1. Traveling with the Team Luis Baerga-Varela, MD Team Physician Puerto Rico Olympic Comitee Assistant Professor University of Puerto Rico Medical School

2. Sports and Spine Fellowship – Kessler Institute Team Physician Puserto Rico National Men’s Volleyball Team (2006 – 2011) –3 Norceca Tournaments –1 FIVB World Cup – Japan 2007 –1 FIVB World Championships – Italy 2010 Team Physician Puerto Rico Olympic Comitee –Olympic Comitte Sports Med Clinic –2 Centralamerican Games –2 Panamerican Games –1 Olympic Games London 2013 My Experience

3. Our Experience How to prepare –Vaccines –Jet lag –Altitude –Traveller’s Diarrhea Overview

4. 1 Delegation – Medical Team –Multiple sports –Full Clinic/Pharmacy –PM&R, Family Med, Orthopedist, Sports Psych, Physical Therapist, Dentist 1 Team – 1 Physician –1 Sport, thus sport specific injuries –Medical Bag –You’re it 2 Different Scenarios

5. Panamerican Games –Guadalajara Mexico 2011 Delegation of 406 (259 athletes) 357 MD encounters (272 patients) –112 Medical illness (41%) –160 MSK injuries (59%) Our Experience

6. Medical Illness by System

7. MSK Injury by Anatomic Area

8. Type of MSK Injury

9. Pre-participation physicals Know your athletes’ needs Prepare for your trip Therapeutic Use Exemptions forms Screen your athletes

10. www.CDC.gov –Epidemics –Local infectious diseases –Special preacautions Prepare for destination

11. Resources available at venue –Ambulance, imaging, pharmacy Nearby hospitals/affiliation to event –Address –Phone numbers Temporary medical license Assume nothing will be available Prepare for destination

12. Assume nothing will be available Take into account athlete’s needs Label medications banned by World Antidoping Agency (WADA) www.wada-ama.org Medications

13. All athletes and team members –Tetanus, diphtheria, pertussis, measels,mumps, rubella and polio Close contact athletes and medical team –Hep B vaccine Hep A is recommended for international travel Consider varicella and influenza vaccine Vaccines Kary JM, Lavalle M Clin Sport Med 26 (2007) 489-503

14. Symptoms: –Daytime fatigue, nightime insomnia, irritabilty, poor concentration, headaches, fatigue Worse with eastward travel Increases with time zones crossed Affects athletic performance Jet Lag

15. 1 day of to adjust for ea time zone crossed Sleep hygene prior to travel –Avoid sleep deprivation, adjust sleep patterns and practice hours to new destination Reach destination close to new bedtime* Avoid dehydration during travel* Light training sessions on arrival* Recommendations * Expert opinion, poor evidence

16. Evidence in reducing subjective feeling of jet lag No evidence of improved performance May cause drowsiness and headaches Not recommended if athlete not familiar with its effects Melatonin

17. Diet –High protein in the AM –High Carbs in the PM Light –Shift body clock 1hour/day –Delay body clock Light exposure early evening –Advance body clock Light exposure late evening and early morning Other alternatives

18. Frequent hand washing Bottled water/ No ice! Avoid uncooked vegetables Avoid fruits that can’t be peeled Fluorquinolones are first line –Cipro 250mg PO BID x 1day –Careful with tendon ruptures –Azithromycin 1000mg x 1 Traveller’s Diarrhea

19. Reductions (day 1) in: –O2 consumption –Peak power output –Time to exhaustion Improves significantly by day 14 Travel with 2 weeks to adapt to altitude exposure Altitude Schuler B, et al. Scand J Med Sci Sports 2007;17:588-594 Clark SA, et al. Eur J Appl Physiol 2007;102:45-55

20. Know your athletes –Preparticipation physicals Know your destination –www.cdc.govwww.cdc.gov –Resources, assume nothing –Time zone –Altitude Conclusion

21. Thank you luisbarga@yahoo.com