Q&A with USF assistant AD Steve Walz
Sports medicine continues to come up in news with college athletes in the state of Florida. USF had a tragedy on its campus in January 2007 when running back Keeley Dorsey collapsed and died during a team conditioning workout, and the Bulls narrowly avoided another tragedy when trainers were able to save softball pitcher Cristi Ecks' life this spring when she collapsed during an afternoon practice.
There's been much attention on the University of Central Florida since freshman football player Ereck Plancher collapsed and died during a team practice this spring, and USF announced Tuesday that soccer player Lindsay Brauer's career ended early when a routine physical this fall revealed heart irregularities, potentially saving her life.
Steve Walz, USF's assistant athletic director for sports medicine, sat down with the Times last month to talk about some of the issues and new technologies helping certified athletic trainers in their jobs.
GA: With so many things coming up in the news, I wanted to ask you how much has changed in recent years with the physical exams you give to all USF athletes each year. For instance, I understand that USF requires that all athletes' physicals be administered by staffers, instead of outside physicians.
SW: That part has changed in the last 5-6 years. You'd get some walk-on kids who had personal family physicians doing physicals. As time went on, I became more and more uncomfortable with that. I played high school sports and I needed to get cleared for some things, and our coach would kind of give me a certain doctor to go see. We know the qualifications of the doctors we use here.
GA: Are there things you're screening for that didn't used to be part of the annual physicals?
SW: Two years ago, we started doing a blood test screening for sickle-cell trait, so every incoming athlete will have that done. We base a lot of stuff we do off what the latest medical trends are, The American Academy of Family Physicians, the American Sports Medicine Academy, National Athletic Trainers Association. We started doing the sickle cell because I started hearing rumblings through the NATA that they were going to put out a position statement recommending it. You obviously want to follow those things, so we started doing that (in fall 2006).
This past year, we started doing baseline EKGs (electrocardiograms). That was something we had talked about. It's a highly controversial thing, because you can get a lot of false positives, so you have to do follow-up testing, which is fine. Our theory, with the team physicians and myself, was that if you have the resources to do it, let's do it. With some smaller schools, money becomes an issue, but that's not really an issue with us. The doctors are great and work with us. We started doing that this year on everybody. We did physicals back in May that were the first round.
GA: What kind of irregularities can those EKGs show you in an athlete?
SW: The national averages show about 10 percent of those are going to be abnormal. Most of them are just due to athletic hearts. They're bigger, stronger hearts, but you have to differentiate between that and a heart problems. You put the electrodes, the leads on, and they look at the heart rhythm. If that's abnormal, then you go to the next round of testings, which is a stress echo cardiogram. They actually look at the picture of the heart, like an ultrasound, while they're running on a treadmill. You can see how the blood flows going through there, the size of the heart, the chambers, all that kind of stuff. You can keep going to make sure it's a healthy heart: cardiac MRIs, things like that. Most of the time, you get to that stress echo and everything's fine. You find out it's just an athletic heart.
GA: Have you guys already found things from blood tests, from EKGs, that alerted you to health conditions in athletes?
SW: With the sickle-cell testing, we had a couple of guys graduate last year who had the trait. I think we have four or five that have the trait. Most of them didn't even know they had it. One of them didn't know he had it, but his mother knew and never told him. That was an interesting one, and he wasn't real pleased about that. Those are guys we just watch a little closer. We educate them on signs and symptoms. With those guys, they want to stay a little bit better hydrated, they don't want to get out of shape, that type of thing. The other thing you worry about with that is altitude, but we don't worry about that here since we stopped playing Utah and other schools out there.
With sickle cell, the other thing we educate them on is lifelong stuff: If you get married, you might want to have your wife tested. If you have two sickle-cell trait people having kids, you have a higher probability of having a child with a disease. So we educate them about that as well, talk to them, give them handouts.
GA: You mentioned proper hydration and staying in shape. Is there anything else you do to make other people in the program aware of an athlete with sickle-cell trait?
SW: I go over it with strength coaches and the coaches from whatever sport it is, basically just saying "If they're struggling, let us handle it," instead of yelling at them. They've been great with that. They're like "OK. He's yours.' If he starts cramping or whatever, just let me deal with it. If I think he's trying to get out of practice, I"ll let you know. We sit down the last couple of preseasons and go over those guys. The other important thing is that (head strength and conditioning coach Ronnie McKeefery) and his staff know if they're working somebody out and he's struggling, go ahead and send him into me. We'll just be a little bit more careful.
The argument for the schools that don't do sickle-cell trait (testing) is that they treat everybody that way. I don't know if they do or not. I would rather know.
GA: Do you know what the costs are to administer a sickle-cell blood test?
SW: It's $17 to get the draw and the results from the lab. (So for 400 athletes, about $7,000)
GA: Are there other things that will come into play this year that you haven't dealt with in the past?
SW: After we made the decision on the cardiac testing, I don't know if there's anything on the horizon out there. There's better ways to do body composition, that kind of stuff, and we're doing the heat-pill study we've been doing the last three or four years. I feel like we're as comprehensive as anybody out there, and part of that is due to our relationship with the College of Medicine. They're very supportive of what we do. We're going to continue using the heat pills to monitor guys' core temperature.
GA: Is football two-a-days in August the main place you do that?
SW: We do the first couple of weeks for sure, getting acclimated to the weather again and having the pads on. That's when you really worry about them the most.
GA: Do you know how many players get the pills during a study?
SW: We'll probably monitor 40 or 50 guys over the first two weeks of practice. If we have problem kids that tend to heat up, we'll continue watching them.
GA: What's an allowable deviation in body temperature that wouldn't set off flags?
SW: We look at 102.5 -- everybody's different -- as kind of the point where we might want to grab them for a little while. You can take them out and hydrate them and put a cool towel on their head, and 8 to 10 minutes, they're down to 101. You can make a difference. You still have to go by symptoms. You might have one kid who's crampy and nauseated at 101.5. Not to give out names, but (former offensive lineman) Frank Davis, that guy, I don't know if it's because he grew up near the equator (in Panama), but he could get up to 103.8 and he's "Why are you pulling me out? I'm not hot." It's funny, and it's all individual. The first thing is symptoms. If they don't have symptoms but are still at that 102.5 level, we'll back them down for a couple. I think it's really helped us keep kids from getting IVs and hold off on some of that heat-related.
GA: I'd think there's a heightened awareness in the state of Florida because there's been such a high, number of incidents involving athletes and sudden collapses.
SW: We try to keep a good ear out. You don't want any tragedies to happen, No. 1, but if another one happens someplace else, you want to learn from what happened there. I was close with the situation at Missouri (football player Aaron O'Neal, in July 2005) because I graduated from there. When that young man passed away, because I knew the people there, I called and said "Would you do anything different?" When we're doing things, you make sure there's not an athlete left behind without an athletic trainer there. If it's the last one doing punishment running, there's got to be somebody looking out for them. Little things like that, being aware of different situations at different schools, keeping up with the literature and medical journals, going to seminars.
GA: In terms of personnel, how much has your staff grown?
SW: I came back here in 2000, and I think we had five certified athletic trainers then. Now we have 12. The big difference is sports go on forever now. We were getting into a situation where we'd have a person cover volleyball and baseball in fall and spring. They'd get more competitive in their offseasons, so in the spring volleyball is playing matches, and baseball doesn't play games in the fall, but they practice. You've got to have people out there. We needed to go to one ATC per sport, because they go the whole year-round. We didn't want to share athletic trainers between sports.