To prepare for his senior season of football atTrinity Christian Academy, Jabriel Wash-ington was focused throughout the presea-

son camps, scrimmages and workouts —determined to be in his best condition. He waslooking forward to playing his best at quarterback,safety and cornerback for the Lions.

Following a scrimmage game, he began to noticethat pressing his left arm above his head caused painin his shoulder and that he had trouble making thepressing motion. He and his parents turned to Dr.Mike Cobb at West Tennessee Bone & Joint Clinicfor answers.

An MRI indicated that Jabriel had a torn labrumin his left shoulder. Dr. Cobb told the Washingtonsthey had two options: surgery at the beginning of theseason, which would mean Jabriel would be out forat least half of his senior season, or wait and have thesurgery at the end of the season. Knowing he wanteda full season to impress the college scouts who werelooking to recruit him, Jabriel took the second op-tion and put off surgery.

“I played football all throughout highschool, and I knew I really wanted to play atthe college level,” said Jabriel.

“Dr. Cobb understood my desire, andbased on the MRIs I had done, he gave me anoption that I could live with, wait untilafter the season to have the surgery.My preseason workouts be-came limited becauseof my shoul-der, but I

was determined to have a successful season.” He did. The Lions finished as state runnerup

champions. In early December after playing in thestate championship game, Jabriel underwent arthro-scopic surgery on his shoulder. Once in the operatingroom, Dr. Cobb discovered that the injury was not asextensive as he had first suspected. Rather than hav-ing to repair the labrum in Jabriel’s left shoulder, Dr.Cobb did a less complex procedure by shaving a flaptear that was causing the pain and limiting Jabriel’sability to move his arm above his head.

By mid-January, Jabriel was back to working outwithout the pain he had been experiencing. He wasselected to play in the USA versus The World all-stargame in late January. He had a great game and waspain free with full mobility. In February, Jabrielsigned to play with the University of Alabama. OnMay 31, he began working out and practicing withthe Crimson Tide and is looking forward to playing cornerback for Alabama this fall.

“Throughout the entire process, Dr. Cobb keptus well informed about our options and howJabriel was progressing,” said Sonya Wash-ington, Jabriel’s mom. “His dad, Ray, and Icould not have been more pleased with thecare he got at West Tennessee Bone & Joint

Clinic.”

Keeping you...

ActiveActive

Summer 2011 Sports Medicine • Orthopedic Excellence

Keeping you...

Active Active Athlete headed for Alabamaafter successful senior season… is a quarterly

newsletter fromWest TennesseeBone & Joint Clinic.

The clinic’s tenphysicians special-ize in sports medicine and or-thopedic problems.

For copies of thenewsletter, contactAdam Kelley, Marketing Director,at 731.661.9825.

Inside…Prevent heat illnessand heat stroke...

Tips on how to beatthe heat...

Fifth Quarter Clinicopen on Fridaynights after football games…

A tale of two kneereplacements —Alice Wright andKaren Britt…

Join us on Facebook!

Jabriel Washington will play football withthe Crimson Tide this fall. Dr. Mike

Cobb repaired a problem inJabriel’s left shoulder so he

could play with fullmobility.

731.661.9825 n 888.661.9825 n www.wtbjc.com

Summertime means heat, particularlyhere in the South. It also is the timefor outdoor activities like baseball and

football. While staying active and exercisingis a great way to stay healthy, activity in theextreme heat of summer carries some risks.Heat stroke and heat illness are dangerousconditions that can affect athletes who exer-cise in hot environments.

Heat stroke is defined as a life-threateningillness characterized by elevated core bodytemperature above 104 degrees associatedwith nervous system dysfunction. This in-cludes nausea, vomiting, dizziness, fatigue,seizures and unconsciousness.

Heat cramps can be a precursor andoften represent a state of inadequate fluidintake or hydration. Heat stroke carries ahigh death rate if diagnosis and treatmentare delayed. The recent deaths of prominentathletes from heat-related illness have gener-ated significant media coverage and a betterawareness of this condition. However, heat-related illness and death are on the rise.

Heat Stroke……is a condition were the heat generated

by the body overloads the body’s ability todissipate the heat. The body tempera-ture rises, and a point is reached wherethe internal functions of the body shutdown. During exercise, excessive sweat-ing (an attempt to cool the body) andinadequate fluid intake decrease bloodvolume. Blood circulation to the skinis the primary mode of cooling, andwhen blood volume is reduced, so isthe ability to dissipate heat.

Diagnosis……starts with a heightened aware-

ness when the temperature or heatindex climbs above 90 degrees Fahren-heit. Heat stroke is characterized by acore body temperature greater than104 degrees. The brain is extremelysensitive to temperature. Confusion,one of the first signs of heat stroke, canbe associated with dizziness and canprogress to delirium, unconsciousnessand coma.

Treatment……starts with removing the athlete from

the hot environment and starting coolingmeasures. This consists of removing cloth-ing and equipment, fanning and applyingcold or ice packs to the neck, groin and armpits. If able, the athlete should drink fluidswith sodium, such as sports drinks. Ifsymptoms persist, take the athlete to anemergency department as soon as possible.

Prevention……is the most effective treatment for

heat-related illnesses. n At the beginning of a strenuous exer-

cise program or after traveling to a warmerclimate, initially limit the intensity and du-ration of exercise, gradually increasing itover 10-14 days to allow time for acclimati-zation. When this period of time is notavailable, the length of practice sessions andcompetition should be shortened.

n Check environmental conditions be-fore and during practice and adjust sched-ules accordingly. Avoid practice timesduring the hottest part of the day, typically

10 a.m. to 5 p.m. Use caution and adjustpractice intensity when temperature or heatindex rises above 90 degrees. Incorporaterest breaks into practice, making them morefrequent as temperature rises. During thisrest time, rehydrate and remove participantsfrom radiant heat sources, such as directsunlight. Use the Wet Bulb Globe Tempera-ture, an index of climatic heat stress, as aguide for exercising in the heat.

n Begin hydration before the exerciseperiod. Consume 500 ml of fluid two hoursbefore exercise to ensure hydration. Allowtime for excretion of excess ingestedfluid. Consume another 200-300 ml offluid 30 minutes before exercise. The rec-ommended fluid intake during exercise is200-300 ml of cold tap water or a flavoredsalted beverage every 20 minutes.

n The type of fluid replacement is de-pendent on the duration of the event. Plainwater is adequate for events lasting less thanone hour. For longer events, however, thereplacement fluid should contain carbohy-drates, sodium and potassium — standardcomponents of commercial sports drinks.

n Avoid caffeine, particularly in hotweather. Sodas, tea and energy drinks typi-

cally contain caffeine or caffeine typeproducts. They increase heart rate andact as a diuretic, which leads to orworsens dehydration.

n Clothing should be light-coloredand limited to one layer of absorbentmaterial to facilitate evaporation ofsweat. Replace sweat-saturated gar-ments with dry garments if possibleduring competition.

n Weighing athletes before andafter practice (particularly during two-a-day football season) to estimateamount of body water lost during exer-cise is beneficial. This can be used toensure return to near prepracticeweight before next practice. The goalshould be to lose no more than 2-3%of body weight during each practice.After exercise, athletes should consume500 ml of fluid for every pound lost.

Again, the key is prevention. Thisalways begins and ends with hydration.

By David Pearce, M.D.

Preventing heat illness and heat stroke

For years, Karen Britt put off knee re-placement surgery on her left knee.She and Dr. Trey Antwine were wor-

ried how the surgery would react withlupus, a disease she has where the body at-tacks its immune system.

Occasional steroid injections would re-lieve the pain, but her knee continued todeteriorate year after year, partly becauseof her lupus medications. When Dr. TreyAntwine did arthroscopic surgery last yearon her knee, her recovery went well, despiteher lupus. It was timeto replace her knee.

Then she put off thesurgery one more timebecause she was deter-mined not to miss anyof her son’s footballgames last fall. LukeDavid, her son, was asenior at UniversitySchool of Jackson and ateam co-captain.

“I was not going to

miss a game,” Britt said. “The end-of-the-season football banquet was February 2, andDr. Antwine did the knee replacement onFebruary 8.”

She was amazed at how quickly she re-covered. “The next morning, the hospitalstaff had me up, trying to walk. I never useda cane or a walker. After four nights in thehospital, I went home and started outpa-tient physical therapy. I was discharged fromtherapy after six weeks.”

She credits Dr. Antwine; his nurse,Laura; Physical Ther-apy Director TomJohnson; and thephysical therapy stafffor being able toachieve her excellentoutcome.

Five weeks out ofsurgery, she was in SanDiego as part of herduties as a patient am-bassador for an Continued…

Summer brings extreme heatand humidity. According to

the Centers for Disease Control,more than 300 Americans dieevery year from heat-related ill-nesses. When exposed to excessiveheat, the body can be unable toproperly cool itself, leading todangerously high body tempera-tures and medical conditions,such as heat exhaustion and heatstroke. Here are tips to help youavoid a heat-related illness…n People 65 and older, children,

infants and those with chronicmedical conditions are the mostvulnerable to heat stress.

n Air conditioning is the best pro-tection from heat. During peaksun hours, try to stay indoors. If

your home is not air condi-tioned, visit public facilities,such as shopping malls, librariesor movie theaters to stay cool.

n When outdoors, drink plentyof water to stay hydrated, seekshady areas and take frequentrest breaks from your activity.

n Avoid coffee, alcohol and tea —all contribute to dehydration.

n Wear a hat and loose, light-col-ored clothing to dissipate heat.

n Recognize the signs of heatstroke: high body temperature,rapid pulse, difficulty breath-ing, the absence of sweatingwith hot red and flushed skin,hallucinations, confusion anddisorientation.

By Jesse Gatlin, Physical Therapist

Beat the Heat!

Fifth Quarter ClinicWest Tennessee Bone & Joint

Clinic offers its Fifth QuarterClinic on Friday nights during foot-ball season at its main clinic, 24Physicians Drive in Jackson. An in-jured athlete can be seen by a clinicphysician for a specialty consultationinstead of going to the emergencyroom. Athletes must be accompa-nied by a parent or coach and ar-rive immediately after the game.

Karen Britt’s knee replacement

Karen Britt and Tom Johnson, Director of Physical Therapy

Let’s get physicalDr. Michael Cobb gives Andrew Macdonald, a JacksonChristian soccer player, a physical. West Tennessee Bone &Joint Clinic offered complimentary athletic physicals to areaschools so teams could meet TSSAA guidelines. About 1,000athletes had a free physical.

Lowell Stonecipher, M.D.

Michael Cobb, M.D.

David Johnson, M.D.

KellyPucek, M.D.

HaroldAntwine III, M.D.

DavidPearce, M.D.

JasonHutchison, M.D.

AdamSmith, M.D.

J. DouglasHaltom, M.D.

JohnEverett, M.D.

Donna Klutts, CMPEPractice Administrator

Keeping You ActiveThe physicians at West Tennessee Bone & Joint Clinic, P.C. specialize in comprehensive orthopedic care.

They diagnose and treat diseases and injuries of the bone, muscles, tendons, nerves and ligaments in adults and children. They are Board Certified in Orthopedic Surgery.

Jackson • Brownsville • Selmer • Lexington • Parsons • Dyersburg • Union City • Bolivar • Ripley

24 Physicians Drive, Jackson n 731.661.9825 n 888.661.9825 n www.wtbjc.com

Three years ago, Alice Wright’s lifewas pretty challenging. The painin her left knee made it impossible

for her to play with her grandchildren,work in her garden or just go places. AtJackson-Madison County General Hospi-tal where she worked as director of casemanagement and social work, she used ascooter to get around.

“I was just miserable with my left knee,”she says. Her life changed dramatically in

October 2008 after Dr. David Johnson dida total knee replacement. The day after sur-gery when the hospital staff got her up towalk, the pain was already better.

“For years I had been putting off sur-gery,” Wright says. Her problems with herknee started with an injury about 15 to 20years ago. The chronic pain started about10 years ago and worsened in 2006. Shetried cortisone and other injections to re-lieve the pain, but finally had the knee re-placement. Now she can’t believe she put itoff. When her right knee needed replace-ment, she had it done in March 2010.

Both times, she had inpatient rehab atthe hospital for about a week, followed upwith about six weeks of outpatient rehab.

She encourages people to go to an out-patient rehab center for physical therapyrather than have a therapist come to theirhome. “It helps to see other people with thesame surgery go through rehab. You pushyourself more, and it helps you avoid post-operative depression,” says Wright, who re-tired from the hospital in March.

She calls Dr. Johnson her hero. “I can’tsing his praises enough. He is so patient andkind. He got my life back for me.”

Riding her scooter is a thing of the past.“I can take care of my flowers and play withmy grandkids. I even took a trip to Francewith my daughter and son-in-law to spendthe Christmas holidays with his family.”

Alice Wright walks in the park.

Alice Wright’s knee replacement

experimental lupus drug she takes. (Thetrip included touring a submarine.) Sevenweeks after surgery, she toured MurrayState’s college campus with Luke and herhusband, Andy.

“My knee is awesome,” she says. “I’mwalking in the neighborhood and increas-ing my other activities. I can’t believe howwell I’m doing. If I had known I would dothis well, I would not have put off surgery.”

Karen BrittContinued from inside …