David Greenaway remembers his mother giggling when he finally regained consciousness at home after taking a hard knock to the head during a football game years ago.
He kept repeating himself. Then he asked for a piece of cheesecake. But he hated cheesecake.
It was his first major concussion. He remembers being struck hard by the cast on another player's arm and blacking out before he hit the ground. It was a badge of honour back then to hit hard and to keep playing after a hit. He remembers feeling joy from it, from all the accolades he received for being such an intense hitter.
Mr. Greenaway believes he suffered five or six concussions from the time he was 10, playing football in Toronto until he was 30, when he played a University of Toronto alumni football game and landed in hospital, getting a CT scan and waking up to his nephew and niece giggling at him.
But with all the revelations that have surfaced recently about long-term, profound neurological degeneration among hockey and football players, Mr. Greenaway doesn't think it's funny any more. He hears stories about how to help vulnerable young athletes and National Hockey League players, but knows there are hundreds of people like him who suffered multiple concussions years ago. What do they do to prevent symptoms like those of Bob Probert, Reggie Fleming and Marty McSorley?
"What about Dave?" asked Mr. Greenaway, now 49.
Dr. Charles Tator said he gets three e-mails a day from patients concerned about whether head injuries they've suffered in the past explain their current neurological difficulties.
"We just don't have the answers for a lot of these people," Dr. Tator said Thursday. "And we just don't have effective treatments to restore any lost function or to treat most of the symptoms."
There are exceptions, though. Dr. Tator said researchers now recognize the relationship between repeated concussions and depression, a breakthrough on the way to understanding long-term neurological effects of concussions. There is treatment for that kind of depression, he said. The same drugs that work for non-traumatic depression work for depression caused by concussions.
But it's only a first step. Dr. Tator believes it will take another five to 10 years to figure out how strong the correlation is between concussions and neurological aftermath.
Dr. Tator is part of a team at the Krembil Neuroscience Centre in Toronto that is studying brain degeneration after concussion. He's also looking at the effect of genetics - do genes play a role in whether someone will suffer a concussion, and the speed and extent of recovery? Dr. Tator believes there is a connection.
In his own practice, Dr. Tator has found that some young concussed athletes have siblings who have also suffered concussions. Brothers Eric and Brett Lindros both suffered concussions that halted their NHL careers.
Shannon Bauman, sports medicine doctor from the Sports Medicine and Rehabilitation Clinic in Barrie, Ont., said she thinks there is much more awareness in the community today and recognition of the severity of concussions. In her practice, she sees many athletes from all different sports - as young as 10 and as old as late 70s and 80s.
Pro athletes, she noted, have a lot of resources for concussions. "They have people that do neurocognitive testing for concussions at their fingertips. They have a lot of people that follow them through."
Today, "we are also available to those young athletes and non-pro athletes in the community," she said.
"We get concussions in within a week, we follow through to the conclusion, from resting to all of the symptoms resolved, and follow through to return to play, whether it's a week or three or four weeks, or if they need additional services, testing for concussions, all of those things we follow. That's the majority of our practice."