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So what about people with mood instability? Or what about people with poor eyesight? If we want people to work with what they were born with, why is ANYTHING that isn't in food allowed?
What is interesting to me is how they keep rewriting the DSM (our "Bible", if you will) and changing what's in it. Some dxs disappear (e.g., homosexuality) and new ones are invented all the time. Like I said earlier, ADD is no longer an actual dx in the DSM.
There are also distinct periods in hx where some dxs become "trendy". My favorite was when "Multiple Personality Disorder" became super trendy and doctors and psychiatrists everywhere were dx people with that crap. LMAO!!!
Lately, it appears (to me) that "Bi-Polar" is the most trendy dx of all. I swear to God, every kid that gets referred to me that has EVER had ANY change to his mood at all comes with that dx from someone. Lame. It doesn't add up to me.
The first week was rough. It messed with my head a bit. But it passed. I didn't have a single physical side effect from it.
I was on it for about 14 months, felt like I needed to bump up the dose and just decided to stop. And yeah, coming off sucked.
In hindsight, I think I became kind of apathetic while on it. I wasn't as creative on it either. No doubt I needed it when I did. But I didn't plan on being on something long term.
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I guess I pretty much haven`t studied this for over twenty years and all the knowledge I have gained and experienced is just a bunch of shit . Sure you are a doctor , but a doctor of what ? Did you have a couple brief chapters in med school on the subject or have you come up with your own conclusions based on years of practice in this area?
Check out the DSM-IV-TR ............it might help you with your confusion.
in this case, if the need is proved, medically, let the guy take the drugs and let him go to work.
If there were a laser surgery to fix the brain and help people with ADHD concentrate better, people wouldn't have a problem with it. But because it's a drug, it's a problem.
It's a vasodilator, which means it opens up your blood vessels, which is potentially beneficial in a lot of ways, and could even be beneficial in terms of concentration, although that hasn't been studied.
But most side-effects of drugs happen to a small percentage of people who take it.
Pit Row
The clinical review (cited) said it is subject to manipulation and where the results are extreme they need to be checked against other diagnostic criteria. The test is not objective in the sense that it filters subjective input that the test subject can skew. It is objective to the extent that it provides an unbiased filter on that input. Beyond that, it apparently overdiagnoses ADHD when checked against other tests; it is good at catching true cases but also errs in including people without ADHD. So it is a tool, not a definitive tool by itself. Sometimes it will cut to the chase, as in your case, or sometime be the beginning of the chase. You can read that as well as I.
We're not talking about whether your diagnosis is valid and the treatment is effective. I am incredibly happy for you, sincerely. I have been chest deep for more than a decade in more medical testing than I would wish on anyone. Sometimes accurate answers come quickly, sometime longer, and sometimes after reversing from wrong paths struck by bright doctors with the best of intentions. Good for you that they nailed your diagnoses right away. Now get the fuck over yourself as some sort of authority. No one has questioned the reality of your diagnosis, the efficacy of your treatment and the benefit you've enjoyed.
What we are talking about is the potential for using therapeutic drugs for illicit purposes, in this case for purposes of gaining a competitive advantage. There are many drugs that have therapeutic applications (for example, I take EPO to counteract side effects of other anti-rejection meds I have to take), but also can function as performance enhancers outside apart from their therapeutic application. There isn't any question that some drugs used to treat ADHD are abused by non-ADHD individuals as neuro enhancers. No question whatsoever.
So the question is whether someone in a competitive occupation is truly ADHD and using the drug for a valid purpose or someone feigning that to validate use that in fact is not therapeutic but to enhance performance. What's a sanctioning body to do about that? I think it depends on the drug, and the ability for a neutral evaluator to validate a diagnosis. It absolutely would be a charade to rely solely on the athlete's prescribing physician. And, in this setting, the test that worked for you would be a beginning, but the not the final word if a sanctioning body was being vigilant and had concluded it could strike that balance rather than absolutely ban the drug in question.
Like I said, it's not for the racing organization to decide what is medically necessary for a participant. It's for doctors to do. That's what they're trained for. If as a racing organization you make decisions that are only to be made by doctors, I think that is way beyond your level of expertise.
On top of that, if the doctors are providing drugs for fake reasons, then they need to be reported to the government and the government will handle it.
If a sporting body chooses to regulate performance enhancing drugs, then there is nothing wrong with them implementing a system to validate allegedly therapeutic prescriptions, and if there is no means to distinguish valid from performance enhancing uses, to ban use of the substance entirely. The notion that somehow a sports body could not preclude use of a drug, but could test for it and then report the individual and his physician to the government for legal action on the assumption that it was illicitly prescribed, but not directly affect the athlete's participation has far more problems, legal and otherwise, than directly regulating, testing and enforcing the agency's own drug rules.
By JENNA FRYER – 4 hours ago
DAYTONA BEACH, Fla. (AP) — Brian France defended NASCAR's drug testing policy as the toughest in professional sports, despite a federal judge's ruling that overturned driver Jeremy Mayfield's suspension.
Mayfield was indefinitely suspended May 9 for what NASCAR said was a positive test for methamphetamines. He sued to be reinstated, and a federal judge issued an injunction Wednesday that allowed Mayfield to race this weekend based on Mayfield's argument that NASCAR's testing system is flawed.
U.S. District Court Judge Graham Mullen questioned the test results, saying the possibility of a false positive was quite substantial and ruled the harm to Mayfield significantly outweighed the harm to NASCAR.
But NASCAR's chairman said the sport needs a tough system that bans impaired drivers from competition.
"We remain very comfortable and very calm despite the ruling, that our policy is thorough, it's accurate, and it's fair," France said Friday at Daytona International Speedway, site of Saturday night's race.
"It's our responsibility to protect the drivers, the fans, other participants within the events. We have a very unique challenge relative to all sports, which is the inherent danger of somebody impaired on the racetrack."
http://www.the-aps.org/press/journal/06/15.htm
Viagra Boosts High Altitude Exercise Up To 45% For Some Cyclists
But others don’t benefit at all; Possible side effects still a concern
BETHESDA, MD. (June 27, 2006) – Sildenafil (Viagra) significantly improved the cardiovascular and exercise performance measures of trained cyclists at high altitude, mostly because the drug helped some participants improve a lot -- up to 45% -- while others showed little change. Sildenafil provided no benefit at sea level.
Ten cyclists who took sildenafil at altitude collectively lowered the time it took to cover six kilometers by 15% compared to placebo trials at altitude. The cyclists also significantly improved stroke volume (the volume of blood moved out of one ventricle of the heart per beat) and cardiac output (stroke volume times heart rate) compared to the placebo trial. Sildenafil also minimized the decline of arterial oxygen saturation of the arteries when the cyclists were at simulated altitude of 12,700 feet.
But the researchers discovered that these improvements occurred largely because some people achieve major gains with sildenafil at altitude while others improve much less or not at all. The responders improved 39% in the time trial performance at altitude compared to their performance at altitude with a placebo. Some in the responder group improved as much as 45%, according to a study in the Journal of Applied Physiology published by The American Physiological Society. Non-responders improved an insignificant 1%.
The study, “Sildenafil improves cardiac output and exercise performance during acute hypoxia but not normoxia,” by Andrew R. Hsu, Kimberly E. Barnholt, and Nicolas K. Grundmann, Veterans Affairs Palo Alto Health Care System; Joseph H. Lin and Stewart W. McCallum, Stanford University Medical Center; and Anne L. Friedlander, Veterans Affairs Palo Alto Health Care System and Stanford University appears in the June issue of the Journal of Applied Physiology.
Drug expands the blood vessels
Sildenafil citrate is best known as Viagra, a drug used to treat erectile dysfunction. The drug was originally developed to relieve high blood pressure. It causes blood vessels in certain tissues, such as the lungs, to relax. This improves blood flow from the heart and increases oxygen transport to working muscles. Because the high altitude atmosphere contains less oxygen, it is more difficult to get enough oxygen to support strenuous physical activity than it is at sea level.
Sildenafil works by inhibiting phosphodiestrase-5, an enzyme which degrades cyclic guanosine monophosphate (cGMP) a cell messenger that causes the blood vessels to relax, Friedlander explained. By inhibiting the enzyme, the drug allows greater vasodilation and greater blood flow. Although the drug works in different target sites, this study focused on the lungs.
The researchers hypothesized that the drug would allow the study’s participants to improve their performance at altitude because it would reduce the constriction of vessels in the lungs that sometimes occurs at altitude. In turn, that would allow greater blood flow through the heart, better transfer of oxygen from the lungs to the blood and improved oxygen delivery to working muscles.
The participants, all trained cyclists, performed a total of 10 cycling trials, with and without sildenafil at sea level and at simulated altitude of 3,874 meters. Neither the participants nor the researchers knew whether the trial included a placebo or one of the two sildenafil doses, 50 mg or 100 mg.
The high altitude simulation was achieved by changing the mix of air. The cyclists began breathing the high altitude mix starting one hour before the exercise session and continuing through the session. The simulation did not include the lower air pressure that would occur at altitude, Friedlander said.
Researchers analyzed the changes in each individual’s performance under various exercise conditions and also compared the group’s performance under different drug conditions.
Responders versus non-responders
Four of the 10 participants responded to sildenafil while the remaining six did not, Friedlander said. The responders showed the greatest drops in stroke volume, cardiac output, and cycling performance between the sea level and high altitude trials without the drug.
“Without sildenafil, their performance went down more than others,” Friedlander said. “With it, it brought them back up to the levels of the non-responders.” The results suggest that the responders experienced a greater degree of constriction of the vessels in the lungs at altitude and therefore benefited more from the vessel relaxation effects of sildenafil.
“One of the messages of the paper is that not everybody benefits,” Friedlander said. Sildenafil could be considered as a treatment for those who suffer most at altitude but, because of side effects that can include severe headaches and the apparent inability to help some people, it should not be taken as an exercise aid by everyone, she said.
The bigger picture
This study adds to the scientific knowledge of what physiological factors limit performance at altitude, including the role that cardiac output plays, Friedlander said. For instance, physiologists don’t know why some people have trouble at altitude and may develop illnesses such as acute mountain sickness or high altitude pulmonary edema while others adapt quickly. Studies like this may help identify some of the underlying differences between people and lead to better treatments.
In future studies, Friedlander wants to identify:
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what steps individuals could take to acclimatize before they go to altitude
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who is likely to acclimatize quickly at altitude and who may need additional help
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how to minimize performance declines at altitude
Friedlander and her team are working on issues that could apply to those who have to rapidly acclimatize to high altitude. For instance, when soldiers deploy to Afghanistan, they must quickly undertake physically taxing work at 12,000-14,000 feet, conditions that can severely affect performance under potentially life-threatening conditions.
In a study Friedlander and colleagues conducted at 14,000 feet on Pike’s Peak, Colorado, participants showed marked hormonal changes at altitude. These changes facilitate oxygen delivery. However, this benefit is suppressed when individuals don’t eat enough and the body shifts focus to store more energy, Friedlander explained. That study appears in the June issue of the American Journal of Physiology-Endocrinology and Metabolism, also published by APS.
Next steps
One next step is to do a study with women, to see if they react the same way to sildenafil and altitude. The researchers also want to take a closer look at sildenafil responders to see if they can identify ahead of time who will benefit from treatment. In addition, a question still outstanding is whether non-responders would benefit from sildenafil at a higher elevation.
Source
“Sildenafil improves cardiac output and exercise performance during acute hypoxia, but not normoxia,” by Andrew R. Hsu, Kimberly E. Barnholt and Nicolas K. Grundmann, Exercise Physiology Laboratory, Clinical Studies Unit, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Joseph H. Lin, Department of Medicine, Pulmonary and Critical Care, Stanford University School of Medicine; Stewart W. McCallum, Department of Urology, Stanford Medical Center; and Anne L. Friedlander, Exercise Physiology Laboratory, Clinical Studies Unit and Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System. The study will appear in the June issue of Journal of Applied Physiology published by The American Physiological Society.
Editor’s note: The media may obtain a copy of Hsu et al. by contacting Christine Guilfoy, American Physiological Society, (301) 634-7253, (978) 290-2400 (cell), or cguilfoy@the-aps.org.
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The American Physiological Society was founded in 1887 to foster basic and applied bioscience. The Bethesda, Maryland-based society has 10,500 members and publishes 14 peer-reviewed journals containing almost 4,000 articles annually.
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APS provides a wide range of research, educational and career support and programming to further the contributions of physiology to understanding the mechanisms of diseased and healthy states. In 2004, APS received the Presidential Award for Excellence in Science, Mathematics and Engineering Mentoring (PAESMEM).
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