Note that this entry comes from a "guest" blogger. I am Robert Centor, the db of db's Medical Rants. In my real world, I am an academic general internist. I teach residents, interns and medical students internal medicine. Most of our teaching is not classroom based, rather we teach based on patients - either admitted to the hospital or seen in the clinic. We use the Socratic method, and explore differential diagnoses, the physiologic basis of abnormalities, and discuss treatment options. Differential diagnoses refers to considering all the diagnostic possibilities for a patient's complaints.
For many years, I have taken advantage of athletes' deaths to make teaching points. For example, Flo Hyman (the world class volleyball player) died of Marfan's Syndrome and subsequent dissecting aortic aneurysm. Hank Gaithers died from an arrythmia secondary to hypertrophic cardiomyopathy. Walter Payton died of cholangiocarcinoma secondary to primary sclerosing cholangitis. Each of these athletes' deaths raise important teaching points. By understanding why someone died, we can often learn lessons which might prevent future deaths or injuries.
When I first heard that Bechler had died, I started wondering what had happened. I saw the same news reports that you had. He did not die suddenly, this "rules out" most cardiac causes. Cardiac deaths occur in young athletes, but they die almost immediately. He on the other hand made it to the ICU.
The next information that I heard was that he had had a heatstroke. This information came along with information that the ambient temperature was only 81 degrees. Heatstroke is well recognized as a cause of death in athletes, but I generally associate that cause with August football in Texas (temperatures in the 100s). But then I remembered the Korey Stringer story. At that point I wondered what Bechler had taken.
I also wondered about his underlying health. Did he have any unknown diseases? His autopsy gave some clues. Varied Factors Caused Pitcher's Death
The autopsy performed yesterday on the Baltimore pitcher who died of heatstroke produced a portrait of a young man with an assortment of potentially dangerous medical problems who was also desperately trying to lose weight. An accompanying investigation revealed that the pitcher, Steve Bechler, was using an over-the-counter weight-loss supplement containing an ingredient that has been linked to heatstroke.
Now I understood. He was not in good shape, was trying desperately to lose weight, and probably had underlying disease.
The use of Xenadrine added to the risk factors that were present, Perper said, explaining that heatstroke was "brought about by the convergence of a number of factors."
He listed those factors as an enlarged heart, abnormal liver functions, borderline hypertension, an overweight condition, use of Xenadrine and dieting.
I blogged earlier today on my site about the idiocy of Ephedra - Ephedra - PLEASE DO NOT TAKE!!! . Let's look at what he was taking. SUPPLEMENT FACTS: XENADRINE
Last time I had a bad cold, I took cold medicine with pseudoephedrine in it, and–despite the severity of my cold–it made enormous improvements in my stamina, flexibility, and overall execution as a dancer. It doesn’t surprise me in the least how one could come to rely on ephedrine as a performance enhancement, especially since it is so readily available (hence, “safe”).
As a side note, remember that Olympic gymnast who was stripped of her gold medal because she took cold medicine? It was a shame, but at the same time I do not doubt the need to regulate such a drug in athletic competitions, based on my own experience with its effects. (Note also that “my experience” refers to the cold medicine, not Ephedra, and not taken outside of my own period of illness.)
Stuff like this is actually more common than the general public is aware. For years in the NHL, hockey players have been regularly popping Sudafed before games to get an extra boost. That it’s taken this long before someone has actually died at least partially as the result of abusing Ephedrine seems like a major miracle to me.
I remember taking ephedrine as a body building supplement. If I took it with coffee it gave me a burst of energy like I have never known before. I would not ever be hungry for the next 48 hours. I began to worry about the way it made me feel because I knew that this was not normal. Out of fear, I stopped taking this drug. I threw away all of my supplements and do not take anything anymore (although I still drink coffee). It scares me to think of the damage that I have caused my body from taking ephedrine for a few years in my twenties to give me an edge for bodybuilding. Forget about it! I want to age gracefully and not have medical problems in the future that I can voluntarily prevent now. It just is not worth it. We are fragile (not as powerful as we think we are) and need to take care of ourselves.