learning medicine from sport

Tuesday, August 6, 2013

One moment, Vinko Bogataj is on top of the world, or at least at the top of the 90m ski jump at the world championship in Oberstdorf, Germany, and the next, he is the “agony of defeat” as he crashes out of control off the side of the ramp and into the crowd. His fall became the yang as part of the opening sequence of ABC’s Wide World of Sports, to the ying of the “thrill of victory”. His was a reminder that bad things can happen to elite athletes and that their misfortune can be used to teach medicine to the sports fan. This week brings the opportunity to learn too many lessons.

Orthopedics: Tony Stewart fractured his tibia and fibula and required emergent surgery. His injury occurred driving in a sprint car race in Iowa. Lessons: Fractured, broken, cracked, all mean the same thing, that the integrity of the one has been compromised. Urgent surgery is often required if the fracture is open, meaning that the skin overlying the injury is broken, and there is potential for infection to enter the damaged bone. Surgery may be required if the fracture is unstable and cannot be held in place with a cast or splint, or if there is has been damage to nearby arteries or nerves. Sometimes surgery has to be delayed if there is so much swelling that if the surgeon cut into the skin to fix the fracture, the skin would not be able to be closed at the end of surgery.

Parkinsonism: Dave Parker, former Pittsburgh Pirate star revealed this week that he had been diagnosed with Parkinson’s disease 18 months ago. He has been dealing with the tremors and according to the team spokesperson, has good days and bad. Parkinson’s disease affects the production of dopamine in the brain, one of the chemicals that act as a neurotransmitter. Symptoms begin with mild tremors but may eventually progress to rigidity, slowness of movement and walking disturbance. In advanced disease, thought processes may be affected, potentially leading to dementia. Actor Michael J. Fox has been a vocal advocate and educator about the disease. The disease cannot be cured but symptoms may be controlled with medication and on occasion surgery.

Leukemia: Shawn Burr retired from the NHL after almost 900 games and moved back to Michigan, where he was an integral part of the hockey community, president of the Port Huron Icehawks, as well as the Detroit Red Wing Alumni Association. In 2011, he developed acute myelogenous leukemia (AML), completed chemotherapy but the disease returned a year later. Mr. Burr passed away this week, after a brain injury due to a fall. AML is a cancer of the myeloid cells of the bone marrow. These precursors of white blood cells fail to develop into normal cells, proliferate and take up space in the bone marrow so that normal red cells, white cells and platelets are crowded out. Initial symptoms may be associated with the lack of these cells. Decreased red blood cells or anemia can cause weakness, fatigue and shortness of breath. Neutropenia or low white cells can present as fevers or recurrent infection. Thrombocytopenia, or low platelet count, can cause easy bruising and bleeding. The diagnosis is suspected on a CBC blood test but confirmed by bone marrow biopsy. Treatment often begins with chemotherapy but may patients who relapse may require stem cell transplantation or immunotherapy. There are different genetic mutations that cause AML and each has a different prognosis, with 5 year survival rates ranging from 70% to 15%.

Drunk driving: The NFL is trying to teach its players that drinking and driving is not acceptable but the details of education, rehabilitation and suspension have to be worked out with the players union. It has not been a good summer for the NFL PR department. Lion, Seahawk, Bronco and Patriot payers have been arrested for DUI. It’s not just the players but the front office that can be an embarrassment to a team and a danger to the community. Two Denver Bronco executives were arrested while drinking and driving. For the first time in forever, the number of people killed per year in drunk driving crashes fell below the 10,000 mark (9,878) but not for lack of trying. According to the CDC, adults drank too much and got behind the wheel an average of 300,000 times per day or 112 million times per year. While the behavior of an NFL player may be no different than the rest of the population, being a role model should be part of the job description.

Performance enhancing drugs: Too much time has been wasted on those who choose to risk their bodies for the glory and riches that come to those who can run faster or jump higher.

Next week’s lesson: Football has always been a sport of attrition and this week’s training camps have been filled with sprains, strains and head injuries. This week has not been kind to Green Bay Packer receivers. Jordy Nelson underwent a knee “procedure”, Charles Johnson has damaged his knee and Randall Cobb hurt his bicep. Only the strong and lucky survive to the next practice or next game.

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