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Daily Dose

Sudden Cardiac Death In Young Athletes

1.30 to read

I received a question via iPhone App from a mother who was concerned about the recent discussions in both the media and in the medical community surrounding sudden cardiac death (SCD) in young athletes.

Each year between 10–12 million kids in the U.S. participate in sports.  The tragedy of a sudden death in an otherwise  “presumably healthy” child causes not only sadness, but concern as to how the death might have been prevented. Doctors are often asked, “isn’t there a test or something to prevent this? “.

Depending on the studies I have read, the sudden cardiac death of a child or adolescent accounts for about 100 deaths a year in the U.S.  The prevalence rate for sudden cardiac death is 1:100,000- 200,000 and is higher among males than females.  Statistics show that 90% of these sudden deaths occur immediately post training or competition with football and basketball having the highest incidence.

In 2007 the American Heart Association came out with guidelines to evaluate athletes who may be at risk for sudden cardiac death. The most important screening mechanism has been found to be the “gold standard” in medicine, a thorough history and physical exam. The history that should be taken on any athlete who is being screened for sports participation should include a history of any unexplained or sudden death in a family member. Are there any family members with unexplained fainting episodes or seizures? Are there family members who had unexplained deaths (drowning or single car accidents)?   Are there any family members with a known genetic disorder that predisposes to sudden cardiac death?  The history should also ask about any fainting (syncope) in the athlete.

After a good history is taken (which should be updated yearly), the child/adolescent needs a complete and thorough physical exam. This exam should include blood pressure measurements, and a careful cardiac exam looking for new murmurs.  Symptoms such as palpitations during exercise, visual changes, fainting while exercising or immediately after exercise, and chest pain should all warrant further evaluation. Studies show that about half of pediatric patients who succumb to sudden cardiac death had experienced a warning sign. 

There are about 20 causes for SCD, with the most common causes being hypertrophic cardiomyopathy, anomalous coronary artery, and myocarditis. While some may advocate routine EKG screening and echocardiograms on athletes (this is done in Italy), many studies have been done which show that it would take the screening of 200,000 student athletes to prevent 1 death.   At the same time you will certainly identify some children with clear risk factors for SCD, but for every positive finding there may be 10–20 athletes who have “borderline” or questionable findings that would require even more expensive follow up. These pediatric patients might also be told they cannot participate in sports during the evaluation time and some might be told that they cannot participate even if they were not found to have disease, but were excluded just due to liability concerns. 

There does not seem to be one right answer to this issue. If your child is going to begin competitive sports make sure to see your pediatrician for a complete physical exam including a good family history.  Also advocate that your school have automatic external defibrillators viable at all times and personnel that know how to use them. That's your daily dose for today.  We'll chat again tomorrow.

Send your question to Dr. Sue right now!

Your Child

Heat & Your Young Athlete

2.00 to read

Football season usually means cooler weather and exciting times for high school and college age kids.

This year though, the extreme heat is not only causing great concern among parents, students and coaches- it’s been responsible for at least 3 deaths. So far this year, there have been four football-related deaths; two teenage football players from Georgia, a high school player in South Carolina, and a 55-year-old football coach in Texas.

According to a recent study excess weight, along with the high temperatures, could be a contributing factor for certain athletes.

An analysis of 58 heat-related deaths among U.S. football players from 1980 to 2009 showed that about 80% involved players who were obese by the conventional definition of a body mass index of over 30.  Ninety-five percent were overweight or obese.

The rate of heat-related illness and death among football players has increased since the mid-1990s, according to Andrew J. Grundstein, PhD, of the University of Georgia in Athens, first author of the study.

The reason for the increase is not entirely clear but could reflect the increasing body weight of players, he said.

Most of the deaths occurred in August, when fall practice typically begins, and most occurred within the first two weeks of practice. Surprisingly, a majority of the deaths occurred during morning practices.

"Mornings may be cooler, and a lot of coaches may recommend having practices in the morning because it is cooler, but high humidity levels can make the conditions very oppressive and stressful," Grundstein said during a teleconference, sponsored by the Union of Concerned Scientists.

"I think people may put their guard down because they think the risk of heat-related illness is less in the morning," he added.

Grundstein also noted that more than 60% of the deaths happened on days when practice should have been cancelled.

Your Teen

Cheerleading Still Most Dangerous Sport

Cheerleading continues to cause more serious and deadly injuries by far than other sports.Cheerleading continues to cause more serious and deadly injuries by far than other sports, despite the fact that safety efforts have led to modest reductions in the number of serious injuries in recent years. However, until recently, records about such injuries were poorly kept. An updated to the record-keeping system last year found that between 1982 and 2007 there were 103 fatal, disabling or serious injuries recorded among female high school athletes, with the vast majority, 67, occurring in cheerleading. The next most dangerous sports were gymnastics, with nine such injuries and track, with seven injuries.

Recently the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill released its annual report on the topic. The report defines catastrophic injuries as severe or fatal injury incurred during the participation in the sport. The new numbers for 1982 to 2008 showed that there were 1,116 catastrophic injuries in high school and college sports. Cheerleading accounted for 65.2 percent of high school and 70.5 percent of college catastrophic injuries among all female sports. The report, however, shows that cheerleading injuries fell slightly in the 2007-2008 academic year. “Progress has been slow, but there has been an increased emphasis on cheerleading safety,” said the study’s author Frederick O. Mueller. “Continued data collection on all types of cheerleading injuries will hopefully show that these safety measures are working to reduce injuries.

Your Teen

Sports Drinks May Damage Teeth

Those sports drinks that your young athlete sips on may be eroding their teeth a new study suggests.040509healthlines1 Those sports drinks that your young athlete loves to sip on may provide an energy boost, but they could also be eroding their teeth a new study suggests. Findings by New York University dental researchers show many popular energy drinks contain levels of acid that can cause tooth erosion, hypersensitivity and staining. The beverages can also cause excessive tooth wear and may damage underlying bone-like material, causing teeth to soften and weaken the researchers say. They also say the drinks may possibly trigger conditions leading to severe tooth damage and loss. "This is the first time that the citric acid in sports drinks has been linked to erosive tooth wear," says Mark Wolff, DDS, professor and chairman of the department of cardiology and comprehensive care at New York University College of Dentistry. He says people who use sports energy drinks for energy should brush their teeth immediately after drinking the beverages. Softened enamel, he says, is highly susceptible to the abrasive properties of toothpaste. The five sports drinks tested were Vitamin water, Life Water, Gatorade, Powerade and Propel Fit Water. The study involved cows' teeth that were cut in half. Half of the specimens were immersed in a sports drink, the other half in water. Cows' teeth were used because of their close resemblance to human teeth. All the teeth immersed in a sports drink softened, but Gatorade and Powerade caused "significant" staining, according to an abstract of the study. Craig Stevens, spokesman for the American Beverage Association, says such studies are unfair and do not present "an accurate or actual picture of the way sports drinks are consumed." "The testing procedures they used are outside the realm of what happens in real life," he says. "Beverages pass right through the mouth, and these beverages have a purpose, and are proven to enhance physical performance. To use them like this is simply providing unhelpful information to consumers." He adds: "To suggest that sports drinks are a unique cause of dental caries or tooth erosion is overly simplistic. Oral health is determined by a variety of factors, including types of food consumed and the length of time foods are kept in the mouth."

Daily Dose

ACL Injuries in Young Athletes

1.30 to read

I have many young patients that are regular soccer players and many of them are adolescent girls. A recent article in the British Medical Journal caught my eye. The title “Simple Warm-Up Program Prevents Anterior Cruciate Ligament Injuries”. 

In my early days of training, I was taught that children rarely had ligamentous injuries especially involving their knees. Boy has that information changed over the years! I can’t even count the number of teenage patients of mine who have had serious knee injuries, many requiring surgeries and some injuries ending their athletic careers.  

We now know that adolescent female soccer players experience anterior cruciate ligament (ACL) knee injuries at a rate that is twice that of their male counterparts.  This study looked at whether these serious injuries can be prevented. 

4,600 females between the ages of 12 - 17 years participated in the study. Two-thirds were instructed in how to perform a 15 minute warm up program focusing on new control and core stability. This consisted of 5 minutes of jogging followed by six exercises (one-legged knee squat, two-legged knee squat, lunge, bench press, jump/landing technique, and pelvic lift).  The program was completed twice weekly during soccer season and progressed through 4 levels of difficulty. 

 

The outcome? Seven players in the intervention group, and 14 in the control group experienced ACL injuries. The rate of ACL injury was 64% lower in the intervention group. Pretty impressive! 

So, a simple warm up program which is easy to institute can prevent ACL injuries in young female soccer players.  It would be interesting to see another study looking at whether these same warm up programs can be applied to male soccer players as well as to athletes in other sports (basketball and softball) where knee injuries are common. 

These exercises seem to help minimize lateral trunk movement and knee valgus (knock knees) which are risk factors for ACL injuries. Might be worth starting this program in your young athlete! 

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Best Ways to Hydrate

1.15 to read

The temperatures across the country have hit triple digits and while your kids are outside playing and maybe sweating a bit they need to make sure to stay hydrated. But, do you really know when it is appropriate for them to have water? What about a sports drink?  Who picks?

While pediatricians have been effective in discouraging families from drinking full calorie carbonated beverages, and schools have phased out full-calorie soft drinks in cafeterias and vending machines, there has been huge growth in the sports drink market.   It seems that these sports drinks are now the third fastest growing beverage category in the US, after energy drinks and bottled water. Many of these beverages are being marketed towards children and teens and are not always the best beverage of choice.

Sports drinks are flavored beverages that contain carbohydrates, along with minerals and electrolytes, and they should be used specifically for hydration in athletes. Advertisements would suggest that these products may optimize athletic performance and replace fluid and electrolytes lost in sweat during exercise. For the average child who is just outside playing and participating in routine physical activities, the use of a sports drink is really unnecessary, good old water will do the trick.

It is important to teach children to hydrate with plenty of water before, during and after regular exercise.  If we doctors and parents are encouraging exercise as a means of improving overall health and wellness, providing sugary sports drinks seems counter intuitive. Some kids may not even burn as many calories with their exercise as they may receive from one bottle of a sports drink. In other words a child’s overall daily caloric intake may increase without any real nutritional value provided by a sports drink. Back to reading labels!!

For athletes who are participating in vigorous exercise, or in conditions of prolonged physical activity, blood glucose is an important energy source and may need to be replenished; in which case sports drink providing additional carbohydrate may be appropriate.  But, different sports drinks contain differing amounts of carbs, anywhere from 2-19 grams of carbohydrate per 8 oz serving. The caloric content of sports drinks is 10 – 70 calories per serving.  You must look at the labels and judge the intensity and duration of exercise to decide which drink to use. Children are not looking at calories, but rather the labels they recognize from ads, so pay attention.

With summer here it is good to know that sports drinks really are not indicated for use during meals or snacks, and are not a replacement for low fat milk or water. Turn on the faucet and cut down on calories and cavities!

That’s’ your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Keep Your Athletes Hydrated On and Off the Field

With summer heat in full swing all across the country and kids heading back to school athletics, band practice, drill team and the like it is a good time to discuss heat related illnesses and their prevention.

It is always at this time of year that I begin worrying about heat exhaustion and heat stroke and I find myself re-emphasizing the importance of maintaining hydration, even before you start back to outside activities. The Centers for Disease Control and Prevention reported 3,442 deaths between 1999-2003 due to heat and exposure to elevated temperatures, while children under 15 years of age accounted for approximately 7% of the total deaths. Among high school athletes, exertional heat stroke is the third leading cause of death and is often related to lack of acclimation to the heat and dehydration. You can’t just head out to run three miles in the heat or work out in pads or march in the band on the hot field without preparing ahead of time. Heat exhaustion occurs when the core body temperature is elevated between 100.4 and 104 degrees. This is different than having a fever secondary to illness. Symptoms are typically non-specific but include muscle cramps, fatigue, thirst, nausea, vomiting and headaches. The skin is usually cool and moist from sweating and is indicative that the body’s cooling mechanism is working. The pulse rate is rapid and weak and breathing is fast and shallow. Coaches, athletes and others should all be aware of these symptoms. This is the body saying, “I am overheated” and don’t keep going! (You would not drive your car when overheated; you pull over, and at least add water.) The mainstay of treatment is to prevent progression to heat stroke by moving to a cooler place, in the shade, air conditioning etc. Remove as much clothing as possible (uniforms, pads, helmets etc) to help heat dissipation. Water misting fans may be helpful. Begin rehydration with appropriate oral electrolyte solutions and water. When treated quickly and appropriately, symptoms usually resolve in 20 -30 minutes. The child should not return to activities that day, and should avoid heat stress for several days. Heat stroke is a MEDICAL EMERGENCY and will require transportation to the ER for aggressive treatment. In this case the previous symptoms have been missed and the core body temperature rises to 104 degrees or greater. The skin is flushed, hot and dry from lack of sweating. The athlete is confused, or even unconscious. The heart rate is fast and there is hyperventilation. The blood pools away from vital organs and can result in encephalopathy, liver, kidney and multiple organ failure. While awaiting transportation to the ER the athlete should be moved to a shaded area, clothing removed and ice packs may be applied to surface areas overlying major vessels, (i.e. the neck, beneath the arm pits, and the groin). Cooling and misting fans may also be used. Continue to educate your children about the need for hydrating the evening prior to events, and for continuous hydration while exercising in the heat. They should know to drink fluids even when not thirsty, as once you become thirsty you are already behind in your fluid intake. With good education, and recognition of early signs over overheating heat related illnesses are preventable. That’s your daily dose, we’ll chat again soon! Send your question to Dr. Sue!

Daily Dose

Young Athletes and Overuse Injuries

I see more and more kids who come in with complaints of back pain, knee pain, ankle and elbow pain often secondary to repetitive motion from sports.We had a pediatric orthopedic surgeon on the show recently and we discussed overuse injuries in adolescent athletes. I see more and more kids who come in with complaints of back pain, knee pain, ankle and elbow pain often secondary to repetitive motion from sports.

They usually don't have a lot of swelling, and they complain of pain with their activity, but otherwise are fine. When taking a history their biggest complaints occur during the sport or immediately after, and they usually feel better after resting overnight.The pain re-occurs once they resume their work out the next day. The cycle is continuous. The best treatment for overuse injuries is to follow the pneumonic RICE: Rest, Ice, Compression and Elevation. For further relief of pain add an anti-inflammatory medication such as Aleve, Motrin or Advil. If the athlete can play through the pain, it does not awaken them throughout the night and they are fine attending school and other activities, they are probably fine to continue in the sport. If the pain becomes persistent during the day, disrupts their sleep etc, then they will need to have further evaluation. For persistent stress-related injuries rest may be the next step. Many times it is just necessary to let the body have some "time off" and may also involve stretching exercises to strengthen their core muscles, or yoga and Pilates to improve flexibility and strength. This is usually a four to six week period away from their sport. One caveat that was discussed was the importance of watching for depressive symptoms in an athlete who has had to take time off from their activity. Parents need to recognize not only the physical pain their child is experiencing, but also the child's emotional pain related to stopping their sport. Many of these kids have such passion for their sport and also gain a great deal of self worth from their participation. To take that away from them is emotionally devastating, and their young minds are not cognitively developed enough to deal with the loss of their athletic endeavors, even for a short time. Watch closely and be supportive and acknowledge their feelings. It is just as important to seek help for their mental health if that seems necessary. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

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