As summer vacation winds down, the two-a-day practices for fall athletes heat up.
This year, those intense workout sessions are coming with a new warning attached, a medical term that most people probably have never heard of: exertional sickling.
It's a rare condition, one that strikes people who carry the sickle cell trait -- the most common genetic trait in the United States. However rare, it's enough of a concern that the National Collegiate Athletic Association issued a recommendation in June that all college athletes be screened for the sickle cell trait.
The recommendation, which follows a similar one made in 2007 by the National Athletic Trainers Association, is part of a lawsuit settlement with the family of a Rice University football player who died suddenly in 2006 after a strenuous workout.
But the NCAA's heightened precautions are not trickling down to the high school (or pee-wee) level just yet. The Ohio High School Athletic Association does not require that schools test for the sickle cell trait.
The Ohio association's pre-participation physical evaluation form that athletes and their parents fill out (and have their doctors sign) includes one question about sickle cell trait -- "Has a doctor told you that you or someone in your family has sickle cell trait or sickle cell disease?" But the group has no plans to make testing mandatory, a spokesman said this month.
OHSAA is a member of the National Federation of State High School Associations, which publishes playing rules in 17 sports for the country's 19,000-plus high school athletes.
"We're watching closely what the NCAA did," said Bob Colgate, the federation's assistant director over football, wrestling and sports medicine. "We always do."
The group's advisory committee will hold its regular twice-yearly meeting in early October. On the agenda is how to minimize the risk of concussion-, heat-, and cardiac-related injuries -- and risks associated with the sickle cell trait.
Since 1990, Ohio has tested all newborns for the sickle cell trait with a quick heel stick before they leave the hospital. It is one of a dozen automatic newborn screening tests.
If the trait is present, follow-up tests are done to determine if the baby has sickle cell disease.
The problem, however, is that countless families may not have copies of the screening results if they no longer have the same initial pediatrician or primary physician.
They may not know what those test results were.
And others may have previously lived in a state that did not provide sickle cell trait screening when their child was born. Today, all 50 states and the District of Columbia screen for the trait.
"It's all about being informed," said Colgate of the federation. "Yeah, their children were tested, but some parents kind of look at you funny and say, 'What are you talking about? ' "
An official with the Ohio Department of Health said it plans to convene experts in the field for a series of meetings that will begin in October.
The group will review the National Athletic Trainers Association and NCAA recommendation and craft Ohio-specific guidelines, said Cheryl Jones, the Ohio Department of Health's sickle cell program coordinator.
In July, Dr. Jeffrey Hord, a member of ODH's Newborn Screening Advisory Committee, spoke to coaches and trainers of the Columbus public schools about exertional sickling.
He also is working with the NCAA to provide information to families on how to seek out newborn screening results, to avoid having their athlete retested.
"We have to figure out a way of making sure that the results stay with [the family] so they understand what they have," said Hord, a hematological oncologist and director of the Showers Family Center for Childhood Cancers and Blood Disorders at Akron Children's Hospital.
Parents should contact their newborn-screening physician to get test results or, if that is not possible, contact their primary care physician to arrange for the test.
The traditional teaching of physicians has been that if someone inherits the sickle cell trait, they won't have any clinical problems, Hord said. But because it's an inherited trait, it's important to be aware of when you're ready to start a family.
"There has been a gradual accumulation of cases of individuals with sickle cell trait who have been found to have problems," Hord said. "We've known that there have been unusual problems [brought on by] high altitudes and low oxygen levels."
One of the first discoveries of a tie-in between sudden death incidents and the sickle cell trait came out of research that reviewed all deaths that occurred during military basic training from 1977 to 1981.
Those findings, published in the September 1987 New England Journal of Medicine, showed that the recruits who have the sickle cell trait have a "substantially increased, age-dependent risk of exercise-related sudden death unexplained by any known pre-existing cause." That risk, they found, was 27 times higher in African-American recruits with sickle cell trait than those without the trait.
Seven of 19 nontraumatic deaths in college football since 2000 were caused by exertional sickling, according to the NCAA. Others, looking at deaths before that time, say the number of deaths is closer to 20.
On July 8, nine days after the NCAA testing recommendation, an African-American Western Carolina University football player collapsed during conditioning practice. The cause of his death has not yet been determined.