Dateline investigation - supplements

Last night, March 18th 2012, I was channel surfing and came across a Dateline story with Chris Hansen of  "To Catch a Predator" fame that looked into the dangers of the dietary supplement market.  They discussed many of the issues that I have been presenting at coaches' education lectures for many years.  Dateline was investigating one product that was purchased at a nationwide retailer that was making several people very ill.  The interesting part is that they even went one step further.

By now, it should be widely understood by the U.S. consumer that the supplement market is highly unregulated and there is little the FDA can do to stop bogus or dangerous products from reaching the market.  What the Dateline investigation exposed was that the problem may be even more widespread than most of us originally feared.  Since the FDA does not have the authority to regulate the supplement market before products reach the shelves, the work is left up to private labs to authenticate the products.  Dateline investigated and exposed one of these private labs for their questionable testing standards.  The process was referred to as "rubber stamping" products.  This was made clear when the lab in question missed the obvious poisons that Dateline secretly added to their bogus products.  The lab in question tried to place the blame back on the Dateline crew for "falsifying their product research" despite the fact that all the other labs that Dateline gave product to for testing found the poisons and warned against selling the product.

This investigation clearly shows that the labels on the containers don't always accurately describe what is in a product and need to be researched well before a dietary supplement product is consumed.  This completely validates the warnings that I have been giving for many years in the seminars for high school coaches.

The most disturbing part is that the commercially available supplement that Dateline was investigating was found at a store that works hard at projecting a strong, safe image.  The retail outlet outlet, in their defense, pulled the product from their shelves quickly after the problem was discovered.  However, if this retailer was truly looking out for their reputation and best interests, they would be demanding that suppliers of the products that they sell work with specified labs that are of high reputation and avoid certifying their products using labs with questionable methods.

A day late, but hey, it lasts all Month!

Yep, the calendar affirms my belief that we are now in the month of March.  That means a lot of things like tournament basketball and state wrestling tournaments in the world of high school athletics.  However, there is one other thing that it means to the athletic trainers.  It also means that March is National Athletic Training Month.  The one month of the year where athletic trainers across the country will work hard to promote the work that they do for high schools, colleges, professional teams, and many other settings.  Since I don't want to miss the bandwagon on this one, Happy National Athletic Training Month.

A rememberance.

The only thing for this week is to remember those families that were affected by the shootings at Chardon High School.  Please keep them in your prayers.

Super Bowl NFL Safety Commerical

Last night in the Super Bowl, the NFL played a 60 second commercial that was billed as their message on the safety of the players.  Upon hearing the initial hype about the spot, I was intrigued since I had read that it was intended to promote safety in the game at all levels.  I was anticipating a message aimed at young athletes and their parents about using appropriate tackling technique or to report all symptoms of injuries, especially TBI, to appropriate medical professionals.  There was even a small hope that the NFL would also have promoted the use of athletic trainers on the sidelines of every high school game and practice.  The possibilities of their message were endless as far as I was concerned and hoped for.  What better way to promote the safety in the game than to do so in the biggest arena on the biggest stage?



After watching the spot, which aired as the first commercial at the end of the third quarter, I found it was seriously lacking in its message.  I was sincerely disappointed to see a history of safety advancements in the game with no explanation as to why the improvements were made.  A simple explanation of why helmets were first introduced would have been wonderful, but it was left up to the viewer to interpret the reason.  Only those familiar with the history of the game, and in particular with the history of the football helmet, would have understood the significance of each stage presented in the commercial.  Casual fans of the game would have no chance of understanding without researching it.

Instead of promoting the safety of players in the game, the commercial gave the message "Please stop the lawsuits against the league, we are trying to make things better, really we are."  Unfortunately, the history of the NFL argues against this statement.  The rules changes were usually very slow in coming in the NFL.  In some cases they were much later than the NCAA and NFHS rules, and were implemented in smaller increments.  This slow responses continues to indicate a bigger interest in the league's finances over player safety.   It certainly is not the best way to win over the NFL's critics.

In the end, the commercial was a nice collection of video clips that promoted the game and only offered a passing thought to the safety of the players.  It should be recorded as a badly missed opportunity to make a real difference in youth football.

Recent media review

Since I missed the airing of the CNN presentation last weekend, I will be setting by recorder to make sure it gets the re-airing this weekend. (There is, of course, a basketball game to work at the same time.)

In the meantime, the ESPN Outside the Lines piece that took on Riddell and described their marketing campaign on their revolution helmets as being questionable was very informative for the public.  The article exposed the issue of Riddell trying to quote a 2006 study that found a 31% reduction rate in TBIs with their helmets.  The problem with this claim is that the critics of this study find it to be seriously flawed with a big conflict of interest since Riddell financed the study.  The ESPN piece also describes the Virginia Tech helmet comparison study in some detail and how the independently funded study's findings.  It is worth the time to watch the video that is posted by following the above link.

ESPN also turned the spotlight on to the helmet reconditioning industry and exposed some serious flaws in that process as well.  They describe a particularly scary situation where a 1 year old helmet is likely to be returned to a school with parts that are much older or mismatched that compromise the safety of the helmet.  While this is certainly beyond the reach of any individual to change these practices, I think that a sufficient outcry across the football world will get more done.  This industry has too much at stake to cut corners and needs to increase the standards to which they perform.  None of these inconsistencies are excusable especially when you are dealing with young athletes.

Here we go again

Another professional athlete makes some irresponsible statements and a major newspaper is more than happy to perpetuate the mistake by publishing his comments.  This time, Brian Urlacher of the Chicago Bears admits that he would hide potential TBI symptoms form the team's medical staff so that he could continue to play.  The comments are incredibly irresponsible and they give kids terrible ideas on how to usurp their medical staffs and stay on the field.  It is because of incidents like this that the education of the public slows to a crawl.  It would be my hope that at some point, the NFL would be able to fine athletes for comments like this, but I don't see that ever happening without risking a lawsuit from the ACLU.

A recent, concerning event

A couple of weeks ago, we hosted our biggest wrestling tournament of the year.  It is a two day event using eight mats in our field house.  The event starts on Friday night with four groups of four round robin that determine the seeding for the two eight man double elimination brackets in each weight class for Saturday.  Needless to say, there is a lot of wrestling and certainly a lot of opportunity for injury to occur.

On Saturday, a young man came limping over to me from a visiting team and asked me to look at his knee.  He was unable to bear full weight on the leg and most of the pain was on the medial side.  It turns out, according to his history, he likely injured his knee early in the fall during his football season.  He was able to "grit it out" and competed through the rest of football and here we are in early January looking at it after his opponent twisted his leg.  As it turns out, when I stressed the knee with a valgus stress, it opened up by about a centimeter compared to his contralateral knee.  Obviously, the concern was very real at that point and I disqualified him from continuing.  According to the coach, he was completely unaware of the prior status of the injury and he agreed with my decision to end the kid's day.

The most concerning part of this injury is the parent involvement. Granted, I have dealt with my fair share of kids that were neglected or ignored by their parents and minor injuries have gone untreated.  This seemed to be of an entirely different level.  The MCL that was injured was not, by any measure, insignificant.  It was only by luck that this young man didn't end up with a far worse injury by continuing to participate in athletics and not get the injury looked at by a medical professional.  I am not sure whether this school employs a certified athletic trainer or not at this time.  However, this situation is demonstrates why there should be an AT employed at every school.  This young man should not have been participating and this should have been caught much sooner.

New tech to detect TBI

Another new piece of technology is being talked about that may help diagnose serious head injuries.  This new device detects hematomas in the skull as a result of a head injury.  Subdural hematomas, by definition, are classified as moderate and severe traumatic brain injuries.  These are not mild TBIs, commonly referred to a s concussions. 

Mild TBIs are more insidious and involve the process of calcium and potassium ions crossing the cell membranes and causing an energy crisis in the brain.  There is no bleeding to speak of in an mTBI.  Therefore, it must be made clear that this new piece of technology, while it may prove useful, will not rule out mTBIs.  This must be very carefully explained each and every time this piece of technology is purchased and used to test for a head injury.  Otherwise, it will have the same problems that CT scans and MRIs do when emergency room staff erroneously tell a victim of an mTBI that they are fine because the test came back negative.

New Years Wish 2012

I  would just like to wish everyone a safe, happy, and healthy new year.  Hopefully this year will bring many more advances that will allow every ATC to care for their athletes better and keep them participating in their chosen sports as much as possible.

NFL athletic trainers in the booth

In light of the incident with the Browns and Colt McCoy's belatedly diagnosed concussion, the NFL has decided to put an independent athletic trainer in the press box of every football game to watch each of the league's 32 teams for proper adherence to TBI assessment protocols.  This can be a unique opportunity to promote the profession of athletic training and to demonstrate that we are capable of performing more than just taping ankles and getting ice.  I hope that this will not only bring more stability to the NFL, but will also promote the safety of the players, and bring some positive publicity our profession.

Upon reading many comments of fans and others interested in the TBI crisis, I found a great many of them had a very negative response to this new rule.  Many of them were asking "Why can't a doctor just be hired to do it and forgo the AT.  To this, I have two answers.  The first is cost.  ATs are far cheaper to hire to watch from the press box than are physicians.  Secondly, according to neuropsychologist Dr. Mickey Collins at the University of Pittsburgh Medical Center, the designers of the ImPACT program, "There is a large number of athletic trainers that are practicing better medicine with regards to this injury than many physicians."  I can't think of a better endorsement than that for allowing ATs to have this chance.

One thing is certain, I will be investigating the position and see if I can get into this for a side job.  After all, it sounds like fun.

The Value of an Education

This post is a significant tangent to the theme of this blog, but I can't help but blow my horn a little.  Yesterday, I walked through my third commencement and received my Masters of Education.  My field of study was educational technologies.  Imagine that, I learned more about using current technologies for instructional purposes.  I think that has something to do with this blog, after all.  So all I really have to say here is "Yay Me!"

Colt McCoy and the Browns TBI

The Cleveland Browns are involved in a controversy.  I should also report that the sky is blue, the grass is green, and water is wet.  This time, the Browns have come under fire for how they treated Colt McCoy after he got hit by James Harrison in the fourth quarter of the football game this past Thursday night.  I was just as shocked as the rest of my colleagues were when Colt reentered the game.  His return is being reported as occurring just 3 minutes and 50 seconds of real time (not game time) after getting hit.  Local radio talk show hosts are using the incident to further their cause for ousting Pat Shurmur as the head coach and people calling in are agreeing with them.  Colt's father even discussed with a local journalist and called the Browns' actions egregious and that his son should not have returned to play. Needless to say, it has caused quite a lot of conversation locally, and a fair amount nationally.


To nobody's surprise, fans' amazing powers of prediction were confirmed when the Browns released the injury report and Colt was listed as suffering "concussion like symptoms."  According to reports, the symptoms started after the game was over.  This is not out of the realm of possibility and symptoms may not have appeared until after the game ended since it was the fourth quarter when the hit occurred.  I have seen many instances where it takes 10, 15, or even 20 minutes before any symptoms appear that would indicate the athlete's cognitive function has been compromised.  A bigger issue arises in the fact that Colt was only on the sidelines for less than four minutes.  There is no way to perform a comprehensive evaluation of a person's cognitive functions in that short amount of time.  Simply getting symptom score from the SCAT2 would be difficult in that short time given the amount of noise that was present around the evaluator and Colt in Heinz Field.  To complicate matters, Colt did complain of some pain in his thumb that the ATCs would also need to examine in that short time and Colt was lying on the field for some time after the hit while the broadcast cut to a commercial.

Granted, there were only a few people on the sideline that would know what the story is and how it unfolded, but it does seem to me that after a particularly hard hit like that, it would behoove the medical staff to at least get a concussion exam performed.  It does seem highly likely that a TBI screening was never performed on the sideline before allowing Colt to reenter the game, which would confirm Mr. Mortensen's assertions on Sunday that the Browns lied about the TBI evaluation and allowed him to return to play.  The critics' arguments are based on the fact that Colt "was suffering from concussion like symptoms" at the time of the hit because he was "obviously knocked out when the hit occurred."  I would love to know what kind of visual aid these critics were using to diagnose this because I cannot possibly confirm or disprove that Colt was indeed, "out cold."  The only person that might know that would have been James Harrison, if he bothered to look at Colt after the hit.  Unfortunately, the replays cut away too quickly to know if Mr. Harrison had looked.  I have seen a lot of athletes simply lie on the ground for a half second after a hit to "catch their breath" before getting up and running off.  This "knocked out cold" diagnosis is impossible to make from the camera angles, the existence if the helmet, and distance.  Therefore, we must rely upon what the medical staff saw at the time of the hit.  Since I wasn't there, I cannot offer an opinion and I believe that nobody else should either, especially non-medically trained radio talk show hosts and callers.

Since the medical staff will not be speaking to the press anytime soon (the federal law, HIPAA, makes it highly improbable that it will ever happen), we have to rely on the official information being released by the Browns.  This information has been tightly controlled and therefore, leads to a lot of speculation.  The problem is that the media needs to realize that they won't always be given all the answers to report and their speculations are not the truth.  This often leads to other issues that make every athletic trainer's job significantly more difficult.  The issue that faces the high school and collegiate AT is that leaves athletes and parents wondering about what the proper protocol is when their son or daughter gets hit in the head.  Why do I take so much longer to evaluate a kid when the Browns can do it in under 4 minutes?  It makes me look like a poor professional and it leaves the high school and collegiate ATs in a pinch when this situation comes up.  It then takes an extraordinary amount of time to explain the difference that I can only hope takes place after I have completed my thorough examination, not during it.

James Harrison Strikes Again

How many times does it have to happen for some fans to get it through their thick heads that the rules have changed from the days when they ran up and down the football field?  Medicine has advanced considerably and has proven that these actions have a high probability of leaving a person with a life altering injury.  The face tackling, butt blocking, and spearing techniques have been illegal at all levels of football for nearly 40 years.  What has changed is the awareness of head injuries associated with these collisions.  The rules have only recently changed to create better rules enforcement because of recent discoveries with head injuries.  I understand that this is a violent game played by consenting adults (in the NFL), but that doesn't mean the players need to be at an unnecessary risk for injury.  This risk is easily minimized by making a solid tackle at the hips using the chest and shoulders.  The headhunting and ESPN highlight reel hits are unnecessary.  This oaf has been been repeatedly fined for these actions and has not learned his lesson.  The slow motion video clearly shows that instead of lowering his level and breaking down to make a tackle, he lowers his head slightly and launches at the QB's head.  Since this is not the first time he has done this, he needs to be suspended without pay for an extended period and warned that expulsion is a consideration.

To all the former high school and college players who want to say "this is just football", think about that when it is your 7-17 year old son imitating these hits in their Pop Warner, middle school or high school games.  When it is your son who gets hit like this and ends up as a special education and special needs child as a result of of the hit.  This IS HAPPENING all over the country.  It is not well reported, but you can find the stories over the internet every year.  I would refer you to websites like http://www.theconcussionblog.com or http://www.sportsconcussions.org where you will find many resources to educate you about what is happening.  It is time for the fans of "traditional" football to wake up and realize that we can significantly decrease the injury rate and maintain the integrity of the game.

 Finally, there may also be some reason to question the Browns' medical staff as to the nature of a head injury to Colt McCoy as a result of this hit.  There have been a few reports including this one that state that McCoy doesn't remember the hit and that the media was requested to not use the intense lights on McCoy after the game.  Both of these are indications that there may have been something wrong and a possible traumatic brain injury.  I hope that there will be more comprehensive updates of Colt's status released in the next few days.

An open question to ATs covering wrestling

History
Several years ago, the NFHS followed the NCAA, NJCAA, and the NAIA in implementing the weight certification process for high school wrestling. I had the unique opportunity to offer input into how the rule was written for Ohio. Before I ask my question, let me explain what we are doing in Ohio high schools. We are using skin fold calipers and urine dipsticks as required by the Ohio High School Athletic Association. Furthermore, the OHSAA has a required parental consent form for the urinalysis. Also, there is a two tiered system of certified assessors. We maintain both master and general assessors. The difference is that general assessors can only perform an initial assessment. The master assessors can perform the initial assessment, the first appeal assessment, and conduct the class required by the OHSAA for new general assessors.  There is also a second step appeal by using a BodPod air displacement test or an underwater weighing, both of which are performed by labs approved by the OHSAA.

My question to my fellow ATs is regarding the urine dipsticks. When the rule was being written, I conducted a pilot of the weight assessments with the cooperation of most of the schools in our conference. At the time, we used refractometry to do the urinalysis. However, a short time later, a coworker from the hospital's lab asked me how we were able to get CLIA certification to perform the refractometry. I was left staring at her with a very dumb look on my face. She referred me to the CMS site to look at the Clinical Laboratory Improvement Amendment. What I found was discouraging. Refractometry, when used to determine a health plan, required an expensive license to perform. There is a waiver that can be obtained, but it required payment for individual tests. That quickly got equally expensive for the number of wrestlers we were looking to test statewide.

When I recognized this issue and brought it to the attention of the OHSAA, they balked at the idea of using refractometry and decided to use the urine dipsticks instead.  The dipsticks required a very small waiver fee and the OHSAA pays that each year for all the assessors in Ohio.  Therefore, for the last six years, we have been using the dipsticks.

By now, my question should be obvious, what is everybody else doing to stay legal while performing the refractometry assessments?  Any information would be helpful since I now have two refractometers sitting in my desk collecting dust.  One brand new and never used and the other is only used the one day of the pilot test.

The following section is included to prevent other questions about why Ohio did what they did in other parts of the assessment.
The OHSAA also decided to the skin fold calipers instead of the BIA because of the cost and questionable accuracy associated with BIA.  I had no issues with this, but this was also why Ohio decided that there would be a class required before being eligible to perform the assessment.  In doing so, the OHSAA could assure better competency with the skin fold calipers by the assessors.  To further ensure competency and credibility, the OHSAA mandated that the minimum requirements for an assessor was a bachelor's degree in a related health field.  That standard includes MD, DO, DC, PT, ATC, RNs, dieticians, and exercise physiologists.  Needless to say, there were some very unhappy health club employees out there (personal trainers, fitness trainers, etc.) because they were excluded from the rule.  Since I am a master assessor, I fielded more than one angry call about why they were excluded when they wanted to become assessors found they weren't eligible to take the class.

Congratulations to Pennsylvania

It is nice to see that state legislatures are taking this issue of TBI in youth athletics seriously even though it bucks the trend of the culture surrounding youth sports.  Pennsylvania became the 32nd state to enact similar legislation to help protect the young athlete.  The interesting part in Pennsylvania is that it requires a suspension of any coach caught breaking this law.  I find that to be a very positive step even though it may be hard to enforce.

Unfortunately, it does appear that certain other uninformed, yet boisterous individuals got their outdated opinions heard and the law reflects that.  While athletic trainers are designated specifically, the physicians are allowed to designate people that they trust to return an athlete to play in a timely manner.  I understand that this individual was nowhere to be seen or heard from when the bill was being signed.  It is truly a shame that he could not be bothered to show after he decided to interject himself and his ridiculous opinions into the conversation.

Finally, I am now wondering where my home state, Ohio is on its bill.  It has been sitting in committee for months now with little to no movement and it seems to have stalled.  There have been no updates released about the legislation in a couple of months now and I am beginning to worry about it.  I trust our state legislature is still working on getting it passed in a timely manner.