Adderall creeping further and further into athletics

Adderall is a stimulant medication prescribed by physicians to treat Attention Deficit Hyperactive Disorder (ADHD).  It has also become a popular “performance-enhancing drug” used by athletes.

ADHD is a behavioral disorder consisting of an inability to maintain attention along with features of hyperactivity and impulsivity.  It is typically seen in both boys and girls under the age of 7 but symptoms can persist into adulthood.  It affects approximately 8% of children.

Adults with ADHD typically have difficulty remembering information, completing tasks and concentrating.

There is no specific test for ADHD.  The diagnosis is primarily based on observing a child’s behavior or extensive neuropsychological testing in adults. 

The treatment principally consists of stimulant medications that can improve the ability to remain focused.  The dosage must be carefully adjusted based on symptoms and the response to therapy.

Adderall (dextroamphetamine-amphetamine) is the principal drug used to treat ADHD.  It is a potent stimulant that can cause increased blood pressure, rapid heart rate and seizures.  It has become an attractive performance-enhancing drug for athletes due to its ability to fight fatigue and improve concentration.

Non-prescription use of Adderall has increased recently among high school and college students to enhance academic performance.

The challenge for sports organizations like the NCAA, NFL and MLB is deciding which players have a legitimate reason for using Adderall.  Like other medications, an athlete can apply for a Therapeutic Use Exemption (TUE).

 “ADHD is overwhelmingly the most common diagnosis associated with TUEs in Major League Baseball,” said Dr. Jeffrey Anderson, Director of Sports Medicine at the University of Connecticut.  He also serves as the Independent Program Administrator for MLB’s Drug Prevention and Treatment Program.  He is responsible for overseeing the 119 TUEs issued by MLB this year of which 116 were for ADHD.

The use of medications to improve athletic performance is a growing problem.  The solution is not in more regulation but increased honesty among athletes.

Youth sports require balance between practice, free play

Over 35 million children in the United States participate in some form of organized sports.  Many parents believe that this is the beginning of a professional athletic career.  Unfortunately, without careful monitoring, it is often the end of a professional sports career.

Youth sports participation can provide a boost to a young athlete’s self-esteem, confidence and discipline.  The ability to work as a team is a skill that leads to lifelong success.

There is an ongoing argument as to whether successful athletes are born or made.  Many believe that continuous practice is crucial, while others believe that success is based on a perfect genetic make up.  Interestingly, both are required to some extent.

The issue of early sport specialization was a recent topic of discussion at the University of Connecticut in a lecture by Dr. John P. DiFiori a sports medicine physician from UCLA.  

Dr. DiFiori discussed the differences between  “deliberate practice” and “deliberate play.” There is a belief that 10,000 hours of practice are required to achieve a sufficient level of skill to be successful at an athletic task. This type of deliberate practice often leads to overuse injuries and limits an athlete’s options to be successful at other sports.

Deliberate play refers to a less organized approach where children are not closely supervised and allowed to be creative.  It is this latter style of play that helped develop many older athletes and is found today in many inner city playgrounds.

During the cold war era, East German Olympic athletes were recruited to sports academies where they trained from a young age.  Interestingly, these young athletes were not allowed to specialize in a particular sport until after the age of 14.  Until then, they played many different sports and were allowed to develop a variety of athletic skills.

The development of a successful, healthy athlete requires a careful balance between random and organized play.    

Pushing intense exercise too far can lead to exertional rhabdomyolysis

Military training is regarded as the optimum test of physical fitness.  New workout programs like Cross-Fit, boot camp, P90X and Insanity strive to emulate that training.  Unfortunately, this intense physical drilling has lead to a variety of injuries that can be avoided with proper precautions.

One prominent and life threatening injury is exertional rhabdomyolysis (ER).  ER is the result of dramatic muscle breakdown allowing release of enzymes into the blood stream.  Once these enzymes reach toxic levels, they lead to renal failure and potential death.

Non-physical causes of ER include drugs, illness and physical compression.  Most cases are the result of a combination of physical and non-physical causes.

In a recent lecture at the University of Connecticut, Dr. Francis O’Connor, a military physician and researcher who has been studying ER for many years, reviewed many of his findings of military recruits and their relevance for all athletes.

Most serious cases of ER are experienced in military recruits during basic training.  This finding relates to the inability of athletes to acclimate to a new level of performance.  Gradually increasing exercise tolerance is crucial.

Intense drilling and the use of exercise and dehydration as punishment is another common factor in patients who experience ER.  Coaches and personal trainers must rethink these time-honored practices of pushing athletes beyond their limits to produce physical “toughness.” 

Underlying illness, most notably influenza, is a common predisposing factor to ER.  The typical aches and pains experienced with the flu is actually a form of muscle inflammation and breakdown.  Attempts to use exercise to alleviate this discomfort only escalate the damage.

Supplements designed to improve athletic performance often contain stimulants like DMAA that increase body temperature and blood pressure.  These supplements also diminish an athlete’s ability to recognize physical limits and allow them to push beyond muscle tolerance.

Intense exercise can improve overall fitness but caution will avoid potential tragedy.

As athletes get larger, focus on spinal injuries grows

Kinetic energy is best defined as “the energy possessed by a body because of its motion.”  This physical principle provides a basis for the excitement and attraction of high-velocity collision sports.  Unfortunately, it may also be the basis for their downfall.

It is no secret that athletes have become larger, stronger and faster over the past decade.  Attending a high school or youth sporting event will provide sufficient proof.

The human body is an efficient and durable machine but the question of whether it can withstand the kinetic forces it is currently subjected to in sports is now in question.  This issue has particular importance regarding the bony vertebrae that protect the spinal cord.

Last week alone, two high-profile football players sustained significant spinal injuries.  Devon Walker, a defensive back for Tulane University, suffered an awkward head-to-head collision while tackling an opponent. This resulted in a fracture of the spinal vertebrae just below the skull in an area known as the cervical spine.

Roger Saffold, a tackle for the St. Louis Rams, was also involved in a head-to-head collision and had to be taken from the field on a stretcher.  Although no fracture was reported in Saffold’s injury, there is concern regarding the potential for further injury.

The spinal cord provides the main link for the nervous system between the brain and the peripheral nerves. Those nerves provide sensation and movement.  Head-to-head impacts result in the entire kinetic force of the collision to be directed on the spine.

Similar to other forms of injury, an inflammatory response is triggered and produces swelling and subsequent damage to the nerve fibers.  Unfortunately, this damage is often permanent and results in paralysis of all extremities (quadriplegia) or just the lower extremities (paraplegia).  Aggressive treatment and surgery can often limit damage.

As kinetic forces increase, so does the apparent danger of participation in football and similar sports.  A solution to this dilemma is a necessity.

Cardio Tennis serves up a workout with a twist

Tennis is an exciting sport that incorporates fitness, strategy and technical skill.  The game has now entered a new phase in the form of “Cardio Tennis.”

The modern game of tennis developed in the late 19th century.  Since then, the rules have changed very little. The original lawn surface has added options of clay and a variety of artificial surfaces.

The tennis racquet has undergone dramatic change from its origins.  Originally made from wood with thick strings, the incorporation of space age materials and dramatic changes in the shape and surface area of the racquet over the past 40 years has resulted in an implement that bears little resemblance to its predecessors.

Tennis is a sport that requires episodic bursts of activity that can require extreme fitness as demonstrated by long, intense professional-level volleys or a slow-paced doubles match.

Cardio Tennis is a training program that incorporates tennis skills with a high-energy aerobic work out.  Like other forms of aerobic exercise, the goal is to raise the athlete’s heart rate to a safe level and maintain that level of exertion.

In Cardio Tennis, the emphasis is on the fitness component and ability to burn calories rather than the ability to play tennis.  Constant movement during the hour-long class is combined with returning forehand and backhand volleys.  The groups consist of up to eight participants of varying ages and skills.

“Cardio Tennis is perfect for people looking for an unintimidating, cardiac workout that is designed for all fitness levels,” said Bobby Schlink, a USPTA certified tennis professional who teaches Cardio Tennis at the Lyme Shores Tennis Center.

Multiple studies have confirmed that aerobic exercise performed for sixty minutes three times per week can increase longevity.  Cardio Tennis is one way to achieve that health goal.


Healthy ideas for a vacation at sea

Over 10 million people will select a cruise as a preferred means of vacation travel.  Most cruise lines provide all-inclusive packages with meals, entertainment and lodging.  Maintaining a healthy weight and following a prescribed diet can be a difficult task.

There is no magic formula for maintaining a healthy weight.  The human body is an efficient machine, calories are taken in to provide energy and calories are expended with effort.  Often, a cruise provides many opportunities to take in more food with fewer opportunities to work out.

Fortunately, many cruises now present healthy options for fitness and dining.  Some healthy cruising tips include:

•  Fitness center.  Locate the fitness center and become familiar with the equipment available.  Modern cruise ships have an extensive assortment of workout gear.  Treadmills, ellipticals and stationary bicycles are among the most popular. A television set mounted to the apparatus also makes the time go by faster.
•  Fitness classes.  A cruise is a good occasion to try something new.  Personal trainers direct spinning, yoga, Zumba and TRX sessions.  A personal trainer on board may be able to put together an effective exercise program for year-round use.
•  Jogging track.  Ships now map out an area designated for guests who wish to jog or walk.  This area is typically located on the upper deck allowing for great views and a chance to enjoy some time outdoors.
•  Stairs.  Passengers who wish keep off some pounds should pass the elevators and opt for the stairs whenever possible. 
•  Pool. The swimming pools on board are typically very busy during the day but early morning is a perfect time to swim laps or perform a water aerobics program.

The most effective way to enjoy a cruise without gaining weight is to find a like-minded partner to support you at the gym and at the buffet.

Local approach to the concussion crisis

The sport of football is facing a growing problem regarding the health and safety of its athletes.  Approximately 3.8 million athletes in the United States will suffer a concussion this year.  Many of these may be the result of high velocity collision sports like football and hockey.  Since last season, four NFL players have committed suicide and autopsies revealed chronic brain damage associated with multiple brain injuries.

Concussion is best defined as “a syndrome of immediate and transient alteration of neurologic function as a result of a biomechanical force.”  The biomechanical force is generally a blow to the head.  Athletes have become bigger, stronger and faster over the past twenty years and protective equipment has not been able to keep up.

Many experts in the field of sports medicine have focused their efforts on reducing brain damage from repeated concussion.  Recommendations include modification of rules, teaching proper playing skills, providing appropriate, well-fit equipment and assuring the presence of trained medical personnel at sporting events.

Education is crucial to the success of any far-reaching public health effort.  Locally, Backus Hospital has partnered with the NFL Players’ Association and St. Louis Rams Super Bowl champion Ernie Conwell to produce an eight-minute video educating coaches, parents and athletes on the signs and symptoms of concussion.

Six local high schools have already agreed to show the video to every athlete involved in a high-velocity collision sport.  The goal of this program, titled, Concussion: Recognition, Rest, Recovery, is to increase early awareness and reporting of concussions.

The video is available online at  Copies of the CD can be obtained free by sending an e-mail to 

Concussion is a serious consequence for all athletes regardless of gender and level of competition.  The widespread dissemination of accurate information can be lifesaving.

Olympic passion spreads from Europe to eastern Connecticut

A young woman is living in Manhattan in 2007, applying her Ivy League education in the financial field.  It is an ideal life by many standards.  Then, while visiting her sister in Vermont, they go for a bike ride in the hills.  Upon her return to Manhattan, she purchases her own bicycle and begins a daily regimen of riding each morning at 4 a.m. in Central Park.

After several months, she enters an amateur race with her sister.  She not only wins this race but also catches up to the professionals who had started five minutes earlier.

This event sparked a passion in Evelyn Stevens that led her to leave her comfortable life in 2009 to begin a journey that has culminated in her first Olympic cycling competition.

Many Olympic athletes are seasoned veterans in their sports by the time they are teenagers.  Stevens story goes against this trend.  Starting at age 26 may give her a physiological and psychological advantage.

Over the course of the next two weeks, Backus Hospital is sponsoring an Olympic participation program.  The program is designed to encourage participants’ involvement in a variety of sports.

Information regarding this innovative program, along with training tips, can be obtained by going to

Another Olympic story of interest involves physicians and medical personnel chosen to treat American athletes.  There are 80 medical professionals available to treat 525 athletes.

Among these practitioners are physicians, chiropractors, nurses, athletic trainers and massage therapists.  This team must be ready to treat a wide variety of medical conditions including complex orthopedic problems and general medical issues like influenza.

The Olympic games continue to evolve as a spectacular sports event that provides entertainment value for everyone.

Training the brain for high-speed decision-making

Repetition is a time-honored method for sharpening technical skills needed in an emergency.  Physicians, pilots, soldiers and police have utilized sophisticated simulators to create scenarios requiring rapid and precise decisions for many years.  There may now be a way for athletes to train their brains in a similar way.

The nervous system can be described as an electrical grid with wires (neurons) that interact to form intricate networks.  These networks carry sensory and motor signals that result in conscious actions. Neural plasticity refers to the ability of the brain to create new pathways that replace injured areas of the nervous system.

Recent studies have looked at a generation of subjects who have been playing video games.  The results show that people who play action games are able to make decisions 25% faster than people who don’t, without sacrificing accuracy.

Experienced video game players can process information and act on the information four times faster than non-gamers.

Axon Sports is known for designing and implementing computerized cognitive testing used in the assessment of concussion.  Their latest venture involves training the brain to make rapid and accurate decisions in a variety of athletic situations.

Computerized sports training is specific to an athlete’s sport and position played.  Quarterbacks are presented with different defenses and batters visualize various pitches.  One goal is to present many game situations without subjecting the player to injury.

The “athletic brain” is trained for high-speed decision-making, visualization, emotional regulation, focus, reaction and spatial reasoning.

“The athletic brain is a vehicle for athletes to make optimal decisions in game-time situations,” said Jason Sada, President of Axon Sports.

Soon these computerized training programs will be accessible to the general public and many young athletes.

In addition to aerobic and resistive training it appears that cognitive training is becoming an essential component to a balanced fitness regimen.

The benefits of Bikram Yoga

Most athletes hope to sweat profusely and lose weight when working out.  Bikram Yoga may be a quick way to accomplish both of those goals while improving overall health.

I was recently invited to participate in a standard 90-minute Bikram session.  I agreed with cautious curiosity.

Yoga is an ancient Indian practice that combines mental, physical and spiritual disciplines.  It consists of poses or postures designed to increase strength and flexibility.  Another crucial element to Yoga is controlled breathing to relax the body and mind.

Bikram is a form of “hot Yoga” where postures are performed in a room heated to 105 degrees Fahrenheit with 40% humidity.  Developed in the 1960s, Bikram Yoga consists of 26 postures and two breathing exercises. 

Many Yoga postures can be prescribed for specific medical problems similar to physical therapy.  The 26 Bikram postures were chosen to provide the best overall mental and physical experience.

The heat component increases circulation to muscles and allows muscle fibers to become more supple.  This reduces the likelihood of tearing and soreness after maintaining difficult postures.

“The most important feature of Bikram Yoga is the fact that anybody can do it,” said Richard Mercer, director and owner of Bikram Yoga Simsbury.  Mercer, a former Division I football player, advises new participants to set small goals of being able to stay in the room for the allotted period and participate in the poses within individual limits.

Bikram is an outstanding workout that uses a variety of muscle groups.  One of the biggest obstacles to a new workout is the degree of post-exercise soreness.  Bikram produces minimal discomfort and presents a good fitness option for both beginners and trained athletes.

Wellness programs provide professional support

A recent article in The Bulletin told the story of a 6-year-old boy who, along with his mother and others, was rescued at sea by the U.S. Coast Guard. The group was escaping oppressive conditions in Haiti 18 years ago.  The young man decided that he would eventually serve in the Coast Guard like his rescuers.  Last week, he graduated from the Coast Guard Academy as an officer.

This story exemplifies the fact that children are impressionable and often emulate both the positive and negative behaviors of adults.  Health and fitness habits are no exception.

More than 60 million Americans are considered obese or overweight.  This epidemic has carried over to the pediatric population and the connection is more than coincidence.  The solution may be establishing healthier role models.

The transition to a healthy lifestyle often requires professional support. Wellness programs provide a variety of options for comprehensive diet, exercise and stress management.

Wellness councilors serve as coaches through what is hopefully a dramatic change for the individual and their entire family.  Although the approach is multidisciplinary, exercise is a crucial element.

Regular fitness activities can reduce stress by providing an outlet.  Both aerobic and resistive exercise can improve sleep habits and reduce food cravings.  Many people have used regular exercise as a substitute for smoking.

“Wellness programs are designed to re-energize a person’s life by attaining health goals and managing risk factors for chronic disease,” said Sheri McNally, a local wellness counselor who provides programs for employers.  McNally utilizes Skype, email and telephone conversations in addition to personal attention to support participants.

Many people are concerned with the financial legacy they will leave their heirs.  A legacy of good health by setting an example may have the greatest value of all.

The curious case of turf toe

Toe injuries are not often associated with the need to remove an athlete from a contest. Turf toe is a painful foot injury that has pushed athletes to the sideline for extended recovery periods.

The human foot is divided into three basic sections: the hindfoot (heel), the midfoot (arch), and the forefoot (toes).  Turf toe affects the forefoot.

Turf toe involves the first metatarsalphalangeal joint.  This joint is the connection between the great toe and the bone that anchors it to the foot.  Like other sprains, it consists of damage to the connective tissues that stabilize the moving parts.

The mechanism of injury consists of the sudden, extreme dorsiflexion (upward bending) of the great toe.  The force results in stretching and tearing ligaments beyond their normal range of motion.  Cartilage can also be injured in more severe trauma.

Inflammation follows with swelling and pain.  Initial treatment includes rest, ice, compression and elevation.

This type of injury usually involves an activity on a firm surface.  Turf toe is most common in football.  The recent popularity of artificial turf over natural turf is part of the reason for the rise in cases.  A force applied to the calf muscle while the knee is flexed is another cause of turf toe.

“The injury is primarily mechanical in nature and so is the treatment.  Putting the foot in a more rigid shoe or an orthotic device will avoid further injury,” said Dr. Joseph DiFrancesca, a Norwich podiatrist who treats many athletes with turf toe.  He also believes that careful selection of athletic shoes with a rigid shank will reduce injury rates.

The healing process for turf toe can take several weeks.  Unfortunately, an early return to activity without sufficient healing can lead to a chronic debilitating injury

Professional athletes and depression

There are many terms used to describe professional athletes.  Some of these include famous, rich, leader and superstar.  One word not commonly applied in this context is “depressed.”

Depression is an illness that affects approximately 15 million American adults each year.  Like many other illnesses, depression has no boundaries in regard to gender, profession or socioeconomic status.

Previously thought to be an illness of adults, depression is often overlooked in children and young adults.

There is no single factor that causes depression. Stress, sleep deprivation, genetics and hormonal fluctuations are among the influences that cause an alteration in brain chemistry ultimately resulting in depression.

Depression often impacts other illnesses.  It can significantly worsen diabetes, stroke and heart disease.

 In athletes, head injury can play a big role in precipitating a bout of depression.  Athletes typically enjoy the benefits of being popular among peers, access to higher education and being in excellent general health.  Unfortunately, many of these advantages can be fleeting.

Eric Hipple, a former NFL quarterback, currently works as an outreach specialist at the University of Michigan Depression Center.  In his book, "Real Men Do Cry," he chronicles his personal experience with depression, bankruptcy and the death of his 15-year-old son from suicide.  “Depression is often brought on by transition and athletes face transition on a regular basis.  Being cut from a team often results in loss of friends, income, support mechanism and daily structure,” said Hipple.

Hipple advises parents to monitor stress levels, be aware of a family history of depression and look for early signs of depression.  Some early warnings are changes in appetite and sleep pattern, poor concentration in class, lack of motivation and overwhelming sadness.

Depression is a treatable illness but identifying and admitting to it early are crucial for a full recovery.

All sports supplements are not created equal

A visit to any athletic training room reveals a variety of tools used to heal the wounds of battle including whirlpools, various adhesives and pads. A recent addition is an area occupied by strength and conditioning specialists. It is in this area of the locker room where discussions of injury prevention predominate.

Improving human performance involves multiple disciplines. Developing a powerful muscular system relies on a variety of fitness activities.

Aerobic or cardiac fitness uses activities like running, biking and swimming. These are designed to build stamina and allow the human body to utilize oxygen efficiently.

Weight lifting and stretch bands are categorized as resistive fitness. These movements are designed to increase power and strength.

Fueling the human body involves a variety of nutrients. The basic components are fat, protein and carbohydrate. It is often the refinement of the nutrition regimen when the picture becomes cloudy.

The use of nutritional supplements that promise to magically transform the human body are often a problem for strength and conditioning specialists responsible for the health of athletes.

Supplements are not subjected to mandatory regulation like drugs.

The National Science Foundation (NSF) is an independent federal agency that provides certification for supplements. The NSF seal of approval means that the contents have met stringent standards and no substances banned by sports leagues are present.

“When athletes inquire about what supplements they can take I tell them to keep it simple and only use those that are NSF approved,” said Mike Wickland, the New York Yankees minor league strength and conditioning coordinator.

Wickland’s advice regarding supplements is certainly applicable for all athletes and he firmly believes that food is the best source of nutrition. “After a workout or a game, I recommend a peanut butter and jelly sandwich with chocolate milk,” advises Wickland.

Be prepared before hitting a sports fantasy camp

A professional pianist slides into second base, fracturing his right hand a week before a scheduled performance with Aerosmith, an orthopedic surgeon breaks his ankle rounding third and a homemaker dislocates her finger trying to barehand a ground ball. These are all examples of injuries seen in the growing business of fantasy baseball camps.

Adult fantasy sports camps allow participants to swing, shoot, putt, ski or bat with their sports idols. As the variety of camps and participation has grown, so has the number and type of injuries.

“I advise campers to start out slow and gradually build up as the camp progresses,” said Greg Spratt, a certified athletic trainer with the New York Yankees who has worked with many baseball fantasy campers over the years. “Unfortunately, many try to go all-out on day one and often end their camp experience in the training room. There is no fantasy disabled list.”

Spratt provides incoming campers with a program that includes stretching, running, hitting and throwing drills. He advises that the program begin 12 weeks prior to the big week.

Preparation for a sports fantasy camp will only involve a small percentage of athletes but the lessons are easily applied to any athlete preparing for a competitive season.

Some important tips include:

Physical exam. Make an appointment for an annual physical exam with your physician before heading to the gym. This should include a cardiac stress test if necessary.
Lose weight. Spring is a good time to get rid of any extra pounds put on over the winter. It will also put less stress on muscles and tendons.
Stretch. The most common injuries in sports camps are torn muscles, particularly the hamstrings. Adequate warm-up cannot be over-emphasized.
Sport-specific movement. Incorporate activities that involve swinging, throwing and jumping similar to the actual sport.

Sports fantasy camps usually require a significant financial investment. That investment will pay off greatly if it includes getting into better shape.

The viability of sports medicine academies

Recently, a high school classmate who has become a successful orthopedic surgeon approached me about becoming involved in establishing a sports medicine academy within our alma mater.

The concept of sports medicine academies has arisen from the increased number of people participating in athletic activities and subsequent sports-related injuries. Several recent surveys project a growing need for health care professionals with a background in sports medicine.

Sports medicine is generally associated with professional and collegiate sports teams. Interestingly, although highly publicized, these high profile injuries make up a relatively small percentage of the sports injuries evaluated each year.

Medical studies continue to demonstrate that many chronic illnesses can be more effectively treated with a regimen that includes regular exercise. Among these are vascular diseases, diabetes, obesity and dementia.

Health professions involved in sports are physicians, athletic trainers, physical therapists, psychologists, nurses, exercise physiologists and conditioning specialists. The goal of sports medicine academies is to provide fundamental education with transferrable skills that allow students to enter any of these areas of study.

In addition to a basic liberal arts high school course load, students are required to study anatomy, physiology, biology, biostatistics, sports conditioning and marketing. All students are also required to work in a variety of sports medicine settings to gain clinical and practical experience.

Although sports medicine is often associated with the treatment and prevention of athletic injuries, one of the most exciting areas of sports medicine involves the study and improvement of human performance.

Making the human body more efficient is one key to improving health and avoiding disease. A foundation in sports medicine may provide the necessary skills for future health care professionals.

When heading for the hills, practice avalanche safety

Seventeen people have lost their lives this year in accidents related to avalanches. Although uncommon in the northeast, many winter sports enthusiasts will soon be heading west for the spring season.

An avalanche consists of large volumes of snow sliding down a mountain at high velocity. These sudden events result in destruction of roads, homes and lives. Trees, boulders and debris often become part of the descending flow.

Snow and ice will accumulate in layers as the winter season proceeds.

As the adherence of these layers weakens, the chances of an avalanche will increase.

Many factors play a role in loosening these layers. Natural causes include rapid warming, sudden precipitation and falling rocks. Artificial influences consist of skiers, snow boarders and snowmobile riders who may disrupt the snowpack. Animals may cause stress just by walking over a weakened area. Explosive use will certainly cause an avalanche in a vulnerable zone.

Avalanche risk can be calculated based on prevailing conditions and location. They are most commonly seen on back country ski trails that are not frequently used. Warnings are posted when the chances of an avalanche are high. Sometimes they will be intentionally triggered as a way of avoiding an unsuspected downfall.

Safety equipment and measures have proven to be effective:

• Pay close attention to warning signs and closed trails. Closing trails are not arbitrary decisions and there is most likely a reasonable degree of danger.

• An avalanche beacon will emit a signal to allow others to quickly find a victim and begin digging out.

• The avalanche balloon is a device that is designed to keep a person above the rising snow when deployed.

When planning to escape the unseasonable warmth of the northeast for a northwestern adventure, remember to invest in specialized safety equipment along with common sense.

Digging deeper into exercise immunology

One of the most exciting fields of research in human physiology involves the effects of physical training on the immunologic response.

Immunology is the study of the ability to fight off attack from infection and certain forms of cancer. It consists of a response that utilizes white blood cells that isolate and destroy an offending agent.

Among the more common triggers of the immunologic response is the influenza virus. It also has a negative effect on the ability of athletes to attain their peak performance.

Pertinent findings regarding the effect of exercise on the immunologic response include:

• Studies performed on marathon runners reveal that intense exercise lasting longer than 60 minutes has an adverse effect on the ability to summon immune cells. This results in more frequent upper respiratory infections. Moderate regular exercise is associated with an improved response.

• There is a natural decline in the ability to mount a response to infection with age. Physically conditioned elderly subjects had a superior response to infection versus a sedentary group.

Mental stress has also been shown to have an adverse effect on the immunologic response. Athletes who meditated for one hour a day for 8 weeks had an enhanced response to infection.

Diet plays a big role in immunologic function. Athletes who were undernourished or involved in rapid weight loss were more susceptible to infection. This particularly applies to combat sport athletes and other athletes who must achieve a weight level.

Adequate sleep is crucial to efficient immunological function.

After a very thorough review of the current literature in a recent lecture at the University of Connecticut, Professor Neil Walsh from Bangor University in the UK discussed the importance of hygiene.

Ironically, in addition to following solid training principles, it may be merely proper hand washing and covering the mouth and nose when sneezing that can lead to victory.

Cardiac arrest during marathons are rare, but possible

Millions of Americans participate in long-distance running events. The marathon distance (26.2 miles) and the half-marathon (13.1 miles) have become increasingly popular. It is because of the extreme physical demands of these competitions that the occasional report of sudden death during an event is not surprising.

The human heart consists of four chambers that contract and expand in sequence to pump blood throughout the vascular system. In order to do this, the heart has a carefully synchronized electrical network that must fire signals in a rhythmic manner.

The muscular heart chambers have thick walls that allow for the maximum volume of blood to be ejected with each beat. Aerobic training reduces the amount of effort necessary for the heart to function.

A recent study looked at the incidence and outcomes of cardiac arrest associated with marathon and half-marathon events from January 2000 to May 2010. The number of participants steadily grew from 1 million in 2000 to 2 million in 2010.

Of the 11 million people studied over the 10-year span, only 59 suffered cardiac arrest during a race. Cardiac arrest was most common in males who participated in full marathons as opposed to half-marathons. Men were also most likely to die from the arrest and are clearly more susceptible to exertional cardiac arrest.

Surprisingly, the most common cause of arrest was not due to blockage of coronary arteries but an oversized left ventricle. The increased size (hypertrophy) eventually blocks the outflow of blood from the heart.

Cardiac hypertrophy is most common in younger athletes and associated with poor outcome.

The rate of cardiac arrest should in no way discourage participation in long-distance athletic events. Instead, it should alert athletes to the need for proper pre-participation physical examinations.

Giants' Mark Herzlich overcomes bone cancer

Inspirational comeback stories abound in the world of sports. This year’s NFL season is no exception, such as the come-from-behind, underdog victories by the Denver Broncos, led by Tim Tebow.

One story that bears noting is the return of Mark Herzlich to the sport many thought was part of his past and not his future.

Herzlich, a 24-year-old linebacker for the New York Giants, was diagnosed with Ewing’s sarcoma, a form of bone cancer, while playing for Boston College. His treatment included chemotherapy, radiation therapy and excision of the tumor that involved the largest bone in the human body, the femur. A titanium rod reinforced the bone shaft.

A two-year course of physical therapy and intense training followed. After being invited to try out for the New York Giants, he accomplished something many thought was impossible: He made the team.

Ewing’s sarcoma is a malignant tumor that typically is seen in children and young adults. It generally appears in the long bones of the body.

The most common presenting symptom is intense bone pain. Unfortunately, in approximately one-third of patients, the tumor already has spread to the lungs and other bones at the time of diagnosis.

Treatment of Ewing’s sarcoma includes aggressive chemotherapy and radiation therapy that is focused on the tumor site. Surgical excision of the tumor follows.

Dr. Dinesh Kapur, an oncologist and director of cancer services at The William W. Backus Hospital, isn’t surprised by Herzlich’s recovery.

“Early detection, combined with the multimodality approach of chemotherapy, radiation and surgery, has dramatically improved survival from Ewing’s sarcoma,” Kapur said.

Herzlich’s return to the highest level of professional sports not only required a combination of modern medical therapies, but an unwavering spirit and commitment to succeed.

Celtics player saved from aortic aneurysm

Amidst the confusion of ending the NBA lockout and hurriedly beginning a shortened season, a young life was saved.

Jeff Green, a 25-year-old forward, had signed a one-year, $9 million contract to play for the Boston Celtics. During a routine preseason physical examination, he was diagnosed with an aortic aneurysm. Instead of heading over to the practice court, Green was headed to the operating room.

The aorta is the largest artery in the human body. It provides the main passageway for richly oxygenated blood to vital organs. The aorta is divided into two main sections:

• The thoracic aorta leads blood from the heart and downward through the chest cavity.
• The abdominal aorta continues into the abdomen feeding branches to the kidneys, liver, spleen and intestines.

An aneurysm is an abnormal enlargement of a blood vessel. It results from a weakening of the supporting tissue that provides a firm lining in an artery. Under constant pressure, the weakened area will enlarge and cause the artery to dilate and eventually rupture. This results in profuse life-threatening hemorrhage.

Aortic aneurysms can be repaired by cutting out the affected section of aorta and replacing it with a synthetic segment. Another approach is an endovascular repair. In this procedure, a new lining is inserted in the weakened area via a catheter through an artery in the groin.

Aneurysms are typically associated with high blood pressure, elevated cholesterol levels, obesity and smoking. All of these potential causes are not typically associated with professional athletes.

Green’s aneurysm will be repaired and he is expected to return to the NBA next season.

Jeff Green’s circumstance should serve as a reminder of the importance to have annual physicals performed by a physician even if you are young and in excellent health.