DEAR DR. DONOHUE: The only sport I’m really good at is running. Last year, I had to quit our team because I fractured my lower leg. At first I was told I had shin splints. When my leg didn’t get better, my mother insisted I see a bone doctor. He had me take a bone scan, and he found I had a stress fracture in my lower left leg. He said I got it because I’m a girl. Is that for real? What else could cause it? I’d like to run this year. – M.C.

ANSWER: “Shin splints” is a name that ought to be retired. It has little meaning. People use it for any pain between the knee and ankle.

Stress fractures are true breaks in the bone, but they are very tiny breaks. Often an X-ray misses them, but a bone scan reliably demonstrates such breaks. They occur when forces on the bone exceed the bone’s strength to tolerate them. They’re very common among runners. Females get them more often than men because their legs are lined up a bit differently from the way men’s are. The difference subjects women’s leg bones to slightly greater forces when their feet strike the ground. Being a woman is not the only cause – more important is too much running with too little time taken for recovery.

This year, start the season slowly, and don’t increase mileage rapidly. Get a pair of shoes that cushion your feet and legs when your feet hit the ground. Running style is another stress factor for leg bones. Don’t let your foot strike the ground with the knee rigidly straight. There should be a slight bend in the knee to take some stress off the foot and the leg bone when the foot meets the ground. If you develop shin pain, stop running and rest until the pain completely goes away.

DEAR DR. DONOHUE: Our son is a three-sport athlete. Actually he’s a four-sport athlete if he wants to be. His dad was and is an excellent athlete, too. For the first time ever, he was benched in basketball because the coach felt he wasn’t playing as hard as he could. Now my son tells us he doesn’t want to play baseball this year. We thought he might be sick with something like mono and made him see the doctor. The doctor gave him a very thorough exam and did lots of bloodwork. Nothing was found. Do you think this might just be a psychological thing? – M.M.

ANSWER: It could be. It could also be overtraining. It appears that this boy is either practicing or playing a sport all year round. Each sport takes its toll. His body might be rebelling, and he’s not able to perform as he used to.

Poor performance is a sign of overtraining. Other signs are difficulty concentrating and sleep disturbances. Have you noticed either? Let the boy do what he wants. He could stand a break. Maybe with a season of no athletics, he will regain his energy.

Overtraining is something adults often fall victim to – running adults, in particular. They train with such dedication that they forget to take time to rest and let their body recover. They find themselves unable to run the distances they once could, and they usually double the amount of time spent running to make up for their reduced performance. Adults can tell if they’re overtraining not only by a reduction in their mileage but by an increase in their resting pulse rate. If, on wakening in the morning, their pulse rate increases over what it usually is, that’s a sign of overtraining.

DEAR DR. DONOHUE: Since I was 12, I have played tennis. I still do, four times a week, and I am 77. I have had to cut the time I play tennis in half because I’m getting short of breath. What kind of lung exercises can I do? – R.K.

ANSWER: Forget lung exercises. See your doctor, and you should do that as soon as you can. Becoming breathless doing things you used to do without any trouble can be a sign of many serious illnesses.

DEAR DR. DONOHUE: What are the facts on sickle cell anemia? My relative’s infant child has it. I thought this was found here only in African-Americans. We are Caucasian. Will this baby reach adulthood? – T.O.

ANSWER: Sickle cell anemia is an inherited disease. In North America, African-Americans are the ethnic group having the greatest number of sickle cell patients. However, many other groups carry the sickle cell gene and can develop the illness: Greeks, Italians, Arabs, Turks, Iranians, Egyptians and Asiatic Indians.

To inherit anemia, an infant must receive a sickle cell gene from the mother and the father. (Having only one gene confers the state known as sickle cell trait, something that usually produces no big troubles.)

Having two genes causes red blood cells to transform from their normal round shape to the shape of a sickle when blood oxygen levels drop, as they often do when the person becomes dehydrated. Sickled red blood cells are sticky and form plugs that block blood flow through vessels. That leads to death of parts of bone and muscle. It also happens in the digestive tract, where sections can die. Kidneys are often involved in the sickling process. Ulcers might break out on the skin of the lower legs. When there is widespread sickling, the episode is very painful and must be treated in the hospital with intravenous fluids for hydration. If the red-blood-cell count drops very low, blood transfusions are required. Pain medicines are essential to ease the discomfort that comes with these crises. The drug hydroxyurea is prescribed when a sickle cell patient has frequent sickling crises. Your relative’s baby should make it to adulthood and beyond.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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