Cometh the hour, cometh the man.

IMG_1630Every so often, sports takes a back seat to other world events. So too for sports medicine.

We all know this, whether in our personal lives or in our interactions with the world at large.  There is the NFL player who is torn between performance on Sunday and ‘being there’ for his young daughter with leukemia.  There are cases where the athlete him- or herself is felled with illness–think of Lou Gehrig and amyotrophic sclerosis.  The issues of who won the last game, the intricacies of a salary negotiation, or the season missed from a knee injury pale in comparison with such ‘real world’ contingencies.

In sports medicine we sometimes experience directly the intersection between serious illness and athletics.  I think immediately of the young gymnast I saw with anterior knee pain that turned out not to be Osgood-Schlatter’s but osteogenic sarcoma of the tibia…….a ‘game changing’ event not precisely of the sports kind.

As followers of this blog or of our social media (Twitter – @CJSMOnLine) know, I have been travelling in South Africa as one of the Travelling Fellows of the American Medical Society for Sports Medicine, one of our partner societies.  We will be talking at the South African Sports Medicine Association’s Congress (SASMA) which begins tomorrow; and we have already begun to connect with several luminaries in the sports medicine world to share our research and thoughts on the various problems and puzzles in our special world.

Our hosts have been extraordinary in their hospitality.  They provided one more special gift to us by organizing today a tour of Johannesburg’s Soweto, the Apartheid Museum, and Nelson Mandela’s home in Orlando West, outside of Johannesburg.

What a beautiful country South Africa is! And what an extraordinary sports medicine scene has developed here.  The SASMA Congress has been highly anticipated the world over, and I can’t wait to hear the talks and, even more, see the collaborations that develop from this meeting, which is bringing people from all over the world as well as South Africa.

But how much more beautiful South Africa is now than it was only 25 years ago, a mere blink of the eye in historic terms. Apartheid is a thing of the past.  South Africa is vibrant, and democratic.  And so much owes to the life and work of one man:  Nelson Mandela.  Absent his presence on this country’s stage, who knows where South Africa and South African sports medicine may be now?

IMG_1623Travelling through Soweto today, and visiting sites such as the Apartheid Museum, remind me of the importance of how each and everyone of us live our lives.  And how one man and his decisions can literally affect the history of a country and of the world.  “Cometh the hour, cometh the man”--a phrase I remember from history classes of my youth.  A phrase I associate with people like Mandela, whose one life has affected the world.  At that pivotal moment in time, South Africa needed such a man as Mandela.  He rose to the occasion, and an entire country was transformed.

This is true of our smaller stage of sports medicine.  It is one of the truths I am reminded of when I go to such meetings–the work we do and the research we do is so important, but how much more important are the people behind that work.  It is always such a joy to meet someone whose work I have come to admire–to meet them in person.

And so, in our own smaller way in the universe of ‘sports medicine,’ the hour is nigh.  Cometh the men and women such as Carl Askling, Margo Putukian, Cindy Chang, Lyle Micheli, Karim Khan and more.  It should be a great three days here in Johannesburg.IMG_1624

I look forward to sharing with you some of that work which will be presented.  Stay tuned.

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AMSSM 2015 Travelling Fellowship — Chapter One

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It’s a dog’s life as an AMSSM Travelling Fellow — Middelvlei Farm Winery. Photo: Dr. Alison BrooksIt’s a dog’s lifeThat is what I have been living over the last ten days.

It’s a dog’s life.

That’s what I have been living the last ten days.

I have been travelling through the country of South Africa as one of the 2015 travelling fellows of the American Medical Society for Sports Medicine (AMSSM).  I have had the privilege of sharing this journey with one of AMSSM’s founders, Dr. Doug McKeag, and one of the organization’s bright young starts, Dr. Alison Brooks.

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One American’s contribution to Springboks’ pride

We have all enjoyed the extraordinary beauty and hospitality of our hosts.  We’ve given talks (and drunk excellent wine) at Stellenbosch University, outside of Cape Town, as we visited Dr. Pierre Viviers. We’ve done similar ‘work’ (talks and, yes, more wine) at the rival University of Pretoria, where we have been hosted by Drs. Phatho Mondi and Christa Janse van Rensburg. We spoke both to students of the university and, in a separate session, to sports medicine clinicians at the University’s affiliated High Performance Centre. At each place we’ve seen extraordinary sports medicine work being done and have been exposed to sports ranging from cricket to rugby–in the latter case we’ve found ourselves shifting allegiances (rooting for the ‘Maties’ in Stellenbosch and the ‘Tuks’ in Pretoria); we’ve watched professional Currie Cup rugby live and Springboks Rugby World Cup games in a sea of national green and gold surrounding televised feed.

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Drs. Carl Askling & Phatho Zondi (SASMA president-elect) enjoying some time together before SASMA2015

It has already been an extraordinary journey, but it will not end until we have enjoyed the three packed days of the 16th biennial congress of the South African Sports Medicine Association (SASMA), the highlight of our trip.  Among the speakers will be Sweden’s Carl Askling, the premier voice on the management of athletic hamstring injuries.  Carl has become one of the many new friends I have made on this trip, as we’ve shared some close encounters of the elephant kind on safari.

From “Learners to Leaders,” that’s the theme of SASMA2015, and for sure South African sports medicine is in the lead in so many respects.  I look forward to meeting so many more people associated with sports medicine in Johannesburg.

There is so much more I could write, but I’m very very busy……well, um, in a special kind of way.  Indeed, I need to do some last minute preparations on my several talks for SASMA, and there is the ever-present email inbox where some work from overseas still calls my attention overseas.  And, yes, there is the ‘work’ of getting ready to view more African wildlife and enjoy more of the superb culture and food that this special country has to offer.  Such are the true joys the AMSSM Travelling Fellowship has to offer.

I know this will not be the last post I will be filing from this visit, as I will be sure to have some in depth sports medicine content to share as the SASMA proceedings progress.

And so until next time:  Totsiens, Hambani Kahle, Good bye!

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The End

Born Free

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Diana Muldaur as Joy Adamson from the television program Born Free–NBC Television

Born Free, that’s the song running through my mind this morning as I am writing this post.

Er, not the Kid Rock song.

I hope there are some readers who are familiar with the movie ‘Born Free’ and its theme song.  Or perhaps they watched the TV series in the early 70’s…..I hope I don’t go too far at revealing my true age here (I’m a Baby Boomer) as I wax nostalgic about the beautifully filmed movie about a lion and its human family in Africa.

Perhaps it’s not surprising that this is currently the ‘theme song’ of my life, because I have Africa and ‘Wilderness’ on my mind: in three days  I head out to South Africa en route to the 16th biennial congress of the South African Sports Medicine Association(SASMA 2015); and I’m still reading through and enjoying our fabulous September 2015 CJSM, entirely dedicated to the subject of Wilderness Medicine.

I want to note here and now that our Wilderness Medicine theme issue, published just a month ago, remains free as of this writing–each article is freely available for a time, the better to widely (wildly?) disperse the messages about pre-participation evaluation, risk stratification, and injury prevention in the wilderness adventurer/athlete.

One of the articles I particularly enjoyed was written by Tracy Cushing et al., “General Medical Considerations for the Wilderness Adventurer:  Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.” I especially liked this because I learned so much from it.  If I have a patient heading to altitude who has a bleeding diathesis, how do I manage that?  A patient with Parkinson’s heading to an Antarctic adventure of a lifetime–are there risks I should anticipate? There are so many similar questions, pertaining to combinations of disease and wilderness/adventure exposure, that this article addresses.

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Big Cats (and Dogs) in store at SASMA2015

As things get a bit ‘wild’ in my personal life–as I toggle between seeing Big Cats on safari (e.g. Lions) and Big Dogs at SASMA2015 (e.g. Lyle Micheli)–I’ll check in as ever on this blog and on the CJSM Twitter stream.  Follow the hashtags #SASMA2015 and #AMSSM2015TF for documentation of these adventures. Look me up, please, if you are in Johannseburg for SASMA2015, and look up the current issue of CJSM regardless of where you are–you’ll be sure to learn a lot about managing those patients heading to….well, places like Africa!

5 Questions with Dr. Irfan Asif

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Dr. Irfan Asif, at the podium, AMSSM 2015 Conference

As I get ready to head out to South Africa as one of the ‘Travelling Fellows” of the American Medical Society for Sports Medicine (AMSSM), I can’t help but think what previous Fellows may have experienced on their own journey.

I decided to reach out to one of the 2014 Fellows, Dr. Irfan Asif, who happens also to be a rather productive CJSM author. Dr. Asif is Associate Professor in the Department of Family Medicine, in the Greenville Health System at the University of South Carolina Greenville School of Medicine, and is Vice Chair, Academics and Research Director of the Sports Medicine Fellowship there.  He is also co-chair for the fellowship committee within AMSSM.

In a tangential way, Dr. Asif came to mind this morning as I was driving to work, catching up on the overnight sports news while listening to ESPN’s Mike & Mike. Mike Golic, in commenting on Derrick Rose’s most recent injury, stated that a key ingredient to success in life boils down to this:  often times, the secret to ability is one’s availability.

I couldn’t agree more, and I couldn’t pick a better examplar of this notion than Dr. Asif.  With all the many, many hats he wears, with all the duties he has, he responded within minutes to my initial query about being a guest on “Five Questions with CJSM.” And within one day we got down to business and conducted this interview.

Talk about availability.  Talk about ability….and now, let’s talk about the AMSSM Travelling Fellowship and more, with Dr. Irfan Asif.

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1) CJSM: In 2014 you were one of the inaugural travelling fellows for the AMSSM. Who joined you on your journey to Australia? What do you remember as some of the high points of that journey?

IA: It was an honor to be selected as one of the AMSSM inaugural traveling fellows to Australia. I was accompanied by my colleague Chad Asplund, as well as, one of the founders of AMSSM and current president/CEO of the ABFM, Jim Puffer.

The trip was fantastic. We had the opportunity to meet legends in the field of sports medicine including: Peter Brukner, Peter Fricker, and John Orchard. Each uniquely contributed to our trip. For example, Dr. Brukner demonstrated the power of dry needling, Dr. Fricker provided valuable insight into the medical care offered at the Australian Institute of Sport, and Dr. Orchard demonstrated the significance of developing league-wide (Australian Rules Football) research that can ultimately manifest as rule changes in sport to provide a safer environment for competition. In addition, we had the privilege of meeting Andre La Gerche and Chris Semsarian who are some of the premier thought leaders in sports cardiology.

Aside from these experiences, we participated in educational grand rounds and conferences on topics such as: Sports Cardiology, Sports Concussion,Heat Illness, Regenerative Medicine, and Exercise as Medicine.

The most meaningful memories, however, were getting to know Chad and Jim on a deeper level, including Chad’s personal stories of providing medical care during tours in Afghanistan, and Jim’s journey to becoming a leader in family and sports medicine.

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The AMSSM Travelling Fellows, 2014 (L to R – Irfan Asif, Peter Brukner, Chad Asplund, Jim Puffer)

Special thanks to DJO Global for sponsoring our trip.

2) CJSM: What is your work like on a day-to-day basis? Can you tell us a little bit about your clinic responsibilities; your teaching and research; what sports teams you may have to cover?

IA:  Work is exciting, with heavy doses of family and sports medicine. My major roles within the Greenville Health System/University of South Carolina Greenville School of Medicine include being the Vice-Chair of Academics and Research for the Department of Family Medicine, and the Primary Care Sports Medicine Fellowship Director.

As Vice-Chair I oversee the training curriculum and environment for medical students rotating in family medicine, two family medicine residencies, and our fellowship programs. In addition, I am developing the research infrastructure for our research division, which is focused on patient-centered outcomes research, comparative effectiveness trials, and quality improvement initiatives. We partner with local programs such as USC Greenville School of Medicine, Furman University, and Clemson University to improve the healthcare of our region.

As the director of our sports medicine fellowship, I have the opportunity to lead one of the largest PCSM Fellowship Programs in the country (12 CAQ PCSM physicians with an athletic training network covering 50 locations and >20,000 athletes). Aside from high school sports, we assist in the care of athletes from USA Karate, USOC Para-athletes, professional baseball, and Division I & II Collegiate programs.

Currently, my clinical focus is centered on using lifestyle modification measures (exercise as medicine, healthy nutrition, behavioral modification, etc.) to prevent, manage, and treat non-communicable diseases such as cardiovascular disease, diabetes, and hyperlipidemia. We still see routine musculoskeletal injuries, but I believe that primary care sports medicine can also play a larger role in the health of the every day individual…everyone is an athlete; sometimes, they just don’t know it yet.

Last, my primary research focus has been on the prevention of sudden cardiac death in young athletes. Our research team has examined several different domains within this field, including: epidemiology, screening, resuscitation strategies, and the psychological impact of being diagnosed with cardiovascular disease. This year, we developed the “Connected by Hearts” program as a support mechanism for athletes who are diagnosed with potentially lethal cardiac disorders.

3) CJSM: You were chair of the 2015 AMSSM Annual Meeting’s planning committee, and we thought you did a fabulous job with that. What role do you have with the 2016 meeting, in Dallas? What are you looking forward to in Texas?

IA:  Thank you for the kind words regarding the 2015 AMSSM Annual Meeting. If I could be humble, this was professionally the most fulfilling task that I have completed in my career. None of it would be possible without the leadership of Jon Divine and the entire program planning committee…They were simply outstanding.

The 2016 Annual Meeting commemorates the 25th Anniversary of the AMSSM organization. Marci Goolsby has put together a phenomenal program using a “Back to the Future” theme that celebrates the work of our founding members. As part of the program planning committee, I have focused my efforts on Faculty Development, which you will see at least 6 times within the program. Most physicians equate faculty development solely with academic medicine; however, faculty development encompasses any environment of education, regardless of where it may be. We kick off the meeting with a special lecture by an invited speaker, Dr. Michael Wiederman, who will explain this paradigm during a session titled, “What is Faculty Development?” We then offer 4 free Faculty Development ICL sessions that cover how to provide feedback, masterful mentoring, journal club, and journal publication (Editors from CJSM, BJSM, and Sports Health will participate). Finally, we will offer a special session on how to implement and teach an ultrasound curriculum.

4) CJSM:  If you had to compose a 140 character tweet to describe how the AMSSM travelling fellowship has impacted your life, your career, what would it say?

IA:   New friends, novel therapies, and an incredible journey to the land down under. An educational experience like no other. #AMSSM2014TF (with Peter Brukner, Peter Fricker, and John Orchard) [a little over the 140 limit, but it comes from the heart–the tweet passes muster!] 

5) CJSM: You were lead author of a 2013 CJSM study on the leading cause of death in NCAA D1 athletes that got a lot of press. Were suprised by the results? Prior to that study’s initiation, had you any idea of the impact of MVAs on our NCAA student athletes?
IA:  This study was, no doubt, a surprise. While is it common knowledge that MVA’s are the leading killer in the general population for this age group, I wasn’t sure if this was the case for athletes or not. Often, we hear only about morbidity and mortality that occurs on the playing field. While sudden cardiac death, heat illness, and concussion are important health concerns in the athletic population, we must consider the impact of medical care for the athlete both inside and outside of competition. Simple questions that assess potentially risky behavior (e.g. Do you wear a seat belt, do you drink and drive, do you text while driving, etc.) can go a long way in ensuring the health and safety of the athletes we manage. We hope that this article, and some of our new work on mental health in the athlete, can go a long way in re-defining our role as sports medicine physicians.

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Thanks a lot Irfan, for your time and your insight.  Exciting to hear about AMSSM’s celebrating its 25th anniversary:  we are doing the same here at CJSM!  We may just have to figure out a joint way to celebrate our organizational silver anniversaries in Dallas!

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