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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

 

Podcasts:
Part 1 – RiamAASpart1.mp3

Part 2 – RiamAASpart2.mp3

Part 3 – RIamAASpart3.mp3

Articles:

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.

Summary:

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

 

Psychological:
Mood Disorders – Anxiety, Depression
Body dysmorphia
Comorbid substance abuse

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.

 

References:

http://bestpractice.bmj.com/best-practice/monograph/987/treatment/step-by-step.html

Swedish Guidelines – PDF
Dopingjouren_EN_sept2013