Chapter 29: Additional Health Conditions

Role of the Immune System

• Collection of disease fighting cells that neutralizes foreign substances

– Illness results when immune system does not neutralize foreign substances (antigens) – Cell-mediated response, humoral immune response (B-cells that produce antibodies), or nonspecific immune response (inflammation)

• Auto-immune response against the body leads to damage of body’s own tissues

Viral Infections

• Rhinovirus (Common Cold)

– Etiology • Over 100 different rhinoviruses • Transmitted by either direct or indirect contact (cough, sneeze, speaking, touching contaminated article)

– Sign and Symptoms • Begins w/ scratchy, sore throat, stopped-up nose, watery discharge and sneezing • Second batch may produce thick yellow nasal discharge, watering eyes, mild fever, sore throat, headache, malaise, myalgia, dry cough – Secondary - laryngitis, tracheitis, acute bronchitis, sinusitis, and otis media – Management • Symptomatic treatment (may last 5-10 days) • Non-prescription cold medications • Eat a balanced diet, consume 64 oz. of water • Avoid emotional stress and extreme fatigue

• Influenza (Flu)

– Etiology • Caused by myoviruses (A, B, C) – Type A is most common – Virus enters through cell genetic material – Sign and Symptoms • Fever (102-103 degrees F), chills, cough, headache, malaise, and inflamed respiratory mucous membrane w/ coryza • General aches and pains, headache becomes worse • Weakness, sweating, fatigue may persist for many days – Management • Bed rest and supportive care • Symptomatic care should be avoided by those under age 18 ( Reye’s syndrome) • Steam inhalation, cough medicines, and gargles

• Infectious Mononucleosis

– Etiology • Epstein-Barr virus (member of herpes group) that has incubation period of 4-6 weeks • Transmitted through saliva – Sign and Symptoms • First 3-5 days -severe fatigue, headache, loss of appetite and myalgia • Days 5-15 - fever, swollen lymph nodes and sore throat (50% will experience enlarged spleen) • Possible jaundice, skin rash, puffy eyelids – Management • Supportive symptomatic treatment • Acetaminophen for headache, fever and malaise • Resume training after 3 weeks after onset if spleen not markedly enlarged/painful, athlete is afebrile, liver function is normal, and pharyngitis is resolved

• Rubella (German Measles)

– Etiology • Highly contagious viral disease (childhood disease) • Results 13-24 days after exposure • May cause developmental difficulties for fetus in pregnant females – Sign and Symptoms • Temperature elevation, sore throat, drowsiness, swollen lymph glands and red spots on palate • Rash – Management • Prevent by early childhood immunization – Measles, mumps, rubella vaccine (MMR)

• Rubeola (Measles)

– Etiology • Childhood disease • Incubation time of 10 days following exposure – Sign and Symptoms • Sneezing, nasal congestion, coughing, malaise, photophobia, spots in mouth, conjunctivitis, and elevated fever (rash appears - causes itching) – Management • Inoculation w/ MMR vaccine at 12-15 months and 4-6 years of age • Bed rest, isolation in dark room and use of antipyretic and anti-itching medication

• Mumps (Parotitis)

– Etiology • Contagious viral disease that results in inflammation of parotid and salivary glands • Appear in 12-25 days following exposure – Sign and Symptoms • Malaise, headache, chills and moderate fever • Pain in neck - swelling of glands may last up to 7 days • Pain w/ jaw motion and swallowing; increased or decreased saliva production – Management • Varicella-zoster immune globulin w/in 96 hours of exposure will prevent clinical symptoms in normal healthy children • Acyclovir meds should be administered to adolescents and adults w/ in 24 hours of exposure • Anti-itching medications to prevent scratching

Respiratory Conditions

• Sinusitis

– Etiology • Stems from upper respiratory infection caused by a variety of bacteria – Sign and Symptoms • Nasal mucous swell and block ostium of paranasal sinus • Painful pressure occurring from accumulation of mucus • Skin over sinus may be swollen and painful to the touch • Headache and malaise; purulent nasal discharge – Management • If infection is purulent, antibiotics may be warranted • Steam inhalation and other nasal topical sprays w/ oxymetazalone can produce vasoconstriction and drainage

• Tonsillitis

– Etiology • Acute inflammation and bacterial infection of tonsil epithelium – Sign and Symptoms • Tonsil appear red, swollen, w/ yellow exudate in pits • Pain w/ swallowing, high fever and chills, headache and neck pain • Sinusitis, otitis media, tonsillar abscesses may also develop – Management • Culture to check for streptococcal bacteria and antibiotics for 10 days • Gargling w/ saline water, liquid diet, and antipyretic medication • Frequent bouts of tonsillitis may necessitate removal

• Seasonal Atopic (Allergic) Rhinitis

• Hay fever, pollinosis from airborne pollens – Etiology • Reaction to pollen - airborne fungal spores (allergens) resulting in allergic antibodies causing the release of histamine – Sign and Symptoms • Eyes, throat, mouth and nose begin to itch, followed by watering eyes, sneezing and clear watery discharge • Sinus type headache, emotional irritability, difficulty sleeping, red & swollen eyes and nasal mucus membranes, and wheezing cough – Management • Oral antihistamines and decongestants

• Pharyngitis (sore throat)

– Etiology • Caused by virus or streptococcus bacteria • Transmitted by direct contact of infected person or one who is a carrier – Sign and Symptoms • Pain w/ swallowing, fever, inflamed and swollen glands, malaise, weakness and anorexia • Mucus membrane may be inflamed and covered w/ purulent matter – Management • Throat culture • Topical gargles and rest • Antibiotic therapy for streptococcal infection

• Acute Bronchitis

– Etiology • Infectious winter disease that follows common cold or viral infection • Fatigue, malnutrition or becoming chilled could be predisposing factors – Sign and Symptoms • Upper respiratory infection, nasal inflammation and profuse discharge, slight fever, sore throat and back muscle pains • Fever lasts 3-5 days while cough can last 2-3 weeks • Yellow mucus indicates infection • Pneumonia can complicate condition – Management • Avoid sleeping in cold environment, avoid exercise in extreme cold w/ protection • Rest until fever subsides, drink 3-4 quarts of water daily, ingest antipyretic analgesic, cough suppressant, and antibiotic

• Pneumonia

– Etiology • Infection of alveoli and bronchioles from viral, bacterial or fungal microorganisms • Irritation from chemicals, aspiration of vomitus • Alveoli fill w/ exudate, inflammatory cells and fibrin – Sign and Symptoms • Bacterial will cause rapid onset • High fever, chills, pain on inspiration, decreased breath sounds, rhonchi on auscultation, coughing of purulent, yellowish sputum – Management • Treat w/ antibiotics; perform deep breathing exercises to removal of sputum through heavy coughing • Analgesics and antipyretics may be useful for controlling pain and fever

• Bronchial Asthma

– Etiology • Caused by viral respiratory tract infection, emotional upset, changes in barometric pressure or temperature, exercise, inhalation of noxious odor or exposure to specific allergen – Sign and Symptoms • Spasm of smooth bronchial musculature, edema, inflammation of mucus membrane • Difficulty breathing, may cause hyperventilation resulting in dizziness, coughing, wheezing, shortness of breath and fatigue

• Exercise-Induced Bronchial Obstruction (Asthma)

– Etiology • Brought on by exercise w/ exact cause unknown – Metabolic acidosis, post-exertional hypocapnia, stimulation of tracheal irritant receptor, adrenergic abnormalities, defective catecholamine metabolism and psychological factors, loss of heat and water, sinusitis can also trigger – Sign and Symptoms • Airway narrowing due to spasm and excess mucus production • Tight chest, breathlessness, coughing, wheezing, nausea, hypertension, fatigue, headache, and redness of skin • May occur w/in 3-8 minutes of exercise

• EIA (continued)

– Management • Regular exercise, appropriate warm-up and cool down, w/ intensity graduated • Inhaled bronchodilators may be useful • Exercise in warm, humid environment

• Cystic Fibrosis

– Etiology • Genetic disorder that can manifest as obstructive pulmonary disease, pancreatic deficiency, urogential dysfunction and increased electrolyte sweating • Cause of severe lung disease w/ life expectancy of about 30 years – Sign and Symptoms • Bronchitis, pneumonia, respiratory failure,gall bladder disease, pancreatitis, diabetes and nutritional deficiencies • High production of mucus – Management • Drug therapy to slow progress of disease (ibuprofen) • Antibiotics to control pulmonary disease • Consistent postural drainage to mobilize secretions • High fluid intake to thin secretions and use of humidifier

Muscular Disorders

• Duchenne Muscular Dystrophy

– Etiology • Hereditary disease causing degeneration of skeletal muscle (gradual replacement of muscle w/ adipose and connective tissue - decreases circulation and perpetuates condition) – Sign and Symptoms • In children, exhibited by frequent falls, difficulty standing • Muscles tend to shorten as they atrophy, causing scoliosis and other postural abnormalities – Management • Cannot be cured; consistent exercise can be used to retard atrophy • Ambulation w/ braces until the individual is confined to a wheelchair • Death generally occurs by age 20

• Myasthenia Gravis

– Etiology • Autoimmune disease where antibodies attack synaptic junctions • Deficiency in acetylcholine producing early fatigue • Often occurs in females age 20-40 – Sign and Symptoms • Drooping of upper eyelids and double vision due to weakness in extraocular muscles • Difficulty chewing and swallowing, weakness of extremities and general decrease in muscle endurance – Management • Treat w/ drugs that inhibit breakdown of acetylcholine • Corticosteroids can be used to suppress immune system - reducing production of antibodies that destroy acetylcholine

Nervous System Disorders

• Meningitis

– Etiology • Inflammation of meninges surrounding spinal cord and brain • Caused by infection brought on by meningococcus bacteria – Sign and Symptoms • High fever, stiff neck, intense headache, sensitivity to light and sound • Progress to vomiting, convulsions and coma

• Meningitis (continued)

– Management • Cerebrospinal fluid must be analyzed for bacteria and WBC’s.

• If bacteria is found isolation is necessary for 24 hours (very contagious), antibiotics must be administered immediately • Monitored closely in intensive care unit

• Multiple Sclerosis

– Etiology • Auto-immune inflammatory disease of CNS that causes deterioration and damage to myelin sheath, disrupting nerve conduction – Sign and Symptoms • Blurred vision, speech deficits, tremors, muscle weakness and numbness in extremities • Tremor spasticity, neurotic behavior and mood swings • May progress slowly or may be acute attack followed by partial or complete temporary remission – Management • Deal w/ symptoms as they occur • Avoid over exertion, extreme temperatures, and stressful situations • Establish exercise routine • Drug therapy to slow progression

• Amyotropic Lateral Sclerosis (Lou Gehrig’s Disease)

– Etiology • Sclerosis of lateral regions of spinal cord along w/ degeneration of motor neurons and significant atrophy – Sign and Symptoms • Difficulty in speaking, swallowing and use of hands • Sensory and intellectual function remain intact • Rapid progression of atrophy resulting in paralysis – Management • No cure • Even after incapacitation, normal intellectual function remains; inability to communicate feelings and ideas

• Reflex Sympathetic Dystrophy

– Etiology • Abnormal excessive response of sympathetic portion of autonomic nervous system following injury – Sign and Symptoms • Commonly seen in hands and feet following immobilization of injured part (change to bone, connective tissue, blood vessels and nerves) • Develop extreme hypersensitivity to touch, redness, sweating, burning pain, swelling w/ palpable tightness and shining skin; atrophy • Possible psychologic depression

• Reflex Sympathetic Dystrophy (continued)

– Management • Early recognition and intervention is critical • Must direct sympathetic response (nerve block) • AROM exercise through pain free range, use modalities to modify pain and reduce swelling • Anti-depressant drugs may be necessary for chronic conditions

Blood and Lymph Disorders

• Iron Deficiency Anemia

– Etiology • Prevalent in menstruating women and males age 7-14 • Three things occur during anemia – Small erythrocytes – Decreased hemoglobin – Low ferritin concentration (compound that contains 23% iron) • GI loss of iron in runners is common • Aspirin and NSAID’s may cause GI bleeding and iron loss • Menstruation accounts for most iron lost in women • Vegetarian athletes may also be deficient in intake relative to iron loss

– Sign and Symptoms • First stage of deficiency, performance declines • Athlete may feel burning thighs and nausea from becoming anaerobic • Ice cravings are common • Serum ferritin levels must be assessed • Mean corpuscular volume and relative size of erythrocytes must be checked – Management • Eat a proper diet including more red meat or dark poultry; avoid coffee and tea (hamper iron absorption) • Consume vitamin C (enhance absorption) • Take supplements (dependent on degree of anemia)

• Runners’ Anemia (hemolysis)

– Etiology • Caused by impact of foot as it strikes the surface • Impact destroys normal erythrocytes w/in vascular system – Sign and Symptoms • Mildly enlarge cells, increase in circulatory reticulocytes and decreased haptoglobin (bound to hemoglobin) • Varies according to training – Management • Run on soft surfaces, wear well cushioned shoes and run w/ light feet

• Sickle-Cell Anemia

– Etiology • Hereditary hemolytic anemia - RBC’s are sickle or crescent shaped (irregular hemoglobin) • Less ability to carry oxygen, limited ability to pass through vessels, causing clustering and clogging of vessels (thrombi) • Severe cases can result in death if embolus develops and travels to lungs • Exercise factors - 1)acidosis, 2) hyperthermia, 3)dehydration, 4) severe hypoxemia • Can be brought on by high altitudes

• Sickle Cell Anemia (continued)

– Sign and Symptoms • Fever, pallor, muscle weakness, pain in limbs • Pain in upper right quadrant indicating possible splenic infarction • Headaches and convulsions are also possible – Management • Provide anticoagulants and analgesics for pain

• Hemophilia

– Etiology • Hereditary disease caused by absence of clotting factors • Prolonged coagulation time, failure of blood to clot and abnormal bleeding – Sign and Symptoms • Physical exertion can cause bleeding into muscles and joints -- may be extremely painful • Joints may become immobilized – Management • If bleeding occurs, athlete should be taken to a medical care facility • No cure • Clotting factors have been developed to control bleeding for several days • Avoid trauma and wear medical alert bracelet

• Lymphangitis (blood poisoning)

– Etiology • Inflammation of lymphatic channels • Caused by streptococcal bacteria – Sign and Symptoms • Usually occurs in extremities • Deep reddening of the skin, warmth, lymphandentitis and raised border over affected area (particularly in case of infection) • Chills and high fever w/ moderate pain and swelling – Management • Patient should be hospitalized and vital signs monitored • Following evaluation warm compresses should be applied to the extremity • Antibiotic administration and fluid intake (restore fluid balance)

Diabetes Mellitus

– Most common forms are Type I (insulin dependent diabetes mellitus) and Type II (non insulin-dependent diabetes mellitus) – Etiology • Result of interaction between physical and environmental factors • Involves a complete or partial decrease in insulin secretion

– Sign and Symptoms • IDDM is most commonly seen in childhood with sudden symptoms of frequent urination, constant thirst, weight loss, constant hunger, tiredness, weakness, itchy dry skin and blurred vision • NIDDM occurs later in life and is usually associated with being overweight • Body either does not produce enough insulin or resist insulin that is being produced – Management • Monitor and control glucose levels • Diet, doses of insulin • Vigorous exercise increases peripheral insulin action and enhances glucose tolerance • ATC must be aware that extreme temperatures and unpredictable activity levels may require the administration of rapid-acting carbohydrates

• Diabetic Coma

– Etiology • Loss of sodium, potassium and ketone bodies through excessive urination (ketoacidosis) – Sign and Symptoms • Labored breathing, fruity smelling breath (due to acetone), nausea, vomiting, thirst, dry mucous membranes, flushed skin, mental confusion or unconsciousness followed by coma.

– Management • Early detection is critical as this is a life-threatening condition • Insulin injections may help to prevent coma

• Insulin Shock

– Etiology • Occurs when the body has too much insulin and too little blood sugar – Sign and Symptoms • Tingling in mouth, hands, or other parts of the body, physical weakness, headaches, abdominal pain • Normal or shallow respiration, rapid heart rate, tremors along with irritability and drowsiness – Management • Adhere to a carefully planned diet including snacks before exercise

Seizure Disorders

– Defined as recurrent paroxysmal disorder of cerebral function characterized by periods of altered consciousness, motor activity, sensory phenomena or inappropriate behavior caused by abnormal cerebral neuron discharge – Etiology • For some forms of epilepsy there is genetic predisposition • Brain injury or altered brain metabolism

– Sign and Symptoms • Periods of altered consciousness, motor activity, sensory phenomena or inappropriate behavior caused • May last 5-15 seconds (petit mal seizure) or longer (grand mal seizure) • Include unconsciousness and uncontrolled tonic clonic muscle contractions – Management • Individuals that experience daily or weekly seizures should be prohibited from participating in collision sports (blow resulting in unconsciousness could result in serious injury) • Must be careful with activities involving changes in pressure • Can be managed with medication

Hypertension

– Etiology • Primary hypertension accounts for 90% of all cases with no other disease association • Secondary hypertension is associated with kidney disorder, overactive adrenal glands, hormone producing tumor, narrowing of aorta, pregnancy and medications • Long term cases increase the chances of premature mortality and morbidity due to coronary artery disease, congestive heart failure and stroke

– Sign and Symptoms • Primary hypertension is generally asymptomatic until complications arise • May cause dizziness, flushed appearance, headache, fatigue, epistaxis and nervousness – Management • Thorough examination must be performed to determine type of hypertension • Primary hypertension can be controlled through lifestyle changes (diet, exercise, weight loss) • When conditions associated with secondary hypertension are cured, blood pressure commonly returns to normal

Cancer

– Etiology • Condition where cellular activity becomes abnormal and cells no longer perform normal function • Cells do not multiply at increased rate but continue to develop ultimately taking over normal tissue • Tumors may be benign or malignant • Malignancies are classified based on the types of tissue they invade • Variety of causes including, ultraviolet radiation, chemicals (tobacco), alcohol, fatty diet, combination of heredity and environmental factors

– Sign and Symptoms • Vary tremendously depending on type of cancer • Warning signs include change in bowel and bladder habits, sore throat that does not heal, unusual bleeding or discharge, development of lump in breast or elsewhere, indigestion, change in wart or mole – Management • Early detection is critical • Effective forms of treatment include surgery, radiation and chemotherapy

Sexually Transmitted Infections (STI’s)

• Chlamydia

– Etiology • Caused by bacterial organism – Sign and Symptoms • May result in pelvic inflammation and is important cause of infertility and ectopic pregnancy in females • In males, inflammation occurs along with purulent discharge 7-28 days after intercourse • Painful urination and traces of blood in urine, vaginal discharge • Can cause conjunctivitis and pneumonia in newborns – Management • Identify infection and exact organism present • Treat with antibiotics

• Genital Herpes

– Etiology • Caused by type 2 herpes simplex virus – Sign and Symptoms • Develops 4-7 days following sexual contact • Begins to crust 14-17 days in primary genital herpes and 10 days in secondary • Females may be asymptomatic while males will experience itching and soreness • Development of lesions – Management • Herpes and pregnancy • No cure just systemic medication (antiviral medications) to lessen early symptoms or the disease

• Trichomoniasis

– Etiology • Caused by the flagellate protozoan

trichomonas vaginalis

– Sign and Symptoms • Vaginal discharge that is greenish yellow and frothy • Causes irritation of the vulva, perineum and thighs • Painful urination • Males tend to by asymptomatic but may experience purulent urethral discharge – Management • 2 grams of metronidazole cures up to 95% of cases in women • Males require 500mg twice daily for 7 days • Complete cure is required before engaging in intercourse

• Genital Candidiasis

– Etiology • Transmitted through sexual activity and appear as warts on the glans penis, vulva or anus – Sign and Symptoms • Cauliflower-like wart or can be singular • Soft, moist pink or red swellings that develop cauliflower-like head • May be mistaken as secondary syphilis or carcinoma – Management • When moist - 20-25% polophyllin • Dry warts - may be frozen with liquid nitrogen

• Gonorrhea (clap)

– Etiology • Caused by organism infection - gonococcal bacteria which is spread through intercourse – Sign and Symptoms • In men - experience tingling of urethra followed by 2-3 hours of greenish yellow discharge and painful urination • 60% of women are asymptomatic • Females will experience vaginal discharge • May result in sterility if not treated or arthritis – Management • Penicillin • Avoid sexual contact until it is known that the disease is no longer active

• Syphilis

– Etiology • A spirochete bacteria is the organism related to syphilis and enters body through mucous membranes or skin lesions – Sign and Symptoms • 4 stages – Incubation is usually 3-4 weeks but could be anywhere from 1-13 weeks; painless chancre or ulcer forms that health w/in 4-8 weeks (can occur on penis, urethra, vagina, cervix, mouth, hand, foot or around eye) – Secondary stage occurs 6-12 weeks after initial infection and is characterized by a rash, lymph swelling, body aches, mild flu-like symptoms and possible hair loss – Latent syphilis is characterized by no or few symptoms but if untreated it may result in tertiary syphilis

– Sign and Symptoms – Late stage is characterized by deep penetration of spirochetes that damage skin, bone, cardiovascular system and nervous system – Late stage may develop w/in 3-10 years of infection and cause neurosyphilis - muscle weakness, paralysis and various types of psychoses – Management • Penicillin is used for all stages • Other drugs may be required due to increased resistance

Menstrual Irregularities and the Female Reproductive System

• Physiology of the Menstrual Cycle

– Menarche • Onset of menses and puberty normally occur between ages 9-17 • Female becomes capable of reproduction • May be delayed through strenuous sports training

– Menstruation • 28 day cycle that consist of follicular and luteal phases (each lasting ~14 days) • Result of cyclic hormone pattern – Follicle stimulating hormone stimulates maturation of ovarian follicle while luteinizing stimulates development of corpus luteum and encourages secretion of progesterone and estrogens – Progesterone will ultimately inhibit LH – Menstrual Cycle Irregularities • Strenuous training may alter cycle (25-38 day long cycles) • Oligomenorrhea - diminished flow (refers to fewer than 3-6 cycles per year)

• Amenorrhea

– Etiology • Exercise related is often a hypothalamic dysfunction • Gonadotropin-releasing hormone is often deficient • Must rule out pregnancy, abnormal reproductive or genital tract as well as ovarian failure and pituitary tumors – Sign and Symptoms • Complete cessation of menstrual cycle – Management • Re-establishment of normal hormone levels • Thorough medical examination, nutritional counseling, reduction of exercise intensity and emotional stress • Estrogen replacement may be considered

• Dysmenorrhea

– Etiology • Painful menstruation prevalent in active women • May be caused by hormonal imbalance, ischemia of the pelvic organs, endometriosis • Most common menstrual disorder – Sign and Symptoms • Cramps, nausea, lower abdominal pain, headache, occasionally emotional lability – Management • Mild to vigorous exercise that help to ameliorate dysmenorrhea are usually prescribed • Continued activity as long as performance levels do not drop

The Female Athlete Triad

– Etiology • Relationship between disordered eating, amenorrhea and osteoporosis • Driven to meet standards of sport or to meet a specific athletic image to attain goals – Sign and Symptoms • Disordered eating - bulimia and anorexia • Osteoporosis - premature bone loss in young women, inadequate bone development – Management • Prevention is key; identify and educate

Bone Health

– Etiology • Decrease in bone is seen commonly in older women and is linked to declines in FSH, LH, progesterone, and estrogen • Athletic women with irregular menses – Sign and Symptoms • Increased risk of stress fractures • Decreased bone mineral density – Management • Decrease training volume, increase total caloric intake and increase calcium supplementation • Estrogen replacement therapy

Contraceptives and Reproduction

• Oral contraceptives

– Should not be used to delay menstruation during competition • May result in nausea, vomiting, fluid retention, amenorrhea, hypertension, double vision and thrombophlebitis – Use under supervision of a physician – Low dose preparations (<50mg of estrogen) provide little risk to healthy women

• Intrauterine devices

– Not recommended for adolescents that have not given birth

Pregnancy

• Physical activity and competition can be engaged in up to the 3rd month unless complications present • May even be able to continue up through the seventh month • Impact on performance • No indication that exercise is harmful to the fetal growth patterns • Extreme exercise may result in low birth weight

• Should avoid activities that involve severe body contact, jarring or falls • Contraindications include – Pregnancy induced hypertension – Pre-term rupture of membranes – Pre-term labor during the prior or current pregnancy or both – Incompetent cervix or cerclage – Persistent second or third trimester bleeding – Intrauterine growth retardation

• Ectopic Pregnancy

– Etiology • Fertilized egg implants outside the uterine cavity due to inflammation of fallopian tubes or mechanical blockage – Sign and Symptoms • Amenorrhea, tenderness and soreness on affected side, referred pain to shoulder, pallor, possible shock and/or hemorrhaging – Management • Operative treatment is necessary to terminate nonviable pregnancy and control hemorrhaging