SharonBates
08-15-2005, 11:56 AM
Student heart tests not a feasible option
Parents of teen who died on ballfield say exam should be added to sports physicals
Sunday, August 14, 2005
By Daniel Duggan
Staff writer
--------------------------------------------------------------------------------
Dominic Duran slipped through the cracks.
The 14-year-old Oak Lawn boy seemed healthy. He played four sports every year, and his sports-related physicals showed no warning signs.
Then, in the middle of an April 4 baseball practice he collapsed, dying 10 days later.
His death has led his family members and former coaches to push for more heart testing for high school student-athletes as they prepare for fall sports. The goal is to identify undiagnosed heart conditions and save lives.
"This shouldn't happen again," Dominic's father, Michael, said. "Every child who participates in athletics should have their heart checked."
But doctors say it probably will happen again.
Either an echocardiogram or electrocardiogram test might have caught the boy's condition. But doctors say it's not practical to give expensive heart exams to every student-athlete, especially seemingly healthy ones.
"It's like giving a shot to everyone in the world for a disease almost nobody will ever get," said Robert Pallay, a New Jersey physician who helped craft the guidelines followed for sports physicals.
Dominic had a condition called ischemic cardiomyopathy, a rare disorder caused by hardening of the arteries on the surface of the heart, according to his autopsy.
In 2002, 11 children younger than 18 died of sudden cardiac death, a broad category that includes Dominic's condition and a range of other undiagnosed problems, according to the U.S. Centers for Disease Control. There was no data for Dominic's specific condition.
In older people, sudden cardiac death is more likely, causing the death of 2,800 people of all ages in 2002, the last year for which statistics are available, according to the CDC.
Dominic's condition is a rare form of a rare disease, said Vincent Bufalino, a Naperville cardiologist and president of the American Heart Association's Midwest affiliate.
He said the boy's heart condition might have been detected with an echocardiogram. But a healthy 14-year-old boy, considered "low risk" for heart problems and with no warning signs, likely would not be tested, he said.
"But low risk means nothing when someone falls down on the field," Bufalino said.
In 1995, Bufalino responded to several sudden deaths in the Chicago area by testing 2,500 children at random with an echocardiogram machine.
"We found nothing," he said. "That was a pretty big sample, and there was nothing abnormal."
The test led him to a conclusion held by many other doctors: Children should be tested only when they show warning signs, such as dizziness or fainting while exercising, shortness of breath, fatigue or a family history of heart disease.
To give each of the roughly 72 million children younger than 18 in the United States a $300 echocardiogram would cost about $21.7 billion. And the test typically is not covered by health insurance.
In addition to the cost of screening, there's the added problem of false positive results with the echocardiogram. The test typically has "gray areas" that require more expensive tests.
And even if every child were tested, some heart conditions won't show up until later in life, Bufalino said.
"As doctors, our priority is help people," he said. "But there are practical limitations to this situation."
Dominic's former coach, Oak Lawn High School freshman baseball coach Clyde Anhalt, has proposed the use of a Palos Heights-based program called Sportlink USA. The program was co-founded 10 years ago by Dr. Alex DeJong and is now being used at some Southland private schools and public school districts.
DeJong and a crew of technicians and doctors conduct a 9-station physical examination. The $35 cost includes a limited echocardiogram administered by a technician, who refers any abnormal results to the on-site doctor.
DeJong said the program was created as a cost-effective way to screen student-athletes and their hearts. The key, he said, is to examine the student's entire physical condition, not just the heart.
"When properly used, this can pick up conditions that might be missed," he said. "But mass screenings, without a full physical, would bring out too many false positives."
DeJong said the use of the limited echocardiogram is still experimental. Information obtained is used to refer students for further testing, he said.
But in Dominic's situation, the thickened walls of his heart's septum would have been noticed as a sign for further testing, DeJong said.
Few Southland schools now use an echocardiogram as part of their program of physicals for student-athletes. Most sports physicals stick to guidelines, established by a coalition of six medical organizations, that do not require heart exams.
Pallay said doctors from the coalition debated the matter of heart checks while crafting the standards for sports physicals. For the parent of someone who dies suddenly, it seems obvious that everyone should be tested, he said.
"But you can't set policy for the entire country based on a few sad and catastrophic cases," Pallay said.
For Marist High School parent Lynn Bush, whose son Brett had a heart murmur as a baby, the piece of mind from an echocardiogram helps her sleep at night.
"I'm sure there are things it won't catch, but this extra amount of screening makes a big difference for me," she said.
Michael Duran said that looking back, it would have been easy to get his son a heart test, no matter the cost.
"I hope we can build awareness and get these tests done," Duran said. "I hope we're the only family that should go through this."
Daniel Duggan may be reached at dduggan@dailysouthtown.com or (708) 633-5969.
Parents of teen who died on ballfield say exam should be added to sports physicals
Sunday, August 14, 2005
By Daniel Duggan
Staff writer
--------------------------------------------------------------------------------
Dominic Duran slipped through the cracks.
The 14-year-old Oak Lawn boy seemed healthy. He played four sports every year, and his sports-related physicals showed no warning signs.
Then, in the middle of an April 4 baseball practice he collapsed, dying 10 days later.
His death has led his family members and former coaches to push for more heart testing for high school student-athletes as they prepare for fall sports. The goal is to identify undiagnosed heart conditions and save lives.
"This shouldn't happen again," Dominic's father, Michael, said. "Every child who participates in athletics should have their heart checked."
But doctors say it probably will happen again.
Either an echocardiogram or electrocardiogram test might have caught the boy's condition. But doctors say it's not practical to give expensive heart exams to every student-athlete, especially seemingly healthy ones.
"It's like giving a shot to everyone in the world for a disease almost nobody will ever get," said Robert Pallay, a New Jersey physician who helped craft the guidelines followed for sports physicals.
Dominic had a condition called ischemic cardiomyopathy, a rare disorder caused by hardening of the arteries on the surface of the heart, according to his autopsy.
In 2002, 11 children younger than 18 died of sudden cardiac death, a broad category that includes Dominic's condition and a range of other undiagnosed problems, according to the U.S. Centers for Disease Control. There was no data for Dominic's specific condition.
In older people, sudden cardiac death is more likely, causing the death of 2,800 people of all ages in 2002, the last year for which statistics are available, according to the CDC.
Dominic's condition is a rare form of a rare disease, said Vincent Bufalino, a Naperville cardiologist and president of the American Heart Association's Midwest affiliate.
He said the boy's heart condition might have been detected with an echocardiogram. But a healthy 14-year-old boy, considered "low risk" for heart problems and with no warning signs, likely would not be tested, he said.
"But low risk means nothing when someone falls down on the field," Bufalino said.
In 1995, Bufalino responded to several sudden deaths in the Chicago area by testing 2,500 children at random with an echocardiogram machine.
"We found nothing," he said. "That was a pretty big sample, and there was nothing abnormal."
The test led him to a conclusion held by many other doctors: Children should be tested only when they show warning signs, such as dizziness or fainting while exercising, shortness of breath, fatigue or a family history of heart disease.
To give each of the roughly 72 million children younger than 18 in the United States a $300 echocardiogram would cost about $21.7 billion. And the test typically is not covered by health insurance.
In addition to the cost of screening, there's the added problem of false positive results with the echocardiogram. The test typically has "gray areas" that require more expensive tests.
And even if every child were tested, some heart conditions won't show up until later in life, Bufalino said.
"As doctors, our priority is help people," he said. "But there are practical limitations to this situation."
Dominic's former coach, Oak Lawn High School freshman baseball coach Clyde Anhalt, has proposed the use of a Palos Heights-based program called Sportlink USA. The program was co-founded 10 years ago by Dr. Alex DeJong and is now being used at some Southland private schools and public school districts.
DeJong and a crew of technicians and doctors conduct a 9-station physical examination. The $35 cost includes a limited echocardiogram administered by a technician, who refers any abnormal results to the on-site doctor.
DeJong said the program was created as a cost-effective way to screen student-athletes and their hearts. The key, he said, is to examine the student's entire physical condition, not just the heart.
"When properly used, this can pick up conditions that might be missed," he said. "But mass screenings, without a full physical, would bring out too many false positives."
DeJong said the use of the limited echocardiogram is still experimental. Information obtained is used to refer students for further testing, he said.
But in Dominic's situation, the thickened walls of his heart's septum would have been noticed as a sign for further testing, DeJong said.
Few Southland schools now use an echocardiogram as part of their program of physicals for student-athletes. Most sports physicals stick to guidelines, established by a coalition of six medical organizations, that do not require heart exams.
Pallay said doctors from the coalition debated the matter of heart checks while crafting the standards for sports physicals. For the parent of someone who dies suddenly, it seems obvious that everyone should be tested, he said.
"But you can't set policy for the entire country based on a few sad and catastrophic cases," Pallay said.
For Marist High School parent Lynn Bush, whose son Brett had a heart murmur as a baby, the piece of mind from an echocardiogram helps her sleep at night.
"I'm sure there are things it won't catch, but this extra amount of screening makes a big difference for me," she said.
Michael Duran said that looking back, it would have been easy to get his son a heart test, no matter the cost.
"I hope we can build awareness and get these tests done," Duran said. "I hope we're the only family that should go through this."
Daniel Duggan may be reached at dduggan@dailysouthtown.com or (708) 633-5969.