Tragic news of Buckeye’s Karageorge brings about much discussion on concussion aftereffects

2014-12-05 08:35:19 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the blog.

caption Kosta Karageorge

On the heels of the recent tragic news regarding the Buckeye's Kosta Karageorge, who took his own life, I had the chance to visit in studio WAKR morning show host Ray Horner to discuss concussions and their aftereffects.

Perhaps the most troubling part about this is even with all the research and studies we've done, we still aren't clear on the connection between brain injuries and their affect on the mind.

We've come a long way in implementing objective tests to determine whether an athlete is physically ready and able to get back out on the field. However, there's not much in the way of testing a player's mental state.

That's why, in the meantime, we're doing everything we can to prevent these brain injuries and do a better job managing and treating them when they do occur.

Below is an audio file and transcript of our discussion. Originally aired on 1590 WAKR-AM on Dec. 3, 2014.

HORNER: Dr. Joe Congeni is in our studio, Sports Medicine Center, Akron Children's Hospital. Joe, there's been some comments, uh, Chris has used from you, on the air this morning pertaining to the young man Ohio State, (Kosta) Karageorge. symptoms of concussions and, unfortunately, the young man took his life over the weekend.

I know it's troubling to you, a lot of work you've put into the concussion side of things. You saw this story, what immediately went through your mind?

DR. CONGENI: It's one of many things that are troubling, but perhaps the most troubling is trying to wrap our arms around some of the mood disorders that seem to be related to the chronic nature of multiple concussions or significant concussions.

Objectively, there's no great way to test for it, uh, because the athletes and the kids don't tell a lot of people about these symptoms, sometimes that they're even going through some of the anxiety, depression, um, behavior changes.

Dr. Joe Congeni Dr. Joe Congeni

It's hard to assess yourself as far as behavioral changes. The people around you have to assess those kinds of things. So, they aren't telling anybody, those things are going unrecognized and it's part of the longer-term effects.

And, we really still don't know, even with all our research and everything else, we just don't know that connection between brain injury and the affect on the mind. The mind is different than the brain, and so that's probably an area that is most disconcerting about this.

HORNER: I'm glad you brought that up because so often when we talk about concussions and the effects, we talk about memory loss. We talk about the long-term effects from the body and such. But, the mind itself, I wanted you to get into concussion's aftereffects and what are some of the effects of the concussion. Does depression set in on those lines?

DR. CONGENI: Yeah, I mean, I think there's enough research now to say there's no question that there's an association . Not so much in the 80 percent that fortunately do well early on. You know, within 2 weeks or so … they look like they recover pretty close to normal as far as their function.

Not so much in that group, but in that 15 or 20 percent that have longer lasting effects, more than 6 weeks. When we get into that population — more than 6 weeks, more than 6 months longer-term effects — then that's when, um, trying to get a good idea on these mood disorders and trying to get people in for help becomes a real important issue.

HORNER: Yeah, mood disorders are an area because when it came down with the young man, they had mentioned he had some mood swings and had been in depression. From a medical standpoint, when you look at this as a doctor, does that come under concussion or is that still under research and study?

Kosta Karageorge with his mother. Kosta Karageorge with his mother.

DR. CONGENI: It's still under research, but I think there's enough evidence it happens. But what we don't know is some of this predisposing? Was it going on before? Is some of it post because this has changed and screwed up their life in so many ways? Is there something about this injury to the brain that affects the mind?

All three of those things I think are a part of this: pre, post and the brain injury itself affecting the mind and affecting personality. But, how do you assess that? It's a very hard thing to know. What was their personality like?

So, we have these concussion tests where we look at an objective number. Here's what their, um, memory was before. Here's what their reaction time was before. That's why we do the baseline testing, right?

HORNER: Mmm-hmm.

DR. CONGENI: So, we at least have something we can look at objectively. And, I've been telling you about a few things that we can look at from the standpoint of, you know, speed and heart rate, and reaction time to know when their brain is recovering to get back on the field as far as physical parameters.

But as far as those mental parameters, we don't have anything really to go on other than what the athletes are telling us. And, just like on the field acutely, they hide some of the symptoms chronically over periods of time. They either don't know better or they don't tell anybody and then we hear a terrible story like this. The windup of this story just breaks everybody's heart.

HORNER: Uh, Joe, you and I have talked and taken considerable time pertaining to the NFL game and I know you work with a lot of different high schools and high-school athletes about the determination, the education of those working hard in concussion education and doing the research and making sure these kids aren't on the field and that type of thing.

What about the college game? What about the Division I college football game where there's a lot of pressure to win each and every week? Are they doing the good job, as well?

DR. CONGENI: There is a lot of pressure and the answer is: tremendous progress in the last 10 years. I've seen a lot of progress. I've seen some of that awareness and education on the coaching side, on the athlete side and so definitely, it's become easier for the sports medicine teams. The NCAA is regulating that pretty closely. All of those areas have a significant improvement in the last 10 years.

On the other hand, though, the problem is you're treating something for the now that you don't know what the effects are gonna be later. So, even with all the study that I tell you about and all the research going on, everybody's trying to do what they can now. But, we don't know the longer-term effects.

Kosta Karageorge was a defensive tackle. Kosta Karageorge was a defensive tackle.

I would just say to you from the standpoint of now versus 10 years ago, asking specifically in that area, the college game, yes, much better from the standpoint of initial recognition and also in initial treatment, acute treatment, to make sure that we're not allowing people to go back to play too soon when they're at risk.

HORNER: The education is one side of it, uh, making sure these young men aren't going into the game too quickly is another side of it. What else can you do?

You and I have talked about equipment and the helmets and that type of thing, but football is a violent game.


HORNER: So, what's the big picture here with this, Joe?

DR. CONGENI: Uh, the future is not altogether certain. We've also talked about the fact that this is America's passion and everybody loves this game. But on the other hand, there's some risk.

The fact is we know with the numbers going down in youth sports, there is concern on the standpoint of parents and that may be something that affects the longevity of this game. We don't know that.

So, we have to do everything we can to be safer. That's what I'm talking about. The studies in 5 and 10 years will say, yeah, we did a whole lot better job, or you know, even with all we could possibly do, we're still having problems with this particular sport.

You know the issues. You know that it occurs in soccer and it occurs in basketball, and those are the two fastest-growing sports even growing faster than football. But, football gets the headlines and football has the highest percentage. But, football's at the greatest risk. There is a chance in 5 or 10 years that that sport would not be around anymore.

HORNER: I was gonna say, numbers are considerably low. I remember seeing this a couple of months ago where the percentage is dropping considerably when you're talking about the youth programs and above.

DR. CONGENI: So, our job in sports medicine is to do everything we can upfront to prevent , and do the best job managing and do the best job treating, and keep the game as safe as possible.


You mentioned at the pro game level, it's visible. At the college , much, much better and at the youth sport, without question. doing everything with rules changes; doing everything with prevention; objective tools that may help us in the future that are being studied right now; those athletic trainers, that are our eyes and ears on the field, are picking up those subtle symptoms early on when they have 'em.

Do all those things the best we can do. Make it as safe as possible and then as we watch in the next 5 or 10 years, is that good enough? It'll be really an intriguing thing to watch.

HORNER: A lot of this also comes back to the players themselves and I think that's the education standpoint. Isn't it, Joe? I've talked numerous times to Jay Brophy.

DR. CONGENI: Mmm-hmm.

HORNER: Jay and I have done a lot of football games and been on the road a lot together. And, he told me quite frankly, when he went to Miami, there was pressure to get right back out onto the football field. When he played with the Dolphins, there was pressure to get right back down onto the football field.

They didn't necessarily say, you get out here or you're gone. But, you knew that if you didn't go back out there, next man up means you're next man out.

Those are the things that sometimes we forget to evaluate: the pressures of these kids. You're talking 14, 18 and college level, 18 to 21 year olds that feel the pressure that they wanna play, but they have to be honest with themselves first and understand the long-term ramifications here.

DR. CONGENI: For sure. So, we can teach, teach, teach. There were studies a decade or two ago that many people played knowing they had symptoms.

We think we're doing better, but it's one of the great unknowns. When it comes right down to it, are there still a lot of people that are ignoring symptoms to continue to play because of the pressures of this game? It's another one of the great unknowns.

I know that everybody's better educated. I know that there's a heightened awareness. But, I don't know if that equals our people being a lot more honest early on. I think they're being better, but I still think there's probably a lot of hiding these symptoms.

HORNER: For a parent and a grandparent listening to us right now, what are obvious symptoms of a concussion, and not just that the young man is woozy.

DR. CONGENI: Yeah, you know, there's so many. There's headache. There's dizziness. Uh, the brain slows down; the kids just slow down. There are memory issues. There's sensitivity to light. There's sensitivity to noise.

You know, look at how many things I listed right there. There are so many different symptoms …


DR. CONGENI: … and that's what makes it so hard. So, everybody's just looking for, you know, that one question to ask about memory. That's not enough. Checking the vision. That's not enough.

It can be any of those types of symptoms. It depends on what part of the brain is affected. And so, it's many different initial symptoms. A lot of times the coaches, especially the parents know when their kid's acting right or not. And if they're not acting right, get 'em in to be tested.

HORNER: Mmm-hmm. Alright, Joe, great stuff this morning. Thanks for coming on in with us this morning.

DR. CONGENI: Okay, Ray. Have a great week.

HORNER: There you go. Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital.

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