Chapter 23: General Medical Conditions and Additional Health Concerns

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Chapter 23 General Medical Conditions and
Additional Health Concerns
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• Like everyone athletes can become ill
• It is important to recognize these conditions
  early and refer them for the appropriate medical
  attention
• The majority of these illnesses and conditions
  will require referral to a physician for care

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Skin Infections
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Viral Infections

• Virus
• Small organism that can live only in a cell
• Upon entering cell it may immediately trigger a
  disease (influenza) or remain dormant (herpes)
• Can damage host cell by blocking normal function
  and using metabolism for own reproduction
• Virus ultimately destroys cell

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Herpes

• Cause of Condition
• Herpes simplex viral infection that tends to
  occur in the same location (mucous membranes)
• Type I (cold sore) Type II (genitals)
• Herpes zoster
• Appears in specific pattern on body (innervated
  by specific nerve root
• Re-appearance of chicken pox virus

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• Signs of Condition
• Early indication tingling or hypersensitivity
  in an infected area 24 hours prior to appearance
  of lesions
• Local swelling followed by outbreak of vesicles
• Heal in generally 10-14 days
• Care
• If an athlete has an outbreak they should be
  disqualified from competition due to contagious
  nature of condition
• Utilize universal precautions when dealing with
  herpes virus
• Use of antiviral drugs can reduce recurrence and
  shorten course of outbreak

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Verruca Virus and Warts

• Varied of forms exist
• verruca plana (flat wart), verruca plantaris
  (plantar wart), and condyloma acuminatum
  (venereal wart)
• Different types of human papilloma virus have
  been identified
• Uses epidermal layer of skin to reproduce and
  grow
• Wart enters through lesion in skin

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• Signs of Condition
• Small, round, elevated lesion
  with rough dry surfaces
• Painful if pressure is applied
• May be subject to secondary
  bacterial infection
• Care
• If vulnerable, they should be protected until
  treated by a physician
• Use of electrocautery, topical salicylic acid or
  liquid nitrogen are common means of managing this
  condition

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Bacterial Infections

• Bacteria are single celled micro-organisms
• Disease development
• Bacterial pathogen enters host, growth of
  bacteria and production of toxic substances
  occurs and host attempts to fight infection
• Two types
• Staphylococcus
• Streptococcus

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• Impetigo Contagiosa
• Caused by streptococci
• Spread through close contact
• Furuncle (Boils)
• Infection of hair follicle that results in
  pustule formation
• Generally the result of a staph infection
• Become large and painful
• Folliculitis
• Inflammation of hair follicle around face/neck or
  in the groin

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• Symptoms of Condition
• Mild itching and soreness followed by eruption of
  small vesicles and pustules that rupture and
  crust
• Exhibits signs of inflammation
• Tenderness, warmth, redness and swelling
• Care
• Cleansing and topical antibacterial agents
• Systemic antibiotics
• Pus filled lesions should be drained
• Minimize the chances of the infection to spread
  to others

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• Methicillin-Resistant Staphylococcus Aureus
  (MRSA)
• Cause
• Strain of bacteria that is resistant to
  methicillin and other antibiotics
• Often times occurs in patients in hospital that
  are already ill, have open wounds/bed sores/burns
• Can also infect individuals outside of the
  hospital
• Symptoms
• Broad range of symptoms
• Typically redness, tenderness and swelling
• May carry MRSA without having symptoms
• Care
• May require much heavier dose of antibiotics
• Some infections can only be treated with
  intravenous antibiotics (requires several weeks
  of treatment)

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Fungal Infections

• Cause of Condition
• Ringworm fungi (tinea)
• Cause of most skin, nail and hair fungal
  infections
• Tinea of the Groin (tinea cruris)
• Signs and Symptoms
• Mild to moderate itching and found bilaterally
• Brownish or reddish lesion resembling outline of
  butterfly in groin

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• Care
• Treat until cured
• Will respond to many of the non-prescription
  medications
• Medications that mask symptoms should be avoided
• Failure to respond to normal management may
  suggest a non-fungal problem (such as bacteria)
  and should be referred to a physician
• May require additional topical medications and
  oral prescriptions

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• Athletes Foot (tinea pedis)
• Cause of Condition
• Most common form of superficial fungal infection
• Webs of toes may become infected by a combination
  of yeast and dermatophytes
• Signs of Condition
• Extreme itching on soles of feet, between and on
  top of toes
• Appears as dry scaling patch or inflammatory
  scaling red papules forming larger plaques
• May develop secondary infection from itching and
  bacteria
• Care
• Topical antifungal agents and good foot hygiene

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Respiratory Conditions

• The Common Cold
• Cause of Condition
• Attributed to filterable virus that produces
  infection in upper respiratory tract in
  susceptible individual
• Susceptible individual
• Physical debilitation from overwork or lack of
  sleep
• Chronic inflammation from local infection
• Inflammation of nasal mucosa from allergy or from
  breathing in foreign substance
• Sensitivity to stress

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• Sign of Condition
• Begins w/ scratchy, sore throat, stopped-up nose,
  watery discharge and sneezing
• Some may experience a fever
• Various aches and pains
• Nasal discharge becomes thick and discolored from
  inflammation
• Care
• 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

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• Sinusitis
• Cause of Condition
• Stems from upper respiratory infection caused by
  a variety of bacteria
• Inflammation of nasal sinuses
• Sign of Condition
• Nasal mucous swell and block sinuses
• Painful pressure occurring from accumulation of
  mucus
• Skin over sinus may be swollen and painful to the
  touch
• Headache and malaise purulent nasal discharge
• Care
• If infection is purulent, antibiotics may be
  warranted
• Nasal vasoconstrictor may be helpful with drainage

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• Pharyngitis (sore throat)
• Cause of Condition
• Result of postnasal drip
• May be virus or streptococcus bacteria
• Symptoms of Condition
• Pain w/ swallowing, fever, inflamed and swollen
  glands, malaise, weakness and fever
  (occasionally)
• Throat may appear dark red and swollen with
  mucous membranes coated
• Care
• Throat culture
• Topical gargles and rest
• Antibiotic therapy may be prescribed by a
  physician

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• Tonsillitis
• Cause of Condition
• 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
• Care
• 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

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• Influenza (Flu)
• Cause of condition
• Occurs in various forms as an annual epidemic
• Caused by a virus
• Symptoms of Condition
• Fever (102-103 degrees F), chills, cough,
  headache, malaise, and inflamed respiratory
  mucous membrane w/ non-productive cough, watery
  eyes
• General aches and pains, headache becomes worse
• Weakness, sweating, fatigue may persist for many
  days
• Care
• Bed rest and supportive care
• Steam inhalation, cough medicines, and gargles
• Flu prevention avoid contact with someone that
  has it

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• Seasonal Allergies (Rhinitis)
• Cause of Condition
• Hay fever from airborne pollens and in some cases
  fungal spores
• Symptoms of Condition
• 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
• May also experience adverse allergic reactions
• Care
• Oral antihistamines and decongestants

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• Acute Bronchitis
• Cause of Condition
• Infectious winter disease that follows common
  cold or viral infection
• Fatigue, malnutrition or becoming chilled could
  be predisposing factors
• Sign of Condition
• 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
• Care
• Avoid sleeping in cold environment, avoid
  exercise in extreme cold w/out protection
• Rest until fever subsides, drink 3-4 quarts of
  water daily, ingest antipyretic analgesic, cough
  suppressant, and antibiotic

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• Bronchial Asthma
• Cause of Condition
• 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 of Condition
• 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
• Care
• Prevention determine causative factors
• Use of prescribed inhalers are effective in acute
  cases

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• Exercise-Induced Bronchial Obstruction (Asthma)
• Cause of Condition
• Brought on by exercise w/ exact cause unknown
• Loss of heat and water (airway reaction), eating
  certain foods, sinusitis may also trigger
• Sign of Condition
• Airway narrowing due to spasm and excess mucus
  production
• Tight chest, breathlessness, coughing, wheezing,
  nausea, hypertension, fatigue, headache, and
  redness of skin

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• EIA (continued)
• Care
• Regular exercise, appropriate warm-up and cool
  down, w/ intensity graduated
• Inhaled bronchodilators may be useful
• Exercise in warm, humid environment
• Coaches should be sure to remind athletes to have
  inhaler with them at all times

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Gastrointestinal Disorders
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• Indigestion
• Cause of Condition
• Some athletes develop food idiosyncrasies which
  cause them distress after eating
• Reactions before competition
• Emotional stress, esophageal and stomach spasms,
  or inflammation of mucous linings in stomach and
  esophagus
• Signs of Condition
• Increased HCl secretion, nausea, and flatulence
• Care
• Elimination of irritating foods, development of
  regular eating habits, avoidance of anxieties
  that cause gastric distress

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• Vomiting
• Cause of Condition
• Result of some irritation, most often in the
  stomach
• Stimulates vomiting center of the brain, causing
  a series of forceful diaphragm and abdominal
  contractions to compress stomach
• Care
• Antinausea medications should be administered
• Fluids to prevent dehydration (by mouth or
  intravenously depending on the situation)

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• Food Poisoning (Gastroenteritis)
• Cause of Condition
• Ranges from mild to severe
• Caused by infectious microorganisms that
  contaminate food particularly during warm weather
  and periods of improper refrigeration
• Signs of Condition
• Nausea, vomiting, cramps, diarrhea and anorexia
• Usually subsides within 3-6 hours (staph.
  infection)
• Care
• Rapid replacement of fluids lost
• Bed rest in all but mild cases
• Nothing should be given by mouth if vomiting and
  nausea persist
• Re-introduce easy food first
• Physician referral is necessary

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• Diarrhea
• Cause of Condition
• Acute or chronic
• Caused by a problem in diet, inflammation of the
  intestinal lining, GI infection, ingestion of
  certain drugs and psychogenic factors
• Signs of Condition
• Abnormal, loose stool or passage of fluid,
  unformed stool
• Abdominal cramps, nausea, vomiting and frequent
  elimination of stools
• Extreme weakness caused by dehydration

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• Diarrhea (continued)
• Care
• Determine cause (irritant, infection, or
  emotional upset)
• ATC can treat less severe cases by omitting
  certain foods from athletes diet
• Utilizing over the counter medications
• Have athlete consume bland food that does not
  irritate system
• The BRAT diet (bananas, rice, apples and toast)
  has also been recommended
• Continue to hydrate

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• Constipation
• Cause of Condition
• Failure of the bowels to evacuate feces
• Causes include, lack of abdominal tone,
  insufficient moisture in the feces, lack of
  roughage and bulk in diet to stimulate
  peristalsis, poor bowel habits, nervousness,
  anxiety, and overuse of laxatives and enemas
• Signs of Condition
• Feeling of fullness, with occasional cramping and
  pain in lower abdomen
• Care
• Regulate eating patterns (cereal, fruits,
  vegetables)
• Avoid medications unless prescribed by a physician

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• Gastrointestinal Bleeding
• Cause of Condition
• Distance running, gastritis, iron-deficiency
  anemia, ingestion of aspirin or NSAIDs, stress,
  bowel irritation, colitis
• Care
• Refer to physician is bleeding is occurring

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Other Conditions That Can Affect the Athlete
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• Infectious Mononucleosis
• Cause of Condition
• Virus 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
• Care
• 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

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• Iron Deficiency Anemia
• Cause of Condition
• 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 NSAIDs 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

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• Sign of Condition
• First stage of deficiency, performance declines
• Athlete may feel burning thighs and nausea from
  becoming anaerobic
• May display some mild impairments in maximum
  performance
• Care
• 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)

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• Sickle-Cell Anemia
• Cause of Condition
• Hereditary hemolytic anemia - RBCs 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)
• Signs of Condition
• Fever, pallor, muscle weakness, pain in limbs
• Pain in upper right quadrant indicating possible
  splenic infarction
• Headaches and convulsions are also possible
• Care
• Provide anticoagulants and analgesics for pain

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Diabetes Mellitus

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

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• Insulin Shock
• Cause of Condition
• 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
• Care
• Adhere to a carefully planned diet including
  snacks before exercise
• Must determine food and insulin intake during
  questioning

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• Diabetic Coma
• Cause of Condition
• 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.
• Care
• Early detection is critical as this is a
  life-threatening condition
• Insulin injections may help to prevent coma

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Epilepsy

• 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
• Not a disease
• Symptom manifested by a large number of
  underlying disorders
• Cause of Condition
• For some forms of epilepsy there is genetic
  predisposition
• Brain injury or altered brain metabolism

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• Sign of Condition
• 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
• Care
• 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

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• Care (continued)
• Athlete may experience undesirable side effects
  care giver must be aware
• Be sure to have individual sit or lie down
• Remain composed
• Try to cushion athletes fall
• Keep athlete away from surrounding objects that
  could cause injury
• Loosen restricting clothing
• Do not force anything between the athletes teeth

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• Meningitis
• Cause of Condition
• 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

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• Meningitis (continued)
• Care
• Cerebrospinal fluid must be analyzed for bacteria
  and WBCs.
• If bacteria is found isolation is necessary for
  24 hours (very contagious), antibiotics must be
  administered immediately
• Monitored closely in intensive care unit
• Ultimately, athletes should not share water
  bottles because of chance of transmitting
  meningitis

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Hypertension

• Cause
• 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

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• Sign and Symptoms
• Primary hypertension is generally asymptomatic
  until complications arise
• May cause dizziness, flushed appearance,
  headache, fatigue, epistaxis and nervousness
• Care
• The upper range of normal blood pressure is
  120/80
• Risk of heart disease or stroke begins to rise at
  pressures over 115 and 75
• Risk continue to double for every 20 or 10mm/Hg
  increase
• Normal lt120/lt80
• Pre-hypertension 120-139/80-89
• Stage 1 hypertension 140-159/90-99
• Stage 2 hypertension at or greater than 160/ at
  or greater than 100mm/Hg

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• Medication is not recommended for those with
  pre-hypertension unless other conditions
  (diabetes, kidney dysfunction) are present
• Lifestyle changes may be necessary
• Exercise
• Diet/ weight loss
• Quit smoking
• Decrease alcohol consumption
• Those that have stage 1 or 2 hypertension should
  be on medication, in addition to taking the
  aforementioned precautionary steps

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Common Contagious Viral Diseases

• Athlete exhibiting infectious disease should be
  referred to physician for treatment
• Coach should be aware of certain signs
• See Table 23-2

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Testicular Cancer

• Cause
• Most common form of cancer in males 15-34 year
• Cause is not known
• Potential risk factors include
• Past medical history of undescended testicle,
  abnormal testicular development, low levels of
  male hormones, sterility, development of previous
  testicular cancer, family history of testicular
  cancer
• Typically only affects one testicle

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• Signs Symptoms
• Pain and discomfort in testicle or scrotum
• Lump or enlarged testicle
• Swollen or collection of fluid in scrotum
  feeling of heaviness in scrotum
• Dull ache in groin or abdomen
• Unexplained fatigue
• Unexplained enlargement of breast
• Care
• Highly treatable when diagnosed early
• Several treatments
• Surgery, chemotherapy, radiation
• Regular self exams can help to identify growths
  early

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Breast Cancer

• Cause
• Most common form of cancer in women and can occur
  at any age
• Family history of breast cancer is a major risk
• Hormonal influences play a significant role in
  the development of breast cancer
• Often metastasizes into the lymph nodes, liver,
  brain and bones

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• Signs Symptoms
• Early stages present with no SS and is not
  painful
• Often presents with a lump in breast or armpit or
  identified via mammography before symptoms are
  noticed
• Care
• Self exams should be preformed frequently and any
  irregularities should be assessed by a physician
  (ultrasound, mammography, biopsy)
• Surgery is primary treatment with additional
  treatment involving radiation, hormonal,
  chemotherapy

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Menstrual Irregularities and the Female
Reproductive System

• During the prepubertal period girls are of equal
  and often superior to boys of the same age in
  activities requiring speed, strength and
  endurance
• Differences arise following puberty
• Males exhibit slow gradual increases in speed,
  strength and endurance

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• Menarche
• Onset of menses occurs normally between the ages
  of 10 and 17 in females
• Engaging in strenuous activity may delay onset
• Particularly in high caliber athletes
• Late maturing-girl often has longer legs,
  narrower hips and less adiposity and body weight
  for height all conducive to sports

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• With growing participation and interest in female
  sports many myths have been dispelled concerning
  menarche, menstruation, childbirth
• Impact of strenuous training on menstruation and
  menstruation on performance cannot be fully
  explained

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• Menstrual Cycle Irregularities
• Strenuous training may alter cycle (25-38 day
  long cycles)
• Amenorrhea absence of menses
• Oligomenorrhea - diminished flow (refers to
  fewer than 3-6 cycles per year)
• Dysmenorrhea
• Menorrhagia (excessive menstruation)
• Polymenorrhea (abnormally frequent menstruation)
• Irregular periods
• Any combination of these

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• Dysmenorrhea
• Cause of Condition
• 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

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The Female Athlete Triad

• Cause of Condition
• 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
• Care
• Prevention is key identify and educate

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Contraceptives

• 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 (lt50mg of estrogen) provide
  little risk to healthy women

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Exercise During 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

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Sexually Transmitted Infections (STIs)

• Major concern in sports
• Many athletes are at an age of increased sexual
  activity
• Any STI could potentially be transmitted through
  sexual contact with an infected partner
• While STIs do not occur with participation in
  sports activities some understanding of how these
  infections can impact an individual is warranted
  on the part of coaches, healthcare providers and
  fitness professionals
• May be bacterial or viral

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• Bacterial Infections
• Gonorrhea, syphilis, chlamydia
• Treated with antibiotics
• Viral Infections
• Herpes, genital warts, HIV
• Difficult to treat often no cure exists
• STIs do not go away by themselves
• Quick and painless treatments are available
• No one is immune to STIs
• Prevention
• Safe sex practices and STI treatment
• Some could cause serious long-term health
  problems or death