Nicole Gazzola, a 17-year-old high school athlete, suffered two concussions in less than a year. But she is active again, starring on the Longwood High School softball team.
Her return is a testament to head-injury guidelines that she and members of the athletic staff followed when the first injury occurred.
"This is an example of the system working and Nicole going through the right protocol," said Longwood High School athletic trainer Michelle Cordova. "The kids are more aware of concussions now and are much more willing to come to you and report it right away."
The dangers of traumatic brain injuries have become all too real recently as suicides of former pro athletes have been linked to depression caused by frequent blows to the head.
The arc of Gazzola's long, frustrating recovery can serve as a blueprint for athletes who might try to hide head injuries or consider rushing back too soon.
In Gazzola's case, both a serious concussion suffered while playing indoor soccer in March of 2011 and a less severe episode incurred while snowboarding in February were quickly diagnosed and treated. Rigid return-to-play guidelines, starting with no exertional activity and concluding with full-contact training, were followed at every stage.
Resting up reluctantlyGazzola, a three-sport athlete who will be attending the University of Delaware on a softball scholarship, said it wasn't pain from the head-to-head impact in the nonscholastic soccer game that gave her the most distress.
The symptoms -- dizziness, nausea, headaches, sensitivity to sound -- were tolerable, she said. But doing nothing for more than three weeks -- no TV, no cellphones, no sports -- was what she found the hardest to deal with.
Doctors believe the best way for concussions to fully heal is for the brain to rest and for loud stimuli be eliminated, according to Dr. Hayley Queller, who treated Gazzola.
"It was extremely frustrating," Gazzola said. "Especially when the doctors told me I couldn't do anything, no physical activity whatsoever. I couldn't even go home and read if I wanted to."
Gazzola admitted with a laugh that she used SpongeBob coloring books to get through last year's ordeal.
"I couldn't even watch my team play at first. That was worse than the injury," she said.
Gazzola, who also plays varsity soccer and basketball, said she didn't immediately think her injury was serious.
"It was a head ball. I was on defense and I was trying to get the ball out of the box," she said. "As I was trying to head it, a girl came up trying to score and her forehead banged into the side of my head."
Her competitive spirit kicked in immediately.
"When it happened, there was only like a minute left in the game, so I kept playing," Gazzola said. "I didn't really think anything of it. I got hit and I thought, 'Wow, that was really hard.' My head kind of hurt the rest of the night and it was hard to get to sleep because I had a headache.
"The next day I came to school. It didn't go too well. My head hurt. I came to Michelle after school. She told me I had a concussion."
The guidelinesLongwood, like many high schools on Long Island, has a concussion program in place, in compliance with a state law signed by Gov. Andrew M. Cuomo in September. Among the guidelines of the law, which are expected to be enacted this summer, is a suggestion that schools establish concussion management teams.
Cordova said it didn't take long to make the evaluation.
"If you know Nicole, she's very quick and responsive," Cordova said. "She was slowed down and mentally foggy. It was easy to pick up that she had a concussion."
Once the assessment was made, the next step was to see a concussion specialist. Queller, from Orthopedic Associates of Long Island in East Setauket, confirmed Cordova's findings. She gave Gazzola the troubling news that she would not be playing sports -- or doing much else -- for a while.
"It's very hard to restrict kids from texting, playing video games, watching TV," Queller said. "But I find that when you do shut that down, at least in the initial period, that you have a better chance of recovering.
"None of the kids are disappointed when I tell them they can't do academic activities, but they are quite disappointed when I tell them they can't participate in athletics, or even watch their sports teams. But their brain needs time to rest."
Gazzola reluctantly became a good patient, something that surprised her father, Bob Gazzola.
"To see her doing nothing was absolutely bizarre," he said.
His daughter adhered to the instructions of Queller and Cordova, literally counting the days until she could resume activity.
'Anxious moments'"When I started my return to play, I loved it, even though I was sore every day," Gazzola said. "I just couldn't wait to do it because for a whole month and a half I absolutely couldn't do anything. It just felt so good to be doing something again."
Longwood softball coach Alicia Smith said she made sure Gazzola didn't push too hard. "We started with light throwing, even before we got to running," Smith said. "No live pitching, no live baserunning. Then came easy repetitions -- rolling ground balls, taking some fly balls and increasing the number each day.
"There was constant monitoring. We asked her every day, 'How are you feeling?' "
What Gazzola was feeling was impatient. "I was eager to get back to playing," she said.
That happened late in her junior season, shortly after her practice sessions began to include live game situations -- fielding, throwing and running. The last step in the recovery was when she started taking batting practice.
"There were some anxious moments when she first came back," Smith acknowledged, "but now she's the same player she was."
That player has led Longwood to the No. 2 seed in the Suffolk Class AA tournament with an 18-1 record. She entered the playoffs with a batting average above .400 as a speedy leadoff hitter and strong-armed centerfielder.
Gazzola said she plays the same high-energy, aggressive game she did before the concussion: "I'm the same player. I don't even think about it now."
Using her head
She was forced to in February, however, after suffering another concussion while snowboarding during school break.
"At first I thought, 'Oh no, not again.' But I knew it wasn't as bad," she said.
She reported the concussion to Cordova, who again referred her to Queller. This time the recovery took only two weeks instead of six.
"It proved that any concussion in any individual is its own unique thing," Queller said. "If the first concussion wasn't appropriately treated, her second concussion would've been markedly worse."
For Gazzola, an honors student who made up all the class work she missed without needing summer sessions and will graduate in June, the concussion experiences have been daunting but educational.
"I was scared a little on the first one," she admitted. "But I trusted my trainer and my doctor. I learned that when they told me what I couldn't do, that I really couldn't do it. Otherwise, I wouldn't have gotten better."
RETURN POLICY FOR STUDENT ATHLETES
To resume contact sports, a sidelined athlete must follow a medically supervised stepwise process known as Return to Play Protocol. The process goes as follows:
1. No exertional activity until symptoms go away for 24 hours.
2. Light aerobic exercise such as walking or stationary bike. No resistance training.
3 Sport-specific exercise such as skating or running.
4. Progressive addition of resistance training may begin.
5. Non-contact training/skill drills.
6. Full-contact training in practice setting.
7. Return to competition.
Source: National Federation of State High School Associations