UPMC specialists see 10,000+ concussions a year
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Anthony Watkins, a hulking two-way lineman in a gray Brownsville Area High School T-shirt, sat slouched on an exam-room table. He sprang upright once the bespectacled, bearded expert ambled through the door.
In a half-whisper, Anthony informed the mother and stepfather seated barely three feet across from him: "He's the one who invented the test."
It was this brain-function test, developed by the same Mark Lovell standing before him, that helped Anthony return to play.
A week before, Anthony had come to the UPMC South Hills clinic in Bethel Park to take a computerized exam known as ImPACT, for Immediate Post-Concussion Assessment and Cognitive Testing.
On just the third day of camp, on his first attempt to return to football after quitting in junior high, the 6-foot-6, 260-pound 17-year-old had collided helmet-to-helmet with another player in a tackling drill.
"I had a headache real bad, and I threw up," he recalled. The California University of Pennsylvania student trainer sent him to an emergency room.
There was no blackout, no amnesia. Other than persistent headaches and that one bout of nausea, the young man admitted to sleeping and being tired more often, which Dr. Lovell called "teen-aged symptoms." The headaches dissipated the day before that first office visit and ImPACT test one week earlier.
Now, by improving his scores on his second ImPACT exam, the senior offensive tackle-defensive end earned Dr. Lovell's clearance to return to play, starting with practice a few days after Labor Day and then game action this past Friday against Yough.
The gregarious teen greeted the news with a grin: "I can hit?"
He was just one of the many patients who visit concussion specialists in Western Pennsylvania at this early time in the football season. Dr. Lovell -- founding director of the UPMC Sports Medicine Concussion Program that is the nation's first and the largest of its kind -- had seen 14 patients in a single day the week before.
His assistant director, Michael "Micky" Collins, likewise a Ph.D. in neuropsychology, joked about his ImPACT co-founder's comparatively lighter patient caseload.
"Fourteen's a ... walk in the park as far as I'm concerned," said Dr. Collins, who estimates seeing 20-25 patients daily of late. Most come from football.
UPMC specialists, at various locations, get 200-250 visits per week from concussion patients -- more than 10,000 visits per year. That's a sizeable number of the 3.5 million sports-related concussions that occur annually in America, as estimated by the Centers for Disease Control and Prevention.
"We see a lot of concussions happen during camp just because they're doing a lot of repetitive tackling drills that they don't do in games," Dr. Lovell said. "We kind of brace ourselves every year. And we just got hammered. This year, it was more difficult -- it was so hot, kids were dehydrated. Personally, I think that probably raised" players' chances at sustaining concussions.
That aspect hasn't been studied -- concussions, after all, are still a burgeoning science. But Dr. Lovell believes dehydration may render an athlete more susceptible because it can slightly reduce the brain's fluid level.
Josh Gramm doesn't remember the jolt. His bout of amnesia and the headaches that remain three weeks later are what Dr. Lovell called the "main concerns."
Josh is 13 -- less than two weeks shy of 14 -- and plays for Bethel Park's Big Mac Orange in the South Suburban Youth Football League. He was returning a punt Aug. 28 when a tackler clouted him underneath his chin, a torque injury to the neck and brain, a sudden acceleration and deceleration that concusses the brain.
"I didn't think I was hit that hard," said the serious-faced boy, amazed still.
His mother thought otherwise, having seen her daughter, Alyssa, 17, get hit in the temple with a lacrosse ball and lose consciousness in the family's first concussion episode. This one has proven to be worse.
"We went straight from the field to the emergency room. We couldn't get the dizziness to go away," Judy Gramm said of Josh, a cornerback and receiver -- two positions that Dr. Lovell said rank the highest in concussion incidence outside of running back. His headaches started once they reached the hospital minutes later. They haven't stopped.
"I'm just shocked how long it's lasting," she added.
In August, his team had taken the ImPACT test at Bethel Park High, so that provided a baseline score of his normal performance. Upon retaking the test on this office visit, Josh complained that it caused dizziness and a headache, which is standard.
Recent research shows that the inner-ear is often involved in concussions. For that reason, Dr. Lovell tossed a black pillow of memory foam on the floor and asked the 5-1, 100-pound Josh to stand on it. With his feet together and eyes closed, Josh lasted five seconds, then six before starting to fall. "That will go away," Dr. Lovell told the mother and son. But it may require balance therapy. This could well be what's known as an inner ear or labyrinth concussion, where particles of the inner ear were thrown off kilter from the blow.
They made an appointment for next week, with no football or physical activity in the meantime. "Everybody is different," Dr. Lovell told them. "There is no rule how long it's going to take to recover. It's a very individualized basis. The brain is in a vulnerable state until he gets back to normal."
Brownsville's Anthony Watkins was overjoyed at the clearance to play football, and half-jokingly vowed never to return to these exam rooms: "I don't want to come back here. That test is difficult."
This experience opened his eyes even after, he said, a close friend was forced to quit football after four concussions.
"Like, I didn't think it would be that bad, that I'd have to go through all this."
His mother, Michelle Pellick, eagerly anticipates his return.
"I can't wait until he goes back. I have someone to cheer for now," she said. "I'm a football mother. I love football."
Nevertheless, she worries about her son's health. She seized on Dr. Lovell's comparison that the brain is the egg yolk inside its shell, the skull.
She said, "I'll hold a sign up in the stands, 'Protect the Egg.' "
First Published September 19, 2010 12:00 am