Sickle Cell Trait: What You Need to Know

As previous blogs have demonstrated there are a variety of conditions that can be of concern and potentially fatal if not treated quickly by trained professionals.  Some of the topics discussed include  sudden cardiac arrest, infectious mononucleosis, exertional heat illness, an asthma attack, and diabetic emergencies among others.  The topic I am going to discuss today is another one of those topics, sickle cell trait (SCT).  Understanding SCT is particularly important for certain segments of the population as it is more common in certain ethnic groups.  Additionally, exertional sickling and sickling collapse, an emergency condition that can result during intense exercise may sometimes be mistaken for exertional heat illness (EHI).  My goal today is to define SCT, differentiating it from sickle cell disease (SCD), provide you key identifiers that differentiates SCT from EHI (most often heat cramps) and provide a brief introduction to the mandated NCAA testing policy.

SICKLE CELL TRAIT (SCT) BASICS

SCT is present in those people who inherit one sickle cell gene and one normal gene (CDC).  SCT can be diagnosed with a simple blood test; infants in the United States are tested at birth.  SCT is different from sickle cell disease (SCD) because SCD requires the inheritance of two abnormal genes, one from each parent.  This gene results in the mutation of hemoglobin cells, causing them to take on a crescent or sickle shape (see image below) and making it more difficult for these cells to transport oxygen.

SCT affects 1 in 12 African Americans, but the condition can also be prevalent in those with ancestry from South American, the Caribbean, Central American and Mediterranean countries including Saudi Arabia, India, Turkey, Greece and Italy. As parents, it may be important that you ask for the results of this test for your new infant.  Despite the required testing most people do not know their sickle cell trait status unless they have sickle cell disease.  People are typically asymptomatic, but there can be potential for complications when the following conditions/situations are present:

• Increased pressure in the atmosphere (ex. when scuba diving)
• Low oxygen levels in the air (ex. very intense training, exertion at altitude)
• Dehydration
• High altitudes

SCT AND ATHLETES

As of this time, there is no recommendation that athletes with SCT should be withheld from participating in sports, however, some research has shown that athletes can be particularly at risk of complications from SCT when completing intense training.  The possibility of complications can be enhanced by training in extreme temperatures or at high altitudes (as previously mentioned).  The key to SCT is prevention is to set your own pace, rest often between drills/activities, stay hydrated before/during/after activity and keep the body as cool as possible when exercising in hot conditions according to the CDC fact sheet.

For an individual who has SCT and completing intense exercise the biggest concern is a condition called exertional sickling (and the resulting sickling collapse).  In exertional sickling the intense exercise causes normal the sickle shaped blood cells to “logjam” the blood vessels, slowing oxygen transport to the muscles.  Muscle tissue begins to breakdown after a prolonged period of a lack of oxygen resulting in a condition referred to as rhabdomyolysis.  This condition is a medical emergency and can lead to death if not treated immediately.  The biggest key to proper treatment is immediate recognition of the condition and proper treatment.  Exertional sickling/sickling collapse can sometimes be confused with exertional heat illness, particularly heat cramps.

EXERTIONAL SICKLING	EXERTIONAL HEAT ILLNESS
Typically happens within first 30 minutes on the field	Typically happens after prolonged exercise for more than 30 minutes
Core temperature is not elevated	Core temperature is typically >1040F
Pain is strong and generalized	Heat cramps:  muscle twinges and focused pain
Typically slump to ground with weak muscles; sufferers will lie fairly still and muscles will look and feel normal to the observer	Heat cramps:  suffers “hobble” and muscle are locked up and hard to touch, suffers will yell out/writhe in pain

If you or your athletic trainer suspect exertional sickling the athlete should be removed from activity immediately.  Oxygen can be administered if available (and someone is trained in its use) and the EAP should be activated.  A sickling collapse is a medical emergency.

RYAN CLARK, PROFESSIONAL ATHLETE WITH POSITIVE SCT STATUS

Want to know more about an athlete who’s competing in the NFL with sickle cell trait?  Check out Ryan Clark, Pittsburgh Steelers.  He has been able to have an NFL career despite being held out of recent games in Denver, Colorado given is SCT status.  Remember, exertion at high altitudes has the potential to result in exertional sickling/sickling collapse.  He has now started a foundation to search for a cure for the condition.

NCAA MANDATED SICKLE CELL TRAIT TESTING POLICY

The National Collegiate Athletic Association (NCAA) has mandated sickle cell testing for athletes.  This requirement is considered controversial by some based on the available (or lack thereof) research, but my goal is not to debate the merits of the requirement, but to help you understand it.  If you’d like to learn more about why some people believe the mandated testing policy is unnecessary check out this article.  Testing has been mandated for Division I athletes since 2010 and Division II since 2011.  Legislation just passed that will mandate testing at the Division III level starting this year (2013).  For those of you who are concerned and do not wish to have your child tested as part of their initial college pre-participation examination there is a waiver you can sign to opt out of the testing.  Additionally, SCT positive athletes are not restricted from participating in athletics, it simply allows the medical staff to be more aware of the possibility of a exertional sickling and sickling collapse.  Testing is expected prior to the start of the freshman year, or for any transfer whose status is not known.  Remember, if you have the SCT status of your child documented at birth, additional testing prior to the entry into college may not be necessary.  Find out more information and resources from the NCAA here or contact the sports medicine staff at the college/university your child will be attending.

RESOURCES

The documents listed here are mostly statements from various professional organizations regarding SCT trait status in athletes.  Some of the statements discuss recommendations for the safe sports participation and treatment in the instance of exertional sickling/sickling collapse.  Others discuss the need (or suggest there is no need) for SCT screening of athletes.  As always you are encouraged to take a look.

Recommendations of the Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC) to the Secretary, US Department of Health and Human Services on Screening of Student Athletes for Sickle Cell Trait

American Society of Hematology Statement on Screening for Sickle Cell Trait and Athletic Participation

American Medical Society for Sports Medicine Statement on Sickle Cell Trait

Consensus Statement:  Sickle Cell Trait and the Athlete

ACSM and NCAA Joint Statement on Sickle Cell and Exercise

National Athletic Trainers’ Association Position Statement:  Preventing Sudden Death in Sports

The Inter-Association Task Force for Preventing Sudden Death in Collegiate Conditioning Sessions:  Best Practices Recommendations

Submitted by Heather L. Clemons, MS, MBA, ATC

Are you Prepared for Your Summer Sports League?

School is ending in the coming week(s) and summer will be officially under way for many families.  With summer comes camps, vacations and travel teams.  With all this parents should be aware of how (and by whom) their children's health and safety is being managed.  Parents who have children who will be signing up for fall travel sports should also begin asking questions now about health and safety concerns. Asking questions early means that if changes need to be implemented there is time before the actual sporting season begins.  In an effort to help parents ask the right questions here are five questions every parent should ask before their children participates in organized sports.

DOES THE LEAGUE HAVE AN EMERGENCY ACTION PLAN (EAP) IN PLACE?

This post defines what an EAP in and the major components is should include.  It also refers readers to a key resource regarding EAP development, the NATA Position Statement on emergency planning.  While there are several conditions that may require specific detailed EAPs, given the focus on concussions time is spent specifically on the topic.

IS THERE AN ATHLETIC TRAINER AVAILABLE?

This post takes a significant amount of time to make you familiar with what an athletic trainer is and the skills they have.  Much time is spent on the major educational requirements and the knowledge and skill areas athletic trainers are qualified in once they pass the national certification examination and begin practicing.  The post also introduces you to the major organizations associated with athletic trainers including the NATA, BOC and CAATE.  There are also a variety of position statements put out by the NATA on topics such as heat illness, emergency planning concussions, asthma and other topics that are relevant to youth athletes and are available for public review.

IS SOMEONE WHO IS TRAINED IN CPR AVAILABLE AT ALL TIMES?

This post explains what CPR is and how you can become trained to utilize it in an emergency.  Links are provided to the three major organizations that provide courses around the topic of CPR (and AED) as well as providing information on the topic of hands-only CPR.  

IS THERE AN AUTOMATED EXTERNAL DEFIBRILLATOR (AED) AVAILABLE?

This post takes the time to explain what an AED is, how it works and how to use it.  Many states also have public access laws in place which means when you're in the airport, at the mall, or at the public pool there may be an AED available for use in an emergency.  This post can help you understand where AEDs may already be available in your state and to help you get AEDs in your school or for your league if you don't have them already.

ARE COACHES TRAINED IN KEY SPORT SAFETY GUIDELINES?

This posts lists/discusses key governing organizations for some of the most popular youth sports such as USA Football, AYSO and Little League Baseball among others.  It also discusses key equipment safety organizations such as NOCSAE and HECC and finally provided some resources for proper coaching technique around football tackling and managing baseball pitch counts in young players.

Submitted by Heather L. Clemons, MS, MBA, ATC

Dietary Supplements: Energy Drinks

The most popular dietary supplement outside of a multi-vitamins are energy drinks.  Red Bull.  Monster. 5-Hour Energy. NOS. Full Throttle and many others.  According to some research there are over 500 different energy drinks on the market.  I bring up the topic of energy drinks because they are particularly popular among teens and young people and some research has shown that energy drink companies are marketing to this group.  The biggest concern connected with energy drinks is the potential for caffeine intoxication and other side effects including seizures, mania and even sudden death.  To understand the popularity of these beverages in the United States you only need to know that in 2012 the energy drink market was valued at $12.5 billion and young adults are considered the core market. 

WHAT IS AN ENERGY DRINK?

Energy drinks typically contain caffeine, taurine, sugars and sweeteners and herbal ingredients that are combined to give an “energy boost”.  These drinks are distinctly different from sports drinks and vitamin waters.  According to the National Federation of State High School Association (NFHS) Position Statement and Recommendations for the Use of Energy Drinks by Young Athletes, “An energy drink is a beverage marketed to both athletes and the general public as a quick and easy means of relieving fatigue and improving performance” usually using very high concentrations of caffeine and carbohydrates.  Energy drinks differ from sports drinks because sports drinks are designed to provide rehydration (and basic carbohydrate replacement) during or after athletic activity, containing a 6% - 8% carbohydrate solution and a combination of electrolytes formulated for maximum absorption.

Caffeine is typically the main active ingredient in any energy drink, containing 70-80mg per 8 ounce serving; energy shots can be even more concentrated.   To give you an idea, a typical energy drink contains about 3 times as much caffeine as a cola-based soft drink. The concern with energy drinks is that although the amount of caffeine (added as pure caffeine) may be listed on the ingredient label, the actual amount of caffeine in any given drink is hard to calculate. This calculation is difficult because most of these drinks include additional ingredients that contain caffeine, not reflected on the ingredient label.  Some typical additives are guarana, kola nut, yerba mate, cocoa, green tea, synephrine, and yohimbine among others.

The International Society of Sports Nutrition (ISSN) Position Stand:  Energy Drinks (2013) has published several tables that can easily help you understand the ingredient list of several common energy drinks in the United States as well as the purported effect of many of the ingredients found in energy drinks.

Sample energy drink ingredient list #1

Sample energy drink ingredient list #2

Ergogenic nutrients that may affect cognition/mental performance

Potential stimulants in energy drinks

Other ergogenic ingredients

TEEN AND ADOLESCENT CONSUMPTION OF ENERGY DRINKS

According to some study data teens consume 60 – 70 mg/day of caffeine, mostly from soft drinks.  Caffeine consumption has ranged as high as 800 mg/day in some studies and energy drinks are becoming more and more popular.  Some research shows that drink makers are even marketing to younger consumers.  These companies are savvy and use sporting events and athlete sponsorships, along with key product placement on social media sites and in video games to connect with your kids.  Consumption rates vary, with one study finding that 28% - 34% of 12 to 24 year-olds regularly consume energy drinks,  College students were particularly prone to consuming energy drinks habitually to improve energy (usually due to a lack of sleep). 

HEALTH CONCERNS RELATED TO ENERGY DRINKS

Energy drinks can pose a risk to anyone who consumes them, with the most commonly reported symptoms centering around caffeine toxicity.  Energy drinks are not regulated by the FDA because they are considered dietary supplements (unlike soda which is limited to 71 mg caffeine per 12 oz. soda).  The FDA is currently responsible for investigating “Adverse Event” reports related to energy drinks and energy shots.  Currently there are reports regarding Monster, Rockstar, Red Bull, and 5-Hour Energy that you can view HERE.

The top 10 side effects associated with energy drinks according to a study by the Medical Journal of Australia are listed below.  These results are based on analysis of 7 years of phone calls to their poison control center.

1. Palpitations/tachycardia (rapid heart rate)
2. Tremor/shaking
3. Agitation/restlessness
4. Gastrointestional upset
5. Chest pan/ischemia
6. Dizziness/syncope (fainting)
7. Paraesthesia (altered sensation)
8. Insomnia
9. Respiratory distress
10. Headache

Of these, the most concerning are the cardiac symptoms.  There is a concern that caffeine toxicity in children with a cardiac condition (known or unknown) could ultimately lead to death due to sudden cardiac arrest.  Cardiac events could be especially of concern in children with ADHD, an eating disorder or those with diabetes.  There is some research (although controversial) that suggests calcium deposition in the bone is decreased in adolescents because caffeine interferes with intestinal calcium absorption. I bring this up because the adolescent years are the period of the most significant bone development

An additional concern, particularly for college age adults is the combination of alcohol and energy drinks.  Doing so often gives individuals a false sense of sobriety, leading to poor decision-making.  This topic is beyond the scope of this post, but if you’d like more information check out this article to learn more about the warning issued by the American Medical Association.

POSITION STATEMENTS AND OTHER RESOURCES REGARDING ENERGY DRINKS

Listed in this section are current position statements and other articles regarding the consumption of energy drinks with a particular focus on teen and adolescent consumption as sources allow.  I have used these sources to help inform this blog post, but I encourage you to read the full articles and position statements to gain a fuller understanding of the topic.

The International Society of Sports Nutrition Position Stand:  Energy Drinks (2013)

The National Federation of State High Schools Association (2011)

Sports Drinks and Energy Drinks for Children and Adolescents:  Are They Appropriate (2011) Pediartics, 127 (6)

Health Effects of Energy Drinks on Children, Adolescents, and Young Adults (2011) Pediatrics, 127 (6)

 Submitted by Heather L. Clemons, MS, MBA, ATC

Drew Babb's Incredible Journey from Arapahoe High School Lax Star to Denver Defenseman

How many athletes can you think of who have been forced to take three years off due to injury or sickness, only to come back stronger and start in their return to their respective sport? I can only think of one – Drew Babb, Senior Defenseman for the University of Denver Lacrosse team.

Drew Babb had just finished his high school career at Arapahoe High School where he was a four-year varsity letterman, a two-time All-State selection, an All-American as a mid-fielder, and a team captain who led his team to a state championship title in 2009. He was slated to play Division I lacrosse at the University of Denver, where he would presumably continue the immense success that he had in high school. Babb’s future coach at the University of Denver, Bill Tierney, was expecting nothing less of the talented, high school phenom.           

“He was a guy you couldn’t stop gushing about,” Coach Tierney told Lax Magazine in an interview last year. “What a great player this kid was.”

Unfortunately for Drew, the story was not going to go quite like that. Drew had been competing with neck pain in his senior season at Arapahoe after his neck began to swell in February of 2009. He was in and out of the doctor’s office for the next few months after repeated failed attempts to treat the swelling. Drew’s doctor had him take a full biopsy on July 1^st after graduating from high school. The day after, Drew was watching TV when his father walked back into the house shortly after he was supposed to have left for work and passed on grave news to him from his doctor – Drew had been diagnosed with Stage I Hodgkin’s Lymphoma. Drew’s father received the results and delivered the news to his son. Drew was more shocked than panicked when he heard the news.

“When my Dad told me the news, he was very positive about it. It was very comforting to know how good it was that we caught it that early,” Drew told me over the phone.

Drew subsequently went through five months of chemotherapy while taking classes at the University of Denver during his freshman year. When asked about the difficulties of managing a college course load and attending practices along with the chemotherapy, Drew downplayed it and attributed his ability to manage the work to the administration and professors at DU. There are no classes at DU on Fridays, so Drew would receive chemo Friday, wait for the nausea to subside, and return to class on Monday.

“I would miss classes on Mondays occasionally, especially later in the treatment when the nausea was worse,” Drew commented.

At the end of this five-month period, the doctors could find no trace of the cancer. However, during the third round of his chemo, another obstacle blocked Drew’s path on his way to recovery. Like most cancer patients who endure chemotherapy, Drew lost his hair and was very nauseous. Although, in addition to the other symptoms, Drew had exceptionally bad body aches in his hips. He would later find out that the reason for this was Avascular Necrosis, which is a condition that was deteriorating Drew’s right hipbone because of a lack of blood supply. This meant a year’s worth of inactivity according to Drew’s doctors – thus ending his hopes of playing his freshman year at the University of Denver.

Even after being diagnosed with Hodgkin’s, Drew was expecting to be able to play in the spring of his freshman year. When he found out he had AVN in his right hip, he thought he would at least be ready to play by his sophomore year. When he was rehabbing in the summer of 2010, a week before the fall practices began, the doctors informed Drew that his right hipbone was growing back on schedule; however, the AVN was infecting his left hip as well, and it was not healing like his right hip did. Thus, the doctors drilled holes in Drew’s hips to increase blood flow to expedite bone regeneration. Unluckily for Drew, this meant that his collegiate career was being cut in half because he would not be able to play his sophomore season either.

Although Drew had not been cleared to play for two years, he was still around his teammates and assisting the team in whatever way he could. To stay in shape in the fall of 2010, Drew swam. As time went on, he began to use the stationary bike and the elliptical, but until he had his final bone scan, he would not be able to run unless it was evident that the AVN had disappeared and his hipbones were growing back.

When asked about the frustration of being on the sidelines, Drew said, “It was definitely frustrating, especially sophomore year it got tougher. I was expecting all freshman year to be able to play that season, and it didn’t happen.”

In February of his sophomore year, Drew received news from the doctors that he would be able to play again.

“The week leading up to those scans was the most uncomfortable week I felt throughout the whole experience of not being able to play, and that includes being diagnosed with cancer and going through chemotherapy. Because, essentially, [the scan] was going to determine whether or not I would ever be able to run again.”

That week, Drew met with Coach Tierney in what turned out to be one of the most calming and helpful conversations that Drew would have throughout his treatments. Coach Tierney asked Drew how he was doing, and Drew said he was nervous. Coach Tierney told Drew he may not understand why all of this stuff was happening to him now, but he will someday.

“That really helped me get back to that comfort level. Whether I can play or not was not up to me,” stated Drew after talking about the assurance of Coach Tierney’s words.

Drew always tried to stay positive about the whole process.  He is very open about his faith as a Christian, and it was that faith and the Christian household he grew up in that really helped him get through all of the hardships and stay positive. He stated that it was God’s plan, and that he will do what he can, but ultimately will trust in what God has in store for him.

Even after Drew was informed he would play again, that did not mean he was free of the challenges that being on a nationally ranked, division I lacrosse program would bring. Drew was an All-American mid-fielder in high school, but Coach Tierney was in need of defensemen when Drew’s junior year rolled around. To add even more obstacles to returning to his former self on the field, Drew was moved to close defense in the off-season after showing his propensity for the position in a scrimmage against the Denver Outlaws, the local professional lacrosse team.

When it came to switching positions, Drew just seemed happy to be back on the field and playing again. However, when he exceeded even his own expectations and saw a potential starting spot opening up for him, he began to appreciate the ability to play while also wanting to compete.

When Drew took the field for the first time since his injury, he described the day as follows:           

“It was surreal. During warm-ups, I was just looking around and realizing what I was about to do after what I had been through the past years. It was just so exciting to be playing instead of watching,” Drew said.

Evidently, it did not take Drew long to acclimate himself to playing a new position after taking two years off, because Drew started Denver’s season opener against the Ohio State Buckeyes and never looked back, starting all 16 games that season. He played through intense pain all year, and the amount he was allowed to play was at his own discretion.

In addition to the pain he felt because of the AVN, late in the regular season Drew tore his labrum and played through the pain believing it was the AVN. He went to the doctor for another scan, and was informed he would have to undergo another surgery to repair the labrum and spend six months recovering.

After yet another setback, Drew fought through it and did not allow self-pity to sink in.

“Every time I started feeling sorry for myself, I would start thinking about Tommy [Mallon] and his neck injury. I have seen friends go through things like this,” said Drew. “I did my chemo at the local children’s hospital and saw children taking chemo at ages 4 and 5. I would think about those kids going through worse diseases than me, and say if they could do it then so can I.”

Drew continues to play through the pain. When the weather changes it is especially bad, and on rare occasions he has to pull himself out of the game. At the beginning of this year, the labrum was brutal. However, as time has gone on he has gotten stronger and stronger.

“I feel stronger this year in the playoffs than I did in last year’s playoffs,” said Drew when asked about how he currently feels.

Drew and his teammates at the University of Denver play in the Lacrosse Nationals Semi-Final game against top-ranked Syracuse, and Drew likes their odds.

“We feel good about [tomorrow]. Once you get this far it is really anybody’s game,” said Drew about DU’s chances against the #1 team in Syracuse.

Drew succeeded in battling against cancer, bone deterioration, and a torn labrum just to play in tomorrow’s game, so upsetting the nation's top-ranked lacrosse team would just be like any other day for a guy like Drew.

Performance Enhancing Drugs: Anabolic Steroids

I posted last week about using dietary supplements as a way to improve athletic performance and gain a competitive edge; this week I am going to talk about performance enhancing drugs (PEDs).  My specific focus will be(anabolic) steroids, as the larger topic of PEDs is too broad to address in one blog entry.  Athletes who want to be the best at their sport will sometimes make the decision to utilize PEDs in order to gain that competitive edge.  These PEDs, while illegal, more importantly typically have damaging side effects from long-term use.  The focus of this blog is to make parents aware of the possibility that your child-athlete may be using steroids and how to recognize such use.  This post will not address the cultural pressures of sport that may cause young athletes to feel as though resorting to PED use is a key to their athletic success.

According to Drug Free Sport, Inc., PEDs are defined as, “any substance taken to perform better athletically.”  These substances typically fall in the following categories:

• Ergogenic aids
• Amphetamines
• Prescription drugs
• Alcohol
• Over-the-counter drugs (OTCs)
• Recreational and street drugs

Ergogenic aids is a particularly broad category that can include anabolic steroids, human growth hormone (HGH), ephedra (and its derivatives), and creatine to name a few.  Drug Free Sport, Inc. does provide some free information on its website, but is primarily a client-based service that provides information regarding many PEDs, banned substances and dietary analysis of dietary supplements.  Many NCAA institutions may have access to this resource as well as other leagues and teams.  If you’re wondering if a team or program your child is associated with has access, ask the appropriate administrator or coach.  If your child’s team or league does not have access, perhaps you could advocate for a membership as appropriate.  This site can be a valuable tool in learning more about what your child is ingesting and why they should avoid PEDs.

ANABOLIC STEROID USE IN TEENS

Last week I pointed you in the direction of the Taylor Hooton Foundation, whose mission is to educate us all on the prevalence of anabolic steroid (and more generally PED) use among middle school and high school athletes and non-athletes alike.  The organization was founded because of the suicide of Taylrr Hooton, a 17-year old from Plano, TX, as a result of using anabolic steroids.  According to their FACT SHEET, over 1.5 million teens (12-19 years old) admit to using steroids and it’s not just the boys.  The median age for using steroids for the first time is 15 years old.  Also, many users (62.5%) do so to improve their looks, not just their athletic performance.  Steroids can be found online in about 1 second.  Check out the fact sheet for more!

RECOGNIZING THE SIGNS OF USE

Anabolic steroids can result in a variety of physical and emotional signs that in combination should be a red flag for any parent.  The Taylor Hooton Foundation lists a variety of physical and psychological effects that range from acne, oily skin, and gynocomastia (male breasts) as well as severe mood swings, aggressiveness and sudden anger.  Girls who use steroids tend to develop typical male secondary sex characteristics such as deepened voice, facial hair, and irregular menstrual cycles.  Steroids negatively impact bone development and your liver, kidneys and heart.  These effects are often irreversible once you have discontinued steroid use.  Refer to this LINK for a complete description of all listed side effects.

The NATA Position Statement:  Anabolic-Androgenic Steroids (2012) takes a more clinician, evidence-based approach to addressing steroid use, but for those who are interested is some of the current references on the topic , you may find this source useful.  The statement reiterates and emphasizes the need for recognition and education around the topic of anabolic steroids, but includes information particularly relevant to college-age athletes.  The statement importantly notes there are situations where certain types of steroids may be used therapeutically, in very low doses.  Steroid abusers often uses extremely high doses of steroids in comparison. 

TALKING TO YOUR KIDS

One of the biggest challenges for all parents is talking to their kids about difficult topics, drug use (of any kind) among them.  As a college athletic trainer I always found it challenging to talk to adult athletes about difficult topics when they were not my children.  I can only imagine the difficulty for parents trying to reach a child.  I am falling back to the Taylor Hooton Foundation here.  They have put in the time and effort and have an organized list of pointers to help you talk to your children about steroids, click HERE to learn more.  Most importantly, you should talk to your children before they have an opportunity to use steroids, set the expectation that such behavior is inappropriate, unsafe and illegal.  If you believe your child is using steroids you should conduct a urine test.  If you’re unable to complete a home test, take your child to the physician and specifically request it be tested for steroids. Screening for steroids is not part of a typical urine test panel.  It is important that you make the difficult choice as a parent to address the drug use and be persistent until you have reached your child and change their behavior.  Your child’s life could depend on it, especially at the middle and high school level where there may not be an athletic trainer (or another educated individual)  looking out for their safety.

DRUG TESTING PROGRAMS

The NATA Position Statement recommends random drug testing (as allowed) as part of a regular abuse prevention program.  At the collegiate level, drug testing programs are often a regular part of athletic participation.  These tests not only screen for steroids, but other banned substances.  Make yourself familiar with the NCAA Banned Substance List to understand exactly what athletes are being tested for.  Remember, the NCAA has also partnered with Drug Free Sport, Inc., so use them as additional resource as necessary.  You can also learn more about the standard drug testing procedure through the NCAA website.

As a parent of a high school athlete you may not have regular, random drug testing to help you determine if your child is using steroids (testing minors without consent is not allowed), making it even more important for you to recognize the signs and address the matter immediately.  As a previously mentioned, if you believe drug testing is a necessary step you may be able to purchase a test kit, or request that your family physician compete a steroid test.

As you review some of these resources you’ll notice how dietary supplements keep coming up.  The reason for this is the purity issue that I addressed last week.  According to the Taylor Hooton Foundation up to 20% of dietary supplements are spiked with a banned substance (often steroids), which is why it’s important to know what your child is taking.  You may believe your child is taking something that is safe, effective and pure.  Remember, if you are going to utilize dietary supplements, use those that have been verified as pure by a third-party verification system.

In the end, as parents all you can do is educate yourself and then educate your children to make positive choices.  Unfortunately, positive choices aren’t always the easy ones and children can make poor choices under pressure.  I hope this post has given you a head start on learning how to recognize steroid use in young athletes and the strength to help you send a powerful message about the dangers of anabolic steroids.  I hope that no one ever has to take the difficult step of confronting a child about steroid use, but should that situation arise, the earlier you recognize the signs and intervene, the better for your child and his or her health and safety.

Submitted by Heather L. Clemons, MS, MBA, ATC