Stroke Before 50? Is It Possible?

We certainly stereo-type stroke to be an event that occurs to 'older' people - someone in their fifth decade of life or older.  The article below identifies an atypical stroke patient - a 22 year old college student.

http://www.cnn.com/2011/11/11/health/oneill-stroke-anniversary/index.html?hpt=hp_bn10

I selected this story as athletic trainers as the population in which we work with are a seemingly healthy population and we assist them once they have become injured.  This story reminds us that no matter the age of an individual, as a health care provider we need to be ready for what comes our way with regard to our patients.  The care we provide can range from something fairly simple and not so stressful to a life-threatening or life-altering situation.  In the case of this article stroke/CVA is a pathology we need to be aware of, be able to recognize the signs and symptoms and be able to provide first aid.  The National Stroke Association has created a public service announcement in which they use the acronym FAST-

• Face - does one side droop - can they smile?
• Arm - can they raise both arms?
• Speech - is their speech slurred?
• Time - if you see these signs/symptoms call 9-1-1 immediately

http://www.stroke.org/site/PageServer?pagename=symp

Child Taken Away From Parents Due to Excess Weight

Wow - can this really happen?  There has been prior discussion related to obese children and how to handle to safety and welfare of those children.  One directive that was considered was to legally separate the child from the household/care givers/parents in which they reside.  The notion behind this action is to place the blame on the parents for 'allowing' their child to become obese and by taking away the child from the house, they would learn healthier eating habits.  Although in the past this was only at the discussion level, it seems that in one community this, in fact was the case.

  http://www.nydailynews.com/life-style/health/obese-elementary-school-student-parent-home-report-article- 


While I do not hold the answers to the childhood obesity problem we suffer in the US, separating a child from their respective family is a questionable practice at best.  Changing behaviors is difficult to do - think of yourself trying to do something different.  Take a look at all of the New Year's Resolutions that occur each year, and how many people actually meet the goal of their resolution.  There are so many issues tied into obesity - where one lives, the cost of food, types of food being offered in their store, education level, ability to make healthy meals at home, stores available in the area, access to the stores, access to a safe place to exercise, access to parks, time to be able to exercise - these are only a few issues that may contribute to the obesity issues the US seems to be suffering from.  I would like to believe that we will identify a better way to manage childhood obesity, but I fear that we will not.  I am a firm believer that we must involve many more individuals within the community to begin to create change, and do believe that 'it takes a village' to raise a child.  Further, I do not believe there is one approach that can 'fix' all communities, but rather, each community will need to address their own needs and design programs that will be successful within their respective community.

Athletic trainers have a 'community' within their respective work places.  Perhaps we have the ability to help to create a change by creating programs that could be used within our respective work places.  Education alone, has already shown to not be successful.  We know we should be eating healthier, and yet we choose not to.  Therefore, a varied approach needs to be taken into consideration.  I do believe, however, that separating children from parents is not the solution.



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Bullying of our GLBTQ Patients

This post follows my more recent posting of bullying in general.  This post specifically looks at bullying due to one's perceived or actual sexual orientation.

The link to the story is below:

http://www.cnn.com/2011/10/12/us/minneapolis-bullying-schools/index.html?hpt=hp_c2

The Youth Risk Behavior Survey (YRBS) is completed nationally every two years by the CDC.  Click the link below to gain access to the 2009 results:
http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf ;
http://www.cdc.gov/media/releases/2011/p0606_yrbsurvey.html?s_cid=2011_p0606_yrbsurvey


With specifics to bullying, GLBT students identify they are bullied more often.  We also find that with attempts at suicide GLBT students are at greater risk (roughly 88%) than their heterosexual counterparts (40-50%).  So what is our task here, as athletic trainers?  Again, my personal view is to create an atmosphere that is affirming and welcoming to all REGARDLESS of one's gender, orientation, race, socio-economic status, religious/spiritual affiliation, etc.  I realize this is easier said than done as issues of sexuality cross over many lines including family upbringing, religious practices and personal beliefs.  What I am asking athletic trainers to do is to continue to work on being accepting of others who may have different beliefs than us,and to be respectful of those beliefs.

As a society, perhaps we should work more to 'agree to disagree' and to do so with respect.  I would like to believe that we can create safe environments for our patient base where we are not 'tolerant' (this word has a negative connotation for me), but rather accepting.  Too many young people are hurting themselves (even killing themselves) and their families in making difficult decisions when faced with the day in and day out struggle they face in school.  Some have suggested that  they have no place to turn, no place in which the comments and harassing stop.  I would like to believe that we, as athletic trainers, can make the difference in people's lives by treating them with respect and acceptance.

Bullies - What Role Do ATs Play to Decrease Bullying Behavior?

Much has been written about within the last year about bullies and the impact they have on victims.  We know from the literature that bullying has profound effects for both the bully and the victim.  In addition, we know that forms of bullying actually vary between genders (ie. boys being more physical and girls bullying by social isolation and exclusionary behaviors).

When we think about who the aggressors are, many times we visualize the older, bigger kids who threaten the smaller kids to 'give me your lunch money, or else.' This study suggests that "It's really not the kids that are psychologically troubled, who are on the margins or the fringes of the school's social life. It's the kids right in the middle, at the heart of things ... often, typically highly, well-liked popular kids who are engaging in these behaviors."

http://www.cnn.com/2011/10/10/us/ac-360-bullying-study/index.html?hpt=hp_c1

The research suggests that kids are actually have a dual role - they are both the bully and the victim.  The extent to what role they play, is based upon their hierarchy in their social circle.  The study suggests that often the biggest offenders are the popular kids.  Interesting the study also pointed out that most of the behavior is not identified to adults with 81% percent of aggressive incidents never reported.

The study also identifies the findings have been similar in other geographical settings of the U.S.  The author also states that "Family background of kids does not really seem to matter in their aggressive behavior. Instead, what really matters is where they are located in the school hierarchy," Faris said. He said he believes the patterns, "arise in a wide range of schools across the country regardless of what community they may be in."

So what does this mean for us as athletic trainers?  Do we have a role in preventing bullying?  My answer is that we do.  In fact, we may find it difficult to believe that the popular, well-liked student-athlete is also one of the biggest offenders to other students.  Within our professional practice it is identified that we need to treat others with respect.  I believe that we also need to ensure that we create an environment of safety for all of our patients who come into our facility.  That would mean designing, implementing and reinforcing an acceptable code of conduct for both patient and practitioner to ensure all feel the very facility in which they come to 'heal' their injury, is in fact a safe place that 'heals' their body.

More Make-Up = More Trustworthy?

A recent study was conducted from Harvard, Mass General Hospital and Proctor and Gamble that compared observers perceptions of pictures of women's faces with various stages of make-up on.  The results, which shouldn't seem surprising for US culture which seems to glorify beauty, demonstrated that the participants (both men and women) perceived the images of the women with more make-up on to be more attractive, more trustworthy, more likeable and more competent.  It seems, however, that there is an important balance as when too much make-up is used the participants rated the person as less trustworthy than the image of a woman with no make-up on.  The video link is below:

http://abcnews.go.com/Health/video/makeup-changes-perceptions-of-women-14662824#.Tout4zx3xts.google

How does this relate back to us as athletic trainers and educators?  Well, as this is only one study it would be difficult, at best, to generalize the results to suggest that all females should be taking classes on how to apply make-up.  What it highlights for me is the image that we have socially ingrained into our brains that wearing make-up equals being a beautiful person.  I believe the message this study sends to all - men, women, boys and girls - is that if you are not attractive, you are less than worthy, you are not smart enough, trustworthy enough.  I am not sure that is the message we want to be putting out there.  Instead, I would like to have messages sent out - especially to our youth - that each of us is unique and we should celebrate that.  Dove has created a video they are using for girls and self-esteem - I would like to see more of these types of messages rather than the message of putting on more make-up!

Lack of Sleep and Risk Taking in Teens

We already know that when we don't get enough rest, we may not be at our best.  One study, however has shown that teens who do not get enough sleep may be prone to take more risks.  Here is the link
http://thechart.blogs.cnn.com/2011/09/27/sleep-deprived-teens-take-more-risks/

The research also discusses that teens who do not get enough sleep may have higher rates of participating in risky behaviors "such as smoking, drinking alcohol, being sexually active, using marijuana, lower physical activity, and feeling sad or helpless."

What they  were able to identify is that when teens had less than 8 hours of sleep, the teens associated with 10 of 11 risk behaviors.  These risk behaviors included: "drinking sodas with sugar, time spent exercising per week, TV watching time and non-school related computer use, cigarette, alcohol, and marijuana use, being currently sexually active, feeling sad or hopeless, fighting, and whether they had considered suicide during the past year."

Should we be concerned about our teen patient population's sleep patterns?  My argument is that yes, as a health care provider we should recognize that our patients may be participating in risky behaviors.  In practicing risky behaviors, these individuals may be more likely to become injured.  Why, you may ask?  Well, this may be the soccer player who dives to make a goal, or a football player who lowers their head to make a 'crushing' tackle on an opponent.  Perhaps we should be asking our patients, when we take their medical history what their sleep patterns are like and how many hours of sleep they get each night.  Through our queries, we may discover they are not getting enough rest.  Further probing questions may be needed in order to identify the reason or reasons.

I am not suggesting that all student-athletes who take risks on the field are sleep deprived.  What I am suggesting is that perhaps, in light of the literature, we ask our patients what their sleeping habits are.  This may assist us in providing better, quality care that is individualized for them.

Remember Your Uninsured Patients

This story highlights the assumption that once a prescription is written, an individual has the ability to fill it.  In this case, a patient had a tooth that became infected.  They had gone to the emergency room as they did not have insurance.  What follows is a sad story whereby the patient did not have the funds to fill the scripts that were written - one for pain killers and one antibiotic.  They were able to pay for one script and opted for the pain medication.  I am sure had they realized the fatal choice they had made, they would have chosen to fill the antibiotics.  To read the story here is the link:http://abcnews.go.com/Health/insurance-24-year-dies-toothache/story?id=14438171

As athletic trainers, we too, may fall into the trap of making assumptions regarding our patients and their ability to follow through with the treatment plan we prescribe.  Can you think back to a time when a patient may have been suffering from foot pain you know is related to the type of shoe they were wearing and told them to buy a new pair of shoes that would support their arches better?   Has a patient ever broken their glasses and you had assumed they could simply replace them by buying another pair?  Or  have you ever suggested your patient merely needed a pair of orthotics to take away their back pain?  Did you ever consider they may not be able to follow through with your treatment plan due to financial difficulties?

We need to be sure that we get to know our patients and have a better understanding and appreciation of who they are, how they value the medical community and their ability to follow through with the care and treatment plan we create.  Given the economic times that we are living in, it seems rather imperative that we do not make assumptions regarding our patients financial situation.  Rather, we may need to consider that when we make a treatment plan, we also bring up an appropriate conversation in a confidential setting in which we discuss with our patient their ability to follow through with what we would like them to do.  Perhaps theirs is a hardship case whereby they will not be able to complete all areas of the treatment plan.  In that case, working together both health care provider and patient can create an alternative plan that is 'do-able' to both.

Sad, But True Regarding Health Status

America, has it really come to this?  A man robbed a bank for $1 in order to be arrested so that he could get health insurance in jail!  Here is the link to follow the story.


http://abcnews.go.com/Health/Wellness/nc-man-allegedly-robs-bank-health-care-jail/story?id=13887040

In looking at the US and where we stand regarding the health status of our population in comparison to other countries is actually surprising.  We are ranked 30th behind other countries who we often stereotype as being 'behind' the US.  PBS had completed a television series, Unnatural Causes, Is Inequality Making Us Sick.  This chronicles the social determinants of health such as race, socio-economic status, education, and place of residence.  According to one author in this series, ones' health outcomes can be predicted by looking at the zip code in which one lives.  Here is the promotional video to the series:

As health care providers we need to take into account our patients' social determinants of health in order to provide the best care possible as well as creating an environment in which we will be able to have the best outcome for our patients.

Exercise in Our High School Population - Troubling Statistics

The CDC has recently reported findings from a study conducted in 2010 that should not shock us.  Click on the link to the story that was found in CNN below:

http://thechart.blogs.cnn.com/2011/06/16/cdc-high-school-students-dont-exercise-enough/ 

• ·         High school students are not engaging in enough regular physical activity

• ·         Only 15% of HS students get the one hour of daily aerobic exercise a day

• ·         1/3 of HS students drink 2 or more sodas, sport drink or other sugary beverages a day

• ·         HS girls are far less likely than boys to meet the recommendation for exercise

• ·         Students in higher grades are less likely than underclass students to get enough exercise

• ·         63% of the HS students polled consumed at least 1 soda or other sweetened drink per day; 33% drank 2 or more

Studies have also linked increase in consumption of these sugary drinks and lack of exercise by adolescent populations to obesity.  In turn, more adolescents are being identified with Type II Diabetes, traditionally an adult pathology.

There is no easy solution to manage adolescent obesity as there are many more variables that contribute (ie. Parent involvement – or lack thereof; value of exercise; access to safe places to play).  However, something that may be able to assist is to have states follow the guidelines the National Standards for Physical Education (NASPE) has developed both at the preschool level and k-12 levels.  These Standards are linked below.

http://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfm

http://www.aahperd.org/naspe/standards/nationalGuidelines/PA-Children-5-12.cfm

Having our children more physically engaged may assist in curbing the effects of overweight, inactive children who then grow up to possibly be overweight, inactive adults. 

Is Treating All Our Patients "Equally", Equal?

I realize with this post that I may upset some individuals as what I propose and question revolves around the mantra of 'equal treatment for all'.  With regard to medicine, research has been able to identify pockets of populations that have higher risk factors to develop specific pathology - ie. CVD, diabetes, high blood pressure and obesity to name a few.

I am wondering if in fact, to treat our patient populations equal, that rather than provide the same interventions, preventative protocols and treatments that we actually have to treat each individual patient differently.  This would entail actually getting to know our patients on a personal level and finding more about them.  We make assumptions all the time about individuals based upon what they are wearing, the cars they drive, the schools they attend, the neighborhood in which they live and the vernacular in which they use.  The link I have posted below gives one perspective for a teenager who had 'outed' themselves and had identified as being a lesbian.  It not only chronicles both the support she has received from her family, but also the difficulty she has had to endure in her school life.

http://www.cnn.com/2011/HEALTH/06/10/lgbt.acceptance/index.html?hpt=hp_bn6


In reading both this article and another article that was recently published, "The Sissy Boy Experiment", I came to question if in fact, we as health care practitioners are missing something in our practice.  Here is a video of CNN's Anderson Cooper discussing what this experiment was about.

What I propose is that we need to understand and practice that each patient who seeks our assistance is, in fact unique.  They come to us with their own values and life experiences.  We know that literature suggests there are risk factors that will place one individual at a higher rate of developing a pathology.  From the literature, we have observed that GLBTQ populations suffer at higher rates of depression and substance abuse; that certain races will acquire a higher rate of pathology over others; and that there are socio-economic factors that tie into childhood obesity.  Perhaps, as clinicians, we need to be sure we are taking the 'whole person' into account when we provide care to our patients, and not make assumptions based upon what we see or hear.  Just as not all African Americans will develop high blood pressure, nor will all children from lower socio-economic status develop obesity, not all individuals who identify as GLBTQ will develop depression or substance abuse issues.  We as clinicians, however, need to be ready to provide the best health care we can to our individual patient based upon them, not our past experiences with other patients, but our experience with this unique patient.

Grief - Who Helps Us?

 

As athletic trainers we are educated to react and respond to a multiple of scenarios.  Students have courses in prevention, management, acute care, rehabilitation, evidence-based medicine, administration and professional development.  Educators constantly prepare students by asking - “What do we do if?” or “What do we do when?”  

I am not sure how much we prepare ATS to process  tragic situations when they occur.  Certainly, in educational programs we are to cover content that deals with loss – but oftentimes, that is framed as to how our patients will handle loss – the loss of a season due to injury, the loss of the function of a body part, the loss of a game.  I don’t feel we educate enough on how we as ATs, will also be grieving in tragic events, and we too, may need assistance to develop healthy coping mechanisms.

This news article, I believe, highlights the need for ATs to also consider what is done for themselves to healthfully handle tragic situations that may arise in our professional lives.  Hayden Walton was a healthy 13 year old boy, who was struck in the chest while playing baseball.  This strike interrupted his heart rhythm, and although paramedics arrived to the scene to assist, Hayden died the next day.

http://www.nydailynews.com/news/national/2011/06/04/2011-06-04_13yearold_little_leaguer_hayden_walton_dies_after_being_hit_in_the_chest_with_ba.html 

   

I know there was not an AT who provided health care in this news story, but imagine that instead of this being summer baseball, this was a high school athlete.  Imagine the AT was there to provide assistance – to do everything they had been trained to do  - and the outcome was still the same.  I do not feel we have a support system ‘built-in’ the professional framework.  Too often, ATs are left on their own to attempt to process the loss.  Perhaps it is time for the profession to model something similar to the profession of nursing – specifically oncology nursing in which there are networks of support built into their daily work life.

This topic had affected me so much that I wrote a manuscript with a few other colleagues and had accepted into the ATEJ.  I am placing that link here should you want to read.

https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0By8pw-qzu2AZMmM2ZGZhMjMtN2RjOC00MjJhLWFiN2MtZmIzOWU0YjZiOTZk&hl=en_US 

What is Our Role as ATCs in Curbing Diabetes?

I recently watched a podcast that CNN had put on their website - America's Problems with Diabetes.  I have place the link here -
http://www.cnn.com/video/#/video/podcasts/gupta/site/2011/04/11/sgmd.diabetes.epidemic.cnn?iref=allsearch

Some of the startling information that Dr. Gupta provides is as follows:

1. Americans are more sedentary 
2. Americans have poor dietary habits
3. Americans are lacking in regular exercise
4.  By 2020 (tens years from now), one-half of Americans will either be diagnosed with diabetes, or will be considered pre-diabetic
5.  Some consider diabetes to be an epidemic in the 21st Century

Diabetes has been considered a 'twin epidemic' closely tied to obesity.  Where we see one, we more than likely will see the other. Sadly, we are now seeing Type II Diabetes, a traditional adult disease, being diagnosed more and more in our pediatric population.

The questions then arises, hmmm . . . . what can we do as athletic trainers?  What should we do as athletic trainers?  Do we have the content knowledge to be able to assist with this potential epidemic?  It is my belief that we have an obligation to step forward and share the knowledge we have as health care providers to our populations in which we provide health care.  There are several avenues in which we can assist in bringing change to our respective work environments.

Get involved in the culture of your workplace.  Find out who the stakeholders, policy makers and decision makers are.  "Bend" their ear with regard to what data is demonstrating is happening and what the suggested outcomes will be if we do not address the issues of poor food choices on an individuals' part; lack of healthy selection of food choices on the part of the school, college, workplace; sedentary lifestyles; limited access to recess and physical education for children; limited accountability on university's part for addition of activity courses as 'core' curriculum; and  limited access to be able to exercise.  These, of course, are only a few barriers that must need to be addressed.  Others we need to consider include: an individual's value of exercise; one's access to healthy and economical foods; access to exercise - either a safe place and/or time availability; childcare or adult care (family issues); cultural issues revolving around food, exercise, health and medical care.

As athletic trainers we are formally educated on nutrition.  Being educated, and being healthy, however can be two dichotomous variables.   Just because we have knowledge, does not necessarily mean we know how to create behavior change in individuals.  Therefore, I believe it is also imperative that as athletic training professionals we also have an understanding of theories of human behavior.  We need to have a working knowledge of theories like the Transtheoretical Model, the Precede/Proceed Model and the Social Belief Model to name a few.  Once we are 'armed' with this information, we can begin to utilize it to assist others in creating healthy changes in their lives.

I realize that diabetes and obesity are out of control in numbers.  Much more needs to be completed on a community, regional and national level to aid in curbing these numbers.  People need better access to safe environments in which they can bike, walk, rollerblade, exercise.  City and Town Boards need to do better at legislating for federal dollars in order to make exercise and lifetime wellness a priority for their constituents.  Food companies need to be held accountable to place on their food labels all appropriate information to better educate consumers. School districts need to push to have better food choices available, recess AND physical education for all.  Universities must consider the addition of physical education and/or lifetime wellness classes to their 'core'.

This is an uphill battle and one that is most certainly going to be a difficult one as our culture does not seem to value lifetime wellness -- if we did, I believe we would see more pro-active types of programming available.  That being said, I do believe that as athletic trainers we can begin to make change, even if small, within our respective communities.

My Athletic Training Philosophy as a Clinician

As an athletic trainer, I believe in providing the best possible health care to my patients.  In being able to provide this care I realize that I need to possess a variety of skills.  The obvious skills include those cognitive and psychomotor skills any athletic trainer should possess.  These are entities that are outlined through the Role Delineation Study.  Perhaps not so obvious are the skills that can differentiate a ‘average’ athletic trainer from an ‘outstanding’ athletic trainer.

I take pride in learning about the patients to which I provide care.  This includes learning more about the individual, their culture, language and their life.  I feel that I am a better clinician for taking the time to know my patient on more of a personal manner, rather than as a clinician/patient relationship only.  I also realize this philosophy will conflict with what others may follow as their mantra as a professional, however, for me, this type of relationship between clinician and patient affords me the opportunity to provide the best care possible while also taking into account the needs, values and philosophies of my patient.   

I understand the importance of confidentiality and maintaining a level of decorum that reflects the Code of Ethics of the National Athletic Trainer’s Association.  As a ATC, I make it part of my philosophy to demonstrate, through my actions, the importance of being a professional member of the association.  The manner in which I talk with patients, assist with their rehabilitation and manage acute care situations reflects positively on myself and on the profession of athletic training.

I value learning and as such have committed myself to be a life long learner.  I make efforts to hold the role of either a presenter or participant at professional meetings at the state, district and national level. I educate myself through reading and viewing the literature and research being conducted with content in the medical community as it relates to athletic training.  I also feel it important that I am an active participant in developing the very literature in which fellow professionals are reading.  I therefore, make effort to publish within professional journals in order to further promote the profession of athletic training. Ultimately, it is my belief that I am able to provide the best care to my patients when I am up-to-date with what the literature is discussing. 

I believe that through the efforts I have taken, and through the philosophy I have developed I am able to provide the best care possible to my patient base.  This includes providing both acute and long-term care.  I provide best practices as have been identified in our professional literature to give care to patients with the goal of getting them back to their skills of daily living or to participation as quickly as possible while at the same time providing no further harm.