Concussions like the one suffered by Bemidji's Forseth are being diagnosed and treated differently these days
No one can pinpoint the hit that sent John Forseth to the hospital during the recent Section 8-2A championship hockey game against Moorhead. The best guess is that the injury occurred early in the first period when the Bemidji High School junior collided with a Spud player at center ice.
"I have no memory of the hit but I watched the game tape and on the second shift I hit the Moorhead kid at center ice," John said. "I didn't think anything of it at the time and I played most of the rest of the period."
"We don't think John made any contact with his head," said his mother, Terri. "Instead, John's head kind of whiplashed."
Forseth played most of the first period, but late in the stanza and during the break it became clear that something wasn't right.
"John never blanked out or crumpled to the ice," Terri said, "but after the period he wasn't in his right mind. He was confused and his eyes were blank."
John's coaches and teammates recognized that something wasn't quite right during the final few minutes of the period.
"I was doing all right for most of the first period and then, all of a sudden, I was going in circles on the ice," John said. "I was going loopy. When I got to the bench coach (Wade Chiodo) asked me what I was doing out there and I couldn't answer him.
"That's when he pulled me off the ice."
Chiodo said the decision to sit Forseth was easy to make.
"It was only a game and Johnny's health was the most important consideration," Chiodo said. "I've coached Johnny for two years, and I know how he carries himself. When he came to the box his demeanor and mannerisms were really different. It was almost as if his eyes were 'wowed.' I asked him if he was all right and he gave me a blank stare.
"He was not the typical Johnny," Chiodo said.
During the intermission, Forseth was examined by trainer Jon Laakso and a pair of Bemidji doctors who were in the stands cheering on the Lumberjacks. It didn't take the medical staff long to complete the diagnosis. Everyone knew that Forseth had sustained a concussion.
"A concussion is an injury to the brain at the cellular level," said Dr. Mark Carlson of Sanford Bemijdi Clinic, who is treating Forseth. "It is a complex pathophysiological process affecting the brain which is induced by traumatic biomechanical forces.
"In other words, a concussion causes the brain not to work right."
Unlike a broken arm or a lacerated leg, however, concussions cannot be seen by the naked eye nor any device which can delve into the body.
"A concussion is an injury to the brain that doesn't show up on any images," Carlson said. "There are head injuries that you can see with CT scans, MRIs and other means but a CT or MRI on a concussed brain will look normal."
Although it was obvious to the medical professionals that Forseth had sustained a concussion, his parents wanted their son to be examined at the emergency room to fully diagnose the injury.
"We sat in the locker room for the second period and they tell me I kept getting worse," John said. "I don't remember a thing about that night. In fact, I don't even remember getting on the bus to go to Thief River Falls."
"We waited with John through the second period but decided to go to the emergency room for a CT scan," Terri said. "It was our decision as parents. We did it as a precaution to make sure nothing was bleeding or there was any other trauma.
"Fortunately, there wasn't and we were comfortable knowing that."
Having your 'bell rung'
was a common thing
A decade ago when athletes sustained head injuries the practice was to send them back into action as soon as possible. Having your "bell rung" as it was termed then was considered part of the price of being on the ice, the field or the court and most head injuries were thought of as nuisances rather than anything to worry about.
Times have changed, however.
"The term 'having your bell rung' minimizes the injury," Carlson said. "Now, there is no timetable for recovery. You either have the concussion symptoms or you don't.
"If you have the symptoms you don't play. If you don't have the symptoms you go through the (recovery) stages before you return," Carlson added.
Concussion symptoms can vary and each patient may display only some of the signs.
"The brain isn't working right and that can (show up) in many ways," Carlson said.
The warning signs include impaired vision, feeling sleepy, not being able to sleep, loss of appetite, loss of memory, feeling locked into a fog and, simply, just not feeling like yourself.
"In my case, I had a major headache for two days," John said. "Gradually the headache was less and less. But I also was a little dizzy and sensitive to light."
Concussions are not limited to any particular age group or any level of activity, according to Carlson.
"Anyone with a brain can get a concussion but some evidence suggests that children may be more susceptible and their symptoms may last longer," he said. "
The younger the patient, however, the tougher it may be to diagnose the injury.
"One of the reasons it is difficult to diagnose a concussion in younger kids is that they may not be in tune with themselves and may not realize that they have the symptoms," Carlson said.
Anyone who is involved in an athletic activity, especially one with continual contact, is susceptible to a concussion and that has always been the case. It seems, however, that the number of concussions has risen during the past 10 years.
"Athletes have always been getting concussions, but now we are more aware of them and more educated about how to diagnose them," Carlson said. "I also think there now are some changes in athletic activity that are leading to more of them. The athletes are faster and stronger now and, because of that, it is reasonable to expect more injuries and more concussions."
Doing nothing is best treatment
Unlike most athletic injuries where pain tolerance dictates the rehabilitation schedule and the return to the battlefield, the only way to recover from a concussion is by doing absolutely nothing.
"The treatment is rest," Carlson said. "To rest the brain is very hard but to recover from a concussion you must be at full rest physically and cognitively. That means you either sleep or pretend you are sleeping."
A retired person might embrace the concussion recovery process but for a teenage athlete it can be worse than the injury.
"There is nothing we can do to fix the brain," Carlson said. "In order to heal the brain the body and the brain must be at rest.
"With young athletes I tell them to be bored to death until the symptoms are gone. That means don't go to school, don't exercise, don't text, don't surf the web, don't drive and don't talk on the phone."
Forseth has followed his doctor's advice although it hasn't been easy.
"It wasn't fun sitting for 12 straight days," he said. "For the most part I slept and when I wasn't sleeping I was pretending to be sleeping, just what the doctor told me to do.
"Completely resting your brain is not easy to do for a 17-year-old boy who is very active," Terri said. "Fortunately it was spring break and we had 12 days away from school.
"We know the seriousness of this concussion and John laid low."
There is no hurry to return to action
A generation ago having your bell rung was considered part of the job and the "real" athlete would be back in the thick of things at the next break in play. But times have changed.
"We used to think that if you had a concussion and the symptoms went away you were fine to return," Carlson said. "But now we know better.
"There is evidence suggesting that if you have a concussion during a season you are three times more likely to have another in that same season. And if you have had a concussion you are four to six times more likely to have another during a career."
And having repeated concussions can lead to dire consequences.
"There are three main dangers of concussions," Carlson said. "First, it stinks to have one and it makes you feel terrible. There also is the potential for long-term disabilities such as chronic traumatic encephalopathy (CTE) and, finally, there is the danger of second impact syndrome."
Second impact syndrome is the result of a blow to the brain of a person who hasn't fully recovered from a concussion. Although rare, it can be fatal.
"If you have the symptoms of a concussion but are still playing and get hit again, it messes with your brain to the point where you could die within minutes," Carlson said.
CTE is a progressive degenerative disease found in individuals who have been subjected to multiple concussions and other forms of head injury. Similar to Lou Gehrig disease, CTE results in degeneration of brain tissue and individuals with CTE may show symptoms of dementia such as memory loss, aggression, confusion and depression. Those symptoms, however, may appear within months of the trauma or even decades later.
A study on many patients who originally had been diagnosed with amyotrophic lateral sclerosis (Lou Gehrig's disease) discovered that they actually were victims of CTE. In fact, many scientists who performed that study now believe that Gehrig himself was a victim of CTE.
Fortunately, CTE and second impact syndrome are not very common.
"Thousands and thousands of kids play football every year and it is thought that up to 60 percent get a concussion (at some point in their careers)," Carlson said. "Despite that, the nursing homes aren't full of 50-year-olds who have CTE."
Forseth is on way to recovery
John Forseth is in the midst of his recovery process. He returned to school last week and has been cleared to begin aerobic workouts. The BHS junior does, however, plan to take things slowly.
"Little by little my symptoms went away but I wouldn't say I'm cured," he said. "It is scary thinking about this happening again. The worst part is not knowing what happened.
"Everybody has the memory of us losing the game to Moorhead but I don't even have that. I woke up the next day wondering when we would play again," John said.
Normally Forseth plays spring and summer hockey but this year he has decided to forego the spring season and concentrate on healing.
"I'll play golf this spring and in the summer return to hockey, but I'll try to stay away from much contact," Forseth said. "This isn't anything I want to go through again."
Nor do his parents.
"When John goes into the corners the concussion will always be on the back of my mind but John is smart and he's a good player and he'll make his own determination of what he can and can't do," Terri said. "I don't want to be scored or worried every time he competes. We have to move on. We'll give him the best equipment there is but we'll leave the playing up to John."