The 59th Traversée internationale du lac St-Jean

lac st jeanIt started off a bit rocky, with an impatient Canadian border guard at Jean Lesage international airport in Quebec City questioning why I, an American doctor, would be working and taking care of patients in Canada; but things are decidedly looking up now that I have made it over that speed bump and down the road to Roberval, Quebec.

My biggest problem now is getting WiFi access.  Thank God for Tim Horton’s!!  My hotel can’t get me WiFi, other places in town that proclaim free WiFi don’t deliver.  I grabbed a coffee at Tim’s (avoiding the donuts; on the road, sitting in planes and cars, I don’t need those tasty calories) and, voila!  Internet access.

So, lest anyone think I’ve been remiss in communicating over the blog, on Twitter @cjsmonline, or on the Facebook page (, I have simply been unable to do so.

And one more thought about Tim Horton’s before I turn to the swimming. Many readers will know this, but some will not:  the donut chain was founded by a revered former NHL player, Mr. Tim Horton himself.

lac st jean water

The obstacle the swimmers face: Lac St. Jean

I’m here as a FINA medical delegate to supervise the medical set-up and the doping control of two swimming events that will take place on Lac St. Jean–next to Roberval, Quebec, Canada (2.5 hours north of Quebec City)–tomorrow and Saturday.

jacques amyot

Lakeside plaque commemorating Jacques Amyot, first to make the Lac St. Jean crossing.





The 32 km Traversee, to take place on Saturday, promises to be especially interesting.  To put this in context, the distance is just a bit shorter than the English channel crossing, and the water temperatures in the middle of the lake will drop below 20 degrees C.

The medical tent is set up to deal with hypothermia, I can assure you of that!

I will have more to post (pending access to Tim Horton’s……oops, WiFi) when the events have taken place. In the mean time, if anyone in the blogosphere has interesting experiences or medical literature to share on the coverage of long-distance swimming events, I look forward to hearing from you in the ‘Comments’ here or on Twitter @cjsmonline.

Team Physician Consensus Statement: 2013 Update


Nationwide Children’s Hospital Staff Physicians and ATCs
in “the Horseshoe” at the Ohio State University, prior to game.

Earlier this week, several sports medicine organizations released a statement with which all sports medicine clinicians should familiarize themselves:  the “Team Physician Consensus Statement:  2013 Update.”

The Statement represents, in its own words, “…an ongoing project-based alliance” of the major professional associations associated with sports medicine  in the United States.  These include the American Academy of FamilyPhysicians (AAFP), the American Academy of Orthopaedic Surgons (AAOS), the American College of Sports Medicine (ACSM), the American Orthopaedic Society for Sports Medicine (AOSSM), the American Osteopathic Academy of Sports Medicine (AOASM), and this journal’s affiliated professional group, the American Medical Society for Sports Medicine (AMSSM).

This is an update of a statement first published in 2000.  It includes sections which define the role of ‘team physician’;  describe the requisite education and qualifications; enumerate the medical and adminstrative duties and responsibilities; and explore the relevant ethical and medicolegal issues.

The entire statement is worth a read, but I find the ‘ethical issues’ section most interesting.  Read more of this post

Le Tour et La Corse


Les montagnes de L’Île de Beauté: La Corse

…et La Centieme:  The 100th edition of Le Tour, the Tour de France, begins today, with the Grand Start in Corsica for the first time in the race’s history.


Who needs the Tricolor? The Flag of Corsica: once an independent republic, now part of France, still with its own language and distinct customs.

What a way to celebrate the centennial of the Tour!

Corsica, or La Corse, is a French island in the Mediterranean, and is comprised of two of that nation’s departments: Haute-Corse and Corse-du-Sud.  It is the only region of France which has not previously hosted a stage of Le Tour.

The island has a long history, perhaps best told in one of the finer travel books I have ever read, The Granite Island, by Dorothy Carrington.  The island has passed through many hands over its history:  the Carthaginians, Romans, Genoans and others have all claimed the island for their own.  The island even enjoyed an independent existence for some years:  the Corsican Republic was formed in 1755 under the leadership of Pasquale Paoli.  Corsica’s most famous son, Napoleon, was born there in 1769.  And it was during the time of the “Napoleonic wars” that he set loose on Europe that the island became part of France.  It has remained a part of that country ever since.

I have a special fondness for this land, known by the French as  L’Île de Beauté:  the Isle of Beauty.  I have visited Corsica twice, and was smitten with the island from the first my eyes lay sight on the port of Calvi. (Some readers may recognize Calvi as the site of the 2011 IOC Advanced Team Physician course.)

Corsica is quite simply arresting:  from its mountains and trails, to its beaches, to the very smell of the island (its vegetation, known as the ‘maquis’, has a distinctively lovely fragrance), it can put anyone under its spell.

That said, I suspect the cyclists in Le Tour this year may be smitten in a different way than I was on my visits.  Like any beauty, Corsica has its caprices.  The mountains I found lovely will almost certainly pose extraordinary challenges to the competitors.


Cirque de la solitude: in the mountains of central Corsica


The capital of Corsica: Corte, through which the 2nd stage of the Tour will pass











The second stage of the Tour this year will traverse the mountains that form a spine through the center of the Island, heading from Bastia on the east coast, through the mountainous capital of Corte, and ending on the west coast in Ajaccio, the birthplace of Napoleon.  The Tour’s website describes the ride as a rollercoaster; “Expect some real damage,” the site boasts menacingly!    Let’s hope no one meets his ‘Waterloo’!

Read more of this post

Boosting – time to be aware

Most Sports Physicians are well aware of the issue of doping in elite sport and many of the methods used by sports participants. However, some of us may well not have come across a method used by some athletes with a disability called ‘Boosting.’ With the forthcoming Paralympics just around the corner, now is the time to consider this method of doping for those of us who are involved with events later on this year in London 2012.

Some athletes with a high level spinal cord injury (T6 and above) may voluntarily induce an episode of autonomic dysreflexia (AD) prior to, or during, an event in order to enhance their performance. A variety of methods may be used by athletes, including clamping catheters, sitting on sharp objects, and using tight leg straps.

The resulting physiological response leads to a significantly raised blood pressure, with improved blood flow to working muscles. The performance enhancement that may ensue as a result of this response may be significant and lead to an improvement in VO2.

It is not always easy to determine whether or not a deliberate attempt to induce AD has taken place as AD is not uncommonly caused by a number of common triggers including urinary retention due to catheter blockage or misplacement, infections, constipation, or noxious stimuli from other sources such as pain due to a lower limb injury.

My first clinical encounter with a patient with AD was during my registrar training when I was working on a spinal cord injuries unit (SCIU) – the cause on that occasion was a blocked catheter. Recognition was swift due to the awareness of the ward nursing staff to the condition. The patient was treated with nifedipine plus a catheter replacement and bladder washout, and made a swift and uneventful recovery. I was to encounter a few more episodes of AD occurring in in-patients during the next 6 months when I was working on the SCIU.

Whilst not only banned by the International Paralympic Committee as a doping method, boosting is dangerous to the health of athletes and may lead to a hypertensive crisis, stroke and death.

The signs and symptoms of mild-to-moderate AD include piloerection, sweating above the level of the spinal cord lesion, headaches, blurred vision, bradycardia, facial flushing, nasal congestion and anxiety. Systolic blood pressure may rise to over 250mmHg.

Athletes are routinely checked prior to competition for any of these signs and symptoms, and repeated blood pressure measurements are taken if there is any suspicion of boosting or AD. If a systolic blood pressure of 180mm Hg or higher is persistently measured, then the athlete is not allowed to compete in the event and possible causes of AD are searched for.

In this month’s Thematic issue of the Clinical Journal of Sport Medicine on Paralympic Sports Medicine, our featured freely-available article by Krassioukov focuses on blood pressure control and AD in athletes, discussing the physiological mechanisms behind this doping method and what we know about the practice of boosting.

For those who may wish to raise awareness of boosting as a doping method, there is a useful presentation on AD and boosting available on the official website of the Paralympic movement, funded in part by the World Anti Doping Agency (WADA) and the IPC.

(Image of Iran v South Africa at 2008 Paralympic games available at Wikimedia Commons, and Autonomic Nervous System originally from ‘Gray’s Anatomy’ )

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