JOURNAL CLUB – ANTI-DOPING: A PATIENT-CENTRED APPROACH
Journal Club Episode 4: Anti-Doping: a patient-centered approach
Presenter: Dr. Riam Shamma – UofT Primary Care Sports Medicine Fellow Date: December 9, 2014 Special Guests: Dr. Doug Richards Medical Director MacIntosh Sports Medicine Clinic, University of Toronto Dr. Wiplove Lamba Staff Psychiatrist in Addiction Medicine at St. Michael’s Hospital
1. Lindqvist AS, Moberg T, Eriksson BO, Ehrnborg C, Rosén T, Fahlke C. A retrospective 30-year follow-up study of former Swedish-elite male athletes in power sports with a past anabolic androgenic steroids use: a focus on mental health. Br J Sports Med. 2013 Oct;47(15):965-9. doi: 10.1136/bjsports-2012-091340. Epub 2013 Apr 23.
2. Petersson A, Garle M, Granath F, Thiblin I. Morbidity and mortality in patients testing positively for the presence of anabolic androgenic steroids in connection with receiving medical care. A controlled retrospective cohort study. Drug Alcohol Depend. 2006 Feb 28;81(3):215-20. Epub 2005 Aug 24.
Anabolic androgenic Steroid (AAS) use is associated with several physiological and psychological side effects:
Physiological: Cardiovascular – Increased risk of myocardial infraction, heart disease, cardiomyopathy, hypertension Endocrinological – Increased cholesterolemia and lipidemia Male – Male-pattern baldness, gynaecomastia, testicular atrophy Female – Hirsuitism, deepening of voice, clitoral hypertrophy, striae Gastrointestinal – Gastric Ulcer, Hepatic inflammation (elevated LFTs), Hepatic Tumours Infectious Diseases – Blood-borne illnesses from potential needle sharing (Hepatitis B, C, HIV) Nephrology – ? association with nephropathy +- Scarring ? secondary to atherosclerosis
Approach for Athlete with AAS-use: Screening where appropriate – asking about AAS-use, AAS cycling Ask about substances being used. Gauge Patient’s stage of change. Engage patient in discussion of potential side effects if interested. Consider screening for HTN, cardiomyopathy (ECG, echocardiogram), Lipids and cholesterol check, LFTs +- Ultrasound of Liver, blood-borne illnesses (HIV, Heptatitis B+C), BUN, Creatinine, and Urine for protein – nephropathy (usually resolves with decreased protein intake). Consider referral to Psychiatry if associated mood-disorder, or addictions medicine if issue with continued substance abuse.