Transcription of Robert Macdonald for the show Head Games #53
Dr. Lisa: This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and Podcast show number 53, “Head games” airing for the first time on September 16th 2012 on WLOB and WPEI Radio, Portland, Maine. Today’s guest include Dr. James Glazer of Coastal Orthopedics and Sport Medicine, Rob McDonald graduate of Cape Elizabeth high school and current Harvard University student, and also Deb Arthur, who has a doctorate in physical education and a masters in science who currently works at The Body Architect.
Each of our guests will help us explore the theme of the head and how it intersects with the body as in mind, body, and spirit. Dr. James Glazer will give us more of a clinical eye and some history on concussions and what it means to have a traumatic brain injury while playing sports or in other parts of one’s life. Rob McDonald is going to give us a more personal view of this as he describes an episode that took place during his first year of college while playing rugby, a head injury which certainly had an impact on his own life. And Deb Arthur will really bring the idea of mind and body back around again for us. We hope that you enjoy our show today. Please let us know what you think.
The Dr. Lisa Radio Hour and Podcast is pleased to be sponsored by the University of New England. As part of our collaboration we feature a segment we call Wellness Innovations. This week’s Wellness Innovation focuses on head injuries.
It’s interesting concussion rates and prevention strategies at all levels continue to grow, one population that appears to have increasing head injury rates is collegiate football players. Research presented recently at the American Orthopedics Society for Sports Medicine annual meeting in Baltimore highlights that concussion rate in three college football programs has doubled in recent years. The increase comes after a 2010 NCAA concussion management initiative that requires athletic programs to report concussion signs and symptoms and then remove players from play. For more information on this Wellness Innovation visit d-o-c-t-o-rlisa.org. For more information on the University of New England visit une.edu.
Dr. Lisa: Earlier in our show which we have titled “Head Games” we spoke with Dr. James Glazier about the impact of concussions on children. Now I have in front of me a person who well at one point was a child. He’s clearly a very big person now, but he has experience with concussions. I thought it would be really important to bring on Rob McDonald graduate of Cape Elizabeth high school and also student at Harvard University to talk about the impact of concussions on his life, because it’s more significant than I think many parents would think and it’s definitely something that I think maybe coaches need to be paying attention to. So thanks for coming in and talking to us today Rob.
Rob: Thanks for having me. Yeah, concussions are like my baby right now. I’m really passionate about them.
Dr. Lisa: Well let’s tell people, we’re listening, what has your experience been with concussions? Tell us where does this whole story begin?
Rob: At Harvard I was playing rugby and I joined the team earlier. I joined the team in the fall and I knew concussions were almost part of the sport because a lot of guys come in having played American football and so they’re used to like really getting in there with a tackle, getting their head in there, which is not so much how rugby tackles usually supposed to go. But so I knew concussions are part of the sport.
Then in April I got my first concussion and did the dark room rest, which is what doctors prescribe afterwards, that you’re supposed to do, and then felt like I was okay and then feeling normal for a few weeks. Then my cognitive function ended up being a little lacking so I ended up not being able to take finals in the Spring, and so I didn’t finish out the semester and I’m actually taking those finals as medical makeup exams this coming October.
So yeah, my concussion has totally just been a really weird experience for me and also a really hard too. Because when you get a concussion is not just that you can’t play sports for two weeks that a lot of guys have. But a lot of times it’s like your ability to think, your ability to make connections between thoughts, your short term or long term memory even can be really affected. Even since April I’m still recovering from my concussion and it’s now early September and doctors have said I could be recovering for a couple more weeks or I could be recovering for a couple of more months. They don’t really know exactly how long things will be.
That’s been my experience up until now. It’s been pretty tough, but also something that’s showed me a lot about myself in a lot of ways.
Dr. Lisa: Tell me. So you were a high school athlete. You played golf and soccer and baseball at Cape Elizabeth?
Rob: Yeah, a combination of those three.
Dr. Lisa: A combination of those throughout yep, and you played them pretty aggressively. I mean I remember because you played against my son Kemble who was at Yarmouth at the time. He played soccer and baseball against him and I remember you were out there just like Kemble full force like most kids your age, but you didn’t have this experience with concussions before. Is that correct?
Rob: Right, that’s correct. I never had an experience with a concussion. My only experience with concussions was I had friends who were similarly athletes and they had gotten concussions, and it was usually like a two week thing, for two weeks your impact test scores, which is the base line concussion test that I think every athlete in the State of Maine takes now, and if you have like a ding or if you get hit in the head or you’re feeling woozy after a play, then a lot of times the athletic trainer or one of your coaches will sit you out for the rest of the game and then you’ll take the impact test again. And if there’s any sign of a concussion the impact test I think almost always picks it up.
A lot of times what happens is concussed athletes will have a few weeks where their impact scores will be lower, and then as soon as the impact scores are back the coach will put them back in. And that’s fine, that’s how most concussions work. So that was my experience with concussions in high school. And until I had mine I didn’t really understand it. It can be a lot more than just those two weeks of resting and recovering. It can be totally different.
Dr. Lisa: Tell me about what it was like when you first got your concussion, what did that feel like? How were you doing as you were coming off the field?
Rob: Yes, so when I got my first concussion I just pretty much knew right away I got it. I was going in for a tackle and the guy was keeping his knees up really high. It was a much bigger guy than me. I’m 5’11, pretty stocky but there are a lot of really tall guys and big dudes. I was playing against a big Canadian team so they’re tough. But I got hit in the side of the head with his knee when I was going into tackle him and I pretty much knew right after I got up off the ground. I was like, “Okay, I feel really woozy.” It’s almost like your eyes go out of focus so there’s definitely a lot of physical symptoms you can immediately feel. So I went off the field.
Dr. Lisa: So when you talk about having your bell rung it really felt like your bell was rung at that point?
Rob: Yeah, absolutely. You don’t see stars or anything. It’s not like you’re going to a new universe, but you definitely feel that something is going on. And they talk about it on the rugby, on the sidelines as someone’s got a concussed look, like they just look dazed.
Dr. Lisa: Okay, so you came off the field and tell me what happened right then and what happened subsequent to that.
Rob: So right then they checked me out a little bit, one of the trainers who was there, and they essentially what they wanted to make sure is that I remembered having woke up that morning and gotten breakfast and having come to the field and warmed up. That’s the big concern I think for a lot of people is if they forget the portions of the day up until their concussion then they can have some serious damage. I also didn’t lose consciousness which a lot of people do during the concussion. But I think that they found out that whether or not you lose consciousness doesn’t necessarily effect how severe your concussion is going to be, that there are other factors, and it’s tough to say what those factors are of course, but there are other factors that’ll play into the length of recovery time.
Dr. Lisa: And did the trainer pull you out of the game for the rest of it or give you any recommendations at that point?
Rob: Yeah, it was pretty much understood that I wasn’t going back into the game. I would not put myself back in or allow the coach to do that. So yeah, it was basically just rest up, you’re on the sidelines. Then that was on a Thursday and then after that weekend I went to the university health services there and they said, “He’s definitely showing some symptoms consistent with a post concussion.” And of course all the nomenclature and all the different terminologies that go into a concussion are so different so they didn’t know exactly how to call it because post concussive syndrome is this other thing which I learned about later which is with concussions 90% of people have that two week concussion period. I think that’s the statistic, so they have about two weeks or up until a month and they recover within a month.
And the other 10% of people, it’s either a month to three months in which they diagnose post concussive syndrome, which is this whole tension, there’s this whole controversy in the medical community can you even call it a syndrome because the nature of post concussive syndrome is that almost everyone has a unique different recovery time and they don’t exactly know how long it’s going to be or how exactly they can treat it. This is my experience with it, so it might not be everyone’s. So yeah, so people who have those really long concussions have post concussive syndrome.
Dr. Lisa: And did they give you that diagnosis after you had spent a few weeks and weren’t really getting quite back to your normal self?
Rob: I got this diagnosis when I came home to Maine. I got the concussion in April. I didn’t get the diagnosis until around June-July because they can’t really call it until then because you could always get better. Some people wake up one morning and just immediately feel better. And for me the sense is that it’s just going to fade out. And so doctor Bill Haines who he’s an orthopedic surgeon at Orthopedic Associates who I’ve seen him a bunch of times, said that, “Yeah, we’re probably looking at post concussive syndrome here.”
Dr. Lisa: So tell me about what was happening between April and June. I mean it sounds like it was significant enough so that you couldn’t concentrate on your studies so that it wasn’t possible for you to finish your classes.
Rob: Immediately after the concussion I couldn’t go to classes because I just immediately after I was so fatigued, sleeping about 14 to 16 hours a day and then ended up as I said not taking my final exams. Then once I got home I thought that I’ll get home, I’ll be out of the school environment, I’ll be at my house, my parents will be able to bake me meals instead of having to go to the dining hall and what not.
I thought the concussion was fading out, and then I ended up like a month later after I was working. I worked at a company here in Portland and was doing sort low intensity work, but still work, so get up early in the morning and just had a relapse one night and ended up having these horrible migraine symptoms and I started to get a lot of pressure throughout my face. I was pretty upset actually because I thought I’d be getting better and then I know a lot of people who have concussions feel this way. They’ll be counting down the days until they’re getting better or will think they’ll be super optimistic like I’m almost there, I’m almost there, which after a long multiple month period of being injured, especially in your brain, can be really difficult once you get a setback that you ignored, whether that’s a setback for reasons you don’t understand or that you can’t pinpoint.
So yeah, after that relapse I essentially did dark room rest, which is a prescription a lot of doctors will give people with concussions, especially long term concussion.
Dr. Lisa: So what does that actually look like, what is dark room rest?
Rob: Dark room rest it’s actually similar to sensory deprivation torture and what you do is you are in a dark room for as long throughout the day as you can. I was doing up to 10 hours at one point during June and July and you starve yourself of any brain stimulation or activity, so obviously no screens, no phones, no reading, no music. I would play a little soft music once in a while just to create some new space I guess. You could listen like a book on CD anything, because I was concerned that I was stimulating my brain too much and the doctors want you to just to rest as much as possible. Of course though then when you’re thinking about stuff, it’s a very stressful environment even though you’re doing nothing essentially, and it can be tough.
So I ended up after about a few months of doing that of going down to the MassGeneral Hospital to their concussion clinic that they have down there, one of the best in the country, and they put me on a more aerobic based plan. The idea was to get the blood flowing to my brain doing a lot of cardiovascular work to get my body back in shape. Of course I had been essentially vegetating for the last two months so I was definitely out of shape and with that I started to do a lot better, even if going in with a headache and I’d come out with a headache, they said if the headache is about the same intensity that’s okay, that’s good. If it gets worse be careful. If it gets way too much worse you want to stop.
Essentially I did a gradually increasing aerobic routine, doing a lot of running on the elliptical machines, which are good because they minimize impact to the head and ended up just making a pretty good recovery after that.
Dr. Lisa: So what was it like to go from being a college student, well first of all let’s just back up. So you obviously did well enough at Cape Elizabeth that you got into Harvard and you went on and were a college student and your life was progressing along the path, you just kept working hard, nose to the grindstone. All of the sudden you get smacked upside of the head and your life gets completely turned around and you’re lying in a dark room, and you’re not working, and you can’t study, and you can’t exercise. What was that like?
Rob: It was pretty crazy actually. So throughout high school and into my freshman year of college I had progressed into a straight line of step-by-step doing this and that, building up a strong resume. I was always just very studious and very focused in a lot of ways. And so with the concussion it was like a total maybe step back for a second and everything was different around me, my whole life seemed to be different. And for me it felt like it wasn’t part of the big plan that I had for myself. So now I’m taking a year off from school and I’ll do some work hopefully in Maine and then hopefully travel and study abroad, which is something I’d always figured I’d like to do, but might not have actually gotten in the process of planning if it hadn’t been for such an event as this.
Dr. Lisa: So there’s a silver lining is what you’re trying to say?
Rob: Yeah, absolutely, definitely a silver lining. But you know going from a super active, always very social, hanging out with my friends and all that stuff in my life at college to essentially losing my summer to the concussion, the recovery. And it wasn’t just like if you had torn your ACL or something. I know friends who had done that and had to get surgery over the summer. They’re essentially couch potatoes over the summer, it is what they have to be. But at least they get to watch every season of Breaking Bad. I wasn’t able to do that. I was sitting in my room just hanging out with my thoughts essentially.
It was really hard in a lot of ways for me. I went from doing 1000 things at once to doing zero. So I think in those two extremes hopefully I can find a medium between those. I think in a lot of ways the silver lining, you’re right, there was a silver lining and it was probably a good thing for me to do, just decompress for a long time since I never really decompressed or rested, giving myself, my brain any sort of rest in my life. Yeah, it was really hard, but probably later on 10 years down the road I’ll look back and be like that was something that I needed at the time.
Dr. Lisa: It sounds like you’ve worked through a lot of things. You’re still I know going down to New England rehab and doing work with them. I know you have upcoming exams and you’re thinking about the next year. Are things feeling brighter for you now?
Rob: Absolutely. Since my concussion I did a lot of reflecting and lot of thinking about what’s next especially after experiencing this very intense difficult situation that I experienced this past summer. It actually made me appreciate everything about just life in general a lot more and about where I’m at and there are some of the opportunities that I have, even just this year hopefully looking into studying abroad and having experiences there. Yeah, it’s been, I mean I feel a lot better about that, and I feel a lot better about the situation.
So definitely I had a really difficult summer, but I actually used to joke about it. I got one of my buddies who is doing a NOLS India course, which is supposed to be the most difficult NOLS as the National Outdoor Learning Service, one of the most difficult courses, trips that people can do. I was joking with him, “I probably had a similarly difficult summer just as you did. Yours was more physical. Mine was mental.” I just come to terms with this, with the fact that I felt like my whole life had been almost thrown off course, and I didn’t know how I was going to overcome this injury.
To me it’s a really scary feeling, especially if I’ve always been very into school and very studious, into debating people, and I felt like I couldn’t do that at all. And it’s a really scary feeling. That’s like what I do. I like, I process information and I talk to different people, and it was just really scary.
But now I’m learning to really appreciate that. Especially I was to that football player the Harvard football player who’s currently going through a concussion. He says when he’s in the locker room he can feel that pre-game intensity that everyone has in the locker room before a game. He’s like, “Man, you guys should really cherish this, This is really a pretty special thing.” He said the way he thinks of it is every single snap, it’s a gift, that you get to go out and play football with your buddies and fight with your team, it’s an important thing. I think about it in a very similar way I think. So definitely the concussion is though difficult given me like a new perspective. So it’s been okay actually.
Dr. Lisa: I appreciate you coming in and talking to us. I know it’s not always easy to sit in front of a microphone and share your story, and especially a story that’s as intensely personal as this. It sounds like you’ve learned and experienced a lot through this really interesting and strange twist of fate. So you’re 19 now?
Rob: Yeah.
Dr. Lisa: Yep, as a 19 year old there aren’t as many people who could do this and come in a speak with us with the type of mindfulness and thoughtfulness that you have, so we really appreciate talking to you about all of this. We’ve been talking with Rob McDonald, Cape Elizabeth high school graduate and Harvard student who recently has undergone this concussion. Thank you so much for coming in.
Rob: Thank you so much for having me. It was definitely a good experience, even being here. Hopefully I can reach some people who have gone through a concussion or are currently going through one, or if maybe if they will in the future so thanks a lot.