Special report: The dangers of adolescents playing football with concussions
Concussions may be nothing unusual in high-school football, but playing with one could result in a devastating brain injury. The stories of five Washington boys illustrate the risks of not letting the developing brain heal.
Seattle Times staff reporter
Signs observed by coaches, parents• Appears dazed or stunned
• Forgets plays
• Is confused about assignment
• Is unsure of game, score or opponent
• Shows behavior or personality changes
• Moves clumsily
• Loses consciousness
• Answers questions slowly
• Cannot recall events prior to hit
• Cannot recall events after hit
Symptoms reported by athlete• Headache
• Double or fuzzy vision
• Feeling sluggish
• Feeling foggy or groggy
• Balance problems or dizziness
• Sensitivity to light
• Concentration or memory problems
Sources: Centers for Disease Control and Prevention, the Brain Injury Association of Washington and the Seattle Seahawks.
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CAMANO ISLAND — Ben Zipp's memories return in flashes.
He hears a helicopter roar, feels himself rising into the sky.
He sees the paramedics rush him inside the hospital.
He feels the board under him as he is strapped in for a CT scan.
Then Zipp woke up into a world where he might not ever play football again. On Sept. 12, he suffered a subdural hematoma — bleeding of the brain — in the second quarter of Stanwood's second game.
Zipp left the field with throbbing pain in his head before his legs and arms went numb. He collapsed on a bench and had seizures. A longtime friend cut off his jersey as the trainer put Zipp in a neck brace. He was airlifted to Harborview Medical Center, where he was in intensive care for three weeks.
He lives with headaches that never go away and a fog in his mind that makes studying nearly impossible. And he lives with questions of what he could have done to avoid it.
Before that game, Zipp had felt several symptoms of a concussion, including headaches and nausea. He sat out from contact twice that week, but not on game day.
"I kept it all in," he says. "I didn't say much."
Concussions in high-school football, like Zipp's, are nothing unusual. Studies estimate that as many as 47 percent of high-school football players have suffered a concussion, and 35 percent have suffered at least two.
But the developing adolescent brain needs time to recover. And when Zipp attempted to play with a concussion, while his brain was still vulnerable, he put himself at risk for a catastrophic brain injury.
A look through the past 15 years finds several Washington families whose sons have died or suffered severe, life-altering injuries. In almost every instance, the teenager attempted to hide the symptoms of his concussion to keep playing.
As Zipp is discovering, he is one of the lucky ones.
"A doctor told me that with one more big hit, they wouldn't have even needed to call the helicopter," Zipp says.
David Bosse, Kirkland
Stan Bosse has watched the film time and again. He still cannot pinpoint the hit that killed his son.
"There is no NFL highlight hit," he says. "It doesn't take much of a hit."
Not when a child is playing with a concussion.
In his first game of the 1995 season — his ninth-grade year at Rose Hill Junior High — David Bosse ran for more than 250 yards. He scored three times and started at middle linebacker.
But he complained of headaches the next week, and his parents — both in health care — told him he wouldn't play again until his headaches receded. Before the next game, he said they were gone.
"Was it a concussion?" Stan Bosse says. "In retrospect? Yes."
Six plays into his next game, David Bosse collapsed. Stan Bosse rushed to his side, and immediately, he could tell the injury was life-threatening. Within half an hour, David was being treated at Harborview.
But not even immediate, by-the-book care could prevent what was happening to David Bosse's brain.
He was suffering from a rare condition — almost unheard of in adults — called second-impact syndrome. Because David had not fully recovered from his first concussion, it took only minor impact to cause his brain to swell uncontrollably. Almost every second-impact syndrome victim is at least severely disabled. Often, they die.
In David Bosse's case, his parents were told he would not survive the night. They held him until the moment he was pronounced dead the next morning. He was 14 ½.
"We'll never be the same," Stan Bosse says.
When he found out second-impact syndrome was the cause of death, he was appalled that more coaches and parents did not know of the condition. He still cannot believe that the risks of playing with a concussion are not more widespread.
Research by The New York Times found that at least 50 American high-school athletes have died or were critically disabled from 1997 to 2007 because of head injuries in football games. One of those was Tyee sophomore DeShawn Smith, who died in 2004 after a helmet-to-helmet hit caused a crack in his skull. Three more American high-school players died in the past two months, two of second-impact syndrome.
"It makes me sick," Stan Bosse says. "I'm tired of hearing about kids airlifted to Harborview. I get flashbacks."
Thirteen years later, he doesn't know what will get the message across to children who play with concussions and coaches unaware of the risks. He feels the responsibility should go to athletic associations and athletic directors.
"It's got to come from the top," Bosse says. "There are those of us who tried to do it from our heart. And got nowhere."
Zack Lystedt, Maple Valley
Not a trophy, helmet, ball or picture has been moved in Zackery Lystedt's bedroom since he woke up before game day on Oct. 12, 2006. The weight room his father, Victor, built for him more than two years ago has never been used. Neither room, at the top of the stairs, has been touched.
"We're not giving up on the fact that Zack's moving up to this room," Victor Lystedt says.
Two years after a massive brain injury, Zack Lystedt cannot walk. His parents believe he will one day, but that day is likely not soon. His new room is downstairs, next to the living room, where he sat last Monday night and watched "Monday Night Football."
It's still his favorite sport.
"I liked hitting people," he says.
Lystedt made a pair of game-saving hits in a game for Tahoma Junior High. Late in the first half, he ran across the field to catch a runner streaking to the end zone. He hit the ground headfirst and instantly grabbed his helmet and began kicking his feet in pain. His teammates took a knee until he got up, and he sat out the rest of the half.
About 15 minutes later he went back in the game. And late in the fourth quarter, with the other team driving for the winning score, Lystedt forced a fumble at the goal line.
He was the game's hero. And 60 seconds after it ended, he collapsed.
Victor Lystedt ran to his son's side and heard the last words he would hear Zack speak for nine months: "Dad, I can't see."
Zack's brain was hemorrhaging quickly. Five hours after the game, surgeons had removed both halves of his cranium. He has no memories of the next three months until his 14th birthday party, in January 2007. He was comatose for most of that time.
As with David Bosse, Zack Lystedt's team had no trainer, leaving his coaching staff to make the medical decision about whether he could return to the game.
"It's very difficult for a coach to be coach and doctor," said Dr. Stan Herring, the team physician for the NFL's Seahawks and a clinical physician for the Washington School of Medicine.
To prevent future injuries like Lystedt's, the Brain Injury Association of Washington is pushing for a bill that it's informally calling Lystedt's Law.
The bill would require that any athlete showing symptoms of a concussion be removed from play, and that only a medical professional — including certified athletic trainers — could give an athlete permission to return to play.
"We want other parents to never, ever have to go through the things that we've had to go through in our lives," Victor says. "I don't think there's a lot of people that could endure what my wife and I have gone through."
"And me," Zack says.
"And you, of course," Victor adds.
Zack Lystedt underwent intense therapy for a year in Dallas — brain-injury rehabilitation programs are scarce in Washington — before returning home, where his parents worked to create their own program. Zack's numerous therapy sessions keep him and his mom, Mercedes, on the road for about eight hours a day.
Zack's parents used to pray for a miracle, that he would wake up as if he was never hurt. Now they see miracles in smaller recoveries. He can swallow again. He can use his left foot and his left hand.
"It's only getting better," Victor Lystedt says.
When Zack couldn't speak, he cried so loud, just to hear himself make a sound, it echoed through the hospital. But nine months after the injury, Victor heard his son speak again.
"Oh, Dad, I love you," Zack said into the phone from Dallas.
After two years of speech therapy, they can't get him to stop talking anymore.
"Now," Victor says, "if I ask Zackery to say, 'My name is Zack Lystedt, I'm 15 years old, and I'm the second-best looking guy in this room' ... "
"Hi, I'm Zack Lystedt," Zack responds. "And correction: I am the first-best looking guy in this room."
Brandon Schultz, Anacortes
Brandon Schultz is 31 now, and he doesn't want anyone to feel sorry for him. He can hit a golf ball 300 yards. He can bowl a 200. He can belt out karaoke at the neighborhood bar.
But 15 years after a second-impact syndrome injury, Schultz lives under the care of his father, Robert. And though he has become more independent in the last 10 years, he'll likely never live alone. He has permanently lost peripheral vision to his left. His short-term memory is spotty.
"You have to remind him to take his medication," Robert Schultz says. "He's got six or seven that he takes in the morning and the evening. You have to remind him to brush his teeth."
Doctors have described Brandon's condition as a "state of permanent adolescence."
"I still love football," he says. "If I could get on the field and play today, I would."
He has no memory of his sophomore year of football at Anacortes High School. Schultz played right guard and left end, and he swung between the junior varsity and varsity teams.
Like Ben Zipp and David Bosse, Schultz attempted to play while suffering from the symptoms of a concussion. Studies have shown that as many as 20 percent of athletes fake being symptom-free in order to play. Many do not know that only 10 percent of concussions involve losing consciousness.
In Brandon's case, there was no trainer at the school to evaluate the telltale signs of a concussion. According to the Washington State Athletic Trainers Association, as many as 64 percent of state high schools do not have access to a certified athletic trainer, whom Herring calls "the biggest allies" in preventing serious brain injuries. The average trainer in Washington makes about $42,000 per year, though a part-time trainer — working 20 to 25 hours per week during the school year — can be available for about $15,000.
"So if you want to ask me what the booster clubs should spend their money on?" Herring says. "A certified athletic trainer to cover sporting events. Money well spent."
A week after suffering a concussion, Schultz attempted to play again while he still had headaches. Late in the second quarter, after a routine hit, Schultz collapsed. He, too, was airlifted to Harborview.
Schultz went through 8 ½ years of counseling and physical and occupational therapy at a rehabilitation center in Bakersfield, Calif. During his recovery, he has struggled with the realization that his life will never be the way it was. His crawl toward independence has required patience.
"And patience isn't something that I have a lot of," Schultz says.
Matt Peterson, Woodinville
The first concussion came on a run up the middle during Matt Peterson's freshman year at Woodinville High School. At inside linebacker, Peterson lived for this kind of play, when he could meet a runner head-on.
"I was proud of myself," Peterson said. "I hit someone so hard I gave myself a concussion."
During the baseball season, he suffered another one playing catcher, on a collision at the plate. He suffered a third one his sophomore year. A fourth one — on a minor hit in practice — ended his junior football season after six weeks. Staying out of football frustrated him, but not as much as knowing he wasn't as sharp as usual. Studying had never been so difficult.
"I just remember it was the worst two weeks of my life following the fourth concussion," Peterson said.
Once Peterson received his first concussion, he was not only more likely to receive another one; subsequent concussions would require a smaller impact and would cause more severe symptoms.
Whereas studies of NFL players have found that severe post-concussive symptoms extend late into life, information on the long-term effects of concussions for high-school athletes is not definitive.
Peterson, a senior, had been told he had a 90 to 95 percent chance of suffering another concussion if he played this season. He had heard enough. He wants to be an Air Force pilot, and he wants to have all his faculties when he gets there.
So he quit playing. But the inside linebacker in him couldn't stay away from the game altogether. Instead, he joined the coaching staff as an assistant.
His classmates even have to call him "coach."
"I realized, you know what? It's not a good idea," he says. "This is your life you're dealing with. This is more than just a game."
Tom Wyrwich: 206-515-5653
Copyright © 2008 The Seattle Times Company
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