center and came within an hour of dying from a catastrophic brain injury, says Richard G. Ellenbogen, MD, the hospital's chief of neurological surgery.
Second impact syndrome can happen within minutes, hours, days, or weeks after an initial concussion. It leads to dangerous brain swelling and bleeding, because the brain hasn't recovered from the initial concussion.
A concussion happens when the brain shakes inside the skull. As the soft brain gets slammed against the skull's uneven and rough interior, the friction stretches, strains, and tears the brain's threadlike nerve cells, and can affect the blood vessels to cause bleeding and clots. It can cause confusion, disorientation, memory loss, seizures, slurred speech, and dizziness. Most concussions don't make you lose consciousness, which is why sometimes people may be unaware of the seriousness of a head injury.
Zack "had blood clots on each side of his brain and suffered a series of strokes. The blood couldn't flow, it was sort of strangulating his brain," Ellenbogen says. During surgery, doctors removed his skull bone plates to relieve pressure caused by the bleeds in his brain.
While rare, second impact syndrome is so devastating that young, healthy patients can die within a few minutes, according to Robert Cantu, MD, clinical professor of neurosurgery at Boston University School of Medicine.
Doctors couldn't tell Zack's parents with any certainty what would come next. He was on life support for 7 days, in a coma for 3 months, didn't speak for 9 months, and didn't move a leg or an arm for 13 months. He used a feeding tube for 20 months, and it took 4 years until his right leg moved purposefully.
"I lost my son the day he was hurt," Victor Lystedt says. "I gained a new boy, and we've been trying to recover what was our old boy ever since."
The Lystedt Law
Zack's personal crusade, along with the efforts of the Seattle Seahawks, NFL, USA Football, and the Centers for Disease Control and Prevention's "Heads Up" campaign, have raised awareness about the dangers of concussions.
Zack's advocacy sparked a player protection law. Called the Zackery Lystedt Law, or "Return to Play," it says young athletes be removed from games or practice if a concussion is suspected, and that they be followed by a health care professional trained in concussion management. Washington State passed the law first in 2009. It's now required in all states.
Sarah Fields, an associate professor of communications at the University of Colorado, says a lot has changed in how concussions are reported and managed in the past 10 years because of awareness, education, and the Lystedt Law. Fields is part of the High School Reporting Information Online (RIO) study that has collected injury data in dozens of sports from 100 high schools for the past 11 years. Initially, the reported number of concussions increased annually because of the greater awareness, she says, but it has leveled off the past 2 years.
"Earlier on, an athlete might not even miss 1 day of practice, or they returned to play within 24 hours of having a concussion," Fields says. "We do not find that today."
Football is the number one sport for concussions and has a high rate of catastrophic injuries.
From 2005 to 2014, 32 deaths of high-school players directly attributable to football have been reported nationwide, according to figures from the National Center for Catastrophic Sports Injury Research in North Carolina. Last year, there were five.
Most school districts have adapted the CDC's athletes' protocol for concussion management, which is a five-step process of exercise and assessment that gradually returns a recovered athlete to practice.
Still, some studies suggest kids are holding back reporting head injuries from coaches and their parents, and they are being returned to games or practices too soon.
A 2014 study in the American Journal of Sports Medicine found that nearly 70% of high school athletes with concussions played despite their symptoms, and 40% said their coaches didn't know of the injury. "We still have too many athletes who don't report their symptoms of concussion," says lead researcher Frederick P. Rivara, MD, MPH, professor and vice chair, University of Washington Department of Pediatrics.
And young athletes are still dying from concussions. Along with Bui, Ben Hamm, a 16-year-old from Oklahoma, died Sept. 19, about a week after making a tackle in a football game. He had suffered a concussion 2 years earlier as a freshman and sat out an entire season, his father said. Three other high school players have also died this season from injuries and underlying medical conditions unrelated to head trauma. A sixth high school football player died Saturday in Texas. He reported being dizzy in a huddle and collapsed.) An official cause of death has not been announced.
"The first concussion is something you can't prevent, usually," says Stanley Herring, MD, clinical professor in the Departments of Rehabilitative Medicine, Orthopedics and Sports Medicine, and Neurological Surgery at the University of Washington. "But if you don't take them out of the game, something catastrophic can happen. We have clearly raised awareness. We're now seeing if we can change behaviors."
Speaking Out About Concussions
Zack's message is simple: Treat concussions like a fractured bone that must be allowed to heal. Don't "shake it off" -- standard practice not too long ago. Don't fool yourself, or your coach, into thinking you are okay to play.
"You have to treat head injuries seriously," Zack says. "You could end up like me or you could end up dead."
Despite his trauma, Zack's family remains firm in its love of football. He lives outside Seattle, and they are avid Seahawks fans.
"I love the passion and its intensity," Zack says. "It taught me leadership, how to be a teammate, how to work together. It made me feel unbelievable."
He continues to gain strength, balance, and coordination with swim therapy and regular gym workouts. He's attended community college classes and recently began a part-time job entering data for a work source program for people with disabilities.
And he and his family continue to speak out for concussion awareness. They've teamed with regional concussion-prevention advocates including the Brain Injury Alliance of Washington, which provides education and awareness on the challenges faced by people with brain injuries.
Zack's father expressed sorrow and frustration after Bui's death.
"I can certainly feel their pain as a father who's been through this," Victor Lystedt says. "Except I got my son back. They don't get their son back. Obviously, our work is not done."
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