Here's an interesting discussion between cardiologists on Twitter about whether Hamlin would need an ICD if he's able to (and wants to) return to play:
Jan 13, 2023·edited Jan 13, 2023Liked by David Epstein
This is really interesting. After seeing all of the sudden cardiac arrests on the pitches in the UK, we got to thinking about the grassroots footballers, and what happens to them. 36% of adults in the UK don't know how to perform CPR, so we created a product called the Extra Time Badge: https://www.extratimebadge.com/
In essence, it's a badge that's meant to be ironed on to a uniform / training top in the right place to perform CPR. If that athlete then ever suffers from cardiac arrest, someone close to them can put their hands on the badge and follow the instructions there to perform CPR.
Check it out. It's obviously not going to solve the stuff you wrote above, but it's a first small step.
I'm really sorry to hear about your loss and personal connection to this as well <3
David - thank you for writing this. That fact about the number of doctors in Italy :0 -- blew my mind. I grew up playing lacrosse and heard a story about a goalie taking a shot to the chest and dying on the field, so this was really interesting to read. As always, great stuff.
Great article. My story: I ran some 90 miles per week until my stroke and heart attack. I received an ICD 4 months later, and gradually started running again. I dropped to around 50-60 miles per week for 8 years on an EF of 30. No shocks or misfiring. Then it went downhill and EF reduced to 18, kept running. Blacked out once HR hit 245, device shocked me and I carried on just fine. Carried on running regimen through further EF degradation and an ablation surgery after multiple VT episodes. Degradation continued until ended in a VT storm, ER and the Shocking failed, surgery and ECMO. Heart transplant followed a couple of days later. 4 months later resuming my running. Slowly increasing frequency and distance. Now 8 months post transplant and really enjoying my daily 6 miles of running. Looking to build up again.
Thanks for this article and the offshoot articles!
I appreciate your dedication to bringing this complex though devastating problem to light. I have done roughly a thousand pre-sport physicals from middle school through college, over the years as a physician assistant - though I'm now retired. The history and physical portions of the exam are done with special attention to abnormalities that could be potentially lethal or catastrophic under the right combinations of circumstances. So many times the students or their parents belittled the importance of concerning symptoms such as chest pain or dizziness with sports. Many fought tooth and nail to evaluate newly discovered heart murmurs. As I say - it was and is a very complex problem. I think I turned up only a handful of students with either echo changes consistent with hypertrophic cardiomyopathy or EKG findings of prolonged QT.
You might enjoy reading about the biological effects of non-native Electromagnetic Radiation, especially Wireless Radiation. This is a confounding variable for our current societal challenges, including heart palpitations and sudden collapse. I share more on my Substack page: https://reclaimedwellness.substack.com/
This was very well written as usual, and the analogy of the interventricular septum stacked like scattered bricks really helps. I’m sorry that your high school friend passed away - that would have left an indelible scar for me, too. My best friends were my X-C and distance medley teammates. We ran so hard I often worried about my own heart. And to lose another friend (Grant Wahl) recently must bring up old sadness and new.
I do sometimes check ECGs for high school athletes at routine physicals based on guidelines or family history or family request. Have picked up a few long QT and WPW possibilities which are then referred to pediatric cardiologists, a luxury perhaps here in a metro area.
I have not followed the Hamlin case very closely, but I would guess from the video it was vfib/impact induced (commotio). I know many others have dangerous jobs, but watching the hits and physical damage that happens in football, leading to chronic pain, CTE, and all the rest, has forced me to look away from a sport I used to love as a kid.
I can’t watch it anymore.
Thanks again for this post and the previous about Grant. Helps motivate me personally and professionally to be careful and proactive.
> Nobody ever really suggested genetically screening every athlete anyway.
Indeed. With WGS at $100-500, the rational suggestion is to genetically screen *everyone*, pre-natally, for all the rare diseases, and not merely the heel-prick subset.
As soon as I heard about and saw the Hamlin news, I thought about both Hank Gathers and your story (Kevin, ETHS and the Sports Gene). Obviously a bit different, but figured you’d be sharing something interesting on this subject.
Great article, David. I really appreciate how clearly and sensibly you explain your recommendations. I also really like how open you are about your career decisions. One question on the personal genetics-based medicine front. From what I took from what you wrote, it sounds like it is the complexity of the genome (and number of genes involved in each trait) is what is holding the field back. Do you think it's a data processing problem or something more fundamental? By that I mean do you think that an increase in computing power/analysis will be able to overcome that? Or do you think the problem is bigger than that? The paper you linked to didn't seem very optimistic. Thanks!
(By the way, do you know more about the history of Italy having had nearly open admissions to med school? That sounds fascinating. Do the downsides (slightly lower average quality of doctor?) outweigh the huge upside of just simply having more doctors? I know people like Ezra Klein, Derek Thompson, and more have advocated for an abundance agenda, and this sounds similar. Also, I can't help but ask/quip if it was with a Fermi approximation that you questioned the 8 doctors per thousand people statistic ;)
I had never heard of ICDs, especially not in athletes, and the info was both fascinating and uplifting. To think their effectiveness, as studied, is so high, and yet we do not hear more about them. Condolences on the tragic loss of your friend as well as this vital information this lead you to investigate that might just help someone save a life.
Really appreciate your article, David! I had a pacemaker (not ICD) implanted almost four years ago and people assumed that I would give up my 3x a week weightlifting regimen and playing contact sports (I am a field hockey goalie). I have definitely not! Just saw my cardiologist yesterday and they said what many people do not consider is that the injury to Damar Hamlin was a perfect storm of circumstances. Yes, football is dangerous, but these types of cardiac arrest events in sports are relatively rare.
Here's an interesting discussion between cardiologists on Twitter about whether Hamlin would need an ICD if he's able to (and wants to) return to play:
https://twitter.com/DavidLBrownMD/status/1611134709815447552
This is really interesting. After seeing all of the sudden cardiac arrests on the pitches in the UK, we got to thinking about the grassroots footballers, and what happens to them. 36% of adults in the UK don't know how to perform CPR, so we created a product called the Extra Time Badge: https://www.extratimebadge.com/
In essence, it's a badge that's meant to be ironed on to a uniform / training top in the right place to perform CPR. If that athlete then ever suffers from cardiac arrest, someone close to them can put their hands on the badge and follow the instructions there to perform CPR.
Check it out. It's obviously not going to solve the stuff you wrote above, but it's a first small step.
I'm really sorry to hear about your loss and personal connection to this as well <3
David - thank you for writing this. That fact about the number of doctors in Italy :0 -- blew my mind. I grew up playing lacrosse and heard a story about a goalie taking a shot to the chest and dying on the field, so this was really interesting to read. As always, great stuff.
Excellent article. Thanks David and sorry for the loss of your friend years ago.
Don't mention vaccine-induced myocarditis! The elephant in the room. Hamlin would have been screened for hypertrophic cardiomyopathy.
Great article. My story: I ran some 90 miles per week until my stroke and heart attack. I received an ICD 4 months later, and gradually started running again. I dropped to around 50-60 miles per week for 8 years on an EF of 30. No shocks or misfiring. Then it went downhill and EF reduced to 18, kept running. Blacked out once HR hit 245, device shocked me and I carried on just fine. Carried on running regimen through further EF degradation and an ablation surgery after multiple VT episodes. Degradation continued until ended in a VT storm, ER and the Shocking failed, surgery and ECMO. Heart transplant followed a couple of days later. 4 months later resuming my running. Slowly increasing frequency and distance. Now 8 months post transplant and really enjoying my daily 6 miles of running. Looking to build up again.
Thanks for this article and the offshoot articles!
Steve
WOW!
Anthony Van Loo collapse on the field, and then a few seconds later he jerks when the ICD shocks him, and then he sits up. Amazing
I appreciate your dedication to bringing this complex though devastating problem to light. I have done roughly a thousand pre-sport physicals from middle school through college, over the years as a physician assistant - though I'm now retired. The history and physical portions of the exam are done with special attention to abnormalities that could be potentially lethal or catastrophic under the right combinations of circumstances. So many times the students or their parents belittled the importance of concerning symptoms such as chest pain or dizziness with sports. Many fought tooth and nail to evaluate newly discovered heart murmurs. As I say - it was and is a very complex problem. I think I turned up only a handful of students with either echo changes consistent with hypertrophic cardiomyopathy or EKG findings of prolonged QT.
You might enjoy reading about the biological effects of non-native Electromagnetic Radiation, especially Wireless Radiation. This is a confounding variable for our current societal challenges, including heart palpitations and sudden collapse. I share more on my Substack page: https://reclaimedwellness.substack.com/
Arthur Firstenberg, independent scientist and author of The Invisible Rainbow, wrote a great article about the sudden death of birds on the Dutch island of Texel. This is one of many similar instances over the past few years: https://cellphonetaskforce.org/wp-content/uploads/2022/07/Birds-on-Texel-Island.pdf
It is worth a read when you have the time. May our curiosity for confounding variables lead us to a better outcome. 💚
This was very well written as usual, and the analogy of the interventricular septum stacked like scattered bricks really helps. I’m sorry that your high school friend passed away - that would have left an indelible scar for me, too. My best friends were my X-C and distance medley teammates. We ran so hard I often worried about my own heart. And to lose another friend (Grant Wahl) recently must bring up old sadness and new.
I do sometimes check ECGs for high school athletes at routine physicals based on guidelines or family history or family request. Have picked up a few long QT and WPW possibilities which are then referred to pediatric cardiologists, a luxury perhaps here in a metro area.
I have not followed the Hamlin case very closely, but I would guess from the video it was vfib/impact induced (commotio). I know many others have dangerous jobs, but watching the hits and physical damage that happens in football, leading to chronic pain, CTE, and all the rest, has forced me to look away from a sport I used to love as a kid.
I can’t watch it anymore.
Thanks again for this post and the previous about Grant. Helps motivate me personally and professionally to be careful and proactive.
> Nobody ever really suggested genetically screening every athlete anyway.
Indeed. With WGS at $100-500, the rational suggestion is to genetically screen *everyone*, pre-natally, for all the rare diseases, and not merely the heel-prick subset.
As soon as I heard about and saw the Hamlin news, I thought about both Hank Gathers and your story (Kevin, ETHS and the Sports Gene). Obviously a bit different, but figured you’d be sharing something interesting on this subject.
Great article, David. I really appreciate how clearly and sensibly you explain your recommendations. I also really like how open you are about your career decisions. One question on the personal genetics-based medicine front. From what I took from what you wrote, it sounds like it is the complexity of the genome (and number of genes involved in each trait) is what is holding the field back. Do you think it's a data processing problem or something more fundamental? By that I mean do you think that an increase in computing power/analysis will be able to overcome that? Or do you think the problem is bigger than that? The paper you linked to didn't seem very optimistic. Thanks!
(By the way, do you know more about the history of Italy having had nearly open admissions to med school? That sounds fascinating. Do the downsides (slightly lower average quality of doctor?) outweigh the huge upside of just simply having more doctors? I know people like Ezra Klein, Derek Thompson, and more have advocated for an abundance agenda, and this sounds similar. Also, I can't help but ask/quip if it was with a Fermi approximation that you questioned the 8 doctors per thousand people statistic ;)
I had never heard of ICDs, especially not in athletes, and the info was both fascinating and uplifting. To think their effectiveness, as studied, is so high, and yet we do not hear more about them. Condolences on the tragic loss of your friend as well as this vital information this lead you to investigate that might just help someone save a life.
Really appreciate your article, David! I had a pacemaker (not ICD) implanted almost four years ago and people assumed that I would give up my 3x a week weightlifting regimen and playing contact sports (I am a field hockey goalie). I have definitely not! Just saw my cardiologist yesterday and they said what many people do not consider is that the injury to Damar Hamlin was a perfect storm of circumstances. Yes, football is dangerous, but these types of cardiac arrest events in sports are relatively rare.