LeMond III

[DamianoMachiavelli]

Re:

Hagerman testing anabolic steroids in the mid-70s, then doing testing on Lemond (and Heiden) at the OTC in the late 70s. It got me thinking again, firstly, about Testa's suggestion that Lemond basically had to quit because he'd doped too much and, secondly, about the rumors that his mitochondrial myopathy (which Lemond himself has credited as a, or even *the*, major factor in his decline) was a result of long-term drug (steroid) abuse.

Here's an example of what I'll dub the 'steroid-induced myopathy rumor', as put forward by an anonymous poster on some google-blog. The poster draws an interesting parallel with Thevenet:

My recollection from a few years back when the mitcondrial(sp?) myopathy story broke, is that one standard internal medicine text that I looked at, Clinton(?), noted that steroid abuse can cause such myopathy. Digging deeper in to the recesses of my brain, I recall Bernard Thevenet suffered a similar decline in his cycling career (he damn near fell off his bike during the 78 or 79 Giro due to fatigue) and stated publically that steroid abuse did cause him physical damage, renal and bone marrow I think. https://groups.google.com/forum/#!topic/rec.bicycles.racing/xAs5Ag1ABOY

And so I looked further into the myopathy issue to see if there is anything plausible about the rumor.

First thing worth noting is that when Lemond was diagnosed with myopathie he was in fact considered a very a-typical and unexpected myopathie patient:

http://articles.latimes.com/1994-12-04/sports/sp-4822_1_greg-lemond
“Rochelle Taube, LeMond's physician, said the disorder usually afflicts children and the elderly, adding it is the first known case diagnosed in a healthy person.”

Here's another source (in French) saying the same: http://www.humanite.fr/node/92565

The second thing I found is that drug-induced myopathy is in fact quite common:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092639/

A drug-induced, or toxic, myopathy is defined as the acute or subacute manifestation of myopathic symptoms such as muscle weakness, myalgia, creatine kinase elevation, or myoglobinuria that can occur in patients without muscle disease when they are exposed to certain drugs.

A particularly common and well-studied form of drug-induced myopathy is (cortico)steroid-induced myopathy:
http://erj.ersjournals.com/content/erj/5/8/997.full.pdf

In recent years renewed attention is being paid to the involvement of the resp
iratory muscles and its consequent significance in pulmonary patients. Two different clinical patterns of steroid-induced muscular changes are known. In acute myopathy and atrophy after short term treatment with high doses of steroids, generalized muscle atrophy and rhabdomyolysis occur, including the respiratory muscles. Chronic steroid myopathy, occurring after prolonged treatment with moderate doses, is character-ized by the gradual onset of proximal limb muscle weakness and may be accompanied by reduced respiratory muscle force.

That's one of many sources on the topic. Here are some others:
http://emedicine.medscape.com/article/313842-overview
http://emedicine.medscape.com/article/313842-clinical
http://www.uptodate.com/contents/glucocorticoid-induced-myopathy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784879/

Looks like Testa was right. Too much dopage.

Shut up, Drugs.

 

[ScienceIsCool]

I think there's some misunderstanding. Myopathy is a disease of the muscles. Mitochondrial myopathy is a very particular form of myopathy and is *genetic* in cause. You can not dope your way to mitochondrial myopathy. Full stop.

John Swanson

 

[Irondan]

Re:

I think there's some misunderstanding. Myopathy is a disease of the muscles. Mitochondrial myopathy is a very particular form of myopathy and is *genetic* in cause. You can not dope your way to mitochondrial myopathy. Full stop.

John Swanson

^This^

 

[blutto]

....from the horses mouth....wherein the medical people looking into LeMond's problem are looking for a particular cause and not simply hereditary bad luck...

"I have a very big physical disability that does not allow me to compete at the world-class level. I have a physical condition that is not allowing me to race at the level I should."

The condition, he continued, is called mitochondrial myopathy. "I can't spell it," he said with a laugh, "but I can say it's basically dysfunctional mitochondria, which won't help me produce energy. My energy- delivery system has been off whack. It's a mild state that affects my performance at a high level but not my day-to-day living."

Parts of each cell, mitochondria produce energy through respiration. When they are impaired, muscles are impaired. "I hate to say it," he continued, "but it would mimic some sort of muscular disease."

According to the Merck Manual, a standard medical reference book, mitochondrial myopathies are among a group of progressive muscle disorders of unknown cause that are inherited through the mother. LeMond said he and his doctor believe, however, that the condition is caused by the 40 lead shotgun pellets left in him when he was accidentally shot while hunting in California on April 20, 1987. Three of the pellets rest in his heart lining.

"It's very possible it could be the lead," he said. "We're hoping to tie it to the lead because it would at least give me a clear answer for the future."

But Dr. Michelle Taube of the Minneapolis Sports Medicine Center, "who has worked the last three months researching me," is still not certain of the cause, LeMond said. "That's only the most likely theory."

....and there is this , which is close in its symptoms ....from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092639/

Many drugs used for therapeutic interventions can cause unexpected toxicity in muscle tissue, often leading to significant morbidity and disability. Myotoxic drugs can cause myopathies through a variety of mechanisms by directly affecting muscle organelles such as mitochondria, lysosomes, and myofibrillar proteins; altering muscle antigens and generating an immunologic or inflammatory reaction; or by disturbing the electrolyte or nutritional balance, which can subsequently impact muscle function. Muscle tissue seems particularly susceptible to drug-related injury because of its mass, high blood flow, and mitochondrial energy metabolism.

....and...

Toxic myopathies can occur from a variety of different mechanisms and types of muscle injury and are typically classified according to the types of injury to the muscle fiber or muscle organelle (Table 1) [1–3]. Myopathies induced by drugs most commonly result in necrosis, vacuolar changes, or mitochondrial dysfunction. Necrotizing myopathies such as those caused by statins lead to necrosis of muscle fibers and secondarily involve inflammatory cells such as macrophages. However, they do not typically demonstrate widespread major histocompatibility complex-1 expression or the primary inflammation by aggressive T lymphocytes that one sees in the immune-mediated inflammatory myopathies that can be induced by D-penicillamine or interferon (IFN)-α. Vacuolar changes and lysosomal accumulations typically occur with colchicine and the antimalarial class of medications, respectively. Mitochondrial dysfunction characterized by ragged red and cytochrome C oxidase–negative fibers occurs with zidovudine toxicity. Still other drugs (eg, ipecac and emetin) can cause disruption of myofilaments or myofibrillar proteins, which can lead to toxic effects in muscle.

....also note that high levels of iron are also linked to the occurrence of the above....

...and there is this note of caution...

Mitochondrial disease in adults is a complicated disorder to diagnose. It has myriad signs and symptoms and body systems involved. This, coupled with the fact that it is not a well-known disorder, makes diagnosis a long and difficult task.

The symptoms of mitochondrial disease can fluctuate day-to-day, as can various test results, thus complicating the picture. The situation is made somewhat easier if other family members have already been diagnosed with Mito. It usually takes a variety of specialists to diagnose the problem but even then, one central doctor, such as a Mito specialist (of which there are few), is needed to coordinate the various test results and the clinical picture into one -- not so simple diagnosis.

- See more at: http://www.mitoaction.org/blog/dealing-with-difficulties#sthash.lWvjARs5.dpuf

Cheers

...edit...the other thing to understand is this condition is relatively rare...

While mitochondrial myopathies and encephalomyopathies are relatively rare, some of their potential manifestations are common in the general population. Consequently, those complications (including heart problems, stroke, seizures, migraines, deafness and diabetes) have highly effective treatments (including medications, dietary modifications and lifestyle changes).

It’s fortunate that these treatable symptoms are often the most life-threatening complications of mitochondrial disease. With that in mind, people affected by mitochondrial diseases can do a great deal to take care of themselves by monitoring their health and scheduling regular medical exams.

...so we have a situation that is rare and complicated and hard to diagnose and has shadow conditions that are tied to drug use....and I wonder how fleshed out the understanding of this condition really is...clinical trials would be hard to organize because your sample size draws from a very small population base....the complexity would make it very hard to compensate for other factors and the ideal of one cause may well be impossible...and the "market" for a cure or understanding would be limited so funding for studies would also be limited...

...very complisticated ain't it...and then there is the way this problem has played and not played in the LeMond narrative ( first it was absolutely the reason for his career's demise, heck it was studied for months by experts, and then presto zesto it disappears and the focus changes to Lance, errr, the drugs and then back to driving around with his old cycling buds in the limelight ).....and oh, may I add, this condition is a great medical swamp in which to bury a problem...

 

[Semper Fidelis]

Re:

I think there's some misunderstanding. Myopathy is a disease of the muscles. Mitochondrial myopathy is a very particular form of myopathy and is *genetic* in cause. You can not dope your way to mitochondrial myopathy. Full stop.

John Swanson

Yeah well he was clean Brah. So no worries. I have no idea why you would have to worry about it.

 

[Stingray34]

Re: Re:

Hagerman testing anabolic steroids in the mid-70s, then doing testing on Lemond (and Heiden) at the OTC in the late 70s. It got me thinking again, firstly, about Testa's suggestion that Lemond basically had to quit because he'd doped too much and, secondly, about the rumors that his mitochondrial myopathy (which Lemond himself has credited as a, or even *the*, major factor in his decline) was a result of long-term drug (steroid) abuse.

Here's an example of what I'll dub the 'steroid-induced myopathy rumor', as put forward by an anonymous poster on some google-blog. The poster draws an interesting parallel with Thevenet:

My recollection from a few years back when the mitcondrial(sp?) myopathy story broke, is that one standard internal medicine text that I looked at, Clinton(?), noted that steroid abuse can cause such myopathy. Digging deeper in to the recesses of my brain, I recall Bernard Thevenet suffered a similar decline in his cycling career (he damn near fell off his bike during the 78 or 79 Giro due to fatigue) and stated publically that steroid abuse did cause him physical damage, renal and bone marrow I think. https://groups.google.com/forum/#!topic/rec.bicycles.racing/xAs5Ag1ABOY

And so I looked further into the myopathy issue to see if there is anything plausible about the rumor.

First thing worth noting is that when Lemond was diagnosed with myopathie he was in fact considered a very a-typical and unexpected myopathie patient:

http://articles.latimes.com/1994-12-04/sports/sp-4822_1_greg-lemond
“Rochelle Taube, LeMond's physician, said the disorder usually afflicts children and the elderly, adding it is the first known case diagnosed in a healthy person.”

Here's another source (in French) saying the same: http://www.humanite.fr/node/92565

The second thing I found is that drug-induced myopathy is in fact quite common:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092639/

A drug-induced, or toxic, myopathy is defined as the acute or subacute manifestation of myopathic symptoms such as muscle weakness, myalgia, creatine kinase elevation, or myoglobinuria that can occur in patients without muscle disease when they are exposed to certain drugs.

A particularly common and well-studied form of drug-induced myopathy is (cortico)steroid-induced myopathy:
http://erj.ersjournals.com/content/erj/5/8/997.full.pdf

In recent years renewed attention is being paid to the involvement of the resp
iratory muscles and its consequent significance in pulmonary patients. Two different clinical patterns of steroid-induced muscular changes are known. In acute myopathy and atrophy after short term treatment with high doses of steroids, generalized muscle atrophy and rhabdomyolysis occur, including the respiratory muscles. Chronic steroid myopathy, occurring after prolonged treatment with moderate doses, is character-ized by the gradual onset of proximal limb muscle weakness and may be accompanied by reduced respiratory muscle force.

That's one of many sources on the topic. Here are some others:
http://emedicine.medscape.com/article/313842-overview
http://emedicine.medscape.com/article/313842-clinical
http://www.uptodate.com/contents/glucocorticoid-induced-myopathy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784879/

Looks like Testa was right. Too much dopage.

Shut up, Drugs.

Ok, back to logic 101 we go!

In our last lesson we looked at Modus Ponens and Modus Tolens syllogistic forms of propositional logic. If you can't remember, check your notes.

Now, we move onto a new one, the Fallacy of the Affirmed Consequent (FAC)

It's form goes like this:

If A, then B
B, therefore A

This is a fallacious form as the consequent B can have many causes; one cannot assume the proposition A is true and sound - this as we know is called circular logic, or 'begging the question' by assuming that what's in question is already true.

Let's look at an example of FAC:

If a bike racer dopes with steroids, they will get mitochondrial myopathy (MM)
A bike racer has MM, therefore they doped with steroids.

We know abusing steroids can lead to MM, but a particular racer with MM may have acquired the disease in another way, such as, I dunno, getting shot with lead pellets.

Can class come up with some other examples? I'm off to shag my grad student honey.

 

[Dr.Guess]

Yes. Let's look at all the tdf winners and the logic behind Lemond being the only one who was clean. Logic 101.

 

[gillan1969]

Re:

Yes. Let's look at all the tdf winners and the logic behind Lemond being the only one who was clean. Logic 101.

I'm not sure anyone here is arguing that...I would have thought the only position you could only take that if one tour winner were clean he would be the most likely...my emphasis

This is pro cycling after all

in order to try and prove something/anything we have heard here how it was likely that not only was he the trailblazer in blood doping and epo but also now in steriods.....and doing them his whole career from a teenager

meanwhile, $300k or not....Armstrong enmeshed also on the american cycling scene for decades (some of them overlapping) and with far more resources embroiled in both a media and legal war with lemond...doesn't mention it once....

 

[sniper]

Re:

...snipped for brevity...

brilliant post, very insightful.
I think this post sets the standard for the discussion: those who argue against steroid-induced myopathy should really address it in detail.

I think I'm gonna go with the common steroid-induced myopathy hypothesis, until somebody addresses blutto's post in detail and makes something of a semi-plausible case as to why we should believe Lemond when he says the myopathy was genetic.

 

[sniper]

I think there's some misunderstanding. Myopathy is a disease of the muscles. Mitochondrial myopathy is a very particular form of myopathy and is *genetic* in cause. You can not dope your way to mitochondrial myopathy. Full stop.

John Swanson

Yeah well he was clean Brah. So no worries. I have no idea why you would have to worry about it.

It's funny. No doubt Lemond would have told the world if the myopathy was steroid-induced.

The "Lemond said so, and therefore it must be true" arguments...I'm honestly not sure how to address those kind of arguments, but it's tempting to do so with a shipload of sarcasm.
The double standards are insane. The same people who are in here taking Lemond's words as fact are ridiculing Team Sky's words when they say Henao is an altitude native, or Cancellara's when he says he didn't use a motor, or Simon Yates' when he claims he always was asthmatic. And did anybody ever take anything from Lance Armstrong's mouth as fact? Well if anybody ever did, we all know that that anybody would not survive long in the Clinic. Ridicule, sarcasm, and accusations of trolling would be his/her share.

Now, and I'm trying not to exaggerate, basically Scienceiscool's entire defense of Lemond is based on stuff from the horse's mouth, or on the words of dopers such as Phil Andersen vouching for him. Maybe Willy Voet or Yvan Vanmol somewhere also said something about Lemond being clean, too.

Here's the thing: if we're going to argue like that, we might as well close the Clinic.

Close the Sergio Henao thread already. His team, his coaches, his wife, the people who ride with him, hell, even the Colombian Cycling Federation, they all say he's an altitude native, and that all possible anomalies on his passport (if there are any) can be explained by that simple fact. Full stop.

Close the Cancellara motor threads already. He's sworn that he never used a motor. On multiple occasions. Very consistently. Riis has backed him up and said Cancellara simply has two of the most powerful legs in the game, so of course, if anyone can drive Boonen off his wheel on the Muur while seated, it's gonna be Cancellara. As it happens, there was also a bunch of journalists who were allowed to look at Cancellara's bike after De Ronde and after P-R. They all wrote about what they saw: no motor. And so the rumors about Cancellara using a motor are just ridiculous. Period.

Close the Froome threads already. He's shown us a fax from 2007 which shows that he always had the high VO2max. He just needed to loose some weight, which he did. So that satisfactorily explains his transformation. Just ask Jeroen Swart. End of.

Simon Yates...He and several of his colleagues have confirmed he really is asthmatic and has struggled with it all his life. I think if you ask his wife, she will confirm, too. Full stop.

If we're gonna take stuff from the horse's mouth as fact, let's at least do it consistently.
And give Lance his jerseys back already. I remember literally tons of people vouching for him. Why were we having all these Lance threads in the Clinic in the first place? Couldn't we just have taken his word for fact? He said he didn't dope didn't he? Said he never bribed the UCI. Verbruggen confirmed. End of story. Well, not really, but hey, it's Lance. And Lance was a bully. Lemond isn't.

Sarcasm aside, should anyone still insist on taking the words from Lemond (and his entourage) for fact, then at least do so consistently. For instance, there's an interview where he says "drugs came on the scene in the 90s" (http://bikeraceinfo.com/oralhistory/lemond.html). Who's he kidding there? I guess we can conclude he didn't see those blood transfusions in 1984 as doping.

There's another (only audio: http://competitorradio.competitor.com/2006/08/20greg-lemond/) interview where he says he only learned about EPO when a Spanish ONCE rider told him about it in 1993. Which is close to incredible, considering he invested large sums of money in the company that set out to commercialize EPO and considering in 1990 there is a newspaper article accusing him of introducing it.

In that same audio interview he makes the remarkable claim that, in two years after being released from the hospital, he didn't do one single blood test (until the Giro d'Italia 1989 of course, when he discovered why he was riding backwards). How likely is that? Well, he says so, so must be true I guess, even though he contradicts that claim in other interviews where he says he always did regular blood tests throughout his carreer (which, of course, makes sense, just that it doesn't fit the 1989 "sudden recovery" narrative).

In the same audio interview, he says EPO could have "sped up [my] recovery dramatically". But according to Scienceiscool and djpbaltimore, that is nonsense and we must suddenly assume that Lemond is ignorant on the matter. So when his words don't fit with the clean narrative, we just discard them like that. Easy. When his words do fit the narrative, we shall take them as fact. Same with the "two kidneys", I mean "one kidney". Whatever fits the narrative, we'll go with it.

Also, there are tons of interviews where he (or Jacome, or someone else close to Lemond) have claimed the only thing he ever took to enhance his performance was vitamin pills. One of many instances can be found here:

QS: There is a huge culture of the needle in cycling.
Greg: Well, they all took Vitamin B12 shots…I mean, who knows what else they took.
QS: You never succumbed?
Greg: Never. I took a multi-vitamin if I remembered to take a multi-vitamin...It might be every six weeks.

On closer inspection, it seems as if that claim doesn't quite correspond to the truth.

1989: After a few [iron] injections, he started to make a remarkable recovery.
https://www.washingtonpost.com/archive/lifestyle/1990/06/29/lemonds-self-made-miracle/eb9b3fe2-ee74-4b6d-9d65-b26484c27c14/

1991: Indeed, antibiotics helped tide LeMond through the three flat stages before the Alps.
http://www.si.com/vault/1991/08/05/124658/tour-de-courage-greg-lemond-fought-sickness-and-adversity-in-the-78th-tour-de-france-and-finished-a-hero-though-not-a-winner

1991: LeMond was forced to drop out of the Tour of Italy in June because he was suffering from fatigue. His father-in-law, Dave Morris, an immunologist, said the cause was never determined, but LeMond was getting regular blood tests. LeMond's lawyer, Nathan Jenkins, said the blood disorder was being treated with shots.

1993: Allergist David Morris, LeMond's father-in-law, said Greg is being treated with flu vaccine injections that help improve his immune system. http://articles.latimes.com/1993-07-03/sports/sp-9645_1_greg-lemond

Again, until somebody addresses blutto's post in detail and makes something of a semi-plausible case as to why we should believe Lemond when he says the myopathy was genetic, i'm gonna stick to the (much) more plausible hypothesis of steroid-induced myopathy.

 

[Fearless Greg Lemond]

No offence but I wonder if posters have read much of Hegel lately, if not, please try.

Game on.

[ pssst, perhaps Greg was on AIDS meds? ]

 

[sniper]

Re: Re:

Yes. Let's look at all the tdf winners and the logic behind Lemond being the only one who was clean. Logic 101.

I'm not sure anyone here is arguing that...

Trust me on this, people are and have been arguing it.

I would have thought the only position you could only take that if one tour winner were clean he would be the most likely...my emphasis

That's a fair position to take. But you'll agree that that still doesn't make him a likely clean TdF winner. And how does Hampsten fit in. Suddenly the two most likely clean GT winners happen to be American, emerging in the exact same period, beating highly doped riders from traditional cycling countries. What are the odds.

This is pro cycling after all

Indeed. And therefore, in the complete absence of evidence, the logical assumption is that he doped. If you want to challenge that common sense assumption, you have to face a burden of evidence and serious scrutiny of that evidence. That's all you're seeing here. Fair game I think.

in order to try and prove something/anything

See previous comment. The presumption of cleanliness, and the arguments/evidence to that extent, are the seed of the discussion.

we have heard here how it was likely that not only was he the trailblazer in blood doping

I don't remember anybody saying that.

and epo

according to this article http://postimg.org/image/vgxgqxt7f/ and severe rumors in the peloton. I think that warrants closer inspection.

but also now in steriods.....and doing them his whole career from a teenager

For the record, this is an attempt to scrutinize Testa's claim and place it against the newly surfaced Hagerman evidence. It sounds like you prefer we just leave that claim out there, not address it, and move on. Correct me if wrong.

meanwhile, $300k or not....Armstrong enmeshed also on the american cycling scene for decades (some of them overlapping) and with far more resources embroiled in both a media and legal war with lemond...doesn't mention it once....

Thanks for pointing this out, as it sheds important light on the conspiracy theory that Armstrong has been hiring spies and private detectives and offering big bucks to find dirt on Lemond. This stuff on Hagerman testing steroids then testing Lemond, Testa's claims on Lemond, the widespread EPO rumor, Nick777's doc, the 1990 whistleblower, Lemond's investment in Montgomery, the plausibility of steroid-induced myopathy and implausibility of genetic mitochondrial myopathy, the medically inexplicable iron-shot-transformation, Lemond's love for Eddie, Eddie's history, Jacome's history, Lemond's frequent use of the needle, the lack of testing at the Coors, US junior doping in Poland, Lemond traveling to Poland on Eddie's advice, USOC encouraging doping, to name just a few pieces of info that have emerged in the Clinic, it's all out there on the internet for anybody to access. I think Lance has had better things to do.

 

[Dr.Guess]

Brilliant sniper! Perhaps they (the defenders in here) are friends of LeMond. Then I would understand. Also if the case is "he's had a rough childhood, leave him be") (my own hypothesis). I would look into studies about the psyche of molested children. Just typing that sentence makes me angry and sad, and I understand said hypothesis if it would be the case.
I'm gonna do some googling myself about it.
Btw, LeMond was molested as a kid wasn't he? So that I haven't got that tiny bit wrong.

Edit: I'm speculating in the self esteem part and adulation from being the greatest American cyclist ever of course.

 

[Maxiton]

No offence but I wonder if posters have read much of Hegel lately, if not, please try.

Game on.

[ pssst, perhaps Greg was on AIDS meds? ]

The Geist of Performance and the Phenomenology of Cyclesport perhaps?

It seems to me Hegel is already here with us, but if you'd like to elaborate, by all means do so.

 

[blutto]

No offence but I wonder if posters have read much of Hegel lately, if not, please try.

Game on.

[ pssst, perhaps Greg was on AIDS meds? ]

....nice find that one....yeah that wasn't as cleanly laid out as it could have been....included that particular reference not to show the possibility that a particular drug was involved but to show that the use of drugs could produce a condition similar to/not unlike/exactly like mitochondrial myopathy which the quick drive-by google search shows is unequivocally hereditary....

.....find below another reference that kinda extends the post I made earlier....this from 2013....

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3561461/

Treatment of mitochondrial disease is still in its infancy. Aside from symptom-based management, treatment of mitochon-drial disease focuses on maintaining optimal health, using preventive measures to mitigate symptom worsening during times of physiologic stress (such as infection, dehydration, or surgery), and avoiding mitochondrial toxins.

Some evidence supports the use of antioxidant supplements aimed at reducing reactive oxygen species that are produced in increased amounts in this disease. The evidence for these and other treatments is still developing. Progress has been slow for several reasons: 1) Mitochondria have been linked to human disease only since the 1960s, and much of the knowledge has been discovered in the past 20 years. 2) Mitochondrial diseases are classified as rare disorders, so funding for research is limited when compared with more common ailments. 3) Similarly, because most treatments for mitochondrial diseases are categorized as medical foods, the financial incentive to study and develop these compounds is small. 4) Obtaining a standardized pool of patients for trials is difficult because of continually evolving diagnostic criteria, limited ability to establish molecular genetics–based diagnosis, fluctuations in symptom severity, and an overall lack of genotype-phenotype correlations.

....so to confirm....mitochondrial myopathy is a complex issue that has not enjoyed the same kind of research attention other more common ailments have attracted....read, medically its a bit of a mystery whose unravelling began around 23 years ago ( ironically around 1993 )....

....and...

No definitive means of halting disease progression is yet available, and the clinical ability to predict therapeutic responsiveness, achieve optimal dosing of medications, and quantify benefits in individual patients remains limited. The long-term benefits of treatment remain unproven

....and here is the other thing I didn't include in the earlier post....if LeMond indeed did have mitochondrial myopathy that was heredity based that disease would continue to march and he should be exhibiting more effects of the disease ( which include loss of motor skills, blindness, and deafness among others )...he should also be following the then SOTA strategy to mitigate the march of the disease, that is, to have a good diet and avoid abusing drugs and alcohol...but the fact is he is, and has been, overweight tending towards obesity and prone to alcohol abuse, with no march of the disease evident...

....now if the condition he was suffering from was the drug related shadow condition mentioned earlier the symptoms would disappear soon after the drug that was causing the problem left his system....

...so to summarize, the condition is still far from understood, and as a result it is still a fine medical swamp in which to bury a problem....

Cheers

 

[blutto]

Re: Re:

Hagerman testing anabolic steroids in the mid-70s, then doing testing on Lemond (and Heiden) at the OTC in the late 70s. It got me thinking again, firstly, about Testa's suggestion that Lemond basically had to quit because he'd doped too much and, secondly, about the rumors that his mitochondrial myopathy (which Lemond himself has credited as a, or even *the*, major factor in his decline) was a result of long-term drug (steroid) abuse.

Here's an example of what I'll dub the 'steroid-induced myopathy rumor', as put forward by an anonymous poster on some google-blog. The poster draws an interesting parallel with Thevenet:

My recollection from a few years back when the mitcondrial(sp?) myopathy story broke, is that one standard internal medicine text that I looked at, Clinton(?), noted that steroid abuse can cause such myopathy. Digging deeper in to the recesses of my brain, I recall Bernard Thevenet suffered a similar decline in his cycling career (he damn near fell off his bike during the 78 or 79 Giro due to fatigue) and stated publically that steroid abuse did cause him physical damage, renal and bone marrow I think. https://groups.google.com/forum/#!topic/rec.bicycles.racing/xAs5Ag1ABOY

And so I looked further into the myopathy issue to see if there is anything plausible about the rumor.

First thing worth noting is that when Lemond was diagnosed with myopathie he was in fact considered a very a-typical and unexpected myopathie patient:

http://articles.latimes.com/1994-12-04/sports/sp-4822_1_greg-lemond
“Rochelle Taube, LeMond's physician, said the disorder usually afflicts children and the elderly, adding it is the first known case diagnosed in a healthy person.”

Here's another source (in French) saying the same: http://www.humanite.fr/node/92565

The second thing I found is that drug-induced myopathy is in fact quite common:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092639/

A drug-induced, or toxic, myopathy is defined as the acute or subacute manifestation of myopathic symptoms such as muscle weakness, myalgia, creatine kinase elevation, or myoglobinuria that can occur in patients without muscle disease when they are exposed to certain drugs.

A particularly common and well-studied form of drug-induced myopathy is (cortico)steroid-induced myopathy:
http://erj.ersjournals.com/content/erj/5/8/997.full.pdf

In recent years renewed attention is being paid to the involvement of the resp
iratory muscles and its consequent significance in pulmonary patients. Two different clinical patterns of steroid-induced muscular changes are known. In acute myopathy and atrophy after short term treatment with high doses of steroids, generalized muscle atrophy and rhabdomyolysis occur, including the respiratory muscles. Chronic steroid myopathy, occurring after prolonged treatment with moderate doses, is character-ized by the gradual onset of proximal limb muscle weakness and may be accompanied by reduced respiratory muscle force.

That's one of many sources on the topic. Here are some others:
http://emedicine.medscape.com/article/313842-overview
http://emedicine.medscape.com/article/313842-clinical
http://www.uptodate.com/contents/glucocorticoid-induced-myopathy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784879/

Looks like Testa was right. Too much dopage.

Shut up, Drugs.

First thing worth noting is that when Lemond was diagnosed with myopathie he was in fact considered a very a-typical and unexpected myopathie patient:

http://articles.latimes.com/1994-12-04/sports/sp-4822_1_greg-lemond
“Rochelle Taube, LeMond's physician, said the disorder usually afflicts children and the elderly, adding it is the first known case diagnosed in a healthy person.”

Here's another source (in French) saying the same: http://www.humanite.fr/node/92565

....yep that LeMond guy is pretty special ain't he, and like in so many ways....and there are probably levels to his specialisticalness that we can only guess at, eh....though I'm sure they will become awfully apparent as the saga unfolds....

Cheers

 

[djpbaltimore]

Re:

It's funny. No doubt Lemond would have told the world if the myopathy was steroid-induced.

The "Lemond said so, and therefore it must be true" arguments...I'm honestly not sure how to address those kind of arguments, but it's tempting to do so with a shipload of sarcasm.
The double standards are insane. The same people who are in here taking Lemond's words as fact are ridiculing Team Sky's words when they say Henao is an altitude native, or Cancellara's when he says he didn't use a motor, or Simon Yates' when he claims he always was asthmatic. And did anybody ever take anything from Lance Armstrong's mouth as fact? Well if anybody ever did, we all know that that anybody would not survive long in the Clinic. Ridicule, sarcasm, and accusations of trolling would be his/her share.

Now, and I'm trying not to exaggerate, basically Scienceiscool's entire defense of Lemond is based on stuff from the horse's mouth, or on the words of dopers such as Phil Andersen vouching for him. Maybe Willy Voet or Yvan Vanmol somewhere also said something about Lemond being clean, too.

Here's the thing: if we're going to argue like that, we might as well close the Clinic.

Close the Sergio Henao thread already. His team, his coaches, his wife, the people who ride with him, hell, even the Colombian Cycling Federation, they all say he's an altitude native, and that all possible anomalies on his passport (if there are any) can be explained by that simple fact. Full stop.

Close the Cancellara motor threads already. He's sworn that he never used a motor. On multiple occasions. Very consistently. Riis has backed him up and said Cancellara simply has two of the most powerful legs in the game, so of course, if anyone can drive Boonen off his wheel on the Muur while seated, it's gonna be Cancellara. As it happens, there was also a bunch of journalists who were allowed to look at Cancellara's bike after De Ronde and after P-R. They all wrote about what they saw: no motor. And so the rumors about Cancellara using a motor are just ridiculous. Period.

Close the Froome threads already. He's shown us a fax from 2007 which shows that he always had the high VO2max. He just needed to loose some weight, which he did. So that satisfactorily explains his transformation. Just ask Jeroen Swart. End of.

Simon Yates...He and several of his colleagues have confirmed he really is asthmatic and has struggled with it all his life. I think if you ask his wife, she will confirm, too. Full stop.

If we're gonna take stuff from the horse's mouth as fact, let's at least do it consistently.
And give Lance his jerseys back already. I remember literally tons of people vouching for him. Why were we having all these Lance threads in the Clinic in the first place? Couldn't we just have taken his word for fact? He said he didn't dope didn't he? Said he never bribed the UCI. Verbruggen confirmed. End of story. Well, not really, but hey, it's Lance. And Lance was a bully. Lemond isn't.

Sarcasm aside, should anyone still insist on taking the words from Lemond (and his entourage) for fact, then at least do so consistently. For instance, there's an interview where he says "drugs came on the scene in the 90s" (http://bikeraceinfo.com/oralhistory/lemond.html). Who's he kidding there? I guess we can conclude he didn't see those blood transfusions in 1984 as doping.

There's another (only audio: http://competitorradio.competitor.com/2006/08/20greg-lemond/) interview where he says he only learned about EPO when a Spanish ONCE rider told him about it in 1993. Which is close to incredible, considering he invested large sums of money in the company that set out to commercialize EPO and considering in 1990 there is a newspaper article accusing him of introducing it.

In that same audio interview he makes the remarkable claim that, in two years after being released from the hospital, he didn't do one single blood test (until the Giro d'Italia 1989 of course, when he discovered why he was riding backwards). How likely is that? Well, he says so, so must be true I guess, even though he contradicts that claim in other interviews where he says he always did regular blood tests throughout his carreer (which, of course, makes sense, just that it doesn't fit the 1989 "sudden recovery" narrative).

In the same audio interview, he says EPO could have "sped up [my] recovery dramatically". But according to Scienceiscool and djpbaltimore, that is nonsense and we must suddenly assume that Lemond is ignorant on the matter. So when his words don't fit with the clean narrative, we just discard them like that. Easy. When his words do fit the narrative, we shall take them as fact. Same with the "two kidneys", I mean "one kidney". Whatever fits the narrative, we'll go with it.

Also, there are tons of interviews where he (or Jacome, or someone else close to Lemond) have claimed the only thing he ever took to enhance his performance was vitamin pills. One of many instances can be found here:

QS: There is a huge culture of the needle in cycling.
Greg: Well, they all took Vitamin B12 shots…I mean, who knows what else they took.
QS: You never succumbed?
Greg: Never. I took a multi-vitamin if I remembered to take a multi-vitamin...It might be every six weeks.

On closer inspection, it seems as if that claim doesn't quite correspond to the truth.

1989: After a few [iron] injections, he started to make a remarkable recovery.
https://www.washingtonpost.com/archive/lifestyle/1990/06/29/lemonds-self-made-miracle/eb9b3fe2-ee74-4b6d-9d65-b26484c27c14/

1991: Indeed, antibiotics helped tide LeMond through the three flat stages before the Alps.
http://www.si.com/vault/1991/08/05/124658/tour-de-courage-greg-lemond-fought-sickness-and-adversity-in-the-78th-tour-de-france-and-finished-a-hero-though-not-a-winner

1991: LeMond was forced to drop out of the Tour of Italy in June because he was suffering from fatigue. His father-in-law, Dave Morris, an immunologist, said the cause was never determined, but LeMond was getting regular blood tests. LeMond's lawyer, Nathan Jenkins, said the blood disorder was being treated with shots.

1993: Allergist David Morris, LeMond's father-in-law, said Greg is being treated with flu vaccine injections that help improve his immune system. http://articles.latimes.com/1993-07-03/sports/sp-9645_1_greg-lemond

Again, until somebody addresses blutto's post in detail and makes something of a semi-plausible case as to why we should believe Lemond when he says the myopathy was genetic, i'm gonna stick to the (much) more plausible hypothesis of steroid-induced myopathy.

Do you see the implicit inconsistency in the two bolded statements? You seem to want to take LeMond at his word only when it suits your opinion. Please quote where I have called any of his statements 'nonsense' as you have implied. Otherwise, that is a poor strawman. My arguments about LeMond don't rely on the veracity of any of his statements. IMO, his claims about 70% blood loss would lend me to believe that he is no expert in medicine. But at the end of the day, none of his ailments were medical conditions that required EPO and many came before EPO was ever in use clinically. Whenever I ask this question, nobody answers... Do you find it likely that he was prescribed EPO at any time in his life?

 

[Semper Fidelis]

Re: Re:

Do you see the implicit inconsistency in the two bolded statements? You seem to want to take LeMond at his word only when it suits your opinion. Please quote where I have called any of his statements 'nonsense' as you have implied. Otherwise, that is a poor strawman. My arguments about LeMond don't rely on the veracity of any of his statements. IMO, his claims about 70% blood loss would lend me to believe that he is no expert in medicine. But at the end of the day, none of his ailments were medical conditions that required EPO and many came before EPO was ever in use clinically. Whenever I ask this question, nobody answers... Do you find it likely that he was prescribed EPO at any time in his life?

Nitpicking here but there is more than 2 bolded statements. Anyhow I think everyone uses LeMonds words to suit their opinion. The REASON is LeMond himself. HE IS so dam inconsistent with his opinions on his self diagnoses for illness, his own health and cycling ups and downs.

 

[djpbaltimore]

Re: Re:

Nitpicking here but there is more than 2 bolded statements. Anyhow I think everyone uses LeMonds words to suit their opinion. The REASON is LeMond himself. HE IS so dam inconsistent with his opinions on his self diagnoses for illness, his own health and cycling ups and downs.

Point taken. The statements that I have bolded regarding the horse's mouth argument.

Agreed about LeMond and his inconsistent statements. No argument there.

Personally, I find this commentary about LeMond the most plausible.

http://www.nejm.org/doi/full/10.1056/NEJM199601253340415

 

[sniper]

Re: Re:

...
Do you see the implicit inconsistency in the two bolded statements?

to be honest, no i don't.

You're overlooking two things:

Firstly, I'm not taking, and have never taken, his statement on EPO as fact. As plausible, yes. As fact, no.
Scienceiscool on the other hand presents the genetic mitochondrial myopathy as fact ("Full stop").


Secondly, and most importantly, you fail to differentiate between
A. statements that Lemond does have a (clear) motivation to invent and/or lie about;
B. statements Lemond does not have a (clear) motivation to invent and/or lie about.
This distinction is crucial: type A statements should obviously be taken with (a lot) more caution than type B statements.
The "EPO would have sped up my recovery" statement doesn't really benefit his "clean athlete" narrative, and so he would not have had any plausible reason to just make it up (--> type B statement).
The genetic mitochondrial myopathie, on the other hand, is a 'fact' that obviously serves his narrative of being a clean athlete, and thus it's something he has a rather straightforward motivation to lie about (--> type A statement).
To make this point clearer still, Lance may again serve as a case in point:
(i) Lance claimed he was clean and (ii) Lance admitted he trained with Ferrari.
Now, statement (i) was widely met with much doubt and scepsis; statement (ii) wasn't, and for obvious reasons: he had a clear motivation to lie about (i) (--> statement type A), but no clear motivation to invent (ii) (--> statement type B).

 

[blutto]

Re: Re:

Nitpicking here but there is more than 2 bolded statements. Anyhow I think everyone uses LeMonds words to suit their opinion. The REASON is LeMond himself. HE IS so dam inconsistent with his opinions on his self diagnoses for illness, his own health and cycling ups and downs.

Point taken. The statements that I have bolded regarding the horse's mouth argument.

Agreed about LeMond and his inconsistent statements. No argument there.

Personally, I find this commentary about LeMond the most plausible.

http://www.nejm.org/doi/full/10.1056/NEJM199601253340415

...so if the comments are more or less correct why did LeMond continue to explain his loss of form as a function of mitochondrial myopathy....

Cheers

 

[ScienceIsCool]

Re: Re:

Nitpicking here but there is more than 2 bolded statements. Anyhow I think everyone uses LeMonds words to suit their opinion. The REASON is LeMond himself. HE IS so dam inconsistent with his opinions on his self diagnoses for illness, his own health and cycling ups and downs.

Point taken. The statements that I have bolded regarding the horse's mouth argument.

Agreed about LeMond and his inconsistent statements. No argument there.

Personally, I find this commentary about LeMond the most plausible.

http://www.nejm.org/doi/full/10.1056/NEJM199601253340415

...so if the comments are more or less correct why did LeMond continue to explain his lose of form as a function of mitochondrial myopathy....

Cheers

When I read that it sounds like the most likely scenario is that he was misdiagnosed with mitochondrial myopathy because of otherwise explainable mitochondrial abnormalities from a muscle biopsy. His performance went off a cliff in 93/94 and this was probably an easy diagnosis to latch onto.

So I guess it's still unexplained why his performance cratered. Or it could be a combination of things plus the rise of EPO.

John Swanson

 

[djpbaltimore]

Re: Re:

to be honest, no i don't.

You're overlooking two things:

Firstly, I'm not taking, and have never taken, his statement on EPO as fact. As plausible, yes. As fact, no.
Scienceiscool on the other hand presents the genetic mitochondrial myopathy as fact ("Full stop").


Secondly, and most importantly, you fail to differentiate between
A. statements that Lemond does have a (clear) motivation to invent and/or lie about;
B. statements Lemond does not have a (clear) motivation to invent and/or lie about.
This distinction is crucial: type A statements should obviously be taken with (a lot) more caution than type B statements.
The "EPO would have sped up my recovery" statement doesn't really benefit his "clean athlete" narrative, and so he would not have had any plausible reason to just make it up (--> type B statement).
The genetic mitochondrial myopathie, on the other hand, is a 'fact' that obviously serves his narrative of being a clean athlete, and thus it's something he has a rather straightforward motivation to lie about (--> type A statement).
To make this point clearer still, Lance may again serve as a case in point:
(i) Lance claimed he was clean and (ii) Lance admitted he trained with Ferrari.
Now, statement (i) was widely met with much doubt and scepsis; statement (ii) wasn't, and for obvious reasons: he had a clear motivation to lie about (i) (--> statement type A), but no clear motivation to invent (ii) (--> statement type B).

You missed my point entirely. I don't think LeMond is necessarily lying about his medical condition. A lot of people present false medical information because they don't have the requisite level of understanding to adequately explain themselves or they were misdiagnosed.

@blutto. I don't know. John does make a reasonable argument. Diagnoses are not always as clear cut as you see in a medical textbook.

 

[sniper]

Re: Re:

...

You missed my point entirely. I don't think LeMond is necessarily lying about his medical condition. A lot of people present false medical information because they don't have the requisite level of understanding to adequately explain themselves or they were misdiagnosed.

fair enough.

But is his 'level of [medical] understanding' that bad that he doesn't even know the difference between a vitamin pill and flu-vaccin injections? (see second part of this post: viewtopic.php?p=1914773#p1914773)

And why would he claim not to have done a single blood test during two years after the shooting. He said he had the first one during the Giro 1989, which for someone with his entourage and medical history doesn't make sense at all.
And in two other interviews he contradicts this with statements which, in turn, contradict each other. So there are three versions in total about when he had his blood tested.
This and several other inconsistencies in his background story (e.g. wrt when he allegedly first 'learned' about EPO) really do not have much (if anything) to do with what you call "having the requisite level of [medical] understanding to adequately explain oneselve".

If he has something to hide and is lying or deliberately not telling the whole truth, such inconsistencies wrt crucial issues make perfect sense.

 

[djpbaltimore]

Context is key. He is clearly referring to PEDs and supplements, not medicine, so your point is moot.

I already noted the inconsistencies of his statements earlier in this thread. I don't know why you are conflating my opinion in general with an opinion I made in respect to a specific situation (i.e EPO for recovery). You still have yet to answer my question. Do you think he was ever prescribed EPO for any of his treatments? If so, for which one?