CJSM Podcast 10: Exercise-associated Hyponatremia, the 2015 Consensus Statement

jsm-podcast-bg-1#DrinkToThirst is the hashtag that needs to trend in the sports medicine world!

Exercise-associated hyponatremia (EAH), a preventable and treatable but potentially life-threatening condition that can affect athletes under our care, is the topic of our tenth podcast.  And #DrinkToThirst is one of the chief themes to be found therein.

We’re proud to publish the 3rd international consensus statement on EAH in our July 2015 CJSM, and we’re delighted to have the lead author as our guest on the associated podcast.


Dr. Hew-Butler and friend.

Dr Tamara Hew-Butler is an associate professor of Exercise Science at Oakland University in Rochester, MI. She obtained her: BS in Kinesiology at the University of California at Los Angeles, CA; Doctor of Podiatric Medicine (DPM) at Temple University in Philadelphia, PA; Residency and Fellowship at the Harris County Podiatric Surgical Residency Program, Houston, TX; and Philosophy Doctor (PhD) at the University of Cape Town, South Africa. Dr Hew-Butler is a Fellow of the American College of Sports Medicine (FACSM) and specializes in both sports medicine and exercise physiology. Her expertise is in exercise-associated hyponatremia and the endocrine regulation of fluid balance during exercise. She trained under Timothy D. Noakes MD, DSc and Joseph G. Verbalis MD and has published ~50 papers on the topic.

Join us in the rousing conversation, and learn i) why athletes should #DrinkToThirst; ii) why sidelines should have hypertonic saline as well as AEDs and access to cold-water immersion therapies; iii) and so much more.

Osteoarthritis: Part I

I’ve been an Associate Editor for CJSM now for six months, and so some of you in the blog world may already know a little bit of my background as it has come out over time in my various posts.

For those of you who may be new readers of this blog, I thought for today’s post it was important for me to let you know that I work at Nationwide Children’s Hospital, the pediatric hospital affiliate of Ohio State University, and my specialty is pediatric sports medicine.

So……I don’t manage a lot of osteoarthritis (OA) in my current practice.

ocd of knee jpeg

Adult OCD of the knee,
unstable lesion: destined for osteoarthritis?

However, I didn’t narrow my clinical scope of practice to the younger crowd until 2010, and I have managed my fair share of OA in my career, injecting plenty of knees with hyaluronic acid derivatives, encouraging weight management and low impact exercise…….Now, I suppose I’m more on the end of the spectrum of primary prevention of the disease: if I manage my young patients’ knee osteochondritis dissecans properly, perhaps I can spare them from degenerative joint disease later in life.

I’m not telling anyone reading this something they don’t know already when I write that career paths are varied in modern medicine.  There’ s no telling if I’ll be taking care of kids exclusively in 10 years.  We all have mandates from Certification Boards requiring us to stay abreast of the current medical literature; we’re tested on it every few years now, as Maintenance of Certification is a phenomenon here to stay.  Forces like these make it incumbent that I read and ‘stay on top of’ developments in the world of OA diagnosis and management, even if I am not seeing much of this disease in my current practice.

After all, OA is the leading cause of chronic disability among older adults in the United States.  That’s a disease worth knowing about.

I thought, therefore, that I would share with you a couple of interesting studies that have come out recently on major issues in the world of osteoarthritis.  Both studies were just published within the last month:  the first, “Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee,”  published in the Journal of Bone and Joint Surgery (JBJS), I will discuss in my next blog post.  And the second, “Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults with Knee Osteoarthritis,” published in the Journal of the American Medical Association (JAMA), I will review now.   They are both large, high quality evidence (Level 1) studies which focus on low tech, low cost interventions that have the potential of having major clinical impact.  They are both studies primary care sports/MSK clinicians like myself might be expected to be aware of. Read more of this post

Dr. Jason Mihalik guests on ‘5 questions with CJSM’: concussions and apps

We’re already seeing an uptick in our concussion clinics now that the football (both ‘American Football’ and soccer) seasons have begun.  It promises to be a busy few months.

jason mihalik

Dr. Mihalik and colleagues with their
pre-participation ‘sports drinks’

How fortunate my colleagues and I were, then, to have a special guest visit us a couple weeks ago:  Jason P. Mihalik, Assistant Professor in the Department of Exercise and Sport Science at the University of North Carolina and Co-Director of the Mathew Gfeller Sport-Related Traumatic Brain Injury Research Center.  

I first became aware of Dr. Mihalik from the work he has done regarding what is generally considered the most user-friendly layperson’s app for recognizing a concussion on the field of play.  The app, known as “Concussion Recognition and Response App,” can be downloaded to both iPhone and Android systems, has a version specifically designed for coaches and parents; it is designed to assist the layperson in recognizing when a concussion may have occurred.  Dr. Mihalik himself talks about the app in this YouTube video.

mihalik and pommering

From Left to Right:
Drs. Mihalik, Pommering, and Patrick,
on ‘Pediacast’

Dr. Mihalik ripped through his 24 hours with us with little time to breathe as he dispensed his wisdom concerning sports-related concussions, one of the hottest topics in the world of clinical sports medicine.  The highlights included the taping of a podcast; a lecture to the research staff and faculty; and the requisite beers and lounge experience in an informal setting.

I had to breakaway to cover a FINA open-water swimming event.  In lieu of attending the lecture Dr. Mihalik gave at our hospital, I tracked him down for a quick Q & A session.

—————Five Questions for Dr. Mihalik————–

1) CJSM: What do you think accounts for the dramatic rise in incidence of sports related concussions over the last decade? is it just a matter of recognition bias, or is something more going on?

Dr. Mihalik:  Research has shown a steady increase in the incidence of concussion across many sports. There is always an issue with incidence rates since precisely identifying the denominator (exposure) is always tricky at best. Notwithstanding, I believe this rise can be attributed to the increased hypersensitivity of this injury. More people know about concussions, which I feel biases recognition in more recent publications that highlight increases in concussion rates. I don’t think we should sensationalize these findings to suggest that concussion is now a problem when, in the past, it may not have been. Concussion has always been there, but we are now educating parents, coaches, and athletes to recognize the signs & symptoms. Read more of this post



The Crescent Moon rising at sunset, marking the start of the month of Ramadan

The month of Ramadan begins tomorrow, July 9, and lasts until August 7.  As many of this blog’s readers will know, observant Muslims will fast from dawn until sunset:  no food, no liquids…..no sports drinks or power bars.  The questions of ‘carb loading’ or ‘gluten free’, (‘should i drink some chocolate milk after my workout?‘) can all be put on the table until the evening.  The diet is one of pure abstinence, morning until night.

Muslim athletes are not unique in observing a fast: Catholic Christians will consume much less than usual if observing the prescribed tenets of Lent on Ash Wednesday and Good Friday, and Jewish athletes will go a full 24 hours consuming nothing on Yom Kippur: friends have told me they will be loath to brush their teeth or even shower, lest anything whatsoever pass into their mouths on that, the holiest day in the Jewish calendar.

And, of course, there are athletes who experiment with fasts, juices and cleanses that have nothing to do with religious observance (I’ve tried the “Master Cleanse” myself once).

What may be unique, however, to Islam  is the duration of the practice:  a full 30 days, where an observant Muslim will forego all food and drink from dawn (Sahur) to dusk (Iftar).

I admire the discipline the act of fasting requires.  As a sports medicine clinician, I have often wondered how athletes observing such fasts might be impacted.  Of course, I am  not alone in this, as the subject of the Ramadan fast and its effect on athletes was, for instance, a subject of considerable interest in the 2012 London Olympics, which took place during Ramadan.  The effects of Ramadan on sports performance have even been discussed in this blog in a 2011 post.  And now  the most recent issue of the CJSM, which rolls out today, highlights a study looking at this very practice of fasting and its impact on footballers:  “Does Ramadan Affect the Risk of Injury in Professional Football.” Read more of this post

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