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Ointment Overdose Raises Questions

By BILL WARD The Tampa Tribune

Published: Jun 12, 2007

TAMPA - The news of a New York teenager dying from using too much sports cream has doctors, trainers, coaches and athletes all asking the same question: How could it possibly happen?

"This is an extremely rare and unusual case," said Eric Coris, a medical doctor and assistant professor in the University of South Florida's department of medicine in the division of sports medicine. "I've never heard of another situation like this before."

Arielle Newman, a 17-year-old track and cross country standout from Staten Island, N.Y., died in her sleep April 3. Following a two-month investigation by the New York City medical examiner, a spokeswoman for that office said Friday that Newman died because her body absorbed a toxic amount of methyl salicylate, the active ingredient found in sports creams such as Bengay and Icy Hot.

The spokeswoman, Ellen Borakove, said Newman used "topical medication to excess." She not only was using methyl salicylate in an ointment on her legs, but also in an adhesive pad and in a third, unspecified product. Borakove said the overdose was a result of use over an extended period of time and not from a single instance of overuse.

Newman's mother, Alice-Lynn Newman, disputes the examiner's findings. She said her daughter only used the products on race days and had borrowed what she had been using from teammates.

Either way, doctors and trainers alike are perplexed by Newman's death. Robert Sallis, an M.D. and president of the American College of Sports Medicine, said he has never seen an overdose of methyl salicylate by topical application in his 20 years of practice. Oral overdoses of a similar chemical found in aspirin, salicylic acid, are common but even those usually do not result in death, Sallis said. He believes Newman could have boosted the chemical's absorption by increasing the skin's blood flow with intense exercise, or by wrapping her skin after heavily applying the ointment.

But even with those methods, Sallis questions how Newman could have overdosed by simply applying it topically.

"I can't imagine she was using large enough doses [of the sports cream] to go across her skin to be fatal," Sallis said. "And even if she did, she would have experienced very specific symptoms that she would have noticed long before it was potentially lethal."

Sallis said the warning signs of an overdose of methyl salicylate and salicylic acid include a ringing in the ears, upset stomach, agitation, rapid breathing, irregular heartbeat, dizziness, nausea and convulsions. If left untreated, this can result in heart failure, respiratory arrest and death.

For most patients suffering from muscle soreness or injury, many doctors and certified athletic trainers recommend icing as the primary treatment. Chris Smith, a physical therapist and former athletic trainer for the Tampa Bay Buccaneers and college sports teams at Arizona State and Alabama, said icing is one of the oldest and most effective methods for injury and pain management of soft tissues; sports creams, he says, are "way, way down" his list of treatment methods.

"For the most part, all topical creams do is affect certain nerve endings in the skin to where you get a sensation of feeling heat or cold," said Smith, who has been a certified athletic trainer for 29 years. "I've seen some fair-skinned guys get irritation from it but I've never, ever seen an athlete get even mildly sick from using [sports creams]. Until I'm proven wrong, I just think there's something a little suspicious there."

Wharton track coach Wes Newton, a veteran of 33 years of high school coaching, said he has never seen an athlete become ill from using sports creams. He says his athletes use ice baths after workouts and, occasionally, an ointment called Biofreeze, which does not contain methyl salicylate.

One of Newton's star athletes this season, Teona Rodgers, said she usually would apply a small amount of Icy Hot about 20 to 30 minutes before her first race. But she admits using the ointment was "probably more of a mental thing than anything else." It was the ice baths, she said, that "did the trick" when it came to relieving soreness.

Former Gaither standout distance runner Amanda Quick said she used a variety of sports creams in high school, some that did and some that did not contain methyl salicylate. Quick said the balms sometimes relieved pain but since arriving to run at Florida State, she said more effective treatments such as icing and electrical stimulation of muscles are the usual methods of treatment.

Like Smith, Coris believes there could be more to the story of Newman's death that has not been discovered, including possible dehydration. Until then, he said her death should be a warning to coaches, athletes and parents.

"The take-home message to me is for people to realize that just because it's over the counter, just because it's a supplement, does not mean it's totally safe and that they don't have to be careful with its use," Coris said. "We see this all the time with athletes using oral supplements. They get into trouble because they think that just because they can buy it at the local vitamin store that they can take as much of it as they want."

Tribune reporter Bill Ward can be reached at (813) 259-7456 or wward@tampatrib.com