Conquering College After Concussion

by Amy Zellmer, Editor-in-chief

Looking at college freshman Rachel Mischel you wouldn’t know that she has struggled with lingering symptoms from multiple concussions suffered several years ago.

Fortunately for Rachel she found the right treatment path, but it was a long road getting there.

In 2017, during her junior year, she sustained her first (documented) concussion while playing varsity volleyball. Diving to save a ball, she hit her head on the floor and heard her neck crack. She saved the ball but when she got up and cracked her neck the other way to relieve it, she felt woozy. No one realized she had hit her head. Those who heard it thought she hit her elbow so she didn’t argue with them and went back into the game.

Later that night she was freezing cold and remembers not being able to get warm when she went to bed, even though the house was quite warm.

The next day at practice she couldn’t get the words out to call the ball. She couldn’t say “Mine” and pass the ball; she could only do one or the other. This was troublesome for her, as she was the libero and needed to be able to communicate her calls to the team. She was exhausted after practice, but still didn’t realize she had a concussion.

A few days later her neck was still quite sore and she asked the athletic trainer to stretch her neck. The trainer asked if she had any other issue and Rachel responded, “Yeah, I have a headache.”

The trainer decided to do a concussion test using the SCAT test. Rachel was only able to remember three of the five words given to her, her balance was off, and she couldn’t stand with her eyes shut. The trainer made her sit out of practice.

The next day she was only able to remember two of the five words, her neck was still tight, and she still had the headache. The trainer refused to clear her to play volleyball that night, which devastated Rachel. “It was the first time I’d ever had to sit out. It was foreign to me. I was totally prepared to play through, just as I’d always played through every injury.”

Return-to-play protocol

The school’s return-to-play protocol included passing the SCAT test, and then passing the IMPACT computerized test. After that, there was a five-day progression to get back to practice, first with no contact, then full contact. The player had to pass each level before receiving permission to play.

Rachel continued to struggle with the SCAT test for about a month. She took the IMPACT several times before passing, and she admitted to sort-of lying when she self-reported symptoms (e.g., Are you dizzy? Do you have a headache?).

All of this happened right before regionals and Rachel was determined to play. Her trainer helped her work hard at getting through the protocols. By the time she was finally cleared she had one day to practice before the first regional game.

Rachel was uncharacteristically nervous playing during regionals, and knew she probably shouldn’t be playing as the dives were taking a toll on her. The team made it to the state finals, during which Rachel remembers zoning out during the games and that her eyes had trouble focusing. She was determined to play through it and didn’t tell the trainer she was struggling.

The volleyball tournament ended on a Saturday, and basketball practice started the following Monday. During the third day of basketball practice, Rachel took an elbow to the head but got up and kept going. When she came off the floor her coach asked Rachel if she was okay. She said she was fine, just a little dizzy. He wanted her to sit out for a bit, but she insisted she was fine and went back into practice.

After practice, the coach ordered Rachel to see the trainers. Her symptoms were more obvious right away. She didn’t know where she was and couldn’t answer any of the trainer’s questions. She kept staring off and was dazed and confused. She stood near the garbage can because she thought she was going to throw up. Her eyes and head hurt. Everything was too bright and too loud.

The trainer called Rachel’s mother to pick her up and told Rachel to get her stuff from her locker. She wandered the halls looking for her locker and then couldn’t remember the combination to the padlock. Her mom noticed she was mixing up her words and wasn’t making sense, and thought Rachel looked like she was high or drunk.

The next day was Thanksgiving and family members kept asking what was wrong with Rachel. They could tell something was off. When she went back to school the following Monday Rachel couldn’t understand what the teachers were saying. “They all sounded like Charlie Brown’s mom,” she said.  Her friends kept asking if she was okay, and were freaked out because one of Rachel’s eyes was dilated more than the other. She was sweating and pale and acting strange enough that one of her friends called her mom and told her she should really come get her. The trainer advised them that they should go to the hospital.

The ER doctor didn’t feel a CT scan was necessary but Rachel’s mom pushed for the imaging until he said, “Okay, we’ll do it if it will make you feel better and give you peace of mind.” The scan came back clear but Rachel’s mom wasn’t satisfied and took her to a chiropractor because her neck was still super tight and sore. When he looked at her CT he saw a vertebrae was out of place and was putting pressure on Rachel’s brain stem.

Rachel continued going to school but sat out the entire season of basketball and spent much of her time seeing teachers after school because she was struggling.  Her teachers were accommodating because Rachel had always been a 4.0 student, so they knew she wasn’t faking it. They were worried because her personality had completely changed; she was zombie-like in class, not her normal bubbly self.

Rachel’s mom had been searching for resources to help her, and in the spring she met Jami and Braden Benz. Like her, Jami had searched for help when her son Braden suffered a concussion a year earlier. Jami told her, “Don’t waste your time here in Bismarck (North Dakota). Go to The Functional Neurology Center in Minnesota.” As luck would have it, the Center had a cancellation and Rachel was able to get into TheFNC the following week where she worked with Dr. Erik Reis.

From the Doctor

“Rachel came to our office with persistent symptoms of headaches, neck pain, dizziness, fatigue, altered balance/coordination, visual strain/blurry vision, and changes in her cognitive processing. She was struggling in school and with sports and saw a dramatic change in her lifestyle at home as a result of her concussion, which seemed small at the time, but eventually changed the way she functioned throughout the day. 

“When she was in the office, we did a major workup on her, including a bedside assessment, objective diagnostic testing, tilt table evaluations, and in-depth metabolic testing to assess potential underlying nutrition deficiencies. It was evident that she was struggling with multiple factors, with the biggest one being her inability to handle body-based movements like going from seated to standing without getting dizzy and/or disoriented, a condition known as dysautonomia, which can also include cold hands/feet, rapid alterations in heart rate and blood pressure, and heart palpitations. That factor alone would explain a lot of what Rachel was experiencing, as she was operating at a far lower capacity due to the fact that her brain wasn’t getting adequate blood flow throughout the day, especially while in school. Her associated symptoms of dizziness, altered balance/coordination, and delays in cognitive processing were primarily and secondarily affected by this as well, which further promoted this type of dysfunction. 

“Our first week together showed great results, with Rachel leaving with notable changes in her headaches, dizziness, and energy levels, which remained constant and continued to improve as time went on. She wasn’t perfect, as she was slowly getting back into playing sports and had a few flare-ups here and there with the headaches and dizziness, so we had to work out a plan to pick and choose our battles with her therapies and rest, as this is always a big factor in recovery. Over time, Rachel continued to make great strides in getting back to her normal self. With continued care and virtual check-ups, she was able to get back to her regular status and eventually get back to her true passion, playing sports.

“Before seeing us in the office, Rachel had tried a lot of standard therapies, including continued rest and recovery, but it wasn’t enough. She wasn’t a part of the lucky 80% of people who eventually “fully” recover from a concussion on their own, so we had to take a different approach with her treatment(s). Over the past few years we have realized how important cardiovascular exercise can be in the recovery from a brain injury, so we used this information to our advantage, as Rachel was already very athletic and had an athletic mindset toward her therapy. 

“Rachel made great progress both in and outside of our office, which is an important factor to take into consideration, as therapy can and should happen in both places under the appropriate circumstances. As she was the one who had to do all the hard work, we must give Rachel 99.9% of the credit for her recovery, which is a factor that also speaks volumes to the type of person she is and has continued to become.”

“The intensive week changed my life, Rachel says. “I had energy again, could think clearly, and actually felt alive again. It’s was like when you have a dirty windshield and then wipe it off and can see clearly again.”

When she went back to school the following week she still had accommodations; however, the teachers could see a difference. They could tell by her eyes that she was better — her eyes were no longer glossed over and she was no longer zoning out, they also could tell that she comprehended what they were saying.

Dr. Reis wanted Rachel to get back to playing sports and begin practice, but her family and coaches in Bismarck wanted her to wait. She had to follow protocol and be cleared by the trainer, which she finally was after a few weeks. She was able to play the rest of the softball season.

During basketball camp the next summer Rachel took yet another hit to the head and went to TheFNC for a three-day follow-up with Dr. Reis. Because she now had the tools to control her recovery, she bounced back fairly quickly.

During her senior year Rachel felt 90% recovered and was able to play a full season of volleyball as well as basketball — until she tore ligaments in her ankle.

Rachel went on to graduate high school as valedictorian with a 4.0 and is now a freshman at University of Mary in Bismarck. Before her experience at TheFNC she was undecided about what she wanted to major in but was always interested in the brain and how it functions. After working with Dr. Reis, she decided on a biology/pre-chiropractic major and plans to attend Northwestern Health Sciences University in Bloomington, Minnesota, as well as Florida’s Carrick Institute in preparation to becoming a functional neurologist so she can help others after concussion.

Her advice to anyone struggling with the effects of brain injury is, “No matter what comes your way, never give up. You can’t go back in time — it happened and you’re not going to reverse it. Get the help you need, and once you get that help continue to do the exercises. Doctors can only take you so far; at some point you have to be accountable and take the responsibility to do the exercises and continue your treatment plan. But no matter what, never give up!”

Editor’s Note:

If you think you or a teammate have suffered a concussion during practice or play, please report it to the athletic trainer or coach immediately. Even when the player thinks they’re “fine” they aren’t in the right frame of mind to make coherent decisions if they have been concussed. It’s important to pull a player out; a second impact can have devastating effects. If you are a parent, you know your child best. If they aren’t acting “right” be persistent in your quest to find out what is wrong and how to help them. Most important:Do not let them play again until their symptoms have resolved, even if a coach insists that they’re “fine.”

Amy Zellmer is an award winning author, keynote speaker, and TBI survivor and advocate. She is Editor-in-chief of The Brain Health Magazine, and hosts the Faces of TBI podcast series, as well as TBI TV on YouTube.