Right Medication, Wrong Use
THE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO. 10 - OCTOBER 1997
In his article "Insulin as an Anabolic Aid? A Danger for Strength Athletes," J. Warren Willey II, DO, describes a normal young man—a body-builder—who experienced repeated, dangerous attacks of hypoglycemia. The patient was injecting himself with insulin in a misguided attempt to increase his muscularity. Despite the continued occurrence of the attacks, he believed he could predict and control the symptoms he was experiencing—incoordination, confusion, sweating, and anxiety.
Proper insulin use keeps many diabetic patients alive, but used inappropriately, the drug can cause illness and even death. This is an extreme example of a fairly common problem in medicine, often initiated by patients, but sometimes by physicians: use of medication for the wrong condition.
Even more often, a patient takes the right medicine for a disease but at the wrong dosage. One is reminded of the pharmacologic principle, "Enough of anything will kill anything."
Pharmacologic pain relief in athletes is an area, like bodybuilding, where multiple options, ready availability, and intense need (or desire) increase the potential for mistakes or abuse. The best safeguard is to follow standard medical procedures: Before prescribing, consider treatment goals, dosage, efficacy, side effects, and the rule "first, do no harm." Recommendations for pain relief with and without medication are considered more fully in "Pain Relief for Acute Soft-Tissue Injuries," by James S. Thornton.
Most often, medication errors or red flags for misuse or abuse can be identified in a careful patient history. A little extra questioning to find out what drugs patients are experimenting with on their own—or have received from another physician—may prevent serious consequences.
PS: In this issue, we begin a series of articles by internists who care for active patients. The first is on atypical pneumonia, written by Thomas J. Melham, MD, and edited by Donald Christie, MD. Conveying a diagnostician's perspective on disease in people who "should be" healthy, these articles highlight The Physician and Sportsmedicine's "primary care perspective on the medical aspects of exercise, sports, and fitness."