Human growth hormone (hGH) is a protein that is produced and stored within the pituitary gland, a part of the brain. It goes into the blood in pulses, resulting in fluctuating blood levels. Levels may be affected by age, gender, sleep, physical activity, stress, fever, steroids and environmental factors. HGH stimulates many metabolic processes in cells and the production of other hormones, such as insulin-like growth factor and somatomedin-C. These hormones help with cartilage production, the release of lipids from fat tissue and increased production of cell proteins. The overall effects are increased bone growth, more lean body mass and organ growth.
The Food and Drug Administration (FDA) has established guidelines for the proper use of hGH, used most commonly for hormonal deficiency that causes short stature in children. Off-label use has been abused by athletes and adults who hope to increase lean body mass and improve athletic performance. However, there has been no definitive evidence for improvements in strength or athletic performance.
A recent review of all the available studies provided evidence suggesting that healthy young athletes only increased body weight and lean body mass while decreasing fat mass after using hGH. There were limited effects on performance outcomes in relation to endurance and strength. Furthermore, it was suggested that fluid retention accounted for a large proportion of the increase in lean body mass.
There is a low risk for side effects in replacement doses that are close to the levels that the body naturally produces (0.003-0.004 mg/kg/day) for GH-deficient persons. The risk for adverse effects increases when higher than normal doses are prescribed, which include: increased pressure within the brain, elevated sugar levels, sugar in the urine, fluid retention, painful joints, painful muscles, breast enlargement in men and numbness/tingling in the extremities. Acromegaly (abnormal growth of the hands, face, and feet) is a serious side effect associated with large doses. Death from bone tumors and cardiovascular events have also been associated with high-dose use of hGH, correlating with a decreased life expectancy in users.
Sports Medicine Evaluation & Treatment
Growth hormone is listed on the banned list of substances by the World Anti-Doping Agency and continues to be on the list as of recent updates for 2018. Testing is performed through blood samples. hGH use does not have an immediate effect, in contrast to stimulant drugs. Rather, to be effective, it requires the user to inject doses right under the skin regularly for an extended period of time. Athletic abuse doses probably will range from 15 to 180 micrograms/kilogram, 3-4 times per week, for 4-6 weeks in a cycle. Testing is thus performed typically weeks to months in advance of competition, or after unexpected sporting victories are achieved.
Unless used under FDA-approved indications, the use of hGH should be avoided and discouraged. Prescriptions without a GHdeficiency diagnosis may constitute illegal prescribing.
AMSSM Member Authors
Scott Marberry, MD and George Pujalte, MD
References Madden CC et al. “Drugs and Doping in Athletes.” Netter’s Sports Medicine, Elsevier, 2018. 182-183. “Human Growth Hormone Testing.” https://www.wada-ama.org/en/questionsanswers/human-growth-hormone-hgh-testing. Accessed 11/30/2017. Hermansen K et al. Impact of GH administration on athletic performance in healthy young adults: a systematic review and meta-analysis. Growth Hormone & IGF Research. June 2017. 34:38-44.
What is it?
Trench foot, also known as immersion foot syndrome, develops
when feet are cold and wet for prolonged periods of time
without the ability to warm or dry the skin. This can result
in pain, swelling, and numbness in the feet. This condition
received its name during the 1st World War as this became a
serious problem for soldiers on the battlefield, contributing to
tens of thousands of casualties. Symptoms/Risks
Symptoms may include, but are not limited to, tingling, itching,
swelling, pain, coldness, numbness, pain, prickliness, and
blotchy skin. Blisters may form which eventually lead to skin and
soft tissue dying and sloughing off. In severe cases, an untreated
foot may involve the entire foot destroying not just the skin but
the soft tissues and bones of the feet. Exposure to extreme cold
may cause frostbite or gangrene to develop, which are both
devastating conditions with lifelong consequences and potential
disability if not treated immediately. Sports Medicine Evaluation & Treatment
As the skin of the feet becomes macerated, the underlying
tissues are exposed to potentially infectious organisms. Skin
is the first line of defense and a protective barrier to bacteria,
fungi, and parasites. However, when the skin is compromised,
these organisms may infiltrate into the tissues deep to the skin
and cause infections. If there is any concern for an infection,
medical care should be sought out immediately as these
infections may penetrate into the blood stream, leading to
shock and death.
Your doctor should inspect the feet carefully. Typically the
diagnosis of a skin infection can be made clinically; however, lab
tests and cultures may be ordered to rule out infections within
the blood stream. X-ray and/or MRI tests are also sometimes
ordered if there is concern of infection deep to the skin or in
the bone. Your doctor may prescribe oral antibiotics if necessary
to treat a suspected infection. Some infections in the feet may
require hospitalization. Frostbite and gangrene may also require
hospitalization. Dead skin and tissues require debridement as
they serve as a nidus for infection and continued inflammation. AMSSM SPORTS MEDICINE TOPICS TRENCH FOOT
Patient Resource Courtesy of SportsMedToday.com. Injury Prevention
Trench foot may be prevented by keeping feet dry. Wet shoes
and wet socks should be exchanged for dry ones. Shoes should
be well-fitted and not overly-tight. Keep feet clean and check
for any developing foot wounds at least once daily. Remove
socks and shoes whenever resting or sleeping to allow the
feet to air-dry. Athletes who tend to sweat profusely may
use an aluminum-containing antiperspirant on their feet to
prophylactically reduce the risk of trench foot.
Return to Play
Athletes may return to play when the feet are fully healed, the
skin is intact, and there are no signs or symptoms of infection.
Returning to play too early may not allow the skin to resume its
protective barrier for the body, leading to further irritation and
potential for infection.
AMSSM Member Author: Scott Marberry, MD References: Fudge JR et al. Medical Evaluation for Exposure Extremes: Cold. Clin J Sport Med. Sept 2015;25(5):432-436. “Trench foot or Immersion Foot.” Centers for Disease Control and Prevention. Last updated Jun 20, 2014. https://www.cdc.gov/disasters/trenchfoot.html Atenstaedt, RL. Trench foot: the medical response in the First World War 1914–18. Wilderness & environmental medicine. 2006;17(4):282-289. Schwartz RB, McManus JG, Swienton RE. Trench foot (immersion foot). Tactical Emergency Medicine. Lippincott, Williams & Williams. 2008: 80.
Dr. Osborn, Dr. Marberry and Dr. Northrup’s
Injury Evaluation Clinic
Free Injury Evaluations
We would like to announce our bumps and bruises clinic for the fall. Every Saturday morning during football season we will open our office for athletes who need injury evaluations. Our clinic is staffed by sports medicine trained physicians, Dr. Ross Osborn, Dr. Scott Marberry and Dr. Tod Northrup. HOURS: 8:30-9:30 am
WHERE: The Center for Health and Sports Medicine 115 Bartram Oaks Walk, #104 St. Johns, FL 32259
(Located in the Bartram Oaks Walk Center)
(Note: While evaluation and recommendations for treatment are free, any treatments, advanced diagnostics, bracing or casting are not, and will be subject to professional fees if a patient so chooses.)
With schools starting back up and athletics getting in gear, keeping our youth athletes safe while having fun is the primary goal. Fundamental safety measures include a thorough health screening and evaluation by a licensed medical expert. Primary prevention involves finding and addressing potential health issues before injury or illness occurs. Optimizing the health and wellness of our athletes can prevent unnecessary emergency department visits and hospitalization.
Even with optimal health, injury does still happen unfortunately. Muscle sprains, ligament strains, fractures, and concussions are exceedingly common in many contact sports. Soccer and football consist of the majority of contact sport injuries from late summer through the fall. Care by specialists focusing on the medical needs of the student athlete target quick recovery with a safe return to play. “Student” being the formative principle, where rapid recovery is vital to once again excel in academics.
Recent medical evidence regarding sport-related concussions has shown that immediate removal from play potentiates quicker recovery with less severe symptoms. Individuals may experience the effects of a concussion differently, therefore it’s critical to receive a medical evaluation for assessment of appropriate treatment. The saying “rest is best” is supported my multiple animal and human studies, but newer research is suggesting “exercise is medicine.” After 24-72 hours of rest, systematic evaluation of exercise tolerance can be performed on either bike or treadmill testing. This should only be performed with proper supervision, typically by an athletic trainer or physiotherapist, in the event that symptoms develop or worsen.
At the Center for Health and Sports medicine, our board certified physicians in primary care and sports medicine are adept at diagnosing and treating concussions, along with other sports-related injuries. Developing a targeted treatment plan with close monitoring allows our patient athletes to receive the care needed to return to the classroom and safely return to the playing field.
Asken BM et al. Immediate removal from activity after sport-related concussion is associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes. Am J Sports Med, 2018;46(6):1465-1474.
Murata NM et al. Maximizing recovery from concussions for youth participating in sports and recreational activities. Am J Phys Med & Rehab, Aug 2018 (Epub ahead of print).
Giza CC, Choe MC, and Barlow KM. Determining if rest is best after concussion. JAMA Neurology Apr, 2018;75(4):399-400.
Leddy JJ et al. Exercise is medicine for concussion. Curr Sports Med Reports, 2018;17(8):262-270.
I’m excited to start practice here at the Center for Health and Sports Medicine! Originally from Tulsa, OK I’ve made Florida my home since 2013. I completed my undergraduate degree in Nutrition and Food Sciences at Auburn University followed by my medical degree at the University of Oklahoma. My wife and I then moved to Tampa for an orthopaedic research fellowship in 2013. We then moved to Winter Park where I trained at Florida Hospital’s allopathic family medicine residency and completed my final year as chief resident. I then trained at the Mayo Clinic Primary Care Sports Medicine fellowship from 2017-2018. I am board certified in both family medicine and sports medicine.
Since childhood I’ve been an avid sports enthusiast, which serves as the foundation for my passion for athletes. I’ve overcome my fair share of injuries and know the value of properly addressing the medical needs for recovery. Getting people back to the activities they love gives me pride in my work. I advocate healthy lifestyle, nutrition, and adaptive changes to encompass whole-body care for patients. Attention to the physical, mental, and biological aspects on an individual allow for the provision of targeted treatment and counseling of medical conditions. Whether treating acute or chronic conditions, improving health and quality of life is what I strive for with each patient.
Continuing medical research remains an important and allows me to stay on the cusp of evidence-based diagnosis and treatment. I’ve co-authored and presented numerous reports, with several on-going studies. As a clinician, I find it important to contribute to the medical evidence to enhance the care we provide to all patients. I enjoy providing local presentations on various health topics.
For leisure I can be found with my wife and daughters at the pool or group bike rides. I also enjoy rooting on my favorite sports teams, paddle boarding, grilling, and competing with friends in local trivia events.
Dear Bartram Family,
As myself and my practice embark on our 13th year of working with Bartram Trail as the team physician, I would like to share with you some of the changes I am making to the practice to better provide services for both primary care and sports medicine care of our patients.
First, many of you may have heard about my affiliation with MDVIP, a preventative health company that sets up physicians in a practice model to proactively treat our patients by focusing on nutrition, exercise and lifestyle changes to promote health.
Second, we have started the process of building a new office building, which will offer a wider range of services to treat our primary care and sports medicine patients. This is set to open in January of 2019.
Third, starting August 1st, we have Dr Marberry joining our practice. Dr Marberry is double boarded in sports and family medicine and will assist in the care of our primary care and sports medicine patients. Additionally, he will help with covering athletic events and coordinating the care of our athletes with Mrs. Vann, the trainer at Bartram.
Lastly, we have expanded our sports medicine services to include the most up to date treatments for injuries such as concussion. We have started a concussion clinic that assists in the better assessment and comprehensive recovery of concussions, based on the most recent research in this area. Additionally, we are beginning a sports sciences lab to work with athletes in areas of sports nutrition, injury prevention and areas of sports performance.
For those of you interested in learning more, I have an event coming up at Maple Street Biscuit Company on June 26th at 4 and 6 pm, that will go into more depth for all of the above. This is a free event, and all are welcome to attend and bring a friend. Please RSVP at 877.813.6181.
We appreciate your continued support and look forward to an upcoming year. I am hoping lucky season number 13 for me will bring a long-awaited football victory over St Augustine. We also appreciate your continued consideration by supporting our practice with your referrals.
Thanks and Go Bears!
I, Dr. Osborn am excited to share with you the announcement, that we are on our way to a new office building. Construction should begin this month and we hope to open in January 2019. In our new space we will be able to increase the breadth of services, return a lab to our office and resume our wellness and athletic development programs in a state of the art facility. Don’t worry we are not moving far. Our new space will be right across the street, behind PDQ’s on San Jose.
There are many individuals looking to get fit and are not sure how to. Society is under the impression that you need to join a gym and get a trainer. Yes, those are helpful but are not necessary. There are many exercises you can do on your own that are weight bearing and can provide similar results to that of which you would get at a gym. Our Exercise Physiologist at Dr. Osborn’s office, Fred has put together a great body weight workout that you can do at home or on the go. This workout takes 15 to 30 minutes to complete and is a great overall workout to help motivate you as well as work your core muscles.
No gym, no problem! You can get a great workout with 15-30 minutes of body weight only exercises. Performing body weight exercises are easy to add to any workout regimen because they’re easily modified to challenge anyone. Adding extra reps, performing the exercises faster or super slowly, taking shorter breaks, or adding a ballistic movement (like a clap at the top of each push-up) are just a few ways to make the simplest workout tougher. And with each added modification, your progress is obvious. Workouts are very efficient because you can move from one exercise to the next without adjusting equipment. This will help keep your heart rate up burning more calories in a shorter period of time and increasing your aerobic capacity. By limiting rest time in between exercises you can combine a cardio and strength session performing a body weight workout. Sessions can be modified to concentrate on core, flexibility, and balance. Body weight exercise programs are also ideal for injury prevention and you’ll never have an excuse not to work out. No equipment needed and even 15 minutes of constant motion can improve your fitness. At the Center of Health and Sports Medicine our RISE Wellness clients that travel or are unable to get to the gym are prescribed a body weight workout they can do anywhere. See the link below of an example of a 15 minute workout you can try today.
Turmeric is the spice that gives curry its yellow color. There are many articles supporting the benefits of turmeric. Recently, science studies have indicated that turmeric does in fact contain compounds with medicinal properties. These compounds are called curcuminoids. The most important of which is curcumin. Curcumin is the main active ingredient in turmeric. It has powerful anti-inflammatory effects and is a very strong antioxidant. The actual curcumin content found in turmeric is not high though. Most of the studies that have been done are using turmeric extracts that contain mostly curcumin itself, with dosages over 1 gram per day. These results would be very difficult to reach using only the turmeric spice in your foods. If you would like to experience the full effects of this herb, you would need to take an extract that contains significant amounts of curcumin. Unfortunately, even if you do take the extract, the curcumin is poorly absorbed into the bloodstream. It helps to consume it with black pepper, which is a natural substance that enhances the absorption of curcumin. Curcumin is also fat soluble, so it would be beneficial to take it with a fatty meal. If you want to buy a turmeric/curcumin supplement, then there is a great selection on Amazon with customer reviews. Studies recommend that you find one with bioperine (another name for piperine), which is the substance that enhances absorption of curcumin. Without this substance, most of the curcumin just passes through your digestive tract.
Below are more health benefits of Turmeric/Curcumin.
1. Turmeric Dramatically Increases The Antioxidant Capacity of The Body
2. Curcumin Boosts Brain-Derived Neurotrophic Factor, Linked to Improved Brain Function and a Lower Risk of Brain Diseases
3. Curcumin Leads to Various Improvements That Should Lower Your Risk of Heart Disease
4. Turmeric Can Help Prevent (And Perhaps Even Treat) Cancer
5. Curcumin May be Useful in Preventing and Treating Alzheimer’s Disease
6. Arthritis Patients Respond Very Well to Curcumin Supplementation
7. Studies Show That Curcumin Has Incredible Benefits Against Depression
8. Curcumin May Help Delay Aging and Fight Age-Related Chronic Diseases