Michael Abrahams | Take school medicals seriously
The sudden death of schoolboy footballer Dominic James plunged our nation into mourning. Dominic was an outstanding athlete, representing Jamaica College at the under-16 and Manning Cup levels and more recently, captaining the St George's College Manning Cup team. He was also a part of the national under-20 training camp this year.
I do not know Dominic's medical history, and even though the cause of death was unethically leaked to the media following the autopsy, I am unable to say if his death was preventable. However, the incident has brought the topic of medical evaluation of schoolchildren, especially athletes, to the fore. The event has also had a powerful impact on me because of a recent experience that I feel compelled to share, as it may save a life.
On September 1, 2016, less than three weeks before Dominic’s demise, I was asked to perform a school medical on a 15 year old schoolboy about to enter fourth form (grade 10). I am an obstetrician and gynaecologist, but every now and then I am presented with requests such as these and I oblige.
When his blood pressure was taken, it was found to be 150/70, which is elevated. His pulse rate was 96 per minute which, although within range, was at the upper limit of normal. The examination of his chest was even more remarkable. A heart murmur was easily heard at all auscultation points (the areas that physicians listen to for heart sounds), and there was obvious heaving of his chest. I asked him if he has ever been told that his blood pressure was elevated, and he told me that he was informed last year, but that there was no follow-up. I asked him if he experiences shortness of breath during physical exertion, and he answered in the affirmative, stating that this has been observed from he was in first form. Because of this, he keeps goal when he plays football, as it requires little running.
His medical history and examination findings were cause for concern. After the examination, I took him to the pharmacy on the compound and offered him a drink. He chose coconut water. I picked up a can of Red Bull, showed it to him and said, “Do not drink this”. I explained to him that if his cardiac function is suboptimal, exercise will further compromise it, and adding an energy drink to the mix can push his cardiovascular system over the edge, resulting in decompensation and its disastrous consequences.
Subsequently I took blood from him for a variety of investigations, and his haemoglobin was markedly elevated. Haemoglobin is the iron-containing oxygen-transport protein in our red blood cells. Anaemia refers to the condition when the haemoglobin level is low, and is unhealthy. An abnormally elevated level, called polycythaemia, is also unhealthy, and may occur when the body lacks oxygen and produces excessive haemoglobin to compensate. The problem with this is that the proportion of red blood cells in the circulation increases, resulting in increased thickness or viscosity of the blood, which can be associated with a higher risk of thrombus or clot formation in blood vessels, leading to heart attacks, strokes or pulmonary embolism.
Following his evaluation, I documented my findings and recommended to the school that the student abstain from sporting activities until after his cardiovascular system has been evaluated. I referred him to a cardiologist, who discovered even more pathology, as his ECG was abnormal, and an echocardiogram showed an abnormality with one of the valves in his heart. The cardiologist then referred him to a haematologist (a doctor who specializes in blood disorders), who repeated his haemoglobin level, and found it to be even higher than before. He is still being evaluated.
What is interesting, and alarming, is that this youngster has been representing his school in football since first form, but a family member confided to me that this was the first time that he actually had a proper medical, performed as thoroughly as it should have been. That revelation was very disturbing, because the abovementioned findings suggest that the youngster, engaging in competitive sports with a compromised cardiovascular system, was a ticking time bomb, and I shudder to think what could have occurred had intervention not taken place.
Exactly two weeks after examining the schoolboy, I was at a counter at an insurance company when an employee approached me with a school medical form, and asked me to fill it out for his teenaged son, who was present. There was no examination room, and I had no medical instruments on me, so he expected me to just assume that his son was healthy and tick the relevant boxes.
I looked him in the eyes and said “Hell no!”, before relating my recent experience to him and advising him to have his son properly evaluated.
School medicals are to be taken seriously, especially for children who play sports competitively. The students should be examined thoroughly, with no short cuts. We must protect our children.