The extent to which Tyrek Coger’s death might have been preventable is not yet known, but parents of young athletes should be aware of any and all clues.
Coger, a 21-year-old basketball player at Oklahoma State University, died July 21 after a workout. Members of the team had just finished running stadium steps outdoors at Boone Pickens Stadium in the heat of the day when Coger collapsed.
The Oklahoma State Medical Examiner’s Office told the Associated Press that although the final report may not be available for another eight weeks, the initial autopsy revealed Coger died from an enlarged heart and that the manner of death — cardiomegaly with left ventricular hypertrophy — was natural.
But there’s nothing natural about intense exercise in extreme heat. High temperatures for Stillwater on July 21 reached 99 degrees, and the high humidity for the day was 76 percent.
It’s exactly why football leagues at all levels have restricted or altered practicing in the heat and humidity of summer. It’s just not safe, especially for young athletes with existing medical conditions, known or unknown.
Dr. Steven Hardage, M.D., is a primary care sports medicine specialist at Eastern Oklahoma Orthopedic Center in Tulsa. EOOC sees plenty of young athletes for injury care, surgery, rehabilitation and prevention, but also performs the standard pre-participation physical exams.
Hardage explained how extreme heat can be dangerous to an athlete during workouts.
“When you exercise, obviously you increase your metabolic rate, and you increase heat, of course,” Hardage said. “And the way your body lets heat out, one of the major cooling mechanisms is evaporation (of sweat). … So if you’re in an air-conditioned environment, you’re just dissipating heat to the environment. But also, you sweat and that sweat evaporates, so if you’re exercising outdoors in the heat, especially when the humidity’s high — say, the humidity’s above 75 percent — that sweat doesn’t evaporate. So you lose that cooling mechanism. So exercising out in the heat, running bleachers or whatever, versus indoors in an air conditioned environment, obviously impairs your ability to cool your body.”
That lack of efficient and natural cooling puts virtually every bodily function under duress. And when an athlete has a preexisting condition — an enlarged heart, in Coger’s case — extreme heat can become deadly.
The best way to determine an enlarged heart is an echocardiogram or electrocardiogram, but the NCAA doesn’t mandate EKGs. They’re expensive, so it’s just not financially viable, especially for a football team with upwards of 100 players. Many colleges, however, do administer the tests to athletes now.
Hardage said whenever EOOC comes across a young athlete with a heart murmur or other warning signs in a standard physical exam, that athlete will be sent to the family doctor or a cardiologist for a more thorough battery of tests.
“If we find anything that’s concerning, either a family history problems or a sudden cardiac death in someone that was young or if the patient has a history of getting more tired than everybody else, an episode where they’ve passed out or (experienced) chest pain, then obviously we move those patients along and do an echocardiogram or EKG for further evaluation,” he said.
Hardage, however, recommends much simpler steps that parents can take well before the annual cursory summer physicals: personal involvement.
“One of the big things is whenever these kids have their pre-participation physicals, I just think it’s real important that the parents be involved, and that all the information is given,” Hardage said. “A lot of times when these forms are filled out, the athlete filled it out or the parents don’t read all the questions, they just check ‘No’ on everything and you don’t get a great accurate (family medical) history, and the history is so important when we’re going through these things.
“Because if there’s a cousin that died at 23 playing basketball and that doesn’t get reported to us, then we missed a big red flag, and there’s no way for us to catch that. So I think the history is so important, and I think people just kind of minimize that at times, thinking their kids are healthy and everything’s good.
“It’s one of those things, you’re looking for a needle in a haystack. And every clue you can have to help you find that needle in that haystack is huge.”