Diabetes should not derail an athlete's goals

November is Diabetes Awareness Month. Many patient programs are centered on food and medication restrictions. New treatments and a better understanding of this condition have led to increased sports participation.

Approximately 29.1 million people in the United States (~9 per cent of the population) have been diagnosed with diabetes. This represents a rising health problem with significant impact on health care costs.

Diabetes is divided into three types:

• Type 1 or insulin-dependent diabetes is the result of an inability of the pancreas to produce a sufficient amount of insulin. Insulin is a hormone responsible for taking sugar from the bloodsteam and allowing it to enter a cell where it is used for energy.
• Type 2 or non-insulin dependent diabetes is typically due to a resistance of cells to respond to the insulin available.
• Prediabetes or Impaired Glucose Tolerance is a reversible condition where blood sugars are elevated but not to a sufficient level to define the person as diabetic.

The goal of diabetic treatment is to keep the blood sugar at a constant, acceptable level. Establishing this state of euglycemia is much more difficult in a diabetic.

Diet, exercise and medication are the basic approaches to treatment. Increased activity will burn more sugar and therefore lower the insulin demand.

The use of programmable insulin pumps has allowed many athletes to participate at the highest levels of competition. The pump can sense the blood sugar level and release an appropriate amount of insulin.

“I advise patients to just move,” states Dr. Nathan Lassman, Chief of Endocrinology at St. Francis Hospital and Medical Center. “Any activity that a patient enjoys and can perform regularly is a big plus in treating diabetes.” Diabetes should not be a disabling condition for aspiring athletes.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Special Olympics has grown from humble beginnings

At the time of its inception in 1968, Special Olympics was a program designed to provide an athletic outlet for people in the United States who had intellectual disabilities.  It has grown to become one of the largest athletic organizations in the world with over 4.4 million athletes, 1 million coaches and 226 programs in 170 countries.

Special Olympics was started by Eunice Shriver Kennedy and her husband, Sargent Shriver, to address the lack of access to organized sports for people with intellectual disabilities.  Many of the original 1,000 participants suffered from Down’s Syndrome.

In the past, many of these people were isolated from society and often placed in institutions.  This restricted any meaningful physical activity and socialization with peers.

Participants must qualify by being certified by an agency or health professional as having intellectual disabilities, cognitive delays or significant learning or vocational problems.

Special Olympics has grown from summer sports to winter sports with a variety of team competitions.  World games are held every two years and vary between summer and winter venues. 

Unified sports teams consist of participants who have intellectual disabilities with those who do not.  This provides another step toward more inclusive sports participation. There are now half a million participants in unified sports worldwide.

It is clear that periodic training culminating in a single event is not sufficient for athletic fitness.  This has lead to establishing Unified Sports Fitness Clubs where fitness activities are measured and studied.

“The success of Special Olympics over the past 46 years is based on its ability to evolve with the changing needs of intellectually impaired athletes,” states Mr. Beau Doherty, president of Special Olympics Connecticut.

Special Olympics has become part of the fabric of worldwide sports by including athletes who were previously excluded.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN.  He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Athletic activity avoids fractures

Physical activity in children has many benefits including cardiovascular conditioning, muscular development and socialization skills.  A recent study demonstrates fewer fractures in active children.

Bone development begins during the third month of fetal development but is not complete until adolescence.  Cartilage serves as the scaffolding necessary for the deposition of layers of minerals that will eventually form bones. This process is known as ossification.

The principal cells involved in the ossification process are osteoblasts.  These cells are responsible for laying the groundwork and creating ossification centers that will eventually expand and replace cartilage.  Long bones such as the femur and humerus require more time to fully mature.

The process of bone formation and remodeling doesn’t end in adolescence.  As patients get older, bones will remodel based on responses to pressure.  This same hydrostatic pressure stimulates new bone growth and repair of fractured bones.

Osteoporosis is a weakening of the bone structure as a result of demineralization of bone that often occurs with poor nutrition and age.

The study cited above looked at two groups of children.  The first group had 40 minutes of moderate physical activity daily as part of their school curriculum while the second group had only 60 minutes per week of activity.  After eight years of study, the first group showed less risk of fracture.

Additional studies on these children measured bone mass.  These reports showed greater bone mineral density in the active group and subsequently less chance of developing osteoporosis.

Approximately one-third of all children will experience a bone fracture before bone growth is complete.  Many school districts have cut back on time dedicated to physical activity during the school day for economic and academic reasons.

Increasing active playtime in elementary schools may have a huge impact on future health care costs.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN.  He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Chocolate milk: The next great recovery drink

Sports nutrition is an industry that has experienced steady growth since Gatorade first came into use in the 1960s. Some teams have now rediscovered the benefits of chocolate milk as part of an athlete’s dietary regimen.

Most successful athletes and teams have specific nutritional plans formulated by dietitians, strength and conditioning coaches and a variety of other consultants. Typically there are pre-performance, performance and post-performance elements. The post-performance nourishment has become known as the recovery phase.

Each segment has a specific goal regarding replacement of fluids, electrolytes, fats, proteins and carbohydrates. Recovery supplements are specifically focused on rebuilding muscle. “The best options for a recovery snack are those that provide carbohydrates to replenish glycogen lost in muscles as well as protein and amino acids,” states Carrie Taylor, a registered dietitian from Big Y Foods.

“The recommended carbohydrate-to-protein ratio falls between 3:1 and 4:1. A glass of chocolate milk is ideal by providing a ratio of 3.5:1.”

More recently, several college and professional sports teams have begun to follow this trend by providing easy access to chillers that dispense chocolate milk. Locally, the Coast Guard Academy has also advocated for its athletes to use chocolate milk for recovery.

This trend has not been lost on dairy farmers. The Farmer’s Cow is a group of six family-owned dairy farms that have supported this movement by becoming involved in many athletic events throughout the region.

“The Farmer’s Cow Chocolate Milk combines 1 percent chocolate milk that is free of artificial hormones with calcium, vitamin D and protein,” according to Robin Chesmer its managing partner.

Chocolate milk can provide a less expensive and equally beneficial alternative to specialty bars and shakes.  

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Severity of spinal fractures can vary

Spinal fractures are among the most variable injuries in sports. Based on the location and type, they can result in death or a minor setback. Fortunately, Baylor quarterback Bryce Petty will only face a short layoff after fracturing his spine last week.

The spinal cord is the network of nerves that runs from the brain to the peripheral nerves that communicate impulses to the muscles in the limbs and vital organs. This crucial network is protected by the bony spinal column.

The spinal column is made up of a series of 33 vertebrae separated by cartilaginous discs. The cervical, thoracic and lumbar levels serve different regions of the body. The discs provide cushioning between the bones that allow the body to twist and bend.

A vertebra consists of three principal parts. The body is the weight-bearing surface of the bone. The vertebral arch is a circular structure that surrounds the spinal cord. The processes are protrusions that extend off of the arch and provide a surface for ligamentous attachments.

Trauma is the principal cause of spinal fractures. Sudden downward pressure results in crushing the vertebral body producing a compression fracture or a more serious burst fracture.

Fractures of the spinal processes, similar to the injury suffered by Petty, are often produced by lateral pressure similar to that seen in a violent tackle.

The biggest factor that determines the extent of injury is whether the vertebra becomes dislocated as a result of the fracture. The sudden movements can severely injury the spinal cord or nerve roots.

Barring dislocation, pain is produced from muscular and ligamentous injury that will improve by immobilizing the levels affected. This can be done through an external brace or surgical fusion.

 Spinal fractures can often be treated with prompt care from multiple medical specialists.

Paddleboarding provides core workout

One of the newest water sports devices that is rapidly growing in popularity is the stand-up paddle board. This device can now be seen on many calm, protected bodies of water. 

Typical dimensions are 12 feet long and 31 inches wide with a weight of about 30 pounds. These boards are surprisingly stable and can support up to 275 pounds.

The fitness aspect includes using core muscles to generate power and maintain balance. Core muscles include lower abdominal muscles that run from the lower rib cage to the pelvis. Low back muscles and ligaments that support the spine are also crucial to providing stability.

Upper leg muscles deliver strength to the hips and are involved in stabilizing the torso during lateral movements.

Muscles throughout the upper extremities from the shoulders to the hands are important for paddling. Although paddleboarding is typically performed on calm bodies of water, any waves or swift currents can quickly increase the intensity of a paddling workout.

Among the greatest health risks the elderly face are falls. This problem is sometimes a result of poor balance and an inability to recover quickly. Paddleboarding and other activities that demand good balance can develop skills that may avoid these dangers in the future. Interestingly, some paddleboarders have incorporated yoga exercises while paddleboarding.

Stretching is always advised before any athletic activity and paddleboarding is no exception. Like kayaks and windsurfers, paddleboards are water vessels and a personal flotation device should always be worn.

In addition to the fitness aspects of paddleboarding, many have been drawn to this activity for its peaceful nature and opportunity to relax.

Paddleboarding presents an opportunity for people with average athletic skills to engage in a new activity.

Foot care integral to athletic success

Among the physical obstacles athletes can face are conditions that affect the feet. Many of these problems can be avoided with good preventive care.

Some common injuries such as sprains, strains and fractures result in painful movement and swelling. These conditions trigger an inflammatory response that will often prohibit further activity and may require a long layoff from a chosen activity.

Another group of conditions that specifically affect the skin, soft tissues and nails may not prohibit activity but can impede optimal performance. Surprisingly, many of these problems are avoidable.
Athlete’s foot is the result of a fungal infection that typically begins in the web area between the toes. A warm, dark, humid environment is a perfect setting for a fungal infection.

Blisters occur with friction from ill-fitting shoes. The inflamed area can easily breakdown and become infected with a variety of organisms. These are particularly dangerous in athletes with diabetes who may have impaired circulation.

When toenails grow into the fleshy borders of the nails they become ingrown and can be a painful site of infection. The toenails are also potential areas for fungal infection, creating a condition known as onchomycosis.

Many of these problems can be avoided through regular inspection of the feet and proper trimming of the nails. Professional foot care may be necessary.

Drs. Karla and Michael Scanlon, podiatrists from eastern Connecticut, offer advice for optimal foot health. After events, wash and dry feet thoroughly and allow sneakers to air-dry completely. Use moisture-wicking socks and change them when damp. Always wear shower shoes when using a public facility. Use Lysol liberally on them and other athletic footwear at least once weekly.

Practicing good foot hygiene can keep athletes performing at their best.

Keep active to ward off fibromyositis

Fibromyositis is a medical term used to describe chronic inflammation of muscles and connective tissue.  It often results in joint stiffness and intense muscle pain.  An unlikely, but effective treatment for this condition is exercise.

Currently, fibromyositis is used interchangeably with a common and equally debilitating condition known as fibromyalgia.  This latter problem is estimated to affect five million Americans.

Similar symptoms of widespread pain and fatigue are found in both conditions but additional symptoms of sleep disturbances and psychological distress are more profound in fibromyalgia.

Fatigue is a big factor in both conditions. The fatigue is most likely related to the increased exertion required to perform even simple tasks and a disturbance in sleep patterns. This can lead to profound depression.

Non-narcotic medications such as anti-inflammatory medications and anti-seizure drugs have been used successfully. Antidepressants have the advantage of providing pain relief and improving a patient's spirits. It must be emphasized that narcotic drugs should never be used for chronic pain.

Regular exercise provides an interesting adjunctive therapy to medications. Multiple studies have demonstrated that moderately intense aerobic exercise can improve pain thresholds.

A typical regimen should include adequate stretching and a program such as low-impact aerobic dance, tai chi or an aquatic exercise.  Light resistive exercises are also helpful.   Any program should be adjusted to the patient’s pain tolerance to assure adherence to the program.

"I believe exercise programs are beneficial because they help to develop better coping skills to deal with the condition,” states Norwich rheumatologist, Dr. Harjinder Chowdhary, who treats many patients with fibromyalgia. “This may be related to a release of naturally-present brain chemicals known as endorphins that can reduce pain.".

A regular exercise program will build stamina and improve any person's physical appearance despite the presence of a chronic painful condition. 

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN.  He can be reached at agalessi@alessimd.com.

Effects of head trauma can be felt beyond just football, boxing

Pat Grange was a healthy 27-year-old soccer player in 2010 when he was diagnosed with Amyotrophic Lateral Sclerosis (ALS) also known as Lou Gehrig’s disease.  He passed away two years later.

ALS is a neurodegenerative disease that affects motor nerves at their origin in the spinal cord.  It results in profound muscle wasting and loss of motor function.  Its victims lose their ability to speak and breathe.  ALS does not affect sensory function or the ability to think clearly.

Pat Grange’s situation was unique.  He was much younger than the average patient with ALS and he had suffered repeated head trauma in the form of heading the soccer ball.  A previous study of Italian soccer players showed that they were six times more likely to develop ALS than the normal population.  

Grange’s family generously donated his brain for study to investigate a potential link between repeated head trauma and degeneration of the nervous system that appears in the form of chronic traumatic encephalopathy (CTE).  Researchers reported that based on the study of Grange’s brain there was a link.

The hallmark of CTE is the deposition of a  protein in  specific areas of the brain along with brain atrophy.  It has been most widely reported in football players and other athletes who play violent collision sports. 

At this time, the diagnosis of CTE can only be made after a person’s death.  The finding of CTE in Pat Grange is the first time it has been described in a soccer player.

Although some members of the scientific community have speculated that there is a link between heading the ball and ALS, many believe it is a premature conclusion. 

Repeated blows to the head will result in chronic symptoms and should be discouraged, especially in young athletes, but any link between heading and CTE will require more study. 

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN.  He can be reached at agalessi@alessimd.com

NFL trust looks out for former players

Approximately 20,000 athletes have played in the NFL since its inception.  Despite this relatively small number, many of these men are among the most severely injured in sports.

Football is a high-velocity, collision sport.  Success is based on the ability to resist injury and tolerate pain.  Many of the injuries incurred while playing become chronic and lead to lifelong debility.  Although many injuries are orthopedic, an increasing number of traumatic brain injuries and psychiatric problems are emerging.

Sadly, little has been done to support these former football players and their families.  Some have moved into other professions that provide health benefits.  Others have been left to find entitlement programs where health care is limited and preventive care is non-existent.

Fortunately, in the most recent collective bargaining agreement, active NFL players negotiated for approximately $200 million to be set aside for the ongoing health care of former players.  The program through which this is administered, currently known as “The Trust,” has become much more than a health program.

“The Trust is a set of resources, programs and services designed to provide former players with the support, skills and tools to help ensure success off the field and in life after football,” states Bahati VanPelt, executive director of The Trust.

The Trust consists of six pillars that address brain and body, career, education, finances, personal interaction and lifestyle.  The brain and body pillar utilizes national health centers at the Cleveland Clinic, Tulane University and the University of North Carolina.

“I received the most comprehensive medical evaluation I have had since playing in the NFL,” reports former player, Bernard Whittington.

The Trust is a unique program.  Establishing a system of care for former players by active players sends an important message to skeptical sports fans that it’s not always about the money.