Wild at Heart


Mt. Adams, in the Cascades. Photo by Pugetopolis, Wikimedia

September is here, and the first of the month is when we would normally be publishing the fifth edition of CJSM for 2015.  But ‘things’ are a little special this time around.

We’re publishing on 9/9/15 this year, after the Labor Day weekend in the USA has passed.  And we’re not just ‘publishing,’ we are ‘co-publishing’:  along with Wilderness and Environmental Medicine (WEM), the official journal of the Wilderness Medical Society (WMS), we are producing a themed issue on the pre-participation evaluation of adventure and wilderness athletes.

And so, while President Obama is making his own mountain news with the change of a name, we’ll be looking to make a mark in the media and social media with this special wilderness issue (perhaps not as big — @POTUS has almost 4 million followers on Twitter).

We publish research relevant to this world of adventure/wilderness medicine frequently.  In the blog, in the last year, I have written about ‘High Altitude Medicine,’ risk factors for Acute Mountain Sickness (AMS) , and the Badwater 135, the ultra-marathon run through Death Valley in the summer time. In the journal, we have recently published the Canadian Academy of Sport and Exercise Medicine (CASEM) Position Statement on High Altitude Medicine; original research on the renal function of runners participating in an Ultra-Distance Mountain run; and multiple case studies involving adventure athletes, including this interesting one on the ‘heel-hook’ rock climbing maneuver, creating a specific pattern of knee injury.

What is so special about the September 2015 issue is that members of the American Medical Society for Sports Medicine (AMSSM) and the WMS collaborated on the project–the editors and individual authors were members of either or both AMSSM and WMS.  And the final product–a series of articles focused on primary injury prevention and pre-participation evaluation of this special type of athlete–is being co-published by WEM and CJSM.  It’s the culmination of a process nearly two years old, and took the effort of a great many people to put into production.

We have planned several posts and a podcast to highlight various aspects of the new issue.  You’ll be hearing a lot about it, here on the blog and on our social media feeds. You’ll here about it in this podcast too!   And, most importantly, we hope you visit cjsportmed.com to read the issue itself.

Let the adventure begin……

Ebola and the Athlete

twitter rsa pic

The South African Minister of Sport has tweeted a ‘no, thank you’ to being host.

The biennial Africa Cup of Nations (AFCON) is set to begin in January 2015. Organizers are still looking for a host.

Morocco was set to host the tournament but has pulled out because of the fears over Ebola contagion. The Republic of South Africa has already served notice that they will not volunteer to be alternative hosts:  the country’s Minister of Sport has tweeted that the RSA is “…not the Big Brother of Africa….” and will not be standing in as host for the Cup. As I understand it, the Confederation of African Football organizers are meeting November 2 to discuss solutions for what seems to be an impasse.

If sports is indeed a mirror of the culture, then it stands to reason that concerns regarding the Ebola virus would show up in sporting venues, training rooms, sport talk shows, and athletes’ twitter feeds.  The current outbreak of the virus is still largely confined to certain nations in W. Africa, but it  is the largest and most deadly one in history.  Sport, like society at large, is concerned.  How might teams handle potential exposures?  Must consideration be given to quarantining? Is it reasonable to target only those countries at the epicenter in W. Africa?  Is ‘quarantine-lite’ the way to go? Is it wise to consider having large numbers of people travel to and from one country, as in the case of hosting AFCON?


A sign of things to come?

A generation or two ago–most especially in the pre-vaccine and pre-antibiotic era–the quarantine was a standard measure for handling outbreaks of contagious diseases in communities.  My mother describes how she and her whole family were quarantined after she developed strep throat as a young girl in the 1930’s.   In the modern world, however, the quarantine as a response to controlling Ebola has already come under heavy fire, at least here in the United States.

The intersection of public health, international sporting events, and an infectious virus is not unique to this moment in time, of course.  In 2010 CJSM published a thematic issue on “Emerging Issues in Sport Medicine,” and included among the many offerings an article on International Travel and the Elite Athlete as well as an article on Public Health Recommendations for Athletes Attending Sporting Events.The 2009 CJSM published original research on a novel, web-based approach to more carefully monitor illnesses in professional rugby union players.  These documents are potentially useful resources to help teams and sporting federations formulate responses to this newest challenge.

But I want to acknowledge that the Ebola virus raises issues which require a great deal more work to determine appropriate, evidence-based interventions.  Winter is coming in the Northern Hemisphere, and we know we should be offering our athletes influenza vaccinations. We have a ‘system’ to handle the flu.  What to do with a disease like Ebola for which there is no current vaccine let alone an established treatment?  Likewise, what to do in the case of a virus which does not pose an airborne exposure risk like the flu, but has a much higher case fatality rate when the virus is contracted?

Already, popular sentiment has begun ‘making’ decisions of a sort.   Read more of this post

Sochi and Quebec City: Memory and Desire

The first days of summer are almost here, the longest days of the year in the Northern Hemisphere.  I have been looking forward to this since the dark days of December and January.

opening ceremonies connie lebrun

Dr. Connie LeBrun, at opening ceremonies, Sochi 2014 Winter Olympics

Summer carries its intrinsic sweetness with it every year, but this year my anticipation of these days has been wrapped up with dreams of Quebec City, where the 2014 Canadian Academy of Sport and Exercise Medicine (CASEM) will have its annual meeting concurrently with the XXIII FIMS World Congress of Sports Medicine.

There is much to look forward to, including catching up with old friends.  Connie Lebrun–who will be familiar to several readers of this blog–will be among the folks I see.  Aside from communiques via email, I will typically only get the chance to see Connie at such conferences (I saw her last in Orlando, at the ACSM meeting). Among the many hats she wears, she is on this journal’s editorial board, and I enjoy her frequent contributions to the CJSM journal club feature.

Connie was the head physician for the Canadian Olympic team that traveled to Sochi earlier this year. I asked her to give a quick run down of her experiences in sports medicine at the 2014 Winter Olympics, and she has graciously obliged.

What did T.S. Eliot say about mixing memory and desire?  I’m no poet, but I think it’s a natural combination to combine the two; and so here’s to the memories of Sochi, and the anticipation of what is to come in Quebec.


Memories of Sochi – Dr. Connie Lebrun


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Alexey Pleskov and Connie LeBrun, 2014 ACSM Orlando

Just back last week from the American College of Sports Medicine Annual Meeting in Orlando Florida. The last session that I attended was a Special Event entitled “SOCHI 2014:  Sports Medicine Challenges, Strategies and Solutions. It was submitted by the ACSM Olympic and Paralympic Issues Committee, of which I am a member, and Chaired by Dr. Margo Mountjoy, member of the IOC Medical Commission. She later spoke about the International Olympic Committee (IOC) and the Injury and Illness Surveillance system that they have been using at Olympic Games since 2008. A highlight for me, though, was hearing Dr. Alexey Pleskov, the Chief Medical Officer (CMO) for the Sochi 2014 Olympics and Paralympics – discussing Medical Services at the Games. Then Dr. Paul Piccinnini (DDS), also from the IOC Medical Commission, enlightened us about Management of Dental Disease and Oro-Facial Trauma during the 2014 Winter Olympics, which apparently accounts for ~ 40% of all athlete-treatments in the Polyclinic(s) at the Olympics. This was followed by a “tag-team” of Dr. Randy Wilber (PhD, USOC Training Center, Colorado Springs) and Dr. Nanna Meyer (PhD, RD) discussing the preparation of the US Speed Skating team, in terms of physiology and training, as well as outlining some of the sports nutrition challenges and strategies.

The presentations and photos brought back many memories for me, as I was honored to have been the Chief Doctor for the Health and Science Team (HST) for the Canadian Olympic Team. Read more of this post

The 59th Traversée internationale du lac St-Jean

lac st jeanIt started off a bit rocky, with an impatient Canadian border guard at Jean Lesage international airport in Quebec City questioning why I, an American doctor, would be working and taking care of patients in Canada; but things are decidedly looking up now that I have made it over that speed bump and down the road to Roberval, Quebec.

My biggest problem now is getting WiFi access.  Thank God for Tim Horton’s!!  My hotel can’t get me WiFi, other places in town that proclaim free WiFi don’t deliver.  I grabbed a coffee at Tim’s (avoiding the donuts; on the road, sitting in planes and cars, I don’t need those tasty calories) and, voila!  Internet access.

So, lest anyone think I’ve been remiss in communicating over the blog, on Twitter @cjsmonline, or on the Facebook page (https://www.facebook.com/cjsportmed), I have simply been unable to do so.

And one more thought about Tim Horton’s before I turn to the swimming. Many readers will know this, but some will not:  the donut chain was founded by a revered former NHL player, Mr. Tim Horton himself.

lac st jean water

The obstacle the swimmers face: Lac St. Jean

I’m here as a FINA medical delegate to supervise the medical set-up and the doping control of two swimming events that will take place on Lac St. Jean–next to Roberval, Quebec, Canada (2.5 hours north of Quebec City)–tomorrow and Saturday.

jacques amyot

Lakeside plaque commemorating Jacques Amyot, first to make the Lac St. Jean crossing.





The 32 km Traversee, to take place on Saturday, promises to be especially interesting.  To put this in context, the distance is just a bit shorter than the English channel crossing, and the water temperatures in the middle of the lake will drop below 20 degrees C.

The medical tent is set up to deal with hypothermia, I can assure you of that!

I will have more to post (pending access to Tim Horton’s……oops, WiFi) when the events have taken place. In the mean time, if anyone in the blogosphere has interesting experiences or medical literature to share on the coverage of long-distance swimming events, I look forward to hearing from you in the ‘Comments’ here or on Twitter @cjsmonline.

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