Testicular cancer among athletes raises awareness of the disease

Earlier this month, Olympic swimmer Eric Shanteau decided to defer treatment for testicular cancer until after his Olympic competition. Although no one can put themselves in another’s position, the ramifications of this decision could not be greater.

Shanteau’s delay could be life-threatening.

Several other well known athletes have fought testicular cancer, among them Mike Lowell, John Kruk, and Lance Armstrong. Fortunately, these three received treatment and were able to return to their sport, often reaching higher goals than in their pre-cancer careers.

Cancer of the testicles is rarely mentioned in public. In fact, Chicago Bears player Brian Piccolo, whose death became the subject of a popular book as well as the movie “Brian’s Song,” died after testicular cancer spread to his lungs. The movie never mentions the word “testicular.”

It is past time to put embarrassment aside and have a frank discussion about this serious topic.

Thankfully, open dialogue has aided in the tremendous strides made in fighting breast cancer in women of all ages. Breast self-examination has had a dramatic impact on early treatment and cure. The many displays of breast cancer awareness in the form of pink ribbons, charity walks, and other fundraisers have positively impacted this effort.

The statistics are astounding. Testicular cancer is the most common cancer in men between the ages of 15 and 34. Eight thousand new cases are reported each year. It is one of the most highly curable cancers, but can rapidly spread to the lymph nodes, lungs, bones, liver, and brain. This invasion of cancer cells dramatically increases the difficulty of achieving a cure.

There are two types of testicular cancer:

• Seminoma-this can occur in all age groups. It is the less aggressive of the two types and is more sensitive to radiation.
• Non-Seminoma-this is also called a “germ cell tumor.” It grows and spreads rapidly. This tumor is less sensitive to radiation and often requires chemotherapy.

Parents must be vigilant because the group with the highest risk of testicular cancer is children born with cryptorchid or undescended testes. These infants are at a significantly greater risk of developing testicular cancer later in life.

The only way to know the cell type of the tumor is by removal of the testicle (orchiectomy). This procedure is not only diagnostic but also therapeutic since the cancer source is removed. It allows oncologists (cancer specialists) to establish a treatment plan to attack the cancer.

Dr. George Bosl, Chairman of the Department of Medicine at Sloan-Kettering Memorial Cancer Center, is a medical oncologist and considered among the world’s experts in the treatment of testicular cancers. Although the overall cure rate for testicular cancer is 90%, Dr. Bosl references an article he published in a medical journal noting that after two months, the cure rate drops to 80% in non-seminomas.

“Men who note pain, swelling, or a nodule in a testis should get to a physician immediately,” Dr. Bosl urged. Self-examination is the best simple and direct way men can notice early testicular abnormalities.

Monthly testicular self-examination should include the following steps:

1. Perform the exam after a warm bath or shower, allowing the scrotum to relax and permitting a more thorough exam.
2. Stand in front of a mirror to look for swelling of the scrotum.
3. Roll each testicle with the index and middle digits on one side and the thumb on the other.
4. Make note of any palpable masses and report these to your doctor.

A physician will repeat the exam in the office and most likely order an ultrasound of the testicles. This test is not invasive and not painful. It gives a clear image of the testicle and determines if surgery is indicated.

Headline articles often prompt readers to personalize decisions made by those involved in the story. While many observers and medical experts doubt the wisdom of Shanteau’s decision to delay performance of a crucial diagnostic procedure, all support his quest for Olympic gold and, more importantly, the health battle ahead.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org. If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at www.backushospital.org.

Proceed with caution when working out in the summer heat

During mid-summer, athletes throughout most of the United States face the challenge of keeping up with their outdoor workout routines despite high temperatures and humidity.

Normally the skin, blood vessels, and sweat glands work together as a cooling system. The heart serves as a circulatory pump. In extreme heat, blood vessels direct more blood flow to the skin where cooling takes place. This diverts circulation from muscles and leads to muscle cramps – an early sign of heat illness. Anytime ambient conditions reach 70% humidity and 70 degrees simultaneously, this system is at risk to fail.

The dangers of heat-related illness, such as heat exhaustion and heat stroke, include permanent neurologic impairment, heart attack, and death.

Symptoms of heat exhaustion include:
• Heavy sweating; cold, clammy skin
• Dizziness or fainting
• Muscle cramps
• Fast, shallow breathing

Symptoms of heat stroke include:
• Warm, dry skin; no sweating
• Confusion or loss of consciousness
• High fever
• Throbbing headaches

Nausea and vomiting are early symptoms of both conditions.

Potential catastrophe can be avoided by not working out during the hottest part of the day; wearing lightweight clothing that keeps moisture away from the skin and drinking plenty of fluids before, during and after working out.

Some innovative methods of keeping cool during competition include the use of a cooling vest. This was originally developed for Olympic athletes participating in the 2004 games in Greece where average temperatures exceeded 90 degrees. Athletes put on a vest that contains a gel material that is pre-cooled. It is worn until the time of competition. Consider it the opposite of “warm-up.”

Some athletes immerse their hands in buckets of cold water to cool the circulating blood. Wristbands containing a cooling substance are also effective.

Hot, humid weather should not halt your exercise regimen, but it is wise to proceed with caution.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org. If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at www.backushospital.org.

Tennis injuries can be avoided with proper training

Tennis is regarded as a year-round sport for those fortunate enough to live in a region with a moderate climate or to have access to an indoor facility.

Another group of tennis players has a short season extending from Wimbledon to the U.S. Open. Interestingly, both groups are susceptible to different types of afflictions.

Injuries associated with tennis are divided into chronic and acute types. Chronic injuries are those resulting from longstanding overuse while acute injuries are sudden and short-lived. Many of these injuries can be avoided with proper training, stretching, and technique.

Cardiovascular fitness is essential before participating in any vigorous activity. Warm-up exercises and starting off with a slow, deliberate stroke will increase circulation to muscles.

A classification of common medical problems associated with tennis would include:

• Upper extremities: The shoulder, elbow, and wrist are most susceptible to chronic overuse given the nature of the sport. Since the rotator cuff is responsible for stabilizing the shoulder, a tennis serve can lead to a tear or impingement when executed poorly. Shoulder problems typically develop when the shoulder is lifted to a 90-degree angle. Increasing the angle between the shoulder and torso will minimize the chance of injury.

Tennis elbow, acute inflammation of the outer surface of the elbow, is caused by strain during the backhand stroke. A two-handed backhand stroke is helpful.

Wrist injuries occur when a player snaps the wrist to put spin on the ball.

• Lower extremities: Tennis involves a lot of stop-and-go activity that can stress the ligaments that hold the knee in place. This varies with the playing surface. Reports show fewer knee injuries when playing on clay as opposed to a hard surface. Ankle sprains are a common acute injury due to sudden changes in direction.

• Lower back: Constant bending and twisting is part of the sport of tennis. This activity leads to severe strain of muscles and ligaments which support the lower spine. Repeated injury can lead to tiny stress fractures of the vertebrae.

Tennis is a superb sport requiring much skill, strategy, and fitness. As time goes by, many players often transition from competitive singles to social doubles.

Sometimes the next step is golf.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org. If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at www.backushospital.org.

Create your own ‘triathlon’

Since ancient times, multi-sport athletes have always been considered superior in terms of overall fitness. This sentiment has continued to the modern Olympics, where the decathlon champion is considered the world’s greatest athlete. The decathlon consists of 10 track and field events completed over a period of two days.

Cross training brings together a workout where athletes use multiple sports to achieve a higher level of fitness. Many participate in triathlons. Recently made popular by the Hawaiian Ironman event, triathlons consist of various combinations of swimming, cycling and running. The ironman distances include a 2.4-mile swim, 112-mile bike, and 26.2-mile run. In an effort to gain more participation, many shorter variations of triathlons have been established.

Swimming is always the first competition since exhaustion during the swim can lead to catastrophe. This event is held in open water where water temperature, waves and limited visibility are obstacles. Wet suits are often used for warmth.

The bike portion can be grueling and is the only event which depends not only on fitness, but the quality of equipment. A mechanical breakdown will really leave a participant behind. The running segment is last and is always the true test of endurance.

Triathlons are a great way to incorporate three cross training sports into anyone’s workout. There are no rules regarding which three sports must be used to create a friendly competition, or to just challenge yourself.

Try choosing three events you most enjoy. These sports may change with the season, using all indoor sports during winter (stationary bike, treadmill, and rower) or a combination of indoor and outdoor events in summer (running or walking, swimming, and rollerblading). The events should use different muscle groups. Work on at least one different segment each day and if possible try two. Allocate enough time to go through all three events during one long workout each week and keep track of time and distance.

Creating your own triathlon will add variation to your exercise routine and help limit overuse of certain muscles, while eliminating potential boredom.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. He can be emailed at aalessi@wwbh.org. You can listen to a podcast of this column at www.backushospital.org.