Caring for the Olympic Athlete

Kristine Karlson MDDHMC

1992 OlympianUS Rowing Team Physician

1997-Olympic Team Physician 2008

Who am I (and why am I talking about this)?

Not an athlete in high school Tried some new things in college Worked out pretty well…

My Career Spread medical school to 5 years Intern year in family medicine split

into 2 years 3 world championship gold medals 5th in 1992 Olympics

Retired from rowing, finished residency

But Olympics called again

Tried out for 1996 Olympics, 2nd (earns trip home)

Sports medicine fellowship Started at DHMC in 1997

Current practice: Half family medicine, primary care

ages birth to 94 Half non-operative orthopedics Dartmouth College training room

clinic

Travel with US rowing team

Elite Athlete Care

Elite Athlete Issues

Drug testing and drug/supplement use

Public health concerns

Acute illness and infectious disease

Accidents/injuries

Travelling with Athletes Positives

Part of elite group Watch events up close as insider Meet interesting people Interesting locations “Free” vacation USA gear Improvising care

Travelling with Athletes Negatives

On call 24/7 Demands for inappropriate care Hard decisions Boring “Interesting” locations Improvising care Vacation time used up Babysitting adults

The Medical Kit Antibiotics NSAIDs Wound care Ortho ENT/eye/GI Gyn Misc.

Drug Testing Issues WADA

Prohibited list Therapeutic use exemptions

http://www.wada-ama.org/en/ As much as possible done before

leaving the US Asthma testing if needed

NO supplements!

Doping Control

Public Health Officer Food

Anderson Br. J. Sports Med. 1996;30;347-348 – Salmonella at 1996 Junior Worlds

Water Safety

Bikes Walking

Unusual Care in Unusual Locations “Now” care – gyn exam at 11 PM,

earache overnight Pressure to use antibiotics for URI Lower threshold to use antibiotics Close followup

Care of team staff and family members

Improvising/ “Other Duties”

Boring/ Down Time

Babysitting Adults Pre-event safety Post competition party

Seeing other Cultures

Beijing 2008 Staff 32 athletic trainers 16 physicians (some ortho, some

not) 1 chiropractor 1 massage therapist

Beijing 2008 Staff Each sport assigned ATC Some sports shared ATC, many

shared physician

Usually ATC and physician known to the sport and athletes, not always

How did we get there? USOC volunteer medical program

Emphasis on staff who have worked with elite sports

Selected/ sanctioned by NGB 2 weeks volunteer at training center “Minor” trip(s) International games such as Pan Am’s

USOC Medical Volunteers

http://www.teamusa.org/medical/volunteers 5 years experience, 2 years with team Preferred to have worked with NGB US citizen, malpractice insurance, no

criminal background, letters of reference, etc

USOC Medical Staffing Training centers

Resident athletes Camps

Staff at training centers ATC’s Fellows Local MD’s Volunteers

USOC Training Centers Colorado Springs

Largest and “home” for USOC Chula Vista CA

Field sports, rowing, canoe/kayak Lake Placid NY

Winter sports

Beijing 2008 Anticipated issues

Heat Pollution GI illness

Beijing 2008 Village medical clinic USA medical clinic

Always staffed (one ATC always slept there, MD on call)

First contact with ATC ATC may involve MD

BNU Training Center USOC staff, training partners, spares

Beijing 2008 Medical clinic

Lots of rub downs Some rehab for athletes with injuries

who were still able to compete Wound and illness care Heat, ice, modalities

Beijing 2008 At the Venues

Depended on set-up Team room vs sidelines ATC always present, physician during

competition and maybe during training

Beijing 2008 Emergency services

Staff responsible for knowing plan If transported, go with athlete

Beijing 2008 Cases seen

Buttock blister URI Mild diarrhea Fever Asthma Tooth pain/

vaginal yeast infection

Diverticulitis

Knee effusion Foreign body foot Shin abrasion Allergic reaction Post race collapse

Beijing 2008 Worst case for Team USA was

wrestler hospitalized for kidney failure after dehydrating to make weight

Stress fracture Plantar fascia rupture