Is There a Sports Connection?
By Tom Kerr
Sixty years ago, baseball great Lou Gehrig's remarkable career was cut short by a rare degenerative disease--amyotrophic lateral sclerosis. The symptoms first appeared in the New York Yankee first baseman's play--his awesome strength and agility on the field began to suddenly deteriorate. After playing 2,130 consecutive games, the "Iron Man" of baseball was forced to permanently step away from the plate.
Two years later Gehrig died.
Gehrig's name became associated with the disease, which most people had never heard of, but over the ensuing years, other athletes in professional sports also would fall victim to ALS. Some of the more notable players included Houston Oilers quarterback Billy Anderson, former Seattle Seahawks lineman Glen Montgomery, and former San Fran-cisco 49ers quarterback Bob Waters and teammates Gary Lewis and Matt Hazeltine. Most recently, another Hall of Famer who wore the Yankee pinstripes--pitcher Jim "Catfish" Hunter--was diagnosed with Lou Gehrig's disease.
A unique coincidence? Or is there a direct correlation between ALS and athletics?
While he has no direct proof, Dr. Stanley Appel, a neurosurgeon who has studied ALS for the last 20 years and treats ALS patients at Baylor University, Houston, believes that some jocks are more susceptible to the disease.
" The bottom line is that trauma is a risk factor for ALS, and athletes, of course, are subjected to trauma," he said.
Today, 30,000 Americans live with ALS, but once they are diagnosed, their average lifespan isn't very long. While a very few people have been able to live 20-30 years with Lou Gehrig's disease, most patients die two to five years after it begins to destroy the cells that control muscle function. The chronic, progressive disease is marked by gradual degeneration of the nerve cells in the central nervous system that control voluntary muscle movement. The disorder causes muscle weakness and atrophy, and finally death.
Dr. Appel has treated Anderson, Montgomery, Waters and a host of other athletes diagnosed with ALS. He wonders whether significant shocks to the body, such as broken bones, torn muscles, and stretched ligaments that jocks sustain over time, may signal a trigger which activates the disease.
"We do know that injury to nerves can cause inflammation to motorneurons and that the neurons are part of it," he said. "No one has yet proven the relationship (between athletes and ALS) but it makes sense. In animals, if you traumatize a nerve, those cell bodies don't die--the same is true in ALS."
People with ALS suffer progressive weakness and deterioration of the muscles, usually on one side of the body. The nerves of the body controlling muscle function die off, leaving the person sound of mind but virtually non-functional, physically. Dr. Appel has performed some anecdotal studies on ALS and athletes. Trying to find a link associated with trauma, he has studied environmental causes such as broken bones, and even a popular liniment once used in sports that seeped through the skin into the bloodstream. He and his colleagues also looked into the fertilizer milorganite which was previously used on the field at 3Com Park where the 49ers play.
He couldn't find any real evidence that these factors caused ALS, but believes that because viruses, toxins and trauma are all potential risk factors, the theory is a valuable one.
"All athletes go through trauma, so why do only a few get ALS?" he said. "The difference may be something that we don't understand. It may be a genetic predisposition where someone is more susceptible to ALS, in which trauma can flip that switch on."
For now, scientists can only make educated guesses concerning the connection between sports and ALS. Dr. Appel says that a major study on it would be complicated and costly.
"It's a very expensive study to do," he said. "It has to involve a carefully detailed investigation of ALS and athletic injuries to determine the likelihood that athletes are more susceptible to ALS. It would be a huge problem because there is a very small number of athletes who have ALS, so you have to look at the number of ALS athletes and go from there."
Hunter, who was diagnosed with ALS last November, began to experience the symptoms of Lou Gehrig's disease when he first had trouble buttoning his shirt. He told the San Jose Mercury News at that time that he felt good, though he had lost most of the strength in his hands.
"I can do a little bit with them, but just a little bit," he explained. "I can't lift anything. Everywhere I go, I need to have my wife, Helen, with me to button my shirt and zip my pants."
Though the symptoms leave patients feeling hopeless, Dr. Appel has spent his career trying to improve quality of life of people with ALS. That's why the neurosurgeon raised a fuss when 60 Minutes aired a videotape last fall of Dr. Jack Kevorkian using a lethal injection to end the life of Thomas Youk, a 52-year-old patient with ALS. Dr. Kevorkian said his intent was to force a showdown with prosecutors over assisted suicide and euthanasia. In December, Dr. Kevorkian was arraigned on a charge of first-degree murder and violating Michigan's ban on assisting a suicide. His trial is set for the first week of March.
"(Youk) had problems with constantly choking; what infuriated me about this case is that there was no knowledge of alternative ways to handle this problem," Dr. Appel said. "There are a lot of non-invasive ways to improve quality of life for ALS patients."
To deal with the choking problem, Dr. Appel says that he would have first decreased the patient's saliva through medication and possibly suctioned the mouth to rework the food in the right paths. He would have also changed the patient's diet to make it easier for him to swallow.
"If the patient still had problems with choking, I would go to enteral feeding by percutaneous endoscopic gastostomy tubes," he said. "It's a more evasive approach, but I have patients who went through this procedure and are functioning well. In some cases they are walking around and going to work."
Dr. Appel admits that after three years, most have serious breathing problems, but adds that 20 percent of his patients live longer than five years.
" I've learned that most of the people with this disease are highly motivated, courageous people," he said. "They are warm and tough, and it's hard to turn away from them. That's why I am so committed to helping them achieve their highest level of function."
For now, people with ALS and their families hope that researchers will gain a better understanding of the disease. Drugs such as Rilutek have slowed the progression of the disease in some, and several other promising therapies are on the horizon.
"They're hoping by the year 2000 maybe to have a cure for it," Hunter told the Mercury News. "That's what they're hoping. I don't know. *
Tom Kerr is ADVANCE associate editor.