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.

Fitness gifts for the holiday season

Finding an appropriate gift for someone interested in fitness can be a complex and daunting task. The vast array of offerings may be confusing and an error will result in another dust collector. This week is a good time to make some recommendations and provide some caution.

Michael Sena’s Traveling Trainer. This product provides a perfect combination of fitness equipment, instruction and dietary tips in a convenient travel case. Sena, a nationally known personal trainer, provides instruction on the use of elastic stretch tubes of varying resistances. Although the premise is for this product to be used while traveling to places where a gym isn’t available, it is a great way to begin a home workout that requires minimal cost and space.

Fitness Monitors. These devices include pedometers, heart rate monitors and computerized bands that monitor all physical activity and diets. The range is vast and the usefulness varies. In general, the more comprehensive the apparatus the more technical ability is required. The objective here is to provide feedback regarding the intensity of an individual’s activity. That feedback will hopefully encourage more effort. Much of this can be accomplished by using a simple pedometer and bathroom scale.

P90X2. This is the latest iteration in a wildly successful video workout series. Each consists of intense exercises that last approximately 60 minutes and utilize a variety of muscle groups. They provide an excellent daily fitness experience and, based on many testimonials, accomplish the goal of getting subscribers in shape in 90 days. Although the series is expensive, it requires minimal equipment and space.

The current trend in fitness programs emphasizes equal parts aerobic and resistance exercises utilizing body weight for resistance. Stretching, balance and constant movement are essential elements.

A fitness program combined with dietary moderation will lead to a healthy new year.

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most prescribed medications worldwide. In sports medicine, they are often referred to as performance “enabling” drugs.

Common NSAIDs like Motrin, Naproxyn, Toradol, Voltaren and Celebrex can be administered orally, by injection or applied to the skin. As opposed to steroids, the NSAIDs have fewer side effects and do not build muscle like androgenic steroid drugs.

Inflammation is a normal response of the human body to injury. NSAIDs are effective in treating headache, injured nerves, arthritis and painful chronic conditions. In sports, NSAIDs are primarily used to treat acute muscle tears (strains), ligamentous injuries (sprains) and joint trauma (bursitis).

The classic inflammatory response causes signs of swelling, elevated temperature, redness and pain that are readily apparent to an observer. At a microscopic level, there is an intense cellular response where blood flow increases to the affected region allowing chemicals and white blood cells to leave the bloodstream and attack the injury.

While the inflammatory response is essential to good health, it can cause damage if it becomes chronic. NSAIDs are designed to reduce inflammation by blocking the cyclooxygenase enzymes (COX-1 and COX-2) and subsequently halting the production of prostaglandins, essential components of the inflammatory response.

Although NSAIDs have an analgesic effect, they reduce pain by altering the actual process causing the pain, as opposed to opiate drugs that merely block pain receptors.

It is not uncommon in sports to have more than one ongoing injury. NSAIDs do not target a specific injury and work at multiple areas simultaneously.

Although generally safe, potential side effects of NSAIDs include stomach ulcers, kidney damage and elevation of blood pressure.

In sports, where chronic musculoskeletal injuries are common NSAIDs have extended the careers of many athletes. After consultation with a physician, NSAIDs may be able to keep you in the game.

Sports injuries can't hide from imaging techniques

Sports injuries often require the use of x-rays and more sophisticated diagnostic imaging studies to determine the nature and severity of the injury. These studies and techniques have evolved significantly over recent years.

Among the most commonly used imaging studies are x-ray, computerized tomography (CT) and magnetic resonance imaging (MRI). X-rays were first used in the late 19th century, primarily to determine fractures and other boney injuries. CT scans came into use in the early 1970s and are designed to measure differences in density, especially in bones. MRIs create images based on changes in tissues such as tearing and swelling.

Dr. Nathaniel Dueker is a board certified musculoskeletal radiologist at The William W. Backus Hospital. He took time to review some of the most common sports injuries that require imaging:

• Head injuries. Concussions are among the most common injuries seen in sports. While there is no image that can diagnose a concussion, a CT scan should reveal any evidence of acute hemorrhage or skull fracture. Persistent symptoms may warrant the eventual use of an MRI to look for chronic damage.

• Shoulder injuries. These injuries typically involve tendons and ligaments. After a plain x-ray to rule out a fracture, an MRI is the best diagnostic tool. This study can demonstrate structural changes in the complex system that makes up the shoulder joint. An MRI of the shoulder can be performed with dye injected into the joint. This exam, called an MRI arthrogram, can be performed in different positions and may reveal subtle tears.

• Knee injuries. Traumatic sports injuries to the knee typically result in ligament and cartilage tears. While x-rays will rule out bone injuries, MRI is an outstanding technique for viewing damage to these structures.

Appropriate diagnostic imaging studies can limit the need for surgery and get athletes back in the game sooner.

The heart is a muscle that needs training too

When athletes are described as “having a lot of heart” it often refers to their desire to compete even in the face of overwhelming adversity. In sports medicine, an “athlete’s heart” has an entirely different meaning.

The human heart is composed of four chambers: the right atrium, right ventricle, left atrium and left ventricle. The heart functions as a pump moving blood from the right side of the heart to the lungs where it becomes infused with oxygen. The left-sided chambers then jettison oxygenated blood throughout the circulatory system to other organs.

The left ventricle has the greatest demand and tends to become enlarged, creating a condition known as “left ventricular hypertrophy.”

If blood vessels become narrowed due to atherosclerosis, it requires more work for the heart to pump against resistance. The pumping mechanism must work harder and faster. That strain can lead to heart failure and death.

Like all muscles, the heart can be trained to increase in size and work more efficiently. A fitness regimen that will improve cardiac efficiency should consist of several forms of exercise:

• Aerobic activities such as running, rowing or cycling will maintain a high heart rate over an extended period of time.

• Resistance activities include weight lifting and other strength-oriented sports.

• Cross-training programs include a combination of aerobic and resistance activities. Boxers and other athletes who participate in sports where high levels of strength must be maintained over long periods of time rely heavily on these programs.

“The enlarged, more efficient athlete’s heart is a normal response to exercise training,” said Dr. Craig Denegar, a professor of kinesiology at the University of Connecticut. Screening athletes before athletic participation can be challenging since an enlarged left ventricle can also indicate significant cardiac disease.

A regular exercise program can produce a heart that pumps more blood with less effort.

The simple act of jumping rope

The decision to get into better physical condition can become a very expensive enterprise. When the effort involves children, the interest can be short-lived and lead to unused gym memberships.

Some activities involve little cash outlay and can be enjoyed by the entire family. Among these is jumping rope.

The history of jumping rope is believed to date back to Egypt in 1600 AD. Rope jumping not only served as child’s play but as training for warriors.

Dutch children in early America jumped with two ropes simultaneously and subsequently the term “Double Dutch” became common.

Jumping rope continues to provide an outstanding exercise for burning calories, building strength and improving coordination. Jumping rope for one hour can burn 1300 calories.

Modern rope jumping has become a group exercise activity performed as part of exercise classes. Although it is typically associated with children, it continues to be a preferred method of training for boxers and other combat athletes.

Athletes recovering from lower extremity injuries are often prescribed jumping rope as part of their recovery to rebuild strength and joint proprioception. Proprioception is the brain’s ability to detect the position of an extremity in space.

Childhood obesity is a major problem in the United States today. Physical education programs with shrinking budgets have found rope jumping to be an effective, inexpensive exercise.

Locally, a group of students from the Integrated Day Charter School who love to jump rope have put together a service-learning project titled, “Ambassadors for Heart.” Their goal is to perform at public events and raise awareness of the dangers of physical inactivity and obesity in children and adults.

The efforts of these young ambassadors are entirely supported by private donations. They deserve our support.

Jumping rope can be a first step toward better health.

Peyton Manning and cervical radiculopathy

Among recent recurring stories in sports is speculation regarding the successful return of Indianapolis Colts quarterback Peyton Manning. On Sept. 8, Manning underwent a third surgery to alleviate pressure on a nerve root in his neck.

The cervical spine consists of seven bones called vertebrae located below the skull. Discs made of cartilage separate each of the vertebrae to avoid the friction and wear of bone rubbing on bone. This entire system is held together by a series of ligaments.

The cervical spine is designed to protect the spinal cord and the nerve roots that emerge from the spinal cord to conduct motor and sensory impulses to and from the limbs and vital organs. Damage to these fragile nerves can result in paralysis or death.

Typical injuries to the cervical spine include:

• Fracture of the vertebral bones
• Tearing of the ligaments that attach the bony vertebrae
• Rupture of the intervertebral discs from their central location

In football and other violent collision sports, it is not uncommon to see worn and ruptured discs on imaging studies like MRI and CT scans. Unfortunately, these findings are sometimes seen in young healthy athletes.

The cervical nerve roots responsible for triggering the muscles of the arm are also the ones most commonly injured. Without adequate neural control, throwing is a difficult task, especially for an NFL quarterback.

Surgical intervention includes removing pieces of the offending discs. If the surgery or surgeries require removing a large volume of disc, bone chips are inserted between the vertebrae to prevent dislocation.

While fusing the spine creates a firm repair, it also limits the range of motion of the neck. It is this loss of motion, along with arm weakness, that will make Manning’s return a formidable challenge.

Peyton Manning’s recovery will require all the discipline and effort he has acquired over the years.

Amateur boxing has its place when done correctly

Amateur boxing has been described as being a part of the fabric of society. Boxing, for many young athletes, is their first exposure to organized sports.

Recently, the American Academy of Pediatrics and the Canadian Paediatric Society issued a policy statement on boxing participation by children and adolescents. The position states that they “…oppose boxing and, in particular, discourage participation by children and adolescents.”

The position statement goes on to encourage alternative sports such as “swimming, tennis, basketball and volleyball.” This position is based on limited data and doesn’t account for many intangible advantages or disadvantages.

Amateur boxing is highly regulated under the watchful eyes of experienced coaches. Physicians are present for events and pre-fight and post-fight physicals are required.

Head protection and heavily padded gloves protect against serious injury. Bouts are brief and sportsmanship is stressed. Style and finesse are the principal ways to score points and officials are quick to end a one-sided match.

The health advantages for amateur boxers are numerous. Each participant must train regularly to build strength and stamina. The structure of a boxing gym often substitutes for a stable home life.

Boxing provides a reason to avoid tobacco, alcohol and criminal mischief.

Jody Sheeley owned the Second Chance Gym in Norwich and has been involved in amateur boxing for many years. “Amateur boxing helps build self-confidence, especially for children who don’t do well in team sports,” said Sheeley. In his experience, he has never seen a youngster require emergency medical care as a result of an amateur boxing match.

Amateur boxing has provided a healthy outlet for many young people who do not have access to other competitive sports that require significant financial investment. It is a sport that deserves public support and not restriction.

Pat Summitt will battle Alzheimer's from the bench

Pat Summitt is the “winningest” coach in women’s basketball. At age 59, she has reached the pinnacle of her career, including induction into the Basketball Hall of Fame. Unfortunately, she now joins over 5 million other Americans in their battles with Alzheimer’s Disease (AD).

AD is a degenerative disease of the nervous system that prohibits its victims from learning new information and recalling recent events. The cause of AD is unknown but it can occur in families, as is the case with Coach Summitt.

Forgetfulness is a common part of normal aging. Difficulty finding the right word or recalling someone’s name is acceptable. When these difficulties progress to becoming lost in familiar surroundings and not recognizing close family members, AD must be considered.

Symptoms of AD also include difficulties with executive planning, loss of judgment and social withdrawal. The pressure and cognitive demands of successful coaching can be overwhelming. Pat Summitt’s attempt to continue coaching at the University of Tennessee at a high level is amazing.

There are several medications available for patients with mild to moderate symptoms of AD. Unfortunately, none of these medications alter the actual progression of AD.

Coach Summitt has not chosen to “ride off into the sunset.” Instead she is approaching this disease like any athletic challenge. She is preparing her assistant coaches to take on more responsibilities. She is also beginning a regimen of medication, cognitive exercises and mental preparation.

This approach is not surprising to those of us who work with athletes. When presented with an obstacle that is seemingly insurmountable, athletes dig in and prepare for battle.

Pat Summitt is a great coach and a leader for the rights of women in sports. Now she will put a famous face to a crippling terminal illness and hopefully stimulate interest toward a cure.