medical stuff we learn from the sports world

Monday, June 16, 2014

Medical stuff we might learn this week from the sports world:

How amazed are we about Erik Compton. Before this week, most pro golfers knew of his tenacity to make it on the PGA Tour and perhaps a few dedicated fans knew his name, but after his second place finish in the US Open at Pinehurst, the world should beat a path to his door to learn of the physical and emotional strength required to overcome adversity. At age 12, Mr. Compton required a heart transplant because he had developed cardiomyopathy, a condition where the heart muscle does not squeeze enough to supply oxygen rich blood to the body. Medications can help temporize but eventually, a new heart was needed. 6 years later, he reigned as the top junior player in the country and began his rise up the college and pro ranks. At age 28, his golf career was derailed again because of a second heart transplant, and now at age 34, he has qualified for another year on the pro tour and a starting time at the Masters.

The most common cause of cardiomyopathy in kids is idiopathic, meaning that in two thirds of cases, nobody knows. For the other third, myocarditis, an inflammation of the heart muscle and familial inherited diseases are the most common causes of this rare disease (less than one kid in 100,000). There are different types of cardiomyopathy and some children can lead relatively normal lives with treatment, while others deteriorate, leaving their only hope as heart transplant. The challenge facing these kids, including the 12 year old Mr. Compton, is that the one year survival rate after heart transplant is about 80%.


Jozy Altidore damaged his hamstring. Matt Besler tweaked his. Alejandro Bedoya cramped up. The body was not designed to exert itself in a high temperature, high humidity environment. The body cools itself by sweating, but if the air is already holding as much water as it can (high relative humidity), sweat doesn’t evaporate and body cooling fails. Increased sweating leads to dehydration and the combination of loss of body water and rising temperatures results in heat cramps and heart exhaustion. Foundry and construction workers, roofers and bakers can also get into trouble if the temperature is too high and not enough air circulates to allow sweat to evaporate. The US soccer team was given a pass by public opinion as they won their game against Ghana. LeBron James was not so lucky.


Tony Gwynn passed away, succumbing to salivary gland cancer. News articles will no doubt comment upon his tobacco chewing as a potential cause and this is not to give tobacco companies a free pass, but their product has not been associated with causing this type of cancer. Chewing tobacco increases the risk of other cancers of the mouth and tongue, but salivary gland cancers are more likely associated with things out of the patient’s control: old age, being male, family history and being exposed to medical radiation. This type of cancer is relatively rare, making up less than1% of cancers in the United States. Survival depends upon how early the cancer is found, smaller is always better, as is lack of spread. Still even the smallest cancers that haven’t spread, still have only a 90% survival rate after 5 years. That seems like a lot, unless you happen to be one of the unlucky 10%. Statistics are sometimes less than helpful in medicine. They describes what happens to population as a whole and can offer some guidance, but when it comes to the individual patient, they either 100% live or 100% die. May Mr. Gwynn rest in peace.


And finally, how the media affects medicine: the first pick in the NFL draft, Jadaveon Clowney, is recovering from surgery to repair a sports hernia. It seems pretty simple, except that there is no such thing as a sports hernia. The term has made its way into the medical literature after being propagated by the media. There are a variety of structures that make up the floor of the inguinal canal, where hernias do occur, and any of those structures can become inflamed or damaged, leading to lower abdominal pain. The specific cause may not be known and non-surgical treatment includes rest, physical therapy and anti-inflammatory medications. If that fails, surgery may be considered and only when the surgeon is inside the area may the actual diagnosis be made. The injury may occur to one of many structures: a torn external oblique or internal oblique muscle insertion into the pubic bone, a transversalis fascia tear, a conjoint tendon tear, inflammation of the pubic symphysis and more. The anatomy is complicated and every strand of tissue is a potential target to fail. The “official” medical term is athletic pubalgia (pubic + algia=pain)…or you can call it a sports hernia. As for Mr. Clowney, he is expected to recover in time for training camp in July. The textbooks say that it takes 6-12 weeks and more than 90% of players will return to form. But you know what they say about statistics.

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