- The Washington Times - Tuesday, February 18, 2003

Heatstroke, which claimed the life of Baltimore Orioles pitcher Steve Bechler yesterday, has been responsible for the deaths of 20 football players in the last eight years.
According to a University of North Carolina study released last year, 19 high school and college football players have died from heatstroke since 1995.
Two years ago, Minnesota Vikings offensive lineman Korey Stringer became the first NFL player to die from the condition, which occurs when the body is unable to regulate elevated internal temperatures.
No football players died from heatstroke last year, said the author of the North Carolina study, who added that Bechler is believed to be the first Major League Baseball player to die from the condition.
"Heatstroke has really been confined to football," said Dr. Frederick Mueller, chairman of the department of physical education, exercise and sports science at North Carolina. "I've never heard of it in baseball.
"I'm sure that [baseball] has had heat exhaustion and cramps, but there haven't been any deaths in high school or college baseball since the time I started collecting data in 1982."
Usually brought on by extreme heat and excessive physical exertion, heatstroke takes place when elevated body temperatures limit the blood supply to the major organs, causing them to shut down.
When the body is unable to cool itself through the normal mechanism of sweating, it draws blood toward the skin and away from the major organs, which can fail if body temperatures exceed 103 to 105 degrees.
Bechler's body temperature reached 108 degrees, according to Orioles team physician William Goldiner.
Bechler, a 23-year-old prospect, was initially diagnosed with heat exhaustion and dehydration after he looked pale and complained of lightheadedness following a late-morning series of sprints at the Orioles' spring training facility in Fort Lauderdale, Fla.
Symptoms of heat exhaustion, a nonfatal condition that sometimes occurs prior to heatstroke, are similar to those of heat stroke and include headache, dizziness, weakness, nausea and vomiting.
According to Dr. Douglas Casa, an associate professor of kinesiology at the University of Connecticut, the two major symptoms that differentiate heat exhaustion from heatstroke are elevated body temperatures (fever) and changes to the central nervous system (incoherence, convulsions).
"You could have heatstroke without heat exhaustion," said Casa, chair of the National Athletic Trainers Association Position Statement on Fluid Replacement for Athletes. "And someone could drop from a heatstroke without any symptoms of heat exhaustion."
While athletes generally are in good physical shape, Mueller said, they are often at greater risk for heatstroke because they work in hot conditions for extended periods of time.
Poor physical conditioning, excess body mass and certain nutritional supplements can increase an athlete's risk of suffering heatstroke, Casa said.
Orioles manager Mike Hargrove said Sunday that the 6-foot-2, 239-pound Bechler reported to camp weighing more than he did last season and that his physical shape was "not good."
Another member of the team's staff said Bechler's participation in offseason workouts was minimal.
A team source told The Times on Sunday that Bechler had a bottle of a supplement in his locker that contained ephedrine, a stimulant designed to minimize fatigue, control weight and enhance performance.
The NFL banned ephedrine, which has been linked to the deaths of several athletes in recent years, in 2001. Major League Baseball does not prohibit the substance.
"That's one of the main supplements we tell athletes to avoid when you're talking about risks of heat illness," Casa said.
"It's a stimulant. It's going to increase the amount of work you're doing. Your heart rate may be higher. There's also some evidence that it may inhibit your ability to cool yourself."
In order to prevent heatstroke when working in hot climates, Mueller recommends that athletes be given cold water, frequent rest periods and a seven-to-10 day acclimation period in which workouts become more difficult at a gradual pace.
Mueller also said that team trainers need to watch athletes closely for the early signs of heat-related illness.
Orioles staff pulled Bechler out of Sunday's workout as soon as he did not look well. The team provides water coolers near its practice field and allows players to get a drink during drills.
Many college and professional football teams weigh players before and after each practice. If a player loses more than 5 percent of their body weight through sweating, they are considered in the danger zone and may be held out of the next day's practice.
"When you talk about athletes that are always going at their hardest, they may feel tired and hot and not know they're dehydrated," Mueller said. "They keep going full speed because they want to earn a spot on the team. So someone has to be watching you."
When an athlete falls ill, rapid treatment is vital. Ice baths, fanning, spraying water and placing ice under the armpits and groin can cool an athlete's soaring internal temperatures, Mueller said.
"Everybody says [these deaths] shouldn't happen because they are preventable," Mueller said. "You just have to make sure that the coaches and trainers take the proper precautions."

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