Editors notes: Part two main story of CNHI News Service Elite Project three-part series on youth sports injuries.

By Randy Griffith

CNHI News Service

BROOKSTON, Ind. — “I’m cold,” says Cody Lehe, 18, shivering in the warm Indiana sunshine.

“I think your internal sensors are messed up,” his mother, Becky Lehe, tells him.

She smiles as she wraps a blanket around the former high school football captain in his wheelchair.

Almost a year after Cody collapsed on Frontier High School’s football field, his mother is still encouraged by such minor acts of communication.

Cody’s brain essentially shut down the afternoon of Oct. 25, 2006, in what doctors later described as second-impact syndrome — bleeding to the brain triggered by an impact that compounds the effects of a previous concussion. For Cody the first injury came in a game the previous weekend, the result of a hard, helmet-to-helmet hit with an opposing player.

Cody’s parents, coaches and friends still wonder what they could have done to prevent the second-impact injury. Experts say they responded correctly to his initial concussion. A brain scan, in fact, indicated he could return to practice.

Symptoms of head injuries can be subtle, however, even to the medical professionals trained to diagnose them. The danger of these injuries is that much greater when coaches, often the first ones to assess athletes for concussions, do not know how to spot them or what to do when they happen.

Officials at the U.S. Centers for Disease Control and Prevention are so concerned by the potential danger of head injuries — about 300,000 athletes suffer from them each year — they have started an aggressive campaign to teach high school coaches their symptoms.

Those near Cody say only he knew how badly he hurt, and how many symptoms of a concussion he really had. He decided to tough it out and play hurt — a decision that ended his sports career, almost ended his life, and may have life-long effects on his ability to move and communicate.

After his collapse, Cody was rushed to a hospital in nearby Lafayette, then on to Methodist Hospital of Indianapolis. He remained in a coma-like state for three months. Even after he was sent home in February, his family saw little sign of the old Cody.

It wasn’t until he went back to the hospital in March, with a collapsed lung, that doctors changed his medication and Cody finally began interacting with those around him.

Becky remembers the moment: “He looked at me one day and said, ‘What’s wrong?’

“I about fell off my chair. Where do I start?”

Second impacts

Concussions, defined as bruising around the brain brought on by sudden movement, are dangerous enough. Second-impact syndrome — rapid swelling following yet another head injury — can be life threatening.

The second impact itself may be slight. It only matters that the brain is jarred while symptoms of an initial concussion linger, said Dr. George Zitnay, a neuroscientist and brain surgeon.

The incidence of second-impact syndrome is not clear. Long-term effects of repeated concussions, however, are well documented.

Headaches, memory loss, difficulty concentrating and cognitive problems are all linked to multiple concussions.

There is medical evidence repeated head injuries can lead to early-onset Alzheimer’s disease.

Zitnay sees the results every day in patients he treats at the Defense and Veterans Traumatic Brain Injury Centers, a facility he started in Johnstown, Pa., with the support of the Department of Defense.

Soldiers’ repeated close exposures to roadside bombs, he said, make second-impact syndrome the Iraq war’s “signature injury.”

Athletes are also at risk, especially when they and those around them do not recognize - or ignore - the signs of a concussion.

For Cody, that initial injury could not have come at a worse time.

It was the biggest game of his senior season.

‘Some hit’

The stakes of that game were far higher than a shot at a state championship for the Frontier High Falcons, or even hope that Cody might go on to play college football. At 6 feet and 200 pounds, Cody knew his team represented friends and neighbors in the rural farming communities of Brookston and Chalmers.

Connected by 4 miles of Route 43 pavement running as straight as a chalk line, the communities have about 2,100 people between them. Both communities are awash in crops. The Orville Redenbacher Gourmet Popping Corn facility — owned by ConAgra Foods — is the area’s major employer.

The communities share a school district. Their high school enrolls 234 students in grades nine through 12. The sports schedule is an integral part of the local social calendar.

Frontier Falcons teams are also important to the traditions of families. Cody’s older sisters, Kylee and Kinsey, played high school and college basketball. His younger sister, Abbey, 16, plays volleyball and softball. His brother, Zach, 14, looks forward to high school sports as well.

So Cody naturally belonged on the field the evening of Oct. 20, as the Falcons worked to defeat Caston High School, 20-0, in the opening round of the state playoffs.

Cody was a true team player, according to his coach, Greg Martz. As a sophomore he had played tight end and wide receiver on offense, and in the backfield on defense. He agreed in his junior and senior years to play in less prominent positions, as lineman on offense and linebacker on defense, for the good of the team.

His new roles thrust him into the shoving and pounding.

“He was involved in hitting on every play,” said Martz, who did not see the fateful collision that took place on a punt return that night against Caston.

Becky didn’t see it, either, though Cody later told her it happened away from the ball, and away from the focus of fans and cameras.

Cody shook off the cobwebs, she said, and returned to the sidelines after an exchange with the other player, who apparently was uninjured.

“They both commented to each other, ‘That was some hit,’” she said.

Incidental contact

Frontier coaches all complete state-mandated training, said Martz, who also is the school’s athletic director. Lessons include spotting head injuries. The Indiana High School Athletic Association also disseminates to schools posters and films that outline warning signs of concussions.

Martz and an assistant coach certified as an emergency medical technician checked Cody during the Caston game and again at practices the next week. Neither saw signs of a concussion.

Cody’s parents sent him to a doctor when he still complained of headaches three days after the game. A brain scan showed no injury. He received medicine for the pain.

CT scans — or three-dimensional X-ray images — are major tools used to diagnose brain injuries. Doctors acknowledge they might not always be sensitive enough to show concussions, even significant ones.

Cody returned to practice the following Wednesday, Oct. 25, despite a headache.

“He said he played with worse headaches and took harder hits than that,” Becky said. “And this was sectionals. This is what he was living for — football. That was his dream, to play for a Division II college around here. Heaven forbid you sit out on the sideline.”

Playing hurt, his mother said, was not a problem for Cody.

“This football team was his team,” she said. “He was the captain. He was not about to stand on the sidelines just because of a headache. It was his life.”

Friends knew about the headache and, in retrospect, said Cody may have been experiencing blurred vision and behavioral changes — other signs of a concussion.

Yet Cody kept any of that quiet from his coaches, his mother said, and he joined the team for a light, late-season practice. Players were not wearing pads as they prepared for the next round of the playoffs.

The impact that triggered Cody’s collapse happened during practice, but it was so insignificant, no one remembers it.

Doctors say that is not unusual. It doesn’t take much of a collision — not even a blow directly to the head — to cause the minimal jarring necessary to bring on second-impact syndrome.

Cody’s collapse rocked the close-knit school, and especially his teammates.

“When we have 35 football kids on a practice field and Cody’s laying there with the ambulances coming, they don’t know what to expect because they have never seen anything like that,” said Martz.

Cody’s popularity and personality — Martz described him as a smiling kid whom anyone could talk to — made the situation even more stressful.

After Cody was taken to the hospital, the coach tried to focus his team on that weekend’s game. Their hearts and minds were clearly elsewhere.

“It was one of the toughest experiences I’ve been through,” Martz said. “You knew that Cody would have wanted to play very hard, as well as his teammates.”

The Falcons rallied to take the field again, just two days after Cody’s collapse. But they could not manage to defeat Pioneer High School, losing in a 50-0 blowout.

Their season essentially had ended when their captain collapsed.

‘Tough Enough’

Cody’s injury galvanized an already close community. Costs of outpatient therapy and in-home medical equipment exhausted his family’s insurance coverage long ago. Tens of thousands of dollars in bills for medical supplies and a special, wheelchair-accessible van taxed the Lehe Farms income.

Cody’s family, friends and neighbors rose to help.

At the high school, the Sunshine Club service group sold magnets emblazoned with the words, “Tough Enough — Cody Lehe.”

A beauty parlor in Lafayette, where Cody’s great aunt Royetta O’Maley works as a stylist, held a one-day “salonathon” last spring. All 28 Tanglz ‘N Bangz employees donated time for haircuts, manicures and massages, with the money going to the Lehe family.

The event built into a full-fledged festival with face painting, an appearance by a medical helicopter and an auction. Nearly 1,000 people attended and raised more than $30,000.

Frontier High School guidance counselor Kathy Bassett said small farming communities stick together.

“When he gets hurt, we hurt,” she said.

Projects like the salonathon and refrigerator magnet sales focused attention in Northwest Indiana on Cody’s story and the dangers of head trauma, said Zitnay, the neuroscientist. But, he added, more public education about the problem is needed everywhere.

“Parents and coaches should be watching for this,” he said, adding that young people are 70 percent more likely than adults to have a second head injury within a year of their first. “We have to educate schools. We have to educate the coaches and the trainers.”

Cody’s mother said education and adults’ involvement in protecting the health of young athletes are keys to preventing such injuries from happening to others.

“I think it is up to all of us — parents, coaches, players, doctors, everyone,” she said. “The kids have to know that they are human.”

Despite mounting expenses, Becky says she has not considered legal action against anyone — Cody’s coaches, school or doctors — over his injuries.

“I don’t know what that would accomplish,” she said. “Besides, he’d have a fit if he thought I did that.”

She doesn’t blame the Lafayette doctor who gave him a CT scan that cleared him for football practice. Bleeding from the initial concussion was likely too minor for the scan, she said, and may have increased before the fateful practice.

“I don’t think anybody missed anything,” she said.

Cody’s coach also is baffled.

Martz, who with his assistants regularly reviews films and material about head trauma, said he makes a point of teaching players the proper ways to block and tackle.

“Cody, all through his career, had heard that over and over again,” said Martz. “He was one of our better tacklers in terms of technicals. He was very good in the proper, safe way.”

Hope for recovery

Now Cody is working to regain his short-term memory. Getting back long-term memory, motor skills and speech, his mother said, also are part of his road to recovery.

While it is too early to predict which symptoms may linger or how severe they may be, Cody’s family remains hopeful, encouraged by progress that has come with therapy. Doctors were encouraged enough this spring to readmit him to Methodist Hospital’s inpatient neuro-rehabilitation unit for five weeks.

“All three therapists have told me they see no reason why he can’t recover fully,” said Becky.

Cody’s goals are largely unchanged. He still needs to complete English and government classes to finish high school. He still plans to study agriculture in college. That and his involvement in the 4-H Club and Future Farmers of America will have prepared him to become the third generation to run the 5,000-acre Lehe Farms.

Becky has spent much of the past year at her son’s side, overseeing his recovery. The medical bills and other expenses, 75-mile trips to Indianapolis, separation from other family members and watching a once-vibrant boy struggle to speak all cause stress.

Yet she said her Catholic faith and community have carried her.

“It’s hard, but we’ve just seen what our prayers have been doing,” she said. “We are seeing how God works more and more every day.”

CNHI News Service Elite Reporting Fellowship recipient Randy Griffith is a reporter at the Johnstown, Pa., Tribune-Democrat and may be reached at rgriffith@tribdem.com.

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