Tuesday, June 25, 2013

Over $4K Raised during the Annual Running with the Buckeyes Event!

Advocates for Injured Athletes, like any other non-profit organization depends heavily on donations and fundraising to support its programming, including Athletes Saving Athletes (TM).  A4IA is always thankful for the donations and other forms of support it receives from all those willing to promote its work.  This week A4IA would like to specifically thank Alexis Heimert and The Ohio State University Athletic Training Club for their hard working during the 4th Annual Running with the Buckeyes event. 

The event, a 5K race, was held on March 24, 2013 in a effort to promote National Athletic Training Month by raising money to support A4IA.  The event was a success, raising over $4,000, the highest total since the event began.  

For those of you wondering how OSU got connected with A4IA, Alex and the rest of the group found out about A4IA through the Facebook page and Tommy’s video.  They did more research to learn about the organization and its goals.  The club, impressed by A4IA’s desire to promote the profession of athletic training, a primary purpose of the club, decided to help.  They felt it was their responsibility as future professionals to advocate for organization that promotes their profession through public education, pushing for increased access to athletic trainers, and the important role athletic trainers play in athletic health care.

If you're a runner and would like to support A4IA through your running pursuits, join TEAM ASA by contacting Advocates for Injured Athletes at injuredathletes@yahoo.com.  Coming soon is the t-shirt shop so you'll be able to wear your support for A4IA very soon! Keep checking the website, www.injuredathletes.org and our Facebook page for more details.  

CHECK OUT THESE PHOTOS FROM THE RUNNING WITH THE BUCKEYES EVENT!











Submitted by Heather L. Clemons, MS, MBA, ATC

Wednesday, June 19, 2013

Lightning Safety Week: June 23 - 29

It wasn't too long ago that I spent some time writing about lightning safety as part of a few blogs that were intended to help you be prepared for many of the most common summer phenomena.  The National Weather Service (NWS) lightning safety week purposefully corresponds with the time of year that lightning storms are most prevalent.  According to the NWS 54 people are killed annually by lightning, while many more are injured.  There have already been seven (7) fatalities in 2013.


The original blog that I wrote just over a month ago spent time introducing you to lightning safety specific emergency action plan resources (from the NATA), connecting you with lightning strike density statistics, keys to keeping yourself safe or getting to safety if you should get caught in a storm, and some basic first aid tips for strike victims.  I am bringing this blog to the forefront again because the information it presents is important.  In my experience as an athletic trainer I feel that sometimes people do not take this particular weather phenomenon seriously and seek shelter immediately.  I am writing to urge you to take thunderstorms and lightning seriously and respond accordingly to protect yourself and whoever you may be with.



The most concerning thing about a lightning is that it can injure you without having to be directly struck by the lightning bolt.  There are 5 mechanisms of injury associated with lightning:

  1. Direct strike:  Lightning strikes person directly
  2. Contact injury:  Victim touches an object that is part of lightning's pathway
  3. Side flash (splash):  Lightning arcs from struck object to a nearby object
  4. Ground current (step voltage):  Lightning spreads peripherally through the ground
  5. Blunt trauma:  Injury results from an object that is thrown through the air during lightning strike

This is why it is important to understand what a proper safe area is and be sure you're protected.  Additionally, this is also why you shouldn't talk on the phone, take a shower or use other electronic devices during a storm.

Should you be a lightning strike victim and be fortunate enough to survive the range of long-term "side effects" of being struck is wide.  According to NWS, Medscape and other resources some long-term health concerns include:
  • chronic pain syndromes
  • neuromuscular pain
  • headaches that are not relieved with OTC medications
  • depression
  • dizziness
  • sleep disorders
  • hypertension
  • congestive heart failure
  • seizures
  • cataracts
  • many, many more
To read real stories from lightning strike survivors, click HERE.

HEADLINES FROM THIS YEAR

These are just a few recent articles regarding published stories in the United States.  More recently two people died in Russia (mother and child) and two more in Bangladesh.  Again, know your lightning EAP wherever you are and take the warnings from your AT seriously when directed to seek safety.  Doing so could mean the difference between being safe and risking significant long-term complications or even death.  As lightning safety week approaches, make a plan and stick to it as you enjoy the summer season.  Lightning can strike anywhere.... at the family reunion, at the weekend sports tournament, during the big outdoor concert or camping trip.  Be prepared.

Submitted by Heather L. Clemons, MS, MBA, ATC







Tuesday, June 11, 2013

Sickle Cell Trait: What You Need to Know

As previous blogs have demonstrated there are a variety of conditions that can be of concern and potentially fatal if not treated quickly by trained professionals.  Some of the topics discussed include  sudden cardiac arrest, infectious mononucleosis, exertional heat illness, an asthma attack, and diabetic emergencies among others.  The topic I am going to discuss today is another one of those topics, sickle cell trait (SCT).  Understanding SCT is particularly important for certain segments of the population as it is more common in certain ethnic groups.  Additionally, exertional sickling and sickling collapse, an emergency condition that can result during intense exercise may sometimes be mistaken for exertional heat illness (EHI).  My goal today is to define SCT, differentiating it from sickle cell disease (SCD), provide you key identifiers that differentiates SCT from EHI (most often heat cramps) and provide a brief introduction to the mandated NCAA testing policy.

SICKLE CELL TRAIT (SCT) BASICS
SCT is present in those people who inherit one sickle cell gene and one normal gene (CDC).  SCT can be diagnosed with a simple blood test; infants in the United States are tested at birth.  SCT is different from sickle cell disease (SCD) because SCD requires the inheritance of two abnormal genes, one from each parent.  This gene results in the mutation of hemoglobin cells, causing them to take on a crescent or sickle shape (see image below) and making it more difficult for these cells to transport oxygen.




SCT affects 1 in 12 African Americans, but the condition can also be prevalent in those with ancestry from South American, the Caribbean, Central American and Mediterranean countries including Saudi Arabia, India, Turkey, Greece and Italy. As parents, it may be important that you ask for the results of this test for your new infant.  Despite the required testing most people do not know their sickle cell trait status unless they have sickle cell disease.  People are typically asymptomatic, but there can be potential for complications when the following conditions/situations are present:
  • Increased pressure in the atmosphere (ex. when scuba diving)
  • Low oxygen levels in the air (ex. very intense training, exertion at altitude)
  • Dehydration
  • High altitudes

SCT AND ATHLETES
As of this time, there is no recommendation that athletes with SCT should be withheld from participating in sports, however, some research has shown that athletes can be particularly at risk of complications from SCT when completing intense training.  The possibility of complications can be enhanced by training in extreme temperatures or at high altitudes (as previously mentioned).  The key to SCT is prevention is to set your own pace, rest often between drills/activities, stay hydrated before/during/after activity and keep the body as cool as possible when exercising in hot conditions according to the CDC fact sheet.

For an individual who has SCT and completing intense exercise the biggest concern is a condition called exertional sickling (and the resulting sickling collapse).  In exertional sickling the intense exercise causes normal the sickle shaped blood cells to “logjam” the blood vessels, slowing oxygen transport to the muscles.  Muscle tissue begins to breakdown after a prolonged period of a lack of oxygen resulting in a condition referred to as rhabdomyolysis.  This condition is a medical emergency and can lead to death if not treated immediately.  The biggest key to proper treatment is immediate recognition of the condition and proper treatment.  Exertional sickling/sickling collapse can sometimes be confused with exertional heat illness, particularly heat cramps.


EXERTIONAL SICKLING
EXERTIONAL HEAT ILLNESS
Typically happens within first 30 minutes on the field
Typically happens after prolonged exercise for more than 30 minutes
Core temperature is not elevated
Core temperature is typically >1040F
Pain is strong and generalized
Heat cramps:  muscle twinges and focused pain
Typically slump to ground with weak muscles; sufferers will lie fairly still and muscles will look and feel normal to the observer
Heat cramps:  suffers “hobble” and muscle are locked up and hard to touch, suffers will yell out/writhe in pain


If you or your athletic trainer suspect exertional sickling the athlete should be removed from activity immediately.  Oxygen can be administered if available (and someone is trained in its use) and the EAP should be activated.  A sickling collapse is a medical emergency.

RYAN CLARK, PROFESSIONAL ATHLETE WITH POSITIVE SCT STATUS
Want to know more about an athlete who’s competing in the NFL with sickle cell trait?  Check out Ryan Clark, Pittsburgh Steelers.  He has been able to have an NFL career despite being held out of recent games in Denver, Colorado given is SCT status.  Remember, exertion at high altitudes has the potential to result in exertional sickling/sickling collapse.  He has now started a foundation to search for a cure for the condition.




NCAA MANDATED SICKLE CELL TRAIT TESTING POLICY
The National Collegiate Athletic Association (NCAA) has mandated sickle cell testing for athletes.  This requirement is considered controversial by some based on the available (or lack thereof) research, but my goal is not to debate the merits of the requirement, but to help you understand it.  If you’d like to learn more about why some people believe the mandated testing policy is unnecessary check out this article.  Testing has been mandated for Division I athletes since 2010 and Division II since 2011.  Legislation just passed that will mandate testing at the Division III level starting this year (2013).  For those of you who are concerned and do not wish to have your child tested as part of their initial college pre-participation examination there is a waiver you can sign to opt out of the testing.  Additionally, SCT positive athletes are not restricted from participating in athletics, it simply allows the medical staff to be more aware of the possibility of a exertional sickling and sickling collapse.  Testing is expected prior to the start of the freshman year, or for any transfer whose status is not known.  Remember, if you have the SCT status of your child documented at birth, additional testing prior to the entry into college may not be necessary.  Find out more information and resources from the NCAA here or contact the sports medicine staff at the college/university your child will be attending.

RESOURCES
The documents listed here are mostly statements from various professional organizations regarding SCT trait status in athletes.  Some of the statements discuss recommendations for the safe sports participation and treatment in the instance of exertional sickling/sickling collapse.  Others discuss the need (or suggest there is no need) for SCT screening of athletes.  As always you are encouraged to take a look.









Submitted by Heather L. Clemons, MS, MBA, ATC

Wednesday, June 5, 2013

Are you Prepared for Your Summer Sports League?

School is ending in the coming week(s) and summer will be officially under way for many families.  With summer comes camps, vacations and travel teams.  With all this parents should be aware of how (and by whom) their children's health and safety is being managed.  Parents who have children who will be signing up for fall travel sports should also begin asking questions now about health and safety concerns. Asking questions early means that if changes need to be implemented there is time before the actual sporting season begins.  In an effort to help parents ask the right questions here are five questions every parent should ask before their children participates in organized sports.




This post defines what an EAP in and the major components is should include.  It also refers readers to a key resource regarding EAP development, the NATA Position Statement on emergency planning.  While there are several conditions that may require specific detailed EAPs, given the focus on concussions time is spent specifically on the topic.


This post takes a significant amount of time to make you familiar with what an athletic trainer is and the skills they have.  Much time is spent on the major educational requirements and the knowledge and skill areas athletic trainers are qualified in once they pass the national certification examination and begin practicing.  The post also introduces you to the major organizations associated with athletic trainers including the NATA, BOC and CAATE.  There are also a variety of position statements put out by the NATA on topics such as heat illness, emergency planning concussions, asthma and other topics that are relevant to youth athletes and are available for public review.


This post explains what CPR is and how you can become trained to utilize it in an emergency.  Links are provided to the three major organizations that provide courses around the topic of CPR (and AED) as well as providing information on the topic of hands-only CPR.  


This post takes the time to explain what an AED is, how it works and how to use it.  Many states also have public access laws in place which means when you're in the airport, at the mall, or at the public pool there may be an AED available for use in an emergency.  This post can help you understand where AEDs may already be available in your state and to help you get AEDs in your school or for your league if you don't have them already.


This posts lists/discusses key governing organizations for some of the most popular youth sports such as USA Football, AYSO and Little League Baseball among others.  It also discusses key equipment safety organizations such as NOCSAE and HECC and finally provided some resources for proper coaching technique around football tackling and managing baseball pitch counts in young players.



Submitted by Heather L. Clemons, MS, MBA, ATC

Thursday, May 30, 2013

Dietary Supplements: Energy Drinks

The most popular dietary supplement outside of a multi-vitamins are energy drinks.  Red Bull.  Monster. 5-Hour Energy. NOS. Full Throttle and many others.  According to some research there are over 500 different energy drinks on the market.  I bring up the topic of energy drinks because they are particularly popular among teens and young people and some research has shown that energy drink companies are marketing to this group.  The biggest concern connected with energy drinks is the potential for caffeine intoxication and other side effects including seizures, mania and even sudden death.  To understand the popularity of these beverages in the United States you only need to know that in 2012 the energy drink market was valued at $12.5 billion and young adults are considered the core market. 



WHAT IS AN ENERGY DRINK?
Energy drinks typically contain caffeine, taurine, sugars and sweeteners and herbal ingredients that are combined to give an “energy boost”.  These drinks are distinctly different from sports drinks and vitamin waters.  According to the National Federation of State High School Association (NFHS) Position Statement and Recommendations for the Use of Energy Drinks by Young Athletes, “An energy drink is a beverage marketed to both athletes and the general public as a quick and easy means of relieving fatigue and improving performance” usually using very high concentrations of caffeine and carbohydrates.  Energy drinks differ from sports drinks because sports drinks are designed to provide rehydration (and basic carbohydrate replacement) during or after athletic activity, containing a 6% - 8% carbohydrate solution and a combination of electrolytes formulated for maximum absorption.

Caffeine is typically the main active ingredient in any energy drink, containing 70-80mg per 8 ounce serving; energy shots can be even more concentrated.   To give you an idea, a typical energy drink contains about 3 times as much caffeine as a cola-based soft drink. The concern with energy drinks is that although the amount of caffeine (added as pure caffeine) may be listed on the ingredient label, the actual amount of caffeine in any given drink is hard to calculate. This calculation is difficult because most of these drinks include additional ingredients that contain caffeine, not reflected on the ingredient label.  Some typical additives are guarana, kola nut, yerba mate, cocoa, green tea, synephrine, and yohimbine among others.

The International Society of Sports Nutrition (ISSN) Position Stand:  Energy Drinks (2013) has published several tables that can easily help you understand the ingredient list of several common energy drinks in the United States as well as the purported effect of many of the ingredients found in energy drinks.



TEEN AND ADOLESCENT CONSUMPTION OF ENERGY DRINKS
According to some study data teens consume 60 – 70 mg/day of caffeine, mostly from soft drinks.  Caffeine consumption has ranged as high as 800 mg/day in some studies and energy drinks are becoming more and more popular.  Some research shows that drink makers are even marketing to younger consumers.  These companies are savvy and use sporting events and athlete sponsorships, along with key product placement on social media sites and in video games to connect with your kids.  Consumption rates vary, with one study finding that 28% - 34% of 12 to 24 year-olds regularly consume energy drinks,  College students were particularly prone to consuming energy drinks habitually to improve energy (usually due to a lack of sleep). 


HEALTH CONCERNS RELATED TO ENERGY DRINKS
Energy drinks can pose a risk to anyone who consumes them, with the most commonly reported symptoms centering around caffeine toxicity.  Energy drinks are not regulated by the FDA because they are considered dietary supplements (unlike soda which is limited to 71 mg caffeine per 12 oz. soda).  The FDA is currently responsible for investigating “Adverse Event” reports related to energy drinks and energy shots.  Currently there are reports regarding Monster, Rockstar, Red Bull, and 5-Hour Energy that you can view HERE.

The top 10 side effects associated with energy drinks according to a study by the Medical Journal of Australia are listed below.  These results are based on analysis of 7 years of phone calls to their poison control center.
  1. Palpitations/tachycardia (rapid heart rate)
  2. Tremor/shaking
  3. Agitation/restlessness
  4. Gastrointestional upset
  5. Chest pan/ischemia
  6. Dizziness/syncope (fainting)
  7. Paraesthesia (altered sensation)
  8. Insomnia
  9. Respiratory distress
  10. Headache

Of these, the most concerning are the cardiac symptoms.  There is a concern that caffeine toxicity in children with a cardiac condition (known or unknown) could ultimately lead to death due to sudden cardiac arrest.  Cardiac events could be especially of concern in children with ADHD, an eating disorder or those with diabetes.  There is some research (although controversial) that suggests calcium deposition in the bone is decreased in adolescents because caffeine interferes with intestinal calcium absorption. I bring this up because the adolescent years are the period of the most significant bone development

An additional concern, particularly for college age adults is the combination of alcohol and energy drinks.  Doing so often gives individuals a false sense of sobriety, leading to poor decision-making.  This topic is beyond the scope of this post, but if you’d like more information check out this article to learn more about the warning issued by the American Medical Association.


POSITION STATEMENTS AND OTHER RESOURCES REGARDING ENERGY DRINKS
Listed in this section are current position statements and other articles regarding the consumption of energy drinks with a particular focus on teen and adolescent consumption as sources allow.  I have used these sources to help inform this blog post, but I encourage you to read the full articles and position statements to gain a fuller understanding of the topic.


 Submitted by Heather L. Clemons, MS, MBA, ATC


Friday, May 24, 2013

Drew Babb's Incredible Journey from Arapahoe High School Lax Star to Denver Defenseman


How many athletes can you think of who have been forced to take three years off due to injury or sickness, only to come back stronger and start in their return to their respective sport? I can only think of one – Drew Babb, Senior Defenseman for the University of Denver Lacrosse team.


Drew Babb had just finished his high school career at Arapahoe High School where he was a four-year varsity letterman, a two-time All-State selection, an All-American as a mid-fielder, and a team captain who led his team to a state championship title in 2009. He was slated to play Division I lacrosse at the University of Denver, where he would presumably continue the immense success that he had in high school. Babb’s future coach at the University of Denver, Bill Tierney, was expecting nothing less of the talented, high school phenom.           
“He was a guy you couldn’t stop gushing about,” Coach Tierney told Lax Magazine in an interview last year. “What a great player this kid was.”
Unfortunately for Drew, the story was not going to go quite like that. Drew had been competing with neck pain in his senior season at Arapahoe after his neck began to swell in February of 2009. He was in and out of the doctor’s office for the next few months after repeated failed attempts to treat the swelling. Drew’s doctor had him take a full biopsy on July 1st after graduating from high school. The day after, Drew was watching TV when his father walked back into the house shortly after he was supposed to have left for work and passed on grave news to him from his doctor – Drew had been diagnosed with Stage I Hodgkin’s Lymphoma. Drew’s father received the results and delivered the news to his son. Drew was more shocked than panicked when he heard the news.
“When my Dad told me the news, he was very positive about it. It was very comforting to know how good it was that we caught it that early,” Drew told me over the phone.
Drew subsequently went through five months of chemotherapy while taking classes at the University of Denver during his freshman year. When asked about the difficulties of managing a college course load and attending practices along with the chemotherapy, Drew downplayed it and attributed his ability to manage the work to the administration and professors at DU. There are no classes at DU on Fridays, so Drew would receive chemo Friday, wait for the nausea to subside, and return to class on Monday.
“I would miss classes on Mondays occasionally, especially later in the treatment when the nausea was worse,” Drew commented.
At the end of this five-month period, the doctors could find no trace of the cancer. However, during the third round of his chemo, another obstacle blocked Drew’s path on his way to recovery. Like most cancer patients who endure chemotherapy, Drew lost his hair and was very nauseous. Although, in addition to the other symptoms, Drew had exceptionally bad body aches in his hips. He would later find out that the reason for this was Avascular Necrosis, which is a condition that was deteriorating Drew’s right hipbone because of a lack of blood supply. This meant a year’s worth of inactivity according to Drew’s doctors – thus ending his hopes of playing his freshman year at the University of Denver.

Even after being diagnosed with Hodgkin’s, Drew was expecting to be able to play in the spring of his freshman year. When he found out he had AVN in his right hip, he thought he would at least be ready to play by his sophomore year. When he was rehabbing in the summer of 2010, a week before the fall practices began, the doctors informed Drew that his right hipbone was growing back on schedule; however, the AVN was infecting his left hip as well, and it was not healing like his right hip did. Thus, the doctors drilled holes in Drew’s hips to increase blood flow to expedite bone regeneration. Unluckily for Drew, this meant that his collegiate career was being cut in half because he would not be able to play his sophomore season either.

Although Drew had not been cleared to play for two years, he was still around his teammates and assisting the team in whatever way he could. To stay in shape in the fall of 2010, Drew swam. As time went on, he began to use the stationary bike and the elliptical, but until he had his final bone scan, he would not be able to run unless it was evident that the AVN had disappeared and his hipbones were growing back.

When asked about the frustration of being on the sidelines, Drew said, “It was definitely frustrating, especially sophomore year it got tougher. I was expecting all freshman year to be able to play that season, and it didn’t happen.”

In February of his sophomore year, Drew received news from the doctors that he would be able to play again.
“The week leading up to those scans was the most uncomfortable week I felt throughout the whole experience of not being able to play, and that includes being diagnosed with cancer and going through chemotherapy. Because, essentially, [the scan] was going to determine whether or not I would ever be able to run again.”
That week, Drew met with Coach Tierney in what turned out to be one of the most calming and helpful conversations that Drew would have throughout his treatments. Coach Tierney asked Drew how he was doing, and Drew said he was nervous. Coach Tierney told Drew he may not understand why all of this stuff was happening to him now, but he will someday.

“That really helped me get back to that comfort level. Whether I can play or not was not up to me,” stated Drew after talking about the assurance of Coach Tierney’s words.

Drew always tried to stay positive about the whole process.  He is very open about his faith as a Christian, and it was that faith and the Christian household he grew up in that really helped him get through all of the hardships and stay positive. He stated that it was God’s plan, and that he will do what he can, but ultimately will trust in what God has in store for him.

Even after Drew was informed he would play again, that did not mean he was free of the challenges that being on a nationally ranked, division I lacrosse program would bring. Drew was an All-American mid-fielder in high school, but Coach Tierney was in need of defensemen when Drew’s junior year rolled around. To add even more obstacles to returning to his former self on the field, Drew was moved to close defense in the off-season after showing his propensity for the position in a scrimmage against the Denver Outlaws, the local professional lacrosse team.

When it came to switching positions, Drew just seemed happy to be back on the field and playing again. However, when he exceeded even his own expectations and saw a potential starting spot opening up for him, he began to appreciate the ability to play while also wanting to compete.

When Drew took the field for the first time since his injury, he described the day as follows:           
“It was surreal. During warm-ups, I was just looking around and realizing what I was about to do after what I had been through the past years. It was just so exciting to be playing instead of watching,” Drew said.
Evidently, it did not take Drew long to acclimate himself to playing a new position after taking two years off, because Drew started Denver’s season opener against the Ohio State Buckeyes and never looked back, starting all 16 games that season. He played through intense pain all year, and the amount he was allowed to play was at his own discretion.

In addition to the pain he felt because of the AVN, late in the regular season Drew tore his labrum and played through the pain believing it was the AVN. He went to the doctor for another scan, and was informed he would have to undergo another surgery to repair the labrum and spend six months recovering.

After yet another setback, Drew fought through it and did not allow self-pity to sink in.
“Every time I started feeling sorry for myself, I would start thinking about Tommy [Mallon] and his neck injury. I have seen friends go through things like this,” said Drew. “I did my chemo at the local children’s hospital and saw children taking chemo at ages 4 and 5. I would think about those kids going through worse diseases than me, and say if they could do it then so can I.”
Drew continues to play through the pain. When the weather changes it is especially bad, and on rare occasions he has to pull himself out of the game. At the beginning of this year, the labrum was brutal. However, as time has gone on he has gotten stronger and stronger.

“I feel stronger this year in the playoffs than I did in last year’s playoffs,” said Drew when asked about how he currently feels.

Drew and his teammates at the University of Denver play in the Lacrosse Nationals Semi-Final game against top-ranked Syracuse, and Drew likes their odds.
“We feel good about [tomorrow]. Once you get this far it is really anybody’s game,” said Drew about DU’s chances against the #1 team in Syracuse.
Drew succeeded in battling against cancer, bone deterioration, and a torn labrum just to play in tomorrow’s game, so upsetting the nation's top-ranked lacrosse team would just be like any other day for a guy like Drew.