SICKLE CELL TRAIT DOCUMENTATION (6/11)

Transcription

1 SICKLE CELL TRAIT DOCUMENTATION Because of the health related issues stemming from possible outcomes of blood cell sickling in the athletic population, the NCAA is recommending documentation of testing for the sickle cell trait. There are 2 ways you can gather this information: 1) Every one of us was screened or tested for sickle cell trait when we were born if born in a hospital by a blood test. You may provide a copy of the results of this test. This information may be at the hospital at which you were born or in your medical file at your family doctor office. You should request a copy from either, mail, , or fax it to the address below. 2) If this information is not available any longer from either of the sources above, you should make an appointment with your family doctor (or any doctor) to test your blood for this trait and mail, , or fax the results to us at the address below. If you do not want to have the blood test done, there is a waiver below you sign. Some information about sickle cell trait, how it occurs, and what effects it has on the body is included on the following pages and additional information will be presented at the preseason compliance/sports medicine meetings which occur on campus prior to the start of practices. MAIL OR FAX the sickle cell test results or declaration and waiver to: John Ochsenwald, Director of Sports Medicine University of Wisconsin Milwaukee Sports Medicine Center, PAV N. Downer Avenue Milwaukee, WI (fax) johno@uwm.edu If you have any questions, please call John Ochsenwald at

2 University of Wisconsin Milwaukee Sports Medicine Sickle Cell Trait Information, Testing Declaration, & Waiver About Sickle Cell Trait Sickle cell trait is an inherited condition of the oxygen-carrying protein, hemoglobin, in the red blood cells. Although certain ethnic groups are at higher risk for having sickle cell trait, persons of all races and ancestry may test positive. Diagnosis can be made with a simple blood test. Sickle cell trait is often asymptomatic, but during intense, sustained exercise, red blood cells can sickle (change from a normal disc shape to a crescent or sickle shape), which can accumulate in the bloodstream and logjam blood vessels resulting in student-athlete collapse or decrease the blood s ability to carry oxygen to muscles effecting the muscles ability to function properly. Sickle cell trait has been implicated in the deaths of nine athletes in the past 7 years. Precautions if You Test Positive The kind of intense exercise done by student-athletes can put unknowing athletes with sickle cell trait at risk. Although the consequences can be severe, sufficient rest, hydration, and cooling may be all that are needed to treat most cases of exertional sickling. Athletes who have sickle cell trait can follow a few precautions to ensure their safety. These include: Engage in a slow and gradual preseason conditioning regimen. Build up intensity slowly while training. Set your own pace. Use adequate rest and recovery between repetition, especially during sprints and intense station drills. Avoid pushing with full exertion longer than two to three minutes without a rest interval or a breather. If you experience symptoms such as muscle pain, abnormal weakness, undue fatigue, or breathlessness, stop the activity immediately and notify your athletic trainer and/or coach. Stay well hydrated at all times, especially in hot and humid conditions. Avoid using high-caffeine energy drinks or supplements, or other stimulants, as they may contribute to dehydration. Maintain proper asthma management. Refrain from exercise during acute illness, if feeling ill, or while experiencing a fever. Beware when adjusting to a change in altitude, e.g., a rise in altitude of as little as 2,000 feet. Modify your training and request that supplemental oxygen be available to you. Seek prompt medical care when experiencing unusual physical distress.

3 About Sickle Cell Trait Testing The NCAA requires all NCAA Division I student-athletes to have knowledge of their sickle cell trait status. If you do not have prior knowledge of your sickle cell trait status, the NCAA requires that you undergo testing to confirm your sickle cell trait status. You may request the results from the hospital at which you were born or from your family doctor. If this information is not available from either of these sources, the test may be requested by you at home from your personal family physician. Have the results sent to UWM Sports Medicine. Additionally, you may elect to not be tested and sign a waiver (attached) acknowledging that testing was suggested but declined. The UWM Department of Intercollegiate Athletics offers sickle cell trait screening in the form of a blood test as part of the preparticipation physical examination process if there is no other possible resource. Testing can be conducted at the UWM Norris Health Center as part of your pre-participation physical and the results will be reported to a UWM team physician. If the test is positive, you will be offered counseling on the implications of sickle cell trait, including health, athletics participation precautions, and family planning. The presence of sickle cell trait will not restrict you from play. Your health information will remain confidential, but a positive test will be communicated to the appropriate coaches and athletic trainers. One of 4 options must occur prior to sport participation: Be tested at home by your doctor and forward the results to UWM Sports Medicine prior to your scheduled pre-participation physical along with the next page filled in and signed. Get the results from the hospital at which you were born or from your doctor and mail or fax them to us. You must fill-in and sign the next page and return it to us with the results. Be tested as part of your pre-participation physical. You must sign the next page and return it with your other forms to the same address. Fill in the WAVIER sheet 2 pages below this one declining the blood test for sickle cell trait and return the waiver to us. If you check the first box, you must sign the next page and return it along with the records of the test and all the other forms in this . If you check the second box, you must sign and return it with all of the other forms in this . If you are under 18 as of the day you sign any forms, your parents must sign.

4 University of Wisconsin Milwaukee Sports Medicine 2011 SICKLE CELL TRAIT TESTING DECLARATION I,, understand and acknowledge that the NCAA and the University of Wisconsin - Milwaukee Department of Intercollegiate Athletics recommend that all student-athletes have knowledge of their sickle cell trait status. Additionally, I have read and fully understand the aforementioned facts about sickle cell trait and sickle cell trait testing. Recognizing that my true physical condition is dependent upon an accurate medical history and a full disclosure of any symptoms, complaints, prior injuries, ailments, and/or disabilities experienced, I hereby affirm that I have fully disclosed in writing any prior medical history and/or prior knowledge of sickle cell trait status to University of Wisconsin Milwaukee Sports Medicine personnel. (Choose one of the following three options.) Decline the testing. Skip to WAVIER below. I have been tested for the sickle cell trait by my hospital or my doctor and have provided the test results to the University of Wisconsin - Milwaukee Sports Medicine staff along with this form. I agree to sickle cell trait testing at my athletic physical. If you want to decline sickle cell testing, skip to the next page. Student-Athlete Print Name Sport Student-Athlete Signature Date If student-athlete is under 18 years of age: Parent/Guardian Signature Date Parent/Guardian Print Name

5 University of Wisconsin Milwaukee Sports Medicine 2011 SICKLE CELL TRAIT TESTING WAIVER I,, have read the information provided above regarding sickle cell trait status and the risks it could pose to me if I have sickle cell trait and also participate in intercollegiate athletics at the University of Wisconsin- Milwaukee. I understand that the NCAA and the University of Wisconsin-Milwaukee recommend all student-athletes undergo sickle cell trait testing. Nonetheless, I do not wish to undergo sickle cell trait testing as part of my pre-participation physical examination and I VOLUNTARILY AGREE TO RELEASE, DISCHARGE, INDEMNIFY AND HOLD HARMLESS the Board of Regents of the University of Wisconsin System, University of Wisconsin - Milwaukee, and their officers, trustees, employees, agents and insurers from any and all costs, liabilities, expenses, claims, demands, or causes of action for any loss or personal injury, up to and including death, that might result from my non-compliance with the recommendation of the NCAA and the University of Wisconsin - Milwaukee Department of Intercollegiate Athletics to undergo sickle cell trait testing. I have not undergone prior testing for sickle cell trait and have no prior knowledge that I have the sickle cell trait. I HAVE READ AND SIGNED THIS DOCUMENT WITH FULL NOWLEDGE OF ITS SIGNIFICANCE. I further state that I am at least 18 years of age and competent to sign this waiver. Student-Athlete Print Name Sport Student-Athlete Signature Date If student-athlete is under 18 years of age: Parent/Guardian Signature Date Parent/Guardian Print Name