Help, my top HS girl has anemia, 2 weeks to State

This has been my experience as well. It's even worse dealing with a male athlete who is anemic and the Doctor.

Totally Evil Private Coach wrote:

Good gravy

Poor wording given the topic. *shudders*

Totally Evil Private Coach wrote:

If you're training a girl/woman, you should absolutely know what their normal cycle is and if it's changing. Yes, that's a mature conversation you have with them or their parent. Good gravy, can you imagine how irresponsible it would be to train a girl and not know that she's become amennorheic?

This is a HS coach - not college, not professional. There are likely 30+ distance girls on his team. I would find it highly unlikely that any HS coach knows the whereabouts of each girl's menstrual cycle.

As a HS girls track coach, if a girl or parent came up to me and disclosed this information, I would absolutely have a conversation about it. More so, to increase the likelihood of this conversation, I constantly convey the idea that they should approach me with ANY type of question/concern.

Other than that, you aren't going out of your way to find out the details about a 14-17 year old girl's period. To each their own though - have fun explaining that to your AD or SI when a girl (and parent) feels you've crossed the line.

Apparently I'm the only one who can have a mature conversation about the matter without getting in trouble.

(I may also be the only one who doesn't understand the negative connotations of "good gravy"....)

I shudder at the thought of coaches asking the girls when their period was and other personal information.

You are invading their privacy and you have no right to ask.

So many of you coaches (I assume some of you are coaches) think you are qualified to be involved in medical decisions. What are your medical qualifications? Heck most of you don't even have coaching qualifications other than on the job experience and being former runners.

To answer if a doctor is qualified to give advice to an endurance athlete. Actually we are because our first concern is the overall health of the athlete. This is the priority for all physicians especially young women who have far more complex bodies than men.

Run Doctor wrote:

I shudder at the thought of coaches asking the girls when their period was and other personal information.

You are invading their privacy and you have no right to ask.

So many of you coaches (I assume some of you are coaches) think you are qualified to be involved in medical decisions. What are your medical qualifications? Heck most of you don't even have coaching qualifications other than on the job experience and being former runners.

To answer if a doctor is qualified to give advice to an endurance athlete. Actually we are because our first concern is the overall health of the athlete. This is the priority for all physicians especially young women who have far more complex bodies than men.

You're being impressively obtuse in these responses.

Run Doctor wrote:

I shudder at the thought of coaches asking the girls when their period was and other personal information.

You are invading their privacy and you have no right to ask.

I think you're

Missing the point that rarely do coaches ask. Parents or athletes will volunteer the information out of concern for their daughter or their own performance.

Then you have a mature conversation.

You sound like a stereotypical arrogant doctor who thinks that a person without an MD next to their name must be too stupid to know anything about health, the body, or anything else in your field. Also, you seem to think it's a HIPAA violation to ASK about these things?? Weird. As a coach, I pride myself on caring for my athletes' health. I also know that for many of them, running is an important piece of their identity, contributes to their mental health, and I want them to be able to do it! If I ask about their health, it is for a good reason, not because I'm creepy and want to invade their privacy. And as a coach (with some qualifications, BTW, not to mention some success at high levels), yes, I am more informed than the parents about issues related to running than they are. Not a single parent has said they felt I crossed a line talking about these things with their daughters or them- they were glad they had the right questions to ask when they visited the doctor.

OP here.

I left off some details that I thought were irrelevant to avoid a wall of text. However with some criticism towards me, I am feeling defensive. Don't know why I care to get on here and defend my anonymous self against anonymous criticism but here goes:

The girl in question tripled during early lowkey meet because she had no competition in any of the events. It was basically three time trials. Four schools were there with maybe 20 parents in bleachers. I tend to do this early season to set marks in each event for athletes who haven't competed at these distances in a year. In fact, I like athlete early season running event tired to get base time so that when she runs it fresh next time, her time is better and she gets psychological lift. I find too many teenage girl runners have their self-esteem tied to their performance times.

Since then, she never tripled. She would alternate doubling with 1600/800 or else soloing 3200. Usually raced once a week; ran one other workout a week. Runs 35 mpw. Last year ran 30mpw but did tail off badly last 2 weeks of season (hmm?).

Over last six weeks:

1600: 5:01 (solo), 5:03 (solo), 5:13 (solo), 5:17 - gritted out win.

800: 2:17 (solo), 2:20 (solo), 2:22 (close win), 2:23 - gritted out win

3200: 11:01 (solo), 11:27 (close win), 11:45 - gritted out win

At district championship she tripled in order to qualify for Regionals in all three events so that she could then choose which to focus on for States compared to the qualifying competition.

At no time was I "chasing points" or "putting points ahead of girl's health." In fact, my first thought was her performance looked like someone who was running hard intervals prior to season and came in at peak form and subsequently declined. Since we didn't run hard intervals prior to start of season, I questioned her about training outside of practice. The girl she barely beat in 1600 and 3200 was her teammate who has always been slower than her. In fact, her teammate didn't speed up much during season, my top girl faded back to the other's time.

It was only after this last performance looking at the grimacing that I thought something other than "teenagerism" is going on; I recommended to her parents to have lab drawn. The reason I posted was to get other's input since I had never faced significant anemia in one of my athletes (that I know of; I've had plenty slow down for one reason or another). I don't "presume to give medical recommendations to a doctor" but the doctor left it to the parents to decide on oral or IV iron. I thought I would ask around for other's experience.

My first and only comment in this thread:

That is far too reasonable a response. You will probably get flamed for being a liar and trying to CYA.

Noob?

Personally, I see nothing wrong with a coach asking either the athlete or the parent of a struggling runner about her menstrual cycle, especially if it is absent or exceptionally heavy. It's a simple, genuine question that may give the parent information they didn't think of. We put this ridiculous social stigma on a natural process, and quite frankly, a healthy menstrual cycle tells a lot about an athlete, as does an unhealthy one.

I highly doubt any coach would ask 30+distance girls about her cycle. If one girl, who apparently is one of the top runners, suddenly starts faultering on times and expresses being exhausted, etc., then it's perfectly reasonable for a coach to ask a few simple questions, and get the parents involved, then of course a doctor. Many parents of phenoms are NOT runners themselves, and are completely clueless about the importance of iron (ferritin specifically), until it's brought to their attention with their daughter slowing down.

OP, ignore the haters and the supposed Run Doctor. Not all docs are ignorant of the demands of endurance sport, but many certainly are. I've had kids test at 7, 9, 10, 11, 14, 16, 17, etc and not a single doc thought it was an issue.

The girl that was at 9 was running 10:50s consistently after having made it to FLN the previous XC season. Once we found out she proceeded to take liquid iron, reduced mileage and intensity and 3 weeks later broke 10:30. That is not the norm, however. Most girls don't bounce back that fast. The boy that was at 10 had also gone to FLN the season before and then had a bad (for him) track season which is why he got tested, but by then we were in the post season so it was too late. The girl at 12 we found out just before the post season started in track and it was too late for her. However, after about 6 months of Hemaplex at an average of 3mg/kg/day her ferritin was up to about 40 and she was able to qualify for NXN. She had been running consistent 10:50s the previous track season as well and this season has gone under 10:30.

i would consider the IV treatment seriously for myself if I was at 5, but there is a risk of complication involved which is why I don't suggest it to our athletes under any circumstances I've been a part of.

I'd say reduce the mileage/intensity and close out the season running the 800 only or shut it down altogether. I would recommend she start taking Hemaplex at 1mg/kg/day and if after a week there are no side effects increase to 2mg/kg/day. Then up to 3mg/kg/day. Even if she's not having side effects there I'm not comfortable telling kids to take more than that, although an adult I coach has taken 5mg/kg/day with no issue. Be sure to retest often initially so you can see how well she is or is not absorbing the iron. Consider telling all of your kids to get tested, even the boys if you test them. The lowest value I've seen from kids I coach was a boy at 7.

Sounds like you're invested in your kids and doing a great job. Keep it up.

Update?

Many good PCPs would know the significance of a low ferritin for endurance athlete, but some may not appreciate this. If the person is also anemic (low hematocrit) then every PCP should know that they need iron replacement. There is a different mindset between sports medicine and general primary care and as some people have said some primary physicians aren't concerned about how their recommendations would effect athletes from a competitive standpoint even though there might be safe options that would allow someone to return to doing what is important to them more quickly. Sports medicine doctors understand the competitive aspect -- but they aren't going to be the ones managing things like asthma or anemia. I think there is a role for a good generalist that understands the athletic mindset but they are hard to find.

All that said, saying that "doctors are stupid" isn't very helpful.

The 5:01 was the only time trial you needed. That tells you she is not far off from

IV Iron is the only thing that works in such a time frame, but I think you will find most medical personnel hesitant to do that with such a young athlete. If she doesn't go this route, you might as well shut her down for the season, begin iron supplements and OJ in the meantime, and bring her back after a couple of weeks rest so she can begin building up for XC.

OP, your athlete is cooked for the season. I'd have her take some time off running and get her swimming instead. The question you should be asking is, what did you learn from this experience? What warnings did you miss? It is not the end of the world.

"Run Doctor"

Ok, yes I am not a Doctor unlike maybe you,

BUT I am a USATF Level 2 Certified Distance coach where you learn about iron, female athlete triad and a lot of other stuff. Also have lots of experience with several athletes males and females.

Your idea that a Coach can't have conversations with Parents or Athletes about medical stuff is absurd.

OP,

I think the advice about picking just the 8 is probably a good plan.

Uh uh wrote:

Update?

OP here.

Girl received 2 doses of IV iron. Ran easy on 2 days. She chose 3200 as her best chance to reach State...

She ran poorly for her, slower than last week. However, a faster runner by seeding didn't show up and another faster girl tried to run with stomach bug (DNF) so my girl barely qualified for State, out kicking another girl by 1 second. We are ending season but she is going to state champ to get announced on track then drop out. It was her goal past 3 years to make it.