Monday, August 25, 2008

Some final thoughts

Yesterday was the last day of the Games. I assisted with medical coverage of the marathon in the morning. Luckily the weather cooperated and it was not too hot or humid, so there were no problems with excessive dehydration. Most of the injuries that we see in distance runners are overuse injuries, such as stress fractures of the lower extremity (foot, tibia, etc.).

Last night I marched in the Closing Ceremonies with the athletes. We had a blast! The Chinese really put on a show! The ceremony was quite an extravaganza---London has a tough act to follow for 2012. Part of the closing Ceremony is the "handoff" of the Olympic flag from Beijing to London. David Beckham came in on a London-style double decker bus. Quite a show!

One of the best parts of the Closing Ceremony is the chance to mingle with many of the athletes who we have treated and come to know over the past 3 weeks. We also met many athletes from other countries. This is the real unique part of the Olympics: the chance to meet so many different people from all over the world, on a "level" playing field. It definitely makes one realize that people are much the same anywhere one goes. That seems like a pretty good lesson.

Thursday, August 21, 2008

Sports medicine in a Beijing hospital

Today I was given a tour of the Sports Medicine department of the Peking University 3rd National Hospital, which is the largest sports medicine department in Beijing. It was fascinating to see how they do things and to compare treatment and rehabilitation regimens. Overall, their treatment protocols are similar to what we do in the U.S., although there are some differences. Of note, patients stay in the hospital for 4-8 days for procedures that we do as an outpatient in the U.S. However, their ultimate outcomes and return to sports timeline is very similar to ours. We visited the bed side of several post-operative patients, including a professional football (soccer) player. We then had dinner with several physicians, and I met a medical student whose father had worked in research at our hospital with my good friend and mentor Peter Torzilli. Very small world! Another lesson there about the Olympic Games: sports really does bring people together and proves that it truly is a small world.

A great Olympic smorgasbord experience

Yesterday was a great Olympic smorgasbord experience, as I was able to see and provide medical coverage for a variety of events. I provided medical coverage for the "marathon" swim (10 kilometer) in the morning, synchronized swimming in the afternoon, women's 10 meter platform diving in the evening, then went to the National Stadium ("Birds Nest") for track and field at night. Quite a day! One of the great things about the Olympic Games is the opportunity to see so many world class events and athletes in the same day. At the track last night I had the opportunity to watch several track athletes who I had treated in competition.

This was the first time that there was a 10 kilometer swim in the Olympic Games. This is essentially an "open water" swim, which is a growing sport internationally. The event is being held at the rowing venue, which is a man-made course. The swimmers complete 4 laps of a 2.5 kilometer course. There are distinct challenges in distance swimming, somewhat akin to the marathon run. The athletes need to feed and drink during the race. This is done by coaches using a long stick to pass food/drink to the athlete at "feeding stations" on a dock. Hypothermia is a concern in many open water races that are swam in lakes or ocean. However, since this race was contested in a relatively shallow basin, the water was warm. Dehydration is a concern in these situations, so we assured that the athletes maintain appropriate hydration. The race lasts approximately 2 hours, similar to a marathon run. The race was won by a Dutch athlete who had previously been treated for non-Hodgkins lymphoma (this has been widely reported in the press), making for a great story.

Sunday, August 17, 2008

Swimming history

The last 2 days have been as exciting as any that I have ever seen in swimming, and I would venture to say as exciting as any 2 days in swimming history. It all started with Michael Phelps' come from behind win by .01 second in the 100 butterfly. That win was an example of an athlete who just seemed to want it more than his competitors. Great swimmers have a way of getting their hand on the wall first in close races. It was all the more amazing given the circumstances, as this was his 7th gold medal, tying Mark Spitz and keeping his streak alive. The thing that seems to set Michael apart from others is the way he elevates his performance when the stakes are the highest.

After swimming was over in the morning, I covered the women's 3 meter springboard diving semi-finals. The U.S. had 2 divers (Nacilea Foster and Christina Loukas) who advanced to the finals. After covering the diving event I was able to go the National Stadium ("Birds Nest") to see some track and field, including the men's 100 meter final, which was won by Usain Bolt from Jamaica in an amazing world record time of 9.69. Since I have always enjoyed track and field, I would say that yesterday was one of the best days of sports I have ever seen, with these 2 marquee events (M. Phelps' 7th win and the men's 100 meter run) --- right up there with the NY Giants' Super Bowl win. One of the great things about the Olympics is the opportunity to see such great performances in different sports all in the same week or even in the same day!

Although it would be hard to top yesterday's excitement, today may have done so as M. Phelps won his record 8th gold medal. This was especially fun because it was the result of a great team effort on the men's 400 meter medley relay. The team consisted of Aaron Peirsol, Brendan Hansen, Phelps, and Jason Lezak. I was especially happy for these guys because I have known them all for over 4 years, as all 4 were on the 2004 Athens Olympic team. All are classy individuals and great ambassadors for the sport and for all U.S. athletes. The media and security presence was pretty crazy after Michael's 8th win.

Another great story from swimming has been Dara Torres, the 41 year-old swimmer (and mother!). She won a silver medal today in the 50 meter sprint freestyle, just missing winning the gold by .01 second. She made her first Olympic team in 1984! This is Dara's 5th Olympic team, which no swimmer has ever done. Obviously an inspiration to lots of middle-aged folks! We can learn from performances such as Dara's. The Olympic Games offer lots of examples of the limits of performance being re-defined, and this is one more example.

On the medical side of things, I have continued to treat both gastrointestinal illness as well as sinusitis, upper respiratory conditions, coughs, and sore throats. We have also had a few minor injuries in swimmers (finger, elbow) which occurred from a forceful finish. As Phelps demonstrated, a swimmer may hit the wall hard in an effort to get there first. Neither turned out to be serious injuries. I have treated several track and field athletes with various musculoskeletal injuries. I have also treated other Americans here, including family members, officials, and members of the media. As a physician, I am happy to help all Americans here!

Friday, August 15, 2008

Another great morning at the pool

We had another great morning at the pool today: 3 gold (all in world record times), 1 silver, 2 bronze. Ryan Lochte won bronze (missed silver by .01 second) in the 200 Individual Medley just 25 minutes after winning the 200 backstroke. That is a very impressive double. Another athlete with amazing performances is Natalie Coughlin. She has won 5 medals, including a gold in the 100 meter backstroke.

On the medical side, the gastrointestinal issues are still occuring, but are responding well to treatment. My wife (Christine Frissora) is a gastroenterologist, so I have an expert to consult! I have also received expert advice from Dr. Brad Connor, a travel medicine specialist in New York City.

I have helped treat several of the U.S. Track and Field athletes. Their competition started yesterday.

I have also been covering the diving competition. As a physician covering diving, I am prepared for possible head or spinal injury that could occur from contact with the platform. We are also prepared with the appropriate equipment for initial immobilization and treatment of possible head or spinal injury. Common injuries in divers include lumbar spine, shoulder, wrist, and elbow problems. The divers do some gymnastics type of training which can lead to lumbar spine problems.

Another exciting story here was the first and second place finish in the women's gymnastics all-around. One of the great things about the Olympics is the numerous events that are all occuring simultaneously. Although we are so focused on swimming right now, there are equally great competitions going on all over Beijing. Off to the competition now...

Tuesday, August 12, 2008

Breaking world records

We have had 3 amazing days of swimming competition. So far Michael Phelps is 3 for 3, all in World Record times. It is a privilege to help take care of the greatest swimmer ever.

I imagine everyone saw or heard about the Men's 400 meter Freestyle relay. This is one of the marquee events of the Games, and the U.S. won with a truly incredible performance, breaking the world record by 4 seconds and just edging out the favored French team. I remember standing on the sidelines at the Superbowl this past January with the Giants and during the last drive I was thinking that it was just like an Olympics final: it is something an athlete has trained for since they were a kid and careers could be defined based on what happens on the next 5 minutes. Well, the Men's 400 meter Freestyle relay was just the same. I guess you could say that the relay swim was like the Giants last (winning) drive in the Superbowl. The anchor leg (Jason Lezak) was like Tyree's catch against his helmet. This is one of the things I love about sports: to achieve at this level, someone has to step up and do something special. As is said in football: Big players make big plays in big games...

On the medical side, I have kept busy treating gastrointestinal upset and traveller's diarrhea. This is rather common (almost expected) in new environments with changes in food, water, etc. I have also been busy accompanying our athletes during the drug testing process. Both urine and blood samples are being analyzed. The top 5 finishers in each event are tested, as well other random athletes. I am there to ensure that the protocols are followed very carefully.

Monday, August 11, 2008

Meeting other athletes

President Bush came to the National Aquatics Center on Sunday and met some of the athletes. I had a chance to meet him and chat briefly. On Monday many of the NBA players came to watch swimming, and we had a chance to sit with them and talk about sports. This is one of the unique things about the Olympics environment that I also remember from the 2004 Athens Games, the chance to meet many other athletes from all types of sports. One can sit down in the dining hall and eat with a fencer from Romania, a gymnast from Japan, a marathoner from Kenya, etc. As a physician it is interesting and educational to see the different types of injuries that occur in different athletes and sports. I also learn a lot observing and speaking with athletic trainers and physicians from other sports and from other countries. We get to share notes and experiences, as well as form new friendships.

Saturday, August 9, 2008

The competition starts today!

We are all ready, after training camps at Stanford University, Singapore, and then here in Beijing. The U.S. Olympic Swimming team has a number of world record holders, so we look forward to a strong showing. However, there are challenges from athletes from all over the world.

The schedule for the preliminaries amd finals has been reversed to allow for the final to be shown live on the east coast in the U.S. This is great for the U.S. viewing audience, as you will get to see most events live! The finals will be in the morning here, while the preliminaries will be in the evening. This is a huge change (and concession to TV), since most all sports have always had the finals in the evening. This schedule change has had implications for athletes schedules for training, sleep, and meals. We start with preliminaries tonight (Sat. Aug. 9) in swimming.

Friday, August 8, 2008

Arrival in Beijing

We arrived in Beijing August 4. The first thing to strike us was the incredible media presence and the air quality. There is always a media crush with Michael Phelps with the team. The U.S.O.C. security staff helped us get through the media chaos in the airport.

The air quality has been a topic of concern for the past year leading up to the Games. When we landed at the Beijing airport the air was very hazy, as bad as any air pollution I have ever seen. We have activated carbon filtration masks for the athletes to iuse if needed. However, the swimmers have really not been affected by the air so far and have not used the masks. The National Acquatics Center is indoors, so there is less exposure to the outside air. We are carefully monitoring those athletes who have a history of respiratory problems such as asthma, as they are most likely to be affected by the air pollution. There has been a pall of hot, humid, and hazy air hanging over the city for the past 4 days.

Doping control is a big issue in the Olympic Games, as widely reported in the press. A number of our athletes have been tested (blood and urine tests) while we were in Singapore as well as after arriving here in Beijing. One of my jobs as team physician is to accompany the athletes through the process, to ensure that the protocols and rules are followed strictly. This is an area where we cannot be too careful.

Monday, July 28, 2008

Pre-Olympic Training Camp

We departed the U.S. on July 25 for a training camp for the U.S. Olympic swim team in Singapore. This allowed the athletes to acclimate to the heat and humidity that we would experience in Beijing, and to adjust to the time change (Singapore is in same time zone as Beijing). From a medical standpoint, as the physician I am busy prior to the Games with a number of issues. I review all of the athletes (and staff) medical histories and medications. Several types of medications, such as asthma inhalers, insulin, ADD medications, require special permission (a "therapeutic use exemption") before they can be used. One of my duties as team physician is to coordinate these forms. I also spend time educating the athletes about issues related to acclimation to the heat and humidity, how to best adjust to the time change, appropriate and safe nutrition in a new environment, and the importance of maintaining hydration in this hot, humid environment.

Another very important area is doping control, and educating the athletes to the risks of over the counter supplements (these substances are not FDA-regulated, and thus can potentially be contaminated). Over the counter medications for cold and sinus conditions can also contain banned stimulants (especially brands sold overseas), so we educate the athletes about this risk. I have a well stocked medical bag with supplies and medications to treat all of the common conditions that we are likely to encounter.

Sunday, July 20, 2008

Pre-Games Preparation

Just as the athletes prepare intensively with their training, the sports medicine team prepares thoroughly to provide excellent medical care. I believe in the adage: "if you prepare for problems you won't have them". In the months before the Games I arrange for local medical contacts that would be available in the event of an emergency or if we need to obtain imaging studies (X-ray, MRI). We recommend specific vaccines in the months prior to the Olympic Games and also educate the athletes and staff about strategies to minimize the effects of jet lag, the dangers of positive doping tests from contaminated supplements, and issues related to the expected heat and humidity of Beijing.

Monday, June 30, 2008

Issues affecting the athletes

As a clinician, we're consulted for a wide variety of problems. You're almost doing everything but orthopedics. They'll come to you with everything - to the athletes you're just "Doc".

Among swimmers, as well as other athletes, injuries that occur at major sports events are most often related to over-use such as rib stress fractures, tendonitis, impingement syndrome in the shoulder, and some low back pain. We work closely with others on the medical team to treat and prevent a vast assortment of physical problems.

A distinctive quality of sports medicine at competitive events is that taking a few days off to rest and recover is not really an option. We are challenged to use all our skills to address pain and injury in the moment. About half of the swimming injuries are musculoskeletal -- mostly shoulder and knee pain. But, occasionally we see injuries that are more severe.

Part of our role is to treat them and rehabilitate them to get them back as fast as possible, while at the same time truly knowing when someone should be disqualified or when they shouldn't compete.

It's not obvious to outside observers that making time adjustments necessary to ensure live television coverage in the United States presents swimmers with one of their biggest challenges. Swimmers are retraining themselves to swim earlier in the morning since they will be waking up very early to warm-up, eat, and then prepare to compete in the medal finals in the morning, rather than having the finals in the evening as has always been the tradition in the past. Since fractions of seconds count, every nuance of an athlete's state of health can make a difference, and we are especially attuned to addressing any sign of fatigue or strain linked to this change of routine to avoid injury and maximize performance.

We also deal with dehydration and nutritional issues and supervise athletes during random and scheduled drug testing in compliance with Doping Control rules.

Ideally, there will be no injuries at the Olympics. But, given that world-class athletes are pushing their bodies to achieve more than they - or anyone else - has achieved, we are assembled and ready to provide treatment if any physical injury occurs.

Hospital for Special Surgery Physician and Physical Therapist Selected for Beijing Games

Selected by the U.S. Olympic Committee to join its medical team, Hospital for Special Surgery sports medicine experts, orthopedist Scott A. Rodeo, MD, and physical therapist John Cavanaugh are among a group of about 30 health-care professionals chosen to protect the health of the nation's elite athletes at the Beijing Olympic games.

Dr. Rodeo will be providing running commentary on this blog during the games. Both he and Mr. Cavanaugh have been assigned to swimming as their primary sport. As team physician, Dr. Rodeo will also cover diving, water polo, and other events.

Dr. Rodeo first served as a member of the U.S. Olympic Medical Team at the Athens Olympics in 2004.