2006 Sports Medicine in Open Water Swimming

8/14/2019 2006 Sports Medicine in Open Water Swimming

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Sports Medicine in OpenSports Medicine in OpenWater SwimmingWater Swimming

Jim Miller, MDJim Miller, MD

Family Practice and Sports MedicineFamily Practice and Sports Medicine

Richmond, VirginiaRichmond, Virginia

USA SwimmingUSA Swimming

National Team Physician 1996National Team Physician 1996 presentpresent

Chair Asthma and Diabetes Task ForcesChair Asthma and Diabetes Task Forces

Member IAQ Task ForceMember IAQ Task Force

FINAFINA

Doping Control OfficerDoping Control Officer

Chair, FINA Medical Congress 2004Chair, FINA Medical Congress 2004


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Open WaterOpen Water the Challengesthe Challenges

WaterWaterItIts alive!s alive! WaterWaterItIts too cold!s too cold!

WaterWaterItIts too hot!s too hot!

WaterWater

ItIt

s moving!s moving!

WaterWaterI cannot seeI cannot seeanything!anything!

WaterWaterSomething isSomething islooking at me!looking at me!

Things are swimming inThings are swimming inhere!here!

Something touched me!Something touched me!

Feeding? What is that?Feeding? What is that?

What kind of food?What kind of food?

I cannot see the finishI cannot see the finishline!line!

I got sand on me!I got sand on me!


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Key ChallengeKey Challenge

Flexibil ity!Flexibil ity!


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Energy ExchangeEnergy Exchange

ConvectionConvection The transfer of heat fromThe transfer of heat fromthe movement of air or water across thethe movement of air or water across the

body when the temperature of thebody when the temperature of the

water/air is cooler or warmer than thewater/air is cooler or warmer than thebody.body.

EvaporationEvaporation the conversion of liquid tothe conversion of liquid togas, as best demonstrated by sweating.gas, as best demonstrated by sweating.


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Energy ExchangeEnergy Exchange

RadiationRadiation The heat transfer fromThe heat transfer fromelectromagnetic waves either to or from theelectromagnetic waves either to or from thebody to an object that is not in direct contactbody to an object that is not in direct contactwith the body, e.g. sunshine.with the body, e.g. sunshine.

ConductionConduction The transfer of heat from aThe transfer of heat from awarmer to a cooler object that are in directwarmer to a cooler object that are in directcontact.contact.

Note that many of these are often in combinationNote that many of these are often in combinationincreasing the impact on the athlete.increasing the impact on the athlete.


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HypothermiaHypothermia MildMild(Two Levels of Severity)(Two Levels of Severity)

9999 96 F96 F

Shivering and impairmentShivering and impairmentto perform coordinatedto perform coordinatedtaskstasks

Basic treatmentBasic treatment: Simple: Simplerere--warming by blanketswarming by blankets(solar) and removal from(solar) and removal fromthe exposure (can wrapthe exposure (can wrap

in towels and cover within towels and cover withsand if removal is notsand if removal is notpractical)practical)

9595 91 F91 F

Shaking, shivering, mildShaking, shivering, mildimpairment of centralimpairment of centralnervous system with slownervous system with slow

thinking and speechthinking and speechdifficultydifficulty

Basic TreatmentBasic Treatment: Same: Sameas prior but will takeas prior but will take

longer to reverse.longer to reverse.Consider warm showerConsider warm showerand watch closely.and watch closely.


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HypothermiaHypothermia ModerateModerate9090 86 F86 F

SymptomsSymptoms

Shivering slows down andShivering slows down andstops, with profoundstops, with profoundslowing of mentalslowing of mental

function. Confusion mayfunction. Confusion mayinclude hallucinations andinclude hallucinations andparadoxical undressing.paradoxical undressing.Muscle rigidity with jerkyMuscle rigidity with jerky

motions, irregular heartmotions, irregular heartbeats.beats.

Basic TreatmentBasic Treatment

Prevention of further heatPrevention of further heatloss with basicloss with basicmaneuvers as prior. Nomaneuvers as prior. No

aggressive reaggressive re--warmingwarmingattempts since this resultsattempts since this resultsin shunting cold bloodin shunting cold bloodinto the core and mayinto the core and may

further drop the corefurther drop the coretemperature. Evacuate,temperature. Evacuate,where warmed IVwhere warmed IVs, etc.s, etc.will be considered.will be considered.


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HypothermiaHypothermia SevereSevereLess than 86 FLess than 86 F

SymptomsSymptoms

Coma, falling bloodComa, falling blood

pressure, lifepressure, lifethreatening cardiacthreatening cardiac

irregularities.irregularities.


Time is of the essenceTime is of the essence

and this is a trueand this is a trueemergency. Evacuateemergency. Evacuate

and protect fromand protect from

further heat loss.further heat loss.


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HyperthermiaHyperthermia Heat EdemaHeat Edema

SymptomsSymptoms

Swelling of hands andSwelling of hands andfeetfeet


Resolves spontaneouslyResolves spontaneouslyover several days ofover several days of

acclimatization unlessacclimatization unlessthere are problems withthere are problems withrenal function or thererenal function or thereare medications beingare medications being

used for underlyingused for underlyingproblems.problems.

SeeSeeAcclimatizationAcclimatization


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HyperthermiaHyperthermia Heat SyncopeHeat Syncope

SymptomsSymptoms

Dizziness to the pointDizziness to the point

of fainting in theof fainting in theunacclimatizedunacclimatizedathlete. This showsathlete. This showsup typically when theup typically when the

athlete stands upathlete stands upquickly, usually in aquickly, usually in astate of dehydration.state of dehydration.


Supine position withSupine position with

legs elevated, coollegs elevated, cool(not iced) liquids and(not iced) liquids andresting in a coolresting in a coolplace.place.



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HyperthermiaHyperthermia Heat CrampsHeat Cramps

SymptomsSymptoms

Painful muscle crampsPainful muscle crampsand spasmsand spasms


Rehydration and attentionRehydration and attentionto electrolytes, andto electrolytes, and

massage. If unsuccessfulmassage. If unsuccessfulbe attentive to sodiumbe attentive to sodium

content in blood as wellcontent in blood as well

as other electrolytes.as other electrolytes.



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HyperthermiaHyperthermia Heat ExhaustionHeat Exhaustion

SymptomsSymptoms

Fatigue, weakness,Fatigue, weakness,uncoordinationuncoordination, mild, mildconfusion, agitation, headache,confusion, agitation, headache,

sweating, nausea, vomiting,sweating, nausea, vomiting,diarrhea, muscle pain withdiarrhea, muscle pain withcrampingcramping

Body temp (core) is less thanBody temp (core) is less than104 F104 F


See prior recommendationsSee prior recommendations Protection from furtherProtection from further

exposureexposure

Spray with lukewarm water inSpray with lukewarm water ina setting of cooling fans, coola setting of cooling fans, cooloraloral rehydrationrehydration..

Removal to an emergencyRemoval to an emergencyfacility where advancedfacility where advancedtreatment is available andtreatment is available andhyponatremiahyponatremia can also becan also beruled out.ruled out.


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HyperthermiaHyperthermia Heat StrokeHeat Stroke

SymptomsSymptoms

DryDry Skin is dry and verySkin is dry and verywarm with profound confusion,warm with profound confusion,loss of coordination and otherloss of coordination and other

CNS symptoms includingCNS symptoms includingseizures, coma, hallucinations.seizures, coma, hallucinations.

WetWet Less common withLess common withprofuse sweatingprofuse sweating otherwiseotherwisethe samethe same


Medical emergencyMedical emergencynecessitating immediatenecessitating immediatetransfer to an emergencytransfer to an emergency

facility. There gradual centralfacility. There gradual centralcooling will be conducted withcooling will be conducted withattention to potential damageattention to potential damageto cardiac, CNS, renal,to cardiac, CNS, renal,gastrointestinal, hematological,gastrointestinal, hematological,

pulmonary, andpulmonary, andmusculoskeletal damage.musculoskeletal damage.


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HyponatremicHyponatremic CollapseCollapse

SymptomsSymptoms

Long distance eventsLong distance eventstypically with loss oftypically with loss ofcentral nervous systemcentral nervous system

function, ranging fromfunction, ranging fromdecreased coordinationdecreased coordinationand verbal capacity toand verbal capacity tocomacoma


Medical emergency thatMedical emergency thatcannot be evaluated orcannot be evaluated ortreated at the sitetreated at the site

transport immediately!transport immediately! Water intoxication andWater intoxication and

acclimatization areacclimatization arefrequently at the centerfrequently at the center

of this medical event,of this medical event,though other underlyingthough other underlyingmedical conditions havemedical conditions haveto be considered.to be considered.


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AcclimatizationAcclimatization

All athletes vary in their ability to tolerateAll athletes vary in their ability to tolerate

cold or heat; thus their duration ofcold or heat; thus their duration of

accommodation varies. This can also beaccommodation varies. This can also beaffected by medications or underlyingaffected by medications or underlying

medical issues.medical issues.


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AcclimatizationAcclimatization

Layered swim caps (competition rules)Layered swim caps (competition rules) Ear plugsEar plugs

Lanolin and other coating (helps impact but doesLanolin and other coating (helps impact but does

not change heat loss)not change heat loss) Temperature of liquids consumed before andTemperature of liquids consumed before and

during the competition/trainingduring the competition/training

Exposure to high salinityExposure to high salinity nausea, vomitingnausea, vomiting(electrolytes), swelling of face and tongue(electrolytes), swelling of face and tongue


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SunSun

Bad!Bad! Prevention: Use SPF of 40 or more (debate re:Prevention: Use SPF of 40 or more (debate re:how much difference there is above 40) appliedhow much difference there is above 40) appliedevery 4 hours with some exception of Bullfrogevery 4 hours with some exception of Bullfrog

and Zinc Oxide (attention to PABA sensitivity)and Zinc Oxide (attention to PABA sensitivity) Basic TreatmentBasic Treatment: Avoidance of further injury via: Avoidance of further injury via

sunscreens and application of lubricantssunscreens and application of lubricants

including 100% Aloe and Lanolin. True sunincluding 100% Aloe and Lanolin. True sunpoisoning results in needing oral steroids andpoisoning results in needing oral steroids andwill eliminate the athlete from competition.will eliminate the athlete from competition.


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Sun BlindingSun Blinding

Not uncommon due to the intensity of theNot uncommon due to the intensity of thesun as well as reflection off of the watersun as well as reflection off of the waterwith frequent sighting.with frequent sighting.

Symptoms: Tearing and burningSymptoms: Tearing and burningAvoidance: Mirrored gogglesAvoidance: Mirrored goggles

Basic TreatmentBasic Treatment: Liquid tears without: Liquid tears withoutpreservativespreservatives


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ChafingChafing

Chafing is set up by prolonged exposure toChafing is set up by prolonged exposure towater, salt, and the variable strokewater, salt, and the variable stroke

patterns caused by wave action.patterns caused by wave action.

Variances in stroke inherent with theVariances in stroke inherent with theathlete can be an underlying risk. It is aathlete can be an underlying risk. It is a

true laceration, prone to infections with alltrue laceration, prone to infections with all

the complications.the complications.


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ChafingChafing

Common sites: suit lines,Common sites: suit lines,shoulder (caused byshoulder (caused by

breathing patterns), armbreathing patterns), arm

pit, inner thighs, back ofpit, inner thighs, back of

neck (sighting)neck (sighting)

Prevention: LubricantsPrevention: Lubricantssuch as lanolin, Vaseline,such as lanolin, Vaseline,

Body Glide, Bag Balm,Body Glide, Bag Balm,

etc. (Applied by staff,etc. (Applied by staff,

not the athlete)not the athlete) Basic TreatmentBasic Treatment: Topical: Topical

antibiotics that have antiantibiotics that have anti--

StaphStaph activity and furtheractivity and further

protection (avoidprotection (avoidNeoSporinNeoSporin, try, try BactrobanBactroban))


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Critters that Bite and Sting!Critters that Bite and Sting!

Things that FloatThings that FloatExamples: Jelly fish, Portuguese ManExamples: Jelly fish, Portuguese Man--OO--War, Sea liceWar, Sea lice

Symptoms: Localized pain,Symptoms: Localized pain,

searing in nature, potentiallysearing in nature, potentiallyproducing a neuropathy,producing a neuropathy,nausea, vomiting, hives,nausea, vomiting, hives,localized red spots (Sea licelocalized red spots (Sea liceare not imbedded!).are not imbedded!).

Basic TreatmentBasic Treatment: Spray with: Spray with

White Vinegar as soon asWhite Vinegar as soon aspossible. Also may considerpossible. Also may considerAdolphAdolphs meat tenderizer. Dos meat tenderizer. Donot rub the site, since this willnot rub the site, since this willrelease more of the contentsrelease more of the contentsof the imbedded darts.of the imbedded darts.

Sea lice: Lightly apply rubbingSea lice: Lightly apply rubbingalcohol.alcohol.

Severe life threatening allergicSevere life threatening allergicreactions:reactions: EpiEpi Pen, which willPen, which willresult in disqualification of theresult in disqualification of the

athlete.athlete.


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Critters that Bite and StingCritters that Bite and Sting

Things that SwimThings that Swim

Consider the expected (sharks, rays, andConsider the expected (sharks, rays, andturtles) but also anything that is brightlyturtles) but also anything that is brightlycolored ex. Lion Fishcolored ex. Lion Fish

Cardinal Rule #1 If it swims up to you, itCardinal Rule #1 If it swims up to you, itis not afraid of you! That is a bad thing!!is not afraid of you! That is a bad thing!! Cardinal Rule #2 If it is brightly colored,Cardinal Rule #2 If it is brightly colored,

it has no reason to hide! This is also ait has no reason to hide! This is also abad thing!!bad thing!!


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Things that SwimThings that Swim

..and one more to worry about..and one more to worry about....


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Things that Slither and CrawlThings that Slither and CrawlEx. Sea snakes, venomous shells, octopus (spotted)Ex. Sea snakes, venomous shells, octopus (spotted)

Cardinal Rule #3Cardinal Rule #3 If it is prettyIf it is pretty Do notDo notpick it up!!pick it up!!

Cardinal Rule #4Cardinal Rule #4 If it is a shellIf it is a shell --

Somebody is probably at home.Somebody is probably at home. Basic TreatmentBasic Treatment: All bites from anything in: All bites from anything in

this category requires emergencythis category requires emergency

treatment at a medical facility.treatment at a medical facility.


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Things that Sit StillThings that Sit StillExample: coralsExample: corals

Symptoms: Burning and stinging with aSymptoms: Burning and stinging with alocalized rash and hiveslocalized rash and hives

Basic TreatmentBasic Treatment: Like jellyfish stings, the: Like jellyfish stings, the

mechanism of injected barbs is similar,mechanism of injected barbs is similar,thus treatment with sprayed white vinegarthus treatment with sprayed white vinegar

and avoidance of rubbingand avoidance of rubbing


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FeedingFeeding

The topic of feeding during races can raiseThe topic of feeding during races can raisemedical issues such s what, when, andmedical issues such s what, when, and

how often. There are as many theories ashow often. There are as many theories as

to the best approach as there are athletesto the best approach as there are athletesand coaches but some basic principlesand coaches but some basic principles

apply to all.apply to all.


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FeedingFeeding

Rule #1Rule #1

The longer the race, the moreThe longer the race, the more

frequently the athlete should feed tofrequently the athlete should feed tosustainsustainfuel in the tankfuel in the tank. Frequencies of. Frequencies ofevery 15every 15 20 minutes are not uncommon.20 minutes are not uncommon.

Rule #2Rule #2 The longer the race, the earlierThe longer the race, the earlierthe athlete should feed.the athlete should feed.

Rule #3Rule #3 Plan the feeding what, wherePlan the feeding what, whereand how, remembering the 3 Gand how, remembering the 3 Gs.s.


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FeedingFeeding

GrabGrab

GulpGulp

GoGo


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FeedingFeeding

Rule #4Rule #4 Use timed intervals for feeding notUse timed intervals for feeding notdemand intervals. Once the athlete knows thatdemand intervals. Once the athlete knows that

they need food or water it is too late.they need food or water it is too late.

Rule #5Rule #5 The fuel that you consume will not beThe fuel that you consume will not beavailable immediately. Thus, plan the sequenceavailable immediately. Thus, plan the sequence

of feedings i.e.of feedings i.e. carbscarbs early in the race with moreearly in the race with more

water later. Some athletes prefer theirwater later. Some athletes prefer their carbscarbs inin

gel or solid forms.gel or solid forms.


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FeedingFeeding

Rule #6Rule #6 Practice feeding! The athletePractice feeding! The athleteneeds to be accustomed to taking inneeds to be accustomed to taking innutrition during practice/races as well asnutrition during practice/races as well as

working with feeding techniques with aworking with feeding techniques with afeeding extension device. The feedingfeeding extension device. The feeding

station may be a dock or boat (stationarystation may be a dock or boat (stationary

or moving).or moving).


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FeedingFeeding

Rule #7 The athlete selects the flavors andRule #7 The athlete selects the flavors andbrings them to the competition.brings them to the competition.

Rule #8 The temperature of the fluids is a mirrorRule #8 The temperature of the fluids is a mirrorimage of the environmental temperature.image of the environmental temperature.

Rule #9 Nothing replaces proper hydration andRule #9 Nothing replaces proper hydration andnutrition prior to the start of the race. If thenutrition prior to the start of the race. If the

fuel tank is low prior to the start you cannotfuel tank is low prior to the start you cannot

catch up to your needs during the race.catch up to your needs during the race.


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FeedingFeeding

Rule #10Rule #10 -- Coaches may not consume theCoaches may not consume thenutrients until the athlete is finished!nutrients until the athlete is finished!


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Thank you for your attention!Thank you for your attention!

I would like to thank all of the trainersI would like to thank all of the trainersand coaches that I have traveled with overand coaches that I have traveled with over

the years. A considerable amount of thisthe years. A considerable amount of this

presentation is from all that I have learnedpresentation is from all that I have learnedfro them. Every trip has been a give andfro them. Every trip has been a give and

take of information that is constantlytake of information that is constantly

changing as open water swimming moveschanging as open water swimming movesto the forefront as a new Olympic event.to the forefront as a new Olympic event.


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Go USA!!Go USA!!


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2006 Sports Medicine in Open Water Swimming

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Transcript of 2006 Sports Medicine in Open Water Swimming