It has been more than 18 months since Lexi Stewart ran face-first into a pillar during a flag football practice indoors, and the 17-year-old Service High junior looks great. No scars on her face. No clue that she all but lost her two front teeth, which have been capped and could star in a toothpaste commercial.
It has been more than 18 months since Stewart was injured, and you would never guess that every single day since, she struggles. She struggles to stay awake. She struggles to read, and then she struggles to remember what she read. She struggles through debilitating headaches. She struggles with depression. She struggles at school, which even now she attends only part-time.
Unless you live with her or spend time with her on a regular basis, you don't see signs of Stewart's ongoing condition, because it's all in her head.
Stewart has what is known as the invisible injury -- a traumatic brain injury commonly known as a concussion.
"People say concussion because it sounds better than brain injury," she said.
On Saturday, Stewart will put a face on concussions at Coaches Clinic 2012, a two-day course offered by Providence Alaska Medical Center for coaches, teachers, parents, nurses and others involved in youth sports.
She will be the keynote speaker at the clinic organized by physical therapist Wally Wilson, who has helped with Stewart's rehabilitation at Providence Sports Medicine and Rehabilitation Therapy.
"Behind every diagnosis there's a story, and she told me hers while riding the bike one day," Wilson said. "Everybody needs to hear it."
'SOUNDED LIKE A HILLBILLY'
The story begins on a rainy Friday afternoon, Sept. 24, 2010, when Stewart and her teammates were practicing in the cafeteria. Stewart hit a pillar while going for a pass. She doesn't remember the impact or the pain, only that she felt something hard in her mouth.
"I spit out my two front teeth," she said. "I was a little shaken by what happened -- a high school girl with no teeth. I couldn't talk. I sounded like a hillbilly."
And so off she went for three hours of emergency dental surgery.
For the next 48 hours or so, Lexi assured her parents, Brian and Lisa Stewart, that she was fine. She wasn't.
"I started really declining. I'm not really sure when. I started sleeping 16 hours a day. I didn't even get up to go to the bathroom. I had constant headaches. I would stand up and, you know how you get when you spin yourself around and everything goes black? I had nausea and I couldn't eat," she said.
She stayed home from school Monday. On Tuesday she saw a doctor who said if her symptoms got worse, she should go to the emergency room. On Wednesday she went to the emergency room and was told she had post-concussion syndrome and should rest for a couple of days. On Thursday, while sitting in her living room, she blacked out and woke up disoriented and with her nose bleeding. She made another trip to the ER, was diagnosed with severe dehydration and got a CT scan, the results of which were inconclusive. More rest, she was told.
On Friday, Lexi returned to school, partly to talk to her teachers and take home assignments, and partly because it was picture day for the yearbook. She spoke to one teacher before dizziness hit. She went to see the school nurse, who told her, "You need an ImPACT evaluation."
An ImPACT evaluation is a computerized test that measures cognitive skills like memory, reaction and hand-eye coordination. Lexi's scores put her in the bottom 1 percent.
"We thought, well, in a couple of weeks her scores will jump up," mother Lisa Stewart said, "but they didn't."
CONDITION GOES DOWNHILL
Lisa was about seven months pregnant when Lexi got hurt, and on Dec. 3 she gave birth to Luke, the family's third child -- another son, Kyle, is 12. Lisa wound up taking off a full year from her job at Alaska USA because Lexi needed as much care as the baby.
"I couldn't bathe myself," Lexi said. "I would lay limp at the bottom of the shower."
She lost 10 pounds from a body made strong and lean from years of competition-league soccer, mountain biking, flag football and other sports. "Her legs were like lethal weapons," Lisa said of the pre-injury Lexi.
Lexi tried to go back to school three weeks after her injury, but she couldn't manage. More than once, she left in a wheelchair because of fatigue or sensory overload.
"I could only sit and listen for an hour a day," she said. "I had to get used to the lights, and I had to get used to the noise, because kids are really loud."
Lexi was a straight-A student with plans to be a nurse before she got hurt. She was in the top 10 percent of her class, meaning she was on track for a University of Alaska scholarship. Now she gets mostly Bs and still wants to be a nurse.
She's still not back in school full time -- she attends class for four of the seven periods each day. Sports like soccer and flag football are pretty much off the table for life, because no one knows what another blow to the head might bring.
"I completely gave up sports. I cook now. I bake," she said. "If I work out too much, the next day I'll re-read something six times and still not get the meaning of it."
She said good days -- "When I'm not tired and I don't have a headache" -- happen about once a week.
ATTITUDES ARE CHANGING
Lexi said she asked Wilson if she could speak at Saturday's clinic because she thinks it's important for coaches and others to know just how traumatic a traumatic brain injury can be -- and so they know that just because a kid looks OK doesn't mean she is OK.
That's a message that is being delivered everywhere from the National Football League to the Anchorage School District as more attention is being paid to head injuries. Attitudes about concussions are changing and stories like Lexi's might aid the evolution.
"Coaches say, 'Just sleep it off. You'll be fine.' You're not. You're damaging an organ," Lexi said. "There's just not enough information on (the brain). The doctor we saw didn't know. The emergency room didn't know. How's a coach supposed to know? How's a parent supposed to know?"
Reach Beth Bragg at firstname.lastname@example.org or 257-4335.
What: Coaches Clinic 2012, a two-day course for coaches, teachers, nurses and other adults involved with youth sports.
When: Saturday and Sunday at the Providence Cancer Center, room 2285
Registration: Saturday from 7:15-8 a.m. at the classroom or online.
Details: Health care providers will discuss injuries to adolescents, including head injuries, neck injuries, fractures, cardiac issues and injuries to the knee, hip and other joints.