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ORANGE COUNTY VOICES : School Physical Exams Need to Use Latest in Diagnostics : Medicine: Pretesting of athletes to protect life should not be hostage to a dollar sign.

March 07, 1994|ARTHUR D. SILK | Dr. Arthur D. Silk is an internist in Garden Grove. and

There was a funeral for a 16-year-old Orange County schoolboy two weeks ago. We have the knowledge and the technology to prevent these kinds of deaths. This innocent Irvine lad died playing basketball in a high school gym class.

Each year we are jarred by the deaths of young apparently healthy youngsters or young adults not previously thought to be ill who collapse while engaged in some sort of athletic activity. Most such catastrophes occur when a heart rhythm suddenly goes from a life-sustaining regular beat to a wildly chaotic and usually fatal irregularity. This may be what occurred in the Irvine youngster. Paramedics found him in full cardiac arrest.

Most of these tragedies occur because of the presence of a silent potential killer, a congenital abnormal thickening of a portion of heart muscle. The condition itself is not a killer. Recognized and treated, most people with this disorder can live out a normal life span. But sometimes under the strain of physical exertion the heart becomes chaotic and often the patient dies before electrical shock can restore its normal rhythm.

Occasionally an ordinary cold virus can temporarily infect the heart, which makes me cringe whenever I hear of college or professional athletes being pressured to play football or basketball with fever or flu.

The congenital condition can be readily diagnosed by a relatively new but universally available procedure called echo-cardiography, an ultrasound picture of the heart. Every youngster who may engage in moderately heavy physical exertion should have this procedure to avoid the tragedy we lament today.

In a comment accompanying the news of the student's death, a university cardiologist is quoted as saying that "sudden death in adolescents is so rare that it is not practical to screen everyone in that age group for heart disease." Not practical for whom? Not practical for the mourning Irvine family who will no longer have the joy of raising their 16-year-old? Not practical for the friends and classmates who mourn him and may have suffered grievous lifelong psychological trauma?

I used to perform school physical examinations on athletes. Often, they just lined up in the locker room for a perfunctory check with no more than a stethoscope and a tongue blade. Even when they were required to come to my office, only minimal examinations were authorized. I simply could not tolerate pronouncing a student fit because I knew that I had not been allowed to perform all the necessary and available diagnostic tests. The Irvine death as well as others grimly illustrate that insidious killers can be present that can be detected only by the more sophisticated diagnostic tools now available, but which society is unwilling to authorize because "sudden death in adolescents is so rare." I don't do those examinations anymore.

The pretesting of young athletes to protect life should not be hostage to a dollar sign.

The odious term "cost-effective medicine" has made deeper and deeper inroads into the medical lexicon. I hate the phrase. What does it mean and where does it end and who defines it? Kidney transplants, then heart transplants and now liver transplants were all at one time considered beyond the economic pale. Now they are all but routine. Are they cost-effective? How do you measure in dollars the addition of a year or two to a life span?

Every young person entering high school should have a complete examination, including an EKG--and at a time when we are recommending vigorous exercise for everyone, an echo-cardiogram should be mandatory too. I am sure the parents of the students at University High would all now agree.

The death is tragic but if anything at all can be learned from it, it is the price we pay in lives of loved ones when we examine diagnostic procedures through the green eyeshade of an accountant instead of the trained eye of a capable physician.

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