Listed As Probable

Quick Hitters: Track star on suicide watch, coach on trial

Remind me, what was this supposed to accomplish?  The results of the IAAF "investigation" to "determine" Caster Semenya's "gender" were unbelievably leaked to the press. Reports that she is a "hermaphrodite" (do we need more air quotes to convey my intended sarcasm?) have resulted in her needing to be on constant suicide watch. Because of the slippery nature of gender and the public scrutiny she'd be subjected to, Semenya was destined to be the loser from the moment this witch hunt began. If athletes are at high risk for depression and suicide when their identity as a competitor is threatened, imagine the impact when one's gender identity is threatened - while the whole world watches.

Coach responsibility. Kentucky high school football coach David Jason Stinson was found not guilty in the heat stroke death of one of his players, 15 year old Max Gilpin, last August. What I hope comes out of this tragedy is not what liability do coaches have but rather what responsibility they have. If coaches are going to enjoy the mythic role our society grants them - educators, molders of men, a leader who happens to be a coach - then part of deserving that role is to step up and take an active part in keeping athletes healthy. Kentucky is not taking any chances:

Kentucky lawmakers this year passed legislation that led to a four-hour online course for coaches on emergency planning and recognition; temperature-related illnesses; head, neck and facial injuries; and first aid.

Jefferson County Public Schools also now require all athletes and at least one parent to watch a 40-minute video that touches on everything from dietary supplements to bacterial infections. Local high school coaches must attend a seminar on using positive reinforcement when dealing with students.

Here in North Carolina, the HSAA has taken similar steps to educate parents and coaches with mandatory slides about concussions and heat illness added to the required eligibility presentation before each season.

The coaches who attended our medical crisis management workshop here at the WFU Center for Applied Learning were great, really throwing themselves into being a part of the team that is responsible for the safety of their athletes. I think they realized that they could make a critical difference by recognizing dangerous situations, contacting emergency medical services, providing basic life support, providing crowd control, insuring EMS access, and assisting with equipment needs.

The Silent Killer in Sports

The death of Philadelphia Eagles defensive coordinator Jim Johnson from a recurrence of melanoma was an unfortunate reminder that while athletes, coaches, and athletic trainers may direct almost all focus to their sport, they need to remember that those long hours outdoors can put them at risk for skin cancer.

This is not a disease only of older indivduals. I was surprised to learn that melanoma is the second most common cancer diagnosed in women aged 20-29. The potential impact of this disease on young people hits very close to home here at Wake Forest as former Demon Deacon field hockey player Maria Whitehead died from the disease at the age of 25. In her memory, USA Field Hockey has partnered with the Melanoma International Foundation to create the Foundation for Sun-Safe Play and Skin Cancer Education. Mental and physical mistakes are one thing, but it is when one of her players or campers neglects to wear sunscreen that you'll really see WFU coach Jennifer Averill really go ballistic. Now if we could just get field hockey to buy into the idea of eye protection.

In an article from the American Academy of Dermatology Brian B. Adams, MD, MPH says:

 “Perspiration on the skin lowers what's called the minimal erythema dose, the lowest ultraviolet (UV) light exposure needed to turn the skin barely pink.”

I'm guessing that this is from some sort of refraction or magnification of the sunlight as I am not sure how sweat alone would disrupt the skin's outermost barrier, the epithelial layer.

The article also describes 2004 Olympic marathon bronze medalist Deena Kastor's battle with basal cell carcinoma and early stage melanoma.

Distance runners may be a class of athlete that is at even higher risk:

When comparing the runners with the non-runners, researchers found that the runners had more atypical moles, age spots, and other lesions that increase the risk of developing skin cancer.
The reason seems to be the significant exposure during training and competition to ultraviolet (UV) rays emitted by the sun. The researchers also believe that endurance exercise such as distance running suppresses the immune system. A suppressed immune system increases the risk of developing skin cancer.

Only 56.2% of the runners in this study reported that they regularly use sunscreen.

This number towers over the 6% consistent use rate found in a 2005 study of college athletes. And I would bet the number of athletes who bother to reapply after sweating is a tiny fraction of that 6%. "Waterproof" sunscreens can hang in there for up to 30 minutes in water before losing effectiveness...athletes are usually sweating for quite a bit longer than that.

So sweat is part of the problem but could also be part of the solution - hippo sweat that is. Researchers are trying to develop products that mimic the light scattering properties of the rotund mammal's oily secretions. But wait, there's more:

"It would be nice to also try and replicate the antiseptic and insect-repellent characteristics of the sweat, to obtain a four-in-one product: sunscreen, sunblock, antiseptic, insect repellent," co-author Christopher Viney told Discovery News.

And remember, athletes and coaches need to be reminded that a tan - which itself is a result of enough UV energy to damage skin DNA - does not necessarily offer protection. For example, in one small study three Ironman Triathalon participants suffered sunburn during a race despite being tan and applying SPF 35 waterproof sunscreen at the start.

And if preventing llong term health problems like cancer isn't enough, remind your athletes that they don't want to end up like former Oriole Mary Cordova who was forced by the team doctor to sit out a couple of day games because of the severe sunburns he suffered after falling asleep in a tanning bed.

Gender Identity Issues at Track and Field World Championships

18 year old South African runner Caster Semenya, a favorite in the women's 800m and 1500m events at the world track and field championships in Berlin, is having to undergo a 'gender test' by order of IAAF, the sport's world governing body.

Even if you didn't go to med school that test should only take about 5 seconds right? Well, it isn't actually as simple as having the athlete drop his or her pants.

The Androgen Insensitivity Support Group website has a comprehensive explanation of the conditions that could make gender identification less than straight-forward. If allowed to simplify, you could say that sometimes the message from the chromosomes doesn't always get translated into the corresponding gonads (testes or ovaries) and the message from the gonads does not always make it to the external sex organs.

So why not just pick a definition - go by the external sex organs - and use it? Well, as with the rest of life there is quite a bit of gray area between even the mixed message scenarios I presented above - i.e. the genitalia themselves can be incomplete or indeterminate. The ESPN article describes the IAAF gender 'test' as involving "a physical medical evaluation, and includes reports from a gynecologist, endocrinologist, psychologist, an internal medicine specialist and an expert on gender", reflecting that gender determination can be a complex issue.

So what criteria does the IAAF use to render a final verdict? A vote of these specialists? That isn't clear, but I did find this helpful chapter in the book Women in Sport by Barbara Drinkwater. It describes how the medical community actually uses eight criteria when determining gender: 1) Sex chromosomes 2) Sex hormone pattern 3) Gonadal sex 4) Internal sex organs 5) External sex organs 6) Secondary sex characteristics (breasts, facial hair, etc) 7) Apparent sex (as presumed by others) 8) psychological sex (as person identifies him/herself - this is the one legal courts usually rule in favor of).

The problem, the author goes on to say, is that the initial screening tests used by sport organizations are usually only based on one of these criteria. The IAAF screening method apparently is/has been chromosome testing. She also brings up the fact that the main reason gender determination testing was adopted is to simply keep men from attempting to compete as women, not to make a decision in ambiguous cases. This is why, at least as of 2000, only 5 of the 34 Olympic sport governing bodies bothered testing for gender at their world championships. Female athletes themselves have not been clamoring for this type of testing and it has been shown that the more athletes are educated about the potentially complex nature of gender and testing for it the less likely they are to be in favor of screening.

The Science of Sport blog has a nice post about how most of the global scrutiny of this poor young woman could have been avoided if her country's federation had planned ahead. Such a situation indeed is unfair for both Semenya and her competitors.

The story of Erik Schinegger is probably the most famous case of gender identity in sport. Raised as Erika, Schinegger won the world championships in the women's downhill in 1966 only to have the title taken away when chromosomal tests said she was a he. The fact that he then decided to live as a male after 'medical treatments' goes to show the fluid nature of gender in certain cases and the absurdity of trying to break it down into a black and white issue.

I also recommend reading this excellent article from the Washington Post about 1932 Olympic champion sprinter Stella Walsh and the rumors that swirled upon her death in 1980 that she was really a man. Probably the most logical approach to this complicated issue is captured by this excerpt:

The best way to determine such children's sexual identity, says (William G.) Reiner, who directs the University of Oklahoma's psychosexual development clinic, is simply to ask them.