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Traveling with the Team
Luis Baerga-Varela, MD
Team Physician Puerto Rico Olympic Comitee
Assistant Professor University of Puerto Rico
Medical School
• Sports and Spine Fellowship – Kessler Institute• Team Physician Puserto Rico National Men’s
Volleyball Team (2006 – 2011)– 3 Norceca Tournaments– 1 FIVB World Cup – Japan 2007– 1 FIVB World Championships – Italy 2010
• Team Physician Puerto Rico Olympic Comitee– Olympic Comitte Sports Med Clinic– 2 Centralamerican Games– 2 Panamerican Games– 1 Olympic Games London 2013
My Experience
• Our Experience• How to prepare
– Vaccines– Jet lag– Altitude– Traveller’s Diarrhea
Overview
• 1 Delegation – Medical Team– Multiple sports– Full Clinic/Pharmacy– PM&R, Family Med, Orthopedist, Sports
Psych, Physical Therapist, Dentist• 1 Team – 1 Physician
– 1 Sport, thus sport specific injuries– Medical Bag– You’re it
2 Different Scenarios
• Panamerican Games – Guadalajara Mexico 2011
• Delegation of 406 (259 athletes)• 357 MD encounters (272 patients)
– 112 Medical illness (41%)– 160 MSK injuries (59%)
Our Experience
CNS
Derm
atol
ogic
ENT
Ophta
lmol
ogy
Oral
Cardi
ac
Respi
rato
ry GI
Gynec
olog
ic
Gener
al
8% 10%
5%4% 4%
4%
45%
11%
3%6%
System
Affected System (%)
Medical Illness by System
MSK Injury by Anatomic Area
Head
& Nec
k
Spine
Chest
Abdom
en
Pelvis
/Gen
italia
Shoul
der
Arm
Elbow
Forea
rm
Hand
& Wris
t Hip
Thigh
Knee
Leg
Foot &
Ank
le
4%
21%
1% 1% 2%
13%
0%1%
1%
10%
2%
9%
17%
5%
12%
Anatomic Area
Total Numbar of In-juries (%)
Type of MSK Injury
Strain
Sprai
n
Contu
ssio
n
Sublu
xatio
n/Disl
ocat
ion
Tear
Concu
ssio
n
Lace
ratio
n
Tendi
nopa
thy
Myo
fasc
ial P
ain
Syndr
ome
Chron
ic Pai
n
Facet
Syn
drom
e
Discog
enic
Back P
ain
Impi
ngem
ent S
yndr
ome
13% 13%
11%
1%
7%
0%3%
22%
6%
12%
2% 3%6%
Type of Injury
Number of
Injuries (%)
• Pre-participation physicals• Know your athletes’ needs• Prepare for your trip• Therapeutic Use Exemptions forms
Screen your athletes
• www.CDC.gov– Epidemics– Local infectious diseases– Special preacautions
Prepare for destination
• Resources available at venue– Ambulance, imaging, pharmacy
• Nearby hospitals/affiliation to event– Address– Phone numbers
• Temporary medical license• Assume nothing will be available
Prepare for destination
• Assume nothing will be available• Take into account athlete’s needs• Label medications banned by World
Antidoping Agency (WADA)• www.wada-ama.org
Medications
• All athletes and team members– Tetanus, diphtheria, pertussis,
measels,mumps, rubella and polio• Close contact athletes and medical team
– Hep B vaccine• Hep A is recommended for international
travel• Consider varicella and influenza vaccine
Vaccines
Kary JM, Lavalle M Clin Sport Med 26 (2007) 489-503
• Symptoms:– Daytime fatigue, nightime insomnia, irritabilty,
poor concentration, headaches, fatigue• Worse with eastward travel• Increases with time zones crossed• Affects athletic performance
Jet Lag
• 1 day of to adjust for ea time zone crossed• Sleep hygene prior to travel
– Avoid sleep deprivation, adjust sleep patterns and practice hours to new destination
• Reach destination close to new bedtime*• Avoid dehydration during travel*• Light training sessions on arrival*
Recommendations
* Expert opinion, poor evidence
• Evidence in reducing subjective feeling of jet lag
• No evidence of improved performance• May cause drowsiness and headaches• Not recommended if athlete not familiar
with its effects
Melatonin
• Diet– High protein in the AM– High Carbs in the PM
• Light– Shift body clock 1hour/day– Delay body clock
• Light exposure early evening
– Advance body clock• Light exposure late evening and early morning
Other alternatives
• Frequent hand washing• Bottled water/ No ice!• Avoid uncooked vegetables• Avoid fruits that can’t be peeled• Fluorquinolones are first line
– Cipro 250mg PO BID x 1day– Careful with tendon ruptures– Azithromycin 1000mg x 1
Traveller’s Diarrhea
• Reductions (day 1) in:– O2 consumption– Peak power output – Time to exhaustion
• Improves significantly by day 14• Travel with 2 weeks to adapt to altitude
exposure
Altitude
Schuler B, et al. Scand J Med Sci Sports 2007;17:588-594Clark SA, et al. Eur J Appl Physiol 2007;102:45-55
• Know your athletes– Preparticipation physicals
• Know your destination– www.cdc.gov– Resources, assume nothing– Time zone– Altitude
Conclusion
