sudden death

Monday, April 21, 2014

There may be nothing better than the NHL’s sudden death overtime for excitement, drama and the finality as the winning goal is scored. Sudden death has a totally different meaning in medicine and the end game is not a positively anticipated event. And yet there are people who survive sudden death because of a confluence of fortunate circumstances.

The purpose of the body is to take the brain around to experience life and for that to happen, the heart has to circulate blood and deliver oxygen and nutrients to the far reaches of the body. It’s a simple pump that depends upon its electrical system to deliver rhythmic impulses that allow the heart muscle to squeeze in a coordinated fashion. The body is very forgiving and it can tolerate an occasional hiccup where an irregular heartbeat or two is unable to pump blood, but without adequate blood flow, the body shuts down very quickly and the brain is perhaps the most unforgiving of all organs. No blood flow and it turns off in an instant; no blood flow for 4-6 minutes and damaged forever.

The heart is a two stage electrical pump. A group of pacemaker cells generates an electrical signal that is transmitted through the heart’s wiring to allow the heart muscle to beat in a coordinated fashion. It’s a continuous lifelong process, where the natural pacemaker tells the atrium, the upper chambers of the heart to contract and send blood to the ventricle. The electrical signal is also sent to the ventricle but before it arrives, there is a split second delay at a junction box called the AV node (atrioventricular node), so blood can actually fill the ventricle before the muscle squeezes to send the blood off to the body.

There are a variety of rhythm disturbances that can affect the heart and an occasional skipped or missed beat can be a normal variant but in some people, the electrical system can short circuit and not deliver a coordinated electrical impulse to the heart muscle. When this occurs, each heart muscle cell has the potential to generate its own electrical signal and the end result is chaos. Instead of having one coordinated beat, the heart just quivers or fibrillates. If this occurs in the atrium (atrial fibrillation), the AV node can filter the chaos and allow the ventricle to beat normally, though irregularly. Though A Fib has its own issues, sudden is not one of them. However, if it is the ventricle that fibrillates, then blood flow to the body stops and death is almost immediate.

Ventricular fibrillation or V Fib is one of the complications of a heart attack or myocardial infarction, where a blocked artery causes some heart muscle to lose its blood supply and become irritated. This may affected the electrical system leading to fibrillation and it is what kills a heart attack victim in the immediate time frame. In some unfortunate souls, V Fib and sudden death happens just because…there is no warning.

Those who survive sudden death do so because of circumstance. They are fortunate that their heart stopped when other people were around, that those people knew how to perform cardiac resuscitation and that an AED was soon available to shock the heart back into a normal rhythm. It’s an electric problem that kills and it is electricity that saves. Should a victim survive sudden death, a defibrillator is often implanted that can detect future V Fib rhythms and automatically deliver a shock.

An implantable carioverter defibrillator is a lifesaver but it is also meant to allow the body to return to normal function, allowing it to take the brain to the many places it wants to go.  The Twin Cities Marathon is a gathering place for runners who continue their passion for running and for those who decide to embark on their running career even after surviving sudden death. The Global Heroes program sponsored by Medtronics, one maker of ICDs, celebrates those athletic souls.

Sudden death strikes without warning and without regard to age, body size or level of fitness. My brother’s keeper is the treatment, where people take the time to learn life saving techniques and are willing to us them on family or stranger alike. In sports, there is always another game after sudden death even if it need to wait till next season. In life, sudden death may actually mean death.

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gaining weight

Monday, April 14, 2014

Jordan Spieth‘s appearance in Sunday’s final pairing in the Masters was a reminder that age is not always an indicator of skill and the ability to compete. Spieth had already turned pro but there were three amateurs under the age of twenty who might consider forgoing their education to play on the pro golf tour. Sports commentator, Bomani Jones had an interesting observation on twitter about leaving college early: “Anyone think golf needs a rule requiring players to stay in school for three years? Or that only apply to sports you like to watch?”

Presumably the correct answer could be found in physics class and Newton’s second law of motion. Force equals mass times acceleration helps explain why it would be that a teenager never be allowed in an NFL locker room.

College seems to be the place where football players grow larger and their size has become the focus of medical study. Researchers from Oklahoma State University followed football players over the course of their college career and found that linemen’s weight increased by only 3% but at the same time their body fat dropped from 22.5% to 20.6%. Their strength increased by almost 20% but in exchange, they became a little slower. Skill players, like running and defensive backs had a larger weight gain of 9%, they became more just a little more lean, dropping their body fat on average to 8.1% and their strength also increased.

But college players might be considered obese compared to their NFL colleagues. Researchers assessed the height, weight, body fat and BMI (body mass index) of all players who attended the 2003 training camp for the Indianapolis Colts. Skill positions players had body fat measurements as low as 6.3%, while the defensive lineman were 10% leaner than their college counterparts. Only offensive linemen were bulkier, much bulkier at 25% body fat. NFL players represent the players whose talent and body composition have allowed them to rise to the top of their profession. Their performance on the filed mirrors their physical development. As bodies become larger and leaner and as strength increases, the mass and acceleration in F=ma both increase. Unless there is a disparity in skill that can offset the disparity in size, the person with greater F will win the battle in the football trenches.

So how do college players get larger? The Associated Press scoured records from all 120 schools that played in The Football Championship Division, the top tier of college football over an 11 year period. While they weren’t scientists, their data had validity. They found that of 61,000 players reviewed, more than 4,700 had gained more than 20 pounds in a single season. According to the National Center for Drug Free sport, that amount of weight gain should raise suspicion for the use of performance enhancing drugs and yet the number of football players who test positive for steroids and PEDs range between ¼ and a little more than ½ percent. However, the question that could not be answered from the AP review was whether the weight gain was due to fat or lean muscle.

And the trend begins in high school football, more than a decade earlier. Researchers looked at the height and weight of Parade All American football players from 1963 to 1983. Their average height increased by four inches to 6’5” and their average weight went from 213 pounds to 268 pounds. The reason for the rapid growth was not completely clear, though the authors suggested the following: “data do raise questions as to what portion of these gains can be attributed to improved nutrition and training techniques and what portion may be the result of use of performance-enhancing drugs such as anabolic steroids.” (Wang, M. Q., Downey, G. S., Perko, M. A., & Yesalis, C. E. (1993). Changes in Body Size of Elite High School Football Players: 1963 – 1989. Perceptual and Motor Skills, 76, 379-383.)

While those who are blessed with speed and agility are able to progress to the next level in football, for many position players, size matters. Technical skills need to grow alongside physical development but some athletes are in a rush and perhaps use extra help to reach their goal.

Bomani Jones is right when he wonders why we don’t care about golfers or tennis players leaving college early for the pro ranks, but raise the red flag about the integrity of the student athlete. Perhaps it’s because golfers like Jordan Spieth don’t have to evade 300 pound linemen to hit the ball. Few college football players make it to the NFL and those who do have short careers and are unlikely to emerge without significant injury.  And perhaps for that reason alone, football players should be allowed the time to grow in college, though how they grow is a topic for another time.

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