by Leonard Finkel
“It’ll never happen to me!” But it can and does happen to our friends, our playing partners. What we’re talking about is a medical problem or emergency on the golf course. This can range from a simple sprain to something as serious as a stroke or heart attack. Today, many golf facilities maintain extensive first aid kits as well as advanced medical equipment such as defibrillators. These are great, but every golfer should be ready to act if a medical situation arises.
One authority on dealing with on-course medical situations is Dr. Christopher Rogers of the Tri-City Orthopaedics Spine Center in Oceanside, California. Dr. Rogers is a physiatrist (a physician who specializes in physical medicine) and was the medical director for the World Golf Championships – Accenture Match Play Championships at La Costa in 2002, supervising medical treatment for PGA Tour players and their families during the event. Here is his insight on a range of golf ailments:
Early recognition of the symptoms of a heart attack can mean the difference between life and death. Typically, patients describe chest pain that feels like a pressure or tightness. Usually, the symptoms will feel similar to someone sitting on your chest. Other symptoms include pain in the arms, neck or back and shortness of breath, lightheadedness or nausea. Although symptoms can appear while eating or resting, they’re most likely to occur with physical exertion or psychological stress. Hot, humid weather strains the cardiovascular system and can increase the risk of heart attack.
If you have a history of pulmonary or heart problems, avoid playing in excessively hot, humid weather. Golfers with such a history should always have their medication with them on the course. Stay adequately hydrated and do not play after a heavy meal. To ensure your heart is working at optimal performance levels and receiving the proper amounts of blood and oxygen, a cardiovascular conditioning program is recommended.
Call 911 if you even suspect a heart attack is in progress. Monitor the individual for a shortage of breath or stoppage of heart rate. If the person is not breathing, initiate cardio pulmonary resuscitation (CPR). If you don’t know how to perform CPR, you should learn - golfers are often far from treatment facilities. Classes are generally available through the American Heart Association, hospitals, and local community colleges and universities, usually for free or at a nominal fee.
Stroke is the third leading cause of death in the United States. It is caused by a loss of blood flow to the brain, due to a blood vessel rupture or blockage. Older golfers, smokers, diabetics and people with high blood pressure or heart disease are at greater risk than the general population. Symptoms include paralysis of the arm or leg, numbness in the arms, speech or vision disturbance (including double vision or blindness in one eye), dizziness and balance problems, or difficulty in walking. Recognizing early stroke symptoms is extremely important because treatment initiated within one hour is far more effective. If stroke symptoms arise, call 911 immediately and administer CPR as necessary. If there is any doubt, err on the side of caution.
Severe dehydration can cause heat exhaustion, producing profuse sweating, headache, cramps, dizziness and confusion. Severe dehydration can also dramatically increase core body temperature and lead to heat stroke, which is a collapse of the cardiopulmonary system. The most famous example of heat illness in golf came at the 1964 US Open at Congressional Country Club outside Washington, D.C. In those days, the final 36 holes were played on Saturday. Oppressive temperatures in the 100s coupled with 90 percent humidity pushed leader Ken Venturi to the brink of death. Towards the end of his first 18, Venturi became dizzy and light-headed. During the break between rounds, a local physician, Dr. John Knowles, urged Venturi to withdraw from the tournament, warning him that continuing to play in the searing heat and humidity of the afternoon round could kill him.
After taking a light lunch, along with iced tea and salt pills, Venturi went on to win the championship, risking his life in the process. You’re not playing in the Open, so quit before the point of exhaustion. Fluid loss occurs through perspiration, respiration and urination. Risk of injury increases with high humidity, poor cardiovascular conditioning, increased body weight and a lack of proper hydration. A two-pound loss of weight would be equal to a quart of liquid needed during a round.
Water should be carried on the course - drink 10 to 12 ounces prior to the round. On very hot days, continue to drink, even if not thirsty, because by the time you feel thirsty, your body is already dehydrating. Avoid alcohol and caffeine which act as diuretics and contribute to dehydration. Golfers with diabetes and chronic renal failure should avoid playing in extreme heat. To combat the heat, wear porous, loose fitting and light colored clothing to reflect the sunlight and reduce heat absorption.
Should heat-related illness occur, hydrate the golfer if he or she is conscious. Have them lie down in the shade, and apply cool, wet towels to reduce the body temperature. If symptoms are severe and persistent, dial 911 immediately.
ACUTE RESPIRATORY ARREST (Asthma)
Regardless of their present health, asthmatics must always keep an inhaler on hand. Check with your physician to see which types will best apply to your current condition. Golfers with more severe asthma should consider carrying a nebulizer, a prescription device that pumps medication into airways too constricted for a hand-held inhaler to be effective. In the most severe of attacks, call emergency services or rush the person immediately to the nearest medical facility. Asthmatics should avoid smoke and smokers, even outdoors.
SOFT TISSUE INJURIES
There are a myriad of injuries that can occur during a round of golf. Some are a result of outside agencies such as being struck by a golf club or a wayward shot; others the result of the swing motion itself. Sprains, strains, swelling or pain should be treated with ice. Apply as soon as possible and alternate 20 minutes on with 40 minutes off. Anti-inflammatory medication such as Ibuprofen is recommended. Stretch for 20 or 30 minutes (or as long as you can) prior to a round of golf to warm and loosen the muscles and joints. A daily strength and flexibility program will substantially reduce the risk of injury and nagging pain.
INSECT BITES AND STINGS
Insect bites and stings from wasps, bees and ants can lead to serious allergic reactions characterized by a dangerous dilation of blood vessels that can result in shock, loss of blood pressure, impaired respiratory function and occasionally, death. Symptoms include itching, chest tightness, wheezing and breathing difficulty, or abdominal cramps. High-risk groups include people with a history of hay fever, eczema, asthma and anaphylaxis – a reaction to insect stings or bites.
Anyone in the at-risk population should consider carrying a medical kit containing epinephrine in small syringes. Epi-pens are available by prescription. A shot should be taken in the event of a severe reaction. CPR should be administered if difficulty with breathing occurs. In non-allergic bite cases, apply ice for fifteen minutes and look for signs of infection for the next several days.
A foreign body in the eye is the most common eye problem affecting golfers. Sand or material from the ground can cause serious potential damage. Immediate irrigation with water is the first treatment suggested. If you wear contacts, always carry supplies to clean and store the lenses. If the objects cannot be removed, see an ophthalmologist as soon as possible, since the risk of infection is high. Allergies to freshly mowed grass, chemicals and pesticides are common and antihistamine drops or pills are the most effective treatment in these cases. Topical anti-inflammatory medications can also be obtained from an ophthalmologist or your regular doctor.
Unprotected, extended exposure to the sun increases the risk of skin cancer. Even on cloudy days at higher elevations, the sun’s rays are still powerful and potentially dangerous. Use either cream or alcohol based sunscreens with a sun protection factor (SPF) of at least 15. Wearing a hat will minimize exposure to the ears, face and the top of your head. Women’s makeup containing SPF 15 is also available. A long sleeve shirt and/or pants are also recommended.
A first-degree burn will result in redness and pain. Treat this burn with a corticoid-steroid spray. At this point, get out of the sun. A second-degree burn will result in blistering and will require medical evaluation to minimize the risk of infection. One of the best ways to cope with medical problems on the course is by carrying a cell phone. If possible, keep a one in your bag, but turn it off in consideration of other players and local restrictions.
KEYS TO REMEMBER
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