BOSTON—Dylan Mello has good days and bad days.
On the bad days, the 18-year-old, who suffered three concussions while playing hockey and soccer during high school, gets piercing headaches or feels foggy. Often he has trouble reading or concentrating.
Mello should be in college right now but is taking a year off in the hopes that the symptoms of post-concussion syndrome will fade and allow him to return to a more normal life.
"I thought it was like an ankle injury that would go away with time ... but that obviously was not the case," he said.
From high school playing fields to National Football League stadiums, increased awareness about the serious long-term impacts of sports concussions is changing attitudes about an injury once casually dismissed as "getting your bell rung."
Lawmakers in Massachusetts, Rhode Island and Connecticut all passed new laws this year designed to make sure that student athletes who suffer suspected concussions get the proper treatment and do not return to action too quickly. Laws are also on the books in New Mexico, Oklahoma, Oregon, Texas, Virginia and Washington, while national legislation is making its way through Congress.
Mello suffered his first concussion playing hockey in his sophomore year at Portsmouth High School in Rhode Island. His mother, Donna Mello, remembers Dylan coming home that night with his speech slurred and a glazed look in his eyes. The following day, he had to leave church during Mass, complaining the music was too loud.
The symptoms of the initial concussion cleared, but that summer, while playing soccer for a travel team, Mello was struck in the head by an opponent's plaster arm cast. The third concussion happened in the fall, when he was hit in the same spot by a kicked ball in pregame warmups.
Mello says he hasn't felt the same since. He sat out sports his senior year, and while managing to keep his grades up and graduate, he needed accommodations from the school such as extra time on tests and extensions on papers.
"I was struggling to read, write, think and concentrate," he said.
Donna Mello became a catalyst for passage of the Rhode Island law requiring that any athlete with a possible concussion be immediately removed from a practice or game. They cannot resume playing without written permission from a doctor.
Injuries are going to happen, "but if they are handled properly we can totally avoid these long-term situations that devastate these kids," she said.
The law also encourages school districts to provide a "baseline" neurological test for all student athletes, so doctors can better determine whether memory, reflexes or other brain functions have been substantively affected by an injury.
Similar to Rhode Island, the Massachusetts law has 'return-to-play' guidelines and requires concussion awareness training for all coaches, trainers, athletic directors, parent volunteers, school nurses and even marching band directors. Parents or guardians of the estimated 165,000 public school students who play extracurricular sports must also be educated about concussions.
It's all at least partly aimed at changing a culture that sees many young athletes, sometimes with the blessings of their coaches or parents, try to "tough it out" rather than get immediate attention. Colleen O'Brien, director of health, physical education and athletics for the Worcester, Mass., school district, saw that firsthand this summer when a high school football player suffered a possible head injury at practice.
"He didn't want anyone to know ... he wanted to still go out there and play," O'Brien said.
But under a new protocol drawn up by the district in anticipation of the new state law, the boy, who showed no outward concussion symptoms but some swelling around his eye, was immediately removed from practice, O'Brien said. His mother was called at work and told to pick him up and bring him to a doctor.
A 2009 survey by the Massachusetts Department of Public Health found that more than 18 percent of student athletes in Massachusetts reported receiving at least one blow to the head in the previous 12 months and experiencing symptoms such as loss of consciousness, memory problems, blurry vision, headaches or nausea.
The state has yet to draft specific guidelines for concussion training, so in the interim, the health department is referring schools to free online programs offered by the Centers for Disease Control and Prevention and The National Federation of State High School Associations.
"Athletes have been suffering too much brain trauma. No sport should cause a disease in your brain," said Chris Nowinski, president of Boston-based Sports Legacy Institute, which has been studying the long-term impact of concussions.
That rings true to Dylan Mello, who would advise other young athletes that trying to play through concussions just isn't worth it.
"I never thought I wouldn't be going to college at the same time with all my friends. I never thought I'd have to watch my senior year from the bench," he said.
"I never thought I wouldn't be able to wake up every day and feel like a normal kid."