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911DOC
911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5093
Experience:  Emergency Medicine Physician
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Extreme sports question: Is there any way to ease the strong

Resolved Question:

Extreme sports question: Is there any way to ease the strong stomach pains that my 17 year old son is experiencing from excessive running? He's on a varsity sports team and the daily training routine consists of 1 hour of running, followed by 2 hours of scrimmaging, drills, and excercise (200 lunges, 200 push ups, 200 situps, 5 minute planks, etc). Most of the boys throw up during the running, but keep on going. Yes, the parents know the coach has a 'military complex', but we can't stop our teenagers from wanting to be on this school team and, believe it or not, this appears to be status quo for high school contact sports teams. Any suggestions to deal with the stomach pains?
Submitted: 1 year ago.
Category: Medical
Expert:  911DOC replied 1 year ago.

911DOC :

So this is a great question. I assume this is for football though I guess it could be soccer. doesn't matter.

911DOC :

It sounds like the coach is pushing the boys to the point of having heat cramps, which is the first in the stages of heat illness

911DOC :

the second stage would be heat exhaustion, which is the link i sent you

911DOC :

after that comes heat stroke

911DOC :

i would be surprised if the coaching staff were not aware of these illnesses and I too, in high school, used to train to the point of throwing up

911DOC :

is it wise or healthy?

911DOC :

probably not

911DOC :

but now as a military doctor I see it all the time with my patients

911DOC :

in the summer there will always be one or two heat stroke patients here where i work

911DOC :

in spite of doing 'all the right things' (hydration, proper clothing etc...)

911DOC :

some people are simply predisposed to this

911DOC :

a few things you can do

911DOC :

one is to make sure the coaching staff has this information and is well versed in picking up the signs and symptoms of heat illnesses and making sure the trainer is keeping a sharp eye for danger signs amongst the boys

911DOC :

after that, make sure you son's diet is rich in protein and carbohydrates so that his body can replenish it's energy stores after these workouts

911DOC :

his caloric needs are very high right now

911DOC :

as is his need for adequate hydration

911DOC :

when he gets up in the morning his urine should be a light yellow, not a dark yellow or orange

911DOC :

if he gets headaches and vomits then he is at a dangerous stage and needs to sit and rehydrate and get into a cool area

911DOC :

i know this will be difficult as all the boys are competing and pushing themselves and to a certain extent this is good, but the key is to have someone in authority who can recognize when the healthy aspect of this training turns dangerous

911DOC :

heat stroke is the worst of these illnesses and can be fatal if not treated promptly

911DOC :

besides that, having a heat related injury makes it more likely that you will have another

911DOC :

Also, there would be nothing wrong with giving him Tylenol in appropriate doses when he has aches and pains after practice

911DOC :

I would avoid, at least right now, motrin or aspirin

911DOC :

as these can stress the kidneys

911DOC :

in times of dehydration, and after these practices these boys ARE dehdrated

911DOC :

frequent fluid replacement is key

911DOC :

and gatorade or water or mild are very good things for him to drink before, during, and after these sessions

911DOC :

standing by

911DOC :

now that I'm reading that last reference, it's really not for athletes, let me see if i can get a better one

911DOC :

stand by

911DOC :

standing by

Customer:

Okay, thanks for your candid answer. The coaches know these signs, but the boys hide it when they throw up because they know they will be dismissed from the team if they're discovered. Yesterday, 7 of the 20 boys threw up and kept on going. By the way, several of the parents are doctors and know the risks. I am not one of them, but I am passing along your information right now so the boys know to watch their urine and the combination of headaches with vomiting. One of the top players has Lyme disease and Bells Palsy (half of his face is paralyzed) and he keeps on going anyway and everyone views this as a badge of courage. It's unbelievable.

Customer:

Now for the practical questions:

911DOC :

Wow, is the boy with Lyme's being treated?

911DOC :

if it is true that the boys will be cut for vomiting then this is not a team i would let my son be on

Customer:

Yes, he's on big doses of doxycycline. In fact, 3 boys on the team have Lymes (we live in a very deer-infested area). My practical questions are: What do you mean by a diet rich in protein and carbs? ---- Should the boys have carbs before the training and proteins after? I noticed many of them like cookies and smoothies for the sugar rush, but is this ever appropriate?

911DOC :

i would ask the head coach if this is, in fact, the case, and i would ask it with other parents, and I would tell him that many of his players are vomiting and hiding it

911DOC :

cookies and smoothies are fine

911DOC :

protein is the long term fuel for the body

911DOC :

carbs like sugar and pasta are short term

911DOC :

so it's always good to get both

911DOC :

good healthy breakfast with protein and carbs

911DOC :

same for lunch

911DOC :

and then carbs before practice and during (candy bars, energy bars, sports drinks)

911DOC :

with plenty of water

911DOC :

standing by

911DOC :

energy drinks are REALLY BAD in this situation and should be discourage

911DOC :

as many have extremely high doses of caffeine and other stimulants and can cause cardiac irritability

911DOC :

standing by

911DOC :

'discouraged'

911DOC :

standing by

Customer:

Okay, so the daily drills are from 9:30 am to 12:30 pm. Most of the boys won't eat any breakfast because they think it causes more vomiting. Any suggestions for that?

911DOC :

small breakfast then, big pasta dinner night before with good protein sources like meat and cheese

911DOC :

can even do protein smoothie for breakfast along with plenty of water

911DOC :

they should need to pee a couple of times before practice

911DOC :

standing by

911DOC :

actually i may have given some not-so-good advice above

911DOC :

STANDING BY

Customer:

Okay, give me a minute to read this.

911DOC :

okay

Customer:

Okay, I read it and it sounds about right. Your suggestion of a past dinner the night before with good protein is the norm at my house. The problem is my 2 teens don't eat any breakfast. They tried bananas yesterday (2 hours before the excercise) and vomitted. Following their usual eating habits means they will do their daily drills with plenty of fluids but no food. Seems inappropriate to me, but follows their norm and meets the protocol in the article. Also, thanks for the warning about energy drinks. Nobody I know uses them --- at least not anymore, meaning they have all tried them and experienced bad results so they dropped them.

911DOC :

very good

911DOC :

do you have any final questions about this for me?

Customer:

No, this is very good advice and I appreciate your insights and recommendations. Thank you.

911DOC :

Great. Good luck. This 'smoking' as we call it in the military is a weed-out deal, it will lessen especially as they adapt and as games come along. I hope they have a great season.

911DOC :

Thank you so much for your question. It was a pleasure talking with you. Should you need my assistance in the future simply start your question with ‘for 911doc only’.


Positive feedback is always appreciated.


Be Well


911Doc

Customer:

Oh, sorry I forgot one question --- what about hot tub use? Some of the boys want to relax their sore muscles in a hot tub at th end of the day, after their bodies have cooled off. Is this a good idea for the boys who vomitted earlier in the day? ...

911DOC :

i would make sure they did not have a temperature over 99 prior to entering the hot tub, make sure they do not have headache or dizziness, and make sure they have replaced their fluids. if they have, this is fine.

911DOC :

one thing you might also want to do is make sure that they have replaced enough fluid to have to urinate prior to entering the hot tub

Customer:

Perfect, great advice, thanks. I'm done with my questions now and am going to complete the rating after sending this last chat. B4n.

911DOC :

no worries. ask for me anytime, I'm on most days, simply start question with 'for 911doc'

911DOC :

best

911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5093
Experience: Emergency Medicine Physician
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