Pre-participation athletic exam should be thorough
DEAR DR. DONOHUE: I played high-school football in the late 1940s. One of my teammates died during a game. The memory has never left me. It was said he had a heart attack, but that sounds preposterous to me. He was only 16. My two grandsons are playing now. What kind of physical exams are required? In my day it was a check for a hernia and that was all. — B.G.
ANSWER: Sudden death in a high-school or college athlete, the healthiest of the healthy, is shocking and tragic. It happens about 115 times every year in the U.S. to those between the ages of 12 and 23. Most of these athletes died from an inherited heart disorder called cardiomyopathy. That’s an enlarged heart whose muscle fibers are arranged in such a helter-skelter manner that they generate abnormal heartbeats. The beats can be so erratic that they stop heart pumping. Your teammate more than likely had such a condition, rather than a heart attack.
Medical exams are required for all school athletics. The extent of the exam varies from state to state and province to province. Hypertrophic cardiomyopathy gives rise to a heart murmur, which should be detected in an exam but might be ignored or not heard.
A pre-participation exam must be thorough. The doctor has to learn of the athlete’s and his family’s medical history. Relatives who died at an age younger than 50 raise the suspicion of inherited heart problems. The youngsters should be questioned about a family history of seizures, drowning or near drowning — another tip for heart problems. They should be asked if they ever had chest pain when they’re active or if they fainted or came close to fainting during activity. The doctor needs to know if they become out of breath before their teammates.
Whether an EKG should be part of the exam is a question that is unsettled. The American Heart Association says no, but the European Society of Cardiology says yes.
DEAR DR. DONOHUE: Many athletes undergo a procedure known as Tommy John surgery. Will you expound on it? What’s the underlying problem? How about symptoms? What’s the cause? How necessary and extensive is postop rehabilitation? — S.G.
ANSWER: Tommy John was a pitcher for the Los Angeles Dodgers. In 1974, his career was coming to an end because he had torn an important elbow ligament, the ulnar collateral ligament. It’s a fairly common throwing injury, happening mostly to pitchers but not exclusively. The ligament keeps the elbow stable. It’s subject to a great deal of force in the throwing motion. Many professional and amateur pitchers have torn this ligament.
The symptoms are pain on movement and a loss of throwing power. The cause is the number of pitches thrown. Less important but contributing is the type of pitches thrown.
Dr. Frank Jobe, a famous orthopedic surgeon, devised the operation that saved Tommy John’s career. He transplanted a tendon from another site to the elbow. The tendon replaced the torn ligament. The operation has been repeated on many athletes ever since, and it has a success rate of about 90 percent.
A full year is given to rehabilitation, which is almost as important as the surgery. Many pitchers find that their throwing speed has increased after the operation and rehabilitation.
DEAR DR. DONOHUE: I would like to add something to a column you wrote about swimming. I am not a comfortable swimmer, but I can swim laps with my 10-year-old daughter three times a week. I use a snorkel and mask so I don’t have to worry about breathing. I always do my last lap without the snorkel so I can gradually improve my unassisted swimming ability. Not being an expert swimmer doesn’t have to interfere with people’s use of the pool for exercise. — K.H.
ANSWER: Thanks for the tip. It’s a wonderful idea.
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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