Q&A: ‘Some effects of doping are irreversible’
Sports medicine is critical in fighting the doping menace in Kenya. Dr Lutomia Mark Lumbasi is a sports medicine physician and vice chairman of East African Arthroscopy Association, a group of surgeons interested in video scope-assisted joint surgery, and a lecturer at the department of surgery at Egerton University’s School of Medicine. He spoke to our writer Francis Mureithi on the challenges sports physicians face in the era of increased doping in sport:
Q: What does a sports physician treat?
A: Acute injuries such as ankle sprains, joint injuries, dislocations and non-surgical fractures, overuse injuries including stress fractures, tendonitis, general trauma, head, chest, abdomen, ligaments.
Q: As sports medicine doctor, what do you understand by doping?
A: Doping is crime within sports. It involves taking drugs or chemicals by athletes to improve performance or their physique so that they can have an upper hand in competitions and go beyond their body limits.
Q: Does the body make chemicals that can be used for doping by athletes and other sportsmen and women?
A: Yes, we have some chemicals in our bodies that scientists can purify and they could be given to somebody who has less to enhance their performance and that is part of doping.
Q: What are the effects of doping?
A: The side effects depend on the drug that is abused. Some drugs like steroids cause muscles to enlarge and have multiplication effects which leads to bigger and stronger bones which help to execute a bigger task like jumping without incurring fractures.
This affects other tissues in the body. The bigger the bones and muscle the higher the demand they cause in your body.
When you stop using drugs you lose muscle and bones very fast. You also lose your bones very fast.
The heart is also affected as its muscle can enlarge and the athlete can get serious heart problems and die. One could also get diabetes.
Other physiological effects in the body include psychiatric problems, psychosocial effects and athletes can become violent, increased mood swing and depression among other effects.
Q: Some of the drugs are ordinary like pain killers. Your take?
A: Some of the drugs used for doping are as simple and innocent as pain killers such as Panadol which can be used to enhance muscles performance and reduce chances of fatigue.
Asthma drugs are known to be misused for doping.
These drugs are used to treat asthma but when they are given in certain doses, they can enhance muscle growth and can open up the chest so that athlete breathes better and be able to sustain activity for a longer period.
These drugs have side effects like increasing heart beats. When you exert a muscle too much it can also rapture a tendon.
Q: Treatment of doping is a tedious exercise. Your take?
A: The treatment is segmented in three critical areas including detection, deterrence, rehabilitation and treatment. It also involves educating athletes and the general society particularly those who supply the banned drugs on their side effects. We also educate athletes how drugs would destroy their fame and lifestyles. The coaches should also undergo training as they are also to blame for pushing their athletes to go beyond the limit resulting to doping.
Q: The scientists community have been blamed for increased doping cases, what are your views?
A: Scientists should be more stringent. Some of these drugs we use them for treatment and quick healing of muscles should be dispensed in a controlled way that is acceptable by the athletics body and scientists.
Q: Random detection of doping in this country is still a big challenge. Why so?
A: We should have a robust methods of measuring blood levels by setting up laboratories in all the 47 counties where athletes would undergo regular testing.
Q: Is treatment of dopers an easy thing to undertake?
A: It is time consuming as we loop in psychiatrics to rehabilitate athletes, physicians to reverse the effects of doping, orthopaedic surgeons to treat tendon, muscle raptures and other injuries.
To ensure deterrence we need critical arms of government such as police, judiciary, Kenya Prisons and policy makers among others to ensure drug peddlers are arrested and punished.
Q: How complicated are sports injuries when it comes to surgery?
A: Sports surgeries are highly specialised branch of surgery that involves a lot of investment.
We sometimes do traditional surgery by incision but most of the time sports injury are treated via video scope equipment which are highly advanced and have a steep learning curve.
The special equipment used to repair joint injuries or muscle raptures are extremely expensive.
They are beyond the reach of many Kenyans. A ligament repair will cost about Sh500,000. Abroad it will cost about Sh1million.
Very few sportsmen and women can afford that. Even if we use the cheapest methods to save the athlete it is still expensive as it will cost about Sh300,000.
Q: How can the government assist in lowering the cost of such treatment?
A: The taxes imposed on imported equipment should be reduced. The health care should be subsidised.
Government facilities should be equipped with video scope surgery machines for joints.
The capital investment on some of the equipment that enables doctors to carry out surgeries go for between Sh5 million and Sh10 million and that is why it is expensive to treat doping related injuries.
Q: What other investments should the government put in place to address doping menace?
A: The government should increase the number of doctors specialising in sports medicine. Kenya is a world beater and we should have enough doctors to treat our heroes and heroines.
Q: You’re the vice chairman of East African Arthroscopy Association which is a group of surgeons interested in video scope assisted joint surgery. How has your association helped contribute to sports medicine in Kenya?
A: We are pushing for training of young doctors to join sports medicine in this region to help tame the menace while deepening the sports medicine knowledge gap. We could also be part of the bigger consortium that is involved in addressing doping in sports and we could play a crucial role in sensitising the athletes and stakeholders on effects of doping.
Q: What are the first obvious signs of doping in an athlete?
A: Although at first instance it is hard to notice drug abuse the sudden change of the body physique of an athlete could be pointers of drug abuse.
Rapidly gaining weight and height are other physical signs. Changing moods and psychiatric problem are other signs.
Q: What are abnormal features of doping?
A: A lady athlete would start having moustache and excess acne, spotty face, big muscle and develop deep voice. If it is a man he develops breasts.
Q: How does doping affect quality of life for athlete after quitting sports?
A: If you give a plant fertilizers and you withdraw them then plant withers because it depends on fertilizers to grow.
The body has the same kind of mechanism once you use drugs, muscle will develop, bones will strengthen, and once you withdraw you get a rebound effect of muscle weakening and fatigue beyond what the body could cope with.
This results into muscles raptures. The blood vessels and heart muscle get tired and require a lot of blood.
The ends up as a psychiatric patient. These effects are irreversible.
Q: What are some of the drugs used in doping but are hidden as normal drugs?
A: Pain killers like Panadol can enhance body activity and function. Drugs such as erythropoietin (EPO) increase the carrying capacity of oxygen in the blood level, insulin and growth hormones used by fertility experts and Andrestenedione steroids that build your body muscles are some of the drugs, cannabis, stimulus and vitamins and caffeine among others.
Q: What are some of the tricks athletes use to mask the effects of doping?
A: They abuse diuretics that increase the rate of urine flow and sodium excretion to adjust the volume and composition of body fluids to mask the presence of other banned substances so that when a sample is taken it cannot be detected.
Q: Do you think education to end the dangers of doping has been sufficient?
A: I don’t think enough has been done in Kenya and that is why we are having an increased number of Kenyan athletes banned for doping. Education about dangers of doping is at its infancy.
Q: What would be your suggestion to address the menace?
A: Athletics Kenya and other bodies such local International Olympic Committee and Anti-Doping Agency of Kenya need to increase random testing and launch an aggressive awareness campaign right from the grassroots that should involve doctors, counsellors, security personnel, educationists and come up with a consortium that addresses doping issues ranging from policy making, education, coaching, testing and rehabilitation.
Q: Some athletes take steroids and other drugs while they are injured, what are the dangers?
A: They cause thinning of the bones, blood clots and obesity, along with retention of the body fluids, hypertension, and diabetes among other illnesses.
Q: When many people think of doping in Kenya they automatically think of athletes, in what other sports is doping rife?
A: Football is also rife with doping and boxing but they are rarely checked. We should also do random checks in rugby, volleyball and other minor sports such as tennis.
Q: To address this problem what would be your suggestion?
A: The awareness campaign should start at primary schools and escalated in secondary schools and colleges and other institutions of higher learning.
Q: Can the body of an athlete go back to normal after doping?
A: It depends on what the drugs have done to the body but it can be detoxificated.
Weak bones can be treated over a long period of time. Muscle raptures could be treated. However, life opportunities, respect and career can never be recovered.
Q: What do you like most about being a specialist in sports medicine?
A: I admire the ability to use key-hole techniques to sort a problem to a client who is not able to function in high end sport activities like athletics and return him to top form.
I like when I have treated somebody with unstable joints they were unable to walk on and you can’t see the incision you made and when you show this patient the video of what you did inside the joint that they can’t see outside and they marvel at what science has been able to do. Repairing a shoulder of a rugby player and when he looks at it and has no scar and is able to go back to active sport is very gratifying to me.
Q: What disappoints you most?
A: The cost of fixing sports injuries is way above the reach of most sportsmen and sportswomen. This forces many to live with pain for the rest of their lives as they earn peanuts.
Some teams like AFC Leopards and Gor Mahia owe players salary arrears for months, and telling a player with a knee injury to pay Sh400,000 is a big joke.
Q: Has National Hospital Insurance Fund (NHIF) been of any help to sportsperson seeking specialised medical attention?
A: NHIF is a brilliant and beautiful idea. However, the insurer has never understood the seriousness of sports injuries in this country. One screw used in joint repair imported from Germany costs Sh45,000.
Fixing it plus doctors’ fees and other overhead costs is an additional cost. Surgical care by video scope is more expensive than joint replacement.
Whoever allocates money for surgery at NHIF has no clue how serious and expensive sports injuries are.
To repair a joint ligament injury or any other injury is about Sh400,000 but NHIF gives Sh50,000 for your patient.
Q: Any advice for drug cheats?
A: Stay away from banned drugs as they destroy your body and career. If you’re not caught you will end reducing your body into mobile garbage.
Q: What is the most difficult thing about being a sports medicine doctor?
A: The steep learning curve that is associated with video assisted joint surgery. We don’t experiment on patients. We must touch a patient.
However, in this country we don’t have good laws that enable us to get fresh bodies to train young doctors. The few cadavers we have at medicine schools are stiff because of the methods used to preserve them.
Q: Any most challenging situation you’ve had to cope with as sports medicine doctor?
A: Treating a patient with shoulder and two knee injuries at the same time was very challenging. It was not a walk in the park.
Q: What have you learnt from doping?
A: As a country, we need to up our game to include many people in the team dealing with education around doping to create a deeper awareness.