Traumatic Brain Injuries – Sam Fuld [Guest Post]

As with all serious issues, if we don’t talk about concussions openly, we lessen our ability to learn how to avoid and respond to them. We listen when doctors talk about them. We listen more intently when a very recently concussed MLB player tells his personal stories. When that man speaks eloquently and without filter, and weaves in honest assessments related to time spent on the disabled list and subsequent job security, we move to the edge of our seats so as not to miss a word. Sam Fuld is the right man for this job.

A few months ago, I started writing this piece. I wasn’t supposed to. I also wasn’t supposed to be reading, watching TV, exercising or anything else that requires mental or physical exertion. A teammate of mine joked at the time that the best rehab for me would be to sit in a jail cell. I laughed, and then thought, “if only the food were a little better, maybe…”

Those are the sorts of things concussions make you think about. On May 2 of this season, as a member of the Minnesota Twins, I crashed into the outfield wall. Like every other time I’ve run into the wall, I was determined to stay in the game. I also knew, in the back of my (throbbing) head, that our other CF, Aaron Hicks, had been relegated to the 7-day concussion disabled list after having done something eerily similar the night before.  I knew that I was the team’s only real option in CF so, against my better judgment, I stayed in the game.

I continued to play the next few days. With the right amount of Tylenol, Advil and caffeine, my headaches dissipated, and I thought I was over the hump. I blamed my extreme fatigue and cloudy head on the grind of playing everyday (we were going through a tough stretch of extra inning games and a rare doubleheader) and on being the father of three little kids who don’t quite appreciate the value of a good night’s sleep.

My focus turned to our next off day, May 12. “Just make it through this road trip and get to May 12 and you’ll be able to sleep all day, stay off your feet and recharge the batteries.” I envisioned binge watching Modern Family and Mad Men while the kids miraculously played together quietly.

Unfortunately, I didn’t get to that point. During our second game in Cleveland, I made what is normally a harmless ‘janitor throw’ for me but arose with an instant headache and more cloudiness. I never blacked out, never forgot where I was or what the score was. But I definitely felt…off.  I spent the night wondering if I should say something to the trainers, but ultimately kept my lips sealed. The next day wasn’t any better; I remember jogging into the dugout from the outfield after the third out of an inning and holding my hands over my ringing ears, the noise of the sparse Indians crowd too much to bear.

Finally, I reported my lingering symptoms to the trainers the next morning. After a cognitive functioning test and doctor diagnosis, the Twins sent me back to Minneapolis and placed me on the concussion disabled list.

As I sat in the Cleveland airport for a couple of hours awaiting my flight back, I felt an overwhelming sense of relief.  There was zero doubt in my mind that I had done the right thing, and, more than anything, this felt like an important life decision. As most athletes have come to learn, once you experience a concussion, you’re more likely to suffer another, more serious one. Little did I know that day in the airport just how torturous the next few weeks would be.

Traumatic brain injuries (TBIs) are similar to other injuries in that they require time and rest in order to improve. That lost time is why most athletes drive ourselves crazy when deciding whether or not to keep our injuries quiet. What happens if we miss some action and our replacement from Triple-A plays great? What about the dreaded label of being “injury prone?!?!”  Whether you’re an All-Star, a fringe major leaguer or a young minor leaguer, nobody wants an organization to think you’re an injury risk.

TBIs, however, differ from other injuries in a couple of significant ways. First, the recovery and rehabilitation process is far more mysterious and varied. When I pulled my hamstring a couple of years ago, our training staff in Tampa Bay knew exactly what to do to treat the injury. Given the severity of my pain and the location of the strain, I knew within a few days when I could return to the field. But concussion rehab has no set timetable. Some players return immediately after their seven-day disabled list stint ends, symptom-free and back on the field as if nothing had happened. Yet others miss weeks, months and even full seasons with what appear to be similar injuries.

Second, TBI symptoms are more ambiguous than other injuries.  When a 95 mph fastball hits you in the elbow, it hurts. You know it hurts from the misfired fastball, not from an aggressive night at the dinner table or from a high five with your four-year-old son. When you’re sitting at home with a headache and you’re tired and irritable…well, sometimes that’s just real life (especially when you’re a father of young children). As my days of being concussed dragged on, I became consumed with determining what was a TBI symptom and what was a symptom of real life. When I’d sit in the dugout and have to squint when looking at the stadium lights or have to leave the clubhouse because the pregame music was painfully loud, I thought those were legitimate symptoms, but I just wasn’t totally sure.

As I approached my third week on the disabled list, I began to worry that the symptoms weren’t going anywhere soon and that my season (and even career) could be over. Each day seemed like Groundhog’s Day. I’d wake up feeling sluggish, often depressed. I’d head over in the morning to the neighborhood playground and rather than engage with my kids like I normally do, I’d just sit there. I wanted to go over to the monkey bars and help my two-year-old daughter, Jane, swing across, but I couldn’t muster the energy. The same would happen at the ballpark. After concluding my daily rehab program with one of our trainers (which usually consisted of perambulating endless laps around the field), I would sit in the clubhouse and want to mix it up with the guys. But it was as if I had been drugged. Between the headaches and fatigue, I just couldn’t really keep up with the energy of a clubhouse full of guys ready to put on a uniform and compete. It was devastating.

I started pushing the trainers to let me go see a sports-related concussion expert. Dr. Michael ‘Micky’ Collins came recommended to me from several people; among many others, he had helped former Twins star and current Colorado Rockie Justin Morneau recover from some very serious TBI symptoms. So on May 27, I flew out to Pittsburgh to see Dr. Collins, hoping his expertise would be a turning point.

An additional fear had planted itself in my mind. It seemed like you couldn’t turn on SportsCenter without watching the tragic story of a former football player or pro wrestler who was dealing with ALS or who had committed a heinous crime. From Junior Seau to Bernie Kosar to Chris Benoit to my former teammate, Ryan Freel, countless athletes seemed to be suffering from severe physical and emotional changes, all of which could be linked to TBIs. Going to see Dr. Collins, at minimum, would likely give me peace of mind regarding my long term health.

The trip turned out to be more than that. I learned about the several types of concussions (Dr. Collins reasoned, “There are 20 different knee injuries, why do we tend to lump all concussions into one?”) and, because my collision with the wall had altered my vestibular system, was given a slew of specific visual and physical exercises to perform in the coming days. I was reassured that, given my relatively short concussion history, I shouldn’t expect to experience any long term issues stemming from the injury. And, for the first time in weeks, I broke a sweat! Dr. Collins explained that at this point in the recovery, it was important for me to push myself physically. That day, I ran on a treadmill and performed a series of plyometrics and immediately felt like a new person. While my chest ached from being out of breath, the cloudiness had almost instantly evaporated. I knew I was on the right track.

Within a week, I was back on the field in Binghamton, NY, starting a rehab assignment that would only last a few games before returning to the big league team. When I suited up to play the Detroit Tigers on June 13, gone were any fears of re-injuring myself, which, like any other injury, is the true sign of recovery. The adrenaline I felt from pinch-running that night wasn’t too different from the adrenaline I felt during my major league debut.

These days my concussion experience is still very much a part of my life. I’ll sometimes finish a difficult exercise in the gym and wonder if the blood rush to my head will trigger the symptoms again (knock on wood, it hasn’t). The same occurs when I far too frequently bump my head while cleaning up crumbs in the house or when reaching for a toy. When my kids go out on the playground, I often feel the desire to place a big giant bubble made of fiberglass around their heads. I have a greater appreciation for how delicate and complex the human brain really is, and I never want my children to go through what I did.

I’m grateful that I spoke up when I did and only regret not saying something to the athletic trainers sooner. I’m also glad that my wife and others pushed me to go see Dr. Collins. There is a certain peace of mind from the knowledge you are seeing the very best doctor in a particular field; you know you’re receiving unparalleled care. There’s no telling how much additional time I would have missed had I not traveled to Pittsburgh to see him.

Before May 2 of this year, I looked at TBIs in the same light as many others probably do.  I cringed anytime a wide receiver took a crushing blow across the middle or a catcher took a foul tip directly in the forehead portion of his mask. But I also felt a little skeptical. I wondered if our hyper-awareness of each blow to the head, however direct or forceful the blow may be, had led to over-sensitivity on the part of the athlete, convincing themselves that symptoms of their real lives fit the vague description of concussion symptoms. As someone who has played through pain and minor injuries throughout his career, I wondered if the same approach would work with TBIs. Nowadays, I realize that brain injuries of all magnitudes are very real, even if only a short time ago the lesser ones wouldn’t have been considered so.

As TBI research continues to accelerate, we will have a better understanding of how to treat and prevent them. In the meantime, it is crucial that we not allow any previously conceived notions dictate how we deal with what is now a major component of the sports medical industry.