Should high school and college athletes be screened for heart problems?
Yes - by having a doctor listen to the heart and take a history of heart problems, not with the more-extensive testing.
The debate over cardiac screening for young athletes heated up this fall when a 26-year Italian study was published in the Journal of the American Medical Association.
It showed that a nationwide screening program lowered the incidence of sudden deaths from a heart problem by 89 percent. In Italy, young athletes are screened with electrocardiograms (EKGs), which can detect potentially fatal disturbances in heart rhythms.
"This is a very good study, but it doesn't prove everybody needs an EKG," said Dr. Paul Thompson, a cardiologist at Hartford Hospital in Connecticut who is advising the American Heart Association on the problem.
For one thing, even with the screen, the sudden cardiac death rate among Italian athletes was about one in 250,000, "the same as we have in the U.S. without such an elaborate system," Thompson said.
"It's hard for people to understand that screening can make more problems," he said. But any abnormality on an EKG can trigger further testing that can end up keeping young people out of sports for "funky little things" that might never cause serious problems, he said.
Granted, just listening to the heart and taking a history "may not do enough" to detect potentially fatal problems such as thickening of the pumping chamber of the heart, said Dr. Barry Maron of the Minneapolis Heart Institute Foundation.
"But even if we had all the money in the world," Maron said, more extensive screening "would still be a resource issue. With 10 million young people playing sports, it could cost $1 billion per year to screen them as the Italians do."
Worried parents can always pay for EKGs or echocardiograms out of pocket. And all parents of athletes can pay attention to warning signs such as a fainting spell that could indicate heart problems.
What is toenail fungus, and what's the best way to get rid of it?
Toenail fungus, or onychomycosis, is a common affliction, affecting 3 percent to 5 percent of Americans. It can start with simple athlete's foot, a fungal infection that, if untreated, can lead to infection deep in the nail matrix, from which the nail grows.
The microorganism that causes toenail fungus is a dermatophyte, which lives on keratin, the protein that nails are made of. It thrives in the dark, moist, warm environment of sweaty feet.
Fingernails are much less susceptible to fungal attack because they are usually cleaner and dryer.
As toenail fungi grow, the nails get thicker and may smell foul. The thickened nails can press into the nail bed, causing pain, especially in tight shoes.
Topical prescription solutions such as Loprox, Loceryl, Keralac and Penlac may help, said Dr. Peter Paicos Jr., immediate past president of the Massachusetts Podiatric Medical Society. There are also some nonprescription topical solutions available, including Mycocide NS.
If topical treatments don't work, you can try oral medications such as Lamisil or Sporanox, which are usually taken daily for 12 weeks.
But the oral medications can, in rare cases, cause liver damage. Patients should get a liver function test before starting these medications and another during the course of treatment, said Dr. Joseph Caporusso, a McAllen, Texas, podiatrist and trustee of the American Podiatric Medical Association.
In really stubborn cases, the permanent solution is to surgically remove the infected nail and nail root. Cosmetically, the result is "mostly acceptable," said Caporusso, and women often paint the area with nail polish as they would a normal nail.
To prevent toenail fungus, wear comfortable shoes that enable feet to breathe; wear sandals in public locker rooms; wash feet every day; and wear clean socks or stockings every day, the Harvard Medical School Web site says.
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