Female Athletic Triad

Having been blessed to raise a standout teen female athlete (actually, forgive my fatherly bragging, but a standout female–period), the issue of adolescent female athlete’s health is important to me professionally AND personally.  With the new academic/athletic year having begun, let’s quickly review.

The female athletic triad consists of (surprise!) 3 components:

  1. Energy availability (EA)–adequate calorie intake is essential for optimal athletic performance to say nothing of overall health.  Teen girls need about kcals/ kg of fat free mass.  Inadequate calorie consumption in the athletic setting can be triggered by prolonged dieting, injury, coaching change, and especially casual comments by coaches, parents, or friends.  Poor energy intake is the trigger to the next 2 components.
  2. Menstrual abnormalities–girls who do not begin puberty by age 14 , menstruate by 15 or within 3 years of breast budding, who miss 3 straight periods, or regularly have periods > 35 days apart should be evaluated. Of course, medical conditions must be considered (pregnancy!) Note that 21% of sedentary girls experience menstrual irregularities– and 54% of athletes.  And this problem can promote:
  3. Bone health issues–adolescent girls need 1200-1500 mg/d of calcium and 600  IU vitamin D.  Girls who miss 3 consecutive periods (“amenorrhea”) have 3X the risk of stress fractures and some studies show bone mineralization density equivalent to a woman in her 50’s.

Some warning signs of athletes with eating disorders include :

  • excessive leanness of rapid weight loss
  • preoccupation with meals, weight, food, meal time, and body image
  • avoids team meals
  • wide fluctuation in weight
  • daily vigorous exercise in addition to regular team training
  • stress fractures
  • yellowing skin
  • soft baby hairs on skin
  • frequent sore throats without other respiratory symptoms(sometimes from self induced vomiting)
  • chipmunk cheeks–swollen parotid glands from self induced vomiting
  • serious teeth decay (also from acid on teeth from self induced vomiting)
  • chronic fatigue
  • depression, low self esteem

Some screening questions for us to ask of teen female athletes:

  • Do you have menstrual periods?
  • How old for first period?
  • How many periods in last year?
  • Taking female hormones?(birth control pills)
  • Do you worry about your weight?
  • Are you trying to gain or lose weight?
  • Are you following a special diet or avoiding specific food groups?
  •  History of stress fractures, low bone density?
  • History of eating disorder?

Of course I encourage as many girls as possible to be physically active in sports.  But let’s be sure to keep perspective: mostly its about health and fun.  Winning, championships, scholarships are nice when they happen, but for the majority of participants that is not in the cards, so its counter productive to try and force the issue.  Just enjoy it for what it is.

Send along questions and comments, and thanks for following.

Flu shot time

So a wonderful summer season is now mostly behind us (despite this weekend’s sweltering heat).  We primary care doctors are now turning our attention to flu season.  I know, I know–I go on about this every year right about now.  That’s because, every year, on average, studies suggest that in the US 36,000 people die and 200,000 are hospitalized due to flu (although there is some controversy about those numbers).  Still, the great majority of medical and public health experts strongly endorse universal flu vaccination for eligible people.

In the last few years, vaccine efficacy (VE) rates–the percentage decrease in flu incidence in the immunized population–underperformed, protecting only a minority of vaccine recipients.  The good news here is that a good chunk of these poor results were due to the “live attenuated influenza vaccine (LAIV)”–the nasal spray,  which came in with a VE rate of a dismal 3%.  Accordingly, the CDC has withdrawn recommendation for the LAIV.  So even if you hate needles, don’t bother with the nasal spray.  Also, 2016-17 vaccine is comprised of several enhanced factors:

  • A/California 17/2009 (H1N1) like virus
  • A/Hong Kong/4801/2014 (H3N2)-like virus
  • B/Brisbane/60/2008 (Victoria lineage) like virus
  • B/Phukat/3073/2013 (Yamagata lineage) like virus

With these adjustments in our vaccine regimen we can be very hopeful that this year’s version should be most effective and we can save many more lives.  BUT ONLY IF WE GET EVERYONE IMMUNIZED!

So give me a call and schedule your children for their flu shot.  And recall the benefits to senior citizens in the community from immunizing the pediatric population–as I’ve said before–“Grandma, this shot’s for you!” So extra presents for those brave grandchildren.

Thanks for following…