By Dr. Jeff Daniels EBS Medical Columnist

Since I came to Big Sky in 1994, I’ve been performing “pre-participation” school physicals for the students of Big Sky schools. With a new academic year beginning Aug. 31, and sports like football and volleyball attracting numerous student athletes, many Big Sky students in middle and high school are required to get a physical.

All but one of the 50 states and the District of Columbia require students who want to participate in organized sports to get a physical exam. There are no nationwide standards, but common sense has led to the creation of a questionnaire form that tries to cover all aspects of a young athlete’s health history and physical condition.

The form is also used to establish a vaccination history, including the patient’s last tetanus shot—if you read my last column you know this shot also includes protection against pertussis or whooping cough. Many of us remember the pertussis outbreak that happened a few years ago in the Big Sky School District, so getting this vaccination in early teenage years is especially important.

After reviewing a health history with the student and his or her parents, anything significant that has happened in the past is documented. This includes a history of concussions, orthopedic injuries, allergies and asthma, dizziness, or previous sudden loss of consciousness.

Clues that we look for during the physical exam in order to confirm that a student athlete is in good health include assessment of the mobility of the back, neck and major joints. Balance and other neurological tests are done. Vision testing using the Snellen chart has occasionally led to the recommendation of a complete optometry evaluation. And then there’s the hernia check for boys—I’ve actually discovered a couple of hernias in the 22 years I’ve been checking out Big Sky kids.

For a long time, there’s been a controversy regarding the attempt to identify the extremely rare young individual who could have a cardiac event during sports. Hearing a tragic story of a sudden collapse or cardiac arrest by a youngster participating in athletics certainly causes anxiety in parents, coaches and health providers. The reasons that this might happen include an abnormal structure of the heart—hypertrophic cardiomyopathy or a defect in the origin of a coronary artery—or an electrical problem like the congenital prolongation of the electrical wave called the QT interval, that can cause a heart arrhythmia.

Should we get an electrocardiogram and/or an echocardiogram on all young athletes, to identify subtle or overt abnormalities that could lead to sudden collapse? The general medical consensus is that it’s not an effective way of protecting all young athletes, and should only be done if the history or physical exam suggests any cardiac abnormality.

Suspicion can be raised if the blood pressure is too high, or if there is a significant difference in the blood pressure taken in each arm. Another important physical clue is the presence of a heart murmur that follows a certain pattern, consistent with enlargement and blockage of the heart’s outflow tract.

Now that football and volleyball are starting, we’ve been doing plenty of these physicals. We also have kids going to camp this summer coming in for check-ups. We make it easy, just walk in with the form.

I’d like to thank the families who continue to use the Medical Clinic of Big Sky for school physicals.

Dr. Jeff Daniels was the recipient of the 2016 Big Sky Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.