Would a primary care doc prescribe EPO?

[MattTuck]

Just curious.

I went into a PCP for a cold, and the doc suggested sudafed, and the topic of cycling came up, and he did part time coaching and was like, "you can train really well on this sudafed, you'll get big gains!"

I'm not looking for EPO, as I don't race. I'm just curious.

[shovelhd]

Sure. It's used to accelerate healing for stubborn wounds like hematomas.

[54ny77]

Was your doctor Spanish?

:p

[phcollard]

I wander which ingredient in Sudafed is considered a PED.

Pseudoephedrine?

There are several variants of Sudafed so I am curious...

[54ny77]

Here's a question: friend of mine has big race coming up in about 3 weeks. Due to pain from a recent back injury (caused by a car accident) the doc has had him on a regimen of methylprednisolone (pill form) and other anti-inflammatories for a week or so. Phys therapy/rehab begins in a few days, so that, plus the anti-inflammatories, was preferred first step in lieu of surgery. No idea what the dosage has been, but likely not much. The drug part of the treatment regime ends in a few days. Will that be enough time for the steroid to leave his system? We were talking about it today and he's spooked, I suggested he get a TUE just in case and inform USAC. It would be ridiculous to get popped for something like that. Yes the alternative is simply not race, and if it came to that he'd skip it if needed.

[CNY rider]

Sure. It's used to accelerate healing for stubborn wounds like hematomas.

Really?
Not by any primary care Doctors that I know (and I know a lot of them:))

[CNY rider]

Here's a question: friend of mine has big race coming up in about 3 weeks. Due to pain from a recent back injury (caused by a car accident) the doc has had him on a regimen of methylprednisolone (pill form) and other anti-inflammatories for a week or so. Phys therapy/rehab begins in a few days, so that, plus the anti-inflammatories, was preferred first step in lieu of surgery. No idea what the dosage has been, but likely not much. The drug part of the treatment regime ends in a few days. Will that be enough time for the steroid to leave his system? We were talking about it today and he's spooked, I suggested he get a TUE just in case and inform USAC. It would be ridiculous to get popped for something like that. Yes the alternative is simply not race, and if it came to that he'd skip it if needed.

If your friend has been injured seriously enough to need systemic steroids he does not belong in that race.

[rnhood]

About the only time a doctor will prescribe EPO is if you're anemic and struggling to be active....I think. There may be another reason or two but they would have to be pretty well justified for EPO. It has to be administered by a needle.

And even if your red count puts you in the anemic band, you would have to be struggling with mustering up any energy. You need to be suffering from anemia to warrant EPO. And even before considering this the doc might want to have you pop some Folic acid and get some B6 injections.

I guess there could be other medical reasons to administer EPO but they must be accompanied by a abnormally low red count.

[BumbleBeeDave]

I wander which ingredient in Sudafed is considered a PED.

Pseudoephedrine?

There are several variants of Sudafed so I am curious...

. . . then I would think definitely.

About three weeks ago I took two consecutive days of spin classes at my local gym on MLK Day and the following day. Both were 45 minute classes. I normally wear my HRM and keep a log of the stats.

Monday class was at 430pm. I had a diet Coke with lunch (caffeine) and took some Advil Cold & Sinus at 2pm because I was congested and it's all I had with me. Advil C&S has Pseudoephedrine.

My average hearty rate for the class was 158.

The next day I took another 45 minute class at 630pm, so 2 hours longer for the caffeine to clear from my system and no Advil C&S.

My average HR for the class was 142.

It was a very interesting comparison and showed me why FDA banned Ephedrine drinks.

BBD

[rwsaunders]

From the official Sudafed site...

WHY PSEUDOEPHEDRINE IS BEHIND THE PHARMACY OR SERVICE COUNTER
Pseudoephedrine, an active ingredient in some cold, allergy, and sinus products, can be chemically processed into methamphetamine (commonly known as meth). The illegal use of meth has increased in recent years, prompting Congress to pass the Combat Methamphetamine Epidemic Act of 2006. The objective of the law is to eliminate the use of pseudoephedrine in the illegal production of meth. By law, products containing pseudoephedrine must now be sold behind the pharmacy counter and through online retailers who must meet certain requirements.


...ask your Doc what kind of training plan that he had in mind...:cool:

[shovelhd]

Really?
Not by any primary care Doctors that I know (and I know a lot of them:))

Hey, that's what I'm told. I don't have any hematomas. :)

[shovelhd]

Here's a question: friend of mine has big race coming up in about 3 weeks. Due to pain from a recent back injury (caused by a car accident) the doc has had him on a regimen of methylprednisolone (pill form) and other anti-inflammatories for a week or so. Phys therapy/rehab begins in a few days, so that, plus the anti-inflammatories, was preferred first step in lieu of surgery. No idea what the dosage has been, but likely not much. The drug part of the treatment regime ends in a few days. Will that be enough time for the steroid to leave his system? We were talking about it today and he's spooked, I suggested he get a TUE just in case and inform USAC. It would be ridiculous to get popped for something like that. Yes the alternative is simply not race, and if it came to that he'd skip it if needed.

www.globaldro.org

[etu]

if you need to work with a cold, the usual over the counter medications are pretty useless. the stuff with real pseudoephedrine behind the service counter, e.g. alleve cold & sinus, is wonderful.
it's too bad so many have to suffer because of a few bad meth addicts.

[bargainguy]

Here's a question: friend of mine has big race coming up in about 3 weeks. Due to pain from a recent back injury (caused by a car accident) the doc has had him on a regimen of methylprednisolone (pill form) and other anti-inflammatories for a week or so. Phys therapy/rehab begins in a few days, so that, plus the anti-inflammatories, was preferred first step in lieu of surgery.

NSAID anti-inflammatories, sure. The use of high-dose steroids in acute spinal cord injury is nothing new. The use of systemic steroids in non-spinal cord injury is questionable in the context of then exposing the patient to more strain (racing) on top of existing trauma from a car accident. Racing is not going to help the original injury one bit, steroids or no.

While steroids will decrease the inflammation from whatever injury he's had, it also opens up the patient to a much different risk of infection, avascular necrosis, etc. You never want to take systemic steroids unless there's no alternative. I can understand wanting to avoid surgery, but taking them just to be able to race?

In my mind, the issue isn't so much "Will there be trace steroids in my system?" but rather, "What the hell am I doing?" I wouldn't even think of racing under these circumstances. Of course, the usual disclaimers, YMMV.

[54ny77]

sorry but i think you (and others) have misunderstood the scenario. the doc is an ortho who is treating and diagnosing my pal's back problem. i didn't detail the extent of injury, but it's a degeneration that will continue to get worse and, one day, likely require surgery. he (my friend) just happens to race bikes, and has a race coming up. obviously if the back injury is aggravating enough to stay off bike, he will. for now, he's just dealing with it and riding. some days good, some days not so good. the question is would a treatment regime involving steroids (as well as phys therapy) that ends in a couple of days show up in a drug test a few weeks from now.

NSAID anti-inflammatories, sure. The use of high-dose steroids in acute spinal cord injury is nothing new. The use of systemic steroids in non-spinal cord injury is questionable in the context of then exposing the patient to more strain (racing) on top of existing trauma from a car accident. Racing is not going to help the original injury one bit, steroids or no.

While steroids will decrease the inflammation from whatever injury he's had, it also opens up the patient to a much different risk of infection, avascular necrosis, etc. You never want to take systemic steroids unless there's no alternative. I can understand wanting to avoid surgery, but taking them just to be able to race?

In my mind, the issue isn't so much "Will there be trace steroids in my system?" but rather, "What the hell am I doing?" I wouldn't even think of racing under these circumstances. Of course, the usual disclaimers, YMMV.

[gasman]

Here's a question: friend of mine has big race coming up in about 3 weeks. Due to pain from a recent back injury (caused by a car accident) the doc has had him on a regimen of methylprednisolone (pill form) and other anti-inflammatories for a week or so. Phys therapy/rehab begins in a few days, so that, plus the anti-inflammatories, was preferred first step in lieu of surgery. No idea what the dosage has been, but likely not much. The drug part of the treatment regime ends in a few days. Will that be enough time for the steroid to leave his system? We were talking about it today and he's spooked, I suggested he get a TUE just in case and inform USAC. It would be ridiculous to get popped for something like that. Yes the alternative is simply not race, and if it came to that he'd skip it if needed.

It should be cleared in five 1/2 lives. The 1/2 is at most 36 hrs so the levels should be undetectable in about a week. Unless they are using a really, really sensitive assay.

No PCP I know of would prescribe EPO.

I know several sports medicine docs that are asked almost monthly to prescribe EPO-they all say no, never.

[bargainguy]

Ah. Pain from a recent back injury is different than degeneration resulting from or adding to injury, which is more of an ongoing process. In any case, I wish him the best and hope he doesn't have to go through surgery.

[54ny77]

bargainguy & gasman, thanks, that's helpful. the recent back injury, after going in for additional tests, revealed a long term degeneration. double whammy, basically. sucks, but so be it.

his ortho, by the way, is one of the top in country (treats many pro athletes), so presumably knows what he's doing on treating the back issue.

(op: sorry for the thread drift.)

[carpediemracing]

I know two people who got/get EPO. One was my mom when her hematocrit was in the 20s and she could barely move (chemo etc). Her hematocrit was 43 in some short time. She was injected with it at the hospital.

The other person has an anemic cat believe it or not.

EPO can be dangerous in the wrong hands, requires injection, and I doubt a PCP would let something like that go unsupervised.

On the other hand a testosterone patch is pretty effective, easy to use, and I know someone who uses it (father of a friend - my friend was joking about his dad being on dope).

I'm no doctor and I'm morbidly fascinated by doping stuff so I probably have the worst combination of uneducated knowledge possible. Therefore take anything I say on this topic with a grain of salt.

[ultraman6970]

You can get clenbuterol-ish stuff w/o any problem from your doctor just in case.

[malcolm]

I've practiced emergency medicine for many years and have been exposed to many primary docs, some I thought questionable but I've never seen nor heard of one prescribing EPO.

In most medical communities beyone renal failure and other things driving down your red cell volume I can't imagine what EPO would be used for.

[fkelly]

Probably 15 years ago I started having an intermittent problem with bleeding hemorrhoids. It went on intermittently for years. Usually it would clear by itself after a few days but sometimes I had to go to a specialist who would do electric shocks to the area to basically cauterize them. In the worst episodes that lasted the longest it would affect my riding. I can distinctly remember getting dropped on hills where I had been riding well before the episodes. I would tell the medical people and they'd say "oh you can't be losing that much blood". But I was. Finally in 2004 they did a blood test and found I was on the edge of needing a transfusion .. I think my hematocrit was in the mid 20's.

At that point (2004) I had surgery which has more or less put the problem behind me (no pun intended). But while recovering I suggested to my butt doctor maybe EPO could speed up the recovery and he prescribed it. As opposed to requiring an injection they give you a little thimble like thing with points on it. You just poke it into your thigh. It is no more complicated than giving insulin to a cat. It speeds up your blood count recovery. Obviously you need to have your blood counts monitored.

So, yes, in appropriate cases, Doctors can prescribe it and it's not dangerous (if monitored) nor is it complicated to administer to yourself. And, the very simplicity is why racers whose hematocrit might start in the low 40's can inject themselves until they get to 50 or so and get a performance advantage and why it is so hard to control this from an anti-doping perspective.