• Dr David Bolzonello appointed Melbourne Football Club Senior Doctor

    Unfortunately we are no longer offering our Sport & Exercise Physician Service at Warringal Medical Centre.

    Why you ask?

    Because Dr David Bolzonello will now be spending his Monday mornings with the players at the Melbourne Football Club where he's been appointed as a Senior Club Doctor!

    But don't worry - appointments are still available with him at our Clinic on Mondays (pm), Tuesdays (pm), alternate Thursdays (pm) and Fridays.

    http://www.alphingtonsportsmed.com.au/practitioners#dr-david-bolzonello

     

     

     

  • Consensus Conference on Concussion in Sport

    5th International Consensus Conference on Concussion in Sport

    Berlin, Germany. 27-28 October 2016

    A summary from Sport and Exercise Physician Dr David Bolzonello

    "The main value was reassurance that we here in Melbourne are using best practice principles and that we do manage our athletes well."

    Australians were well represented from all our key sports and four of the seven sessions were moderated by Australians, Sport and Exercise Physicians Michael Makdissi, Martin Raftery, and Paul McCrory, who is also a neurologist, and Gavin Davis, Neurosurgeon.

    The format for the event was 7 key topics explored over 7 sessions.

    The seven topics were:

    • Concussion Definition and Sideline Screening
    • Sport Concussion Assessment Tool ( SCAT) and Post-injury assessment
    • Advanced or Novel testing and treatment
    • Physiologic Recovery - Return to play modifiers
    • Childhood concussion
    • Persistent Post concussive Symptoms and Long Term Sequelae
    • Risk Reduction.

    A leader of each working group presented a review of the most recent scientific papers in each topic. Some 2000+ papers were assessed and culled using key words/criteria in each group to sometimes only 15 papers.

    A summary of evidence in each area was presented to the forum. Each session included scientific presentations on that session topic and attendees from the floor added comments, suggestions or even disagreements. These comments were recorded and over the next two days the leaders met to write up the new International consensus position statement. It is due for publication in the British Journal of Sports Medicine in the first third of next year.

    What did I learn?

    The definition of concussion is largely agreed upon by experts, although there is no uniform definition in the scientific literature. There was agreement on a definition as "change in brain function due to a transfer of energy to the brain and its associated structures".

    No definition proposed a prognosis for recovery, and no symptom is specific to concussion.

    Sideline assessment can be very difficult for clinicians as they do not have the benefit of multiple camera angles and slow motion whilst they are testing the player and making decisions. Often, commentators and spectators have a better picture of the impact, and the injured player's response to that impact, than do the staff in the playing arena. Access to tools such as Hawkeye video review are helping doctors to see what the commentators have seen, and be able to respond accordingly.

    The SCAT remains a very important tool and will be refined in its next iteration.

    Universities are looking for a single marker of diagnosis or recovery, be it by scans or blood test which will simplify management.

    Recovery was discussed, women it seems recover more slowly than men and may be more susceptible.

    Not all symptoms are due to brain injury e.g. headache and balance disturbance are likely due to injury to the neck and/or the vestibular structures of the inner ear. It was a surprise to me that this fact seemed to be presented as new discovery.

    Persistent symptoms may in part be due to altered mood state and anxiety from the diagnosis itself, and it was noted that too much medical attention can create an expectation of poor recovery, as may occur in back pain.

    There is no magic bullet in terms of testing or treatment as yet. Clinical assessment using the full gamut of history, examination and special tests such as MRI and neuropsychological testing, remains the mainstay of management.

    Children do not need to rest totally before resuming activity. Low level activity aids recovery and shortens recovery time as compared to those who totally rested. Engaging the school in the recovery process is very important. How long they should remain out of competition was not fully explored but will be considered in the position statement.

    Long term sequelae, specifically Chronic Traumatic Encephalopathy (CTE) remains the most contentious issue in this area of medicine, with believers and sceptics.

    The consensus is that the condition probably exists but current evidence based on retrospective reviews and post-mortem changes is flawed as the contributions of factors such as past alcohol, illicit and performance enhancing drug use are unknown.

    Risk reduction centred on issues such as rule changes, rule enforcement, general and neck specific conditioning and protective equipment.

    Overall I am glad I received an AFL nomination to be invited and enjoyed the collegiality and discussion with clinicians from around the world. The main value was reassurance that we here in Melbourne are using best practice principles and that we do manage our athletes well. As always, continuous improvement comes from doing things well for each and every patient and keeping abreast of the knowledge.

     

  • Educational Workshop

     

    On Tuesday 8 March we presented an Educational Workshop in conjunction with Direct Radiology as a breakfast session.

    The topic was Gluteal Tendinopathy - Implications for Assessment & Management, with local GPs and staff in attendance.

    Speakers were our own Dr. David Bolzonello and Direct Radiology's Dr. Gaurav Gupta.

    If you were unable to make it, here's a copy of the presentation.

     

  • Ciao from Italy!

    From the 26th of June to the 18th July I spent 3 fortunate weeks at the Australian Institute of Sport European Training Centre, Gavirate Italy. My role was to tend to the health needs of all Australian athletes currently training and competing in Europe.

    These athletes included the Australian Rowing team , assisting their team doctor Dr Larissa Trease, and taking over when she left for competition in Switzerland and ongoing locales. The Australian Men’s 23 cycling team are resident in the Area and use the centre for their medical needs. The Women’s national team also staged there before their Giro D’Italia and Tour de France. We had pole vaulters, sailers and a race walker come through. The centre is staffed by Australians who work for the AIS who all speak fluent Italian. There is also an Italian gentleman Luca Broggini, who deals with the local governent agencies. I took trips to Milan with athletes to meet local specialists and arrange tests and X-rays. This was a positive experience being able to interact with excellent local medical specialists, and a chance to improve my conversational and medical Italian.

    The chance to meet and treat Olympic athletes on their journey to Rio next year was a privilege and a great learning experience. While I love the local AFL scene, the knowledge I gained in Italy will help my work with local athletes.

    This was my second tour to Italy, and I hope to get asked back next year.

     

    Ciao Tutti!

     

    - Dr David Bolzonello, Sports Physician

     

     

  • Heart Disease and Sudden Cardiac Death in Sport

    Listen to Dr David Bolzonello on SEN last week talking to Paul Coburn and Daniel Hartford about heart issues and emergency management on the sporting field.

    Click for full Audio ‘Fit and Well for half time’) 

     A Summary of this talk can be found below:

    • Exercise is good for the heart. Sport is good for the individual and the community. Young people do not need a medical check-up unless they are participating in high level elite talent programs (generally considered as more than 6 hours of structured training a week).

    • The benefits of exercise far outweigh risk of heart problems to an individual with no known risk factors as below.

    • However people, irrespective of age, to whom the following applies should see a Sport and Exercise Physician or experienced Sports Doctor for primary assessment and possibly referral to a specialist cardiologist to determine fitness to participate in competitive sport or intense exercise or training:

    -Those who have a family history of sudden death  under the age of 50, heart conditions such as cardiomyopathy or heart electrical / rhythm conditions.

    -Those who have the following symptoms when participating in exercise; dizziness or light headedness , fainting or collapse, unusual shortness of breath or tiredness, chest pain, neck, jaw or arm pain; palpitations of the heart or an irregular heart beat*, any other known heart condition or presence of a murmur.

    -Adults who after a long period of inactivity plan to take up an exercise program and: