Gotta love those ice packs!

Unless you’ve been living under a rock, pretty much everyone must be aware that Kevin Everett suffered a severe spinal cord injury this weekend in the Bills game.  At first, the prognosis was expectedly grim after an estimated impact force of 2/3 of a ton to Everett’s spine.  Now it seems a more positive outcome may be expected.

In listening to some of the interviews, a physician from the Miami Project made a statement that Everett benefited from the earliest application of moderate hypothermia after a spinal cord injury…ever.  That is rather profound.  From what I can gather as a very outside observer, doctors began lowering Everett’s body temperature in the ambulance and further reduced it once at the hospital by means of an IV catheter.

It is widely understood that cooling tissues reduces the damage cause by inflammation.  It is practiced in neurosurgery, with neonates, after sprained ankles, and now with spinal cord injuries.

This image demonstrates the reduction in neural tissue possible with hypothermia treatment.  The top two tissue samples were controls, and the bottom sample was cooled to 32 degrees C.  The highlighted parts of the image shows areas of tissue death.  Pretty amazing!

And, in a big example of "what comes around, goes around," it was reported that the Buffalo Bills owner is a large donor to the Miami Project.

One final note, the Miami Project doctor I cited earlier did upset me with the quote, "…will walk out of the hospital."  This is far from a foregone conclusion and seemed a bit overzealous and self-promoting to say that on ESPN.  Either way, I’m writing about him.

The intellectual downhiller

This story about professional mountain biker Neven Steinmetz, caught my eye for sure.  I have a special place in my heart for downhill mountain bikers, people who survive smashing into things, intellectual pursuits and stories about physical therapy.  This one has it all! An inspiring tale of what a driven person can accomplish.  I’m so inspired, I’m going to start commuting to work on my downhill bike!

Steinmetz has been nominated to represent the United States at the upcoming 2007 UCI Mountain Bike World Championships in Fort William, Scotland, Sept. 3-9.  I will be watching her results for sure!

As an interesting note, this woman suffered a head injury that went undiagnosed, a very popular story in the media right now as it relates to injured troops.

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When Does Rehab Stop and Performance Enhancing Begin?

Here is an article about Oscar Pistorius of South Africa, who is petitioning to be allowed to run in the Olympics with two below-the-knee prosthesis. He is, by far, the best para-olympic runner. His time in the 400 is good enough to win the women’s event at the last Olympics. However, rules are rules and there is now a debate about whether or not he should be allowed to run.

As a Physical Therapist I find myself in an uncomfortable place in this argument. I feel professionally bound to fight for the ablement of the disabled. However, I do also respect that in a human competition of physical performance there needs to be a definite line drawn with respect to mechanical aides. Oscar was born without a fibula in either leg, and so learned to walk without legs. This fact probably proves crucial to both his adept running skill and his outlook on the matter.
“I don’t see myself as disabled,” said Oscar Pistorius, a former rugby and water polo player. “There’s nothing I can’t do that able-bodied athletes can do.”

Robert Gailey, an associate professor of Physical Therapy at the University of Miami Medical School was featured in the article as he described the overwhelming mechanical disadvantage it is to run with prostheses. All well and good, except for the fact that the prostheses are performance aids by definition. For now they are a disadvantage, later they may be an advantage. The SPARKy ankle joint is a prime example of a positive energy prosthesis.

I want to be on the side of Mr. Pistorius. I just don’t think I am. That said, we should all take a moment to acknowledge what a gifted athlete this individual truly is.

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What I Think About Floyd Landis

Ok, first a disclaimer: I like cycling. I coach cycling. I like when Americans win cycling events. I liked everything I knew about Landis except that he left the Discovery Team to race for Phonak. I think there is no sport more corrupt, backwards, and overall annoying than cycling. I do not trust Anti-doping agencies, in that they only get budgeted by convicting people. In other words, my personal bias is to not believe most of the recent press about doping in cycling. Finally, and obviously, I am not an endocrinologist or doping expert.

Good. Now, let’s have a discussion. As background for our discussion, I will direct you to an excellent blog post on the science behind Floyd’s positive test at Jake Young’s Pure Pedantry blog. It’s a great overview of the case. Next, I also recommend the blog, Trust but Verify, which is dedicated to covering the events of this case.

An excerpt from Pure Pedantry:

"There is a very legitimate question related to the timing of the positive test. Floyd Landis tested positive on day 17 of the Tour de France — right before he made a miraculous comeback to retake the lead. Some people may speculate that testosterone may have helped him do this. This is unlikely to be the case. Testosterone is used during training periods to gain muscle mass. It is not a stimulant like amphetamines. It is not likely that testosterone would improve performance on such a short time scale, nor has it ever been shown to have that effect."
And that is the most poignant question: Why would all the tests he took during the Tour be negative except for one?

Yesterday during his hearing, defense expert Dr. John Amory had the same concerns:

"The case didn’t make a lot of sense to me," Amory said. "Initially when I saw the documents, I thought there were irregularities, first with the handling of the samples, then with the results."The ratios went from 1.5-to-1 and 1.8-to-1 to 11-to-1, then quickly back below 2-to-1 over the span of 10 days.
"I don’t consider those results to be consistent with the use of testosterone gel over that period of time," Amory said.

The only thing I have read that could even come close to offering an answer to this is that testosterone could potentially hasten recovery. This is exactly what the USADA (U.S. Anti-Doping Admin.) tried to argue with the testimony of Joe Papp, a former low-tier pro and convicted doper. His testimony got a lot of press and I cannot understand why. This case represents the career and reputation of a man on the line. Yet, the prosecution sees fit to attempt to make a case on the subjective reports of one guilty cyclist about the effects of a testosterone gel on his recovery.

So What Do I Think About Landis?
It doesn’t matter what I think. The facts of the case are what matters. I do think one must question the strength of any case which is going to rely on non-blinded testers and subjective single case reports! That’s not really science, now is it?

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I think this picture is pretty cool. Barbaro was pretty cool. Damn.