May 09, 2013
News Office: Leland Kim (415) 502-6397
Lowell High School football player Jacky Tang went through a barrage of medical tests ranging from cardiac exams to an orthopaedic consult on Saturday morning.
He's not at his doctor's office; rather, this 17-year-old athlete is at UCSF's PlaySafe Cardiac Physicals, a clinic hosted by volunteer UCSF doctors and other health care providers at the UCSF Orthopaedic Institute at Mission Bay. The goal is to detect underlying medical abnormalities in high school athletes and prevent sudden death.
"In the past, we had a player at Lowell who had heart failure, and he died suddenly," Tang said. "It was really shocking, so you just want to do everything you can to make sure that it's not going to happen to you."
That's why Lowell and 18 other public and private high schools in the Bay Area have joined PlaySafe, the most comprehensive health-screening program for high school athletes in the Bay Area. It is the only program of its kind to offer comprehensive cardiac screening, including echocardiography, a type of ultrasound that can detect abnormalities in the size and shape of the heart, as well as identify any tissue damage.
"From time to time we do find some chief abnormalities that may impact their lives — something called hypertrophic cardiomyopathy or the thickening of the heart muscle — which can make it difficult for the heart to pump blood," said Dr. Melvin Scheinman, a cardiologist and electrophysiologist, and one of the founding fathers of the field of cardiac electrophysiology. "These athletes are at risk for sudden death from exertion, so these kinds of examinations are extremely important because we can hopefully detect athletes at risk."
The PlaySafe Cardiac Physicals Event takes high school athletes through multiple stations, which include eye exams, blood pressure checks, cardiology consults, physical exams and orthopaedic consults.
"We're looking for evidence of heart disease, and this could present in a lot of subtle forms," Scheinman said. "So we look for inheritable heart diseases, problems that develop over time. We also look to see if there's any evidence of congenital heart disease, or problems kids are born with, where these kids can get into trouble."
The goal is to keep athletes safe.
"Certainly a good physical exam is important especially before the sports season starts," said Dr. Anthony Luke, a sports medicine specialist. "And if there's anything we can do to try to detect abnormalities and prevent something bad from happening, we certainly should do what we can."
PlaySafe attracts high school programs not only in San Francisco, but also from the East Bay and the Peninsula.
"We're able to screen a large volume of kids in a single day," said Dr. Brian Feeley, an orthopaedic surgeon. "And it gives us, as physicians, peace of mind that the athletes are as healthy as possible."
This free service, supported by more than 100 UCSF volunteer physicians, other clinicians and staff members, is especially beneficial to athletes who may not have the resources to see a doctor on a regular basis.
"EKG is pretty expensive," Tang said. "Some athletes don't have the money to do it. And some pediatricians or family doctors may be really backed up on appointments, which means it could take two to three weeks. PlaySafe is free and a physical lasts a whole year."
If an EKG screening show abnormal results, UCSF's PlaySafe program will use an on-site echocardiogram to determine the exact nature of the cardiac abnormality.
"Most who have sudden cardiac death have congenital abnormality or abnormality they're born with," Scheinman said. "However it's very subtle in the sense that you have no sign of it until you're in your adolescence and it begins to manifest. By the time they're a high school athlete, we have a pretty good chance of detecting it by team screening which involves taking a careful history, listening to the heart for murmurs, as well as doing an electrocardiogram."
The echocardiogram allows PlaySafe doctors to provide care more expeditiously than their counterparts at other free health screenings available to high school athletes.
"There are other programs out there that do something similar where you combine an EKG with a sports physical," said Jason Miyamoto, manager of the athletics trainers with the UCSF Orthopaedic Institute. "But what happens when the EKG is abnormal? You make a recommendation and ask the athlete and their parents to follow up with their cardiologist. It could take a couple of weeks to a month to be seen. Meanwhile mom and dad sit at home very worried and concerned about their son or daughter, wondering about the result.
"To be able to deliver the EKG, have on-site echo, get an almost immediate answer of what we see and diagnose potential abnormalities, set our program apart."
PlaySafe started at UCSF's Orthopaedic Institute in 2009. The program has grown over the years, screening more than 1,300 Bay Area high school athletes. It also has an outreach component with 10 athletic trainers and five physicians who work with high school sports programs year round.
"Every year we involve more and more specialties," said Dr. C. Benjamin Ma, chief of the UCSF Sports Medicine and Shoulder Service. "We have the cardiac group involved and the medical group involved. Now we have the concussion group involved, which does important things the public doesn't know too much about. We have the most comprehensive screening to make sure we don't miss any underlying conditions."
Over the years, the PlaySafe program has diagnosed potentially life-threatening conditions such as Wolff-Parkinson-White syndrome, a heart condition in which an abnormal electrical pathway disrupts the blood flow of the heart.
"Sometimes residents will say they have a lot of normal examinations," Ma said. "But even if you have only one or two abnormalities, those are the one or two that will make a difference, and that will be a worthwhile use of our time because we were able to prevent catastrophic events in these young athletes' lives."
And for the majority of athletes who leave PlaySafe with a clean bill of health, spending their Saturday at a hospital clinic was time well spent.
"It's one less thing for you to worry about," Tang said. "It's better to be safe than sorry, especially since it's free."
About UCSF Benioff Children's Hospital
UCSF Benioff Children's Hospital creates an environment where children and their families find compassionate care at the forefront of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital. For more information, visit www.ucsfbenioffchildrens.org.
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