4

A TRAINING

Varicose Veins, Hemorrhoids,
Varicocoele.

‘These and similar related conditions re-
quire little from the coach or trainer other
than a reasonably well developed ability
to identify such conditions, and to have
the proper steps taken in treatment by
the team or home physician.

Varicose veins occur as a rule in those
parts of the blood stream which are farth-
est from the heart and which are rela-
tively unsupported by surrounding tis-
sues. Varicose veins of the legs develop,
as a rule, in the superficial veins of the
calf and thigh, usually on the inner side.
Any condition which interferes with the
return of blood from: the veins is apt to
cause their permanent dilatation.

The difficulty may be started, in ath-
letics particularly, by direct injury to the
veins. The resulting inflammation
weakens the walls of the veins and they
dilate under the pressure of the blood
stream. The valves in the veins, which
normally keep the blood advanced, be-
come atrophied and useless. The vari-
cose vein appears as a tortuous, bluish
cord beneath the skin. The skin itself

may appear lifeless, shiny and pigmented.

The common symptoms of varicose
veins are a feeling of heaviness in the
legs accompanied by dull, aching pain,
both of which are much relieved by el-
evating the legs.

Advance cases of varicose veins are
subject to hemorrhage as a result of a
blow, since the vitality of the dilated ves-
sel is markedly reduced. Inflammation
within the vein may result in local blood
clotting, which, as a result of a blow or
sudden or violent movement, may cause
the detachment of a piece of the clot into
the blood stream, which, when carried to
the brain or lung, may cause sudden

death.
Palliative Measures

Avoid long standing and fatigue. Walk-

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plemented with the necessary amounts
of minerals and vitamins. If the diet is
truly adequate with respect to properly
cooked meats, cooked and raw vegetables
and milk, the minerals and vitamins are
in the vast majority of cases, taken care

of,

Carbohydrate foods (potatoes, bread,
sugar, such as dextrose, etc.,) and fats
are the energy foods. They are the fuels
which furnish the steam for all athletic
activities.

Proteins, found so abundantly in egg
white, meat, peas, beans, etc., furnish the
material for building new tissue and re-
placing or rebuilding old.

The daily food intake of the ‘growing
athlete must be sufficient to maintain
weight, not as determined at the begin-
ning of the training season, but from two
to three weeks thereafter, after a reason-
able equilibrium has been reached. Well
kept weight charts are, therefore, indis-
pensable.

The adequacy of the diet with respect
to proper amounts and proportions of pro-
teins, carbohydrates, fats, minerals and
vitamins is best determined by constant
observation, by the coach, trainer, and
team physician, of the general health and
vitality of the individual, as evidenced by
how well he stands the rigors of athletics,
his tendency to fatigue, general disposi-
tion, etc.

Too much emphasis can not be given
to the fact that the food requirement of
the growing athlete is extremely large—
equivalent to that of a mature adult at

hard labor.

It is our opinion that many of the diet-
ary difficulties experienced by athletes,
at least, may be attributed to faulty break-
fast habits—too little food eaten with

too much haste. For the average person, «

the time elapsing since the previous even-
ing meal is about fourteen hours. The
digestive tract is empty and the metabolic
processes of the body are at their lowest

ROOM MANUAL " Page 136

ing favors venous return, but violent ex-
ercise should be avoided. The wearing
of elastic stockings or the use of an elas-
tic bandage may give considerable relief.
The legs should be elevated whenever
possible.

In earlier pages of the Manual we have
described the Analgesic Pack treatment
for severe thigh and calf bruises. It is
suggested that this pack, covered as it is
with an elastic bandage, might reduce the
number of varicosities occurring in ath-
letics.

Hemorrhoids (Piles)

Hemorrhoids are masses of excess tis-
sue caused by the dilatation of blood ves-
sels, usually venules or veins, just inside
the anal sphincter. They cause trouble
either by reason of the fact that they be-
come ulcerated and painful when scraped
or crowded by passing feces, or as a result
of bleeding, or because they pass down
through the anal sphincter and require
frequent manual replacement. Marked
anal itching is usually associated with
hemorrhoids. Stubborn constipation is
usually an accompanying factor, and
may, in athletics, at least, be a contribut-
ing factor. This is especially true early
in the season when sweating and food
consumption are extraordinarily exces-
sive. Eliminating constipation at this
time might at least assist in eliminating
many cases of piles.,

Varicocoele, a varicose enlargement of
the veins of the spermatic cord, occurs
infrequently in athletics, but is an ex-
tremely severe condition for the athlete
when it does occur. It results most fre-
quently in athletics from a blow to the
scrotal area, or from wearing supporters
that are too tight. The condition is evi-
denced by marked puffy enlargement of

the scrotal sack, accompanied by a heavy, |

dragging pain in the area. The attention
of the team physician should be directed
at once to such cases. He will probably
suggest long periods of absolute rest with
ice pack application, and a well fitting
scrotal suspensory.

ROOM MANUAL ‘ Page 138

ebb. The normal stimulus for stomach
and intestinal activity is the taking of
food. And it should be taken in suffic-
iently large amounts to replace the de-
pleted body stores, and furnish ample
energy to carry through to the noon meal,

Gastrointestinal Upsets—Nervous
Indigestion

Much attention is given to the pre-
game meal of the athlete, and rightly so.
However, the reasons for pre-game meal
consideration as compared to that given
to other meals are frequently obscure.
The laborer, for instance, doesn’t worry
about the effect of a large volume of
food, readily digestible or otherwise,
upon his efficiency for the afternoon’s
work. And the food requirement of the
football or basketball player is fully as
great as that of the man working for four
hours at hard labor. The difference in
ability to handle normal quantities of food
is explained by the difference in emotion-
al reaction. The laborer is completely
relaxed—digestion proceeds in a normal,
uninhibited manner. The athlete, re-
gardless of past experience, is in a nerv-
ous digestion turmoil.

The human stomach, after an ordinary
mixed meal, empties in from 3 to 414
hours. This emptying time may be
lengthened by pre-game emotional strain
to 6 hours, during most of which time
the food lies dormant—of no benefit
whatsoever to the athlete. It obviously
isn't sufficient just to eat food. It must
be digested and absorbed into the blood
stream before steam can be produced.

Carbohydrate foods leave the stomach
much more rapidly than proteins, and
fats retard digestion most of all foods.
Fluids and semi-fluids start to leave the
stomach almost immediately after being
swallowed.

Careful mastication of food and slow
eating will probably do more to eliminate
nervous indigestion in athletes than will
the choice of food. It is perhaps better
not to eat at all than to eat under ex-

i
it

Ve A TRAINING ROOM MANUAL Page 137

APPENDICITIS

While there is little if anything to be
done by the coach or trainer by way of
first aid in appendicitis, it is extremely
important that the condition be recog-
nized at the earliest possible moment, for
the don’ts are, in this case, more impor-
tant than the do’s.

Appendicitis is one of the important
causes of deaths in every age group, yet
the majority of the 18,000 or more an-

-nual deaths from appendicitis can be ac-

counted for by the single word—neglect.
Experience of surgeons all over the world
shows that there is practically no mortal-
ity from operations undertaken from 12
to 24 hours of the attack, whereas the
death rate for operations delayed until
the third or fourth day is about 10%.

Symptoms

Symptoms in acute appendicitis are
generally speaking, rather confusing. The
first symptom is always pain, but the
pain doesn’t appear first in the region of
the appendix. It is, more generally, a
typical mild to severe belly-ache, evi-
denced frequently by sharp pains in the
region of the naval, or in the pit of the
stomach. The symptoms.are readily con-
fused with those of acute indigestion.
The pain, however, gradually migrates
to the region of the appendix, as evidenced
by marked tenderness to light pressure in
that area.

Nausea is a common symptom and
there may be a desire to vomit, although
the act is infrequently completed.

Fever develops slowly—may not be
significant in the early hours of an acute
attack. The temperature cannot be re-
lied upon for definite diagnosis.

Do’s And Don’ts In Appendicitis

When symptoms that are even mildly
suggestive of appendicitis develop in an
athlete, obtain the services of a physician

at once. REQUIRE ABSOLUTE REST

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cessive emotional strain. No coach would
strap a pound or two of lead to the back
of an athlete during an athletic contest.
Why should he be permitted to carry the
equivalent of a pound or two of lead
around in his stomach during the sam
contest? {

We thoroughly believe that the pre-
game or pre-contest nervous upset ex-
perienced by so many athletes could be
partially eliminated by duplicating as far
as possible, actual game or track meet
conditions, after the warm-up, at the be-
ginning of each’ practice session. Five
minutes of scrimmage in football, ten
minutes in basketball, or short races in
track, set to actual contest conditions and
repeated daily, should help to reduce the
shock of the weekly competition exper-
ience.

Dextrose And The Athlete

We have, for a number of years, ad-
vocated the use of Dextrose by the ath-
lete for the simple reason that its use
seems logical, and perhaps even necessary
in certain instances. Dextrose is, accord-
ing to all authorities with which we are
familiar, identical to the sugar of the
blood, commonly referred to as d-glucose.
The latest revision of the United States
Pharmacopoeia, gives d-glucose as an
official synonym for-Dextrose.

Dextrose requires no digestion. It
moves rather rapidly from the stomach in-
to the small intestine, where absorption
begins immediately. The normal adult can
utilize in the neighborhood of two ounces
of Dextrose per hour, equivalent to about
one-tenth of the total daily caloric re-
quirement.

Dextrose is one of the few carbo-
hydrate foods that may be absorbed as
eaten, without previous digestion, and
it is probably the only carbohydrate food
that may be utilized by the body tissues
without some form of modification. Dex-
trose is, in fact, injected, in solution, dir-
ectly into the blood stream. It may be ad-

DURING ANY DELAY IN DIAGNOSIS
AND GIVE NOTHING BUT WATER
UNTIL THE DIAGNOSIS IS COM-
PLETED by competent authority.

Neither purgatives or sedatives should
be given. Purgatives greatly increase the
danger of perforation and hasten the
spread of the disease. Sedatives of any
sort tend to mask the symptoms and often
lead to fatal delay in treatment. It might
be well to remember that it is always bet-
ter to be safe than sorry.

Diet And Its Effect On The Athlete

Space will not permit a lengthy dis-
cussion of diet for the athlete, although it
is obviously an important subject. Cer-
tainly every coach and trainer should
exhibit an active interest in the diet of
his athletes, and should exert every ef-
fort to see that it be maintained at an
adequate level, remembering, of course,
that there is no place in athletics for the

food faddist.

Some of the larger athletic departments
are able to maintain training tables, and
the diet problems are taken care of by a
competent dietician. Too frequently,
however, the dietician in charge loses
sight of the fact that she is supervising
meals for a group with extremely high
caloric requirements, with wide varia-
tions between individuals. Seconds are
too frequently significant by their ab-
sence, which accounts for the fact that
there is much piece mealing on improper
foods between meals.

Almost every high school, regardless
of size, boasts a Department of Home
Economics, and it would seem logical that
diet education for athletes be delegated
to someone in that department. A few
well organized lectures should acquaint
the athlete with what he must know about
the adequate diet and how to obtain it.

Athletes, of all persons, should know
WHY they should obtain an adequate
diet consisting of the proper proportions
of proteins, carbohydrates and fats, sup-

ROOM MANUAL Page 139

ministered by rectum or injected, in solu-
tion, intramuscularly.

There can be no question concerning
the depletion of the d-glucose or dextrose
reserve in the body of an athlete during
muscular activity. The store exists in the
form of glycogen, frequently referred to
as animal starch, and occurs principally
in the liver and to a lesser extent in mus-
cle. Dextrose is the energy food for
muscular activity, and is carried to the
muscles .by the blood. The amount of
sugar, i.e., dextrose, in the blood (re-
ferred to as the blood - sugar level) is
held fairly constant during muscular ac-
tivity at the expense.of the stored gly-
cogen. The glycogen is converted, as
need arises, to dextrose and thrown back
into the blood stream.

It is quite readily conceivable that prac-
tically the entire carbohydrate reserve
of an athlete could be expended during
the first half of a football game or basket-
ball game, or by the more exacting track
events. This is particularly rue when the
diet of the athlete is restricted during the
preceding twelve hours, by lack of appe-
tite caused by nervous reaction, or for
other reasons.

The following interesting statements
are quoted from “The Living Body’, by
Best & Taylor, Henry Holt & Company,
New York, 1938.

“In the intact animal carbohydrate is also the
fuel for short bouts of muscular exercise. After
a sprint, for example, a fall in blood sugar may
occur, and the ingestion of glucose prior to a
race is now recognized as a valuable means of
postponing fatigue and enhancing muscular per-
formance. In prolonged and exhausting work the
carbohydrate stores bécome depleted; fat is then
burned to furnish the required energy. Protein
apparently is not utilized in muscular exercise,
or, if so, to a very small extent.”

Glucose, as referred to in the above
statements means dextrose. It also seems
logical to assume that the feeding of
dextrose, in reasonable amounts, follow-
ing excessive muscular activity, should
restore depleted carbohydrate reserves
not only rapidly, but with the least pos-
sible derangement of digestive processes.

Sa ae