The last time Veronica Masik got hit on the head and suffered a concussion, she deliberately chose to let herself fall into unconsciousness.
"I've learned that if I let myself pass out for 30 seconds I feel fine. If I fight it, I have a headache afterwards," she said.
Masik, 21, is an expert on what it's like to have a head injury. Since the first blow to her head, when she was a Grade 12 Bellerose high school cheerleader, she's had at least a half dozen more.
"First I lose my sight for a minute — from the pain," she said, providing a second by second description of what a concussion feels like.
"I think you go into shock. But it hurts. When you are first hit, honestly it very much hurts," she said.
Despite being kicked and elbowed in the head numerous times by the falling bodies of other cheerleaders, and even considering the pain she experienced, Masik's skull was not broken.
The World Health Organization (WHO) defines a concussion as a mild traumatic brain injury caused by a fall or mechanical force that may cause loss of consciousness for less than 30 minutes and posttraumatic amnesia not greater than 24 hours. Patients who have had a concussion may or may not lose consciousness.
"It is described as a mild brain injury because a brain scan will show there are no neurological fractures to the skull," said Dr. Martin Mrazik, a concussion psychologist with the University of Alberta.
Mrazik is conducting a 10-year study on the effects of concussions on children, especially young hockey players.
Short circuit
"A concussion is almost like a bruise," he said. "If you get a punch in a muscle, there is cellular damage. But a blow to the head causes a functional injury. If we examine a concussed brain we see an arousal of the system, almost as if it's overstimulated. It's as if the brain cannot process information."
Masik agreed with that assessment, as she described her first thoughts upon regaining consciousness.
"What it feels like for me after I've passed out is my eyes are closed and I can hear people talking and I know they are concerned, but I don't really care. I think, 'what's going on?' Sometimes I'm dizzy and disoriented."
In those first seconds of awareness, she cannot open her eyes or move and yet she understands some of her surroundings and can hear the panic in other people's voices.
The mental disruptions people feel after a head blow cause a loss of electrical connections between brain cells.
"Think of a piece of licorice that you stretch. The cells become elongated and they don't connect as well," Mrazik explained. "Or think of a disruptive Edmonton road-construction project or a car accident on a major intersection. The normal function is disrupted. Traffic is re-routed and it takes longer to get things done."
Misdiagnosis common
Masik still believes the first concussion she suffered was the worst. She was at the bottom of a cheerleading pyramid with two other girls above her. The top girl fell and the force of her full weight, falling from a height of perhaps 10 feet, hit Masik in the head, causing her to lose consciousness.
"She lost her balance and when she fell, [she] hit my head with her elbow. I got a huge goose egg and I think I was knocked out for about five minutes," Masik said.
Masik is still incensed about the reaction from the emergency room physician she saw, who dismissed her injury as trivial and sent her home.
"The doctor said, 'Cheerleading eh? Did they hit you with their pom-pom?" she recalled.
The misdiagnosis of a concussion is a common problem, Mrazik admits.
"If you've had a blow to the head, and you have a series of symptoms, such as feeling dazed, disoriented or confused, and if you have experienced a loss of consciousness, you've likely had a concussion. Not having concussions recognized is a problem and one we have to address," he said.
For a short time after that first concussion in high school, Masik had a lot of difficulty connecting and collecting her thoughts. One week later she fell asleep during a calculus exam.
She remembers going out for lunch with some friends and falling asleep in the back seat.
"My friends freaked out because they thought I'd passed out. But it was so hard to stay awake afterwards."
Play through pain
That year her fellow cheerleaders awarded her the "Most likely to be concussed" trophy, because it seemed every time she got even a light tap on the head, she would black out.
She didn't join the University of Alberta cheerleading team until she was in her second year of studies.
"When I was 18, I had a year off with no concussions. Then when I was 19, I joined the U of A team and had two concussions and three more the next year. This year I've had one, and for my health, my coach asked me to quit the team. I'm out for the year," she said.
She explained the cumulative effects of the concussions as well as her love for the sport.
"I'm not recovering as fast from the last concussion. I'm tired and I have a little headache all the time. I have a hard time to look for words and it's hard to think. Previously I'd describe it as a mild buzz, a bit like being drunk, but it would pass. This time, I have random bouts of nausea."
Masik is a mathematical person, but since the last hit a few weeks ago, she's had difficulty doing simple math in her head. She's altered her way of working to allow her frazzled brain to heal.
"It used to be I could read a page and retain it. Now it seems I have to re-read things. So I multi-task because my mind starts to wander," she said.
New medical scans such as functional MRIs that have been available for about eight years and P.E.T. scans, allow researchers to see inside the brain, Mrazik said.
"Athletes have this playing through pain mantra. That's why they are successful," he said. "That may work with muscles, but in the last 15 years, since we've started seeing inside the brain, we've learned the brain doesn't respond the way other body parts do to injuries."
Post concussion syndrome
Studies show that following a blow to the head, brains produce an excess of calcium. It's the calcium and the resulting chemical imbalance that appears to cause the disruption of electrical impulses.
"Brains do heal after a concussion, but if there are two blows, or multiple blows before the brain has fixed that chemical imbalance, it seems it doesn't mend as quickly," Mrazik said.
Presently, the only known treatment for a concussion is to rest until all the symptoms of confusion, dizziness and fatigue go away, Mrazik said. And hard as it is for athletes such as Masik to accept, it may be that once a player has been concussed, they should consider a less physical game that's less likely to injure their head.
"More and more we're learning that there are cumulative effects. A second impact to the brain can cause it to swell and that's potentially fatal. But once a concussion has happened, it seems it's more apt to happen again and again," he said.
Those aren't answers that Masik wants to hear. She loves the athleticism of her sport and the teamwork. She likes performing as she and her team try new and exciting feats. And like many other athletes, she thinks of her team before she thinks of herself.
"I'm needed on the team. I love cheerleading. It's so cool when you get it to work," she said, but then she also added: "I love cheerleading, but I don't love concussions."
