Scary Sickle Cell

Living at altitude there are some things that you become hyper aware about. One of the more obvious things is the lack of oxygen in the air. When it comes to athletics there are a few advantages but many disadvantages to the limited O2. Having played and watched sports at the mile high level for many years you start to become in tune to ailments or conditions that might worsen because of the high altitude. One of those conditions that you definitely need to be aware of is Sickle Cell Anemia and Sickle Cell Anemia Trait. The National Athletic Trainer’s Association defines Sickle Cell Anemia Trait in their position statement as the inheritance of one gene for sickle hemoglobin and one for normal hemoglobin. Hemoglobin is a protein in the red blood cells that transports oxygen. In times of extreme exertion or exercise the sickle hemoglobin will cause the red blood cell to shrink into a quarter or half-moon shape. This greatly affects the body’s oxygen levels. The sickle cells also causes blockages in vessels because the cells catch on each other and cannot move freely.

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Sickle cell is a genetic adaptation and  it is common in people whose origin is from areas where malaria is widespread. Just carrying one of the sickle-cell genes could defend off malaria (NATA Position Statement). 1 in 12 African-Americans posses the trait. It is good to take note that the trait is also seen in Mediterranean, Middle Eastern, Indian, Caribbean and South and Central American descendents.

Some startling stats about sickle-cell:

  • In the past four decades, exertional sickling has killed at least 15 football players.
  • In the past seven years alone, sickling has killed nine athletes:
    • Five college football players in training,
    • Two high school athletes
    • Two 12-year-old boys training for football
  • Of 136 sudden, non-traumatic sports deaths in high school and college athletes over a decade, seven (5%) were from exertional sickling

(http://ksi.uconn.edu/emergency-conditions/exertional-sickling/)

So what are some signs and symptoms of a sickle-cell attack:

  • Cramping muscle weakness that exceeds muscle pain 
  • Athlete “slumps” to the ground rather than a sudden collapse (Rules out cardiac)
  • Able to speak (Rules out cardiac)
  • Muscles look and feel normal (rules out heat cramps)
  • Rapid breathing, but pulmonary exam reveals normal air movement (rules out asthma)
  • Rectal temperature less than 103oF (rule out heat stroke)

(http://ksi.uconn.edu/emergency-conditions/exertional-sickling/)

Ways to avoid a sickle-cell attack:

  • Build up slowly in training with paced progressions,
  • Allow longer periods of rest and recovery between repetitions.
  •  Encourage participation in preseason strength and conditioning programs
  • Athletes with sickle-cell trait should be excluded from participation in performance tests such as mile runs, serial sprints, etc., as several deaths have occurred from participation in this setting.
  • Stop any activity with onset of symptoms [muscle ‘cramping’, pain, swelling, weakness, tenderness; inability to “catch breath”, fatigue].
  •  Athletes with sickle-cell trait who perform repetitive high-speed sprints and/or interval training that induces high levels of lactic acid should be allowed extended recovery between repetitions
  • Ambient heat stress, dehydration, asthma, illness, and altitude predispose the athlete with sickle trait to an onset of crisis in physical exertion.
  •  Emphasize hydration
  • Control asthma
  • No workout if an athlete with sickle trait is ill
  • Watch closely the athlete with sickle-cell trait who is new to altitude.
  • Modify training and have supplemental oxygen available for competitions
  • Educate to create an environment that encourages athletes with sickle-cell trait to report any symptoms immediately;
  • Any signs or symptoms such as fatigue, difficulty breathing, leg or low back pain, or leg or low back cramping in an athlete with sickle-cell trait should be assumed to be sickling

(http://ksi.uconn.edu/emergency-conditions/exertional-sickling/)

** THIS IS A MEDICAL EMERGENCY!**

How to treat a sickle-cell attack:

  • Check vital signs.
  • Administer high-flow oxygen, 15 lpm (if available),
  • Cool the athlete, if necessary.
  • Call 911, attach an AED, start an IV, and get the athlete to the hospital fast.
  • Tell the doctors to expect explosive rhabdomyolysis and grave metabolic complications.
  • Proactively prepare by having an Emergency Action Plan and appropriate emergency equipment for all practices and competitions.

Sickle cell anemia is a very serious condition and needs to be treated as soon as possible! The good thing about this disease is that it is easily screened for and once the proper people are aware of the condition it can definitely be well managed! Be aware and get screened!

Orange Crushing Cam

NFL: Carolina Panthers at Denver Broncos

I am a Colorado native and have grown up cheering hard for the Denver Broncos. The NFL season opener kicked off last Thursday night (9/8/16) with a rematch of last year’s Superbowl contenders; the world champion Denver Broncos vs. the Carolina Panthers! It was a great season opener as each team battled back and forth for the lead. Ultimately the Broncos prevailed to a 21-20 victory! Go team!

However the much anticipated win was soon flooded with controversy concerning the barbaric punishment Cam Newton (Carolina’s Quarterback) faced from Denver’s defense, and the lack of medical attention he received throughout the game concerning the head to head blows. Numerous questions were and still are being raised about not only Carolina’s medical staff but how the trained NFL spotter (whose only job is to watch for players who might have sustained a concussion) failed to act accordingly! Was the team’s potential victory worth more than the health and safety of one their athletes?

A concussion is considered to be a traumatic brain injury. It can greatly alter someone’s orientation and they do not have to lose consciousness in order for it to be diagnosed as a concussion. One of the main mechanisms of injury for a concussion includes a direct impact or blow to the head. Concussions have been an extremely hot topic over the past 15 years. The medical world has learned so much in regards to diagnosing, treating, and the lifelong impacts of multiple sustained concussions.

A study conducted by Kevin Guskiewicz who is renown concussion expert from the University of North Carolina looked at thousands of retired professional NFL players who sustained concussions during their career and their quality of life after retiring. Of the 2,000+ players he researched he concluded that 61% had sustained at least one concussion and 24%  had sustained 3 or more concussions! He also noted that in the players who had 3 or more concussions they reported 5 times as higher as being diagnosed with mild cognitive impairment.They also had a 3 times higher incidence of self reported memory problems compared those players who did not sustain concussions. Guskiewicz concluded that an early on set of dementia symptoms might be initiated by repeated concussions sustained in the National Football League.

For more information here is a LINK to Guskiewicz’s article from Neurosurgery 

Concussions are an extremely hot topic right now and I am glad the NFL is beginning to take steps to protect their players. However, I believe it is inexcusable to allow a players health to be compromised because of who they are or how close the game is when a victory is on the line. I am glad the NFL is taking action to review these hits and Go Broncos!

UPDATE: Since the conclusion of the game Thursday night numerous media outlets and articles have been composed calling out the lack of medical attention Cam Newton received in regards to all of the head hits he sustained. An article from The Denver Post states that “both the NFL and the NFL players association are going to investigate the implementation of the concussion protocol” (http://www.denverpost.com/2016/09/11/panthers-cam-newton-hits-broncos-investigate/). There were four hits that were aimed at Newton’s head, and only one hit was penalized. The NFL has since determined that two of those hits were bad enough to sustain fines. Brandon Marshall was fined $24,000 where as Darian Stewart received an  $18,000 fine.