Melanie Cole, MS (Host): Welcome to UF Health Med EdCast with UF Health Shands Hospital. I'm Melanie Cole. And today, we're rocking it as it goes beyond the game. Dr. Zaremski's trip to Turkey for the U-16 National Girls' Soccer Team is what we're talking about today. And joining me is Dr. Jason Zaremski. He's a Clinical Professor of Sports Medicine in the Department of PM&R and Chief in the Division of Sports Medicine and the Medical Director of Outpatient Clinics. Dr. Zaremski, it's such a pleasure to have you with us as we get into today's discussion. I'm so excited about this. You work in Orthopedics and Sports Medicine, and it's quite extensive. How did you know this was your area that you were passionate about?

Dr. Jason Zaremski: Well, thanks for having me today. I appreciate it. I'm a former athlete. I played baseball in college. I was a catcher. And I actually hurt my elbow my junior year, and I sustained a partial tear of what's called the UCL or the Tommy John ligament that you hear so much about with baseball players these days. And I actually started spending a lot of time with our athletic trainer. And that really got me interested in more in why did athletes get hurt, how do our bodies work, why do we get musculoskeletal injuries? And that actually was the first time I really thought about helping athletes from the other side, if you will, kind of being the team behind the team.

, That really got me interested in medicine and really sports medicine at that point. I was way back in the mid to late 1990s. And as a result of that, I just kind of pursued my passion of if I couldn't be playing for a baseball team, I wanted to help take care of the baseball player, so to speak. And that kind of got me on the path to sports medicine.

Melanie Cole, MS: That's a very cool story. As someone in the field myself, I know the allure, it's really exciting to work with these athletes, whether they're young or collegiate or professional. So when you think of your greatest strengths when it comes to treating these athletes, tell us what you think those are and also challenges, because we both know some of the challenges that come with working with people with such discipline, such motivation and dedication and dealing with injuries is never fun.

Dr. Jason Zaremski: No, it's not. And part of my role is obviously to make the right diagnosis. But also, particularly in sports medicine, it's a little tricky. Sometimes an injury, the treatment's very obvious. If someone sustained a major injury, a fracture, a complete terrible ligament, I'm going to be referring them to my surgical colleagues. That's a pretty obvious thing.

But it's those in-between injuries, if there's a sprain, a recurrent injury, a strain, can you play safely? Can you return to competition? And this is where, one, I think having a healthcare team that's looking out for your best interests. Number one is very important. Number two, knowing can you push the injury a little bit or not. So, are you safe to return to play or to competition? And then, having really good communication between the athlete, if parents are involved. At times, you're going to have a whole sports medicine team, your athletic trainer or physical therapist, physician, physician non-operatively, physician operatively. And I think understanding that an athlete, particularly someone who's in the middle of competition, it takes a lot to compete, particularly at a high level. So, I think having someone who understands that is important. And honestly, the best thing is just being as communicative as possible to the athlete and anyone else that's involved so we can make a good plan and try to get you back on the field or the court as quickly and as safely as possible.

Melanie Cole, MS: Yes. Return to play is always an interesting discussion with the people involved. Now, you have some unique titles and associations, Dr. Zaremski. And before we get into what it's like to work with a national soccer team, which I can't wait for, I'd like to know if you've ever had the opportunity to treat upper level athletes. And if so, briefly discuss the experience. Tell us about UF Health's partnership as the medical provider for the United States Olympic and Paralympic Committee.

Dr. Jason Zaremski: Sure. So, UF Health is one of the United States Olympic and Paralympic Committee's National Medical Network Partners. We're one of five national medical network partners in the United States. And each National Medical network partner has a medical and clinical liaison. I am that person for UF Health.

So from a medical side, what that means is anytime that there is a athlete that is through the USOPC and needs to be evaluated at UF Health, I basically get contacted. We get a referral. And I review all the information for that athlete, and then I get them to the best possible expert we have here at UF Health, whether it is in women's health, whether it's orthopedics, whether it's non-operative sports medicine, a neurological issue like a concussion or many other issues. That's really my role in that partnership.

It is very humbling to be able to be kind of part of the team behind the team for UF Health to help treat our Olympic and Paralympic athletes. I've had the opportunity to do that as have a lot of my colleagues. And it's really gratifying. And quite honestly, it's really cool to see an athlete that you may have helped treat just a little bit. And every four years, you get to see them on the TV and possibly going for a medal and, in some cases, for the gold. So, it's really a humbling and awesome responsibility, but also very cool at the same time.

I've been fortunate to treat some of these athletes at UF Health as well as in some of my volunteer roles for Team USA. So, it's a pretty fortunate thing and one that I don't take for granted.

Melanie Cole, MS: That's so cool. So, thank you for telling us about that. How exciting. Now, you recently traveled to Turkey with the U-16 Girls National team to watch them play against Spain, England, Denmark. How do you prepare for an international trip like this? Tell us a little bit about your role in Turkey and your experience working internationally.

Dr. Jason Zaremski: So, with US soccer, I am part of the volunteer team physician pool for the U-15 through U-17 Women's national teams. The team physician coordinator who's the head team physician, who is a physician, New York, Dr. Melody Hrubes, coordinates all of the care for all the international travel for these three teams.

I've been fortunate to be selected to go once or twice a year since 2022 for these teams. And I just so happened to be selected for the trip to Turkey this past February. So, entering my fifth year, assisting Dr. Hrubes as well as these three teams for our future Women's National players. And honestly, a lot of the preparation comes from the guidance of our head of medical and athletic training and physical therapy, really our high-performance team.

So, we have a head physical therapist. Her name is Celeste Dix, and she coordinates everything for every camp, for every tournament on the medical side. And we have meetings. Typically, we'll have between one and two meetings at least a month before the trip, sometimes more, sometimes less, depending on the experience of the high performance team that is going. As Dr. Hrubes has had a really good job recruiting physicians, have stayed with the teams over the years, a lot of us have gone on multiple trips now, so we are a little more experienced. And we have to be aware of things such as the nearest hospital, the languages, the emergency action plans on the fields and the hotels with travel. The age of the athletes—obviously, for any athlete under 18, there are different requirements and stipulations as opposed to athletes that are over 18, just in terms of injury and coordination of care and if medication needs to be given.

So, there's a lot of coordination. But quite honestly, and those of us in sports medicine know this, the biggest part of sports medicine, honestly, is preparation and communication. If we can do that, most of the time, outcomes are pretty good as long as we prepare in advance, which we all do at all levels of sport.

Melanie Cole, MS: Wow. So, that's a lot of logistics and planning and that's so interesting. I imagine many people don't think about those kind of logistics, like where's the nearest healthcare And the language barriers and the age. So certainly, that's going to be, you know, parental consent, all of these things going into such a complex situation.

So as we're trying to understand the range of medical expertise in the sports world and this multidisciplinary, comprehensive approach that goes into working with these high-level athletes, tell us a little bit about how this experience with the youth soccer teams differ from your other experiences working in sports competitions, events? I'm sure you've just been in so many of them. How is this really set apart?

Dr. Jason Zaremski: Well, I think in some ways, there's a lot of commonalities. So when you travel with a team, whether it's team USA, the U-17 Women's Soccer team, or any other team, it always is the same in terms of you have to have really good communication, you have to have really good preparation, and you have to have really good what's called emergency action plan.

So if there's an emergency that has occurred, what is the policy? What is the preparation? What do we need to do? Have we communicated with our security team, with our high performance team, et cetera? And that's pretty consistent for both teams. Now, that said, as you alluded to, there are going to be subtle differences if you are in soccer with players that are under 18, that's very different than possibly let's say baseball players who are age 25. So, that's going to be very different. So, that's number one.

Number two, it's also thinking about things that may never happen but you're aware of, just in case. I'll give you a perfect example. When we were in Turkey, some of the equipment and some of the medical training room resources didn't arrive. So, we ended up going to a pharmacy in Turkey. Get on your phone, get on Google Translate. And we had a good bunch of in what the United States would be over-the-counter medication, whether it's some Tylenol or some Advil, you know, a lot of blister care stuff because there's soccer players to prevent blisters, because we didn't have that. But that's something we had to be prepared for. You had to think about such things as, "Okay, how can we pay for it?" Because certain credit cards aren't taken in that country. You had to be able to figure out, "Okay, how much do I need for a 12-day trip, unless you go on multiple trips?" So, things like that. You essentially have a portable medical room, athletic training room that you set up in one of the hotel suites, and that's what any good sports medicine team does when they're traveling. And that could be national, domestic. Or international as well.

And obviously, language barrier is a huge thing. If you're traveling to an English-speaking country, or even a Spanish-speaking country, I think most of us are pretty good at that. And obviously, a lot of soccer players can speak a little bit of Spanish as well. But Turkish is a language that I definitely do not know. So, you had to make sure you had some translating devices on your phone so that you could communicate if those individuals didn't speak English.

Melanie Cole, MS: Yeah. That's so interesting. Now, when we think of working internationally, how has that changed your perspective, Dr. Zaremski, and your general approach as a medical professional? Do the medical teams—I'm so interested in this question, do they operate differently in each place? Do you retain a consistent method?

How are you working with the people on the ground there that have been there, that are inviting you, that are running the event or all of the events? Because that's where the collaboration is really so cool because you're meeting so many people from all over the world.

Dr. Jason Zaremski: I agree. I think that's one of the coolest thing, is our perspective and our knowledge base just grows quite honestly. That's why I love going to conferences or covering sporting events, particularly when I get the opportunity to do it internationally, because I'm always going to learn something that I just never thought of, number one.

Number two, there might be another approach that either we don't do in the states or we don't do at our institution, or maybe there's a better way of doing it or maybe there's an alternative way of doing it that works just as well. So, you can only improve as a healthcare provider, quite honestly, as a doctor and athletic trainer or physical therapist, et cetera.

But on the flip side is when you're traveling with a team, your team sets things up a certain way. And typically, it goes through the head of athletic training or physical therapy or depending who's in charge of high performance or the medical team. So, I'm there to assist—in our case, it'd be a Celeste. I'm there to assist Celeste in any way possible, but also know my role. So for example, before each match or before each competition or practice. We need to make sure that we communicate with the other teams, medical personnel, introduce ourselves. Particularly for matches, we need to communicate with the ambulance that should be there on site, as well as make sure we meet with EMS.

And if there is, you know, soccer with FIFA, if FIFA or UEFA, which is the European Union Football Association. If they have any physicians or physios, which is what in Europe, they would call athletic trainer or physical therapists on the ground and introduce ourselves, and we also go over some of the policies.

So for example, in the United States, we have certain policies regarding lightning. Well, when we were, this tournament, through UEFA, there was not a lightning policy in Turkey. So, we had to explain them, "Well, our policy is this. Would the other team agree to that if there was lightning spotted within eight miles or 10 miles?"—or we to do in kilometers abroad. And we'd have to agree that before the match for safety purposes. And the reason is. especially being at UF Health, Florida's one of the capital of lightning in the world short of being in Australia. So, a lot of folks in Denmark don't worry about lightning, or the UK or even Spain. But in the United States, particularly in the Southeast, we absolutely worry about lightning.

Because as we know, especially with American football games every August, September, there's always lightning. So, it is something that adds a unique perspective that the team from Denmark just didn't think about that, because they don't have to deal with it, whereas we definitely have to deal with it. That's something we prepare for.

Melanie Cole, MS: Wow, that's so cool. A lot to think about. And as we get ready to wrap up, Dr. Zaremski, I have a few sort of ending questions here. But you're a baseball player. Why youth soccer? Why'd you go into youth soccer? What type of difference do you want to make while working with these kind of teams? And I'd love for you to share any other stories that we haven't told here today that you really want to let other providers know, because what you're doing is fascinating. It's exciting, it's fun, it's complex, it's all of these things rolled up into one. And I think for providers that are looking to get into sports medicine, you're kind of the goal. You're kind of like, "Wow, isn't that so cool? He's traveling all around with these teams and working with these international doctors and sports medicine professionals." I mean, it's very exciting. You're kind of the goal. So, tell us any stories. And while you're telling us that, why did you choose soccer when you were baseball?

Dr. Jason Zaremski: Well, sometimes it's better to be lucky than good. I think sometimes you take opportunity where it comes. So, I finished my sports fellowship back in 2012, got hired at UF Health. And one of the first things I wanted to do was find a way to get involved on the international level, and I was fortunate enough to be accepted to do a two week rotation at the United States Olympic and Paralympic Committee in 2015. And I thought it was just the coolest thing in the world, not so much to be working with these high level athletes, but these athletes that are representing our country. And I just think it may sound a little cheesy. I just think it's really cool to be able to help Team USA in any capacity. And that really got me thinking back in 2015, like, this would be really cool if I can kind of help in some way.

And I got a few more opportunities along the way. And also, if I want to help with different sports teams, there has to be an opportunity there. So even though I'd love to help with USA baseball, USA softball, they're pretty well stacked with their medical providers. Well, USA soccer, the U-15, U-17 levels, like I said, Dr. Hrubes was recruiting some physicians. And we know each other and she thought I would be a pretty good fit. I've got two young daughters, so she thought I'd be a pretty good fit for you 15 to 17 women. So, I went on my first trip to Dubai, so that was kind of being thrown into the fire. That was my very first trip in 2022, coming off of COVID, still doing lots of COVID testing, going to an international area, definitely a unique part of the world. And I loved it. And quite honestly, for me, one of the coolest things is yes, travel is fun, especially internationally. But I think being able to help just a little bit behind the scenes, our Team USA athletes, whether it's soccer, whether it's for Olympic and Paralympics, or whether it's for any sport, I just think it's really kind of cool and humbling. It's a nice way to give back. It's also an opportunity to grow yourself professionally, personally, develop skills that maybe you won't have the opportunity to do if you stay in the same area all the time. And then, we have the opportunity to bring that back here. And it's not just me, you know, I know you said some very nice things, but just at UF Health alone, Dr. Katie Edenfield, who's in the Family Medicine Department of Student Health, she's the team doc for USA swimming and diving; Dr. Ashley Zapp, who's in my department. She is also one of the team docs for U-15, U-17 Women's Soccer. And certainly our physicians in family medicine and orthopedics that take care of the Gators, those are all very high level athletes and teams. And it's a really cool thing to be able to take care of athletes. There are challenges that come along with it too. A lot of it's behind the scenes. But for me, taking care of our nation's athletes, who have a chance to represent our country on the world stage is—again, I keep saying the same thing over again—it's just a really cool, humbling thing that I don't take for granted. And hope I get the opportunity to keep doing it.

Melanie Cole, MS: It beautifully said. What an excellent discussion we just had. So exciting. Thank you for sharing with us everything that you're doing that's so exciting with the international teams. Really so interesting. And to learn more about this and other healthcare topics at UF Health Shands Hospital, please visit innovation.ufhealth.org. And to listen to more podcasts from our experts, you can visit ufhealth.org/medmatters. That concludes today's episode of UF Health Med EdCast with UF Health Shands Hospital. I'm Melanie Cole. Thanks so much for joining us today.