Saturday, November 20, 2010

A Look at Drug Use in Sports

On November 10, 2010 I was fortunate enough to sit in on Dr. Thomas C. Werner's lecture titled "Performance-Enhancing Drug Use in Sports: Catching the Cheaters (Sometimes)" at USI.  Werner, a Professor Emeritus at Union College in Schenectady, NY, is currently traveling around the country as part of an American Chemical Society effort to promote an understanding of drug usage in sports.

Werner combined his expertise in analytical chemistry (PhD MIT '69) and his interest in sports to produce an informative lecture outlining the history of drug usage in sports dating back to the 1940's. He prefaced his talk by emphasizing the high profile of drug usage as it has ruled sporting news in recent years. Werner discussed usage and screening of amphetamines, synthetic anabolic steroids, human growth hormones, and erythropoietin (EPO).  This blog entry is based on the eight pages of notes I wrote while Werner talked.

Who sets the rules used to define and monitor performance enhancing drug (PED) usage in sports?  The World Anti-Doping Agency (WADA) was created (coincidentally on Nov. 10) in 1999. Many governments and world sporting organizations, including the International Olympic Committee (IOC), back and fund WADA.  Individual governments create their own agencies like the one created in the US (USADA).  Sports leagues such as the MLB, NFL, NBA, NHL, and NCAA have created their own sets of rules.  Furthermore, 145 nations have ratified the 2004 UNESCO treaty against drug usage in sports.

What follows is a brief layman's analysis of the primary types of PEDs used and the screening processes used by the above agencies to detect the PEDs.

Amphetamines are powerful stimulants used to treat such problems as sleep disorders, asthma, and ADHD.  Amazingly, a 2009 study showed that these drugs are used by MLB players at a rate more than twice that of normal society.  Amphetamines can be detected in urine, even though finding them has been compared to "finding a needle in a haystack."   They are separated through gas and liquid chromatography before being detected using mass spectroscopy.  The identification is based on the known retention time of the amphetamines in mass spectrometers.

Synthetic Anabolic Steroids can be used to build lean body mass, especially muscular tissues.   More than sixty of these steroids are on the list of substances banned by WADA.  These exogenous steroids are derivatives of testosterone that can be detected in urine.  Though used for decades by athletes competing in a wide range of sports, anabolic steroids came to world focus after Canadian sprinter Ben Johnson was stripped of his 1988 Olympic Gold Medal and 1987 100-meter world record for using stanolozol.

An analysis of MLB players hitting 50 or more home runs in a season reveals interesting data.  From 1920 to 1995 the feat was accomplished 1 in 4 years.  From 1996 to 2002 there was an average of 2.4 batters reaching that number of homers each year.  Finally, from 2003 to 2009 there was an average of 0.71 batters hitting 50 or more homers.  It is widely believed that the high level of home runs hit during the 1996-2002 time period were due to the use of the BALCO-produced "cream" and "clear" by MLB players.  The "cream" was a testosterone-based cream used in conjunction with the "clear," an anabolic steroid tetrahydrogestrinone (THG).  THG was a tetrahydrated form of steroid that long avoided or "cleared" screening by anti-drug agencies because the clear did not show the peaks that analytical instruments were looking for and because the combination of the cream and the clear prevented upsetting the natural ratio of testosterone and epitestosterone, which could also be detected by analytical instruments.  The decrease in MLB home runs that occurred after 2002 aligned with the discovery of the cream and the clear.

Human Growth Hormones (hGH) are used to treat growth hormone deficiency and growth disorders.  hGH promotes repair, regrowth, and regeneration in all types of cells.  Screening cannot detect exogenous forms of this polypeptide hormone in urine and a sufficient screening method for its detection in blood was not developed until 2004.  This method involves the use of an anti-body hGH to capture hGH and before another detection particle is attached.  The resulting charged complex is then detected when it produces a light flash in an analytical instrument.  The intensity of the flash is used to measure the level of hGH in the blood sample.

Erythropoietin (EPO) plays a key role in regulation of red blood cells (RBCs).  Exogenous EPO is used to treat anemia brought on by kidney diseases or cancer treatment.  Synthetic EPO (rEPO) can increase the RBC by 5-10%, making it the drug of choice for endurance athletes who rely on RBCs to carry oxygen to muscle cells. rEPO is detectable in urine, but only for a short period of time due to the presence of proteases.  Athletes use microdoses that are undetectable within 24 hours.  Many of the 80+ EPO biosimilars fail standard EPO isoelectrofocusing (SDS-PAGE) tests.  The difficulty in screening for synthetic EPO made it the first "blockbuster" biopharmaceutical drug.  Usage of rEPO has reached world wide attention due to its detection in a wide range of Olympic athletes and Tour de France cyclists. 

The ratio of red blood cell volume to total blood volume is known as hematocrit.  After extensive evaluation, WADA set the allowable hematocrit limit at .50 or 50%, since it is extremely rare for humans to have higher levels.  Some sports have implemented a longitudinal biomarker system known as a Biological Passport to monitor hematocrit over time.  This long-term, multi-test system allows for the creation of a hematocit baseline in athletes which can be used to indicate blood manipulation.  Though the Biological Passport cannot be used to determine if an athlete is using PEDs, it can initiate closer scrutiny that can then produce positive tests for PEDs.  International cycling and skiing unions are already using this system to test athletes.

Dr. Werner concluded his lecture by stating that there is currently debate about the efficacy of drug screening.  While the screening processes are limiting PED usage, they are quite costly to sporting organizations and governments.  Furthermore, knowledge of the screening is likely causing cheaters to continually develop new molecules to replace the detectable ones.

Sunday, November 7, 2010

A Passionate Comback

Thirteen weeks ago I woke up on a Sunday morning feeling pretty good about my health and my overall fitness.  I had just run a 5K in 17:08 off of one fast workout and only a month after completing the Leadville Silver Rush 50 Mile Run.  The cycling was consistent and strong, with several really fast workouts on both flat and hilly terrain.  Little did I know that morning that the previous day's 5K was the last run I would take for almost a month.
While riding a mountain bike equipped with a Jones Counter over the Evansville Half Marathon course, I was chased by a car full of all-night partiers.  The chase ended when I crashed while crossing wet railroad tracks.  That crash left me with a torn hamstring and a strained gluteous muscle.  The torn hamstring bled out over the next week, forming a massive bruise behind my knee and into my calf. It has yet to reach the flexibility and strength it had before the attack. 
Other injuries from the attack have been slower to heal.  A thick scar and calcium build-up formed on my right elbow.  This mass has been pressing on the ulnar nerve which is causing constant tingling and often intense burning in my forearm and fingers, especially when my arm is bent - like it is while running.
The radial nerve in the right shoulder was also compressed in the fall.  This injury has also contributed to tingling, pain, and weakness in the right forearm and fingers.  Several times each day the nerve becomes trapped either in my shoulder or under the scapula. The resulting breathtaking pain seizes control of me for anywhere from a few seconds to several minutes.  This is especially irritating when the forearm feels as if had been set on fire.
I have attempted to see my doctor three times, but I waited so long that I had to leave.  A recent letter from his office states that he is no longer practicing family medicine!  So, now I need to find a doctor to get a referral to a specialist in order to satisfy the demands of the insurance company.
While the nerve injuries have kept me from cycling, I returned to running in early September.  The runs were short and quite slow at first.  I abandoned my normal routine of Tuesday/Thursday/Saturday running because I used the short runs as therapy for the hamstring.  During each run I stopped several times to knead and compress the scar tissue in the hamstring.  It was during the last week in September that the hamstring had enough flexibility and felt strong enough to attempt an hour-long run (8+ mi).
Encouraged by that first long run, I started milling over the possibility of running in the Evansville Half on October 10th.  Ironically, the injuries I sustained while measuring the course had eliminated the potential for me to have a fast race. Throughout the week of the race I continued the therapy runs, but lengthened them to as much as 4.4 miles.  It was during the Tuesday run of race week that I attempted to run at 6 minute pace.
On Sunday, October 10, I lined up for a run that I didn't know if I could finish.  The RAV was parked near the eight mile marker, so I knew I had an easy out if the hamstring became tight.  Acting like a novice, I ran the first downhill mile of the race in 6:02 before settling into a 6:1x pace.  My stride was still a little off due to the hamstring tightness, which would not allow me to come within 5 inches of the reach I had with the left hamstring.  Still, I passed the RAV feeling great.  I became tired, but maintained the 6:1x pace until the final mile.  I covered that 13th mile in 6:02 while pushing the pace to test the right leg.  I was ecstatic about finishing strong and feeling great after the 1:21:23 effort.
I then did what is normal for me:  I set another goal.  I entered the Chicago Monster Dash half marathon that took place on Halloween three weeks after the Evansville half.  And I began to push the training.  I continued to train almost exclusively on the new 1.1-mile stretch of green way on the USI campus.  The pace dropped with each run as of a result of the increasing flexibility and strength of the hamstring.  I even completed runs of ten and eleven miles on a very hilly course.  Honestly, the rate of improvement I experienced was the fastest of my thirty-plus years of running.  I was experiencing a renewed sense of passion like the one I experienced last year after learning of the skin cancer.  Passion is a powerful elixir that permeates body, mind, and soul in a way that can unlock our potential.  It took me more than forty years, but I have begun to understand and utilize passion to benefit several areas of my life.  As the Monster approached I began to believe that I could average less than 5:50 per mile and finish in about 1:16.  I ate, slept, and trained with that goal in mind.
And that is what I did - sort of.  It turns out that Obama made a last-minute decision to participate in a political rally in the Hyde Park area of Chicago.  Faced with canceling an event in which several thousand people had paid for and traveled to, the race organizers settled for a route using lakefront trails to the north of Grant Park instead of the original route that used the lakefront trail to the south of Grant Park.  The new route incorporated a lot of trails near the lakefront.  Several of these trails were concrete. There were, unfortunately, many trail junctions. 
After covering the first mile in 5:40 we turned north into a hard blowing wind.  I became alarmed that the people I was running with immediately slowed down.  Facing the choice of plowing alone through that wind for six miles or surging up to the group that was about fifty feet ahead of me, I surged.  My son, Tyler and his teammate, Lawson, were in that group.  Their legs found the 5:40 pace easy since they were trained for the 5K distance.  I wondered how long they would last.  Lawson dropped back soon after I had joined the pack of nine runners.  Lawson was going to try to enjoy the longest run of his life.
Another interesting development during the second mile was when the group took a hard left turn and proceeded up a long set of stairs.  This seemed wrong.  It was wrong.  The group had somehow gone off course and climbing those stairs put us back on the route.  We hit the 2-mile mark in 12:36, indicating a 6:55 second mile, though we had not slowed a bit.  This was a bit annoying, but it was only the fourth most annoying event of the race.
Somewhere in the third mile we went off course again as we took a right-hand turn when we should have gone straight.  The aid station workers were great at handing out water, but horrible about indicating which direction we would go. After we ran off the route a cyclist chased us down and turned us around.  Of course, he reached the trailing runners first and the fastest runners last.  Consequently, our order was reversed as we returned to the race route.  A younger and faster Hispanic runner yelled something in Spanish to the aid workers as he passed me.  The same scenario took place two more times.  Each time I noted how long it took me to get back on the route.  My total off-course time was 2:34, meaning that I ran approximately 0.3 miles extra from these excursions.
It was during our tour of Lincoln Park that Tyler began to feel the pace.  He had stayed with me for thirty minutes even though illness had caused him to miss most of his summer running and his recent training had  been geared toward the 5K distance.  Amazingly, he would finish 14th overall about 3:40 behind me.  I have always been proud of Tyler's work ethic and running tenacity, but never more than on that tough day in Chicago.  Well done, my man!
At the north end of Lincoln Park the course turned back to the south and the we had relief from the powerful wind for the first time.  My next four mile splits were between 5:40 and 5:45.  Just before the eleven mile mark I surged hard to drop a couple of runners only to be directed off course for the fourth and final time of the day.  When I turned around I became frustrated that the two runners I had just put time into had gained a 30-second advantage over me during the side trip.  Finally deflated, I did not have the energy or the desire to chase them down again.
Though I was sure that we were still running at the same 5:40ish pace, it took us well over eight minutes to cover the last 1.1 miles.  A day later I learned that multiple Chicago-area runners had gone back out and found that the last 1.1 was actually almost 1.5 miles.  Wow!
In the end, my hard-earned 1:21:24 time was for a distance of about 13.8 miles!  That translates into a time of about 1:17 for 13.1.  I was satisfied with the tenacity, tactics, and fitness I exhibited in the Monster, but I was most displeased with not having a good time to show for it.  So, I set another goal.
I entered the Indianapolis Monumental Half Marathon that took place on the next Saturday.  Racing two half marathons in six days would require as much rest as life would allow.    I was going to Indy to record a 1:17 half marathon.
Though my legs seemed to recover quite well from the Monster, I knew from experience that I might get 3, 8, or 10 miles into the IMM and fall completely apart due to incomplete recovery from the Monster.  The only real worry I had on race morning was that the injured hamstring had remained tight all week despite receiving my constant attention.
I was lucky enough to meet up with my good friend Jeremy Aydt in the parking garage before the race.  We visited the icy port-a-potties and then sat in the warm RAV for awhile in an attempt to stay warm.  Jeremy is making a strong comeback after a long layoff that included some weight gain. Seeing Jeremy lifted my spirits.  I am most proud of him and inspired by the way he lives his life.
With almost 7000 runners on hand for the half and full IMM events, there was an incredible mass of people standing in the 27-degree air at sunrise.  This was the largest field I had ever been a part of.  It was dealing with this crowd after my typical last-minute port-a-potty visit that started my troubles for the day.  Unable to find a quick route to the start line, I had to "excuse" my way through the mass of runners for ten minutes.  I had a yellow bib that allowed me access to the front of the field, but I simply could not get there.  When the gun went off there were still about 1500 people ahead of me.  A full fifty seconds passed before I walked across the start.  Thank God for chip timing!
It wasn't until after the first turn and more than a minute of weaving and jogging that I felt like I was finally able to run.  I was frustrated to the point of laughing when I managed to find myself passing much slower runners using both sidewalks along a very wide stretch of road.  I reached the first mile in a hard-earned 5:58.  Soon after that the field began to thin to the point that my weaving was greatly reduced.
Honestly, I didn't know how fast my legs would allow me to run or when or if they would tighten up on me.  But, because I had entered the race to find my limit, I pushed the pace hard.  I continuously passed runners as I ran several consecutive 5:40ish miles.  I reached the 10K time mat in 36:06 feeling relaxed while acknowledging that the effort was high.  Unfortunately, my right hamstring had tightened enough to become slightly painful.  Still, I continued to run at a high level of perceived effort: I ran passionately.
Though I was running with the same intensity, that tight hamstring caused my stride to shorten mile splits to creep into the 5:50's.  When I reached ten miles in 58:43 I knew the last three miles were going to be tougher and slower.  I had been setting the pace for the third place woman, but she passed me near the ten mile mark and gradually pulled away despite my best efforts to stay with her.
Those last three miles rolled by in about 6:05, 6:12, and 6:11.  The hamstring was tight, but I felt fine in every other way.  With the temperature still below freezing and a seemingly constant wind cooling me, I had not sweated much until the final miles.  And with the memory of cold water spilling on me a few days earlier in the Monster, I did not take any aid during the IMM.  My watch read 1:17:46 when I crossed the finish line.  Mission accomplished.
Within minutes my core temperature dropped and I began to shiver madly in my wet shirt.  I tried to eat a Panera bagel, but was unable to due to its frozen state.  Then I walked over to the finish line to wait for Jeremy.  He finished in a PR 1:33:18.  Nice job, Jeremy!
It would be rude of me to not state that all three of the events I participated in were put on with great care and attention.  I have known the people behind the Evansville Half for years and have come to expect great things from them.  I was amazed at the huge quantities of materials (barriers, food, drink, time clocks at each mile) brought in for the IMM.  And I was especially impressed with the Chicago Monster, considering the last minute course change.  I hope to race in all of them in the future, but not necessarily in the same month!
I ran in Scott T2 C racing flats fitted with my orthotics for both the Monster and the IMM.  These shoes are light (228 g/8.25 oz per shoe) and extremely soft.  I believe the cushioned shoes protected me during both races and led to less quadriceps fatigue. As I sit here editing this piece I honestly believe that I could run another 1:17 next weekend.  Perhaps I can rest more and set my sights higher.
This recovery and comeback has been one of the toughest of my long athletic life.  Of course, the knowledge I gained from all of the other comebacks allowed me to make the right decisions and follow successful methods of rehab.  The hamstring is tight right now.  I intend to let it heal while I continue the rehab practices until the flexibility and strength in the right leg match the levels of the left leg.  The nerves are another matter all together.  The self-therapy I am using is helping, but I will probably need professional attention.  I miss cycling.
I intend to keep this rekindled passion for running alive into the foreseeable future.  And I am trying to let that passion fill every facet of my life.  I've given myself a week to set some new goals.