A gentleman came to see me this evening with itchy multiple red patches on his trunk, upper and lower limbs. He remembered going to a Christmas event and putting on an old jacket (belonging to his dad). He thinks he is allergic to the dust mites or fungal spores on the jacket, or is it the food served at the dinner?
He was given an injection of Anti-Histaminics to relieve his symptoms and given some new generation oral histaminics to take in the day time and a drowsy 1st generation Anti-histaminic for the severe itch at night. If his symptoms are severe, he may benefit from some corticosteroids orally or by injection (However, care needs to be taken as these should be given to athletes in emergencies only as they are on the Prohibited list and require TUE).
WADA’s Executive Committee has approved the 2008 List of Prohibited Substances and Methods on September 22, 2007. This List will go into effect January 1, 2008.
You are advised to check out the 2008 Monitoring Program and a summary of modifications to the list. You may download the details from the following websites:-
2008 Prohibited list
2008 Monitoring Programme
2008 Summary of Modifications
Cigarette smoking has been known to adversely affect sporting performance. Despite efforts by the honorable Sports Minister to discourage smoking amongst athletes, elite athletes have found it difficult to stop smoking. Despite making sports venues and training centres smoke-free areas, the general public continue to smoke in these places due to lack of implementation of the smoking ban by the health and sports authorities. Recent developments in medicine has shown that new pharmacotherapy may offer better options to assist athletes in this cause.
The efficacy of smoking cessation methods was systematically reviewed by a United States Public Health Services (USPHS) committee during the development of an evidence-based clinical practice guideline for physicians released in 2000. Based on meta-analyses of the existing data, the USPHS panel concluded that 2 smoking cessation methods had the best evidence of efficacy: behavioral counseling and pharmacotherapy (nicotine replacement products -- gum, patch, lozenge, oral inhaler, and nasal spray -- or the antidepressant bupropion*., known as Zyban or Wellbutrin SR). A combination of counseling and pharmacotherapy produced the best results. There was no evidence to support the efficacy of other methods, such as hypnosis or acupuncture. An independent systematic review of this evidence, conducted by a global network of researchers (the Cochrane Collaboration), came to the same conclusions.
In a randomized trial in which bupropion was compared directly with the nicotine patch, patients using bupropion had significantly higher quit rates at 1 year than those using either the patch or placebo. However, nicotine replacement products and bupropion are considered fairly equivalent by most experts, so patient preference and medical conditions should dictate choice of therapy. The USPHS clinical practice guideline states that combining the patch with other forms of NRT resulted in higher quit rates than use of the patch alone, and recommends that combining nicotine replacement products be encouraged if the patient has failed on monotherapy. Ad lib use of nicotine gum or lozenge with the patch may help to reduce acute cravings. Bupropion SR may also be used in combination with nicotine replacement products, although as mentioned above, combining the patch and bupropion has not resulted in significantly higher rates than bupropion alone.
These meta-analyses also found that physician advice to quit improved adult cessation rates, and the addition of brief counseling (less than 3 minutes) was even more effective. Effectiveness further increases with greater counseling contact time, including proactive telephone counseling. (adapted from a Medscape CME article).
4 weeks treatment with Bupropion costs RM300 to the athlete. It is estimated that the treatment would last 7 to 12 weeks to be effective. Nicotine patches are often not a treatment of choice as the profuse sweating of athletes may affect the effective use of the patch.
Disclaimer: Athletes are advised to seek your doctor's advice before taking these medication.
*2008 Update: In the WADA 2008 Prohibited list bupropion is considered as a Substance under the WADA Monitoring Programme 2008.
I have been treating asthmatic elite athletes with Montelukast (Singulair)for at least 4 years as a single monotherapy drug. Most of these athletes who had Intermittent Asthma and Moderate Persistent Asthma were well controlled with the medication and needed few rescue medication with Salbutamol Inhalers. Salbutamol, other beta-agonist and Corticosteroid inhalers/turbuhalers require Therapeutic Use Exemption.
The new guidelines for asthma treatment is available here. Athletes should discuss the options of treatment with their team doctor or Family Physician. Find out about the Doping Prohibited List 2007.
In a recent clinical trial, the authors suggested that Montelukast provided significant protection against Exercise Induced Bronchoconstriction (narrowing of the airways) having an onset within 2 h following a single oral dose and lasting for at least 24 h. This medication could be useful for athletes who have asthma as an option for prevention of asthma and better control of symptoms.
Three Malaysian national shooters was tested positive for propranolol in March during a local Competition (President Ally T.H. Ong Trophy) along with 4 other athletes. It's quite shocking news as all the national shooters know that they are to stay away from beta-blockers. Although, the National Shooting Association of Malaysia maintains that the athletes did not dope intentionally, it raises our concern that our national athletes are not careful enough to protect themselves from consuming contaminated products e.g. Over-the-Counter medication, traditional herbal medication and nutritional supplements. Read more here.
According to the WADA Code even if the athlete unintentionally consumes a banned substance, the athlete could be sanctioned (see Strict Liability in Anti-Doping).
The standard/normative sanction for a first doping violation is two years, and a second violation calls for a lifetime sanction.
That standard for sanctions (two years and lifetime) can be lessened or enhanced based on several factors relating to the particular case, including:
The type of doping violation
The circumstances of the individual case (level or absence of fault or negligence)
The substance in case of the detection of a prohibited substance
Repetition of an anti-doping rule violation
I urge athletes and officials to read the Athlete's Guide so as to understand the complexity of the doping issue. Educational videos are also available free here. Athlete's should take precautions during competition so as to avoid consuming contaminated drinks or food due to the severity of the sanctions.
Every elite athlete i.e. international, national, state or club athlete should be aware of the latest Doping Prohibited list updated at least once every year. The Prohibited List is an International Standard identifying Substances and Methods prohibited during competition (in-competition), outside competition or during training (out-of-competition), and in particular sports. Substances and methods are classified by categories (e.g., steroids, stimulants, gene doping).
In Malaysia, the National Sports Council Doping Control Unit coordinates 'no notice' doping control testing and some of the in-competition testing for international, national and state athletes. National Sports Associations (NSA) undertakes some of the other doping control testing for their respective sports. Meanwhile, International Sporting Federations may appoint their own doping control officials to carry out the doping control testing.
It is vital for such athletes to inform their treating doctors of their status as athletes and the need to review the Prohibited list to ensure that they avoid taking the 'illegal' substances unknowingly and risk being sanctioned or losing their medals. Ignorance of the Prohibited List shall not constitute any excuse and athletes may face a ban of up to two years or a lifetime ban.
Athletes should also be cautioned that some traditional supplements and nutritional supplements may contain Prohibited substances as they may not be subject to such stringent manufacturing and labelling processes as drugs ( 1,2)
Some Prohibited Substances may be used by an athlete for medical reasons by virtue of a Therapeutic Use Exemption. For example inhaled beta-agonists in asthmatics. However, such use must have adequate documented laboratory evidence submitted to the respective NSA or International Federations.
For further information, go to http://www.wada-ama.org/en/index.ch2. If you are a Malaysian athlete you may also approach the Doping Control Unit of National Sports Council at 03-8992 9600.
A young person in his twenties came to see me one fine day for a medical problem. He then asked me whether it was true that I am also a trained Sports Physician. "Yes", I said. "How may I be of help?". He then shuffled backwards in the chair and reached out for something in his shorts. He showed me a white coloured box (rather poor quality packaging, I would say) with the words, Stanazolol staring at me. "Can I use this drug? Is it legal?"It was definitely not something approved by the Ministry of Health for normal use. Besides, it was only supposed to be sold in India for Rs 32 and he got it for 25 times the price from a gymnasium instructor. Funny, I thought I'd never had to hear of the product now that I dont deal with weightlifters are much as before. The medical fraternity never prescribed the drug unless the doctor is linked with clandestine doping activities.
Refer http://www.wada-ama.org/en/prohibitedlist.ch2 for the latest Prohibited list. Take note of the "Therapeutic Use Exemption" for asthmatics.
I gave him a quick description of the possible side effects and consequences of taking the drug. I advised him to also get assistance from a trained conditioning expert using scientific safe methods of 'bulking' up without the use of doping substances. Besides, without hard work there will not be any hypertrophy of the muscles!
Posts
All Comments
