Parents, demand thorough physicals before high school athlete starts to play


IF YOU ARE the parent of a high school athlete and have not yet done so, you'd better line up an appointment with your family doctor for a sports physical.

Practice doesn't start until the middle of August, but you'll find that his appointment book is filling up fast.

When you arrive for your child's examination, I recommend that you do what I did:

Grab the poor, unsuspecting doctor by the necktie and demand that he listen to your child's heart for the next 30 minutes if that's what it takes to make absolutely certain he does not have a pre-existing heart condition that will cause him to drop dead in the middle of a high school playing field.

I know, I know. This is just one more piece of evidence that I am a head-case mother and woe to the well-meaning professionals who cross my path.

But during my previous life as a sportswriter, one of my first assignments was to go to the house of a high school athlete who had died suddenly of a pre-existing heart condition and ask his shocked and grief-stricken family for a picture for the newspaper.

I am reminded of that awful day each time - admittedly rare - that a high school athlete dies in the same way.

Most recently, 17-year-old Jamal Mohammed, a senior at Northwestern High School in Hyattsville, collapsed and died after running the bases on the first day of baseball practice in March. He had an abnormality in an artery that led to his heart.

Along with cardiomyopathy, such abnormalities are the leading cause of the sudden, tragic deaths of young, mostly male, athletes. These deaths are exceedingly rare: 6.6 per million high school males and 1.3 per million high school females. But each one renews public concern about the screening of high school athletes. Isn't there a test? Shouldn't the doctors have known? Can't we find a way to prevent this from happening to another child?

The American Academy of Family Physicians recommends that a complete and careful personal and family history be taken as part of the high school sports physical. Its guidelines are designed to identify or raise suspicion of cardiovascular problems.

This means questions for the athlete about exercise-induced chest pain or shortness of breath, fainting, unusual fatigue, serious viral infections, past hypertension, plus a detailed family coronary history.

But a survey of all 50 states and the District of Columbia reported in the Journal of the American Medical Association in June 1998 found that 40 percent of the high schools had no formal guidelines for screening for heart conditions or that the guidelines they used were woefully inadequate. Many health forms were not much more than a parental permission slip.

And many schools, researchers David Glover and Barry Maron wrote, allowed athletes to be examined by a physician's assistant or by chiropractors who have limited experience diagnosing heart conditions.

Their report prompted a spate of letters to JAMA suggesting that the high school sports physical also be used to screen kids behaviors - such as drinking, drugs and STDs - that would be more likely to harm them than a rare heart condition.

And why not check those big linemen for cholesterol problems and the runners for iron deficiencies?

Why not take the opportunity to make sure the menstrual cycles of girl athletes are not disrupted so as to cause them to be vulnerable to bone loss and therefore stress fractures?

Why not check boys and girls for chlamydia, the silent epidemic among sexually active teens that is scarring young women into barrenness?

While we are at it, shouldn't athletes be screened for cocaine, steroids and dietary supplements because of known associations between these substances and heart damage?

And certainly athletes should be screened for concussions, seizure disorders, sickle-cell anemia , eating disorders, significant knee injuries and any spinal abnormalities. Some of these questions are included in the screening physical form recommended by the American Academy of Family Physicians (AAFP).

That form is also recommended by the governing body of Maryland's public schools, but the bylaws only require that the athlete undergo a physical. Its thoroughness is not specified.

The medical establishment has concluded that administering an electrocardiogram or an echocardiogram to every incoming high school athlete would be costly and impractical.

But that makes the screening standards, and who examines your children, all the more important. It is up to the parents to make sure that these physicals are as complete as the AAFP recommends and that the heart-screening portion of any sports physical is administered by a physician who has experience listening for trouble.

And, finally, we must make sure these screenings are available to all athletes, not just the ones who have a family physician or the medical insurance to pay for it.

Michael Harr, a family practitioner in Maryville, Mo., has been the volunteer team physician for Maryville High School and Northwest Missouri State University for 25 years and he sat in on the drafting of the AAFP form.

He says things are better than they were in 1998, when JAMA researchers found such woefully inadequate physical screening of high school athletes in this country.

"A level of attention and appreciation was drawn to the issue by that study," Harr says.

What is needed now, he says, is a national standard that is a requirement at all the nation's high schools.

"We have a long way to go. If the high school federations were to adopt a single physical form, that would be a big step. It would force everyone to do the exam, especially those who might not be tuned into sports medicine.

"We will still have kids who slip through the cracks, but it reduces the risk. It would be a very big step."

In the meantime, you can do what I did: Get hysterical and grab your pediatrician by the shirt collar.

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