Guns, Hypnosis, Sudden Death – PediaCast 229
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It’s time for another research round-up! Join Dr Mike in the studio for a look at gun safety in the wilds of Alaska (and your home!), hypnosis as a treatment option for kids with functional abdominal pain and irritable bowel syndrome, and the sudden deaths of NCAA athletes with sickle cell trait. It’s all right here… on PediaCast.
Topics
Guns (safety in the Alaskan wilderness… and your home!)
Hypnosis (for functional abdominal pain and irritable bowel syndrome)
Sudden Death (in NCAA athletes with sickle cell trait)
Links
Transcription
Announcer 1: This is PediaCast.
[Music]
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike!
Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. I like to welcome everyone to the program. It is episode 229 for October 10th 2012. We're calling this one Guns, Hypnosis and Sudden Death.
Yeah. It's kind of a fitting title for the upcoming Halloween season. It's actually a research round-up show. And for those of you who are new to the program, we do this about once a quarter where we just take three research articles and kind of pick them apart, break them down to the terms that you can understand and give you a little life application for the results of the research that you can apply in your own life and in your own family.
01:16
So how in the world are we going to get guns, hypnosis and sudden death into a research round-up? I'm going to tell you in just a couple of minutes.
First, a few housekeeping items. There's a site that I've not actually talked about on the program before, but I've been writing a blog for them for the last few months. They're called iTriage and this is basically an online medical site with lots of helpful information; has an online symptom checker and a hugely popular mobile app. These folks at iTriage are really into the social media/medicine kind of scene.
Their mission is to empower consumers with control and convenience to effectively manage their personal healthcare and improve healthcare delivery for providers and pairs. So if you're not familiar with iTriage, their website is actually itriagehealth.com or you can Google iTriage and you can find it that way.
So they're a pretty cool site. If you haven't check them out I would encourage you to do so. Their blog is blog.itriagehealth.com and we'll put a link to that in the Show Notes for you. And if you search for Dr. Mike and actually now that I think about it I'll actually do the Dr. Mike search and then the results page for the blog at itriagehealth.com, we'll put a link to that in the Show Notes at pediacast.org for episode 229, so you can find it very easily and find my posts easily.
What have I done? We've talked about the cinnamon challenge, which we've talked about here on the program before. Also trampolines and bubble wrap, CAT scans and brain tumors, pink slime and coming a little bit later this month bats and rabies. Again, a good upcoming Halloween topic for you. So check that out, my blog posts over at blog.itriagehealth.com and again link in our Show Notes if you want to find it easily.
03:12
All right. This next item I am really excited about. We now are on Pinterest. You know we've had Facebook presence and the Twitter presence and Google+ for quite some time but we are on Pinterest now. So you just do a search for PediaCast, it's pinterest.com\pediacast. You can find this really easily.
We have two boards up there right now. The first we have our episodes, so this is a place where you can find, re-pin and share our episodes. But we also have a board with News Parents Can Use and these are going to be news items that are not covered in the weekly podcast. So they're all pediatric news parenting-related and child health related stories that are personally handpicked by me, so you can be sure it's information that I would pass along if I had a daily podcast or a longer show.
There's just too much good stuff out there to squeeze into our weekly hour together. But you can find the extra stories and resources on our News Parents Can Use board on Pinterest. And my promise to you is that we'll keep adding fresh new material, so be sure to check it out, again, pinterest.com\pediacast. Follow us, tell your family, friends, co-workers and of course your child's doctor about our boards and re-pin the stories and episodes you like to help us spread the word about our little program.
All right. One more item before we get to this week's lineup. For those of you in Central Ohio, three days from now on October 13th, Nationwide Children's Hospital and Kohl's will host a car seat safety check. It is Saturday, October 13th, from 10 AM to 2 PM at the Kohl's, located at 3360 Olentangy River Road, here in Columbus.
We'll be checking out car safety seats to make sure you're using the right one and that you're using it safely and correctly. So if you're in Columbus this weekend be sure to join us. And for details just follow the links in the Show Notes, we'll have all the information there for you over at pediacast.org.
05:05
All right. What's up with our show's title today – Guns, Hypnosis and Sudden Death? And how are we accomplishing a research round-up with these topics?
In terms of guns, no I'm not chiming in on the gun control debate, but we are going to talk about gun safety and in particular, the use of gun cabinets. Researchers in the wilds of Alaska, where you can pretty much find a gun in every home, they have some results and tips for you so we're going to share those.
Hypnosis. We're going to take a look at kids with functional abdominal pain and irritable bowel syndrome. Could hypnotherapy replace drug treatment for these disorders? In other words, could hypnosis actually eliminate abdominal pain and other symptoms for these kids? Or is that just wishful thinking? The answer may or may not surprise you. So stay tune for that.
And then we'll wrap things up with sudden death. In particular, Division 1 NCAA football players' undiagnosed heart condition certainly plays a role in athletes who have sudden death either on the playing field or while they're conditioning or practicing.
But did you know that sickle cell trait is just as big of a problem? We're going to explain why and look at the numbers. And if you are a student athlete with sickle cell trait or the parent of a student with sickle cell trait, we'll help you decide what to do.
But before we dig into the research I do want to remind you if there's a topic that you'd like us to talk about on PediaCast it is easy to get a hold of me, just go to pediacast.org, click on the Contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S.
Also, I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child's health, be sure you call your doctor and arrange a face-to-face interview and hands-on physical examination. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.
And with all that in mind we'll be back with our research round-up, right after this.
[Music]
07:40
All right. We are back and we are read and we are ready to roll into our research round-up. And first up and let me mention this too, for those of you again who are new to the program our research round-up programs are a little more relaxed, a little less formal than some of our other shows. Pretty much I have my notes on these research articles and we're kind of go through it, so not quite as polished of a presentation. But the way that these research articles work I think it's a little easier that it sort of take a laid back approach to go through these, otherwise, the science can get a little bit intense.
So the first one, installing gun cabinets improves firearm safety. This is a research article that came out of the University of Washington. The Group Health Research Institute in Seattle and also the Native and Tribal Health Groups in Alaska, they all collaborated to bring you this study. It was published in the American Journal of Public Health last May, so May of 2012.
And as always, if you are interested in the actual article we'll have a link in the Show Notes to the abstract on PubMed. And then if you're interested in reading the entire article they have links from there. A lot of them cost you, you got to pony up a few bucks to see the entire article and that's because these journals have to make some money somehow. But you get to at least read the abstract at PubMed and we will have a link in the Show Notes so you can find that easily.
09:05
OK. So the question for the researchers, among households with guns, does the installation of gun cabinets improve the safe storage of guns and ammunition?
So these study groups came from rural Alaskan native villages and guns in the homes as I mentioned in the introduction they're extremely common in this region, which made it easy to enroll a fairly large number of people and families. So the families were enrolled and randomized into two groups. So they had an early group and a late group.
Now the early group had gun cabinets installed at the beginning of the study and families were given instructions for proper use of the cabinet and given a safety message about keeping all the guns and ammunition locked inside the cabinet.
Each cabinet would hold up to eight long guns, three handguns and all the ammunition that the homeowner would need. And the cost of the gun cabinet was about $80 and it was provided to the family free from the research grant.
Now the late group had the same intervention but their gun cabinet came 12 months later. So they knew that they were going to be in a study that involved gun cabinets but instead of getting the cabinet right away and the instructions for it they waited 12 months and gave the late group their gun cabinet at that point.
The end point of the study was going to be six months after the late group intervention. So in other words, at the end point we're going to ask them questions about their use of the gun cabinet and the late group will have had their gun cabinets for six months while the early group will have had it for 18 months.
10:50
So you can see here what the researchers are trying to get at. You give them the gun cabinet and an intervention and instructions and tell them how to use it. And then you're going to look at one group 18 months after that intervention and then the other group you're going to look six months after. And just to see if there's some decay, eight months out, are people really still using it the way that they're supposed to. In other words, does that teaching and the use of the gun cabinet stick after 18 months compared to after six months.
All households were surveyed with the same survey with regard to firearm storage practices. OK. So what did they find? Well, they enrolled 255 households and the greater than 70% of the households included children less than 18 years of age, 93% had at least one unlocked gun and 89% had unlocked ammunition.
So these are all homes in rural Alaska, most of them have kids, almost all of them have at least one gun and almost all of them have ammunition for the gun and pretty much they were unlocked. So these are families that didn't use a gun cabinet. They just have their firearm kind of lying around.
OK. Let's first look at the 12-month survey. So what they did at this point is they did survey everyone when the early group had reached 12 months. So the early group had an unlocked gun rate that dropped from 93% at the beginning of the study to 35%. So at the end of the year the number of unlocked guns in the house did decline from 93% to 35%. These are real world studies, so some people kind of roll their eyes and say I'm not using that gun cabinet and they didn't use it or they were using it and then stopped using it. But we did see a decrease in the unlocked gun rate from 93% to 35%.
12:49
Now the late group, so this is the group that they're just now going to get their cabinet, they also had an unlocked gun rate that dropped from 93% to 8%. So they did drop a little so you can imagine these folks know that I'm going to be involved in a study, a gun cabinet is coming, hey, you know what, why wait the 12 months, let's be safe now. So a few of them did go ahead and locked up their guns so their rate dropped even though they haven't really had the intervention yet, from 93% to 89%.
What about ammunition? Well the group that had the gun cabinet right from the beginning, their unlocked ammunition rate dropped from 89% to 36%, so big drop there. And the late group who didn't get the gun cabinet quite yet, their unlocked ammunition rate dropped from 89% to 84%. So again, some of them said hey, we're going to be in this study, gun cabinets coming, let's just go ahead and lock up the ammunition right now.
In terms of the early group, their rate of unlocked guns and ammunition at the end of 12 months was just 23% compared to the late group who didn't have their gun cabinet yet and their unlocked guns and ammunition was 78%. If you kind of look at it that way we had a drop from 78% to 23% when you look at unlocked guns and unlocked ammunition.
The bottom line is at least at the end of 12 months they were using the gun cabinets pretty well. Not everyone was doing it but we definitely see an increase in the use of the gun cabinet 12 months out.
14:26
All right. What about at 18 months? So now the early group will have had their gun cabinet for 18 months and the late group will have had their gun cabinets for six months. What do we find there?
Well the early group unlocked guns and ammunition really remained constant. So 35% of them still had unlocked guns, 36% had unlocked ammunition and 23% had unlocked guns and ammunition. So it's very similar to the 12-month survey. With the researchers what that shows is that even once you pass a year after the cabinet arrives and you did the instructions, you go another six months and it's still about the same number of people who are still using the cabinet and the same number who are rolling their eyes and saying you know what, we're not going to do that.
In terms of the late group, the unlocked gun rate dropped from 89% to 38%, so in that six months it was kind of similar to what we saw with the early group. Unlocked ammunition dropped from 84% to 29% and the late group unlocked guns and ammunition together dropped from 78% to 16%.
Incidentally, ownership of trigger and the cable locks at the baseline of the study, so these are people who they had another way of securing their guns, they didn't lock them in a gun cabinet but they did have trigger and cable locks and those are about 26% of them at the baseline had those and this did not increase for either group during the study period.
So the authors conclude that installation of gun cabinets in study homes was feasible, acceptable and improved safe storage of firearms and ammunition, which may reduce firearm injuries and deaths overtime.
16:07
So let's talk about this. I think it's important to point out because the main media is going to say, hey, this showed having a gun cabinet in your home is safer. And that's actually not what was studied. So this was not the question before the researchers, but it's a good one. And that question is does properly and consistently using a gun cabinet decrease the incidents of accidental and intentional shootings.
Even without current research to back us up on this question it makes sense, especially when there are children in the house. And consider this too, suicide is the second leading cause of death among teenagers in many states. And of those, older teens who do commit suicide firearms are used 50% of the time.
You could argue that if an older teen wants to commit suicide and they don't have access to a gun, they'll either find a gun or they'll find another way. But maybe not. And you know firearms are quick. You can't easily take it back. It's much more difficult to call out for help after the fact. And firearms don't really require a plan. They don't give you time to think things through. They don't provide an opportunity for someone to intervene and help.
So how many compulsive suicides by gun could have been prevented if a firearm wasn't readily available at the moment that the teenager had the compulsion? So you can kind of see where I'm going there. I certainly don't want to get into the whole gun control debate here on PediaCast because I usually get myself in hot water when I wade into the more political issues. I'm sure many of you have a good idea where I stand with regard to an American's right to bear arms, but we do as of today I have that right.
And so as parents behooves us to bear arms safely and responsibly. And while we don't have a research study that says locking guns and ammunition in a properly used gun cabinet reduces injury and death, we can say that until such a study comes to light that that hypothesis certainly makes sense. So if locking guns in a cabinet makes sense, would gun owners with a gun cabinet in the home actually use said gun cabinet?
And I think this study shows that most of them will. So should we as doctors and other community leaders be advocating for gun cabinet use? Should communities provide cabinet as a public service? Should we legislate a requirement by a gun cabinet when you buy a gun, much like we require seatbelts and car insurance? So these are all things to think about. But most importantly, if you're a gun owner I would urge you to keep your guns and ammunition locked up and away from your kids including your teenagers.
18:36
All right. Let's move on to hypnosis. This one is really an interesting study. This comes out of St. Antonius Hospital and Academic Medical Center in the Netherlands. And it was published in the American Journal of Gastroenterology, a very well thought of journal that is peer reviewed. This one came out last April, so April 2012 and as with the other we'll have a link to the PubMed abstract of the article in the Show Notes over at PediaCast 229.
So the question for the researchers, among pediatric patients with functional abdominal pain or irritable bowel syndrome, does gut directed hypnotherapy have a lasting benefit? Investigators started with 49 pediatric patients with the diagnosis of functional abdominal pain or irritable bowel syndrome.
Let's pause for a moment and define these terms. These are kids with ongoing abdominal pain for which there is no known medical explanation. So they complain a frequent pain but we can't find anything wrong and we call that functional abdominal pain.
Now if other symptoms are present along with the abdominal pain like increased passing of gas or flatulence, intermittent bowels or mild constipation or mild diarrhea, then we call it irritable bowel syndrome. But again, after an extensive workup there's no medical explanation for these symptoms.
So these are the kids we're talking about and our Dutch researchers enrolled 49 of them. Why 49 you may be asking. Why didn't they enroll an even number, maybe 50 or more? Well 49 of them completed this study, so those are the ones that we're going to look at.
20:14
So of these 49 kids they we split into two randomized groups – the control group and the experimental group. The control group consisted 22 of the kids and they received standard medical treatment for functional abdominal pain.
Now what does that look like? Well they had dietary adjustments, fiber supplements and stool softeners. Some of them may have had anticholinergic medications like Periactin that helps sort of relax the bowel. Sometimes antidepressant medications like Prozac or Paxil are a couple of examples that can be used for this. These are all standard medical approaches for kids with functional abdominal pain and irritable bowel syndrome.
In addition to the standard medical treatment, the control group also received some counseling because that's also a standard treatment with these disorders. And the counselors discussed the symptoms, helped the kids identify a possible food, environment and stress triggers and over a one year period they had six 30-minute counseling sessions. So pretty typical standard for kids with functional abdominal pain and irritable bowel syndrome.
Now what about the experimental group? Well this group consisted of 27 kids and they did not receive any medication or dietary advice. Instead, over the course of year they met with a specially trained nurse for six 50-minute sessions and these sessions focused on teaching and reinforcing hypnotherapy techniques.
So they learned general relaxation skills and biofeedback techniques for elimination of abdominal pain and normalization of gut functions and also ego strengthening suggestions, so this was the one year plan.
21:55
All right. So all the kids in both groups at baseline were evaluated to determine the severity of their symptoms and surveys were used to assess pain frequency; pain intensity; medication used prior to the onset of the trial; school attendance; somatic complaints, headache, feelings of weakness, fatigue, those kinds of things; quality of life was also assessed.
And the survey scores were synthesized into a standardized score and then this process was repeated at the end of the one year period. And then one other definition that we have to define for you before we get to the results, what did they consider to be clinical remission of the disease? In other words, at what point do we say with our intervention whether it's standard or hypnotherapy, what are we going to consider a positive outcome?
And so clinical remission of the disorder was considered an 80% decrease in that standardized score when the end of one year score was compared to the baseline score. OK. So what did they find out?
In the control group, so the standard medical therapy group, the remission rate was 25%. So with the standard medical treatment 25% of the kids improved over the course of the year in a significant way. So they had an 80% decrease in their symptoms and problems and the way it affected their lives. So 25%, not so great.
The experimental group, which is the hypnotherapy training group, their remission rate was 85%. So 85% compared to 25%. So this was wildly statistically significant. But the authors didn't stop there. They wanted to see if the intervention continued to help in the long run.
So they had the kids in both groups keep regular diaries and continued to have them filled out surveys over a four-year period. And at the end of the four-year period what they found was that 68% of the kids in the experimental or hypnosis group remained in remission, 68% of them, while only 20% of the control group, which had the standard medical therapy, maintained their remission.
24:17
So the authors conclude that hypnotherapy has long-term benefits for pediatric patients with functional abdominal pain and irritable bowel syndrome and should therefore be considered as a therapeutic option.
All right. This is a well-done study. A larger sample size would certainly have been nice but that's really my only complaint. No, I have another complaint. A bigger sample size would have been nice but here's another complaint, when you have a study with such impressive results, I mean you're looking at one group has an 85% success rate and the other group has a 25% success rate, do you really want to follow both of those groups another four years?
I mean, seriously, when you're convinced there's a better way to go? I mean, at what point do you give up on a long-term follow-up and say, hey kids in the control group, why don't we try some hypnotherapy and see if it'll help your symptoms? I don't know. Maybe it's just me, but it seems a little unethical to follow the control group out for four years and let them continue to have their symptoms when the other group is doing so well.
One more thing I want to point out and this is as important, functional abdominal pain and irritable bowel syndrome are not things you diagnose at home. They are serious medical disorders that can cause chronic abdominal pain, constipation, diarrhea, all these things. So you really do want a medical workup before you hang your hat on functional abdominal pain or irritable bowel syndrome as a diagnosis.
Now, once you've had that workup and you're satisfied with the diagnosis, then if your doctor doesn't suggest hypnotherapy as an option then you may want to suggest it to him or her. And if you want to print out an article that shows your doc the possible benefit of this technique, you may want to visit the Show Notes, again episode 229, follow the link to the article or the abstract on PubMed and maybe this is one that's worth ponying up the extra money and printing out the whole article for your doctor.
26:21
Now notice I did say the 'possible benefit'. And it's a compelling study but as I mentioned the sample size is a little low. On the other hand, the intervention is not harmful as long as it doesn't delay the diagnosis of an underlying medical disorder. So again, a medical workup for the abdominal pain is required and you got to do that as a first step and then you can decide if you want to maybe try this hypnotherapy thing.
One last issue and this is a very big issue, where do you find someone qualified to teach effective hypnotherapy to a kid with functional abdominal pain and irritable bowel syndrome? So these Dutch researchers obviously they had access to someone who had some good techniques, but they don't really spell out exactly what they did in terms of these techniques, what exactly will they tell the kids to do.
So who is the professional who provides this training? OK. Let's try hypnotherapy. There's a big leap from saying that to what do you actually do and unfortunately I don't have a good answer for that. But as time goes by and the results of this are kind of out there maybe we'll have some folks trained in this who can help.
But again, it's going to be important to actually get a medical diagnosis. Don't go straight to the hypnotherapy for your abdominal pain. Get it worked up, make sure it's not a medical reason that could be serious or life threatening and get that taken care of and then once you have the diagnosis of functional abdominal pain or irritable bowel syndrome then maybe try some hypnotherapy.
27:49
All right. Let's move on to sudden death. This once comes out of the University of Washington and with cooperation from the NCAA, published in the British Journal of Sports Medicine, also last April, April 2012. Of course we'll have the abstract, the PubMed version of the abstract for you over in the Show Notes.
So the question before the researchers, among college athletes with sickle cell trait, what is the relative risk of sudden death compared to athletes without sickle cell trait? Before we talk about this let's do a quick reminder of sickle cell trait.
We did an entire episode of PediaCast on sickle cell anemia this past January and that included the discussion on sickle cell trait. So if you want to know much more about these conditions check out PediaCast episode 194 and we'll put a link to that in the Show Notes of this episode so you can find it easily.
But in a nutshell, what is sickle cell trait? Well people with sickle cell anemia have abnormal hemoglobin, which results in abnormal red blood cells and these abnormal red blood cells are rigid and sticky and shaped like sickles or crescent moons. They get stuck in small blood vessels and clumped together and disrupt blood flow and oxygen delivery.
Now, they don't last in this circulation very long, so the spleen takes them out and removes them from circulation or they're damaged and are removed. This results in anemia and the decreased capacity to carry oxygen to tissues. So that's sickle cell anemia.
Now what about sickle cell trait? Well trait is a genetic condition. Well both sickle cell anemia and sickle cell trait are genetic conditions. So to have sickle cell anemia you have to have two affected chromosomes, one from your mom and one from your dad.
If you only have one affected chromosome then you make a combination of normal hemoglobin and abnormal hemoglobin. So you have lots of normal red blood cells floating around in addition to the abnormal red blood cells. And the number of normal red blood cells is usually enough to keep you out of trouble. So this is sickle cell trait.
29:55
So why would sickle cell trait be dangerous for athletes? Well most of the time it's not. But in the face of increase oxygen demand like vigorous exercise or decrease partial pressure of environmental oxygen like high altitude locations, then the number of normal red blood cells may not be enough. And in light of dehydration and low volumes of blood plasma then the sickling effect of the abnormal red blood cells may become more significant.
So for athletes with sickle cell trait even though they usually don't run in to problems, during moments of vigorous exercise and relative dehydration or with the high elevation where you're playing like Denver, Colorado and elsewhere, there is the possibility of problems developing.
And one of these problems could be sudden death. And this is understandable if you have high oxygen demand accompanied by low oxygen delivery and sickled cells critically block off blood flow to important organs like the heart or the brain, then bad things can happen.
But they don't happen all the time and some people may not know that they have sickle cell trait so you can sort of see the ingredients here for the occasional disaster. So the researchers here want to see if sudden death events are really more common in college athletes with sickle cell trait or is this risk merely a hypothetical one.
So this type of survey is best done as a retrospective study. I mean, we don't want to take athletes with known sickle cell trait, expose them to vigorous exercise and dehydration and see how many experience sudden death. That's not a good idea. So this is going to be a retrospective study. We're going to take incidents of sudden death and then look back and see how many of them had sickle cell trait. And how did they do that exactly and what did they find out, we're going to talk about that.
31:45
Investigators looked at all cases of sudden death in NCAA athletes from 2004 through 2008. And during those five years they identified 273 incidents of sudden death in athletes. Now five of the deaths occurred in athletes with sickle cell trait. That's just 2% of the deaths occurred in athletes with sickle cell trait.
All of them were black Division 1 football players and all of these deaths took place during practice or training and all of these deaths were attributed to sickle cell trait as the cause of death at autopsy.
Now, since all of sickle cell trait associated death occurred in football players, let's just take those. Let's just examine the football players. So now instead of 273 incidents and 2% of them being caused by sickle cell trait since all of the sickle cell trait once were in football let's just look at the football numbers.
And if you only examine the sudden deaths that occurred in football players then the incidents of sickle cell trait is the cause of death jumps from 2% to 25%. Now this makes sickle cell trait the second leading cause of sudden death in college football players. The most common cause was cardiac or heart problems at 45%.
Now if we only look at sudden deaths that were exertional. In other words, the death happened during exertion. So the student athlete was vigorously exerting themselves. They weren't just standing around during a practice. They were vigorously exerting themselves when they died, then the incidents of sickle cell trait is the cause jumps to 42%.
And by the way, cardiac or heart issues also accounted for 42% of sudden death that occurred during vigorous exertion associated with NCAA Division 1 football. And heat stroke as it turns out accounted for the remaining 16%.
Now if you break that down, back into raw numbers, in a recent five-year period just to sum up, in a recent five-year period 12 Division 1 football players experienced sudden death while exerting themselves during practice or conditioning. Five died from a heart problem, five died from sickle cell trait and two died from heat stroke.
34:04
Let's play with the numbers a little more. Five athletes died from sickle cell trait. Now that doesn't seem like very many. I mean, don't get me wrong, it's five too many. I understand that, especially for the families involved. But when you look in from a public health standpoint, five athletes across the entire country over a five-year period doesn't seem like it's too many.
But if you compare that to the number of kids who play college football, an average of one each year, first may seem like a little number but if I told you that only five players had sickle cell trait, so 100% of those with sickle cell trait died a sudden death while playing football, suddenly those five are way more significant when you look at the big picture, right?
I misled you a little bit to make my point. More than five players with sickle cell trait were involved. But my point here is that five may not seem like a lot but you really have to look at how many sickle cell trait kids are playing football. If it's a 100% of them then yeah, it's significant and maybe even less than 100% is significant.
So let's look at the actual numbers. As it turns out, 4,135 Division 1 football players had sickle cell trait, which means that 1 in 827 experienced sudden death. OK. That seems a little better. But compared that number to those without sickle cell trait and their chance of sudden death is only 1 in 30,599.
Let me say that again, if you have sickle cell trait and you're playing Division 1 college football, your chance of sudden death during football is 1 in 827. If you don't have sickle cell trait the chance is only 1 in 30,599.
So even though it's only five deaths in five years, your odds of sudden death while playing football are 37 times greater if you have sickle cell trait. So that's significant. I know, again, one death is significant, I absolutely get that. But I'm trying to paint the big picture here for you.
36:18
So if you have sickle cell trait and you play college football, your risk of dying from sudden death is 37 times greater than players who don't have sickle cell trait. Is it worth the risk? Should those with sickle cell trait avoid playing football?
Well that's something that each student athlete must decide. You do have to also look 4,000 kids with sickle cell trait played college football without any problems at all. And there might be some things that those with sickle cell disease and sickle cell trait can do to theoretically decrease this risk. Things like minimizing periods of extreme oxygen consumption, not playing, practicing or conditioning in venues with high elevation and keeping themselves well hydrated.
Maybe if the rest of the team is vigorously exerting themselves and running a mile and prolonged oxygen consumption, maybe the kids on the team with sickle cell trait need to be exempt from that. Again, this is hypothetical. We don't have a study showing that if you minimize periods of extreme oxygen consumption, you don't play at high elevations, you keep yourselves hydrated, we don't have any kind of study that shows that those interventions actually do reduce the incidents of sudden death if you have sickle cell trait, but they make sense.
And in the end maybe they would reduce the risk, maybe they wouldn't, but certainly it's worth trying until we do know. At the end of the day, those with sickle cell trait you may want to find a different endeavor to pursue than NCAA Division 1 football because that's where we saw all of them or accept the risk.
Incidentally, the authors conclude that deaths during exertion in athletes with sickle cell trait occur more frequently than previously recognized and recommended targeted screening and education for players, coaches and staff as well as universal attention to adequate hydration, heat medication strategies and rest for struggling athletes.
38:11
The NCAA responded to this information as it became available and acted before the results were published. And since 2010 the NCAA does require all Division 1 schools to screen athletes for sickle cell trait or allow a waiver to be signed if sickle cell status is already known.
I also want to point out while black players are most at risk for sickle cell trait with about 7% of all black athletes affected, the disease is not limited to black athletes; 0.16% of all non-black athletes are also affected, much lower than blacks but not zero.
A couple more points, what is the cost of the screening protocol and who pays for it? And again I only bring this up from the public health standpoint. Again, we're talking about five deaths and so we're going to screen a whole population. When you look in at, again, one's too many, I totally get that. But when we look at the cost analysis of this, what is the cost of the screening protocol for all athletes and who pays for it?
Well, they start with the sickle cell solubility test, which costs about $5. There are some false positives with that test, so all positives get a hemoglobin electrophoresis to confirm and that ranges in cost from $30 to $150 depending on where you get the test done and who's paying for it.
The authors of this study point out that the cost to screen all black football athletes, so a targeted screening of those most susceptible to sudden death, the overall cost of that over a five-year period is about $40,000. But if you expand that to all athletes, now we're talking over $23 million to screen everybody.
40:00
So what's the bottom line here for student athletes and their parents? For me, my bottom line would be if you are a black Division 1 football player you get screened and that's the NCAA rules. Now, in my mind, Division 2 and Division 3 athletes can also be big competitors. You work hard, you use lots of oxygen, you might let yourself to get a bit dry when you're working out, so even though there weren't any deaths at this level in the five-year study period the possibility is still out there.
And what about basketball? What about volleyball, swimming, track, soccer? What about high school athletes? All of these kids and young adults have the potential to exert themselves vigorously and while these student athletes may not have the same body mass as Division 1 college football players, meaning their oxygen demand is not quite as high, the potential is still there.
So I'd make the case that any black athlete playing in any sport at any level ought to be screened if you don't know your sickle cell status. Actually, I'd say any black person, athlete or not, ought to be screened if you don't know your sickle cell status, not only for your own health but for informed choices about family planning as well.
Now from a public health standpoint, screening all black athletes may end up being considered to costly to justify it given five deaths in five years. As I said before, one death is too many if it can be prevented. And while the cost to the system may be too high to screen everyone, the cost to one family isn't that high and that's why I would do it. I know what about families who can't afford it? I'll let the public health officials and the politicians wrestle over that one.
OK. One more point and then we're going to run. What if you the student athlete, or you the parent of a student athlete, what if you or your child has sickle cell trait, what then? Do you avoid vigorous sports? Do you play but modify your conditioning and watch how hard your playing? Or do you just stay hydrated and go for it?
That's something you have to decide but you should know the risk. The ultimate decision rest with you and your level of risk tolerance. As we discussed, there are things that might diminish the risk but even with the best plan risk remains. So my job here is to identify that risk, provide you with the information you need to make an informed decision and hopefully I have accomplished that goal.
All right. So there you have it, guns, hypnosis and sudden death, an apt title for an October program here on PediaCast. We're going to take a quick break and I'll be back to wrap up the show, right after this.
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43:06
All right. We are back to wrap up the show. We have lots of great topics coming your way in the coming weeks. I do have a couple of vacation weeks. Let's see one coming up this month and another one is going to be in December. And I'm not exactly sure how we're going to handle the whole holiday thing around Christmas and New Year.
So just to give you heads up on that, there may be some weeks coming up where we don't have programs, but the ones that we do have are great ones. So just to give a little sampler, we're going to have someone stop by the studio to talk about developmental dysplasia of the hip. So this is you're going for your two-week well-child check up and your baby has a hip click or a clunk or a little looseness in the hip and your doctor wants your child to be seen again in a couple of weeks or they may want an ultrasound done or they may send you to see an orthopedic surgeon.
It's a pretty common problem like 1 in 60 newborns actually have at least some looseness. Now again, a lot of that goes away on its own on the recheck or they'll have a normal ultrasound. But 1 in 60, many of you out there who are listening right now are like yeah, I went through that with my kid. So we're going to talk about developmental dysplasia of the hip.
Also we have a show coming up on lazy eye, amblyopia, strabismus, these terms mean anything to you. Lazy eye I'm sure does for most parents and the clinicians out there will know what I'm talking about when I say strabismus and amblyopia. But that's all coming up a little bit later.
44:30
We're also going to do one on atopic dermatitis or eczema; urinary tract infections in babies and how you screen and treat and do they need a workup of their bladder and their kidneys to make sure they don't have reflux. We're going to have a nephrologist and a urologist to talk about, there's been sort of some changes in the way that primary care doctor should handle these things. We're going to discuss that.
Also we have a show coming up before the end of the year on short stature and growth hormone use. So lots of good interview shows and then of course we're going to sprinkle in our news and listener shows as well.
Also I want to remind you our Pinterest once again. I'm kind of really plugging this because it's brand new. I think this is the first time I mentioned it on the show and I think as of right now we have six followers. So by the next time that we're together I'd like to see that number be a lot more. And I know a lot of you out there are on Pinterest, there's a lot of moms and dads on Pinterest.
So just search for PediaCast or you can search for Dr. Mike that might get you there too. It's pinterest.com\pediacast. We have an episodes board, so every time we have a new episode we'll pin it there. And of course you'll probably get the episode either by subscribing to the feed or visiting iTunes or you download it on your own or listen at the website and you'll find out about it on Facebook or Twitter.
You might say why do I need the Episodes board. Well, what we'd like for you to do is if there's a show that you like with the topic you think people who follow your board would be interested in, you could repin our episode and share it and just help to spread the word about PediaCast. So that's something that would helpful.
46:03
Our News Parents Can Use board is going to point you to lots more news worthy items for parents, stuff you won't find on the show. So be sure to check that out and I am going to keep it up to date. We've got lots of stuff there now. I'm really excited about that. So check it out and you'll see some really cool news stories on our News Parents Can Use board over on Pinterest.
Also I want to remind you of Car seat Safety Check, Nationwide Children's and Kohl's teaming up for that this Saturday, October 13th 2012, from 10 AM to 2 PM at the Kohl's at 3360 Olentangy River Road in Columbus. And we'll check out your cars eat and make sure you got the right one and you're using it correctly and that your kids are safe in the car. And details on that are on the Show Notes, you can find it there.
I want to thank all of you for taking time out of your day to be a part of PediaCast. We really appreciate it. We haven't had an iTunes review since like, I think it's been like since August. So if you are a listener and especially if you found us on iTunes I would ask to please go over there. In order for us to maintain a visibility in iTunes those reviews are really important because the What's Hot List in the kids and family section of the podcast directory in iTunes really looks at the reviews and how many new reviews that you're getting.
So if you found us on iTunes please spread the love, go to iTunes, write up a quick review, it doesn't take long and that'll just help keep us visible and that's really what we're after. And again, honestly, we're not trying to self-promote here and make PediaCast this big, national phenomenon.
We really just want to give parents chance to have access to this information. And without getting it in front of their eyes they're not going to know that it exists. And so if you would be so kind as to write us up an iTunes review, it would be very helpful.
47:57
Also mentions in your blogs, on Facebook, in your Tweets, on Google+ and now Pinterest. I usually fly through this stuff but it's important. You're getting great free pediatric information here. And what with our information from a source you can trust cost you in book or subscription form. And we provide it free and all I ask is you please help us spread the word so we can grow the audience and have more parents like yourselves.
And it's not just parents we're after. Make sure you let your doctor and your child's doctor know about PediaCast as well. And if you are a doctor we do have posters that you can download and hang up in your office to helps spread the word. You can find them under the Resources tab at pediacast.org.
Those posters, of course, are not just for doctors. Parents, you are more than welcome to print those out and hang them up as I always say wherever moms and dads hang-out. At the daycare, at the Y, in your classes, at the church, wherever you are where you can hang stuff that would be of interest to parents I would just encourage you to use our resources there over at pediacast.org.
All right. One final time, if there's a topic that you'd like us to talk about or you have a question for the program or you want to point us to an interesting news story, just head over to pediacast.org, click on the Contact link, you can get a hold of me that way.
You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. Again 347-404- K-I-D-S.
And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody!
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Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.
