Poison Ivy and Summer Conditioning – PediaCast 466

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Description

• Sports Medicine experts, Dr Jim MacDonald and Kirk Sabalka, visit the studio as we consider student athletes and summer conditioning in the age of COVID. It’s also time for our yearly reminder on itchy rashes caused by the poison plants of summer. We hope you can join us!

Topics

• Poison Ivy, Oak and Sumac
• Summer Conditioning in the Age of COVID

Guests

• Dr James MacDonald
  Sports Medicine Physician
  Nationwide Children’s Hospital

• Kirk Sabalka
  Sports Performance Specialist
  Grandview High School

Links

• The Poison Plants of Summer: Poison Ivy, Oak and Sumac
• Sports Medicine at Nationwide Children’s Hospital
• Are You Prepared for Your Sports?

Trancription

Announcer 1: This is PediaCast.

[Music]

Announcer 1: 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. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio.

It's Episode 466 for July 15th, 2020. We're calling this one "Poison Ivy and Summer Conditioning". I want to welcome all of you to the program.

So there is lots of uncertainty regarding the upcoming fall sports season, which begs the question, should student athletes embark on their usual summer conditioning program to prepare for sports participation in the fall?

0:01:12

If so, what should that conditioning look like? How can students work on aerobic exercise and endurance and flexibility and weight training, and special skills related to a particular sport in the age of COVID-19 and social distancing? What is the role of coaches and athletic trainers? 

And then, there are injuries and rehab to consider. What should student athletes do if they're injured while training at home? Can they see their doctors safely? And what about sports medicine clinics, are they open? What role does telemedicine play in helping these families? All great questions which we will ask our experts this week. 

Speaking of them, I will be joined shortly by Dr. James MacDonald. He's a sports medicine physician at Nationwide Children's Hospital. Also, Kirk Sabalka, he's a sport performance specialist for Grandview High School. We're also going to ask them about the postponed 2020 Summer Olympic Games, which was supposed to kick off this month in Tokyo. 

0:02:15

What are the Olympic athletes doing? Are their training facilities open or are they taking a break as well? So we'll consider those questions. 

Before we get to them, it is time for our  yearly reminder regarding the poison plants of summer. Now, if like me you're in Ohio, the one that we think about the most is going to be poison ivy. There's also poison oak and poison sumac if you are in other parts of the United States. 

Poison ivy is a stout, weedy vine that climbs trees east of the Rocky Mountains. Now, it's not always right up against trees. Sometimes it's also in and amongst other weeds. But it's kind of a tall weedy plant, whereas poison oak is a little larger, more shrub-like and tends to be found west of the Rocky Mountains. 

Poison sumac grows in swampy areas of the southeastern United States, and it's the largest of the bunch. It can reach heights of 20 feet.

0:03:16

Now, what's recommended is think about what area of the country you live in and then you probably know is it poison ivy I have to worry about or poison oak or poison sumac? And look up pictures, so you can identify what these plants look like. And make sure you show your kids what these plants look like. 

And if you're out and about, point them out. Say, "Hey, look, there's poison ivy. There's poison oak, There's poison sumac. We want to stay away from this stuff." So you really want to know what these things look like, and that's just going to take looking at pictures on the Internet and sharing those pictures with your kids. 

Again, here in Ohio, poison ivy is going to be it's like knee-high, maybe mid-thigh high growths. And it has leaves of three that are very characteristic. And my Grandma Bert used to say, "Leaves of three, you let them be." So that's a nice phrase you can teach your kids, "Leaves of three." If it looks like this, show them those pictures, stay away from it. 

0:04:14

So what's the problem with poison ivy, poison oak, and poison sumac? Well, they have an oil on their leaves called urushiol. And this an oil that a lot of people have an allergic reaction to. And even if you've never had an allergic reaction to this oil in the past, it can happen at any time. You can have been in contact with poison ivy several times. You can get to be 40 years of age, and all of a sudden, your body decides this is a foreign material that I need to react against. 

So don't feel like because you've never had a poison ivy rash before or you know that you have been in contact with it, it's not been a problem, that does not mean that you are immune to this stuff. You can develop a rash. 

0:05:00

And the problem with this oil is it forms a permanent bond with your skin. It doesn't go away; you cannot wash it off once it's been there for an hour or two. So it binds pretty quickly to the skin, and that's why this rash lasts for so long because you really have to make new skin in order for the rash to go away. 

And that is a process that can take anywhere from two to four weeks, sort of depending on what stage of the skin sloughing process because we'll always making new skin. And if you were just kind of been shedding your skin and you're making new one, it could be up to a month before you really have a new layer of skin on the outside. 

So you are going to have that oil bound to your skin until you renew it. And that can take several weeks, and that's going to result in a really patchy red itchy, very itchy rash. And swelling of underlying tissue can also happen particularly where there are sort of loose skin. So think about the face around the eyes, the eyelids down in the groin area. You can really get quite a bit of swelling in addition to the red itchy rash.

0:06:12

So what do you do if you find yourself with this rash? So you've been in the woods, you've been in the weeds, against trees. It's highly likely that you've been exposed to poison ivy and you do break out in this red itchy rash. Well, certainly, if you have any question about a rash, you want to make sure that it's not a skin infection, that it really is an allergic reaction kind of rash or contact dermatitis. 

And usually, skin infections can be uncomfortable, can be sort of itchy. They tend to be more tender, whereas a poison ivy rash is going to be really more intensely itchy. 

But if you do have a question, make sure you contact your child's doctor or your doctor, if you're not quite sure what it is. If we determine, yes, it is a poison ivy rash and it's localized -- so it's just in one area, and it's not on the face, not in the groin, so it's not in an area where you're going to have the potential for a lot of swelling -- a lot of times, what we'll do then is use 1% hydrocortisone cream which you can just get over the counter, and use that a couple of times a day, while you're getting through that rash. 

0:07:24

So again, that's going to be possibly two to four-week period of time that you use this cream to kind of keep things calmed down. 

And then you can also use an antihistamine medicine. So histamine is one of the chemicals that our body uses to make this allergic reaction, this contact dermatitis. So we want to calm those down with an antihistamine. And in the past, we had recommended diphenhydramine, which goes by the brand name Benadryl, but that particular drug penetrate across the blood brain barrier and it goes into the brain and causes quite a bit of sedation. In younger kids, it can cause irritability and behavioral changes. 

0:08:06

And so, we don't recommend that medicine as much anymore. What your doctor's likely to recommend is one of the newer antihistamine medicines, things like Cetirizine, which goes by the brand name Zyrtec. It's much less likely to make you drowsy or cause behavioral changes, and only has to be given once a day as well. 

So again, ask your child's doctor or your doctor for specific recommendations. But in general, 1% hydrocortisone cream and non-drowsy and the newer antihistamine medications are typically recommended. Now, if it's in an area that can get a lot of swelling, so in the face, in the groin, or if you just have it all over, so you know you'd be going through a tube of hydrocortisone cream every few days just because you got so much of it. 

Then in those situations, oftentimes, we'll use an oral steroid medicine rather than a topical one. And that does require a prescription. And often, again, you need it for a longer period of time than you do for like let's say you have asthma and you need a few days on oral steroid. Usually, that's just like five days or so. 

0:09:11

With poison ivy, because this rash lasts for so long, as you're on to oral steroid medicine, your body's own steroid production actually down regulates. So your body's like "Hey, there's a steroid here. I don't need to make my own." And so oftentimes, your body's own internal steroid levels will go down. And so we will taper the dose of the oral steroid so that your body will start to increase the level of its own steroid production over time. 

That why we've called it taper of steroid where we just decrease the dose. After a few days, we decrease it. A few days more, we decrease it some more. A few days later, decrease it some more. So that by the time we get two to three weeks out, now we have a very minimal dose and your body's own steroid production has kicked back in, all the time when this poison ivy rash is getting better. 

0:10:00

It's also important to remember, these treatments are going to help the symptoms but they're not going to eliminate them altogether. There's still going to be some form of a rash that's there. Hopefully, it's less intense, less itchy because of the treatment. But again, until you make new skin, that oil is there, and your body is going to have some degree of  reaction. So it's really best to prevent poison ivy rash rather than sort of get behind the ball and be chasing it and treating it. 

So how do you prevent it? Well, that goes back to knowing what it looks like, knowing where it grows, where you can expect it. And look out for it and actively avoid the plant. 

And just, I personally am very allergic to poison ivy. I get it quite easily. And I was out weeding about a week ago. And I was really paying attention. You know, "Leaves of three," I was remembering what my grandma told me. I'm going to let them be. 

And sure enough, I picked a plant and  I looked at it and I dropped it. I just thought, "Oh my goodness, this looks like poison ivy. This is poison ivy." I had my wife come over. She's like, "Oh, yeah, that's poison ivy, get out. What are you doing?" 

0:11:07

And so, I had gloves on. I immediately took the gloves off and I went inside and washed very quickly. Just scrubbed my hands even though they were in gloves, scrubbed my arms, also my legs with soap and water. And fortunately, I did not break out. If there had been any oil that touched my skin, I was able to eliminate that. 

And so that's what you want to do if you do come in contact with it unknowingly, and then you become aware of it, is to immediately scrub with soap and water. There are special soaps that exists that say, "Hey, this is going to help keep that poison ivy oil off a little bit better." That's fine, if you have those around, you absolutely use them. But any soap is going to be fine, as long as you get to it within an hour, maximum of two hours after exposure. The quicker, the better. And you just want to really scrub well with soap and water. 

0:12:01

A shower, if you really get into it and your kids are rolling around and you're like, "Oh, that's terrible, they're rolling around in poison ivy." Get them in, shower them off, make sure you use lots of soap as they're in the shower. 

You don't want to take a bath, again, especially in that first couple of hours after exposure because, until it's bound permanently, you don't want the oil floating on the surface of the water and then getting to other parts of your body, including your genital region at that point because you're naked in the bath, and your face as well. So those areas can become very swollen and very intense reaction.

And so shower's okay, but you don't want to be in the bath, again, especially in the first couple of hours after the rash. Once the oil has bound permanently to your skin, it's not going to spread. So that's important. 

It may look like it spreads because areas of the skin that have the most exposure tend to break out first. There are also certain areas of your body like your groin area and your face area that tend to break out first. That's more sensitive, more likely to have an allergic reaction. And you are more likely to notice it because swelling may go along with that reaction. 

0:13:15

So a lot of times, after poison ivy exposure, it can seem like it's spreading as it appears on different areas of the body. But likely, it's still from that same exposure point. And again, once that oil is bound permanently to the skin after an hour or two, it's really not going to spread to other areas very easily. 

There is a medication known as Bentoquatam, which goes by the brand name of Ivy Block and this does prevent the rash by providing a barrier on the surface of exposed skin. So if you are in landscaping business and you know you're going to be around an area with poison ivy, this is something that can be used to help prevent the oil from getting on to your skin by creating a barrier. 

0:14:02

It's approved for ages six and up, so this is not something you want to give to young kids and should be applied at least 15 minutes prior to an expected exposure and then reapplied every four hours in order to remain effective. But this is sort of last resort, when you know you're going to be working around. Really, the best prevention is avoiding it, knowing what the plant looks like and avoiding it altogether. 

I did write a blogpost on the poison plants of summer that goes into a little bit more detail about poison ivy, poison oak and poison sumac. That's available on the 700 Children's Blog. And I'll put a link to it in the show notes for this episode, 466, over at pediacast.org. 

All right, let's take a quick break. We are going to get our sports medicine expert connected to the studio. 

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0:15:06

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0:16:04.

So, let's take a quick break. We'll get Dr. Jim MacDonald and Kirk Sabalka  connected to the studio and then we will be back to talk about summer conditioning in the age of COVID. That's coming up right after this.

[Music]

Dr. Mike Patrick: Dr. James MacDonald is a Sports Medicine Physician at Nationwide Children's Hospital and an associate professor of Pediatrics at the Ohio State University College of Medicine. Kirk Sabalka is a certified strength and conditioning specialist and serves as head strengthening conditioning coach for Grandview High School. 

0:17:03

They're here to talk about summer conditioning in the midst of a worldwide pandemic, one which canceled the 2020 Summer Olympic Games in Tokyo and has caused much uncertainty regarding high school-based sports in the Fall, not just high school, middle school, too.

So what is a student athlete to do with regard to summer conditioning? They're here to answer that question and more. So let's give a warm PediaCast welcome to Dr. James MacDonald and Kirk Sabalka. Thanks so much to both of you for stopping by today. 

Dr. James MacDonald: Yeah, thanks for having us, Dr. Mike. 

Kirk Sabalka: Yeah, absolutely. Thanks for having us. 

Dr. Mike Patrick: Really appreciate both of you taking time out of your busy schedules. So Jim, what is your hunch for this Fall sports season. It is a go or a no-go? 

Dr. James MacDonald: I got to say, I'm a podcaster too and this is a question I'm asking all my guests too, Dr. Mike. I'm not sure is my best answer, but my hunch is that there will be some kind of sports season but different than what we have previously known. What I mean by that is that even now, we're going through different phases, right? Different phases of opening and different phases, and Kirk will probably get into this, of what athletes can do on campus and what they can't do. 

0:18:14

I do think all athletes in Fall sports in Ohio middle school and high school will have an opportunity to engage in some kind of sport, even if that means they're just training within their teams. When it comes to interscholastic competitive, it's Grandview versus Bexley, or it's a state championship in November, that is a total guess, and part of it has to do with the fluidity of the situation with COVID. 

I mean, it's going to vary depending on if we're in level three or level four COVID crisis as defined by the state. But I think we might be able to get into this a little bit more, but my hunch is there will be something. It's going to be different than what we know, and I don't know what level we're going to have full-on competition between schools. 

0:19:06

Just this one last thought, are there going to be 500 cross-country runners in some huge invitation in Pickerington in October like they usually are? I don't know.

Dr. Mike Patrick: Yeah, absolutely. So with all this uncertainty, should student athletes be waiting on a final verdict before they start conditioning? I mean, do you need to know the end result to know what you ought to be doing right now? 

Dr. James MacDonald: No, but Kirk will be going into this a little bit more too, but definitely not. And part of my answer is that if you're really interested in sports, to some extent, you'll always be in some cycle of training. And by that, it comes with a little asterisk. It can mean like part of your training is actually I'm in the middle of a rest period, like I'm post-season and I'm resting. 

But that's part of an integrated approach to how I approach sports in my life over the course of a year. And so I would be saying don't wait for the final verdict. If you do, you're not going to be prepared. And what's more, I think if you go now, you will get the benefits and the joy of the training that come even independent of the competition. So don't wait for the verdict. 

0:20:15

Dr. Mike Patrick: There are benefits to exercise whether you participate in sports or not, in terms of cardiovascular health, mental health, getting better sleep, even better immune system functions. So certainly, if the sports season is not what you expect, you definitely are going to benefit for having conditioned and exercised. And that holds true for all of us, right? 

Dr. James MacDonald: Yeah, absolutely. And my last thought, I do want to acknowledge, this is literally a unique situation that none of us had gone through before, globally, the whole world, right? And nobody really knows the perfect answer. I constantly think in my mind, I'm thinking what is the least bad answer or something like that. 

And I want to acknowledge for a lot of athletes, that not knowing can be hard, right? Senior year, this was the year we were going to try to make it to the playoff. We're going to go as deep as we could in the states. And that question mark at the end, it can be hard to find the motivation. So I think a lot of athletes will need to find a special hook this season. 

0:21:21

And I wanted to acknowledge the challenge of that. I don't want to make this sound easy. But if you're interested in sports and you want to be playing this Fall, don't wait for that final verdict and get what you can out of your sport. You might be surprised how much we can do this Fall. It may be, we'll see. 

Dr. Mike Patrick: Yeah, yeah, time will tell. So Kirk, as a sports conditioning specialist, what do you think student athletes can be doing? What's the best plan right now for them to ready themselves for the Fall? 

Kirk Sabalka: Yes, so just coming off of quarantine, these kids were essentially inactive for 10 to 12 weeks. And so they had to start off as if they were starting for the very first time. Unlike when they were starting for the first time though, and it's slow buildup, they can come back quickly. 

0:22:09

So they're going to be doing basic movements. You're just easing back into sprints, easing back into jumps, squatting, any kind of lifting. And especially right now, like what Mike said, even though this season is debatable right now, as far as OHSAA has claimed, practices can start as of August 1st, which is in three weeks. 

And so, if you haven't started by now, your risk of injury is very high. And so these kids have to be doing something, because even if they were doing body weight workouts during quarantine, that's nothing compared to the forces that are put on to you when you're on the field. 

Dr. Mike Patrick: I would imagine that this is going to really vary from district to district and sports to sports. But is there something that student athletes should be doing to connect with their coach and athletic trainers and fellow athletes right now?

0:23:05

Dr. James MacDonald: Yes, that's the simple answer and I think to your point, depending on what district you're in, you may have different options. I'm aware that some schools, the kids have been staying in touch with coach the same way we're doing. We're doing this like, your listeners won't know, it's probably some kind of visual, it's not Zoom, it's not Google Hangout.

But Dr. Mike, whatever you have going for this podcast, we're connecting but we're not physically together. That's being done by a lot of student athletes in the state and around the country. But not all school districts have those resources and have that ability. So I think, again, it would be dependent on what your school district looks like and what resources you have but yes, I would be saying the student athletes will want to connect with the coaches and the athletic trainers. 

I know, on our end, the schools that we work with, our athletic trainers from mid-March have been doing a huge amount of outreach to the schools that we cover, keeping kids active, keeping them engaged, keeping them aware. And so, I think the schools that we worked with as Nationwide Children's Hospital have really benefited from this relationship because we've gone out and given that outreach. 

0:24:21

But as you know, forgive me, I don't remember the exact number, there'd be about 25% to 30% of high school's at least around the country who have no athletic trainers, right?  So I don't know what they get to do, that's a big question mark. 

Dr. Mike Patrick: Kirk, is having a plan, you get up in the morning, you think, "Oh, I want to be active, I want to do the squats. I want to run." But having a written plan, is that helpful for the students? 

Kirk Sabalka: Oh, absolutely. You know the old adage, if you fail to plan, you plan to fail. And so you have to have this long-term goal in life which poses the problem that we are in uncertainty. So it's like how long do you plan out? Most of these phases of strength conditioning where you have your quadrennial cycle, which is the Olympics, which is what we originally can talk. You have a yearly plan, you have a 12-week plan, a monthly plan, even a weekly plan. 

0:25:17

And so if you don't take into account what you're doing day to day, week to week, month to month, you actually will stagnate in progress because you need to spin your wheels. 

Dr. James MacDonald: You know what, if I can just follow up with what Kirk said, I will also say more than ever in a time of uncertainty, having a plan can enhance your resiliency. All that we don't know stuff can generate a lot of anxiety. And if you focus on the plan, that can get you through. And I think like what we're seeing now on a much larger level, like globally and temporally, this is what tennis players play, right, when they're in the match? Boom, it rains, oh, oh, we're out. 

I was just about to serve for match point, "Oh, oh, I got to sit over there for two hours. Rain breaks over. How am I going to manage that? How am I going to manage that? How am I going to deal with that uncertainty? What will I be able to do mentally?" 

0:26:14

This is like a global months-long, seasons-long example of that. And those great tennis players, they stay focused on the plan. They're not going to be thinking when's the rain and when's the.... I do this and this and this when that break happens. That's what I do. I focus on the process. 

Dr. Mike Patrick: And if you have difficulty coming up with what your plan ought to be, that would be a great opportunity to reach out to the coaching staff, the athletic trainers. And maybe they'll have some ideas, especially that are particular to your sport that can help you with the conditioning. 

And it's not just exercises either, right? I mean, part of that plan has to incorporate eating and nutrition and getting enough sleep and having a balanced approach to life and making sure that your sports life balance are in check. Kirk, what do you advise students to do to make sure that they're paying attention to all of those things, in addition to the exercise? 

0:27:11

Kirk Sabalka: Oh, man, this is a daily conversation and it might get through our kids. It's trying to get kids to, and I always use the term "Everyone wants to outwork their opponent, but no one wants to outsleep and outeat their opponent," which is important. And so we have daily conversations about it. 

So like, we're training in the morning right now. So first thing, "What did you eat for breakfast?" And most of these kids will be like, "Nothing." And I was like, "Well, you got to get something." And so then, it's probing what do they like to eat? I'm not going to force them to try to eat something they don't like. I just want them to get calories in. 

And then, it's "What time did you go to bed?" And a lot of these kids, especially high school are like, "Two or three in the morning." Well, training's at eight. So I know they only got couple of hours of sleep. So I was like, "Okay, so if we're training at eight, you need to wake up at seven. You need to go to bed by 11 to get eight hours at most." 

0:28:03

And it's just a daily argument with these kids to get them to treat it like a lifestyle. I want them to eat at least three or four times a day. I want them to get eight hours. And it's nagging, it's nagging them until they do it. 

Dr. Mike Patrick: Yeah, do you find the difference between sort of your casual athlete and you're really high-performance competitive athlete with regard to their attitude toward those things? And then, on that same line of thinking, our Olympic athletes, are they also really thinking what they're eating and how much sleep they're getting, and all of those things? 

Kirk Sabalka: So yes to both questions. So high-performance athletes, so we're talking about the high school one first. It's almost like an aha moment for them. So they'll be training and you'll talk to them about nutrition and sleep. And then, of course, your high-performance ones, they want to do better, so they'll go and do it. And then, all of the sudden, whatever performance gains they were getting in a month, they're now getting in like two weeks. 

0:29:07

So it's vastly different from what they were doing. So it's that's aha moment, so then it continues. And then, as you get higher in level, so let's say you take the high school and they go to college, and college freshman Olympics, they then will start hiring people. 

They'll have a dietitian. They'll have a sleep expert. They'll have everyone to make sure that this stuff is perfect. Because it gets very stressful if you start managing all that.

And so, the goal of professional Olympic athlete's actually to minimize stress. And so, if you can have somebody to take care of your stressful stuff, like to make sure you're eating properly, that's less you have to worry about. 

Dr. Mike Patrick: We have a lot of parents who listen to this program. And Jim, do you think that this is a role then that the parent can play in terms of really stressing the importance of the non-physical parts of this? 

0:30:00

Dr. James MacDonald: It is and then I also want to acknowledge a conversation that's fairly often. It's like everything, it's sometimes hard to come from mom and dad, right? It's like, yeah, you know again. 

But I do think like what Kirk said, it can be helpful for parent if the hook can be... So it's about injury prevention for sure, but there's also performance component. For a lot of kids, if you can bring that hook in the performance, like, "Mom is not just nagging you to get to bed and get eight hours of sleep." But it's like "You know, Draymond Green of the Golden State Warriors has his sleep specialist saying you got to get nine hours. And when Draymond listened to her finally, he's like free throw average." 

Seriously, this is true life story. I mean, he was playing video games all night. And his sleep specialist, really, within two weeks, like Kirk said, free throw average went through the roof. It's about injury prevention but also performance. So like, yes, so I think parents reminding their kids, get screens out of the room, not just because parents never like that, but you will sleep better. 

0:31:10

Not just as if it's like out of the room. That's been proven, you will sleep better. That's number one. And two, helping them get that sleep hygiene which pretty much means you'll wake up the same time every day. If you do that, you'll pretty much go to sleep naturally at the right time. And the final thing is, again, if you're having trouble, are they doing something wrong, like exercising too late in the day drinking caffeine? 

But yes, parents, absolutely can play that role. And finally, like everything in life, parents can model that role. If the parents have good sleep hygiene, if the parents don't bring their iPads and iPhones and have TVs in the bedroom, that's a great example for the kids. So yeah, parents can play a huge role. 

Kirk Sabalka: And if may jump in to add something, part of sleep hygiene and even connecting food to sleep hygiene, it's been shown if you have a higher carbohydrate meal two to three hours before bed, you actually improve sleep quality. And so now, you get the kid to eat and then sleep better. 

0:32:10

Dr. James MacDonald: And then, finally, if I just add on to Kirk, that sort of the current rage, of course, is the high protein guide. Or is my kid getting enough protein? So as Kirk just said, yeah, yeah, yes to that, but the evening thing, we want to focus more on a different macro nutrient for variety of reasons, but including you will improve our sleep. 

So lots of people are wigged out by carbs these days and really love the proteins but like everything, we need all macronutrients, all micronutrients. 

Kirk Sabalka: Absolutely.

Dr. Mike Patrick: Yeah, and it's fuel, right? In fact, the reason breakfast is so important is you need the energy because you're going to now go out and practice and condition and you need some fuel to do that.

Now, as we think about physical activity and sort of the components of conditioning in the summer, we think about cardiovascular endurance, flexibility, strength training, special skills that may be specific to a particular sport. Let's take each one of those individually. 

0:33:16

And Kirk, how can student athletes work on cardio and endurance while they're also maintaining social distancing?

Kirk Sabalka: So the easy answer is, of course, if you go running, that is the ultimate cardiovascular. You can go run outside and if you do it by yourself, obviously, you maintain social distancing. But a lot of people I guess, they think of only running when they think of cardiovascular health. But really, all we need to do to achieve a cardiovascular stimulus is get the heart rate between 120 to 140 beats. 

So if you're doing pushups, crunches, lunges in your house, and you maintain a 120 to 140 beats, you're getting a cardiovascular stimulus. You just have to do it for more than five minutes because five minutes is about the starting point of true stimulus for the cardiovascular health. So you could do that in your home and get heart health. Or you can do the old fashion, go out, go for a run. 

0:34:22

And so, those are two real quick easy ways to make sure that your heart healthy. It's just maintained that 120 to 140 beats per minute and do it for extended period of time. 

Dr. Mike Patrick: And if you don't like running, there are other outdoor activities you can do like biking, roller skating, rollerblading, skateboarding. I mean, there's other ways to move and still get your heart rate up, right? 

Kirk Sabalka: Exactly, exactly. Any activity done for a long period of time is going to get your cardiovascular health. You just don't have to go for a run at a treadmill or go for a ride. As long as you do an activity is great for cardio. Just go do an activity. 

Dr. Mike Patrick: And if you have two levels of your home, you have stairs and going up and down the stairs really gets your heart rate going, right?

0:35:05

Kirk Sabalka: Oh, yeah. 

Dr. Mike Patrick: You just have to do it enough times. Can be kind of boring. Put a TV at the top of the stairs and up and down. I know we want to limit the screen time, but you got to have some stimulation of your brain, too, right? 

Kirk Sabalka: Yeah.

Dr. Mike Patrick: Or listen to an audio book or music. 

Kirk Sabalka: They have these new apps now for people that you can basically listen to almost like a zombie chasing you and it makes it so you could go on a run and it tells you to run. It's like you have a zombie and it tells you this whole story. So whatever gets you out and active, right?

Dr. Mike Patrick: Yeah, absolutely. I've got to look that up. That sounds interesting. 

What about strength training, flexibility, those sports specific skills. I mean, the things that you think about really being in a gym and being with your team and doing those drills. How can you do that with social distancing just at home? 

0:35:59

Kirk Sabalka: So right now, we are in phases where we can have small groups within gyms. So we went from ten people, now, we can have about 20 people in the room. And we leave, so I'll have eight racks at Grandview. So you will leave, so if you're in rack one, you'll skip rack two, and you'll go to rack three as the next group. So for us, it's like 12 feet actually in distance. 

And so we're maintaining that and in small groups possible on this. And so, we're trying to just keep our distance the best we can. We're hand sanitizing in, we're hand sanitizing out, we're cleaning all the equipment. And in that way, we can have some sense of normalcy when it comes to our weight training and our sport performance training. So we can get ready for the season in three weeks for Fall sports, football, soccer, or volleyball, the rest of them.

Dr. Mike Patrick: Yeah, yeah. It's so different from one community to another. I mean, in some places where the virus is really ramping out right now, especially in the southern part of the US and in southeast, southwest. In places where the gyms are not open are there things that folks can be doing at home as we think about strength training, flexibility, and stuff? 

0:37:14

Kirk Sabalka: Oh, absolutely. Your body is an amazing load on to itself, you can do body weight squats, body weight lunges. You can do pushups, you can do dips. If there's a playground near you, you can go to that playground and climb on the monkey bars, all sorts of things. 

Really, when you're at home, your only limitations to what you can do is what you can come up with in your own head. Because you have your body, you have things around your house, that you can lift and move and of course, sprinting and jumping are always free, you can do those anywhere. And so, those are especially those two because of the fact that those are the most sports specific things you can do is go sprinting and jumping. 

Dr. James MacDonald:  Really quickly. I love your idea of like your imagination. And I'll give you an example, so right now, if you try to go to Dick's and get some plates for barbells, good luck. Get a kettlebell, good luck, they're all gone, right? 

0:38:12

And I guess we used to get them from China. They're like no foundries in America makes them. They're trying to ramp up but there's this huge lag getting that kind of basic weight equipment which you could have gotten easily back at like at the end of February. 

Well, I wanted to do some stuff, so I just went to Ace and got a 50-pound bag of sand. And I'm kind of running holding up the sand or doing squats with my 50-pound bag of sand. And it's like the dang thing was like $4 or something. I don't know, it's like cheap and it's heavy but you can't get weights, but you can get sand. 

Kirk Sabalka: Absolutely. I love sandbags and wheelbarrows. 

Dr. Mike Patrick: Yeah, absolutely. As we think about really being active and doing weight training, and maybe even doing some things that we're not used to doing as we're being creative. But there's some dangers associated with summer conditioning, too, right? Injuries can still occur. Jim, what are some of the things that student athletes should be thinking about to do summer conditioning in a safe fashion? 

0:39:16

So I kind of break down a lot of injuries into two basic categories. There are acute and overused injuries. So as far as the acute injuries that can happen with conditioning, it does help to have supervision, right? So this is a little bit of a Catch 22 in the COVID era. And so there are people in Grandview who are going to work with Kirk and that's great. But at the end of March, it was shelter in place, they're not able to do that. 

But what I'm building up to say is when possible, you get supervision. So a couple of months ago, that's supervision for a lot of people where coaches were sending kids their workout. And asking them to stay within certain limits. Again, supervision helps, right? So Kirk might the first person to say like, "You're lifting weights and you better have a spotter, and if you don't have a spotter, you may not want to be lifting weights, right?" 

0:40:16

So those things can be a little bit of a Catch 22 with the COVID era, but that's on the acute injury side, I especially think about supervised practices and supervised workouts, if your coach or someone like Kirk is giving you. Secondly, on the overuse side, kids likewise need that supervision, but you really want to be aware of what your training load is. 

So let's say someone is listening to this and listening to what Kirk was saying earlier, "Oh, my god, like this way, OSHAA, August 1st." And I actually have been sitting on my couch. I have been. It's like, I'm going to go out and run. I got to run eight miles today. You've got to progress. You've got to progress your training load.

And even if you do feel like time is pressing, time is the master, you can't cheat it. Ideally, you would have started your pre-season conditioning back on June 1st. 

0:41:11

If you didn't you can still start now. You've got to go low, go slow. Or else you're going to have an overuse injury like a stress fracture. So supervision's key and progression of training load, I'd say, are kind of the big keys to avoid injury and summer conditioning. 

Dr. Mike Patrick: Hydration is also going to be important when you're out and about and thinking about the heat exhaustion and those things too, right? 

Kirk Sabalka: God bless you, Dr. Mike. That's a huge component. And just in my mind, I was thinking about our southern hemisphere. All those people falling into the southern hemisphere and it's winter. So that's less important for them, right?

But absolutely, you're spot on. I'm aware that tomorrow's going to be like 94, right? So there are two, the timing of your workout is going to be important. You're going to be wanting to do it in the early morning, in the cool maybe of the early evening, all the while juggling "I need to get my good sleep. Exercise late in the day can affect my going to sleep."

0:42:13

So you got to juggle a few things, but you want to do it in cool or indoors where you got to control climate and absolutely paying attention to hydration. Hydration is huge but I want to also emphasize, you can outwork out hydration. You can be the most hydrated athlete out there and if it's 90% humidity and 90 degrees and it's noon, and you're wearing a football helmet and in gear and doing repeat sprints, you're going to get heat helmets despite how hydrated you are. 

So paying attention to the coolness of your environment where you work out is one thing. Hydration is also a big thing, though. You're absolutely right.

Dr. Mike Patrick: A lot of people ask, "Do I have to have sports drinks, or do I use water? What's the best way to hydrate? What are your thoughts there?"

0:43:05

Dr. James MacDonald: Well, my simple thought is whatever basically gets you to drink more or taste good. A lot of the benefit honestly of the products, the sport drinks product are just they have a little flavor to them. Even the color has been proven to induce more hydration. So those things can be good in terms of increasing the hydration of youngsters. 

But they're not superior to water, and you drink a glass of oranges, have a banana, and then the rest of the time, you're just hydrating with water. You're going to be as good as those sports drinks. 

So there's a little part of sports drinks you pay good amount of money for them, but it absolutely can induce people to drink more because they have little more flavor. So my ultimate preference is go with water, but I don't have a big bug there against sports drinks. I don't know, what do you think, Kirk? 

Kirk Sabalka: I'm of the same mind. As long as you're taking in fluids. I have some athletes that have not had an ounce of regular water probably since I've known them. 

[Laughter]

0:44:13

Kirk Sabalka: They do fine, but most of their drinks are like sports drinks and they actually crystal white in their water, but that's what gets them to drink. And so, at the end of the day... 

Dr. Mike Patrick: So Kirk, when you've worked with athletes in past seasons, when you're actually with them more often than you are right now, and folks start to complain of some aches and pains or starting to get those overuse injuries that Jim was taking about, what should they do when they start to have some aches and pains. I mean, is this now going to be do they need to slow down? 

At this point is when is they will usually talk to an athletic trainer, like what do I do? In what way can I continue to work out safely and at what point do I really need to see a sports medicine doctor? What kind of advice do you give those kids now when you're not with them as much? 

0:45:05

Kirk Sabalka: Yes, so usually, it would be you send them to the athletic trainer. And if the athletic trainer comes back, it's like, yes, this is due to overuse. You then come to conversation of how much are they doing outside of our training? Because the training we should be doing shouldn't cause overuse injuries. It should be regimented. There should be a plan to not cause it. And so then we're got to be like, "So what are you doing outside of this?" 

And majority of the time, you find out that, especially high school athletes is they're getting ready for football, they're still playing basketball and they're still with their throwing coach for baseball. And so, they're doing all these three sports at once and it's just too much for them. 

And so, you then come to conversation be like, obviously, you don't want them then to run off. It's like if baseball's their main love, you don't want them to stop playing baseball. You're like "Hey, look, I know football's coming up, would you like baseball? Why don't we draw back a little bit more on baseball and basketball, so we can do football right now?" 

0:46:13

And then, it's basically trying to make sure that any stressor they have outside of what you're getting ready for is drawn back so that they can recover as much as they can. And then, obviously, you let pain be their guide on their overuse injuries. So if something causes it pain, don't do it, right, until it's healed. 

Dr. Mike Patrick: That really makes a lot of sense and I think that could be a good motivator for not only are you going to be better prepared for football but by not injuring yourself, it's going to make the next baseball season actually more likely to occur. So even though you love baseball, like backing off on it right now is going to actually make you better ball player than if you overdo things down the road.

Kirk Sabalka: Absolutely. 

Dr. Mike Patrick: Jim, so let's say, there is an injury. It's time to see the sports medicine physician. Are you guys open for business? Is it safe to come in and see a sports medicine doctor at this point in the pandemic? 

0:47:11

Dr. James MacDonald: I'd say yes to both. And interestingly, we never shut our doors. We did most of our visits by mid-March to late April video. The same style we're actually conducting this podcasting. And we've gotten pretty good at telemedicine and that's still an option. And we'll take that option, we basically screen everybody. 

Children's does a great job screening everybody who comes in their door, whether they can be there or not, or might they be at risk for carrying coronavirus. So we sometimes will use telemedicine if, for lack of better phrase, the parent guardian and or child fails the COVID screen and we consider they shouldn't come into the building. Or the parents want to take that options, like "I just don't feel comfortable bringing my child into that kind of setting."

0:48:10

We can see them telemedicine. It's remarkable how much can get done. I think we're finding that at every level, right? Life's going on whether it's school or things like this, or how we connect with our colleagues. It's amazing to me how much we've all ramped up and we're doing a lot of telemedicine, but we're doing a lot of live visits, too. 

And if a parent and child call in with an injury, we walk them through COVID screening. We also walk them through some of the details of the injury to guide us in terms of our recommendation, like we really need to see, you're telling me your child was on a trampoline, fell off and now cannot put weight on the leg. Almost always, we've got to see that person to see if it's a fracture. They'll probably going to need an X-ray, that sort of thing. 

0:49:02

But we never shut our doors. We've always been open. We're now seeing with summer and the ramp up of some sports, not the highest levels yet, but we're definitely seeing more and more injuries. And come on in, if you're concerned about your child or give us a call because we'll guide you and we can still provide the care you guys need. 

Dr. Mike Patrick: Yeah, very good to know. Kirk, we've talked a lot about this from the student athlete's perspective. What has it been like for the coaches and the athletic trainers? To some degree, this must be really frustrating and yet, you're learning to live and work in this new reality. What's it been like? 

Kirk Sabalka: Yeah, you've nailed it on the head. It's been frustrating, because you don't know if you got to have anything waiting for you in fall, but you're optimistic that it will be there. And so, we approach every week and every day, and we just come to the assumption that we are going until somebody tells us not to. 

0:50:02

And so, for us, it's just making sure that we are, because we do the same things as the hospital. We have a thermometer, so we're checking for symptoms. If anyone comes automatically, they got to be taken in to get checked. And so, we're taking as much precaution as anybody and we're just hopeful that no one comes to us with corona, so that we don't get shut down.

Dr. Mike Patrick: Have you found that the student athletes are supporting one another? How are the teams still building that team mentality? That must be difficult, too. 

Kirk Sabalka: Actually, not really. They want to play and have their season as much as we do. And so they are more than willing to comply with all the guidelines, so that especially when you feel like, "Look, if we don't do this, you don't get to play x sport." And so they will do what needs to be done so they can play. And so, it's actually been very easy for them to buy in and do the guidelines and still continue on as a team. 

0:51:11

Dr. Mike Patrick: Yeah, because there's always that very real risk that by not following those guidelines, you could ruin things for your entire team. And so, that means there's at least that sort of inter-accountability between players because they all have a collective goal that they're trying to meet. 

Kirk Sabalka: Oh, exactly, 

Dr. Mike Patrick: So Jim, we're supposed to be heading into the summer Olympics right now. Would canceling the Olympic games, was that the right call? 

Dr. James MacDonald: Yeah, it was. I'd say, in the rear-view mirror, right now, I guess we'll be going out here, it's definitely was the right call. I think it was obviously a hard call. I got to say I think all credit should be given to Canada and Australia. Their Olympic committees, unlike the US OC or the IOC, the Australian and Canadians said, "We're not coming. We're out, sorry. You can't guarantee our athlete's safety. There's too much uncertainty. They're not going to be able to train appropriately, so we're just not showing." 

0:52:15

And when those relatively big players, they both punch pretty much above their weight in Olympics in terms of their performance, I think that started the domino. And the IOC realized they couldn't pull this off. So yes, I think the cancellation was correct. It would be really, really strange, not only to see what it would look like right now with Olympic Village and thousands of athletes around the world coming to one spot. It'd be like, "Oh my god." 

Not to mention the reality that the training that these athletes would have had to do in April, May, June. This is the greatest event in their life, they wouldn't be able to train appropriately. So it was the right call, for sure. I hope it can come in 2021 but that's a big question mark, to be honest. 

0:53:08

So one year down the road, only a year, and we're like what, four months into this thing, right? At least in America, the world's like six months in this. There's no light at the end of the tunnel, yet. The year's actually pretty close, I hope it comes off in 2021.

Dr. Mike Patrick: Absolutely. I think this is one instance, Kirk, when student athletes can look toward those Olympic athletes are real models. I mean, because this has been a big letdown for Olympics athletes, just as alterations in the Fall sport season is going to be a big letdown for student athletes. 

So in your experience, how have the Olympic athletes sort of handled this change in what they have been expecting and working toward for so long? 

Kirk Sabalka: So the way they handled it isn't, I don't want to call it disappointment because for a true Olympic athlete, disappointment comes from actually like losing. But the fact that they have to requalify, and you have a whole another year of possible injury risk, it's one thing you made the Olympics. There's no one else you have to go against except for the other top people in the world. But now, you have to do it all over again. And you have to go against new competitors that have come up this year. 

0:54:23

And so, it's going to be, I think, you're going to actually see more fire out of some of these athletes who got close and didn't get there because of the virus. And so they're going to come back and they're really going to really want to show that they deserve to be in the Olympics next year, especially against even newcomers that are going to come up this year. 

Dr. Mike Patrick: So this is an important point. So it's not like you qualified for the Olympics or you're on the Olympic team and it's a guarantee, they're just postponing it, and then you're going to do it then. You really have to still compete to make the team, right? 

Kirk Sabalka: Oh, yeah.

Dr. Mike Patrick: I think a lot of people don't realize that.

0:55:00

Dr. James MacDonald: I think another thing to say that's really important is for a lot of these athletes, there's only a few that make a lot of money, right? Like back in the day, with Michael Phelps or you name it, right, and with endorsements. Most of them survive on very limited funds. Some funds from their sports like the Rowing Association of America, USA Rowing kind of thing. And they have odd jobs and they were delaying entry into law school or you name it. And that agonizing choice, do I spend another year? With still some uncertainty to Kirk's point, "Am I on the team?"  to "Is it even going to go off?" 

I have to delay those plans again for another year, eat peanuts, which most of them are doing. They're not living a high life and train my butt off. I've spent a lot of time following those stories, I'm not privy to any individual ones. I've got to believe it's a really really intense... It's going to be an intense year for a lot of people at that level. 

0:56:12

Dr. Mike Patrick: Yeah, absolutely. 

Kirk Sabalka: Oh yeah.

Dr. Mike Patrick: Do they take a break or does conditioning; they just keep powering through? I guess it just depends from when one sports to another. 

Dr. James MacDonald: What's kind of funny is back in March, April, when it was shelter in place, they took a break. What was kind of limited now to have, like USA swimming. These swimmers would normally swim thousands of meters a day every day of their life. They're like lying on benches with some kind of bands trying to do something?

There was no water. There are no pools open. There's huge gap of training. That was part of that, especially certain sports, we can't even train. How are we going to... We're not going to be ready in for Tokyo. You can't do this to us. 

So anyway, like some of them had an enforced break, which may I don't know. Some of these things are experiments of nature. We might find like wow, that month whole is actually helpful to some people, recovery for some chronic injury or something. It might be a silver lining for some people. 

0:57:17

Dr. Mike Patrick: Are the Olympic training facilities, are they back open at this point? I'm sure there's still the cleanliness and social distancing and all that going on, but they are open again. 

Kirk Sabalka: Yes. Most Olympic athletes don't actually go to Colorado. Most of them's training out at their college facilities and then some private facilities. The Colorado facility's actually not as big as it once was. But all the colleges are open, which means that they can all get back into their training environments there. 

Dr. James MacDonald: And actually, I think, Kirk might speak to us more of that, I believe there are some individual Olympic centers around the country. And I just kind of merge summer and winter together for the sake of a thought experiment like Lake Placid is one, Colorado Springs. I think down in San Diego, Chula Vista, I believe. 

0:58:14

I think some of what can happen there is also predicated on what's happening locally, right? So the same thing our kids are facing, like we are in Phase 1 where you're trending at home. We're in Phase 2, like Kirk's alluding to, maybe ten people can get together. We're in Phase 3 where 20 people can get together. But we still have to play this game, where you can be on the squad rack and that group has to be on that squad rack. We have to stagger it. 

I think whether it's they're training in colleges or whether they're training in Olympic centers, what's happening locally matters in terms of what they're able to do. So I think everybody's story's going to be a little bit different. 

Dr. Mike Patrick: Yeah. It's one of those things like the rest of life right now. Five years from now, what do we learn and how have things changed because of this pandemic? It's just going to really have a long-lasting effect on every aspect of our lives including sports, right? 

0:59:11

Kirk Sabalka: Absolutely, yeah. 

Dr. James MacDonald: And I mean, we're seeing it right now. Is it conceivable that we're going to have any kind of continuation of "Hey, some sports we can do virtually?" We don't have to have fans in the stand. To your point, Dr. Mike, it's so wide open right now, predicting on where this is going to go. I don't know but I'm absolute certain what you said, it's going to be different. It's we're not going back to the normal of February 2020. It's going to be a new normal like everybody says. 

Dr. Mike Patrick: Well, one thing that has not changed and will not change is the excellence of the Sports Medicine Program at Nationwide Children's Hospital. So Jim, tell us a little bit about the program. It's just so far-reaching. You do so many things for so many different athletes. Just give us a little bit of a picture of what your program looks like. 

1:00:13

Dr. James MacDonald: Well, it's huge. And it starts with people like Kirk. It starts with the providers who are on the ground with our young people ranging from young kids. I'm talking here like "I'm a youth hockey at a chiller arena kind of scene," to "I'm at a college like Ohio Dominican" to "I'm at a high school or middle school."

So we have, god, I've lost track, 50 I thought. I don't know, it's so many I don't know athletic trainers, strength and conditioning performance specialist. And that is the centerpiece of our approach. That is the best thing I've think we've got and makes us stand out compared to other centers around the country. 

1:01:00

These are the people who do the best job of keeping the kids healthy. So they don't get injured in the first place. So yes, yes, then when they get injured, and a lot of times, the athletic trainers can take care of that but every so often now, you got "Now, we'll see the doctor." So they'll come in and see us. 

And we've got I think I believe it's nine now physicians. I'm just about to celebrate my tenth anniversary and when I arrived, I was the fifth. We have centers all over the city of Columbus. 

And we've historically drawn all over the state in the region including Kentucky and West Virginia. But again, one of the things that's happening in telemedicine, it's like I can see people in Charleston, West Virginia. I can see them in Pittsburgh, Pennsylvania. And people are coming to us from  around the region as well as around the estate because of our excellence. 

And as it's said, it starts with the I don't know, Kirk, do you know, Mike? The 50's, I don't know, there's so many I don't know anymore, but it's a huge program. 

Dr. Mike Patrick: And really, every aspect of sports, you guys deal with, including psychology and nutrition, physical therapy in addition to athletic trainers and the sports medicine doctors. 

1:02:10

And so, folks, we will put a link to your program in the show notes for this episode, 466, over at pediacast.org. Folks can find out lots more information about the Sports Medicine Program here through that. 

So Dr. Jim MacDonald, sports medicine physician at Nationwide Children's and Kirk Sabalka as sports performance specialist at Grandview High School, once again, thanks to both of you for visiting us today. 

Dr. James MacDonald: It was great to spend time with you, Dr. Mike. 

Kirk Sabalka: Yeah, it was great. 

[Music]

1:03:09

Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. 

Thanks once again to our guests this week, Dr. Jim MacDonald with Sports Medicine at Nationwide Children's Hospital and Kirk Sabalka, sports performance specialist at Grandview High School here in Central Ohio. 

They also wanted me to let you know about a web resource that they have. It's called Are You Prepared for Your Sports? And it really goes into more detail about summer conditioning and what student athletes should be doing right now to get themselves ready for the Fall sports season. And I'll put a link to that resource in the show notes for you over at pediacast.org. This is Episode 466.

Don't forget, you can PediaCast wherever podcasts are found. We are in the Apple and Google Podcast apps, iHeart Radio, Spotify, SoundCloud, Castbox, Himalaya and most other podcast apps for iOS and Android. 

1:04:07

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1:05:11

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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.

[Music]

Announcer 1: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.