Limiting dangers for young athletes

Thanks to Junaid Khan, MD, cardiac surgeon with Alta Bates Summit for his help in educating the community regarding sudden cardiac events in young athletes. The attached article appeared in yesterday’s Contra Costa Times.

http://www.contracostatimes.com/high-school-sports/ci_14359447


Limiting dangers for young athletes
By Sandy Kleffman, Chace Bryson and Ben EnosContra Costa Times
Posted: 02/08/2010 02:02:45 PM PST
Updated: 02/09/2010 07:06:44 AM PST

In a four-day span, two seemingly healthy East Bay high school basketball players suddenly collapsed during games this year. One died and the other was hospitalized.

The incidents, on Jan. 29 and Feb. 2, have shaken the school sports community and prompted soul-searching about avoiding such tragedies.

Experts point to many ways that students, coaches and administrators can lessen the risks such as better physical exams, more attention to players' problems and concerns, better emergency equipment and training.

But sometimes, despite everyone's best attempts, problems remain hidden and the first symptom is a collapse, said Dr. Casey Batten, associate team physician for UC Berkeley.

It has not yet been determined what caused the death of Joshua Ellison, a 17-year-old senior at Calvary Christian Academy in El Sobrante, or the collapse of 15-year-old David Gurganious, a varsity basketball player at El Cerrito High School.

But most sudden deaths of young athletes involve heart problems, according to a 2009 study in the Journal of the American Heart Association.

Researchers looked at 1,866 athletes in 38 sports who died suddenly or survived cardiac arrest from 1980 to 2006. The athletes ranged in age from 8 to 39.
Of the deaths:
· 56 percent were due to cardiovascular disease. About a third of these deaths involved an enlarged heart.
· 22 percent were caused by a chest injury that structurally damaged the heart.
· 4 percent were due to a chest blow that interrupted heart rhythm.
· 2 percent were caused by heat stroke.

Such deaths remain rare. Young people have a much greater risk of dying from cancer, leukemia, cystic fibrosis, automobile fatalities, meningitis and homicides.

"It's like getting struck by lightning," said Dr. Junaid Khan, director of cardiac services at Alta Bates Summit Medical Center in Oakland.

Yet prevalence statistics matter little to communities rattled by tragedies, and the most recent incidents were not the first in the East Bay.

Last year, 15-year-old Darius Jones from Concord's De La Salle High School collapsed and died of apparent heart failure at a nonschool league basketball game.

And Cal freshman Tierra Rogers's basketball career ended after having a defibrillator implanted to address a rare heart problem. Doctors discovered her condition, known as arrhythmogenic right ventricular dysplasia, after a workout in which she had trouble breathing and then collapsed.

So what can be done to protect young athletes?

A thorough pre-screening can be an important step, experts say.

The California Interscholastic Federation, which oversees high school sports, requires all students to have a physical exam before participating in a practice or game. The exam must include a family health history.

Among the questions doctors should ask, Batten said, is whether any of the student's relatives died of heart problems before age 50.

Students should also reveal whether during exertion they have nearly passed out, felt discomfort or pain in the chest, or had their heart race or skip beats.

Although young athletes must file a form with the school indicating they have had a physical exam, how much scrutiny such forms receive varies.

"Sometimes those forms just get put in a file and that's the end of it," said Frank Allocco, De La Salle basketball coach. His school's training staff is " taking those forms and looking at them and taking action on them," he said. At Oakley's Freedom High School, athletes must get an annual physical from either their personal physician or a chiropractor. Because some insurance companies pay for a physical only once every two years, many athletes choose the cheaper option of seeing a chiropractor the second year, said athletic director Steve Amaro.

Students with risk factors such as a family history of heart disease or warning signs should have an electrocardiogram, or EKG, recommends Khan, president of the East Bay division of the American Heart Association.

But experts are divided over requiring EKGs of all young athletes. Khan worries that false positives could needlessly disqualify students or subject them to additional costly tests. EKGs can also miss problems, giving a false sense of security.

Khan noted that in Italy, where EKGs are mandatory for young athletes, the frequency of sudden deaths is slightly higher than in the United States.

The cost could also be prohibitive. Mandatory EKG screening of all middle school and high school athletes in the United States could run as high as $2 billion annually, according to a 2007 statement by the American Heart Association Council on Nutrition, Physical Activity and Metabolism.

As a result, such massive EKG screening is probably impractical, the council said.
But others insist that screening requires additional study, particularly since an EKG can pick up signs of an enlarged heart, the cause of many of the sudden deaths.

This condition, known as hypertrophic cardiomyopathy, typically results from an inherited genetic defect. The walls of the ventricles thicken and become stiff. The problem may be present at birth, or it can develop later. That means that screening a student at 14 would not reveal a condition that develops at age 18, Batten said.

For these reasons, experts say it is crucial that students and coaches watch for warning signs, including fainting, chest pain, shortness of breath, irregular heartbeats, severe headaches, dizziness and blurry vision. Students should tell their coaches if they feel ill rather than "toughing it out," Khan said.

Parents and coaches need to be observant and proactive when an athlete may be struggling, said Lindsay Wisely, girls basketball coach at Antioch's Deer Valley high.

"One thing to be aware of is that sports are not just a seasonal thing anymore," Wisely said. "We're training kids 365 days a year. "... with athletes trying to play and train at an elite level, perhaps we should be screening them a little more than a standard physical."

Amaro agreed that coaches must be attuned to students who appear to be having difficulties.
Communication is key, he said. "If they're not feeling better, you need to dig a little deeper and find out why."

Such suggestions struck a chord with Travis Carrie, who sat out two years of athletic competition at De La Salle High after he fainted during football conditioning and doctors discovered a heart condition.

Carrie's coronary artery developed on the wrong side of his heart. It was operable; he returned to the field and earned a scholarship to Ohio University.

"The doctors knew I had a problem," he said. "But until I fainted, we didn't know how serious it was and exactly what it was."...

"I think coaches should listen more," he said. "During a couple of my incidents while running. I'd tell my coach that my chest is really hurting and I think I need to stop. Coaches need to really pay attention to their players and listen to them. That's a big factor."

Some say much more can be done to protect young athletes.

"I think we have a long way to go," North Coast Section Commissioner Gil Lemmon said. "I'm not saying that our contests are unsafe, but if we're talking about having top-notch safety within our programs, then I think every school needs a full-time trainer on campus and maybe some reform needs to go into our physicals."

For the past four years, the NCS has partnered with Children's Hospital to have a certified medic at its championship events. Lemmon said that 90 percent of the section's fall championships were covered and 100 percent of its football games.

But along with the focus on safety, Batten encourages people not to lose sight of the many health benefits of exercise and team sports.

"There's a much more well-defined risk of inactivity than there is with activity," he said.

REDUCING RISKS
Pre-screening
Students must have a physical exam before playing sports. The exam should include a family history, including relatives' heart-related deaths before age 50, or who had Marfan syndrome. Students should be asked whether during exertion they have ever nearly passed out, felt discomfort or pressure in the chest, or had their heart race or skip beats. Those with risk factors should have an electrocardiogram, or EKG. Experts are divided about whether EKGs should be required of all young athletes.

Warning signs
Fainting, chest pain, shortness of breath, irregular heartbeats, severe headaches, dizziness and blurry vision.

What students can do
Don't "tough it out": Tell a coach if you feel ill during a workout or game.
Make sure you drink enough water.
Avoid energy drinks, which cause dehydration.

What schools can do
Have an automatic external defibrillator on-site.
Ensure water and First Aid supplies are available at all practices and games.
Make sure all coaches know how to use the school phone system to call 911.

Source: Bay Area News Group research