Think twice before indulging in that Thanksgiving football game

Thanksgiving traditions include parades, family gatherings, turkey and often a friendly game of touch football. It is this last custom that may require medical consultation.

The athletes involved in any holiday competition fall into two groups: those who regularly participate in some competitive sport and those for whom competitive sports are a pleasant memory. It is this latter group that has the highest probability of visiting an emergency facility.

This Thanksgiving scenario provides a perfect background for a discussion of how to prevent and treat musculoskeletal injuries such as sprains and strains.

The best way to avoid any injury involving muscles, bones and their connections is with adequate warm up. This can be accomplished by an easy jog or jumping jacks.

Using any prescribed braces or wraps should not be ignored.

A sprain is best defined as the stretching or tearing of a ligament. Ligaments are the tissues that connect bones to other bones. Wrist and ankle sprains are commonly associated with recreational sports. A wrist sprain commonly involves a fall on an outstretched hand. Ankle sprains result from sudden inward motion of the ankle.

A strain involves injury to muscles or the tendons that connect muscles to bones.

The spine, especially the neck and low back, is particularly susceptible to strain injuries. Tendonitis such as that seen in tennis elbow is also considered a strain.
The best immediate treatment for these injuries consists of Rest-Ice-Compression-Elevation (RICE therapy). Ice should be applied for no more than 20 minutes, four to eight times per day. Longer applications of ice may result in frostbite and rebound swelling. RICE therapy should be continued for 24-72 hours or when swelling subsides.

Excessive swelling, bone pain or loss of motion in the joint involved makes a doctor’s visit necessary.

Many will see any avoidance of a family athletic contest as a sign of weakness, but discretion is always the better part of valor and no one wants to be in an ER when pumpkin pie is being served.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at, listen to his podcasts, comment on his blog or buy his book at

Diuretics for weight loss can have unintended consequences

What do actresses Joan Collins, Melanie Griffith and Beverly Johnson have in common with at least six NFL players? They all take the same weight-loss supplement.

Strange as that may seem, in recent weeks players from multiple teams have been suspended for using Star Caps, a popular 20-year-old weight-loss supplement primarily used by women. Advertised as being a natural way to lose weight, ingredients are listed as papaya, valerian, garlic and corn spices.

Unfortunately, off-shore labs are unregulated and all these athletes have tested positive for Bumetanide, a diuretic banned by the NFL.

Bumetanide is a potent diuretic commonly known as “water pills.” They act at the level of the kidney where they promote the excretion of electrolytes and water. Patients with heart failure are especially prone to dangerous fluid retention in the lungs and other organs. This retained fluid causes dangerously high blood pressure. Bumetanide and other prescription diuretics can be life-saving in these instances.

The fluid loss from diuretics also results in temporary weight loss. Athletes, models and others who are required to perform at a certain weight are particularly attracted to diuretics. Wrestlers and boxers have used diuretics to drop weight, allowing a powerful athlete to compete at a lower weight class. Bodybuilders use diuretics for appearance.

Some diuretics, including Bumetanide, are used to mask the presence of steroids in urine.

Diuretic use also has many dangers. By lowering blood pressure and depleting the body of electrolytes, they can cause dizziness, fatigue, irregular heart rhythms, muscle cramps and eventually permanent kidney damage.

Diuretic use has resulted in the deaths of several young high school and collegiate wrestlers.

The makers of Star Caps deny that their product contains Bumetanide.

The lesson here is that athletes thinking of taking any supplement should check with the team’s athletic trainer who can arrange for it to be tested. By not taking advantage of this option, several NFL teams will be without key players.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at, listen to his podcasts, comment on his Healthy Sports blog or purchase his book at

MRSA invades athletic arena

Much has been written about serious, and sometimes deadly, infections caused by so-called “super bugs.” Recently, this discussion has moved to the sports pages.

Tom Brady’s post-surgical knee infection will undoubtedly prolong his rehabilitation and emphasizes how infections can impact sports. Several NFL players have come forward to report how their careers have been shortened by persistent infections.

Staphylococcus aureus is a common bacterial organism found on skin. It is responsible for pimples and boils. Unfortunately, several factors have caused these bacteria to become a serious health problem.

Over time, “staph” has become resistant to many antibiotics. This is a result of antibiotics being overused when not required and the common use of antibiotics in animal feeds.

This common use has triggered the adaptive properties of bacteria to become resistant. MRSA (methicillin-resistant Staphylococcus aureus) is the most prevalent of these bacteria that have become resistant to many antibiotics.

Another factor in this problem is the nature of sports. Athletes are susceptible to open wounds that easily become infected and close contact during play allows for the direct spread of offending organisms. Towels and razors are often shared, providing additional vehicles for spread. Locker rooms are typically humid and damp, creating a perfect environment for bacterial growth.

“MRSA is not a problem in countries that have restricted the use of antibiotics,” said Richard Quintiliani, MD, a world-renowned infectious disease specialist who recently spoke at Backus Hospital on the topic of MRSA. He believes that people should not require antibiotics more than four times in their lifetimes.

Some tips for stopping the spread of infection in athletes:
• Wash hands frequently and thoroughly.
• Do not share personal items such as towels, razors and unwashed clothing.
• Cover all wounds with a clean bandage.
• Clean any shared sporting equipment with antiseptic solution.
• Avoid common whirlpools.

Paying attention to some basic rules of good hygiene should keep athletes in the
game and not on the sideline.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC in Norwich. To contact Dr. Alessi, email him To comment on his blog, listen to his podcasts or purchase his recently published “Healthy Sports: A Doctor’s Lessons for a Winning Lifestyle” book, log on to

Neurology Sports

In the past year, several sports and medical organizations have taken independent but cohesive actions toward making sports safer from a neurologic standpoint.

The American Academy of Neurology (AAN) represents more than 21,000 neurologists in the United States. In 2008, the AAN issued a position statement calling for greater neurologic participation in the regulation of sports that involve intentional trauma to the brain. Jasper Daube, M.D., chaired the AAN’s boxing task force. “It is the intention of the AAN to work closely with sports organizations to protect participants from serious neurologic injury,” Daube said.

Michael Mazzulli is vice-president of the Association of Boxing Commissions (ABC). “The ABC is working with physicians around the country to make boxing safer by imposing tougher medical regulations,” Mazzulli said. He also believes that only by educating fighters about the dangers of repeated concussions can we avoid chronic brain injuries and early dementia.

In Boston, the Sports Legacy Institute has begun the post-mortem analysis of donated brains from deceased NFL players to study the effect of repeated head trauma and the development of chronic traumatic encephalopathy. So far, five players who died in their 30s and 40s have donated their brains. All show pathologic changes consistent with those seen in dementia. Each player suffered multiple concussions in their careers.

Next week the PBR (Professional Bull Riding) will begin an extensive study including neurologic and neuropsychometric evaluations of its participants in an effort to make their sport safer. This study will include the use of accelerometers to measure the forces involved in injury and will compare results of riders using helmets versus those who do not.

These efforts indicate willingness for both medical and sports organizations to work together to reduce the risk of brain injury in athletes. Substantial changes can’t be far off with everyone moving in the same direction.