Posted by: mdegeorge | August 8, 2011

Weekly Diagnosis: August 7

The diagnosis is back after a bit of a hiatus – call it a summer vacation. But after a week this busy, it’s time to say goodbye to the beach (read: sleep less between work shifts) to chronicle it all. This week’s return follows a touching story from Florida State, the dangers of the summer heat that go beyond melted crayons and sunburn and an issue that is deer to the hearts (and medicine cabinets) of big leaguers.

Going to battle (again) over drug testing? (Courtesy of Creative Commons)

O come ye to Bethlehem

The scariest moment of the NFL’s preseason workouts occurred Wednesday morning at Eagles camp at Lehigh University when defensive lineman Mike Patterson experienced a seizure lasting four minutes during a workout. Patterson was taken to the hospital and has since been released, even revisiting camp while he and his medical team chart a course of medical action.

Patterson, who does not have a history of seizures, was originally diagnosed with arteriovenous malformation by doctors Wednesday, a finding that was relayed to the media by Eagles trainer Rick Burkholder.

But Burkholder seems to be the only one onboard with that decision. All along, the Eagles trainer has included the addendum that tests were ongoing but still stood by the diagnosis. Agent JR Rickert, though, has refuted that the diagnosis of the 29-year-old is final or definite and believes the defensive lineman will return to action shortly.

Whether or not the condition is present in Patterson, it’s good to know what it entails. The cause of AVM is unknown, though it is a congenital developmental disorder that occurs in less than one percent of people and results in a mass of aberrant blood vessels in the brain. Those vessels connect directly from artery to vein without a suffusive capillary bed that can get blood to the cells. The malformations can rupture and leave sufferers with increased risk of hemorrhaging or aneurysms to go along with reduced blood flow to the brain. AVMs differ greatly in size and location, making their danger widely ranging.

Indications are that Patterson’s seizure did not include bleeding of the AVM, which can lead to permanent damage and death in 10 percent of those experiencing it. The most fertile age for ruptures is in the late teens to early 20s, a period Patterson is past. Treatment is possible through radiosurgery (essentially using radiation as a surgical knife) or embolization (use of a catheter like an angioplasty) with a bonding agent; in both cases the AVM vessels are closed off to reduce wasteful blood flow to the area, though the radiation option would take multiple treatments. Either treatment is also dependent on the riskiness of the area in which the AVM is located. Seizures can be controlled by anti-convulsants.

What isn’t indicated in the medical data is whether the condition is exacerbated by playing football. The Philadelphia Daily News’ Les Bowen spoke to neurologist Nirav Shah, who was careful to point out that the injury wasn’t caused by football activities. While he did indicate that under “certain conditions such as stress, dehydration, trauma and whatnot, these things can tend to hemorrhage,” he stopped short of identifying football as such a detrimental stress (I’d tend to think it can’t be good). Let’s just hope Patterson’s agent understands the gravity of the situation and gives the condition the rest and attention it requires.

Gone Fishing for a good cause

While we’re on the subject of rare disorders, there’s the sad story of Florida State head coach Jimbo Fisher’s son, Ethan, who suffers from a condition known as Fanconi anemia.

The congenital disease is an autosomal recessive disorder (though one of the genes is on the X chromosome, altering the inheritance patterns to a degree) that leads to bone marrow failure in 90 percent of sufferers as well as increased rates of cancers such as certain types of leukemia. The incidence of the condition is 1 per 350,000 births, with higher prevalence in groups such as Ashkenazi Jews and Afrikaners.

At the molecular level, the affected genes code for proteins involved in the formation of a core complex that helps identify damaged DNA through uses of the small protein marker, ubiquitin. Once marked, the damaged DNA can be repaired through a variety of other proteins, including breast cancer 2 susceptibility protein (BRCA2), which as its name indicates is also involved in the pathways of certain malignant pathways occurring in the breast.

FA primarily affects long-lasting cells that must replicate their DNA faithfully many, many times, such as the hemopoetic cells of the marrow of the long bones that generates the body’s supply of red and white blood cells and platelets. Over time, in addition to cancers caused by aberrant blood cells, the body’s capacity to regenerate its blood cells is exhausted. Onset of such deficiencies can be seen at as young as 11 years of age and requires a marrow transfer.

Fisher’s son was diagnosed in March, and the coach and his wife are on a crusade to raise awareness for the disease, which currently affects about 1,000 people worldwide. The Jimbo and Candi Fisher Kidz 1st Fund (yes, they can’t spell and violated AP style) was started and profiled by ESPN to raise funds for research of the disease. Already in existence with less fanfare is the Fanconi Anemia Research Fund.

The good news shown by ESPN’s video is that Ethan remains a normal six-year-old despite the tumult brewing in his body. The elder Fisher, seen playing baseball with his active and rambunctious shows little ill-effects to this juncture while his family is hopeful of a way to mitigate future symptoms.

No one should like it hot

When you’re talking two-a-day practices in 40 pounds of pads, the threat of farmers tans and missed days at the pool pale in comparison to the immense danger posed to young athletes. The professionals might remember a day in the distant past when they were out there humping it twice a day for three weeks. But while the lockout has coddled them into an abbreviated mini-session of suffering, high schoolers all over the country have been out there busting it twice a day in record-breaking heat in many parts of the nation.

The unfortunate result has been five deaths – four players and a coach – during practices. Three of the deaths have officially been linked to the heat, though it’s likely the other two had a similar cause.

Miramar (Fla.) senior Isaiah Laurencin was the first to fall victim to the scorching heat, collapsing during an afternoon workout Thursday, July 28 before passing away a day later. Saturday, Lamar (S.C.) freshman Tyquan Brantley collapsed in 101-degree heat. Coach Wade McClain of Prestonwood Christian in Plano, Tex. collapsed Monday, Aug. 1 while his team was practicing in the 31st straight day of triple-digit heat in the Dallas area. Tuesday witnessed two deaths in Georgia: linemen Forrest Jones of Locust Grove and D.J. Searcy of Fitzgerald.

MaxPreps, citing the National Center for Catastrophic Sports Injury (NCCSI) at the University of North Carolina, points out that the four player deaths make this the deadliest season in terms of heat-related fatalities since 2006, and that’s with practice barely started in many places. Reuters indicates that the average number of heat-related deaths per year has increased from one in the 1980s to 2.8 over the last 15 years. Those most at risk are the overweight (95 percent of past victims) such as lineman (all of the players but Brantley were confirmed as linemen, while Brantley appears to have that body-type as well), and those with pre-existing conditions (a malady of the heart appears to have contributed to McClain’s passing). Also noteworthy is that 60 percent of deaths happen during morning practices, likely the result of coaches pushing too hard or players improperly hydrating early in the day, complacent in the relatively less searing yet still dangerous heat.

In light of recent events, the Georgia High School Association has produced a video with recommendations on coping with the heat, while the Florida High School Athletic Association has its own guidelines (though it doesn’t require member institutions to adhere to any of the seven directives established by the National Athletic Trainers’ Association.)

It’s only a shame that such measures only reach the general consciousness after so many young lives are lost. Heat is heat, and it’s been around for a while. The FHSAA cites a figure of $30 million to outfit each member school with a certified athletic trainer, but the cost of educating kids about hydration procedures (especially on their own at home) and coaches on players’ limitations and early signs of problems is much less. It’s a worthy price to pay.

Growing support for drug testing

Most of the compromises between the owners and players in the NFL’s new collective bargaining agreement were fairly ho-hum.

But at least one ramification, other than the return of fantasy football as a continued excuse to not communicate with your significant other and/or forestall finding a job, is worth touting.

That is the insistence of NFL Commissioner and unlikely James Harrison dinner guest Roger Goodell that the league will push for testing of human growth hormone as part of the CBA.

There might be a couple problems in this plan, noble and “critical”, in the words of Goodell and NFLPA senior VP of law and labor policy Adolpho Birch, as it may be. The first would be resistance from the NFLPA, though NFL Network’s Albert Breer cites the example of the Canadian Football League’s union that had no problem with the advent of HGH testing. A statement by NFLPA player development director Stacy Robinson also indicted support, pointing out that the union “believe(s) in and collectively bargained for a system that supports the testing of all banned substances.”

The second problem? Well, there’s not really a reliable test to detect HGH presence in urine, and like the MLB, the NFL doesn’t provide for blood testing of athletes (of which there is a moderately reliable test for HGH) under the current agreement.

So where does that leave the sides? There’s a bit of a gold rush in the industry to refine the testing methodology, the first blow being struck by the positive test of rugby player Terry Newton 18 months ago. Many are skeptical that a reliable urine test for HGH is in the offing, as the profile and audacity of these announcements indicates. For the foreseeable future, expect a lot of what we received during the bulk of the lockout: Two sides touting a road to resolution without taking many tangible steps to get there.

Weekly Diagnosis Shameless Self-Promotion of the Week: Apparently, Major League Baseball is a reader of the Sports Doctor. Or maybe one of a thousand other sources told them.

Either way, I wrote in January about the efforts of the NFL to ban the use of supplements derived from deer velvet spurred by a former sponsorship agreement involving Oakland Raiders head coach Hue Jackson that has since been terminated. Those supplements contained insulin-like growth factor 1 (IGF-1), an enzyme that plays an important roal in various anabolic pathways, including ones that signal HGH.

Now, MLB is following suit. A memo circulated recently and publicized by Sports Illustrated baseball expert Tom Verducci warned major and minor leaguers to the dangers of the substance.

The spray, which is sprayed under the tongue, is undetectable in a urine test, according to Verducci, but it could be detected in a blood test or lead to positives for other banned substances, such as methyltestosterone.

Let this be a lesson to baseball players – and players in the other two major leagues: Check the blog early and often to get a head start on discovering the next outlandish substance you should stop taking before it is deemed illegal.

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