asthma and swimming

[red dragon]

My nine year old daughter is classed as 'asthmatic' following a 'reversibility test' she undertook in the GP's in April/May. This was an objective test we requested because we needed to know whether or not she was asthmatic for ASA regs.
She has never had an 'asthma attack' and had only had one ventolin pump, prescribed at the age of five when following a repeated night time cough the GP told us she was asthmatic. doled out a pump and she probably used 4 blasts from it.
Our dilemma at the moment is that from september to march each year she has no cough whatsoever and appears to be at her'peak' in swimming terms, at this time she has a peak flow of approx 280-300mls. However from April to July she has a persistent morning/night time cough, her peak flow goes down to about 210-230, but her swimming also does not improve at all at this time in the season. This has been the pattern for the past 2 years. but we have not been giving her any medication as apart from the coughing she does not have any complaints.

If we use the ventolin to reduce her cough and bring up her peak flow at this time of the year it could also be 'performance enhancing'. We have been ignoring her cough as it is not a particular nuisance and we prefer not to medicate unless there's a real need. However, we are aware that the reduction in peak flow may be having an adverse effect on her swimming. But herein lies the dilemma, if we medicate to normalise her peak flow we are in fact 'performance enhancing', if she were a non-swimmer we would probably just tolerate the morning cough because we wouldn't be aware of the decrease in lung capacity.

What should we do? Our GP is not particularly interested as our daughter does not have a 'medical' problem - we can give her the pump if we wish to stop the cough etc. But if we do we 'performance enhance' her but on the other hand the reduction in lung capacity may be the cause of her reduced performance over the spring/summer/pollen months.

Comments please or advice on articles we can read relating to asthma control in young swimmers.

[Pete]

There are so many swimmers who use Ventolin. If it has been prescribed by a doctor there surely is no problem. At her age she is not likely to be tested for drugs for many years and if all your validation for using Ventolin is in place no one can object.

[Phil Tanner]

I have zero medical knowledge, but from a philosophical point of view I don't think you should use it unless you could define her as ill and in need of treatment, and the case as presented here doesn't pass that test IMHO. I would define that as her being in distress or at risk of it while competing or training, which doesn't seem to be the case.

[Phil Tanner]

Just realized this is under "Ask the coach", and I'm not a coach. (I get directed to unread posts when logging in.) Please read my opinions as those of a parent

[Shamu]

I know for a fact that people take asthma medication when they dont really need it. I think it's cheating as it can bring your times right d
o
w
n
:copper:

:cool: :cool: :cool:

[Kate]

Are you "performance enhancing" if you are returning her peak flow to what it is normally during the rest of the year?

[Unfit]

i've had very mild asthma since i was very young - i got tested because my mum and brother have it. i have something against using the inhaler if at all possible - i like to try to beat it myself without resorting to drugs! my asthma is what's termed 'exercise-induced' which basically means that as soon as i start to exercise it gets a lot worse which makes it harder. also i get hayfever and thats when my asthma is at it's worst (which sounds like your daughters problem).

over the years i've found that it's better to learn to control your breathing and your O2 intake than to turn to your inhaler. maybe if your daughter just gets used to breathing more often when she's swimming she'll feel better (during teh summer months i breath every two strokes on frontcrawl compared to every three or four in the winter).

but if you'd rather not be as stubborn as me - then just use the inhaler. as long as it has been prescribed by a doctor then i see no problem in her using it before training/compeitions.

[Mel]

I have been given an inhaler as well for exercise induced ashma, but i think mine is more hayfever because when the doctor finally gave me a nose spray and tablets, my "ashma" seemed to clear up. my symptons included a cough and permently blocked nose, maybe she has a form of allergy or hayfever?

[red dragon]

it does only seem to affect her in late spring/early summer - she has no cough or problems once september arrives and is ok again until about april....I think it may be pollen related.
We've now found an asthma clinic where the nurse in charge is accustomed to dealing with swimmers etc and we've been advised to monitor her peak flows twice daily for the next six months before they decide whether or not she needs another type of asthma pump. We have been told that the general approach now is to 'overmedicate' first and then taper down, apparently kids who are under medicated in their pre-teen years tend to continue with asthmatic symptoms throughout their teenage years and into adulthood. Overmedicating tends to work better ion reducing the symptoms competely
Thanks for your advice everyone

[ktcute]

If your daughter is asthmatic, she needs treating. There are various different ways asthma can be brought on, and a classic example is with the cold. Whilst I can go out running quite happily in the middle of summer, and suffer few ill effects, in the middle of winter without medication I can't go for a brisk walk without having an asthma attack.

As for being performance enhancing, you are correct you will enhance her performance. However I think you should be seeing it as treating an illness that gets better, and enables her to perform to her full potential. The drugs that are used to treat asthmatics are not going to suddenly and vastly improve her performance over and above that which she would otherwise be capable of.

On a more serious note, it can be highly dangerous for asthmatics to go untreated. Asthma that does not remain in a constant state is often considered more dangerous than consistent moderate asthama, because it is unpredictable. Your daughter may suffer from undiagnosed allergic conditions, or you might find her condition deteriorates under stress, or due to ill health. The rule of thumb, is always have an inhaler to hand, in case.

I am asthmatic, have been accused of cheating before now, and given up on the medication. That time more or less coincided with giving up swimming. I can't explain to someone how miserable and frustrating it is to know you cannot achieve at the level you should be able to simply because you can't get enough air in and out of your lungs. Its cruel really. Your daughter needs your help and support, and it always makes me mad when people seem to think asthmatics might be in some way cheating. Your daughter is overcoming a hurdle when she gets in the pool, you ought to be proud of her.:angel:

[nsswimmer]

Originally posted by Kate
Are you "performance enhancing" if you are returning her peak flow to what it is normally during the rest of the year?

exactly~

[Bootie]

I am just touching on an old subject for a moment. Recently at after a training session I were asked by another club member if I ever had pain across my chest when swimming hard sets. My answer was of course, I always have a thumping aching chest when swimming at a high intensity. Its because my poor old body needs more oxygen than my lungs can provide hence the pain. Not rocket science and nothing new, too alleviate this I tend to haul my upper body out of the water and breath deeply sucking in as much oxygen as possible for 20 seconds or so until I had recovered.
The point the member was making was that they too had similar pain when performing hard sets and as a result would also haul themselves out of the water to recover.
There are a number of senior swimmers in the club who are "asthmatic" and take inhaler to treat this, neither myself or the other member are in this category.
Earlier this week we performed a hard 4 x 100 freestyle set at pretty well maximum with around a minutes rest between.
After the first set, as usual I were in oxygen debt as were everbody else, I hauled out to breath as usual to recover sufficiently as did the other member.
What was surprising was that around 3 or 4 other seniors lept straight out of the pool to take a puff on their inhalers! Once armed with the steroid, lungs and airways sufficiently relaxed by said steroid they completed the set with ease whilst us mere mortals battled on with our oxygen debt.
My point is that whether you suffer with asthma or not, it seems the easy option is to head straight for an inhaler the moment the going gets tough. I think that the inhaler is overused in sport generally and the whole subject needs looking at in great detail.
By the way I do speak from experience as my son has had asthma since birth and some days is wheezing and short of breath just getting out of bed on a morning and has to use two forms of steroid and when younger even a nebuliser just to maintain a normal breathing pattern.
I would really like to hear from anyone who takes or doesn't take an inhaler for their point of view.

[ktcute]

There's a hell of a difference between suffering from pain in the chest because of hard work, and wheezing. However if a doctor has prescribed a drug because of an asthmatic condition, it is not really for "Joe Bloggs" to be saying that people shouldn't use it.

Incidentally asthma is a heritable condition, so I wonder whether you might benefit from more relaxed airways?

It would be nice to be able to get myself into a state where my lungs were hurting because of oxygen deprivation, unfortunately I seem to hit the can't move enough air to go fast enough problem. I am concerned about the nature of this thread because it seems that people with not a lot of knowledge are advising people who suffer from a medical condition to stop taking the drugs they are prescribed. This doesn't seem like a responsible use of such a forum to be honest.

If people need drugs and take them, so be it. If you don't like it, I suggest you "get over it". These people are entitled to their medication, as are you, if you can persuade a doctor to prescribe it. Whether other people get out of the water to take inhalers is really none of anyones business, in my opinion. To be honest, a lot of this sounds like jealousy. There is a definition of "asthmatic" which the ASA provides, which is 10% reduced peak flow over that expected. The swimmer mentioned at the start of this thread easily qualifies. In fact in the winter, she has lost about 20% of her ability to move oxygen, before she even gets in the water.

There is provision for taking these drugs. The ASA in fact does not recommend that swimmers during training sessions are allowed to jump in and out of the water to take inhalers.

I guess the question I'm asking is, does it really matter to you that much, that people who might have a medical condition treat it? Or are we so competitive that we have to sit around sulking about the fact that other people treat it, and we either don't, or can't because we don't suffer from the condition. It might make them go a bit faster in training, or in competition, however if they aren't asthmatic, they are simply cheats anyway.

Believe me, I'll switch my asthma for your aching lungs any day of the week.

[Bootie]

Ktcute, firtsly I apologise profusely for any offence taken at my comments as none was intended.
I have never and would never tell anybody not to take their medication as you rightly say this "Joe bloggs" is hardly qualified.
My comments were merely an observation of what happened in connection with a question that I were asked.
Fortunately Asthma does not run in my side of the family but unfortunately my son has inherited it from his mum.
My wife had chronic bronchial problems as a child but has overcome them with the aid of her inhaler to represent her running club at County level and indeed post a very respectable time in the London Marathon.
I am not the jealous type and have no problem with anybody taking an inhaler and would never, never call any of them cheats, it was just weird that that all concerned felt the need for their inhalers at exactly the same time, again just an observation.
I am in fact some 20 years older than my colleagues who are all way quicker than me at most of the strokes, I am not a threat to their postition with regard to competition except in the breastroke, so jealousy has no part to play in this.
I do not know how much research has been done in this field but maybe we could start. All swimmers at our sessions have to sign in and declare any medical condition they may have, asthma being the most predominant. Maybe we should also monitor the weather conditions on that day and whether sufferers have taken medication before swimming, how they feel before swimming. How they felt during and after swimming, did they need to take medication during or after the session. It would be interesting to see the results of such research with regard to location in the UK and time of year etc. maybe it would be of use to the real sports scientists in being able to control sports related asthma in the future.
I personally think the use of the forum is the ideal medium to talk about peoples experience as this can sometimes promote debate and get things going in the right direction (generally, not just specific to asthma). The use of the forum just to have a pop at anybody is quite rightly an abuse of the forum.
Once again I apologise for any offence caused by my comments as none was intended and I am sure I will hear from you again.

[ktcute]

My concern is with young people, who might be rather like me at a certain impressionable age, who felt miserable and defeated, because rather than worrying about how good they are swimming, people seem more interested in whether or not they are using their inhalers. Its very demoralising, and my concern for responsible use of the forum was simply to ensure that young people who need treatment for a medical condition continue to take it.

To be fair you didn't really have much need to apologise, you hadn't done or said much that could have caused offense, its just a very touchy subject as far as I am concerned.

My further concern is that swimmers continue to focus on THEIR OWN success and performance, and don't run around looking for other people to point at as being different, odd or whatever.

Swimming can be very cliquely, and almost cultish in its outlook, and the opinions of adults are deeply important and influential to young people. My concern is also that youngsters get the best deal they can, and that they don't feel intimidated or victimised by people who may be "better" or "worse" than they are.

I think its important to encourage an integrated, all inclusive policy with regard to swimming, and to try to avoid being scathing, which simply creates rifts between groups and upset for a lot of people.

[ktcute]

Oh, and just a quick note... the inhalers that are used as "Relievers" don't in fact contain steroids. They act on the nervous system to relax the activity of muscles which cause the airways to contract. They do have a systemic effect, and are in fact stimulants, which is why they are regulated by sports
organisations.

The "preventative" medication which does contain steroids is not actually regulated as far as I can tell. It isn't anabolic, and doesn't have a stimulant effect in the same way.

[Bootie]

I agree 100%. I know how demoralising it can be as my son does swim but does not compete, partly because of his condition and still thoroughly enjoy it. My heart goes out to him and any other youngster affected by this, he does however always have a smile on his face even when his asthma is at its worst.

[ktcute]

I wish I did ;).

[Linny]

When I swam as a child and teenager, I was always amazed that my pals in my lane were complaining of aching limbs. I never actually managed to train hard enough to get to this stage as it always my lungs that prevented me from training harder. I know now that I was an undiagnosed exercise induced asthmatic - eventually diagnosed some time ago at age 25. Health professionals are a lot more aware now than they were then and although I now take inhaled steroids to control my asthma (which can also be triggered by allergies and colds), I always take salbutamol prior to exercise as a preventative measure. This I was advised to do by my GP. Maybe advice to children is not necessarily the same as that given to adults as asthma changes with age but I wouldn't consider swimming without using my inhaler - I wouldn't get very far! Having said that, I never need to get out to take it!
In my view, all that salbutamol and beclamethazone has done for me is leveled the playing field. You would never know that I am asthmatic because you won't see me short of breath (except when I am knackered!)
The use of preventative and relieving asthma medication has completely changed the way I can exercise and enjoy my sport and I don't think that anyone should be deprived of that.

[Bootie]

I agree with you entirely, my wife also takes her medication before training and racing as a precaution rather than let an asthma attack hit her in mid race. To my knowledge this seems to work for her and very rarely does she suffer an attack during her races.
Maybe its and age thing but the colleagues I referred to are all aged between 17 and 19 and don't seem to take their medication before training but seem to wait until they feel out of breath before seeking relief. If they took it as a preventative measure rather than a reactionary measure maybe their performance in training would differ, again I am no expert but merely expressing a comment on my observations

[ktcute]

I've noticed that the advice given to people seems to differ. The reliever inhalers seem to be marked, as required, and I suspect that some doctors are suggesting you use it when you have an attack. For an exercise induced asthmatic, this is probably pretty daft, as doing exercise will inevitably lead to an attack, which taking the inhaler before a session can prevent, or at least help alleviate.

I wonder though if youngsters are feeling guilty about it, and don't like to take it until they <U>know</U> they need it?

[ktcute]

BRONCHOSPASM IN COMPETITIVE SWIMMERS

Reuters Health, March 21, 2001.

A study presented [03/20/2001] in New Orleans at the 57th Annual Meeting of the American Academy of Allergy, Asthma and Immunology, strongly suggested that swimming pool environments adversely affect the lung function of competitive swimmers. Dr. Stephen J. McGeady, and colleagues, from Thomas Jefferson University in Wilmington, Delaware, measured the lung function (FEV1) of competitive swimmers (N = 28) before and after cycle ergometer testing in swimming pool and laboratory settings. The study was motivated by observations of university team swimmers displaying significant airway obstruction and the number of reports that many swimmers use beta-agonist inhalers.

Ss' mean FEV1 was significantly lower in the pool than in the laboratory. Some swimmers (14%), not previously asthmatic, displayed airway obstruction at baseline. Exercise-induced bronchospasm occurred in a further 11% of swimmers not known to have that problem or asthma. Swimmers known to have asthma seemed to do better than swimmers who were not diagnosed with asthma. Exercise-induced bronchospasm negatively affected performance.

Implications. Swimming is worse on bronchospasm than other endurance sports, a paradox since swimming is supposed to promote health. The facility/exercise setting is implicated as the cause of these respiratory afflictions. Because of swimming pool environments, competitive swimming could be bad for one's health!

[Thanks to Johnny Morton, former collegiate swimmer, current parent, official, coach and interested observer, for bringing this to my attention -- BSR]



I thought this was interesting, more is available on the swimming science journal site at: Swimming Science Journal (http://www-rohan.sdsu.edu/dept/coachsci/swimming/chlorine.htm)

[Bootie]

Thanks for that Ktcute, a fascinating article, this is obviously a short summary, I shall read the more detailed version of this study on the net

With just the few paragraphs you have posted, it would appear to me that the swimming pool designers need to get together with these researchers and come up with better environmental conditions on poolside to try and alleviate the symptoms to some extent.

[ktcute]

Yes, I agree. The link is to a collection of abstracts, one of which details how the use of ozone for purification purposes can reduce the levels of chlorine... Its interesting stuff.

I will have more sympathy with the shower before swimming plea in future.

[debbie63]

I have a daughter who is asthmatic she is also a swimmer and I would just like to add that if she needs to take her inhaler in training she is in no fit state to jump back in the pool and complete the next set at all let alone with ease! Having watched her battle with her very severe asthma for years, never giving up unless she absolutely has to, I am very proud of the fact that all her hard training is finally paying off, she's just taken 10 seconds off her 200m free time which she managed to shave a few seconds off a few weeks ago.

Without her inhalers she probably wouldn't still be here I've sat many a night in hospital watching her fight to breathe. It really upsets me that people may think she is cheating. She never uses her inhaler directly before a race as it's too late by then. She needs to take it some 15 minutes before but she does keep it on poolside in case she needs it and does sometimes need it between sets but then she has to sit out until she feels it has taken effect.

[swimmer]

so if you think about it the people who get ou to use inhalers, and then jump straight back in again, sprinting, are probs cheating ( eg to get some more rest) coz as u said if u hav to get out to use the inhaler ur not in a fit state to get in straight after and sprint!

[Unfit]

swimmer, not necessarily true. i have mild asthma, as mentioned before, and generally i don't need to take my inhaler. however, this winter i've had to use my inhaler whilst training twice so far. the first time my breathing got so bad that i was feeling really sick before i remembered that maybe i should get out and take my inhaler! and yes, that time i did have to sit out for a couple of minutes and then i had to take the rest of the session a bit easier. however, the second time i could feel my chest tightening and my breathing getting laboured so i took my inhaler and carried on. This stopped me from getting any worse and i was able to do all of the session without my breathing troubling me.

[bobby]

Reading this thread, there are several degrees of asthma suffers. My daughter has exercise induced asthma but is reluctant to take her inhaler as she feels that it is cheating. Even though she has been told to use it daily there is definitely the guilt feeling even though she has been told that all that is happening is that she performs on the same stage as everybody else. Even though she might feel ok, she might have been better having used the inhaler. It is only Salbutalmol which is not a steroid and she is registered for it with the ASA but it still makes her feel guilty. Unfortunately this is common amongst swimmers.

[ktcute]

Nod. Yes, I stopped taking mine, though to be fair that is not due entirely to being accused of cheating. I think people need to be incredibly careful about their use of the word, and the implications they create. It is enormously hurtful to be accused of cheating in this way.

You might want to note that taking an inhaler in itself is quite a big thing. Mine used to terrify me when I was little, and I got hugely upset about taking it, at a time when they were fairly new devices anyway. Inhaling steroids into your lungs is not a first choice for most people, and they have unpleasant side effects, such as sore throat and horse voice. Even the non steroid inhalers can have some unpleasant side effects, including frequency of urination, and accelerated heart rate. None of these are particularly desirable for swimming training.

I think we need to be very clear that only people who knowingly have gone to the doctor with no symptoms, and have invented them could possibly ever be "cheats" in this way.

Mild asthma attacks are almost unnoticeable to other people, and for many chest congenstion is a permanent feature, as excess mucous is produced all the time. But remember that to show any symptoms at all people will already have lost something like 20% of their lungs function. I also have rhinitus, which mean that my sinuses are blocked constantly. I find work colleagues crack jokes about "spreading germs" which in itself is hurtful. I've also had people literally "accuse" me of being ill all the time, which is hardly very fair. There isn't a great deal I can do about it. So being accused of cheating would be really adding insult to injury.

At its most severe, I think we all need to remember asthma is a life threatening illness that we need to take seriously. Without oxygen being supplied to the brain in sufficient amounts, we become quickly hypoxic, which in the short term is unpleasant and in the not so long term, will kill. Its frightening for sufferers, and its unpleasant for those around them. Even a mild attack is unsettling, and I think perhaps if we can be supportive and encouraging to sufferers, perhaps we can help alleviate their anxieties a little, which in itself will help reduce their symptoms.

Before you accuse someone of cheating, think about what they are taking into their lungs, think about what might happen to them if they are unable to breathe properly, and wonder to yourself if you could knowingly inhale something that in itself may have harmful side effects, knowing full well there was nothing the matter with you.

[debbie63]

That's a really well worded reply and sums up most asthmatics well. No-one wants to be dependant on a medication to breathe properly especially not ones that can cause such serious side effects.

[nsswimmer]

Originally posted by Unfit
however, the second time i could feel my chest tightening and my breathing getting laboured so i took my inhaler and carried on. This stopped me from getting any worse and i was able to do all of the session without my breathing troubling me.

i do not have asthma, but this chest tightening happens to me and my friends occasonaly, as well. and it's major lung squeezing; once i couldnt take in any air and i started hyperventilating; however, when i got this checked out by my doctor, it wuz found i have no problem. 2nd and 3rd opinions sed that i dont have any asthma or other breathing hindrances. so i get kind of confused when i read stuff like this, isnt this normal?

[Bazza]

I have found this can happen really badly when the chlorine is strong in the pool, or sometimes even when it appears not to be, but it isn't a regular occurence for myself or presumably the majority of swimmers or athletes.

[ktcute]

No, it doesn't sound normal at all. I'm curious to know who and how they diagnosed that you don't have asthma. There are several ways of finding out, including symptoms reported by a patient, observations by relatives and other people, peak flow, listening to your chest etc....

<A HREF="http://www.niaid.nih.gov/newsroom/focuson/asthma01/basics.htm#what">Focus on asthma</A>

<A HREF="http://www.aaaai.org/patients/allergic_conditions/exercise_induced_asthma.stm">Exercise Induced Asthma</A>

<A HREF = "http://www.physsportsmed.com/issues/1998/06jun/dis_pa.htm">Guide to Exercising with Asthma</A>

Fraid you'll need an account to see these, but its free!

<A HREF = "http://www.emedicine.com/radio/topic59.htm">Asthma - a highly technical guide</A>

<A HREF = "http://www.emedicine.com/med/topic3390.htm">Allergic and Environmental Asthma - again very technical</A>

<A HREF = "http://www.emedicine.com/sports/topic155.htm">Exercise induced asthma - more readable than the other emedicine pages</A>

There is plenty of information out there if you go looking.

If you just experience these symptoms very occaissionally and it doesn't really affect your training, then it doesn't sound like its too much to worry about, though its worth keeping an eye on. Certainly go to the doctors if it gets any worse. The Swimming Science Journal page on asthma and related conditions held an article showing that chlorine can produce asthma like symptoms in otherwise non asthmatics.

Sorry if this sounds a little remote, but from my point of view its all fascinating. Hopefully we can find an answer to the breathing problems people experience in sport. Though of course if you are looking to lighten the load of training, forget it ;).

:angel:

[Linny]

I would agree. From what I know asthma like many other conditions is a spectrum disorder (think that's the right term) ranging from life threatening on a regular basis right through to a condition which displays symptoms only when the conditions all match. My brother has asthma for two days a year when a particular tree pollinates. The rest of the year he is completely symptom free. Some people only display symptoms when a number of factors all coincide. The same is true for other allergic responses - something to do with the toxic threshold. EG An eczema sufferer might have skin that can cope with a particular allergen but their skin wouldn't cope if they are unwell or if two allergens were present. See what I mean?
Having said that - asthma is not the cause of all incidents of breathlessness.

[swimmer]

in all of my sessions in hard work my lungs feel tight and i feel like i have someone squezzing me really hard and if i work v.hard i can breathe and it feels like i'm breathing through a straw and im wheezing. i was really worred about this so i went to see a doctor and explained everything.

Then she asked me if i got out of breath walking up stairs and i said no, as i dont, so she said as i didn't i don'thave asthma and she said there was nothing wrong with me. do you think shes right?? do i need a 2nd opinion, and if she is right how come i find it really hard to breathe and sometimes become dizzy because of it??

[ktcute]

Well good god, that wasn't overly sensitive was it. I'm afraid that doctors are becoming increasingly cynical and less and less likely to listen to the needs of people with anything less than iminently life threatening illness.

Personally I think you need a new doctor, never mind a second opinion. Anybody voicing these kinds of concerns ought to be taken a little bit more seriously. You are no doubt a very fit human being, so you won't notice the kind of aerobic demands that most people do until you are working at a much higher level. Walking up the stairs in this case is therefore a pretty poor test.

There are some tests that can be done, but they may show nothing. Your doctor does have a point in one sense though in that if you are able to exercise to a very high level without medication then there probably isn't too much to worry about. However you have noted some serious symptoms, and I think someone ought to take you seriously enough to at least investigate them.

Unfortunately I think that people who are otherwise fit and healthy who complain to their doctor about something that might affect them in the course of doing something "exceptional" like swimming don't get taken very seriously. I got told by my doctor to "overmedicate" then was prescribed a child's dosage inhaler! Not much chance of that then.

If you still have worries swimmer I wouldn't hesitate to take them up with another doctor.

[Bootie]

I didn't quite realise what a can of worms this subject is.

It sounds like that there are a fair few doctors who may only pay lip service to somebodies medical worries as because otherwise they are fit and in the normal course of things there is nothing to worry about.

As the condition athsma) seems to be so prevelant in swimmers due to conditions mentioned in previous e-mails that I wont repeat. Maybe it is time that there were specialist sports doctors that an athlete of any discipline could visit to air their concerns on conditions and symptoms which to the average GP are not life threatening and therefore not important but to the athlete concerned can be the difference between participating and competing in sport and not.

Fortunately living in the Channel Islands we are not involved with the NHS but have a system whereby you visit your GP (for which we pay) he can then refer you to a specialist who is expert in their particular field should your suspected condition require it(this is not charged as our national insurance contribution covers the specialists fee). I would say that here in Guernsey the medical cover and expertise in the field of sports medicine is probably very much higher than in the UK.

This goes not only for medical conditions but where physical injury has also occured, the system is not perfect but seems to be well in advance of the NHS model. The local GP's seem to want to help their sportsman as sport plays such an important part of island life.

[Bazza]

I'm off to Guernsey I think - I was once told by my doctor maybe I shouldn't train so hard!! (Ironic to anyone who knows me!!) :(

[nsswimmer]

ktcute... no offense, but this happens to EVERYONE. when you work hard and have an oxygen deficiet (which, btw, is NECESSARY in bulidng muscle becuz it's only when there is no oxygen available in the muscles that lactic respiration can occur) that is what happens. if the pH level is wacked up, this will happen, too. its not that the doctors are cynical or whatever, it's just an aspect of our sport we hafta deal with. at every practice, after a hard set, i get this chest tightening, and i know others do, as well. i'm not saying that inhalers shouldnt be used if people really do have asthma, but i think that going to a doctor for every time one gets dizzy or cant breathe is a little extreme. it just means that after working hard, that's what happens. that's what i believe, anyhow.

[ktcute]

And I'm not suggesting that everyone should take an inhaler every time they feel a bit out of breath. Believe me, you have to move heaven and earth to get me to take the things in the first place.

However I am absolutely concerned that those who do, never get accused of cheating, and those who feel the need to go to the doctors can do so without feeling bad about it. If people are ill, they shouldn't be discouraged from seeking help. I'm more concerned that people look after themselves than they look macho.