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Caring for the Olympic Athlete

Caring for the Olympic Athlete. Kristine Karlson MD DHMC 1992 Olympian US 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.

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Caring for the Olympic Athlete

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  1. Caring for the Olympic Athlete Kristine Karlson MD DHMC 1992 Olympian US Rowing Team Physician 1997- Olympic Team Physician 2008

  2. 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…

  3. 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

  4. Tried out for 1996 Olympics, 2nd (earns trip home) • Sports medicine fellowship • Started at DHMC in 1997

  5. 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

  6. Elite Athlete Care

  7. Elite Athlete Issues • Drug testing and drug/supplement use • Public health concerns • Acute illness and infectious disease • Accidents/injuries

  8. 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

  9. 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

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

  11. 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!

  12. Doping Control

  13. Public Health Officer • Food • Anderson Br. J. Sports Med. 1996;30;347-348 – Salmonella at 1996 Junior Worlds • Water • Safety • Bikes • Walking

  14. 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

  15. Improvising/ “Other Duties”

  16. Boring/ Down Time

  17. Babysitting Adults • Pre-event safety • Post competition party

  18. Seeing other Cultures

  19. Beijing 2008 Staff • 32 athletic trainers • 16 physicians (some ortho, some not) • 1 chiropractor • 1 massage therapist

  20. 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

  21. 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

  22. 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

  23. USOC Medical Staffing • Training centers • Resident athletes • Camps • Staff at training centers • ATC’s • Fellows • Local MD’s • Volunteers

  24. USOC Training Centers • Colorado Springs • Largest and “home” for USOC • Chula Vista CA • Field sports, rowing, canoe/kayak • Lake Placid NY • Winter sports

  25. Beijing 2008 • Anticipated issues • Heat • Pollution • GI illness

  26. 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

  27. 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

  28. Beijing 2008 • At the Venues • Depended on set-up • Team room vs sidelines • ATC always present, physician during competition and maybe during training

  29. Beijing 2008 • Emergency services • Staff responsible for knowing plan • If transported, go with athlete

  30. 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

  31. Beijing 2008 • Worst case for Team USA was wrestler hospitalized for kidney failure after dehydrating to make weight • Stress fracture • Plantar fascia rupture

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