Arcticterntalk.org

The blog of a travelling psychiatrist and football lover. Who happens to be a halfway decent photographer. Takes a cynical view of the world

Archive for the tag “the times”

Therapeutic Use Exemptions (TUE) and Harm. The solution is obvious for Sportsmen and Doctors in Asthma and ADHD


Matt Dickinson , the chief sports writer in The Times, writes an excellent article today 16/9/16 regaring TUEs. Essentially the article reads that more athletes than ever are being granted TUEs and there is a healthy degree of scepticism as to the likelihood that a large proprotion are actually essential. All fair points. However the real debate is why is the medical evidence to support a TUE is not more solid? This is the clear missing factor.

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As a doctor I would be looking at many illness features before offering an opinion or report. Firstly if an athlete is only requesting TUE rarely, why? The types of illness cited mostly here by Matt Dickinson are long term and in general terms stable over a few months, notably asthma and ADHD. It would be a hard hearted person to determine that an asthmatic, and most cases of asthma ( not all though) develop in childhood and early adolescence, cannot compete in sport due to the need for medication. It also needs to be said upfront that asthma does kill people annually and regularly, it can be a very serious illness. Stopping medication is rarely a safe nor sensible thing to do, so to be allowed to continue medication when in competition is essential and medically necessary. And this is the point. Medication usage is generally stable. So TUEs when granted should refect the regular need for a medication over months. Competition is intense sure, but also so is training. Exertion levels are not likely to vary enormously. A TUE should never for example allow a medication to be started just prior to competition. In simple terms, the asthma medication carries on as normal. To be convinced to start a new medication, steroid for example, there needs to be serious evidence of a deterioration in asthma that would not just have occurred overnight. Hence the intermittent usage of Kenalog (triamcinolone) for example could only be entertained on a strictly seasonal basis if hayfever symptoms had been  prominent annually at that time of the year. It requires some explanation why Bradley Wiggins took only 3 injections of Triamcinolone June 2011, June 2012 and April 2013, if these medical facts are indeed correct. They may not be. It would also be interesting to entertain the spcific pollens giving the allergy.

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For ADHD it is much the same. The diagnosis of ADHD is made generally with a history of symptoms that have been present in certain well prescribed patterns for many years. Adults diagnosed with ADHD must have shown evidence of long standing symptoms present since before 12 years old. The need to treat ADHD generally does not differ markedly over a period of time, in that the likelihood that a treatment needs commencing immediatley prior to an event is minimal. Treatment needs tend to be stable. Stopping ADHD treatment is not a good thing either.

Lastly Matt Dickinson points out that ADHD is relatively common in adults, he cites 4-6% of the adult population, which is a little high, maybe 3-4% is probably correct using the updated DSM-5 diagnostic criteria. But his scepticism about Major League Baseball players having ADHD in 10% of cases might be unfounded. ADHD is more common in sportsmen as many of the illness facets tend to be helpful in sport provided they are harnessed appropriately. Thus 10% is not an unreasonable estimate, though no thorough research seems to have been done on this. Creativity, hyperactivity and hyperfocus are features of ADHD and as such gymnasts like Simone Biles as an example may do well despite having ADHD. They too however need treatment. Impulsivity is the one feature of ADHD that does often get sportsmen into trouble. Lastly an interesting recent medical finding is that asthma is far more common in those with ADHD than the general population. The reason is not clear.

00005945So where should the scepticism come in? Firstly any sudden TUE prior to a competition needs a full investigation and critical analysis. Secondly any TUE where there is an unexpected and changed medication need, especially if intermittent, needs again careful analysis. If sportsmen are using TUEs as legal loopholes then it is the duty of doctors to stop this happening, and thats far easier than many imagine.

 

Where are we in the Luke Hyam Saga Four Days On?


Following the appalling reckless challenge that left Alan Judge with a fractured leg in the game versus Ipswich last saturday there has been a degree of media attention this week. What we know is that Mick McCarthy has given nothing resembling apology nor remorse for the awful tackle. At the time of the incident he felt it prudent to announce that it should not have been a yellow card and saw no wrong from his player. Since then current and former players have come out with views with are consistent with those of the Brentford fans. Andy Scott stated that Hyam knew what he was doing with that tackle, Sam Saunders was reported in the The Times as alluding to the fact that Brentford conspired to get Hyam sent off. We saw on the day as Sam was reported as saying ” that Hyam head had gone” in reference to the fact that he was a peripheral figure on the pitch and his team hardly brought him into the game. After the game on the various message boards, Ipswich Town fans were split on the nature of the tackle, but as Hyam left the pitch it was notable that there was almost an eerie silence. Jim Levack has reported his views on what he suggests amounts to appalling behaviour from Mick McCarthy that borders on bringing the game into disrepute.

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It would be interesting to know what Jake Bidwell said to Hyam as he left the pitch.

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There are some things that we presume but do not know. That Hyam has not apologised to Alan Judge. That Alan Judge as evidenced by the limited amount of statements he has made remains unhappy and has in no way condoned that tackle as ” this is what happens in football”.

Some things about Hyam we do know:

  1. On his twitter account on which he was moderately profuse, he has not given any good wishes to Alan Judge, nor expressed anything resembling remorse. Instead we learn of his selfish distraught affect through the Ipswich Town official site. One wonders if this was merely a PR exercise as there seems no other outlet who has interviewed him to obtain his side of the story.
  2. His disciplinary record is far from exemplary. In 2015-16 he has had 3 yellow cards and 1 red card in 18 Championship games in a total of 966 minutes football. In 2014-15 he received 7 yellow cards in only 16 games playing 1208 minutes. In his total championship career to date in 117 games he has received 27 yellow and 2 red cards.

For me the tackle remains dangerous and uneccesary and when viewed in the context both of the game, the early minutes, and almost on the half way line, where Judge was in no position to make a play that might be dangerous to Ipswich, this further confirms my view. There is no way of knowing what if any malicious intent was present, but this is very different to making a dangerous tackle which might cause harm . Certainly in 50 years of watching  Brentford I cannot recall a game in which the whole team were so incensed over a bad tackle, and we have seen a few of those down the years. Those Brentford players were visibly angry, and for Hyam sake it may have been better that he was sent off than carried off, as some fierce challenges were potentially fired at him.

Lastly  Mick McCarthy displayed again bad management in not substituting Hyam  even 5 minutes after the tackle it was clear that he was a peripheral and a marked figure. A good forward thinking intelligent manager would have substituted him. So little surprise then that that failed to happen.

We await updates from Brentford over the double fracture ( which to non-medics means fracture of both the tibia and the fibula, the two lower leg bones). no details have emerged regarding severity, nor even how the surgery went. So we must all wait. Meanwhile Luke Hyam has ended Alan judge hopes of Euro 2016 and a premiership transfer in the close season. We all need to hope and pray that this is all that it ends. I for one do not expect to see Hyam selected versus Brentford next season. You heard it first here.

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A Butterfly reading The Sunday Times


One of those opportunistic photos where a butterfly maybe a little tired landed on my newspaper and the I Phone was handy. just a cute image really. Maybe it stopped to watch the tennis?

The Sunday Times butterfly Copyright Chris Bushe 2015

The Sunday Times butterfly
Copyright Chris Bushe 2015

The Sunday Times butterfly Copyright Chris Bushe 2015

The Sunday Times butterfly
Copyright Chris Bushe 2015

The Times Monday October 7th has Wrong Football Scores!


There will be few who read the scores from the Scottish Cup on a monday morning and there will even fewer who realise that Times has printed the wrong scores and in fact seems to have made up the scores from two games.  Let me firstly add that I do not normally spend monday morning checking and cross-checking the Scottish football scores. I just noticed yesterday that East Stirling had beaten Threave Rovers 6-0 because of all the updates that were appearing on the vidiprinter on Sky football on my mobile.  However today it seems that Times might have left the game early as they report a score of 2-0. Similarly with Berwick Rangers, my Scottish team. They according to Times drew 2-2 with Peterhead but Sky sports assures me they won 2-1.  A double check reveals that i am right and Times are wrong. So that makes it 2-0 to me.

http://www.bbc.co.uk/sport/football/scottish-cup/results

East Stirling used to play in a ground in a supermarket car park in Falkirk and a lovely little ground it was too. I understand that it has been bulldozed sadly. Here are a couple of photos to remind us of the 6-0 winners yesterday.  Lots more images of football grounds on my website http://www.footballgroundz.co.uk if you would like to visit.

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