The USA Rugby teams just completed their week-long training camp in Mimasaka City. The city prepared for 2 years for the arrival of the teams, and their hard work showed.

The stadium and training facilities were top notch, and there was a team of bus drivers to bring the teams back and forth throughout the day. The hotel was first rate, and the food was gourmet. At the hotel players had massages every third day, and each day the spa or ‘onsen’ was available for both the team and staff.

Each morning I was able to work out with the staff before the team schedule began. We had access to the gym, an indoor basketball court, and to the field. We played a ton of games of knock out and PIG – it was a fun way to bond with the staff and players. A small running club began and we did sprint intervals. The last time I did sprint intervals was about 15 years ago in college – needless to say I was sore! The weather was hot and humid, so it was great preparation for the team for Tokyo.

Now that we are in Tokyo we are divided between the Village and a hotel. Some of the staff (including me) are at a hotel due to space restrictions in the Village. Team USA has its own building which includes a whole floor for Sports Medicine. There are many familiar faces there – people that our team at SDSM works with throughout the year at the Chula Vista Elite Athlete Training Center.

The Village is vibrant and full. Everyone is masked and there are hand washing or sanitizing stations every 5 feet. The dining hall is two level and there are plexiglass dividers between each player for safety while unmasked. The food options are diverse – there are vegan, gluten free, and halal options. It is fun to see all the athletes mix throughout the village – in fact I saw Yao Ming (now a coach) with Team China just today!

It is also fun to connect with colleagues at the Village. A friend from medical school, Dr. Kentaro Onishi, is from Japan and is a part of the International Olympic Committee delegation for using musculoskeletal ultrasound on the sideline. Dr. Michelle Look just arrived and we will see each other at the 6 days of men’s and women’s games next week. A former SDSM physician who now works in New York City Dr. Naresh Rao is the team physician for USA Men’s Water Polo and we will be meeting up this week as well.

We are all excited to see Team USA bring home the GOLD!! Cheer us on from afar, and I look forward to sharing more stories throughout the next week!

Tokyo Olympics USA Rugby Sevens arrive in Mimasaka with minimal welcome to prevent Covid infections

DOs at the Tokyo Olympics share the joys and challenges of working with world-class athletes

Get Olympic DOs’ advice for aspiring sports medicine docs and learn what it takes to care for elite athletes.

The DO spoke with Dr. Rao, Dr. Myers and Dr. Lally to get an inside scoop on the highs and lows of practicing sports medicine at the highest level. Following is an edited Q&A with answers from Dr. Myers.

What does the pre-Olympics prep looked like?

For rugby, athletes train at the Chula Vista Elite Athlete Training Center in Southern California. I practice in San Diego, so I see them on a regular basis.

Whenever they have injuries during training, or when they’re competing abroad, they come back and I see them here. In a given week, I’m seeing one or two players. So it’s a pretty close-contact situation.

I also cover their scrimmages. The men had Argentina in town recently, and the women had Brazil in town.

What should viewers watching your sport be looking for when they watch the Olympics?

Olympic rugby is a very quick game, so you have to pay attention. There’s no stoppage time. In football, when the ball is down on the ground, the play is over.

But in rugby, it’s continuous play until somebody gets a try, which is like a goal or touchdown. You have to keep watching the ball.

What are the common injuries you see in your sport?

In rugby, we see lots of broken hand bones, broken fingers and concussions. The big thing we worry about is spine injuries. We’ve had a couple this year, but they weren’t catastrophic. One of our athletes went through getting a cervical disc replacement and rehab and getting back into contact sports.

What advice would you give to medical students who would like to become team physicians for athletes competing at the Olympics one day?

I recommend shadowing a sports med physician and working with local sports teams. When I was in residency, I worked with one of our ER doctors who covered high school football. I took over the high school football coverage, and I had three years of high school football experience before I got into fellowship, which was super helpful.

You may have to recalibrate your income expectations. Sports medicine is not the highest paid specialty, and most of the cool jobs are actually volunteer positions.

At the same time, there are ways to make more money in sports medicine. There are all sorts of new injection therapies that are available for athletes. I don’t personally do a lot of those because I wanted to maintain a family medicine practice in addition to doing sports medicine.

Read Full Article on the DO: DOs at the Tokyo Olympics share the joys and challenges of working with world-class athletes

Simone Biles Withdrawal Puts Athletes’ Mental Health in Spotlight

Physicians attached to Olympic teams say they have been far more sensitive to athletes’ mental health needs during the pandemic.

Alex Myers, a physician for the U.S. rugby team who also works with college students and other athletes in San Diego, said she saw more generally an increase in phone calls regarding self-harm and suicide during the pandemic.

“Because of the pandemic, it ruptured the very frail social structures that a lot of young adults have,” Myers said. “Because of social media, every social interaction became more intense,” magnifying mental disorders that already existed and increasing the rate of emergence, she added.

Read Full Article on Bloomberg: Simone Biles Withdrawal Puts Athletes’ Mental Health in Spotlight

Have you ever seen some extra letters after your doctor’s name?

Well, those extra letters usually mean that your doctor has spent extra time to become an expert in their field of practice.

I was recently honored with the distinction of Fellow of the American Osteopathic Academy of Sports Medicine, and so will be adding the letters FAOASM to my credentials. This is an award given to physicians who have practiced sports medicine and have been active in caring for elite athletes, as well as teaching their colleagues and students on the advancement of sports medicine.

The Physician’s Education Journey

A physician’s education begins in medical school after which they must complete a residency. When a physician graduates from their residency training, they usually complete a process to become Board Certified (BC) in their field such as in Family Practice or Internal Medicine.

Each physician has the option to join their professional organization, such as the American Osteopathic Academy of Sports Medicine. Once joining the organization, physicians have the opportunity to attend educational events to further their specialty education.

Most professional organizations offer a certification program which is meant to assess the knowledge and excellence of each member. Member physicians complete course work and take competency tests in order to obtain their certification, and are required annually to participate in more educational events. After 7-10 years physicians then become eligible to apply to become a ‘fellow’ of the organization. A very small percentage of the member physicians ultimately become fellows due to the rigor of the process.

The physicians at San Diego Sports Medicine and Family Health Center have taken additional formal education following residency training in their Primary Care specialty (Family Medicine or Internal Medicine) and have earned Board Certification in Sports Medicine (the exception is Dr. Cheffet who is residency trained in both Internal Medicine and Pediatrics).

Many of our doctors are also leaders within their professional organizations. Four of our doctors have become President of their specialty college or risen to presidency of our state specialty organizations. No matter the chosen path, each year, our doctors spend many hours completing continuing medical education (CME) in order to stay up to date on their knowledge and provide excellent care.

The Esteemed physicians at San Diego Sport Medicine

I am proud to be joining these esteemed physicians who have also attained Fellowship status within our professional organizations.

Dr. Richard Parker – Fellow of the American Osteopathic Academy of Sports Medicine

Dr. Jeff Anthony – Fellow of the American Academy of Family Physicians, Fellow of the American Osteopathic Academy of Sports Medicine

Dr. Allen Richburg – Fellow of the American Academy of Family Physicians

Dr. Michelle Look – Fellow of the American Academy of Family Physicians

Dr. Steve Rohrer – Fellow of the American Osteopathic Academy of Sports Medicine

Dr. Shannon Cheffet – Fellow of the American Board of Pediatrics

Dr. Lee Rice – Fellow of the American Osteopathic Academy of Sports Medicine, Fellow of the American Academy of Family Physicians, Fellow of the American Medical Society for Sports Medicine

How to Find a Physician who is a fellow near you

Are you a patient looking for a physician who is a fellow in their organization?

Many organizations have a search function to look for qualified physicians in your area. Look for the letters behind the name, and remember an ‘F’ usually represents ‘Fellow.’

Here are some good resources for finding qualified doctors in your area:

• Find a DO Doctor of Osteopathy Near You
• American Medical Society for Sport Medicine Find A Doctor Search

At the end of July, I had the unique opportunity to work with the USA Rugby Women’s and Men’s Sevens teams at the Panamerican Games in Peru. It was a true honor and adventure. The teams met for training in Chula Vista, and we arrived in Lima about a week before the beginning of the tournament. We were one of the first teams to arrive which was nice. We had brand new accommodations, and were welcomed with enthusiasm.

The Panam Games occur every four years, and any country from North or South America has the opportunity to be represented. I met athletes and doctors from countries all over these regions, and it was amazing to see how they all got along. It was a team atmosphere throughout.

The athletes and staff lived in the ‘Village.’ At the village there were six brand new apartment towers, and Team USA occupied most of Tower 3. There was a giant cafeteria, called ‘comedor’ in Spanish. Everything was labelled in both English and Spanish in the village. There was a large gym, pool, and locker room for all the teams and staff to use. There was a ‘Polyclinic’ where there was medical care available to all the teams. Some of the teams came without an Athletic Trainer or Physician, and depended on the Polyclinic for all their care. For example, the El Salvadorean Team brought only one doctor for all 52 of their athletes! Thankfully for our team, we had one Athletic Trainer for each team, and I served as the Team Doctor for both teams. The US Olympic and Paralympic Committee brought a large staff of Athletic Trainers and Physicians to help care for all the USA teams. The USOPC staff was stationed on site at the village.

Every day while in Peru our teams were bused to the stadium. We practiced and played at a brand new stadium called Villa Maria del Triunfo. The stadium was so new that most of the bus drivers didn’t know it existed, and certainly didn’t know how to get there! We got lost a couple of times, but in the end we always made it safely to the stadium and back. The stadium was beautiful and had all the amenities we needed. The Peruvian medical staff at the stadium was competent and welcoming.

The teams did very well, with the women earning a silver medal and the men earning a bronze medal. There were several injuries on the men’s team, and the last game they only had 9 players (2 substitutes). The games were intense and exciting. At one point the Athletic Trainer and I were handling two concussions back to back in the same game. Needless to say we worked hard!

I was thankful that our teams did well and that I had a chance to explore Lima. On one of the free afternoons, I went to the downtown area called Miraflores. It was an affluent area with a beautiful boardwalk and pier. There were tons of surf schools, much like in San Diego. I rented a bike and explored all over town before heading back to the village. On the last day of our trip I also got to go the surf competition at Puntas Rocas. It was amazing to see the beautiful facilities that the Panam Games brought to this area of Lima. It was awesome to see athletes from all over the region competing. It was nice to relax and enjoy the competition before heading home.

San Diego Sports Medicine and Family Health Center physicians Dr. Alexandra Myers and her colleague Dr. Elizabeth Williams were then asked to speak during the protest and report on their observations of scooter related injuries.

On ABC 10 News in San Diego they provided comments and statistics:

“We see concussions, cuts, broken bones, and recently a severe neck injury. Someone almost lost their vision in their eye,”

Sports Medicine Physician, Dr. Alexandra Myers said.

“UCLA published a study over a year, and they’ve noticed over 250 injuries. 40% are causing head injuries. 5% have elevated levels of alcohol in their blood. And 98% of people are not wearing helmets,”

Dr. Elizabeth Williams said.

Watch the news cast on ABC 10 News

Ironically minutes after the rally the news reported on a Teen injured in e-scooter accident hours after e-scooter protest

“Safety not scooters!” San Diego locals gather in Mission Beach to protest the amount of electric scooters on the boardwalk. Many of those I have talked to say they feel unsafe walking on the boardwalk out of fear of the scooters. @CBS8 pic.twitter.com/AkHtMtIPsc

— Tim Blodgett (@TCBlodgettKFMB) April 20, 2019

This interview first appeared on Dr. Marianne Miller’s blog, visit her to read the full interview:
Meet San Diego Sports Medicine and Family Physician Dr. Alexandra Myers, D.O., Specializing in Eating Disorders in Athletes

A portion of  the interview is below, added to this page for convenient reading:

This week’s interview is with Dr. Alexandra Myers, D.O., who works with athletes with eating disorders in San Diego. I think there is a misconception that in order for athletes to recover from eating disorders, they have to give up their sport completely. That is simply not the case. Dr. Myers is THE medical professional in San Diego who can help people heal their disordered eating and return to the sport they love. She is especially gifted in treating high-level athletes. Dr. Myers specializes in sports medicine, and she is the Director of Women’s Athletic Medicine at San Diego State University (SDSU). She also works with US Olympic athletes, other college and high school athletes, people who are active only on the weekends, and even non-athletes! She is incredibly supportive, compassionate, and non-judgmental. Plus, she’s an all-around nice person to know!!!

Why did you choose to become a sports medicine specialist and family practitioner in San Diego?

I came to San Diego to complete my Sports Medicine Fellowship at San Diego Sports Medicine and Family Health Center. I enjoyed working with a dynamic group of people and I stayed. I was particularly interested in taking care of athletes of all levels, of which there are many in San Diego.

What kind of treatment do you provide?

I provide full spectrum family medicine care – everything from a general physical, shoulder pain, colds, etc. I specialize in Sports Medicine, which encompasses the overall care of the athlete, including nutrition and wellness. I also perform Osteopathic Manipulative Treatment to help relieve pain in my patients.

How long have you been treating SDSU athletes?

I have been working with SDSU athletes since 2013. As the Director of Women’s Athletic Medicine, I focus on taking care of the wellness and psychological aspects of the athletes at SDSU.

In what capacity do you work with SDSU athletes?

I am the Team Physician for the Women’s Basketball, Crew, Swim/Dive, and Water Polo teams. I have clinic there once a week, and I oversee the athletic trainers that work with each of those teams.

Do you work with athletes who aren’t SDSU students?

I work with many athletes outside of SDSU: US Olympic athletes—especially USA Rugby Men’s and Women’s Sevens, Major League Rugby, San Diego Christian College, San Diego City College, Cuyamaca College, Santa Fe Christian High School, and many people who are weekend warriors.

What kind of eating disorder symptoms can appear in athletes?

Most athletes who I see for suspected eating disorders have noticeable, rapid weight loss and fatigue. It is often initially referred to as “female athlete triad,” which is usually a misdiagnosis. Sometimes they come to me for decreased performance or mood changes, which can be an early sign of poor nutrition.

Do you treat people in San Diego who aren’t athletes who have eating disorder symptoms?

Yes, I do have patients who have eating disorders who are not technically athletes. A lot of them have backgrounds in athletic pursuits such as dance and gymnastics, and most of them are active.

Who are your favorite types of patients to work with?

I love working with people who are motivated to be healthy—no matter where they are starting from. I take care of babies up to 90 year olds, and they come in all shapes and sizes.

What happens during a first appointment with you?

I try to get to know my patients – their personal history, their family history, their current lifestyle and goals. I try to gain a perspective on where they are and where they want to go.

What do you wish both athletes and non-athletes knew about getting treatment for eating disorders?

I would love for athletes and non-athletes to know that treatment for eating disorders is aimed at helping them be healthy and that it is non-threatening. Everyone involved in their care is there to help them, and no one is judgmental.

How can people learn more and contact you?

They can come see me as a patient and check out my website here.

Share one fun fact about you.

I played college soccer and softball at Cornell College, and grew up ski racing, playing tennis, BMX racing, and running track. I like to surf, SUP (Stand Up Paddle), and cycle all around San Diego.

Photo by Gardie Design & Social Media Marketing on Unsplash

As I arrived at the clinic I saw a group of 10 Haitians waiting patiently.  It was a bit chaotic, but we quickly evaluated the woman in distress. Carol, the nurse that accompanied me, was excited – she was hoping to transition her career to labor and delivery.  Bob, the Lab Tech who was also our Team Leader, was on hand to keep us calm and make sure we were set up. He arranged for a local translator, affectionately known as Little Richard. With his assistance, I learned that our patient was 15,  in her first pregnancy. She had started having contractions 1 hour prior. She was in pain and uncomfortable. I did a bedside ultrasound – the baby’s heart rate was normal and he was in the right position to deliver. I did an exam – the baby was still high up in her pelvis and wasn’t quite ready to come down.  Bob did labs which were all normal. After thorough discussion with our team we determined that she wasn’t going to deliver the baby any time soon, so we sent her home to labor with a midwife. The excitement had drawn to a close, or so I thought.

First thing Monday morning we were up and ready to get an early start for 8 am clinic. Our team was enthusiastic to get to work. When I walked into clinic I saw my pregnant 15 year old patient. I was once again confronted with my fears: what would I do if there was a complicated delivery?  Would I be able to handle the situation? I re-examined her and she was still far from being ready to deliver. Both the nurse and the midwife said that they thought she needed to go to the hospital to deliver, and that likely she would need a C-section. I had no reason to doubt their evaluation, so we called the Haitian Health Foundation who sent an ambulance to transport her to the hospital. I regretted that I didn’t have the skills or resources to help her, but relieved she was in good hands.

Once she was gone my translator “No-No” – short for Jeanot – and I got to work. Our team of five saw about 180 patients a day, and today was set to be a busy one. The clinic was full of people needing their chronic disease medication refills as well as those with more acute needs. Throughout the week we saw a melange of typical Haitian injuries: machete wounds, and skin infections gone awry. There were still people needing assessment for injuries sustained in Hurricane Matthew which struck in October 2016.

After each clinic day we had a team meeting to discuss our most interesting and difficult cases.  One of the Nurse Practitioners was devastated that on the first day of her first trip to Haiti she had to tell a patient she had HIV.  In total there were 3 patients newly diagnosed with HIV. Fortunately, HIV patients in Haiti have access to free care – which is rare in a place that lacks much government support.

My most interesting patient came on the second to last day. By Thursday of each week we are in a flow – the nurses are efficiently triaging and taking care of patients. As providers we are in the groove – we have become familiar with the most common ailments, and what limited resources we have to provide. A woman came to triage with a large pregnant appearing belly and the nurse ordered pre-natal labs.  We screen for anemia, urinary infections, HIV, and syphilis. The woman ended up seeing me and I quickly reviewed her chart. She had been seen in February by another Global Health Team group and had an ultrasound that showed she was pregnant. It was her first pregnancy, and she was excited. I asked her several questions – was she eating well? How did she feel? Was she having any bleeding?

She said that she was bleeding every day of her pregnancy. This is not uncommon and can be a sign of the placenta being low in the womb. I quickly took her to do a bedside ultrasound, but couldn’t find a baby in her large belly. I had my colleague Dr. Mike come look at the ultrasound and both of us worried that we had broken the machine – all we could see was scattered grey and black images swirling around the screen. My first thought was how did I break this very expensive machine?  I was so careful with it and was upset that I would leave a defective machine for the next team. Dr. Mike took a try at the ultrasound, and again we saw nothing. I told the patient it was broken and that we would just have to proceed without the ultrasound.

Surprisingly, my next patient was also pregnant. I thought perhaps I could do an ultrasound on her and see if the machine would work again. Of course the minute I placed the probe on her belly, I clearly saw a little baby, about 5 months in size. The hands, feet, and face were clearly defined, and the mother was overjoyed to see her baby. At that point I brought the other woman back to use the newly functional ultrasound machine. Except this time I put the probe on her belly and again saw no baby, but a mix of grey and black ill-defined images.

At this point I was confused. Her belly looked and measured to be about 7 months along, and she had been diagnosed with a pregnancy 4 months before. I checked her chart and discovered there had been no urine pregnancy test, so I ordered one. It was negative.  We found ourselves in an odd situation – a woman with a large pregnant appearing belly, a negative urine pregnancy test, and a peculiar ultrasound. Dr. Mike and I conferred and decided that she needed further imaging and consultation. The reality is that this level of care is non-existent in that region of Haiti. There is no MRI machine, and there was no one who would be able to figure out what exactly was going on in her belly.

I was heartbroken to look into her eyes and tell her that not only was she not pregnant, but that she might have a difficult to diagnose condition. We had no resources readily available for her. To my surprise she took the news stoically. She said she understood what was going on, and agreed to come back the next week to see our Medical Director who would be able to connect her with any resources in Haiti that were available. Dr. Mike, the nurse, and I were all confused and sad about the situation.  What must it be like to be a childless woman in rural Haiti, looking pregnant – but with no baby coming in several months – or ever. Women in Haiti are expected to produce children, many in fact, so they have family to support them in old age. A childless woman would have a tough life unless she had a very kind sister who would take her in (and could afford to).

Although the not quite pregnant woman cast a pall over the mostly joyful experience in Haiti, I left with more hope than despair. On this trip to Haiti I saw indications of economic improvement. There were actual garbage trucks picking up the piles of trash in downtown Port-au-Prince. The government had graded the long dirt road to the airport in Jeremie, so that it was passable. Wealthy Haitians occupied our hotels and frolicked in the pool, spending money on alcohol and treats. Despite the grim overall economic picture in Haiti, perhaps there is hope for recovery and transformation. Maybe there will be a day when we travel to Leon only to give expert consultation, and when the local medical system will meet the everyday needs of Haitians. Hey, a girl can dream.

If you are interested in hearing more about how you can help in Haiti, please check out Global Health Team at globalhealthteam.org. You can also fill out the form below.

In this video Dr. Myers gives advice to medical students, who are about to finish their residency, on criteria they should use to select and look for their first job in the medical profession.

If you have any questions for Dr. Myers after watching this video please leave a comment below.

In this video Dr. Alexandra Myers makes insightful comments on medical health care reform.

DOs and students share their diverse opinions on how they’d like to see the nation move forward with health care reform.

This video first appeared here:  What DOs and medical students are saying about health care reform

I had the opportunity to return to Haiti this June for another medical mission trip. There were seven group members on the trip – two physicians, a nurse practitioner, a physician assistant, a social worker, a pediatric nurse, and a paramedic planning to attend medical school.   All of us were female, and most of us had been to Haiti before. On this trip I served as the Team Physician – caring for the medical needs of our own team in addition to serving the people of Leon, Haiti.
Over the course of the week we cared for hundreds of Haitians who otherwise have no access to basic medical care. We took care of coughs, colds, tuberculosis, and cerebral malaria. We had all ages of patients ranging from a 5 day old infant to patients well into their 80s. We heard harrowing tales of illnesses and injuries that were the direct result of Hurricane Matthew, which hit the island in October of 2016. Two of the patients lost eyesight in one eye due to the trauma of falling branches and walls. One of my patients lost her son and her mother during that storm.  Many patients were still experiencing emotional stress related to the hurricane. At times there was nothing for us to do except commiserate with the patients on their life-changing experience.

While there were many sad things that happened in Haiti, there was hope too. The presence of the clinic for over 20 years is beginning to have an effect on the health of the community. Patients who have diabetes and high blood pressure are now well managed on medications and dietary changes. They are proud to have doctors who care for them and who regularly return to Haiti to see them.

We were also able to make important interventions in the lives of pregnant women and babies. We have a strong referral program to the Center of Hope which cares for mothers who are age 18 or under. Moms with anemia get nutritional support and supplementation. They are able to provide prenatal care that is otherwise unavailable in Haiti.

Overall I had a wonderful experience. It is touching to know that I can have an effect in such a faraway place like Haiti. I hope to bring back inspiration to my patients here in San Diego. While our lifestyles may look starkly different, we all have the same hopes and dreams: healthy and happy families.

Below are a few photos from the trip.

If you would like to learn more and support these medical missions, please visit the Seattle-King County Disaster Team website.