Every breath counts. Chillicothe Gazette Publication date: 04/10/2010 Page: Edition: Section: Publication: SPORTS Copyright: Byline: JOEY CHANDLER

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1 Publication: Chillicothe Gazette Publication date: 04/10/2010 Page: Edition: Section: SPORTS Copyright: Byline: JOEY CHANDLER Day: Every breath counts Young, tall, in shape -- for most athletes, a set of favorable traits. But for the most unfortunate, they're the perfect conditions for a collapsed lung. Byline: JOEY CHANDLER A severe pain struck Unioto senior J.D. Callihan during his cooldown at the end of club soccer practice in mid-april. With two laps to go, Callihan couldn't breathe and grabbed his chest. His coach told him to sit down and relax -- maybe he pulled a muscle. Still fighting through the pain, Callihan insisted he drive himself home, but a teammate followed to make sure he arrived safely. Callihan hobbled up the driveway, almost keeling over from the excruciating pain on the left side of his chest. He collapsed on the couch and yelled down the stairs to his younger brother, Zack, for help. Huntington senior Brandon Magill picked up a piece of metal during first-period welding May 24 at the Pickaway-Ross Career & Technology Center. The pain that followed was a bit unusual. Seated behind him, Magill's classmate heard a strange popping sound. Magill thought he had cracked his back. The popping noise continued, and when he arrived home, his mother could hear it from three feet away. Two days earlier Magill had qualified for the Division III regional meet with his second-place finish in the 3,200-meter run, a race that left him coughing and unable to catch his breath. Alex Kimsey noticed the pain while drying off after a swim at a friend's house in late June. Kimsey, a sophomore baseball player for Sinclair Community College, thought he pulled a muscle in his back. Later that night, Kimsey lied down on his stomach and placed an ice pack on his back. The pain then moved to his front. What wasn't right with each of these young men is a condition known as primary spontaneous pneumothorax -- or a collapsed lung -- affecting the air in the space between the lung and chest wall which pushes the lung down. All three of these athletes fit the typical profile of the group most commonly affected by spontaneous pneumothorax: Tall, thin, athletic, young males between the ages of 15 and 35. 1/5

2 Take one look at Callihan, Magill and Kimsey and there's no denying they fit the profile. Callihan stands 6-foot-2 at 134 pounds pounds before his recent surgeries. Magill is a lanky, 6-foot, 130-pound runner while Kimsey towers over most at 6-foot-11 and 200 pounds. The reason behind why tall, thin, young male athletes are most prone to this condition isn't completely understood. "I think the thing of it is that they are working their lungs more (than) non-athletes would. They are busy. There is air exchange going on," said Dr. Allen Shaw, family practitioner and division chair of Ambulatory Medicine at Adena Regional Medical Center. "Some of the theories are that they have connective tissue troubles, which means the tissue that holds things together, and if they are doing a lot of air exchange and putting a bunch of pressure in the lungs, that may make them pop in time," Shaw said. Nationwide Children's Hospital Surgical Director Dr. Brian D. Kenney said while it's uncertain, many think those who fit the profile have an underlying defect of the top of their lung. Little blebs (blisters) or bubbles are present on the top of the lung. "We know when one of those ruptures, that's when they can get the collapsed lung," Kenney said. "So when you are athletic or a smoker, you cough, and that is when it tends to happen. You can break one of those little blebs." And while the condition typically is found in young, thin males, it doesn't mean females aren't affected. Shaw once treated a 5-10 female distance runner and volleyball player with spontaneous pneumothorax around 1994 who fit the physical profile. Kenney said Children's sees about 12 to 15 cases of young men with spontaneous pneumothorax a year. The hospital's referrals come mostly from the southeast and central Ohio area. "It happens common enough we do see it, but we also take care of something like appendicitis 200, 250 times a year," Kenney said. "So this is not as common as that, and something like cancer would be rarer than this." Shaw said he's seen four cases, and a family practice doctor carrying a normal load normally will see it at least two to three times in a career as the pediatric population grows up. The bottom line is spontaneous pneumothorax does occur, and while nothing can be done to prevent it, treatment tends to be easy if a patient doesn't ignore the symptoms. About 90 percent of cases can be fixed with a chest tube, while those who suffer a recurrence, as did Callihan, sometimes need surgery. If the condition goes untreated for a prolonged time, it can be fatal. THE SYMPTOMS Athletes are conditioned to push through a certain amount of pain, but the feeling that comes from finishing a hard workout is much different than the pain associated with spontaneous pneumothorax. And once an individual goes through one pneumothorax, they quickly can identify any recurrences. Callihan knew what was transpiring each time he developed another pneumo, and so did Kimsey. 2/5

3 The most common symptoms associated with the condition are shortness of breath and chest pain. Another symptom, which Shaw said is a dead giveaway of having a pneumothorax, is crepitus -- air bubbles underneath the skin and soft tissue structures present near the top of the chest area. A definitive diagnosis of spontaneous pneumothorax is done by chest X-ray, and crepitus is a red flag an X-ray should be taken. Both Magill and Callihan described their crepitus as not only sounding, but feeling, like bubble wrap. "If you have that bubble wrap feeling, you've probably already ignored that chest pain and shortness of breathe for a day or two," Shaw said. "I'd guess that stage probably takes a little while to develop." Anyone feeling these symptoms should seek medical attention immediately. The longer an individual waits, the larger the pneumo can become. TREATMENT AND RECOVERY Most cases of spontaneous pneumothorax resemble Magill's experience. Magill had more than a 15 percent collapse in his left lung and a chest tube put in. By the end of July, and after plenty of rest, he was released to start working out again. Kenney said the recurrence rate among patients who've suffered from spontaneous pneumothorax is 25 percent. If it happens a second time, the chance of recurrence increases to 50 percent. In Kimsey's case, those percentages are concerning. His first pneumothorax occurred in his left lung, a 95 percent collapse, and his second, which occurred in August, was a 20 percent collapse on his right side. Kimsey's first collapse was treated with a chest tube, and his second healed on its own, which can happen with smaller pneumos if the appropriate rest is taken after diagnosis. There is an almost 85 percent chance the condition will happen only in one lung, making Kimsey's case a bit out of the ordinary. "It's always on the back of my mind whenever I go out or start to run," Kimsey said. "It's definitely an eye-opening experience and a pretty scary thing. It's not something I want to experience again, but it's pretty hard to shake that feeling." Callihan's story is the most extreme of all. Since his first pneumothorax in April, Callihan has been through 10 chest tubes and three surgeries, forcing him to miss out on his senior year of varsity soccer while he recovers. And until last week, he did his school work from home. If Callihan suffers another setback, the only treatment that can be used is more chest tubes. His chest resembles a blue print of the work that's been done. Tiny holes from his numerous chest tubes are scattered about, but nowhere near as noticeable as the foot-long scar from his incisions. 3/5

4 "They cut through the muscle and everything, and the ribs separated," Callihan said. "It hurts all the way across to my sternum, and it's bruised pretty bad." His first collapse was at 50 percent to 60 percent, and about a 6-centimeter drop. Callihan came home from the hospital three or four days later, played summer baseball and finished club soccer. At the end of July he started to have complications again and, by Aug. 3, he had his first of the three surgeries, a VATS, Video-Assisted Thoracoscopic Surgery. The pneumo never sealed, and, on Aug. 12, a second VATS had to be performed, but because of difficulties completing the operation, a thoracotomy was done. "We got a phone call in the waiting area saying they wanted to open his chest," said Callihan's mother, Tonya. "Those are the scariest words I've ever heard in my life." Callihan returned home Aug. 20 and was readmitted Aug. 23 with a 50 percent collapse. He spent three to four days with a chest tube, went home again, then returned four days later. That's when a surgery was performed to remove the lining of his chest wall. Kenney said it's unusual to have to do more than one operation when dealing with spontaneous pneumothorax. MOVING FORWARD Magill has had a successful cross country season this fall and hasn't experienced any symptoms of a recurrence. His experience with spontaneous pneumothorax isn't holding him back. The fact the condition forced him to miss the regional meet has been a driving force behind his training. Magill broke the school record in the 3,200 earlier in the spring, and he also qualified for the regional meet as a member of the 800 and 3,200 relay teams. He's ready to get back to some unfinished business on the track with hopes of qualifying for the state meet. Magill said his teammate, Logan Chaney, who pole vaulted at the 2009 state meet, also suffered from spontaneous pneumothorax. Chaney's profile is similar to Magill's, and he is an example of an athlete having a full recovery and still being able to compete at an elite level. "I can't wait until the spring," Magill said. "I'm going to take some more names off the (record) board." Kimsey, a 2009 Unioto graduate, still isn't allowed to lift weights but can run and plans to play baseball. "I still have the same expectations for myself as I did three or four months ago, and I'm still going to try and perform at the same level," Kimsey said. His college workouts are much more extreme than his high school conditioning, especially the extra running and time spent in the weight room. Kimsey has since realized that, with his build, he must be aware of what his body can handle. "I think people should just be more careful as far as lifting and training really hard if they are taller and thinner," Kimsey said. 4/5

5 Callihan attended school for the first time this fall on Monday. He's able to do only half-days but is happy he can go at all. He also went to Unioto's Homecoming dance with his girlfriend, Emily, under close supervision, and did a bit of dancing without overexerting himself. His body still is weak from his procedures, and he still isn't eating well. Callihan will meet with a pulmonary specialist Wednesday and has another checkup with Kenney in the near future. Although Tonya disagrees, Callihan said he'll be playing club soccer this winter, but until then, he'll just continue to rest. If there is one thing each of them have learned from their ordeals, it's to pay attention to the symptoms and to speak up when something isn't right. "Don't ignore it and don't play it off and try to be a tough guy," Callihan said. Chandler can be reached at (740) or jchandler@chillicothegazette.com. Print First This story first appeared in print on Sunday, Oct. 3. Text name: Slug: Topic: Subject: Keyword: Type: Geographic: Art type: Art caption: Proc: Status: B xml Young, tall, in shape -- for most athletes, a set of favorable traits. But for the most unfortunate, they're the perfect conditions for a collapsed lung. centralohio,frontpagecarousel Sports Dr. Brian Kenny examines Unioto senior J.D. Callihan on Monday at Nationwide Children's Hospital's Outpatient Care Center as Callihan's father, Doyle, watches. Evidence of the numerous procedures, including two major surgeries and 10 chest tubes, is visible on the left side of Callihan's chest. Frank Robertson, Gazette IMPORT Sent 5/5

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