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.

Genomics could hold the key to improved athletic performance


Genomics is a scientific discipline that may have significant impact on the future of athletics at all levels.

The human body consists of approximately 50 trillion cells.  Each cell contains a nucleus with 46 pairs of chromosomes.  Half of these are maternal, the other half paternal.  Chromosomes are made of DNA and a gene is a distinct section of DNA that determines particular characteristics such as hair color, height and eye color.  Some genes increase the likelihood of developing diseases like cancer, hemophilia and Alzheimer’s.

The human genome is the complete set of genetic information for humans.  Mapping the human genome remains the “holy grail” of genetics.  Caenorhabditis elegans (C. elegans) is a tiny worm.  It is also the first multicellular organism whose entire genome has been mapped. 

Considering it takes only three days to mature from birth to adulthood and the entire lifecycle is only two weeks, C. elegans provides an excellent opportunity for scientific study.  It can be studied under a variety of conditions and cellular damage assessed.  More importantly, these studies can provide a key to how an organism can adapt.

“When dealing with stress, human metabolism must adjust and this results in fatigue and diminished concentration.  Experiments have shown that C. elegans can be acclimated to heat and stress,” states Dr. Elaine Lee, assistant professor of kinesiology at the University of Connecticut and a leading genetics researcher.

Stress includes conditions such as heat, dehydration, illness, infection, inadequate sleep and poor diet.  These can all result in cell damage.  The cumulative effect not only results in poor athletic performance but also leaves athletes vulnerable to more severe injury.

Genomics can lead to information on how organisms adapt to stress.  The correct balance of aerobic and resistive exercise, along with proper diet, can lead to resistance to illness as well as improved athletic performance.

Interestingly, the key to these breakthroughs may depend on genetic studies performed on a worm that is just one millimeter in size.





Professional athletes not immune to strokes

 
A stroke is the result of a blockage or a tear in a blood vessel that brings blood to the brain.  Among the last people expected to suffer a stroke are professional athletes.

On Jan. 29, Kris Letang, a National Hockey League defenseman for the Pittsburgh Penguins, developed unremitting symptoms of dizziness and nausea.  A thorough medical work-up revealed his symptoms to be the result of a stroke.  Further evaluation discovered a patent foramen ovale (PFO).

PFO is a hole between the upper two chambers of the heart called the atria.  The hole is the result of incomplete closure of a wall that forms between these two structures in the developing fetus.  A PFO is estimated to be found in between 25 and 40 percent of adults.

Obviously, not everyone with a PFO suffers a stroke and in fact, there are no typical symptoms of a PFO.  Nevertheless, Kris Letang has joined a growing list of athletes who have suffered strokes associated with a PFO.  Among the most notable members of this group is Teddy Bruschi.

Letang is expected to make a full recovery and return to hockey in six weeks thanks to quick action and his good health. The controversy is whether the PFO should be repaired.

“Studies looked at closure of PFOs as a means of reducing recurrent stroke and it did not make a difference,” states Dr. Anita Kelsey, a cardiologist and director of the Women’s Heart Program at St. Francis Hospital.  These studies compared closure to medical treatment with blood thinners.

Athletes’ hearts undergo large shifts in pressure during competition and workouts.  It is also unwise for contact sports athletes to be on blood thinning medications. These factors favor surgical repair.

In summary, there is no definitive direction for treatment of PFOs in athletes. More detailed studies in this population are necessary.

Dr. Alessi is an on-air contributor for ESPN and can be reached at agalessi@alessimd.com.

Mental training critical for Olympians

Competing at the Olympic level requires superior physical training and skill. Today, mental training has become a huge component in preparing for competition at this level.
One obstacle to performing at the highest level is anxiety. Performance anxiety is the result of a malfunction in a complex neurologic system.
The human brain is organized into two basic structures. The diencephalon is the reflex portion. Some examples of these reflexes include breathing or removing an extremity from a painful surface. The telencephalon is the thinking portion that controls cognitive activity.
The “fight or flight” response is a reflex that includes a wave of adrenaline resulting in increased heart rate, rapid breathing and tremors. This response is typically brought on by fear. When this reflex redirects the thinking portion of the brain, havoc can ensue.
If the “fight or flight” response can be channeled by the cognitive regions, the energy produced can result in a phenomenal performance. It is the goal of sports psychologists to provide the necessary tools for athletes to harness this energy and direct it appropriately.
Similar to physical training, this is accomplished by practice. Mental and physical repetition of a skill or presentation makes the process more automatic and smooth.
A basic approach involves identifying a goal, visualizing the goal and then blocking out distractions.
“The mental side of sport is actually the mental side of preparation. Many athletes work hard but they don’t work with purpose. One principal aspect of sports psychology is learning how to integrate the mental side with physical preparation,” states Dr. Douglas Gardner, a sports psychologist who works with many amateur and professional athletes.
Application of this approach to training for any endeavor can result in new levels of success.

Russian boxer's plight shows dangers of combat sports


Magomed Abdusalamov is a professional heavyweight fighter who has reached the highest level of his sport. On Nov. 2, 2013, two hours after a brutal 10-round decision loss at Madison Square Garden, Abdusalamov became comatose and remains hospitalized.

Combat sports include boxing and a variety of mixed martial arts contests.  Points are usually scored by successfully neurologically impairing an opponent.

Little has been revealed about Abdusalamov’s injuries other than the fact that he suffered a brain hemorrhage.  Based on descriptions, he most likely suffered an epidural hemorrhage.

An epidural hemorrhage often results from tearing the middle meningeal arteries after a skull fracture.  Blunt trauma is the most common cause as opposed to a concussion that is usually caused by rapid acceleration and deceleration of the brain. Headgear is more effective in avoiding skull fractures and hemorrhages than it is in avoiding concussion.

Epidural hemorrhages are arterial in origin and therefore occur quickly and with large volumes of blood making them especially serious if not detected quickly. A typical presentation includes a brief loss of consciousness followed by a lucid period during which the hemorrhage expands.  This is followed by a deep coma.

During the lucid period, there are few findings to raise suspicion of this deadly condition.

Treatment includes removing the blood and part of the skull to allow the brain to swell without causing deadly levels of pressure within the closed cranium.  Patients are often placed in a medically-induced coma to slow brain metabolism and control swelling.

Abdusalamov has now emerged from coma and has hopefully begun the long process of rehabilitation that includes retraining the brain to perform basic functions like speaking and eating.

This tragedy serves as a grim reminder that combat sports are more than the difference between a win or loss but may be life or death.

Vary your workouts to avoid compartment syndrome


The intense feeling of aching pain in a limb during exertion is a common complaint.  When the pain is easily replicated with progressively less exertion, a compartment syndrome should be considered.

A syndrome is a group of symptoms.  In chronic exertional compartment syndrome the pain may be burning or cramping in nature along with tightness, weakness or numbness in the affected limb.  These symptoms typically clear within 30 minutes of rest.

Although most common in the lower extremities and associated with running, it can also affect the upper extremities.

Muscles provide the engine behind motion.  They are fueled by a steady supply of blood and stimulated into action by nerves.  When injured, a muscle will swell and unless the connective tissue that provides an envelope around a muscle expands, pressure will build up within the muscle. The increased pressure can cause nerve damage and muscle breakdown.

Compartment syndrome is most commonly seen in athletes under the age of 30 who participate in sports that involve repetitive impact.  Athletes who use supplements like anabolic steroids or creatine are especially vulnerable.

Adequate warm up, hydration and resting if pain becomes intense are all ways of avoiding this condition.  Varying workouts and the mechanics involved in a particular sport will decrease the repetitive trauma and allow for muscular recovery.

“Symptoms of chronic exertional compartment syndrome may be relieved by decreasing the intensity and impact of training,” said Dr. Giselle Aerni, a sports medicine physician at the University of Connecticut and team physician for the Connecticut Sun.  “If symptoms persist, surgery may be helpful to release the fascia surrounding the muscles to allow more room for swelling,” said Aerni.

If surgery is necessary, it should be carried out by a physician who treats athletes and can help guide the athlete back to safe participation in a particular sport.

Children with ADHD can excel when the right choices are made


Among the most inspiring stories in sports involve those where an athlete is forced to overcome a physical disability.  Special Olympics, Paralympics and other events celebrate these physical challenges.  Unfortunately, athletes who suffer from Attention Deficit Hyperactive Disorder (ADHD) face less obvious obstacles in life and in sports.

ADHD is a chronic condition that includes difficulty maintaining attention, hyperactivity and impulsive behavior. It is believed to affect as many as ten percent of children in the United States.  Although children with ADHD are a major concern, these symptoms may persist into adulthood.

There are varying levels of severity of ADHD.  Some patients require medication while others respond to behavioral therapy alone or a combination of both.

The most effective medications for the treatment of ADHD are psychostimulant medications like Ritalin and Adderall.  These medications serve to balance the concentration of neurotransmitters in the brain.

Sports can play an important role in development.  Physical fitness, team interaction, discipline and strategic planning are all valuable lessons.  Choosing an appropriate sport for a child with ADHD may avoid frustration and anxiety.

High velocity collision sports and combat sports like football and boxing should be avoided.  Recent studies have shown that athletes with ADHD have more severe symptoms and longer recovery periods from concussions.

Sports that rely on individual effort for success are best suited for children with inattention and impulsivity like those who suffer from ADHD.

Swimming, running, gymnastics and tennis demand individualized attention by an athlete.  This allows coaches to modify workouts that will suit each child and create an environment for maximum enjoyment and success.

Judo, karate and other martial arts are among the best activities for children with ADHD.  These sports emphasize coordination, balance and strength.

Organized sports and fitness provide an essential component to child development.  Children with ADHD can excel when the right choices are made.   


Epilepsy can be managed with proper attention to detail


University of Minnesota head football coach Jerry Kill recently had an epileptic seizure on the sideline.  While this isn’t the first time it has happened, it is the first time this event has gained national attention.

The brain consists of a network of nerve cells that function similarly to a mass of electrical wires.  Electrical impulses are the result of changes in the balance of chemical ions along the nerve cells.

A generalized tonic-clonic seizure, previously referred to as grand mal, is an event that results from an abnormal spark along these nerve cells.  This creates a short circuit that spreads across the brain causing muscles throughout the body to contract uncontrollably.

Epilepsy is best defined as a condition of unprovoked recurrent seizures.  It affects 3 million Americans.  Controlling epilepsy is accomplished through the use of medications, lifestyle changes and possibly surgery. 

The human body functions best when it reaches a state where everything is kept constant.  That means eating, sleeping and exercising at the same time every day.  Unfortunately, this presents a great challenge to controlling seizures in patients who have erratic schedules, including athletes and coaches.

The recent episode that involved Jerry Kill drew the attention of the press and fans, but his players and coaches were able to adjust and proceed with the game.  This is due to the fact that he has been open about his condition and prepared them for this situation.

“How can a school continue to employ a football coach who has had four seizures during or after the 16 home games he has coached for the school?” wrote Jim Souhan, a Minneapolis sportswriter.

Souhan’s insensitive comments have raised the attention of many regarding epilepsy in athletes. 

In order to more effectively manage epilepsy, athletes and coaches must carefully monitor workout, sleep and travel schedules.