DEAR DR. DONOHUE: This is the hardest letter I have ever written. My 23-year-old grandson died. He was on a treadmill at the gym. He just fell off and died instantly. The autopsy didn’t find any cause of death.

He was very health-conscious. He didn’t smoke, drink or do drugs. My daughter (his mother) and the rest of our close-knit family need closure of some sort. Have you any answer for us? – D.T.

ANSWER: My heart goes out to you and your family. Nothing approaches the tragedy of death at such a young age.

Sudden death of young athletes during exercise comes from a handful of conditions. The chief one is hypertrophic cardiomyopathy – enlargement of heart muscle, often with a genetic basis.

The enlarged heart makes it difficult to empty the heart of blood. Furthermore, heart muscle fibers are arranged in a haphazard fashion, which makes the development of serious and often fatal heart rhythms likely.

Unrecognized heart valve disease is another cause of sudden death in athletes.

Marfan syndrome – an inherited condition – is also on the list of causes for unexpected death in otherwise healthy athletes. Marfan patients have long arms and legs, often have eye problems and most dangerously have bulging, weak aortas.

All of these conditions would be discovered on autopsy. Your grandson most likely had a heart prone to generate dangerous heart rhythms, ventricular tachycardia and ventricular fibrillation. “Why” is a question that probably will never be answered. When those heart rhythms occur, and they often do so when the heart is stressed by exercise, they lead to sudden death unless they are quickly treated.

Your grandson’s heartbreaking death points to the need for people trained in CPR – cardiopulmonary resuscitation – to be present at all athletic venues and for defibrillators to be available there.

DEAR DR. DONOHUE: I can lift my stomach up in my hands – that’s how flabby it is. I have a lower-back injury, so sit-ups are not an option. I can’t afford surgery. Do you have any suggestions? – F.T.

ANSWER: Don’t despair. Sit-ups don’t selectively remove stomach flab. They strengthen stomach muscles. Strong stomach muscles act like a girdle holding internal organs in place. So they’re a definite aid, but they aren’t the only way to flatten the stomach. Calorie reduction is a must. With a calorie deficit, the body turns to fat for a source of fuel. The flab you lift with your hands is fat. Weight loss will get rid of it.

Lie with your back on the floor. Your stomach disappears. The reason is that your lower back loses its natural inward curve. That curve pushes the stomach out. If you make an effort to change your posture so that the inward curve of your lower back is not so pronounced, your stomach won’t stick out so much.

Stand with your back against a wall. If you can put your fist between your lower back and the wall, the inward curve of the back is too great. Adopt a posture that lessens that curve and maintain it at all times. It takes practice to become a habit. This might make your lower back feel better too.

DEAR DR. DONOHUE: I am a 72-year-old man in fair condition, and I work out at a local gym. I have a protruding stomach.

All my life I have been told I am a stomach breather. Is that a disadvantage as to proper breathing and getting air into the lungs? What is a stomach breather? – G.B.

ANSWER: Stomach breathing is an advantage when exercising and for people with chronic obstructive pulmonary disease.

It means you’re using your diaphragm to its fullest capacity. The diaphragm is the horizontal band of muscle separating chest from stomach. It’s the most important breathing muscle. When the diaphragm descends, the chest cavity enlarges. Negative pressure is created, and air rushes into the lungs, inflating them to their maximum.

This is good. You can tell if you’re using your diaphragm by putting your hand on your stomach. When you breathe in, your hand will be pushed out if you’re using your diaphragm.

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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