Olympic-style event for Jewish athletes attracts all ages
One of the most rewarding experiences of being an orthopaedic surgeon is getting out of the clinic and hospital and practicing our profession in an international setting with colleagues from around the world.

In 2009 and in 2017, I was fortunate enough to be part of the medical staff for Maccabi/USA. The Maccabiah World Games are held every 4 years in Israel. This Olympic-style event attracts more than 10,000 Jewish athletes from more than 80 nations. For the 2017 Games, the U.S. team had more than 1,100 athletes.

The Team USA medical staff is much larger than that of other nations. It includes athletic trainers, a massage therapist, chiropractors, primary care doctors, and fellowship-trained orthopaedic sports medicine specialists. The certified athletic trainers spend long hours covering multiple sports and teams. The primary care doctors deal with heat-related issues, gastrointestinal disorders, respiratory infections, concussions, and other maladies.

As orthopaedic surgeons, we deal with the typical joint injuries. We are faced with difficult return-to-play decisions because athletes must often decide how competing with an injury may affect their high school or college athletic careers. We do not have hospital privileges so we need to coordinate care with the Israeli health system.

Courtesy of Merrick Wetzler, MD

Merrick Wetzler, MD, is a four-time medical chairman for the Maccabiah World Games. He has coordinated medical teams not only for the Maccabiah World Games but also for the Pan American and European Games. Coordination involves assembling the medical team, soliciting donations for athletic training kits, and arranging for event coverage.

During the Games, in addition to providing team coverage, Dr. Wetzler handles phone calls and questions from athletes, trainers, coaches, and parents. Long days are typical. I arranged for an interview to capture his thoughts.

Dr. Leitman: How did you initially get involved with Maccabiah?

Dr. Wetzler: I wrestled in college. I learned about the Maccabiah Games from one of my teammates who was on the 1977 team. I tried out for the 1981 team and won a gold medal in Greco-Roman wrestling. While in medical school at Temple, I was the graduate assistant wrestling coach so I was able to make the 1985 team, and won a silver medal in Freestyle wrestling. In 1989, while doing research prior to starting my orthopaedic residency, I became part of the 1989 Maccabi Rugby team and stayed over after the Games to work at Hadassah Medical Center in Jerusalem.

Dr. Leitman: Once you started your orthopaedic career, did you want to return to the Maccabiah Games as a physician?

Dr. Wetzler: After finishing my residency/fellowship, I knew I wanted to get involved on the medical team for the Games. In 2003, I spoke to Richard Reff, MD, who was one of my team doctors when I was an athlete. I was subsequently appointed associate medical chairman for the 2005 Games. Since then, I have been medical chairman for the international Games in 2009, 2013, and 2017 as well as medical chairman for the European Maccabi Games in 2007 and 2011 and the Pan American Games in 2015.

Dr. Leitman: What is the makeup of the sports medicine team? How did you recruit athletic trainers?

Dr. Wetzler: The sports medicine team has grown over the years; in 2017, we had 11 doctors—six orthopaedic surgeons and five primary care sports medicine doctors. We had 15 athletic trainers, one massage therapist, one physical therapist, and two chiropractic physicians. Much of the recruiting is done by word of mouth and by head athletic trainer Summer Runestad, ATC.

Dr. Leitman: Do other nations have similar sports medicine teams?

Dr. Wetzler: The U.S. team is by far the largest, most experienced, and best equipped. We will assist any athletes who need help, regardless of the country they represent.

Dr. Leitman: How does the level of care provided to U.S. athletes differ from that provided to athletes from other nations?

Dr. Wetzler: I believe the level of care for U.S. athletes is very high. We do the best we can to duplicate the usual training room environment for our athletes. The expertise of my doctors is tremendous. My athletic trainers, chiropractors, and doctors live by the motto "anticipate and adapt" for treating the athletes.

Dr. Leitman: What is involved with procuring supplies? Logistically, how did you get them to Israel and disseminated to various venues?

Dr. Wetzler: We start preparing for the next Games as soon as the current Games are done. We have developed great relationships with several companies that have been very generous to us, donating braces, equipment, and supplies for athletes. We bring many of the supplies with us; the airlines have allowed us to bring more than the usual number of bags. This year we brought close to 20 duffle bags of supplies. We have them all at one location and distribute them to the other sites as needed.

Dr. Leitman: With venues spread throughout Israel, how do you coordinate the allocation of supplies and personnel?

Dr. Wetzler: The Maccabiah World Games are unique in that athletes may range from 15 years old to master athletes in their 80s. Most members of the medical team cover more than one sport. In the months prior to the Games, we get information on where each team will be staying and where the sports venues are. All 375 junior athletes—those 15 years to 18 years old—stay in one location; this year, it was in Haifa. The remaining athletes were in Netanya, Tel Aviv, and Jerusalem. Allocation of medical staff resources depends on the number of athletes and the particular sporting event, with preference given to higher-level competitions and contact sports. Many staff members had cars, so we had some increased flexibility.

Dr. Leitman: How is care coordinated with the Israelis?

Dr. Wetzler: The athletic trainers were the mainstay of our team; they would initially evaluate and treat the athletes and coordinate any other evaluations as needed. If the athletes required additional care, we had access to the Israeli health system for evaluation and treatment.

Dr. Leitman: What personnel are provided by the Israelis?

Dr. Wetzler: Israeli physicians were at most venues and we worked closely with them to coordinate care in any emergency situation.

Dr. Leitman: What are some of the challenges presented by coordinating care with the Israelis?

Dr. Wetzler: The Israeli and U.S. health systems differ in several ways. In Israel, emergency departments do not dispense crutches, immobilizers, or walking boots in cases of lower extremity injuries, but we were prepared for that and had our own supply. Philosophical differences in how things should be treated also exist. Team physicians do not have surgical privileges in Israel, so in several situations, we have had to discuss treatment options to come to a mutual solution and provide the best care possible for the athletes.

Dr. Leitman: What conditions are most commonly seen and treated?

Dr. Wetzler: It varies by sport. Because so many competitions take place in such a short time, many athletes become worn down. My sports medicine team does a great job of managing the athletes and keeping them competing.

Dr. Leitman: You have been medical director for several Games. What are some of the unique challenges that you encountered over the years?

Dr. Wetzler: Each year has been different. For example, navigating the Israeli insurance system for our athletes changes with each of the Games. I have to find out the key idiosyncrasies of the system so we can get the athletes seen and treated, whether it is for illness or injury. Also, the distribution and location of the athletes changes each time. Figuring the distribution of supplies and staff can be challenging. Because we stay in hotels, finding treatment space is always an interesting endeavor. Many hotels are not equipped for setting up training rooms.

Dr. Leitman: What is a typical day for you during the Games?

Dr. Wetzler: Typical days are long—starting with training rooms and sick call at about 6 a.m. Events need to be covered every day. As medical chairman, I am constantly answering texts and phone calls, being a liaison between athletes who may need radiographs or additional treatment, answering questions from staff, and coordinating care. And, of course, talking with parents of injured athletes and setting up care for them after the Games.

Dr. Leitman: Can you share some of your most memorable experiences?

Dr. Wetzler: There are so many it is hard to say. I remember that, when I was an athlete, I shared my experiences with my parents. So watching athletes whom we have seen and treated during the Games earn medals and share that experience with their family and teammates always brings back great memories for me. As a former member of the USA Rugby team, I really enjoyed watching my former teammate coach the United States to a gold medal victory over a heavily favored South African team.

Summary
The next Maccabiah event will be the 2018 Pan American Games in Mexico City, where athletes and support personnel will face additional challenges. Whether serving as team physician for the Maccabiah World Games, or volunteering in a clinic in a disadvantaged nation, we as orthopaedic surgeons have unique cultural opportunities. I encourage my colleagues to seek opportunities to practice outside of the clinic and experience the world.

Elliott H. Leitman, MD, is a retired lieutenant commander of the U.S. Army who practices at First State Orthopaedics, in Newark, Del.