DEAR DR. DONOHUE: My 18-year-old grandson died while practicing football. He was an outstanding athlete and a successful student. He had a wonderful life ahead of him.

There are several unanswered questions I’d like you to address. What do you think was the cause of death? Could it have been prevented? His father was so grief-stricken that he refused permission for an autopsy. – K.M.

ANSWER: I get a letter with a similar story about every three years, and I am always at a loss on how best to express my sorrow to the family. A greater tragedy is hard to imagine.

Undetected heart illness is the most common cause of sudden death in a young athlete. The heart condition responsible for a quarter of those deaths is hypertrophic cardiomyopathy. It’s an inherited illness in which the heart muscle grows too large. Sometimes, the overgrowth is so great that it obstructs blood flow out of the heart. And sometimes death results from the abnormal heart rhythms that this kind of heart generates, especially when the affected person is engaged in hard physical activity.

Other conditions also could be responsible: abnormalities of the heart arteries, unrecognized viral infection of the heart, heart valve disease and the inherited illness called Marfan’s syndrome.

Prevention? In some individuals, hypertrophic cardiomyopathy produces a murmur that leads to its discovery. In Italy, all school athletes are required to have an EKG before athletic participation is allowed, and the EKG often suggests this problem. Discovery of the problem would have been the only way to prevent your grandson’s death.

Sudden deaths of young athletes aren’t common. They happen from 1-in-100,000 participants to 1-in-200,000. That’s still too many. It would be helpful if coaches, referees and even teammates were routinely taught the basics of CPR – cardiopulmonary resuscitation.

DEAR DR. DONOHUE: Is there any difference between a sprain and a strain? I use the two words interchangeably. – M.T.

They don’t mean the same thing. A sprain is a stretching or tearing of joint ligaments. A strain is a stretching or tearing of muscle fibers.

DEAR DR. DONOHUE: I have jogged for many years. It’s kept my weight down, and I do feel really fit. Twice I have sprained an ankle by stepping in a pothole. What’s the right way to treat a sprained ankle? – G.R.

I can’t improve on the time-honored RICE recipe.

“R” is for rest. Don’t put weight on a joint whose pain increases by so doing.

“I” is for ice. A good way to apply ice is to put it in a plastic bag and then put a thin towel between the bag and the injured joint. Keep the ice in place for 15 minutes. Repeat the icing three or four times in the first day or two. Then switch to hot packs.

“C” stands for compression. An elastic wrap does just fine.

“E” is for elevation. If it’s the ankle that’s injured, the leg should be propped up.

All these steps are done to prevent bleeding and swelling during the first two days of an injury.

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

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