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Lisa Salberg
09-16-2004, 09:48 AM
Copyright 2004 The Tennessean
All Rights Reserved
The Tennessean

September 7, 2004 Tuesday 1st Edition

SECTION: TUES LIVING; Pg. 1D

LENGTH: 1158 words

HEADLINE: Death on the playing field

BYLINE: SAMEH FAHMY

BODY:

More testing, access to defibrillators could save young lives, doctors say

By SAMEH FAHMY

Staff Writer

It happened again last month.

An apparently healthy student athlete collapsed on the playing field and
died, leaving family, friends and the community in shock.

Sadly, sudden death in young athletes isn't unheard of in Middle Tennessee or
anywhere else.

"It must happen in this community at least once or twice a year," says Dr.
Dan Roden, a heart rhythm specialist at Vanderbilt University Medical Center.
"And as a parent, I can't think of anything that could be worse."

How - or if - such deaths could be prevented is the subject of a
long-simmering debate among doctors, athletic departments and parents. There are
plenty of opinions, but no easy answers.

Exams can't find everything

The most recent victim was 14-year-old Bruce Gilley, a Murfreesboro
cross-country runner. He died of cardiac arrest after finishing a five-mile
practice run.

Last year, three student athletes died. Tyler Beasley, a 16-year-old soccer
player at Davidson Academy, collapsed during practice. Nathan Fuhrman, a
16-year-old Tullahoma wrestler, succumbed to a heart defect during practice.
Shalanda Morton, a 15-year-old McGavock High School basketball player, collapsed
during a game. And in 2002, 16-year-old Chad Franklin, a Chapel Hill, Tenn.,
football player, collapsed during pre-game warm-ups.

The sudden death of a young athlete is rare, and researchers estimate the
death rate is between one in every 100,000 and one in every 300,000 student
athletes. The most common cause is an undiagnosed heart problem.

Metro Schools follow Tennessee Secondary School Athletic Association and
Tennessee Medical Association guidelines, which require that a medical doctor,
doctor of osteopathy, physician's assistant or certified nurse practitioner take
a medical history of each prospective athlete.

Using a questionnaire, the physician or other health professional asks
questions such as "have you ever passed out during exercise," "have you ever had
chest pain during or after exercise" and "has anyone in your family died of
heart problems or a sudden death before the age of 50."

The students also receive a general physical exam that measures height,
weight and blood pressure and examines factors such as flexibility and range of
motion.

Scott Brunette, director of athletics and physical education coordinator for
Metro Schools, says the current preparticipation medical examination is one of
the most comprehensive he's seen. If the health professional performing the
screening must refer a student to a doctor for additional testing, parents must
provide the coach with written evidence that the student has passed a physical
exam. The second physician also must submit a letter addressing the student's
condition.

But the consensus among Roden and other researchers is that while
preparticipation evaluations may be well intentioned, their current design makes
them incapable of detecting the few conditions that can kill.

What can be done?

Several things can suddenly and fatally go wrong with the heart. The most
common cause of sudden death is a condition known as hypertrophic
cardiomyopathy, in which the heart muscle becomes thickened and doesn't pump
blood properly.

A routine physical won't detect it, but an echocardiogram - an ultrasound of
the heart - can.

The problem that even advocates for screening acknowledge is that the
echocardiogram is a far-from-perfect test. It can miss genuine cases of the
disorder or unnecessarily worry - or possibly end the sports career of - a
healthy athlete. That's because athletes often have hearts that are larger than
normal due to their sports training. Doctors consider this condition, known as
athlete's heart, harmless.

Other potentially fatal heart problems, such as a heart rhythm defect known
as long Q-T syndrome, can't be detected with echocardiogram. That condition
requires an electrocardiogram (known as ECG or EKG) to measure the heart's
rhythm, and that test doesn't always catch the disorder.

Dr. Thomas Best, associate professor of orthopedic and family medicine at the
University of Wisconsin Medical School in Madison, cautions that the extent to
which these tests can prevent deaths won't be clear until they're implemented
and their effectiveness studied.

"It appears that a significant number of these (heart problems) can in fact
be detected with a combination of an EKG and/or an echocardiogram," says Best,
who edited an issue of The Clinical Journal of Sport Medicine earlier this year
devoted to preparticipation evaluations. "But until we do this, we don't know
for sure."

Best says an echocardiogram can cost anywhere from $100 to $300. Performing
an EKG costs only a few dollars, but a team physician or a cardiologist must
interpret the results.

Vanderbilt's Roden, a professor of medicine and pharmacology, says the
benefits of the screenings easily outweigh the cost.

"There are plenty of things that we do that are more expensive and probably
save fewer patients' lives than this," he says. "You have to just make a choice
about whether you want to build another B2 bomber or screen every child in the
country, because there's no question which one would be cheaper: screening every
child in the country."

Roden and Best also believe that greater access to defibrillators, those
laptop-size emergency devices found at airports and other public places that
shock the heart back into rhythm, and more CPR training could help save lives.

Some of the biggest advocates for better screenings and more defibrillators
are parents such as Yolanda Morton of Hermitage. Her daughter, Shalanda, died
last year after collapsing during a basketball game.

An autopsy revealed a cyst that blocked the flow of spinal fluid to her
brain, but her doctors suspect that a heart rhythm problem killed her. Morton
says a potentially lifesaving defibrillator wasn't available when her daughter
collapsed.

Reba Bryant, program specialist in guidance, counseling and health services
for Metro schools, says that last year the system placed a defibrillator in each
high school. The location of the defibrillator within the school is at the
discretion of each principal, she says, and cost is the reason more aren't
available.

"We don't have money in the budget for more right now," Bryant says. "But it
's always something to think about."

Issues of cost don't sway advocates such as Morton. She says she and her
family have already paid too high a price.

"Anytime a child goes out for any activity, they need to be tested," Morton
says. "I have a granddaughter now and she's a newborn, but if she decides to
play a sport, she's going to get tested no matter what the cost. I'd rather pay
the price, because money can't replace life."