Twelve wires, one for each year of his life, flowed from an electrocardiogram machine and were attached to his body as he lay on a gurney 10 days ago in the gym at Lincoln Hall Middle School in Lincolnwood.
In a couple minutes, the procedure was over, the electrodes were removed. "It felt like bandages when they took it off, that's it," said Amir of the non-invasive EKG.
Amir plans to try out for the basketball and volleyball teams at his school, so the test wasn't optional. Last March, District 74 approved a proposal spearheaded by board member and Chicago attorney Paul Langer to require a "complete sports physical," including an EKG, for sports participation.
"It's my understanding that we're the first middle school in the country to be mandating this," said District 74 Supt. Mark Klaisner as he watched students and their parents forming a line at the door even before testing began at 3 p.m. that day.
Although the death of teenage athletes is an anomaly (about 1 in 200,000 annually), Langer said that's one too many when EKG testing is available that can detect about 40 percent of congenital heart problems. But the major cause of sudden death among athletic kids, a condition known as hypertrophic cardiomyopathy (HCM for short), can be spotted on the EKG about 90 percent of the time, said Joseph Marek, a DuPage County cardiologist and medical director of the Midwest Heart Foundation's Young Hearts For Life program, which was administering the tests at the school.
Catching other heart conditions
Other heart conditions that often turn up on the EKG, he said, are potentially fatal rhythm problems such as long QT syndrome, Brugada syndrome and ARVC, which stands for arrhythmogenic right ventricular cardiomyopathy.
Langer admits that the test isn't perfect but says that sparing even one family from tragedy makes it worth it. "We've stressed it over and over again: It doesn't buy you absolute protection," he said. "In baseball, you know how sometimes the manager will bring in the lefty because he's playing the percentages? We're trying to play the percentages here."
Many parents at the testing liked the odds.
"It's not a guarantee," said Linda Ibrahim, whose soccer-playing son George, 12, was being tested. "But if they could catch 40 percent of the cases, then that would be a great chance for kids to survive."
Denise Fricke, accompanying her daughter Rachel, 13, agreed. "I'm an advocate of it. Anything that prevents a further health problem, I would be fully supportive of."
The test cost $45 per child at the school. Langer said a private EKG could cost $100 to $300. Marek's program, part of the Lombard-based heart foundation, has been doing EKG tests for all students at a number of DuPage County high schools for several years, often for free because of corporate sponsorship. Langer said the speed with which the Lincolnwood program was put together prevented such funding this year, but he hopes to find such backing for the 2008-09 school year.
Testing young athletes for cardiac problems is becoming routine in Europe. Testing every other year, beginning at the age of 12 to 14, is recommended by the International Olympic Committee and the European Society of Cardiologists. Italy, for example, has mandated EKG testing for 25 years and has seen cardiac-related sudden deaths among athletes fall 89 percent.
But an American Medical Association statement in March reaffirmed its position that EKG testing is cost-prohibitive as a national program. In general, it applauds local, volunteer efforts such as the ones in DuPage and Lincolnwood but says they are difficult to sustain and "create uncertain areas of liability."
Langer, a litigation partner at the Chicago firm of Mayer, Brown, Rowe & Maw, says that argument is bogus.
No fear of lawsuits
"I'm not concerned about that and the district isn't either," he said. "In any given test, there's a statistical possibility of false positives or false negatives. My view is I would rather be sued 100 times because they administered the test than to have one child die because we didn't administer the test."
The AMA position also claims that the tests are too expensive, that they would discriminate against minorities in poorer areas and that the resultant medical tests from false positives would be too costly and would cause unnecessary anxiety for the athletes and their families.
Marek said he thinks local initiatives have the best chance of success in the U.S., where grass-roots support for EKG testing is growing.
In Texas, where football is king, some schools offer the testing. Closer to home, state Rep. Mary Flowers (D-Chicago) recently introduced legislation to require the EKG testing, but it failed to pass. Flowers said she plans to reintroduce the plan next session unless she can find a state Senate bill to attach it to. She commended the Lincolnwood district and said that Kidcare, a health-care program for low-income families, should help with the cost of statewide testing.
"There should be no reason why any young person that's involved in any kind of contact sports should not have that as part of their physical," she said.
Julie Younan, who brought her son Joey, 12, to Lincoln Hall's gym to be screened, said she thinks Lincolnwood residents have been especially supportive of the district's trailblazing mandate because of a 1st-grade girl who died suddenly after a gym class in April 2006. She knows the girl's family.
"I think that was the start of why Lincolnwood decided to do the screening," Younan said. "It's a good role model, because once other communities see this, I think that they will slowly follow."
Marek said the AMA report should have focused more on medicine and less on what he calls some flawed economics.
"They made some assumptions that are arguable," he said. "We will never figure out a way to lower the cost if we say, No, we're not going to do it.'"
Meanwhile, Amir, the birthday boy, and his mom, Aida, prepared to head home to a barbecue in his honor.
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