Wiggins, Clinic respect?

[gillan1969]

Re: Re:

What rubs me wrong in Parker's post is that he tries to paint Triamcinolone as a perfectly reasonable treatment for asthma/allergies and people who disagree has not having the athlete best interests in mind.

The Lotto doctor seemed to think it was reasonable treatment when he offered it to Wellens during last year's Tour.

yup...Wellens had to withdraw...because he was.....eh...ill

Froome and Wiggins 'smashed it' (I think the term is) because....eh...they weren't

so...a reasonable treatment when ill...I think we agree on that

 

[samhocking]

Re: Re:

What rubs me wrong in Parker's post is that he tries to paint Triamcinolone as a perfectly reasonable treatment for asthma/allergies and people who disagree has not having the athlete best interests in mind.

The Lotto doctor seemed to think it was reasonable treatment when he offered it to Wellens during last year's Tour.

Was it triamcinolone or another form of corticosteroid? What was Wellens exact condition? It wasn't pollen allergies but something to do with the heat. Lotto is a pretty old school team, it doesn't surprise me at all that they would do that, it's wrong, and Wellens knew better than to take it, kudos to him.

So about the OOC use?

It was heat allergies, similar allergic reaction issue as Wiggins, just triggered by heat not pollen. The treatment Wellens doctor wanted to give him would have been for triamcinolone via intra-muscular using a TUE, same as Wiggins and why Wellens refused it, because he didn't want to be seen as a cheat in the eye of the public, even though nobody would have known unless Fancy bears do another hack lol. That's a pretty sad situation with TUE suspicion is so high, even legitimate use is considered cheating. Obviously we would have had just as little proof his heat allergy was not faked though, even if leaked, so he was probably correct to pull out I guess.

 

[ColonelKidneyBeans]

Re: Re:

What rubs me wrong in Parker's post is that he tries to paint Triamcinolone as a perfectly reasonable treatment for asthma/allergies and people who disagree has not having the athlete best interests in mind.

The Lotto doctor seemed to think it was reasonable treatment when he offered it to Wellens during last year's Tour.

Was it triamcinolone or another form of corticosteroid? What was Wellens exact condition? It wasn't pollen allergies but something to do with the heat. Lotto is a pretty old school team, it doesn't surprise me at all that they would do that, it's wrong, and Wellens knew better than to take it, kudos to him.

So about the OOC use?

It was heat allergies, same immune issue as Wiggins, just triggered by heat not pollen. The treatment Wellens doctor wanted to give him would have been triamcinolone intra-muscular using a TUE, same as Wiggins and why Wellens refused it because he didn't want to be seen as a cheat. Hat's the sad situation, suspicion is so high, even legitimate use is considered cheating. Obviously we would have had just as little proof his heat allergy was real, so he was probably correct to pull out as it would have looked suspicious to those that think that way about TUEs.

Wellens is citing health reasons for his refusal of the TUE, he doesn't even take salbutamol, so i think you are misrepresenting the issue, it's not that he didn't want to pass for a cheat, it's that according to him it is cheating and detrimental to his health.

 

[Parker]

Re: Re:

Wellens is citing health reasons for his refusal of the TUE, he doesn't even take salbutamol, so i think you are misrepresenting the issue, it's not that he didn't want to pass for a cheat, it's that according to him it is cheating and detrimental to his health.

Lotto said he turned it down for ethical reasons. He tried to keep on riding so I'm not sure he was that bothered by his health.

 

[ColonelKidneyBeans]

Re: Re:

Wellens is citing health reasons for his refusal of the TUE, he doesn't even take salbutamol, so i think you are misrepresenting the issue, it's not that he didn't want to pass for a cheat, it's that according to him it is cheating and detrimental to his health.

Lotto said he turned it down for ethical reasons. He tried to keep on riding so I'm not sure he was that bothered by his health.

Yeah, the guy who refused to take corticosteroids and finally gave up doesn't care about his health, he should do it like team sky and soldier on with medications, that's being health conscious...
Do i smell doublethink?
And the OOC use, was it justified?

 

[gillan1969]

Re: Re:

What rubs me wrong in Parker's post is that he tries to paint Triamcinolone as a perfectly reasonable treatment for asthma/allergies and people who disagree has not having the athlete best interests in mind.

The Lotto doctor seemed to think it was reasonable treatment when he offered it to Wellens during last year's Tour.

Was it triamcinolone or another form of corticosteroid? What was Wellens exact condition? It wasn't pollen allergies but something to do with the heat. Lotto is a pretty old school team, it doesn't surprise me at all that they would do that, it's wrong, and Wellens knew better than to take it, kudos to him.

So about the OOC use?

It was heat allergies, similar allergic reaction issue as Wiggins, just triggered by heat not pollen. The treatment Wellens doctor wanted to give him would have been for triamcinolone via intra-muscular using a TUE, same as Wiggins and why Wellens refused it, because he didn't want to be seen as a cheat in the eye of the public, even though nobody would have known unless Fancy bears do another hack lol. That's a pretty sad situation with TUE suspicion is so high, even legitimate use is considered cheating. Obviously we would have had just as little proof his heat allergy was not faked though, even if leaked, so he was probably correct to pull out I guess.

well...you might use other factors to assess whether it was fake...he lost 30 mins the day before he withdrew...so...it looks as though something is wrong

Wiggins and Froome on the other hand look as though they're faking it because they're...eh...winning

this stuff is simple

 

[King Boonen]

Re: Re:

I have to disagree. I think if you were to ask any fan if their favourite athlete/team members should be allowed a steroid injection for pain relief so they can compete, the vast majority would say yes. There's plenty of empirical evidence to support this and other poor health-related medical decisions in sport, such as the problems with concussion in contact sports, to back up an assertion that most people would be happy for it to happen. I remember on the video of the 1997 Lions Tour there was footage of Martin Johnson receiving injections while off the field for a blood injury so that he could continue. It's extremely common in professional sport and there is little to no outrage. I Believe Ledley King was only able to have a football career because of continuous steroid injections in his knee. I've known rugby league players in similar positions, both in the UK and Australia and I'm sure it happens in football, cricket, basketball and so on.

Sadly i think you're right, but it is very wrong IMHO, an elite sport career is already unhealthy, there's no need to add medications that are potentially harmful on top of that, especially if it's to allow you to play/ride injured.
What rubs me wrong in Parker's post is that he tries to paint Triamcinolone as a perfectly reasonable treatment for asthma/allergies and people who disagree has not having the athlete best interests in mind. I wonder if the OOC use described in the report was also completely justified and with the athlete health as the prime motivation?

Yes, it's very, very wrong and I'm almost certain it's a symptom of professional sport. Bigger, faster, stronger but harder and more impact. It all takes its toll on the body and using drugs to suppress that seems a sure fire way to end up with serious problems.It's fine in the short term to allow people to rest and heal, but that's not happening. Personally I try to avoid it as much as possible when I have injuries (as I currently do).

I read Parkers posts differently, I think the point they are making is that, in terms of getting an athlete to the start line in shape and ready to perform, the TA injection is legitimate (seems like a small point but it's not triamcinolone, it's triamcinolone acetonide which is much, much longer acting). It's hard to determine if it's in his best interest as an imuno-suppressant. There are risks using such long acting imuno-suppressant drugs in people who are going to be exposed to the elements. Actually, now I think about it, didn't he have an injection just before the 2013 Giro? And had to withdraw due to a chest infection? I doubt that's a coincidence, it is very possible that using TA opened him up to a serious infection his body might well have dealt with had he not taken it.

However, a one-time injection, before a 3 week race where you are moving thousands of kilometres would seem like a very logical time to use a treatment that lasts for 4 weeks, if you want the rider at their best on the start line. Biological half-lives of the other corticosteroids people have mentioned are short, intense exercise may well shorten them more, and this could easily result in doctors having to manage symptoms literally in the middle of a stage, possibly multiple times over the course of a race. You may put the athlete at risk if you attempt to manage it over the shorter term or it may work better, it's a tough call. Now, I'm sure others do just that, but if you are going to allow treatment then I think you need to allow what could be the most effective. The ethics behind this, whether it should be allowed etc. are a separate issue that's interesting but I think ultimately unfair to pin on Wiggins. Brailsford, yes. The medical staff, because ultimately it is up to the doctor, yes.

The issue is really if the TUEs were a way of covering up a program. At least, that's my problem with it. The single injections before GT's I don't think are that much of an issue.


The OOC use is speculation based on an anonymous source, Sky's speculation on how many of the 55 vials were actually used on riders (which is very hard to believe. If it was used to treat staff then there should be records in their medical files. Freeman can't have lost everything) and their refusal to say how many riders were treated. It could well be legitimate, although personally I would favour less drastic treatment when not racing as it's easier to manage the condition.

For me the real issues here are Sky, BC, Brailsford and Freeman/the medical staff. The evidence certainly points to them. If, and it's a very big if, Wiggins is telling the truth and he really was just using it as a treatment when required and nothing else (he's not a doctor so he needs to be able to trust the medical staff when they say this is what we need to do), then he's essentially been caught up in a massive mess. That is very, very difficult to believe though.

 

[53*11]

Re: Re:

Other cases would be Murray having Corticosteroid and painkiller injections moments before a match in Monte Carlo iirc at the side of the court in order to carry on playing. That is the reality of professional sports, athletes are often ill and injured and Triamcinolone is a standard fix for many issues they face and organisers, fans, sponsors and themselves want to continue.

Last year Andrew Flintoff said he had had 90 cortisone injections during his career. No-one thought that this was even newsworthy.

i think we would all agree that other sports are worse/far worse and have less regulation / repercussions than cycling, but we are on a cycling discussion forum here.

 

[53*11]

Re:

Well Allergies & Asthma is an incurable disease, not a temporary illness or injury that can be fixed with Triamcinolone, so pretty different. For injury Triamcinolone is the fix to get you better more quickly, for Allergies it isn't a fix, simply taken when you are well to prevent a possible attack that might or might not happen to you at some point in the future, but when it does will be pretty bad if you hadn't. As Wiggins said recently, without it, had he had an allergic reaction passing through a field in Tour de France, he would have lost the Tour de France whatever that day might have been.

The main point is if you apply for a TUE for injury, that injection would be intra-articular. There would be very little if no performance enhancement because that route of adminstration is not a systemic corticosteroid treatment, it's local. Wiggins treatment has to be systemic, so is intra-muscular, therefore highly unlikely it would be granted easily.

It all comes down to the ENT specialists report in his TUE. The notes say, pre-2011 he was on maximial therapy treatment for >3 years that wasn't effective according to the RAST tests etc. That means maximum oral, topical and inhaled steroids were not effective at returning him to normal level during the RAST. Next step after maximal therapy has been exhausted and 3 years would be considered long-enough is only Triamcinolone injection, there is no other method and plenty of sufferes are still treated this way if not benefiting from maximial therapy during hayfever season.

You either believe that maximal therapy happened or you don't. Clearly if you look at his TUEs at FdeJ, Cofidis, High Road & Garmin he was often on maximal therapy using topical, oral and inhales corticosteroids, so wasn't invented at Sky at all. His medical TUE history for asthma and allergies looking at what doctors were prescribing him to dea lwith them goes back to 2003 at FdeJ via French Anti-Doping long before Zorzoli.

this bit , most doctors do not prescribe triamcinolone for allergies no matter how bad,m it isnt a first or second linbe drug for that condition; except of course those paid doctors on cycling teams do seem to prefer it for those 'allergies'

 

[ColonelKidneyBeans]

Re: Re:

I have to disagree. I think if you were to ask any fan if their favourite athlete/team members should be allowed a steroid injection for pain relief so they can compete, the vast majority would say yes. There's plenty of empirical evidence to support this and other poor health-related medical decisions in sport, such as the problems with concussion in contact sports, to back up an assertion that most people would be happy for it to happen. I remember on the video of the 1997 Lions Tour there was footage of Martin Johnson receiving injections while off the field for a blood injury so that he could continue. It's extremely common in professional sport and there is little to no outrage. I Believe Ledley King was only able to have a football career because of continuous steroid injections in his knee. I've known rugby league players in similar positions, both in the UK and Australia and I'm sure it happens in football, cricket, basketball and so on.

Sadly i think you're right, but it is very wrong IMHO, an elite sport career is already unhealthy, there's no need to add medications that are potentially harmful on top of that, especially if it's to allow you to play/ride injured.
What rubs me wrong in Parker's post is that he tries to paint Triamcinolone as a perfectly reasonable treatment for asthma/allergies and people who disagree has not having the athlete best interests in mind. I wonder if the OOC use described in the report was also completely justified and with the athlete health as the prime motivation?

Yes, it's very, very wrong and I'm almost certain it's a symptom of professional sport. Bigger, faster, stronger but harder and more impact. It all takes its toll on the body and using drugs to suppress that seems a sure fire way to end up with serious problems.It's fine in the short term to allow people to rest and heal, but that's not happening. Personally I try to avoid it as much as possible when I have injuries (as I currently do).

I read Parkers posts differently, I think the point they are making is that, in terms of getting an athlete to the start line in shape and ready to perform, the TA injection is legitimate (seems like a small point but it's not triamcinolone, it's triamcinolone acetonide which is much, much longer acting). It's hard to determine if it's in his best interest as an imuno-suppressant. There are risks using such long acting imuno-suppressant drugs in people who are going to be exposed to the elements. Actually, now I think about it, didn't he have an injection just before the 2013 Giro? And had to withdraw due to a chest infection? I doubt that's a coincidence, it is very possible that using TA opened him up to a serious infection his body might well have dealt with had he not taken it.

However, a one-time injection, before a 3 week race where you are moving thousands of kilometres would seem like a very logical time to use a treatment that lasts for 4 weeks, if you want the rider at their best on the start line. Biological half-lives of the other corticosteroids people have mentioned are short, intense exercise may well shorten them more, and this could easily result in doctors having to manage symptoms literally in the middle of a stage, possibly multiple times over the course of a race. You may put the athlete at risk if you attempt to manage it over the shorter term or it may work better, it's a tough call. Now, I'm sure others do just that, but if you are going to allow treatment then I think you need to allow what could be the most effective. The ethics behind this, whether it should be allowed etc. are a separate issue that's interesting but I think ultimately unfair to pin on Wiggins. Brailsford, yes. The medical staff, because ultimately it is up to the doctor, yes.

The issue is really if the TUEs were a way of covering up a program. At least, that's my problem with it. The single injections before GT's I don't think are that much of an issue.


The OOC use is speculation based on an anonymous source, Sky's speculation on how many of the 55 vials were actually used on riders (which is very hard to believe. If it was used to treat staff then there should be records in their medical files. Freeman can't have lost everything) and their refusal to say how many riders were treated. It could well be legitimate, although personally I would favour less drastic treatment when not racing as it's easier to manage the condition.

For me the real issues here are Sky, BC, Brailsford and Freeman/the medical staff. The evidence certainly points to them. If, and it's a very big if, Wiggins is telling the truth and he really was just using it as a treatment when required and nothing else (he's not a doctor so he needs to be able to trust the medical staff when they say this is what we need to do), then he's essentially been caught up in a massive mess. That is very, very difficult to believe though.

I completely agree with you on the point that it is the medical staff responsibility and not Wiggins/Brailsford, and that's why i think it's disgusting, because they are medical professional and should think about the health, not the performance. I knew that it was triamcinolone acetonide, i was just too lazy to wrote it all btw, my bad.
Completely agree on the immuno-suppressant capabilities of corticosteroids, i actually made that point about Froome upthread, how i think that his TUE for prednisolone in Romandie didn't make any sense: so he has a chest infection that needs oral prednisolone to clear his airways, and the doctors are happy to send him on his merry way to ride in the cold, rainy mountain of romandie, while under an immunosuppressing drug, that's the perfect way to get pneumonia...
I understand where you're getting at about the practicality of an IM injection of kenacort, but personally i would no take that for allergies unless they are completely debilitating. That Wiggins was able to win the tour suggest that they weren't that bad.
I don't know if we should call the OOC use speculation at this point, the rumours are practically as old as team sky, and there is a lot of evidence about it.
Still i can't believe that it's all there is to it, you don't transform riders that way with "just" TUE/non-Tue medication abuse, there as to be some kind of blood manipulation/use of metabolic modulators somewhere.

 

[samhocking]

Re: Re:

Well Allergies & Asthma is an incurable disease, not a temporary illness or injury that can be fixed with Triamcinolone, so pretty different. For injury Triamcinolone is the fix to get you better more quickly, for Allergies it isn't a fix, simply taken when you are well to prevent a possible attack that might or might not happen to you at some point in the future, but when it does will be pretty bad if you hadn't. As Wiggins said recently, without it, had he had an allergic reaction passing through a field in Tour de France, he would have lost the Tour de France whatever that day might have been.

The main point is if you apply for a TUE for injury, that injection would be intra-articular. There would be very little if no performance enhancement because that route of adminstration is not a systemic corticosteroid treatment, it's local. Wiggins treatment has to be systemic, so is intra-muscular, therefore highly unlikely it would be granted easily.

It all comes down to the ENT specialists report in his TUE. The notes say, pre-2011 he was on maximial therapy treatment for >3 years that wasn't effective according to the RAST tests etc. That means maximum oral, topical and inhaled steroids were not effective at returning him to normal level during the RAST. Next step after maximal therapy has been exhausted and 3 years would be considered long-enough is only Triamcinolone injection, there is no other method and plenty of sufferes are still treated this way if not benefiting from maximial therapy during hayfever season.

You either believe that maximal therapy happened or you don't. Clearly if you look at his TUEs at FdeJ, Cofidis, High Road & Garmin he was often on maximal therapy using topical, oral and inhales corticosteroids, so wasn't invented at Sky at all. His medical TUE history for asthma and allergies looking at what doctors were prescribing him to dea lwith them goes back to 2003 at FdeJ via French Anti-Doping long before Zorzoli.

this bit , most doctors do not prescribe triamcinolone for allergies no matter how bad,m it isnt a first or second linbe drug for that condition; except of course those paid doctors on cycling teams do seem to prefer it for those 'allergies'

What are you talking about. Tim Wellens refused a corticosteroid injection under TUE that his own Team Doctor was wanting to give him so he could continue the race. That's 2 riders we already know out of a recent peloton of 200 in one single race and that's only ones that was leaked or bothered to talk about it. If that's 2 in 200 known, there's clearly more we never hear about so it is more normal than you think.

 

[samhocking]

Re: Re:

Wellens is citing health reasons for his refusal of the TUE, he doesn't even take salbutamol, so i think you are misrepresenting the issue, it's not that he didn't want to pass for a cheat, it's that according to him it is cheating and detrimental to his health.

Lotto said he turned it down for ethical reasons. He tried to keep on riding so I'm not sure he was that bothered by his health.

Wellens also later confirmed he turned down the Triamcinolone TUE for fear of reputational damage if he took it.

Cycling is in real danger of soon to be deciding its medical policy by social media. Things are going to get much worse if we allow that to happen. We are at the tipping point already of both innocent until guilty while also stepping over into guilty until innocent and that is a sign of a broken lynch mob ethic almost. It's very broken already I feel.

 

[King Boonen]

Re: Re:

I have to disagree. I think if you were to ask any fan if their favourite athlete/team members should be allowed a steroid injection for pain relief so they can compete, the vast majority would say yes. There's plenty of empirical evidence to support this and other poor health-related medical decisions in sport, such as the problems with concussion in contact sports, to back up an assertion that most people would be happy for it to happen. I remember on the video of the 1997 Lions Tour there was footage of Martin Johnson receiving injections while off the field for a blood injury so that he could continue. It's extremely common in professional sport and there is little to no outrage. I Believe Ledley King was only able to have a football career because of continuous steroid injections in his knee. I've known rugby league players in similar positions, both in the UK and Australia and I'm sure it happens in football, cricket, basketball and so on.

Sadly i think you're right, but it is very wrong IMHO, an elite sport career is already unhealthy, there's no need to add medications that are potentially harmful on top of that, especially if it's to allow you to play/ride injured.
What rubs me wrong in Parker's post is that he tries to paint Triamcinolone as a perfectly reasonable treatment for asthma/allergies and people who disagree has not having the athlete best interests in mind. I wonder if the OOC use described in the report was also completely justified and with the athlete health as the prime motivation?

Yes, it's very, very wrong and I'm almost certain it's a symptom of professional sport. Bigger, faster, stronger but harder and more impact. It all takes its toll on the body and using drugs to suppress that seems a sure fire way to end up with serious problems.It's fine in the short term to allow people to rest and heal, but that's not happening. Personally I try to avoid it as much as possible when I have injuries (as I currently do).

I read Parkers posts differently, I think the point they are making is that, in terms of getting an athlete to the start line in shape and ready to perform, the TA injection is legitimate (seems like a small point but it's not triamcinolone, it's triamcinolone acetonide which is much, much longer acting). It's hard to determine if it's in his best interest as an imuno-suppressant. There are risks using such long acting imuno-suppressant drugs in people who are going to be exposed to the elements. Actually, now I think about it, didn't he have an injection just before the 2013 Giro? And had to withdraw due to a chest infection? I doubt that's a coincidence, it is very possible that using TA opened him up to a serious infection his body might well have dealt with had he not taken it.

However, a one-time injection, before a 3 week race where you are moving thousands of kilometres would seem like a very logical time to use a treatment that lasts for 4 weeks, if you want the rider at their best on the start line. Biological half-lives of the other corticosteroids people have mentioned are short, intense exercise may well shorten them more, and this could easily result in doctors having to manage symptoms literally in the middle of a stage, possibly multiple times over the course of a race. You may put the athlete at risk if you attempt to manage it over the shorter term or it may work better, it's a tough call. Now, I'm sure others do just that, but if you are going to allow treatment then I think you need to allow what could be the most effective. The ethics behind this, whether it should be allowed etc. are a separate issue that's interesting but I think ultimately unfair to pin on Wiggins. Brailsford, yes. The medical staff, because ultimately it is up to the doctor, yes.

The issue is really if the TUEs were a way of covering up a program. At least, that's my problem with it. The single injections before GT's I don't think are that much of an issue.


The OOC use is speculation based on an anonymous source, Sky's speculation on how many of the 55 vials were actually used on riders (which is very hard to believe. If it was used to treat staff then there should be records in their medical files. Freeman can't have lost everything) and their refusal to say how many riders were treated. It could well be legitimate, although personally I would favour less drastic treatment when not racing as it's easier to manage the condition.

For me the real issues here are Sky, BC, Brailsford and Freeman/the medical staff. The evidence certainly points to them. If, and it's a very big if, Wiggins is telling the truth and he really was just using it as a treatment when required and nothing else (he's not a doctor so he needs to be able to trust the medical staff when they say this is what we need to do), then he's essentially been caught up in a massive mess. That is very, very difficult to believe though.

I completely agree with you on the point that it is the medical staff responsibility and not Wiggins/Brailsford, and that's why i think it's disgusting, because they are medical professional and should think about the health, not the performance. I knew that it was triamcinolone acetonide, i was just too lazy to wrote it all btw, my bad.
Completely agree on the immuno-suppressant capabilities of corticosteroids, i actually made that point about Froome upthread, how i think that his TUE for prednisolone in Romandie didn't make any sense: so he has a chest infection that needs oral prednisolone to clear his airways, and the doctors are happy to send him on his merry way to ride in the cold, rainy mountain of romandie, while under an immunosuppressing drug, that's the perfect way to get pneumonia...
I understand where you're getting at about the practicality of an IM injection of kenacort, but personally i would no take that for allergies unless they are completely debilitating. That Wiggins was able to win the tour suggest that they weren't that bad.
I don't know if we should call the OOC use speculation at this point, the rumours are practically as old as team sky, and there is a lot of evidence about it.
Still i can't believe that it's all there is to it, you don't transform riders that way with "just" TUE/non-Tue medication abuse, there as to be some kind of blood manipulation/use of metabolic modulators somewhere.

To clarify, I think Brailsford needs to take some blame, purely because the medical staff weren't independent. If they were then fine, but as they're not he ultimately carries some blame.

The bold bit is the difficult bit. Would he have won the Tour with no allergy? Would he have won with a different treatment? Would he have won without treatment? There's too many factors for us to work out. Independent doctors, centrally funded by mandatory payments to an external agency is the best way to try solve these issues medically, I've banged on about that for ages. I wouldn't be taking it unless it was debilitating, but I'm not a GT rider with a chance to win the biggest race in the world and secure my name in history. I think if I were, I knew I might be affected and I knew it was bad enough that it could ruin my chances, I probably would take it, if I'm honest. Now it'd just make me slower up the Dukes Pass, and if I want to go quicker I can go back to gears before drugs!

I meant in terms of what is in the report about OOC use by Wiggins, but yes, I accept that it's likely. It's been going on for much longer than Sky as a team have existed, possibly even as a company.

 

[Alpe73]

Re: Re:

Rabbit warren of after the fact sleuths on duty today. All for great purpose of justice and all that. FFS. :lol: :lol: :lol:

after the facts?! this forum has existed a long time and numerous contributors have pointed to skys (and other teams) suspicious results long before now!

Go for it, mate.

Just a suggestion ... discuss what you 'know.' Concede what you don't know. Add a little bit of speculation to taste. Garnish cautiously ( it can be overpowering) with suspicion ... if want to go all out and impress your hosts.

That's a reasonable expectation of most healthy, within the rules of good practice, debate and discussion.

Considering half your posts are personal attacks on posters, questioning and making assumptions about their motives, I'm not sure if "discuss what you know" is advice you should be giving

Hitch ... if I blew you a kiss ... or offered you a hug ... you'd see it as an attack. :sad:

I have no mailice towards you, If I were in your area code, I'd buy you a beer ... we'd laugh ... seriously.

This is all banter, at best, ... mass for the *** ins, at worst.

Some of us are here to debate PEDs in cycling ... some of you pretend to be here for that ... but it 'appears' you are here for non dope, non sports reasons. Envy of position, maybe.

If you're trying to nail people ... that you don't know ... becuase you think they're ponces ... then you're going to get some dissenters. That's fair enough. Bit of sarcasm, maybe. Nothing sinister or nefarious.

Owe you a drink, pal.
Alpe73

 

[ColonelKidneyBeans]

Re: Re:

I have to disagree. I think if you were to ask any fan if their favourite athlete/team members should be allowed a steroid injection for pain relief so they can compete, the vast majority would say yes. There's plenty of empirical evidence to support this and other poor health-related medical decisions in sport, such as the problems with concussion in contact sports, to back up an assertion that most people would be happy for it to happen. I remember on the video of the 1997 Lions Tour there was footage of Martin Johnson receiving injections while off the field for a blood injury so that he could continue. It's extremely common in professional sport and there is little to no outrage. I Believe Ledley King was only able to have a football career because of continuous steroid injections in his knee. I've known rugby league players in similar positions, both in the UK and Australia and I'm sure it happens in football, cricket, basketball and so on.

Sadly i think you're right, but it is very wrong IMHO, an elite sport career is already unhealthy, there's no need to add medications that are potentially harmful on top of that, especially if it's to allow you to play/ride injured.
What rubs me wrong in Parker's post is that he tries to paint Triamcinolone as a perfectly reasonable treatment for asthma/allergies and people who disagree has not having the athlete best interests in mind. I wonder if the OOC use described in the report was also completely justified and with the athlete health as the prime motivation?

Yes, it's very, very wrong and I'm almost certain it's a symptom of professional sport. Bigger, faster, stronger but harder and more impact. It all takes its toll on the body and using drugs to suppress that seems a sure fire way to end up with serious problems.It's fine in the short term to allow people to rest and heal, but that's not happening. Personally I try to avoid it as much as possible when I have injuries (as I currently do).

I read Parkers posts differently, I think the point they are making is that, in terms of getting an athlete to the start line in shape and ready to perform, the TA injection is legitimate (seems like a small point but it's not triamcinolone, it's triamcinolone acetonide which is much, much longer acting). It's hard to determine if it's in his best interest as an imuno-suppressant. There are risks using such long acting imuno-suppressant drugs in people who are going to be exposed to the elements. Actually, now I think about it, didn't he have an injection just before the 2013 Giro? And had to withdraw due to a chest infection? I doubt that's a coincidence, it is very possible that using TA opened him up to a serious infection his body might well have dealt with had he not taken it.

However, a one-time injection, before a 3 week race where you are moving thousands of kilometres would seem like a very logical time to use a treatment that lasts for 4 weeks, if you want the rider at their best on the start line. Biological half-lives of the other corticosteroids people have mentioned are short, intense exercise may well shorten them more, and this could easily result in doctors having to manage symptoms literally in the middle of a stage, possibly multiple times over the course of a race. You may put the athlete at risk if you attempt to manage it over the shorter term or it may work better, it's a tough call. Now, I'm sure others do just that, but if you are going to allow treatment then I think you need to allow what could be the most effective. The ethics behind this, whether it should be allowed etc. are a separate issue that's interesting but I think ultimately unfair to pin on Wiggins. Brailsford, yes. The medical staff, because ultimately it is up to the doctor, yes.

The issue is really if the TUEs were a way of covering up a program. At least, that's my problem with it. The single injections before GT's I don't think are that much of an issue.


The OOC use is speculation based on an anonymous source, Sky's speculation on how many of the 55 vials were actually used on riders (which is very hard to believe. If it was used to treat staff then there should be records in their medical files. Freeman can't have lost everything) and their refusal to say how many riders were treated. It could well be legitimate, although personally I would favour less drastic treatment when not racing as it's easier to manage the condition.

For me the real issues here are Sky, BC, Brailsford and Freeman/the medical staff. The evidence certainly points to them. If, and it's a very big if, Wiggins is telling the truth and he really was just using it as a treatment when required and nothing else (he's not a doctor so he needs to be able to trust the medical staff when they say this is what we need to do), then he's essentially been caught up in a massive mess. That is very, very difficult to believe though.

I completely agree with you on the point that it is the medical staff responsibility and not Wiggins/Brailsford, and that's why i think it's disgusting, because they are medical professional and should think about the health, not the performance. I knew that it was triamcinolone acetonide, i was just too lazy to wrote it all btw, my bad.
Completely agree on the immuno-suppressant capabilities of corticosteroids, i actually made that point about Froome upthread, how i think that his TUE for prednisolone in Romandie didn't make any sense: so he has a chest infection that needs oral prednisolone to clear his airways, and the doctors are happy to send him on his merry way to ride in the cold, rainy mountain of romandie, while under an immunosuppressing drug, that's the perfect way to get pneumonia...
I understand where you're getting at about the practicality of an IM injection of kenacort, but personally i would no take that for allergies unless they are completely debilitating. That Wiggins was able to win the tour suggest that they weren't that bad.
I don't know if we should call the OOC use speculation at this point, the rumours are practically as old as team sky, and there is a lot of evidence about it.
Still i can't believe that it's all there is to it, you don't transform riders that way with "just" TUE/non-Tue medication abuse, there as to be some kind of blood manipulation/use of metabolic modulators somewhere.

To clarify, I think Brailsford needs to take some blame, purely because the medical staff weren't independent. If they were then fine, but as they're not he ultimately carries some blame.

The bold bit is the difficult bit. Would he have won the Tour with no allergy? Would he have won with a different treatment? Would he have won without treatment? There's too many factors for us to work out. Independent doctors, centrally funded by mandatory payments to an external agency is the best way to try solve these issues medically, I've banged on about that for ages. I wouldn't be taking it unless it was debilitating, but I'm not a GT rider with a chance to win the biggest race in the world and secure my name in history. I think if I were, I knew I might be affected and I knew it was bad enough that it could ruin my chances, I probably would take it, if I'm honest. Now it'd just make me slower up the Dukes Pass, and if I want to go quicker I can go back to gears before drugs!

I meant in terms of what is in the report about OOC use by Wiggins, but yes, I accept that it's likely. It's been going on for much longer than Sky as a team have existed, possibly even as a company.

Yeah, there's a good chance that cortioid abuse in elite sport is as old as corticoid themselves. It was a common drug at Festina if i'm not mistaken,further in the past Thevenet admitted to using them, and said that his knees were FU because of it.
I understand what you are saying about accepting the best medical treatment to get you to perform when the stakes are high, maybe i would too, but at least i would not fool myself and think that i'm taking that purely for health reasons. If i was acting with my health as the central point, i would try to manage with antihistamine/inhaled corticosteroids/b2 agonist and quit if it can't hack it.
I mean the rule of thumb about systemic corticosteroid use for me and all doctors i've met is "if you need them, you also need rest"

 

[Blanco]

The issue here is that Wiggins HIMSELF said it was PREVENTIVE! That's not allowed by any UCI rule. I'm sure Dr Freeman applied it differently, but Wiggins said what he shouldn't say. UCI could click investigation on Freeman and Zorzoli and it could easily end up as a doping violation.

 

[samhocking]

Re:

The issue here is that Wiggins HIMSELF said it was PREVENTIVE! That's not allowed by any UCI rule. I'm sure Dr Freeman applied it differently, but Wiggins said what he shouldn't say. UCI could click investigation on Freeman and Zorzoli and it could easily end up as a doping violation.

All allergy relief is preventative. You shouldn't wait, you take the prevention medication when you are perfectly well to prevent the likely debilitating attack your RAST test confirms is likely to happen and how badly it will happen. In Wellens case he didn't use any prevention at start of Tour de France when he was perfectly ok, then got to the point he was suffering from his heat allergy so badly in the middle of the race that he couldn't continue. That is essentially what Wiggins said the other day he wanted to prevent. If he rode through a field and had a bad attack, he loses the Tour de France was his words iirc.

Without being able to look at Wiggins ENT reports since 2003 when he first begun taking corticosteroids for asthma and allergies, looking at how bad his Nasal Polyps were, what his lung function and RAST test results showed and all the TUE notes back from 2003 onwards attached to the TUE application on ADAMS, you simply can't make a sweeping statement of it not being a suitable prevention for grass pollen allergy under the rules at the time. You don't even know how severe it is or not. Wiggins 40mg dose is certainly lower than the normal dose for hayfever which is typically 50-100mg in may/june. I guess that was so he didn't risk immune suppression 3 weeks after injection as he still had Olympics at least in 2012. Injecting as close to start if tour is obviously when you would inject due to the immune suppression coming in 3-4 weeks after. You wouldn't want to inject 2-3 weeks before the tour anyway, that would be a huge risk in last week of tour getting ill.

On the 2012 TUE notes, the ENT specialist and Doctor confirms >3 years on Maximal Therapy using oral and topical corticosteroids etc and then 'significant improvement' when replacing that Maximal Therapy with triamcinolone the previous year to renew the TUE. If there is a marked improvement over Maximial Therapy, it would appear justified to me. The next step after maximal oral corticosteroids is injection.

As I said at the time, although I don't agree any rider would be wise to attempt to try and prove innocence, the supporting medical documents and all his tests results going all the way back to FdeJ TUEs under French Federation and Olympic Committee long before Zorzoli would help him at least build a picture of believability. He's had treatment in every team since FdeJ onwards. Both TUE and not.

 

[TourOfSardinia]

All allergy relief is preventative. You shouldn't wait, you take the prevention medication when you are perfectly well to prevent the likely debilitating attack your RAST test confirms is likely to happen and how badly it will happen.

Surely not sam.
Otherwise the entire population would be taking every drug under the sun just in case.
Homeopathic remedies are safe to take in the absence of symptoms
but don't pile up on anything else.

 

[King Boonen]

Is homeopathy not the medical discussion's version of Godwin's Law?

 

[bambino]

Re: Re:

The issue here is that Wiggins HIMSELF said it was PREVENTIVE! That's not allowed by any UCI rule. I'm sure Dr Freeman applied it differently, but Wiggins said what he shouldn't say. UCI could click investigation on Freeman and Zorzoli and it could easily end up as a doping violation.

All allergy relief is preventative. You shouldn't wait, you take the prevention medication when you are perfectly well to prevent the likely debilitating attack your RAST test confirms is likely to happen and how badly it will happen. In Wellens case he didn't use any prevention at start of Tour de France when he was perfectly ok, then got to the point he was suffering from his heat allergy so badly in the middle of the race that he couldn't continue. That is essentially what Wiggins said the other day he wanted to prevent. If he rode through a field and had a bad attack, he loses the Tour de France.

Without being able to look at Wiggins ENT reports since 2003 when he first begun taking corticosteroids for asthma and allergies, looking at how bad his Nasal Polyps were, what his lung function and RAST test results showed and all the TUE notes back from 2003 onwards attached to the TUE application on ADAMS, you simply can't make a sweeping statement of it not being a suitable prevention for grass pollen allergy under the rules at the time. You don't even know how severe it is or not. Wiggins 40mg dose is certainly lower than the normal dose for hayfever which is typically 50-100mg in may/june. I guess that was so he didn't risk immune suppression 3 weeks after injection as he still had Olympics at least in 2012. Injecting as close to start if tour is obviously when you would inject due to the immune suppression coming in 3-4 weeks after. You wouldn't want to inject 2-3 weeks before the tour anyway, that would be a huge risk in last week of tour getting ill.

On the 2012 TUE notes, the ENT specialist and Doctor confirms >3 years on Maximal Therapy using oral and topical corticosteroids etc and then 'significant improvement' when replacing that Maximal Therapy with triamcinolone the previous year to renew the TUE. If there is a marked improvement over Maximial Therapy, it would appear justified to me. The next step after maximal oral corticosteroids is injection.

As I said at the time, although I don't agree any rider would be wise to attempt to try and prove innocence, the supporting medical documents and all his tests results going all the way back to FdeJ TUEs under French Federation and Olympic Committee long before Zorzoli would help him at least build a picture of believability. He's had treatment in every team since FdeJ onwards. Both TUE and not.

The 2012 as you mentioned looks legit, but I can't help thinking there is something odd on the 2011 approved TUE which is the one right after Jiffy Bag.

We know they applied for TUE already 30/5/2011, but we don't know for sure whether it was approved or not. Wiggins says it wasn't, Sutton somewhat gives a feeling it was approved.

The approved TUE for 29/6/11 actually states for RAST test performed on June 2011 for gras pollen, thus it can't be the same (can be updated) application as 30/5/11. Any previous TUE doesn't speak about gras pollen allergy nor RAST, but obviously that doesn't prove he didn't have it. In any case, Wiggo went to RAST AFTER the application on 30/5/11, during busy month of racing and training. This TUE also says: "ENT specialist performed endoscopy nasal airway 2/7/11 confirmed diagnosis allergic nasal rhinits, and that is on maximal topical treatment >3 years". So the ENT specialist diagnosis was done 3 days after the validity and expiration of TUE, and let's remember, on the same day as the satrt of TDF. And not to mention Zorzoli's authorization date is 30/6/11, day after TUE validity.

Is it perfectly normal that TUE is handed over and the information of diagnosis that the TUE is based are updated after the validity date of TUE? Do we all believe Wiggo was on ENT specialist same day as he started TDF?

I get a feeling there was a level of hurry and "panic" within Sky during month June with Wiggo's allergy TUE and conveniently the Jiffy Bag saga is just in the middle of it, but maybe there is a legic explanation to all this. I think we would all like to hear it from the mouth of Freeman and Wiggo.

 

[Parker]

Re: Re:

The 2012 as you mentioned looks legit, but I can't help thinking there is something odd on the 2011 approved TUE which is the one right after Jiffy Bag.

We know they applied for TUE already 30/5/2011, but we don't know for sure whether it was approved or not. Wiggins says it wasn't, Sutton somewhat gives a feeling it was approved.

The approved TUE for 29/6/11 actually states for RAST test performed on June 2011 for gras pollen, thus it can't be the same (can be updated) application as 30/5/11. Any previous TUE doesn't speak about gras pollen allergy nor RAST, but obviously that doesn't prove he didn't have it. In any case, Wiggo went to RAST AFTER the application on 30/5/11, during busy month of racing and training. This TUE also says: "ENT specialist performed endoscopy nasal airway 2/7/11 confirmed diagnosis allergic nasal rhinits, and that is on maximal topical treatment >3 years". So the ENT specialist diagnosis was done 3 days after the validity and expiration of TUE, and let's remember, on the same day as the satrt of TDF. And not to mention Zorzoli's authorization date is 30/6/11, day after TUE validity.

Is it perfectly normal that TUE is handed over and the information of diagnosis that the TUE is based are updated after the validity date of TUE? Do we all believe Wiggo was on ENT specialist same day as he started TDF?

I get a feeling there was a level of hurry and "panic" within Sky during month June with Wiggo's allergy TUE and conveniently the Jiffy Bag saga is just in the middle of it, but maybe there is a legic explanation to all this. I think we would all like to hear it from the mouth of Freeman and Wiggo.

Have you considered the possibility that it's just a typo? It probably should be 2/6/11.

 

[Robert5091]

Re:

Is homeopathy not the medical discussion's version of Godwin's Law?

Yeah, Hitler invented homeopathy! You may close this thread! :lol:

 

[yaco]

It's a fact that many athletes, especially those in contact sports live on pain killing injections - It's not unknown for athletes to have 10 or 15 pain-killing injections to get up for next weeks match.

 

[samhocking]

Re:

All allergy relief is preventative. You shouldn't wait, you take the prevention medication when you are perfectly well to prevent the likely debilitating attack your RAST test confirms is likely to happen and how badly it will happen.

Surely not sam.
Otherwise the entire population would be taking every drug under the sun just in case.
Homeopathic remedies are safe to take in the absence of symptoms
but don't pile up on anything else.

It doesn't work like that for allergies. I agree, for general illness, sure, piling up on preventative medicine (not that there is many anyway) is pointless, because you don't know if, when or what you might be ill from in the future as it's not decided by your own body like allergies, but a RAST tests confirms you will most definitely suffer an allergic reaction when exposed to that particular trigger, be it a type of pollen, spore, or heat or whatever is the trigger and from that result you can then decide what medical treatment is required to prevent that happening. Calculating when to go from maximal therapy via oral treatments to injected ones is pretty simply to equate, it's not difficult. I think Wiggins should attempt to show Hargreaves report, the RASTs and lung function test results for his TUE. He shouldn't do anything for the Jiffy Bag, but the TUEs I think he could go a fair way with the previous medical record he clear has for what he suffers from according to his TUE notes anyway.

 

[Parker]

Re:

It's a fact that many athletes, especially those in contact sports live on pain killing injections - It's not unknown for athletes to have 10 or 15 pain-killing injections to get up for next weeks match.

Two a day for a year: https://www.standard.co.uk/sport/football/john-terry-reveals-he-went-through-a-year-of-daily-painkiller-injections-to-play-for-jose-mourinhos-a3554976.html

Andrew Flintoff said last year that he had 90 cortisone shots in his career. One paper back then dubbed him the 'Cortisone King': http://www.independent.co.uk/sport/cricket/cortisone-king-flintoff-ready-for-test-487353.html