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Month: September 2015

Heat stroke is a matter of life and death (Naturally@UConn)

Casa Falmouth

Department of Kinesiology Professor Douglas Casa (second from left, middle row) and his Korey Stringer Institute team provide medical assistance for EHS at the 2015 New Balance Falmouth Road Race.

While running a race, teenager Douglas Casa suffered from an exertional heat stroke (EHS) and collapsed. The immediate treatment he received preserved his life and propelled him toward a career of helping others who fall prey to this ailment.

Now, a professor in the Department of Kinesiology and the chief operating officer of the Korey Stringer Institute (KSI), Casa conducts research and educates athletics, the military and industry about preventing and treating EHS.

KSI bears the name of a former Minnesota Vikings football player, Korey Stringer. While attending a 2001 training camp, Stringer suffered from EHS and lost consciousness, but his situation was not as fortunate as Casa’s. Stringer died the next day. In 2010, Stringer’s widow worked with the National Football League and Casa to found the Institute. The Department of Kinesiology, which Casa calls “a hosting home for a lasting legacy,” houses KSI.

Casa gets satisfaction from EHS research and education because he knows from personal experience that it can be a matter of life and death. “As part of my efforts to maximize health and safety during intense exercise in the heat, I have helped save 185 people who were suffering EHS at events or practices in which I was providing clinical care,” Casa said.

Organizations and companies as diverse as Gatorade and General Electric partner with Casa and his fellow scientists to preserve life. Casa manages corporate donations to KSI that total over $1.2 million in the last five years. This is in addition to $1.5 million in research grants for the same period.

At risk for EHS. EHS can strike all kinds of people who exert themselves in high heat conditions. Those at risk include amateur and professional athletes of all ages and levels, soldiers in the military and industrial workers, such as those on construction sites.

The basis for an EHS diagnosis is a core body temperature of over 105 degrees with accompanying symptoms of central nervous system dysfunction, such as collapse or altered consciousness. Medical providers measure temperature with a rectal thermistor, a kind of thermometer that indicates minute changes in temperature, or an ingestible thermometer pill that sends data wirelessly for real-time monitoring purposes.

Recognizing the symptoms and immediately intervening with appropriate treatment that rapidly reduces body temperature within 30 minutes is crucial to assure survival. Based on his research, Casa advocates cooling the patient in an ice bath and then transporting him or her to a hospital. He once treated a competitive runner whose core temperature was 112 degrees. She survived EHS without complication.

Testing, research, education, policies, outreach According to Casa, the work of KSI has five main components: athlete testing, research, education, policy changes and mass media outreach.

Some thermoregulation, hydration and athlete performance testing takes place in a heat chamber lab in Gampel Pavilion. Other studies happen at athletic events. For example, 30 of Casa’s team members attended the New Balance Falmouth Road Race in August to conduct research and provide clinical care to approximately 10 to 15 runners that had EHS. The data gathered helps the researchers understand how fast the athletes cool down and what factors may have predisposed them to EHS.

KSI quickly disseminates research findings to make a difference in places where EHS is most likely to occur. The Institute has given Casa a platform to bring his educational message to decision makers at the top levels. He has advised elite athletes involved with the World Cup, Summer Olympics, Super Bowl and more.

“My most rewarding work is with the US military where I can influence the health and safety of an extremely large number of individuals,” he said. The Pentagon rewrote its heat stroke policies as a result of Casa’s efforts.

High school football is another area where policies are changing and athletic trainers and coaches have greater awareness of the risks. Currently, 14 U.S. states meet the Korey Stringer Institute minimum guidelines for heat acclimatization. KSI statistics show zero deaths from EHS in those states. This has saved more than 20 lives in the last four years, according to Casa’s estimates.

In Connecticut, as mandated by the Connecticut Association of Schools, all secondary schools adopted the KSI guidelines for heat acclimatization by August 2013. Since then, there are no reported deaths from EHS in Connecticut.

Another big component of the current KSI mission is reaching out to mass media. To get the word out, Casa does podcasts and webinars and appears as a guest expert. He enthusiastically spreads the message about the prevention of sudden death to anyone who will listen. TED-Ed heeds the call. USA TodaySports Illustrated and the New York Times pay attention. ESPN, NBC and ABC know. As a result, Casa is one of the most quoted UConn researchers, according to Colin Poitras, a university relations associate in university communications.

It seems that EHS was and is a life and death matter to Casa, and it shows.

Source: Naturally@UConn

Vermont to review training in aftermath of trooper death (AP)

MONTPELIER, Vt. (AP) — A trooper who collapsed at a National Guard firing range while trying out for the state policetactical team died of “exertional heatstroke,” the state medical examiner said in a death certificate released Monday.

An autopsy found that the death last week of Trooper Kyle Young was an accident, with the medical examiner saying it occurred during “strenuous physical activity in high environmental temperature.”

Vermont Public Safety Commissioner Keith Flynn said in a statement that he ordered a review of the application and training processes for all State Police special-purpose teams. He said additional information is needed before a final report can be issued and “a complete understanding of the circumstances that led to the death of Trooper Young is determined.”

Douglas Casa, the head of the Korey Stringer Institute, which works to prevent sudden death in athletics and is named for an NFL player who died of exertional heatstroke in 2001, said Monday that heat deaths are more common than people realize, especially in athletes, members of the military and laborers.

“In a lot of circumstances when there are external pressures, like a soldier in basic training or an athlete trying to make a team, like in an August practice, or … the Vermont situation, he’s trying to get a job or a better job, he might be feeling (badly) but he’s not going to back off, he’s not going to tell anyone because he doesn’t want to appear weak,” said Casa, whose organization is housed at the University of Connecticut.

Young, 28, of Monkton, a father of two young girls, collapsed on Thursday afternoon at the Vermont National Guard’s Ethan Allen Firing Range in Jericho. He was later pronounced dead at the University of Vermont Medical Center.

A funeral is scheduled for Young on Wednesday in Watertown, New York, near his hometown of Brownville. His family could not immediately be reached for comment.

National Weather Service records show the high temperature on Thursday was 86 degrees with about 60 percent humidity.

Source: SFGate (AP)

Back to football, back to life: The story of Miami’s Hunter Knighton (USA Today)

CORAL GABLES, Fla. — Somewhere between the moment his organs started shutting down on the practice field at the University of Miami and the day he woke up connected to a ventilator, Hunter Knighton dreamed he was in a car accident. When he opened his eyes and saw his parents with Hurricanes coach Al Golden, he figured something had happened the night before — he wasn’t sure exactly what — and within minutes asked the doctors how long he might be out of football

“I thought I’d miss a week of spring ball or something like that,” he said.

That was before Knighton knew he had been in a coma for 12 days, before he understood the ramifications of his body temperature reaching 109 degrees, triggering liver and kidney failure. That was before the 6-foot-6 offensive lineman realized he had lost 55 pounds and was lucky to have even survived; before the hallucinations and the therapy to regain cognitive function; before the surgical procedure to fix his paralyzed vocal chords and the treatment for post-traumatic stress disorder; before the months of hopelessness and then the salvation of doctors in Connecticut, who put him on a track to get back on the football field.

All told, Knight’s return for Miami qualifies as nothing short of a medical miracle. Just 19 months after surviving a severe heat stroke, he will be on the field Saturday against Nebraska playing on special teams and getting snaps as a backup center.

“As far as I’m aware, it’s probably one of the more extreme heatstroke cases someone has returned to full activity participation,” said Dr. Douglas Casa, CEO of the Korey Stringer Institute, named for the Minnesota Vikings player who died of heat stroke in 2001. “He faced a real uphill battle.”

Condition critical

Nobody at Miami can forget the morning of Feb. 24, 2014. Knighton, who sat out the previous year as a redshirt, participated in the supervised offseason workout despite not feeling well, trying to make a strong impression on the coaching staff. What he didn’t know is he had the flu, which triggered the heat stroke as his body temperature rose above 105 degrees. Knighton remembers completing three drills, but it wasn’t until about 40 minutes later — a period of time he has no recollection of — that he collapsed on the field.

“He deteriorated pretty rapidly,” said Vinny Scavo, the head athletic trainer for Miami football. “It wasn’t good. As a trainer, you hope you never have to be in that situation but we were prepared and had to make some decisions quickly.”

Doctors at University of Miami hospital told Knighton’s parents to come right away. His mother Carole Knighton, a Southwest Airlines flight attendant, wasn’t sure if her son would ever wake up.

“As we’re going to the airport, the doctor told me he was unresponsive and his temperature was 109,” she said. “Korey Stringer died at 108. Marquese Meadow (a Morgan State player who died of heat stroke last August) was 107. It’s a miracle he survived it.”

The next two weeks were tense as Knighton was put into a medically-induced coma so his condition could stabilize. Golden and Scavo were at the hospital day and night, even sleeping there at times, until Knighton woke up. And though he could barely walk by the time he was released on March 10, the idea of playing football again was still at the forefront of his mind.

“A lot of people, people who don’t really know me that well but heard the story or friends of my parents that don’t really get it and they’re like, why would you want to do that? You almost died once,” Knighton said. “I love football and I wouldn’t be complete if I wasn’t playing.”

But the roadblocks to actually playing football again were almost endless as he and his mother moved into an extended-stay hotel near Miami.

Damage to his vocal cords had left Knighton unable to swallow or keep down food, necessitating a surgery. The Propofol, which he had been given to induce the coma, was causing him nightmares and hallucinations of talking bed sheets and hospital patients telling him he was going to die. He tried to go back to school, but his mind couldn’t focus or retain information. He was withdrawn and angry, at times scaring his three siblings when they would come to visit.

“What we went through as a family was devastating. There were definitely times I wasn’t sure if he might harm himself or me or somebody,” Carole Knighton said. “He couldn’t even be around people, but football became the motivating thing. I knew for Hunter if he didn’t get out there and play, he was dead. Even if he had survived, it would have killed him. That’s what it meant to him.”

A breakthrough

By July 2014, however, Knighton didn’t seem to be making much progress. At that point, they weren’t even sure what progress looked like. He ended up going home to Pennsylvania, unsure what to do or how to take the next step. Though treatment for his post-traumatic stress disorder at the University of Pennsylvania helped him overcome the psychological issues, the physical side was still a mystery.

Was his body too damaged to play football again? Would he be able to get back in shape? Would he be in danger of another heat stroke?

“We were spinning our wheels, not sure what the right path was,” Hunter Knighton said. “My brain had really taken a hit.”

Said Carole Knighton: “He wanted to come back and play but there is no book, there’s no manual. With ACL tears, they know exactly the procedures to follow and where they should be at certain points. But nobody had a clue what his recovery was going to be like, nobody had a real definite plan for what it was going to be like, and unfortunately I wasn’t prepared for all the things that would happen in that recovery. I had no idea what a heat stroke really was. It’s like microwaving your brain. I was so unprepared for any of that.”

But when Miami officials recommended the Korey Stringer Institute, hope returned. Housed at the University of Connecticut, they administered baseline testing last Oct. 31 to determine how his body temperature responded to physical activity and rule out any permanent issues or genetic predisposition to heat stroke. They then established a plan that allowed Knighton to get his fitness level back and become heat acclimatized so that he could regulate his body temperature.

Much like a concussion, each person’s physical response to a heat stroke is different, meaning everyone’s ability to recover is different.

“It’s completely individualized,” said Casa, whose institute works with 12-16 heat stroke victims per year from the sports, military and labor sectors. “That’s where we help people, their families and the medical staff that has to supervise Hunter because we have so much experience. If someone is lucky enough to survive a heat stroke, they have to take this journey to figure out how their recovery is going to take place.”

‘It’s an ever-present threat’

In May, after he had built up his tolerance to physical activity and been tested on a weekly basis to monitor his liver function, Knighton cleared the final medical hurdle to play football again. He worked to gain back his strength, re-enrolled in school and regained his comfort in social situations. Given the devastating effect on his body a little more than a year earlier, it was almost unnerving how complete the recovery seemed.

“I sat by his bedside for 10 days. I didn’t go home,” Scavo said. “You sit there and pray and let the doctors do their job. Then you watch him in the spring and summer and then it’s like, ‘My God, he’s in camp,’ and just thinking about how determined he was, it’s such a great thing because this could have went the other way.”

Knighton now plays with no restrictions or fear of something catastrophic happening again. During training camp, he took a sensor-equipped pill every da that allowed Miami to scan his body temperature instantly, every 10 minutes. Still, he and his mother are constantly questioned about the wisdom of putting his body through the rigors of football.

“People think, are you crazy?” Carole Knighton said. “Other mothers are horrified. I could bubble wrap him and put him on my couch and look at him every day, but that’s not living. He loves football. If he never got the chance, he wouldn’t be complete. He wouldn’t be truly healed. Seeing him back on that field healed all of us.”

And the fact he has been on the field is both a joy for those who watched the recovery and a reason to educate about the dangers of heat stroke. Casa said the numbers of victims in football are increasing, especially at the high school level where there is often intense training without proper supervision. The NCAA established a rule in 2003 that preseason practices had to begin with a five-day acclimatization period, but in Knighton’s case, heat wasn’t really a factor.

“It’s an ever-present threat,” Casa said. “Thankfully, we’re able to treat it when it’s (handled) correctly.”

Though Knighton’s ailment rocked the Miami football program last year, his return now serves as an inspiration. He chose the Hurricanes because he wanted to bring them back to prominence. Now he finally gets his chance.

“Considering where we were 18 months ago, things are fantastic and really football is the dessert,” Carole Knighton said. “Having him survive, that was the win, but seeing him able to fulfill his dream of playing college football, that’s the frosting on the cake. It made it complete. It’s a miracle.”

Source: USA Today

Heat Puts A Dent In High School Sports Practices (Hartford Courant)

With the start of the high school fall sports season just a few days away, many teams ran into an unlikely obstacle Tuesday: record heat that canceled practices and scrimmages.

Lewis Mills of Burlington had a doubleheader scrimmage against Farmington in boys and girls soccer scheduled at Nassahegan Field in Burlington.

The Wethersfield boys soccer team was scheduled to scrimmage against Guilford and Naugatuck in Glastonbury. The Middletown boys soccer team was going to scrimmage at East Hampton and the girls soccer team was scheduled to scrimmage at Southington. Glastonbury had a boys and girls cross country scrimmage with five teams scheduled.

But they were all canceled because of the heat. According to the National Weather Service, the temperature reached a record 96 degrees at Bradley International Airport in Windsor Locks Tuesday afternoon, breaking the previous record of 95 degrees, set in 2007. The weather led to early dismissals for some schools and the opening of cooling centers in cities and towns.

“I think it was the right move, honestly,” Lewis Mills boys soccer coach Ben Kulas said. “I would love nothing more than to get out and, at the very least, get a training session in, but I just don’t see the reward outweighing the risk. There really isn’t much in my opinion that either program can get out of putting players in an environment where it’s 95 degrees, humid and hard to breathe and expect to compete at a high level.”

Kulas said the decision was made early Tuesday. Coaches were also warned on Sunday that there was a possibility of a cancellation.

“Our superintendent emailed the town on Sunday explaining precautions the district was taking, including potentially canceling activities after school,” Kulas said. “Once that came out and I saw other schools dismissing early and canceling games I knew there was minimal chance for a game or training [Tuesday].”

Simsbury athletic director Dane Street said practices for football, boys soccer, girls soccer, boys cross country and crew were delayed until later in the afternoon or early evening. Other Simsbury teams had optional practices. Glastonbury also had a modified practice schedule, with shorter practices starting after 5 p.m., which were optional for athletes, with more frequent water breaks.

“I compare it to the winter when early in the day the roads are not good, but by later in the day, the conditions are better,” Street said.

The Middletown football team’s practice was moved indoors into the air-conditioned gymnasium. Middletown’s main athletic field complex has an artificial surface, which produces more heat than a grass field.

“When I took the heat index, combination of temperature and humidity index, [about 11 a.m.] it was 132, which is an extremely dangerous level,” Middletown athletic director Elisha DeJesus said.

Even the Middletown crew team’s practice on the Connecticut River was canceled.

West Hartford athletic director Betty Remigino-Knapp did not cancel practices or scrimmages Tuesday but did modify them. She and her athletic staff and trainers have worked closely with Doug Casa, the CEO of the Korey Stringer Institute at UConn, which provides information, resources, assistance and advocacy for the prevention of heat-related illnesses and sudden death in sports.

“We have a heat protocol we follow,” Remigino-Knapp said. “We determine what we are going to do based on that and adapt our practices accordingly.”

The West Hartford schools follow a chart that shows what level of activity is appropriate for the heat index, which is relative humidity and temperature; what the rest-to-work ratio should be for athletes and how much protective gear football players may safely wear.

That means more frequent, and longer, rest periods and more scheduled mandatory water breaks, with a trainer monitoring the athletes. There is also a cooling tank at each high school filled with ice water in case an athlete has a heat issue and needs to be cooled quickly.

There were soccer scrimmages at both Conard and Hall high schools Tuesday but they played quarters instead of halves, with longer breaks in between and a lot of substitutions. Football players wore only helmets and shoulder pads.

Remigino-Knapp said she received calls from parents concerned about the heat, after hearing reports of other schools getting out early and canceling practices, so she emailed the school’s protocol and guidelines to parents.

Casa, a professor of kinesiology at UConn, said many schools use the Stringer Institute’s resources and guidelines and the institute has worked closely with at least 25 to 30 high schools in the state to help prevent heatstroke and heat-related illness among athletes.

“I don’t think you have to cancel practices if you have a trainer and if you have guidelines,” Casa said. “But I think it’s wise to cancel if you don’t have [medical] people around.”

Casa said he got a call from a local soccer organization wanting to know if it should practice Tuesday.

“I told them I would recommend canceling today,” he said. “It’s still going to be in the 90s by 5 p.m. and there’s no medical staff and the kids haven’t been practicing that much and you don’t know their status. It’s different with a high school team that has been practicing for a month, has medical staff and they have guidelines and appropriate modifications.”

The weather is supposed to be as hot with more humidity Wednesday.

“Tomorrow’s a new day,” Glastonbury athletic director Trish Witkin said. “We will review everything again tomorrow.”

Source: Hartford Courant

Thirsting for consistent hydration guidelines (The Times of Northwest Indiana)

After a summer without a string of 90-degree days, the first week in September will bring us precisely that from today through Thursday. Friday is supposed to be a shade cooler but still in the upper 80s.

Fortunately, four weeks into the fall sports season in Indiana (three in Illinois), the typical athlete should be heat acclimated. Still, in cross-country, football and soccer over the next few days, exertional heat illness (EHI) will be a legitimate concern. Consequently, athletic trainers and coaches will be pushing the fluids.

For the most part, that is exactly what they should be doing. Regrettably, though, more than a few of those charged with the care of our young — and not-so-young — athletes may now be plagued by some doubts. This is the result of a consensus statement regarding hydration published in the British Journal of Sports Medicine on July 30 — and featured in The New York Times last week.

According to NYT writer Gretchen Reynolds, “Dehydration during sports is rarely if ever dangerous, but overhydration is.”

Therefore, the BJSM article recommends drinking only enough to satisfy one’s thirst.

The scientific name for overhydration is Hyponatremia. Translation? Not enough (hypo) salt or sodium (Na+) in the bloodstream.

The BJSM article reports that the condition has been a traditional concern in endurance sports and military training. However, it cites three fatal cases in American football that occurred between 2008 and 2014. One in particular involved a Georgia high schooler who, suffering from muscle cramps, apparently ingested four gallons of water and Gatorade during practice. Shortly after arriving home, he collapsed and several days later, died.

Keep in mind that four gallons of fluid weigh 32 pounds.

Doug Casa, PhD, ATC, the director of the Korey Stringer Institute at the University of Connecticut, is the lead author of several position and consensus statements regarding EHI by the National Athletic Trainers’ Association. “The information (in the BJSM article) is good for the recreational athlete but not for the serious athlete,” he said.

As an example, he cited the typical football lineman who will experience a net loss of five liters (10 pounds) during a hot practice. “If he comes in at the end of practice and chugs an ice cold liter, he won’t be thirsty again for at least another hour. Thirst is not going to take (him) back to normal hydration.”

As for the assertion that dehydration has little to do with overheating, Casa replied, “During exercise in the heat, body temperature goes up a 1/2 degree Fahrenheit for every 1 percent loss in body weight. Hydration can be very protective.”

Beyond statistics, Casa has plenty of practical experience, “I’ve treated 215 cases of heat stroke in my career and nearly all of them were dehydrated.”

The key is knowing one’s sweat rate. That is why football players are expected to weigh in and weigh out of each practice. The athlete who has gained weight during a practice or game has been drinking too much. The more typical athlete, who has lost weight, needs to replace it with fluids and food.

If for no other reason, fluids should be pushed in the heat to enhance level of play. The data is even acknowledged in the BJSM article; a 3 percent drop in body weight (six pounds in a 200-pounder) will lead to a 10-15 percent drop in performance.

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