Dangerous Games

Ben Holm's head aches every minute of every day, sometimes so badly it feels like his brain is pounding against his skull.

North Andover senior Ben Holm suffered his third concussion in a football game 15 months ago and still suffers from chronic headaches. Alyssa LeBel, MD, at Children's Hospital in Boston in Waltham checks his symptoms and explores possible treatments at a recent appointment.

He has nosebleeds and is sensitive to certain noises.

It's been like this for the last year for the North Andover High senior, ever since he suffered three concussions during the 2008 football season. He suffered the third one in the Thanksgiving Day game, 13 days after the second, and now he wishes he had stayed on the sidelines.

Suffering from post-concussion syndrome, Holm had to sit out his senior year and will never play competitive football again, despite attracting the attention of recruiters from colleges that included Holy Cross, Williams and Northeastern.

Holm is not alone. While his case is an extreme one, dozens of athletes suffer concussions each year at local schools.

Eighteen schools in the Merrimack Valley and Southern New Hampshire that responded to an Eagle-Tribune survey reported a combined 136 concussions so far this school year. That's an average of more than seven per school.

Most were in football. But others were sustained in wrestling, field hockey, soccer, basketball, cheerleading, gymnastics and ice hockey.

Holm said he was one of three football players to miss this season with a concussion. North Andover reported three more concussions during the season.

GROWING AWARENESS

What is a concussion?

A concussion is a brain injury caused by a sudden blow to the head or body. The blow shakes the brain inside the skull, which temporarily prevents the brain from working normally.

Some people have obvious symptoms of a concussion, such as passing out or feeling light-headed, while others do not. With rest, most people fully recover from concussions within a few hours to a few weeks.

On rare occasions, concussions cause more serious problems. Repeated concussions or a severe concussion may require surgery or lead to long-lasting problems with movement, learning or speaking. Because of the small chance of permanent brain problems, it is important to contact a doctor if you or someone you know has symptoms of a concussion.

— WebMD.com

It's not clear whether the number of concussions is increasing. But it is clear that awareness of the risks of concussion is growing.

In New Hampshire, a Sports Concussion Advisory Council launched a pilot project on sports concussions this academic year at five schools — Salem, Londonderry, Windham, Kearsarge Regional and Keene. As part of the program, some student-athletes are taking computerized neurological baseline tests that are used to determine if they are ready to return to play after suffering a concussion.

The National Football League, under fire for a culture that some say pressures players to play through concussion symptoms, issued guidelines this season stating that players should not return until fully asymptomatic and cleared by both a team physician and an independent neurological consultant.

In sports at all levels, there is growing awareness of — and concern — about the long-term health consequences of multiple concussions.

If the athlete returns too soon or while still suffering the symptoms of a concussion, the effects can be long-lasting — even fatal.

"To play through symptoms risks — if you're at the high school age — the second impact syndrome, which carries a 50 percent mortality rate," said Dr. Robert Cantu, chief of neurosurgery service and director of sports medicine at Emerson Hospital in Concord, Mass. "It's not common, but it happens, and happens in predominantly high school athletes who have a second head blow while still symptomatic from a first."

A high school football player in Washington died last fall after sustaining a hit to the head in his first game back after being cleared by a doctor from a concussion.

RETURNING TO PLAY

The timetable for returning to play after a concussion varies depending on the athlete, said Dr. Neal McGrath, a neurophysiologist and the clinical director and founder of Sports Concussion New England in Brookline.

At a minimum, the athlete must be completely symptom free for at least a week, he said.

"In cases where students have had perhaps multiple concussions, maybe we'd have a student wait for two weeks or a month," McGrath said. "The tricky part there, too, is that just because a student athlete says they're symptom-free doesn't mean they really are. They might not be aware that some of the symptoms they're having still count as concussion-related."

For example, he said, a student athlete might no longer suffer from headaches but might have trouble concentrating in school.

Holm believes his symptoms have lasted so long both because he returned too soon and because he had two concussions so close together.

"It just overworked my brain and overloaded it," he said.

Holm and his parents — Chip and Dianna Holm — do not blame North Andover school or athletic officials for what happened.

Holm said he was not experiencing any symptoms before playing in the Thanksgiving Day game, about two weeks after the second concussion.

"So I was cleared to play," he said.

North Andover football coach John Rafferty said Holm showed no signs he was not ready to play again.

"He was cleared through the trainer and then medically," Rafferty said. "The result of what happened to him, I feel terrible about that. I feel real bad for him. He loved football, was really, really good at it. And it was heartbreaking."

Figures are as of mid-January, except for Timberlane (mid-November). Sanborn would not provide numbers, and Phillips Academy did not respond. Methuen figures are estimates. Source: School athletic officials.

Holm's first concussion went undiagnosed when it happened, and he continued to play. His doctor later determined he sustained the concussion when he broke his nose during the first game of the season.

"I didn't sit out at all because I didn't think it was really too bad of a hit or anything," Holm said. "I probably had a headache after the game, but it was football, so it was just a normal feeling, I guess."

He suffered another concussion during the first half of the second-to-last game of the season, against Pentucket. But he played through that game, too, though he was clearly affected by it.

"I remember when I got hit, I got up and I just started running toward the end zone because we had just scored a touchdown, but I wasn't really sure what had just happened," Holm said. "We lined up for the extra point. I thought we were still on offense. And I got down in my three-point stance and everything, and I was really confused."

He said he was diagnosed with a concussion at practice the following Monday. He sat out practice for a week before passing a vision and balance test given by the school, he said.

"My headaches had gone away over the week," Holm said. "I thought I was all set to go."

"We talked about it, and he wanted to play in the Thanksgiving Day game," his mother, Dianna, said. "And I told him, 'I'm not going to tell you that you can't play. It's your decision, but you have to understand that if you get hit again, you could miss a lot more than just the Thanksgiving game.' But had I known then what I know now, I might have said, 'You're absolutely not playing.'"

Holm said that multiple hits — and not one big hit — suffered over the course of the Thanksgiving Day game caused his third concussion.

He played that entire game despite being disoriented at times and once even heading toward the wrong huddle.

PROLONGED SYMPTOMS

Athletes interviewed for this series who suffered blows to the head before fully recovering from a concussion reported prolonged symptoms, including depression, memory loss, sensitivity to noise and light, lack of concentration, headaches, nosebleeds and impaired thinking.

That's not unusual, said Dr. Arthur Maerlender, a neurophysiologist and assistant professor at Dartmouth Medical School.

"I've seen videos of hockey players who get a mild push but had a concussion before that and were still playing, and that mild push brought on incredible symptoms that took a year to recover from."

Besides the continuing headaches, Holm suffers in other ways.

He used to like to write, but the words don't flow anymore.

"I'll have all these ideas in my head, and even when I speak, sometimes I just can't get it out in a way that makes sense," Holm said.

This greatly saddens his parents.

"He was a very good writer," his father, Chip, said, sitting beside Ben on their living room sofa. "He could tell a good story and make things up, and for me that's kind of been sad, you know?

"Remember the things he used to write?" Chip added, looking over toward his wife, who softly replied, "Yeah."

Holm also has struggled in foreign language class, having trouble remembering words no matter how long he studies.

Life, though, was even worse last spring.

"I was, like, completely immobile," he said. "I was in a fog all the time."

He and his girlfriend, Allie Lynch, sometimes would have to pull over to the side of the road when driving home from school because Holm's nose would start to bleed. Holm also could not tolerate music in the car.

As he drove under tree canopies, the sun flickering through the leaves gave him headaches.

He frequently chose to stay at home because the noise often bothered him when he went out with friends. He was depressed and had trouble sleeping through the headaches.

"It was like a great blur ... It was like a mix of everything all at once — pain and different emotions and stuff. It was a weird feeling."

Dianna Holm, who is a nurse, said she had no idea concussion symptoms could last for more than a year.

"Mostly, we saw a decline in him generally, which had us really very concerned," she said. "You don't know if you're looking at a depression or if it is a depression caused by concussion or if it's a depression because of the concussion."

BLESSING IN DISGUISE

Ben Holm has a message for athletes in all sports: "Make sure that you don't push it, because it can really cost you a lot. ... Football players, wrestlers, hockey players — they should all know that, because it could take everything away that you worked for."

Holm sees one positive to his experience: It has sent a message to other athletes.

"It's kind of like a blessing ... Because everyone on the team now knows that if they have a concussion to go get it checked out by a doctor right away and see what the doctor says and make sure you get cleared by him before you go play again," he said. "Everyone this year knew not to ever push a concussion harder than they should."

Kevin MacPhee was one of those North Andover football players who learned a lesson from Holm's experience.

MacPhee said he visited a concussion specialist after he suffered the second concussion of his high school career during a scrimmage against Lawrence High last summer.

"The doctor told me if I got another concussion, I could have suffered long-term damage," he said. "He wouldn't guarantee that, but he said there was a decent chance of that."

The specialist's opinion, and the feelings of his parents, persuaded MacPhee to stop playing.

"Ben had got his concussions before I did, and my parents had seen what happened to him and they really wanted me to avoid a possible injury like his. It was one of the hardest decisions I've probably made to walk away."

MORE SIZE, MORE CONCUSSIONS?

Football equipment has improved greatly over the years, but so has the size of athletes. Some say this size increase could be one reason why the concussion rate remains high.

For example, the average weight of a member of the New England Patriots 50 years ago was just 216 pounds, while today it is 241 pounds. And that weight gain is being seen at the local high school level as well. The average weight of Eagle-Tribune football all-stars in 1970 was 172 pounds, while today that average weight is 198 pounds.

"Your players are a lot bigger and faster," Lawrence football coach Mike Yameen said. "Football is a sport where you have to work out year round, and especially in the summer leading up to the season. And also, you're going to have those big collisions. The kids are growing bigger nowadays."

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