August 18, 2007

Workouts gone awry
Football player's death exposes an unwritten law of toughness.
By MARCIA C. SMITH
The Orange County Register

These sweltering preseason days of Orange County high school football practice are supposed to be brutal, bruising and demanding, pushing players into game-ready condition.

Working with athletic trainers and physicians, many coaches set practices in the cooler morning hours to avoid the 90-degree midday heat that can melt cleats. They stage regular breaks for players to rest and drink water. And they watch, never imagining that one rigorous workout can turn fatal.

But on Friday morning, when Beckman High junior offensive lineman Kenny Wilson staggered dizzily off the Irvine field, collapsed in cardiac arrest and later died en route to a Santa Ana trauma center, the local football and sport medicine communities found themselves with a tragedy – and a mystery – to tackle.

"It's too soon to rush to judgment, so after our practice I gathered the team together to talk about what happened, and we said a prayer for Kenny's family and the Beckman team," Orange Lutheran varsity football coach Jim Kunau said.

Healthy teen-agers just don't die without reason. The Irvine Police Department and the medical examiner will spend the next few days, even weeks, investigating the cause of Wilson's death, the third football fatality in the county since 1999, when Fountain Valley junior lineman Steven "Scotty" Lang," also 16, suddenly collapsed during conditioning drills on the Barons practice field and died soon after at the hospital. Costa Mesa player Matthew Colby, 17, died in 2001, the day after collapsing and losing consciousness during a game. He died from bleeding and swelling of the brain after suffering repeated blunt force head injuries in practices and in games.

Weeks after Lang's death, the coroner discovered that Lang's cardiac arrhythmia – the No. 1 cause of sudden death in American teens – stemmed from the undetected genetic disease known as hypertrophic cardiomyopathy (HCM), a thickening of the heart muscle impairing its ability to hold and pump adequate amounts of blood during exercise.

Like Lang, Wilson had been cleared to play football by submitting the required pre-participation physical evaluation (PPE) form. That 10-minute doctor's exam and interview, which has been criticized for being too cursory, does not require the $500-$1,500 electro- and echocardiogram heart screenings that might have detected problems.

After Lang's death, all Fountain Valley High players were able to undergo those tests at low cost from the Yorba Linda-based nonprofit, A Heart for Sports. Other Orange County schools have turned to A Heart for Sports to safeguard their players against hidden conditions.

"There are so many questions at this stage," said Dr. Sana Al-Jundi, a pediatric intensive care specialist at Children's Hospital of Orange County. "Was he taking anything that could have contributed to dehydration? Did he have head trauma? Was this heatstroke? Was there a pre-existing heart condition? Was he just going too hard? It's all too soon to know."

The competitive culture of football, especially during the grueling "Hell Days" of preseason practices and drills, has often been identified as an early suspect in player deaths. Old-school coaches have been notorious for pushing players to their limits to build tough character, putting teams through two-a-day practices and calling for players to run series of "suicide" sprints until they're breathless, vomiting and nearing collapse.

"In Southern California, where football reigns supreme and we're in the back yard of the No. 1 team (USC) in college football, kids are out there buying into this fraternity mentality that makes them never quit because they don't want to be seen as weak, and that kind of mentality can lead to disastrous effects," said Laguna Hills sports psychologist Jack Singer, who has worked with hundreds of amateur and professional athletes.

"Social pressure and competition for playing time, starting jobs, maybe even a college scholarship, can drive young athletes to play through pain and risk their lives to please."

Wilson, who was on the junior varsity-varsity cusp, stood about 5 feet, 9 inches tall and weighed 250 pounds – "The average weight of an adult male of that height is between 150 and 180 pounds," Al-Jundhi said. He had gone through two hours of the morning practice and had just completed a "Simon Says" agility drill when he left the field in a malaise, a common symptom of heat exhaustion or concussion.

Last season at Orange Lutheran, Kunau had one football player "tighten up" from apparent dehydration in a classroom an hour after practice. The player was taken to the hospital for IV fluids and recovered, but "it gave us such a scare because we didn't see it, so we keep an even sharper eye on players," Kunau said.

"Every coach I know in Orange County is past the era of the 'Hell Day' mindset because we care about our players first and foremost. But sometimes it's difficult to discern that fine line between a tough drill that's supposed to condition players and create a high level of intensity and the one that will affect one player in such a tragic way."

Wilson's death will undoubtedly force coaches to reconsider the stress of their workouts and become more vigilant for players showing signs of struggle. Medical experts hope that athletes will better monitor their exhaustion levels and be less afraid to tell others when they're not feeling well.

The National Athletic Trainers' Association Web site (www.nata.org) has a tips page on "Heat Illnesses" and a "Heads Up" video on concussions. A Heart for Sports (www.aheartforsports.org) provides information about dangerous heart conditions and offers individual screenings locally throughout the year for $65.

"Athletes try to push through the discomfort, never thinking they could die," said Dr. Chris Koutures, an Anaheim Hills physician and team doctor to Cal State Fullerton and Orange Lutheran and Northwood High. "You just never know how much is too much until it's too late."