Ryan Clark, Denver, and Sickle Cell Disease
by Dr Del on Oct 28, 2009 2:14 PM EDT
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It has been well documented that Ryan Clark suffered a life threatening battle the last time he suited up in the oxygen deprived high altitude of Denver. As a result of his sickle cell crisis, he sacrificed his spleen, gallbladder, and could have potentially lost his life. Following this traumatic episode, our galliant Steeler warrior suffered dramatic weight loss as he fought his way back down a long road of recovery. In my opinion, it was the greatest comeback since Rocky Bleier. Presently, the debate continues as to whether or not he should participate in our upcoming battle with the undefeated Denver Broncos.
First, lets take a closer look at the disease that not only threatened his professional career, but also potentially could have cost him his life. Sickle Cell Disease is an inherited disorder of the oxygen carrying cells of the blood. This abnormality involves the substitution of one protein building block, an amino acid, for another amino acid at a key point in one of the chains of the major protein of red blood cells. The name of this protein is hemoglobin. Hemoglobin is an iron containing protein found inside red blood cells. It carries oxygen from the lungs to all parts of the body and releases it to the body's cells and tissues.
Abnormal hemoglobin is very sensitive to conditions of low oxygen within the body. Under these conditions, a sickle cell crisis may occur because the abnormal hemoglobin loses it's solubility in blood and begins to form thick polymer strands. Consequently, these polymers hold the red blood cells in abnormal shapes which have been described as banana shaped or half moon shaped hence the term "sickle cell". Abnormally shaped "sickle cells" cause vasoocclusion which means the blocking of small blood vessels. If these cells become lodged in small blood vessels, they obstruct the flow of blood. If the flow of blood is obstructed, oxygen cannot reach the tissue comprising the organ. As a result, the tissue becomes necrotic (the cells comprising the tissue dies) and organ failure occurs. Organs that require a large amount of blood flow and oxygen are particularly susceptible .
Considering all the potential medical complications that could arise as a result of participating in this game, I do not think it would be wise for Ryan Clark to play in Denver. It is true that these types of complications are rare, but it could certainly happen again. It is only one game in the long journey of a season and Steeler Nation would completely understand if you stood along the sidelines. It is simply not worth the risk. One day the roar of the crowd will subside and your family, who loves you dearly, needs you to be there for them in the future.
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Great post, Doc
I hope you don’t mind a little formatting to make it easier on the eyes. I didn’t change anything regarding the subject, just a little tweak of the layout.
Guns don't kill people. Lamar Woodley kills people. (mattyc_77 on twitter)
So heres a question
Is there a pressure component to causing the cells to sickle? Or is it based solely on blood oxygen levels?
Is it safe to even try and reproduce the sickle effect in an exam context, with an endurance test and blood ox monitoring and normal elevation? Would it be possible for him to reproduce the effect just by deoxygenating his blood in the vein of, say, running a marathon or something?
Guns don't kill people. Lamar Woodley kills people. (mattyc_77 on twitter)
No, a person has to be genetically predisposed to produce abnormal hemoglobin.
It’s not the pressure that causes the problem, it’s the low oxygen levels. At low oxygen levels, this abnormal hemoglobin becomes less soluble in blood and causes the blood cells to form abnormally. It also shortens the life cycle of the blood cell which could lead to anemia. Alot of athletes are monitored but you can’t predict when it would occur. I believe Clark played at Mile High prior to his incident…..
clark is unique because he has sickle cell trait compared to sickle cell disease. you know how you get 2 copies of genes from both mom and dad, well if both of his genes for hemoglobin has his mutation it’s sickle cell disease. if only one is bad and the other is “normal,” it’s sickle cell trait. sickle cell trait isn’t as bad as sickle cell disease. if you have the genetic disease, things like running a marathon could cause an “episode.” low oxygen content in the blood through physical exertion, high altitude causing low O2 levels in the blood, and a lot of different things can lead to episodes.
but very few ppl who have sickle cell actually make it to the level of a professional athlete. clark is lucky in that it apparently takes both unusual low level of oxygen at the high altitude AND the high level of physical exertion to bring on an episode for him
Thanks for the informative post.
Standing on the sidelines? Steeler nation will understand if he stayed at home! Is it even safe for him to go?
"I believe the game is designed to reward the ones who hit the hardest. If you can't take it, you shouldn't play." Jack Lambert
by LongTimeSteelersFan on Oct 28, 2009 2:50 PM EDT reply actions
I see, thanks for the answer.
"I believe the game is designed to reward the ones who hit the hardest. If you can't take it, you shouldn't play." Jack Lambert
by LongTimeSteelersFan on Oct 28, 2009 3:29 PM EDT up reply actions
I'd rather him wait
From what I understand doctors seem to suppose his spleen caused the problem, he no longer has a spleen.
But at the same time I personally would rather him sit. To me, its just smarter. I’d rather have him out one game for sure, than possibly the rest of the season. We need our boof-master.
I was also wondering if during this bye week they could try to send him up to denver to do some light exercise at the altitude. I was thinking that would be a good test. Keep him monitored and such, and if nothing flares up, let him play. That’d be a good test.
I was also thinking how much would having a couple days in denver to acclimatize help him? I think the team should try to do that too. Having gone to Cusco and in the mountains, I know that first day can be brutal no matter how in-shape you are.
He’s got no spleen and no gallbladder, but from what I understand, there are actually other organs int eh body! And they all receive blood!
Kidding aside, there is a lot more damage left to be done. Kidneys, liver, pancreas, digestive tract, etc. All of those organs are at least partially vascularized and it was the blockage that was created by the sickle cells that made the spleen and gallbladder sick, not the other way around.
Guns don't kill people. Lamar Woodley kills people. (mattyc_77 on twitter)
I say he just doesn't play
Football is just a game and not worth any thing life threatening. 3 hours of football is not worth the rest of your life.
" I’m glad we play Pitt twice, and not Tenn this year." - Salty Browns Fan.
by John Stephens on Oct 28, 2009 3:14 PM EDT up reply actions
Agreed, he amost died the last time he played there!
"I believe the game is designed to reward the ones who hit the hardest. If you can't take it, you shouldn't play." Jack Lambert
by LongTimeSteelersFan on Oct 28, 2009 3:35 PM EDT up reply actions
I'm glad to see you on here Johnny
I see that you gave it back to the Viking knuckleheads a few times after my comments. I appreciate it. I know I instigated it but I couldn’t resist my ornery side….. LOL I’m offering the olive branch bro
Forgive and Forget
Let’s move on. I rec’d the post, I am not one who likes to hold long grudges.
" I’m glad we play Pitt twice, and not Tenn this year." - Salty Browns Fan.
by John Stephens on Oct 29, 2009 9:37 AM EDT up reply actions
Ramping up red blood cell counts
requires more than a couple days if I understand correctly. That being said, Denver isn’t exactly Everest base camp.
Yeah
theres also medicines that speed up the process, diamox for instance.
But I will say, im not OUT of shape but I dont really work out or anything and even after 3-4 days at 8-9000 ft I was still more easily exhausted. Denver’s not that high though, but it still makes an impact.
Viagra too
Actually stuides have been done, Viagra helps people exercise better at higher altitude. Opens up the blood vessels you see. Just dont have Holmes poppin any.
One of the great
luck stories of modern pharmacology. Looking for a drug for high blood pressure and finding ‘adverse effects’ in men. Now worth billions
Red blood cell production issue?
Is the red blood cell production itself compromised with this disease or is it a metabolic change in the cells themselves post-production? Procrit works great in cats…. lol Sorry, I deal with Veterinary medicine, but this is very interesting to me. Please continue to inform!
When the tailgate drops, the BS stops. Shut up and play!
I would guess it to be some more severe type of sickle cell. Sickle cell is more common in african americans than it is in white players, and we have a higher percentage of African American players than white ones.
So the odds numbers would suggest it to be a problem we’d see more often, unless there must be some sort of severity to the sickle cell condition or perhaps a secondary thing that we dont know much about.
Because I’ve never heard of this before Clark.
Ryan Clark does not have sickle cell disease, per se; he has sickle cell trait, which is a “milder” form of the disease.
Sickle cell disease and sickle cell trait are both inherited genetic diseases that affect the way your body produces hemoglobin, a protein that is in red blood cells. Your body has two genes from which it produces one of the components of hemoglobin—one inherited from mom, and one inherited from dad.
Those with sickle cell trait have inherited one abnormal (“sickle”) gene, but the gene from the other parent is normal. While sickle cell disease is relatively rare in the scheme of things, sickle cell trait is a very common condition among African-Americans. For most people with sickle cell trait, the other copy of the gene (the normal one) is able to compensate for the sickle gene; these people function normally, and many of them remain undiagnosed for life.
However, in those with sickle cell trait, certain conditions can “tip you over the edge,” causing the sickle gene to “overcome” the normal gene, leading to organ damage. Altitude is one such condition, becuase your body has less oxygen at altitude. Exercise is another, because your muscles eat up more oxygen. Extreme dehydration can affect things as well, as can other inherited genetic traits. There are many other factors that can also tip one’s body over the edge, some of which are poorly understood. Notably, not everyone with sickle cell trait who exercises at altitude will suffer organ damage (otherwise the city of Denver would be in trouble). It takes a “perfect storm” of circumstances (in other words, very bad luck) to cause a person with sickle cell trait to be tipped over the edge, as Ryan Clark was.
As far as why we don’t hear about this more often … one possibility is that other players simply never get hit with the “perfect storm” like Clark was (e.g. maybe Clark was severely dehydrated when this happened in Denver). Furthermore, sickle cell trait could have subtle effects on lung function, which could limit one’s athletic ability and prevent one from performing at Division I or NFL levels, thereby limiting the number of NFL players with sickle cell trait. There is indeed a growing rumble within the NCAA community to call for mandatory sickle cell trait testing in order to identify individuals with sickle cell trait, thereby identifying them as “high-risk” individuals. Like any sort of genetic testing, this would bring up all sorts of ethical dilemmas to work through.
Yes, he would have to have homozygous alleles donated from each parent in order
to have sickle cell disease and obviously he wouldn’t be able to play football. He has one normal gene and one abnormal gene for the production of hemoglobin. Therefore, approximately 50% of his cells are capable of sickling which in his instance caused a sickle cell crisis. By the way, Santonio Holmes also carries this defective gene.
Testing would be interesting in theory-
imagine if it were a part of the combine or something. Having a sickle cell trait might then significantly lower your draft value.
Believe it or Not,
this disease is the leading cause of death of NCAA football players this decade. 5 of the 10 deaths in Division IA has been attributed to the condition. Approximately 8% of the African-American population carry this trait.
Great post
Good information Doc.
BlkGld Fan, it’s a change in the production of red blood cells. As Doc said, the protein itself is mutated. When this mutation exists in conditions of hypoxia, that can cause aggregation. In Clark’s case, the aggregation occurred primarily, I believe, in the blood vessels supplying his gallbladder and spleen, which caused a lack of blood flow to those organs.
It’s also important to note that just being at high altitude doesn’t necessarily make your blood oxygen levels low. These are fit guys, so their actual oxygen consumption is quite low too. It’s only when you’re exercising quite hard that the conditions are right for sickle cell disease to go whack
Hematology is definately not my area of expertise
but I think due to the fact that you have a background in veterinary medicine, you may be referring to the packed cell volume(i.e. hematocrit) Hematocrit is the proportion of blood volume that is occupied by red blood cells. In sickle cell anemia the red blood cells are fragile and prone to rupture. When the number of red blood cells decreases from rupture (hemolysis) anemia is the result. Therefore, I believe PCV levels would be lower in patients with sickle cell.
Yes, Packed Cell Volume
This disease sounds very similar in affect to IMHA (immune-mediated hemolytic anemia) Obviously, different in cellular definition, but ravaging none the less. Body destroys its own RBC’s as fast as they are made.
When the tailgate drops, the BS stops. Shut up and play!
That's why Dracula doesn't bite black people
"A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty." - Winston Churchill
How was the trip?
" I’m glad we play Pitt twice, and not Tenn this year." - Salty Browns Fan.
by John Stephens on Oct 30, 2009 8:40 AM EDT up reply actions
Going good
I’m still in Hampton Roads VA
"A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty." - Winston Churchill
by PixburghArn on Oct 30, 2009 10:23 AM EDT up reply actions
Ahh gotcha
You were in MD just long enough for the crappy weather. Haha
" I’m glad we play Pitt twice, and not Tenn this year." - Salty Browns Fan.
by John Stephens on Oct 30, 2009 11:01 AM EDT up reply actions
It was sunny the next day
but on the way down to Hampton there was a wreck at Woodbridge. Go figure!
"A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty." - Winston Churchill
Good point
Yes, physical exertion causes an increased demand for oxygen. In other words, Clark would be fine on the plane ride there.
I lived over half my life at high altitude..
(around 7000+ ft) and I’ve seen what it can do to people who aren’t acclimated, even if they don’t have sickle cell. I personally don’t think he should even go to Denver. I totally agree with Johnny_S. It’s just not worth it.
Yeah for real
My time spent at 8500 up in Cusco was brutal the first day. Take 3 steps uphill and i was gasping for air.
Its quite humbling if you dont know it.
I've also lived in 7400+ ft
Mexico City is where I live. My bgarndfather and brother are both doctors, and although they are not experts in hematology, they have only seen this type of condition in their practice twice between them, and both times it was a case of someone who wasn’t originally from here.
This all is quite interesting. Thanks for posting this.
+1 on Clark sitting out this one.
It all starts in the trenches.
by The_Nation_in_Mexico on Oct 29, 2009 2:46 PM EDT up reply actions
these chubby fingers!… grandfather I meant…
It all starts in the trenches.
by The_Nation_in_Mexico on Oct 29, 2009 2:47 PM EDT up reply actions
The doctor is in!
Thanks for the info. No reason to risk your life Ryan, it’s just a game.
'I’ve learned to become a flat-liner. There’s a lot out there that’ll make your heart jump if you allow it."
-Coach Tomlin
Ryan stay home
as much as Pittsburgher’s love our football, we are a very compassionate city, a football game is not worth the risk. Life is short enough, don’t tempt fate.
Not again, but again again
Just looked through the game logs – the only other time Clark played in Denver was in 2005. He was inactive the following week. I thought I’ve read that he had problems, but I can’t find those stories. But some articles from the time list (spleen) as the reason he missed the 2005 game.
I’d more afraid of it happening a third time than I would be of it happening a second time.
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