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Transplant Athlete
Sunday, November 14, 2004
  Synthetic EPO good for Transplant Patients bad for Athletes

Background: Nina Kraft won Hawaii Ironman 2004 by 17 minutes over Natascha Badmann. Nina tested positive for synthetic EPO and immediately confessed to taking the banned substance. She was quoted in the attached article as saying, "I was already ashamed after the victory. Success was not as beautiful as in Frankfurt. . . . I began three weeks before Hawaii with the EPO treatment, and I quit it five days before [the October 16 race]."

The first thing to note is that the drug takes between 2 to 6 weeks to take effect, so she may not admit it (saying she only took it for a couple of weeks), but she was racing under the influence of EPO and she did have an unfair advantage over her competitors. I do give her praise for confessing to what she did.

I was prescribed EPO during the period when my kidneys were failing. The gland that produces EPO is on the kidney and in my case as the kidneys failed, the gland also failed. My Hematocrit had dropped to 28. I couldn't function, I was tired all the time, it was like a bad case of Mono. For comparison, Lance tries to keep his hematocrit near 50 and in cycling a Hematocrit above 50 is considered evidence of doping. Hematocrit is actually a percentage of Red blood cells to everything else in the blood, so the higher the number the less plasma you have carrying the red blood cells(don't forget, there are also white blood cells and other solids in there). The heart has to pump a thicker sludge through the arteries when the Hematocrit is at 52 than it would if the hematocrit is 45. Most athletes have strong hearts and can take it, but when you hear of the heart attacks in 25 year old cyclists, my guess is a high hematocrit had something to do with it.
For me, after starting the EPO injections, it took about three weeks for the EPO to have an effect. EPO tells the bone marrow to make more red blood cells. This takes time. Claiming that she stopped taking it the week before the event is a bit disengeuous. It wouldn't have any effect taken so close to the event, so it doesn't matter if she quit one week before or three weeks before, her Hematocrit was still artificially high during the event.

Synthetic EPO is a wonder drug for kidney patients and for Cancer patients, but it doesn't come without risks:
1) Higher Blood pressure - which if left unchecked could result in damage to any organ in the body including the kidneys, heart, etc. When I was prescribed, I was required to check my blood pressure frequently just in case.
2) High Hematocrit - they don't really know how the body will respond to the EPO, so they monitor hematocrit to make sure it doesn't spike. They also measure iron levels in the blood and usually require iron supplments.
3) potentially fatal blood clots - in studies, 42% of patients using EPO who had a previous cardiac condition experienced increased mortality. The risk is significantly lower(about 5%) for people without cardiac problems, but do you really want to take that chance?
4) Taking synthetic EPO in some circumstances can cause the body to reject both synthetic and natural EPO.

From a user perspective, the new found energy supplied by the EPO could make you FEEL like superman: able to leap tall buildings with a single bound and ready for anything. The thing about increasing your hematocrit quickly like this is that besides the feeling of being able to ride farther and faster, you actually can ride farther and faster. As you can imagine this brings the mental side of your game to a whole new level on top of the gains to the physical side of the equation (increased endurance).

Now, my new kidney is solely responsible for EPO production.
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I've gone through kidney failure twice. The first time in 2000, my mother donated a kidney; and again in 2008, I'm on dialysis waiting for a breakthrough in immuno-suppression medicines before seeking a new kidney.

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