Exercise Induced Asthma question

Discussion in 'DoDMERB' started by mnolan, Aug 9, 2007.

  1. mnolan

    mnolan Parent

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    First let me apologize for the long post...but I figure get all the information out first and go from their.

    Second, I have read most of the other posts and found them very useful, so thanks in advance to everyone who asks and answers questions here...it really helps.

    We are new to this military academy thing, no one in my extended family has ever applied or attended one. My question concerns my daughter who will apply to the Coast Guard Academy this fall.

    Her Background---
    She will be a senior in high school this fall, good grades (3.95 GPA, 1600 PSAT, 2000 on SAT). Will graduate 5th out of 550 students.
    Plays goalie and forward on the varsity soccer team. Also plays forward on her spring travel soccer team (they have another goalie).
    Throws shot and disk, long jump and runs 100 and 300 hurdles on the varsity track team.
    She is 6'-1" and between 170 and 180 pounds.
    No health problems other than what I will relate below. Has dislocated both shoulders at various times playing soccer, no surgery needed.
    She attended the Coast Guard Academy summer program this July and passed their personal fitness exam. No problem with sit ups or 1 1/2 mile run....needs work on push ups. They indicated that the USCGA would schedule her for a physical exam for late this summer.

    Here is where the "problem" occured........
    She is a really good goalie on her high school soccer team (they play in the fall). She also likes to play forward. She gets a chance to do this on her spring team since they have 2 goalies on that team. It can be entertaining to watch as she usually begins the year playing like a combination bull in the china shop and a chicken with it's head cut off. (Her description, not mine :smile: ). She ends up running all over the field till she figures the game out again (this is after spending the entire fall season in goal).
    Here's where we first encountered her problem. 2 years ago, when she first got a chance to play in the field, the first soccer game of the season was in early March, in Indiana, temperature 35-40 degrees. After running 25 minutes straight, she asked to come out, as she was having problems breathing. I have coached for years and know the difference between "out-of-breath" and an asthma attack. She was experiencing more than out of breath, but not a severe asthma attack. She stayed out of the game about 25 minutes, then went back as a goalie for the 2nd half. No more breathing problems.

    As a precaution, the next week we went to our doctor to see if she had a problem. (I just went and reviewed her file so this is exactly what he said...)
    He examined her, did NOT make any diagnosis of any type of breathing problem, but wrote a prescription for albuterol and singulair "to be taken if necessary". She was not referred to any pulmonologist. Her medical file states that she came in complaining of "a breathing problem while playing soccer in cold weather". There is no other notation or diagnosis.

    She had one other incident last summer during a game in about 90 degree weather. Same symptoms.....DID use her inhaler, it helped a little but not much...she sat out 20 minutes or so, then went back in to the games with no problems. We did not see the doctor after this occurrence.

    She does NOT have any problem at track. Runs the hurdles pretty well for a shot-putter! Never has a breathing problem. But could be because she only runs 15-45 seconds for each event.

    My question is this. When she takes her physical exam for the CGA, what should she tell them? I most certainly want her to tell the truth, but don't want to screw things up. She has never been diagnosed with any kind of asthma, but does have a doctors record of seeking treatment (at my urging...now I feel stupid...I hope I didn't screw up her chances of admission). How should we handle this at the physical?

    And assuming she were to pass the physical (or even if she failed but was then granted a waiver), what happens if this crops up later at the academy? It seems to only happen during the first part of a soccer season when she is not in the best of shape and during either very cold or very hot weather. If this happened at the Academy after being admitted, would they kick her out?

    Thanks in advance for reading what is a very long post...I appreciate all your input and any suggestions you might have.

    Mike
     
  2. RetNavyHM

    RetNavyHM USN (RET)

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    First, be honest on the physical exam. I would note that she was given a prescription for albuterol and singulair but no diagnosis of asthma. I state this based on your description. If the physician mentioned exercise induced asthma or bronchospasms in his notes, then I would put that down.

    Most likely DoDMERB will not disqualifiy based on the physical exam, but will request all medical records from birth to present. When they request that information I would have your daughter write a detailed statement (similar to what you have just posted) concerning the episodes. I would also have her list what activities she is currently active in, and how this affects her, if at all.

    If DoDMERB does disqualify her, then all the records and her statement will be forwarded to the waiver authority. The waiver authority has much more latitude than DoDMERB when it comes to deciphering what was going on, and they may request additional testing. I would not get any additional testing on your own right now, I would wait to see what DoDMERB and possibly the waiver authorities request.

    If your daughter does get qualified and has more issues while at the academy, then they will treat her, and if it is not severe keep her. If she gets worse while at the academy, they will do everything they can to keep her at the academy, and get her commissioned.

    If your daughter get a waiver to enter the academy, then again, if it doesn't worsen they will keep her and get her commissioned.
     
  3. mnolan

    mnolan Parent

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    I was hoping you would respond this way...thanks.

    We will of course be as honest as possible, I have always insisted on it. I just want to make sure we don't inadvertently make a situation harder to explain.

    Thanks very much for your help and I'll post what her results are.

    Mike
     
  4. mnolan

    mnolan Parent

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    medical records

    One more question......do we get the medical records from the doctors or does DoDMERB? And if we get them, should I start now? As I understand it, CGA was to arrange for a physical exam for her this month.

    Thanks again

    Mike
     
  5. RetNavyHM

    RetNavyHM USN (RET)

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    Getting the medical records and the cost therof (if any) are borne by the applicant. Since you know (well you do now becuase I told you they would be looking for them) that DoDMERB will want the birth to present mendical records, I would start to gather them now, but DO NOT take them to the physical exam or mail them to DoDMERB until they are requested by DoDMERB.

    Once the academy enters an applicant into the DoDMERB system they will receive a scheduling card from either DoDMERB or Concorde, Inc (DoDMERB's physical exam contractor).
     
  6. Luigi59

    Luigi59 Banned

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    Has she been contacted by DoDMERB to schedule the physical yet?

    DoDMERB usually doesn't send an applicant to their physical until they have actually applied to the academy, and the USCGA application will not be active until early September, so you may have a little more time to gather those records.
     
  7. mnolan

    mnolan Parent

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    She attended AIM camp in July and at the conclusion of camp they stated that CGA would set up a physical near the end of the summer. In any event, she is planning to make her college application as soon as she returns to high school and when CGA opens up their application. So it looks like I don't' have to rush right out, but at least I know what I have to look forward to.

    thanks everyone.

    mike
     
  8. Just_A_Mom

    Just_A_Mom Member

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    We were in your position a year ago. Needed all birth to present medical records - some records (like ER visits) were a couple of years old. The provider's needed to get them out of storage. This can take 2-3 weeks. I think one set of records took over a month - we had to pay by credit card in advance then they got them out of storage in Texas. Other providers just made the copies for free when I told them it was for military.

    One helpful thing I did was to get a copy of her records from her pediatrician to have on hand when we completed the Dodmerb medical history. It made it a lot easier to be accurate. They were nice enough to copy them on a Sat morning (still cost me $80). All told, I spent about $150. It was worth it when the waiver came through though!
    Believe me, you are one step ahead in the game knowing all of this now, before her physical.
    Good Luck!
     
  9. mnolan

    mnolan Parent

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    Physical Exam Question

    OK,...I have one last question (I hope!)

    Read all your advice from above and appreciate it. Daughter has physical scheduled in October. We go to the DoD website and fill out the forms before going to the doctors office.

    The day before the medical exam, daughter dislocates right shoulder in freak accident in gym class. Quick trip to our doctor has it fixed. We call the office contracted to do the DodMERB physical, explain the situation and ask if we should postpone the physical, and they say no....come on in anyhow.

    When we get there, for some reason they don't want the pre-done paperwork we got off the website, they want us to fill out new ones, which we do. Then my daughter goes into the physical.

    As would be expected, according to her, a lot of the discussion during the physical involves her recently dislocated shoulder. To the best of her knowledge, she is pretty sure she told the doctor about her one breathing episode, but when asked about asthma, reported that she didn't have it. (And she doesn't...see above).

    When all is said and done, the DoDMERB issues a remedial and wants the records concerning her shoulder (which is not surprising..I am in the process of getting those).

    What surprised me was that absolutely no mention was made by the DoDMERB concerning her breathing episode. I would have thought that would have triggered something. The physicians office gave us a copy of the forms we filled out. I went back and looked at it, and the box for breathing problems is checked as NO.

    Here is my question, and if I am being paranoid or overthinking this, please let me know...I am new at this.

    Did the doctor just miss this, or did he decide it wasn't important, or did the clerk mis-type the form, or was it just overlooked, and should we really worry about it? What I don't want to have happen is for her to get DoDMERB approved (assuming the shoulder thing can be approved), and on the off chance she has a breathing problem at the Academy, them come back and accuse us of not informing DoDMERB. Like I said before, I want her to be truthful, but I also don't want to focus attention on an area that the physician may have decided is not a problem.

    I was just very surprised that DODMERB didn't ask about her breathing episode, and I wonder if, during the physical exam it might have been glossed over. I really don't want someone to come back to us and say we were deceitful in this process.

    Any suggestions on how to proceed? Do we need to point this out to someone, or just let it go. Any advice is really appreciated.

    thanks
     
  10. RetNavyHM

    RetNavyHM USN (RET)

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    On your daughters DD form 2492 - Report of Medical History, did she mark the "Yes" block for question #32 or 33?? If she did, and DoDMERB did not request any additional information then you are covered. If she did not check yes to either of those, then I would contact DoDMERB and let them know there was a minor error on the form she filled out.

    As for the separated shoulder, she may get a disqualification for that, but if its the only time it has happened, and she has regained full range of motion and has been released to full activities, then it should not be an issue.
     
  11. mnolan

    mnolan Parent

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    DodMerb physical

    I am sure we checked "NO" for box 32 and most likely "YES" on #33 when we filled out the original paperwork. But as I said, the office made us fill out a new one when we got there. (Most likely because we needed to add the dislocated shoulder information since she had dislocated it after we first filled out the DD 2492 a week or so prior). I looked at a copy of it just this week and box #33 is checked as "NO". Obviously that is a mistake and we hope to rectify it.

    Do you suggest we email our DodMERB contact and explain it, or send them a letter explaining what happened, (with or without supporting information), or do you have any other suggestions.

    Thanks VERY much

    Mike
     
  12. CC_Candidate

    CC_Candidate Member

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    Just one quick thing on the dislocation thing... I'm in a dilemma with my knee because I dislocated my knee cap twice. I would assume that they may decide once is not bad, but I would highly recommend being careful with anything athletic. As I just said, after doing the same thing twice, it was an automatic disqualification (no word on the waiver yet). Good luck!
     
  13. mnolan

    mnolan Parent

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    dislocation

    We will see...this is the second time it was dislocated, but the orthopod said their is no range of motion limitations, no restrictions, and she was approved to play goalie on the high school team after just one day of rest. But if it an automatic disqualifier, we will deal with it.

    Thanks
     
  14. CC_Candidate

    CC_Candidate Member

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    Right, that's the same situation with me. I'm on my varsity soccer team, ran cross-country, and do weight lifting everyday. It's rather frustrating when my disqualification is for something that hasn't hampered my ability to participate in athletics. There's always ROTC =)
     
  15. mnolan

    mnolan Parent

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    dislocation

    I wish you well on your waiver....let us know how it turns out.

    She is also on the soccer and basketball team. We will see how it turns out.
     
  16. RetNavyHM

    RetNavyHM USN (RET)

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    I would call DoDMERB. If you request to speak with the reviewer on your daughters case they should be able to have you speak directly to him/her and explain the situation. The fact that it was missed will not be a negative for your daughter.

    As for the shoulder disqualification, since it has occurred twice it is considered recurrent, and as such will most likely be a disqualification. Waivers can be granted for this, it all depends on what amount of instability there is in the shoulder.

    The same holds true for the patellar dislocations.
     
  17. mnolan

    mnolan Parent

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    dilocation

    Can't thank you enough for your help. We would not know what to do otherwise.

    I am gathering the records from the ER, doctors offices, etc...Would it be helpful to have the orthopod say something about the chance of recurrence, range of motion, level of instability, etc....or is it better to let DoDMERB make the call themselves?
     
  18. RetNavyHM

    RetNavyHM USN (RET)

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    If the physician is willing to write a letter detailing the the chance of recurrence, range of motion, level of instability then I would definitely submit that to DoDMERB. The more information available, the easier it is for DoDMERB and/or the waiver authorities to make a decision.
     
  19. mnolan

    mnolan Parent

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    Methacholine Challenge Test

    We did as you suggested, writing DODMERB and telling them about the breathing issue and the error on the medical form. They have come back with a remedial and my daughter needs to take the Methacholine Challenge Test. I assume that at least it is a good sign that she wasn't disqualified!

    Is there anything she should do or not do to prepare for the test? I see that it is normally 90% accurate. I suspect that most of the time, the pulmonologists are trying TO diagnose asthma, and in this case we are hoping they DON'T. So is there anything we should watch for as they give the test and interpret the results. She currently stays in shape by swimming now. Would any other kingd of work out make any difference?

    Thanks again for the help

    Mike
     
  20. Just_A_Mom

    Just_A_Mom Member

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    Mu daughter needed a pulmonary function test (spriometry) for a waiver for history of asthma.

    I was nervous, she was nervous. I did not go in with her and that was probably better - but the best thing I did was ask them to send a copy of the results to her pediatrician.
    When she took the test the technician didn't tell her anything, other than have a nice day.
    I knew we would not be able to wait - so a few days later I called the dr's office and they got the test results and said it looked great! What a relief that was.
     

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