Concerned About Irina's Health for Olympics

[Rgirl]

In a recent article taken from a research article, the connection between certain hormones, stress, and diseases such as vasculitis. It mentions elite athlete. What follows is the link to the entire article as well as excerpts relative to elite athletes.

http://www.immunesupport.com/library/bulletinarticle.cfm?ID=6868

Garvan Institute scientists have discovered how a hormone, known as neuropeptide Y (NPY), can prevent our immune system functioning properly, paving the way for two new major opportunities for therapeutic intervention.
"Most of us expect to come down with a cold or other illness when we are under pressure, but until now we have mostly had circumstantial evidence for a link between the brain and the immune system", says lead Garvan researcher Associate Professor Fabienne Mackay.

"During periods of stress, nerves release a lot of NPY and it gets into the bloodstream, where it directly impacts on the cells in the immune system that look out for and destroy pathogens (bacteria and viruses) in the body," explains Mackay....

Associate Professor Herbert Herzog who heads the Neurobiology programme says, "Elite athletes are particularly prone to illness, possibly because of the extreme physical and emotional stressors associated with competition. But our research is relevant to everyone because there is no escaping stress – be it in the workplace or at home. Employment surveys show many workers feel there is more job-related stress today than even a couple of years ago"....

Understanding the connection between NPY and the immune system offers two new major opportunities for therapeutic intervention. The first is to design new drugs to stimulate immune system defences in people exposed to high levels of stress, such as in a bereavement situation, and in immuno-compromised individuals. The second is to exploit this Th1 inhibitory mechanism to prevent immune responses getting out of control as in various inflammatory and autoimmune diseases such as Crohn's disease, rheumatoid arthritis, multiple sclerosis, type I diabetes and lupus.... Rgirl: Vasculitis is an inflammatory and autoimmune disease.

This research is being published in the Journal of Experimental Medicine, Volume 202, No. 11, December 5, 2005, pp1-13.

This information is especially relevant to Irina. So researchers have important new evidence about the connection between stress, hormones, and inlammatory autoimmune diseases, but no treatments yet.

I'm even more concerned that under the stress of Olympics and Irina's training "plan," which she said to Peter Carruthers in her post-win COR interview.
Q: "What are you going to do to keep up this level of skating until the Olympics?" (Paraphrased.)
Irina's Answer: "Work more hard and work, work, work, work, work...work."

Comments?

Rgirl

 

[Kwanford Wife]

I would assume that doctors could hold a symposium in Irina's front living room & explain just how dangerous her current plan of work, work, work is to her long term health and she would simply smile, put on her skates & hit the rink. Irina is a woman on mission & it will take more than medical advice to sideline her... she's a soldier. I didn't get that until the other night when she was doing that interview... Irina skates to win & winner takes all. All one can do is pray for her & root for her... You gotta respect that & love a champion with heart & guts...

 

[rigel434]

I share your concens in theory, but just judging by what my eyes tell me, Irina looks to be getting healthier and healthier as she competes. Think back to how she looked at the 2004 worlds after she had an extended period in the hospital. Irina has often said that she "can't live without skating" and so it's clear to me that she thrives in the competitive environment.

I'm more concerned about all the viruses and so forth floating around in the airplanes she'll be forced to travel in this winter. The prednisone she takes works by suppressing the immune system so there's no doubt she's vulnerable to airborne viruses. My immune system is pretty strong, yet I always seem to pick up some kind of bug when I travel on airplanes.

 

[BronzeisGolden]

Thanks for posting that and researching this topic, RGirl. I think it is a legitimate concern. A weakened immune system is a very dangerous thing for anyone. Perhaps that is why she skates like she does now. She is living in the moment and giving it her best while she can. I hope she can stay healthy for the rest of the season. It would be a real shame for her illness or some related affliction to halt her momentum.

 

[Joesitz (RIP)]

I would like to know more about the treatment. If Prednisone is giving Irina all that energy, I want to get some too. God knows I need it.

Joe

 

[nymkfan51]

Her condition is no doubt a serious one, but from the looks of her, it seems the doctors have found just the right medications to control the disease.
And I think her stress level should be fairly low compared to other seasons. I can't imagine what would worry her at this point (skating related) ... no one has even laid a glove on her this season. I would think most athletes would give anything to be going into the Olympics in this situation.

Whatever happens, I do wish her good health.

 

[R.D.]

According to recent interviews, Irina seems to be pacing herself up to the Olympics. They are playing it smart this time so hopefully, nothing should happen to her between now and February.

 

[rigel434]

"If Prednisone is giving Irina all that energy, I want to get some too."

Actually, it's doing just the opposite- Irina said in one interview that after the European Championships she was so tired she just retreated to her hotel room for a few days straight. Prednisone is saving Irina's life (her condition was generally fatal within a year before prednisone came along) but it's a tough drug with a lot of bad side effects.

Thankfully, however, now that we have prednisone the long-term prognosis for Irina's condition is good. Studies have shown it puts her disease (Churg-Strauss vasculitis) in remission in 90% of cases.

 

[Doggygirl]

Q: "What are you going to do to keep up this level of skating until the Olympics?" (Paraphrased.)
Irina's Answer: "Work more hard and work, work, work, work, work...work."

Comments?

Rgirl

To me, this is MUCH broader than a figure skating fan question, or even a question about a beloved figure skater. This is a question about quality of life v. possible longevity issues.

I get the distinct impression that Irina's love of skating and at this stage in her life, competitive skating transcends counting her life in years on the planet. And IMO this sort of thing is a very personal decision. We each have different priorities in life, and that alone makes each of us unique, and drives personal decisions that others might make for themselves, or not.

My strongest wish for Irina is that she understands as well as she can, her medical options and the risks and rewards of those. I get the impression that she might choose a shorter life of skating than a longer life of something else, but that's ONLY my impression.

My father would rather die at 75 while tending his property (his fruit trees, vegetable garden, flower beds and grass) than die at 95 while deprived for years of doing those things that he loves the most.

Some business / personal friends of ours just lost a nephew - a 16 year old jockey in a horse racing incident in the Columbus area. Young people are even harder to lose, I think. His parents are beating themselves up about their decision to allow their minor child to do what he loved most - ride and race horses. The aunts and uncles are beating themselves up. From everything I have heard about this young and very promising jockey, he died doing what he loved the most. Would he be happier living to a later age had his parent prevented him from doing what he loved? I don't know - these are serious questions that IMO we all have to answer for ouselves.

I'm not trying to turn this into a "doom and gloom" thread. But the truth is, none of us EVER knows when our time here will pass. I admire everyone who makes the most of every single day, and I believe Irina falls into that category.

I hope that Irina will be doing "skating specials" when she is 70+ years old, with her skates still on fire. For now, I'm just happy for her that her skates are on fire NOW, day to day.

DG

ETA: Web link to story about the jockey - nephew of people I know well. None of us EVER know what tomorrow will bring. http://msnbc.msn.com/id/10073718/#storyContinued

 

[Rgirl]

Fascinating responses all!

One thing to clear up immediately. As far as I know, Irina is not on Prednisone now nor as long as she is competing. Believe me, Prednisone only gives you energy the first 24-48 hours you take it and it must be in a very high dose, about 40mg/day, tapering down, depending on the disease and level of inflammation, starting the second day.

If Irina were taking "mainstrream" doses of Prednisone for treatment--about 10 to 20mg/day--she would have gained about 20 LB. and have chipmunk cheeks the size of her other cheeks. She would be weak all over, especially in her quads. I've had patients on 10-20mg/day of Prednisone (or some other corticosteroid) walk into the clinic and just collapse, not because they're tired but because their quads give out because of the Prednisone.

Worst of all, IMO, is that if Irina is on a mainstream clinical dose of Prednisone for any length of time, i.e., months, the cartilage in her hhips and shoulders is destroyed by the Prednisone. I've had patients who required hip and/or shoulder replacement surgery because their hip and shoulder joints become just bone on bone. It's one of the most disabling and painful musculo-skeletal conditions you can have. I could go on and on. If your interested, just Google "prednisone side effects" and read the long, long list.

Many posters who are nurses, pharmacists, physical therapists, and other health care professionals have posted about the negative effects of Prednisone, which is a CATABOLIC steroid, meaning it BREAKS DOWN tissue such as cartilage, NOT an ANABOLIC steroid, which means it BUILDS UP muscle tissue especially, and are taken by those athletes who want "super human" muscle strength, though at the expense of their livers and other organs. Lyle Alzado, a pro football player who died of liver cancer, IIRC, was extremely outspoken about the dangers of using ANABOLIC steroids, talking to high school and college athletes, warning them of the dangers.

When Olympic athletes go through "doping" after they compete, one of the things the physicians are looking for in their urine are traces of anabolic sterioids, or hormones such as abnormally high levels of growth hormone. There's even "blood doping" where athletes "give" their own blood into the standard retaining bag and freeze it about four to six weeks before the event, enough time for their bodies to build up enough normal red blood cells again. Then they reinject themselves with the blood they'd removed before and had kept frozen (they defrost it before reinjection), thus giving their blood extra high levels of red blood cells. This used to be especially popular with long distance athletes.

However, rest assured that all the "performance enhancement" methods I've described above have been easily detectable at the Olympics for at least the last15-20 years. It's the new "unknowns" that keep the sports medicind doctors on their toes, sending athletes "underground" years before and right up to the Olympics to try to found out what the latest methods are of trying to beat the system with illegal performance enhancing substances.

Sorry for being didactic, but I really would like to see all the misinformation about Prednisone come to an end, especially with regard to Irina.

There is a chance that Irina may be on an extremely low dose of Prednisone, e.g., 1 or 2 mg/day or less in an attempt to ward off a recurrence of vasculitis. However, Irina would not be allowed to compete with any traces of Prednisone in her system even if it does nothing but interfere with her performance and reduce the inflammation from the vasculitis. At least that's how I understand the doping standards of the IOC.

Also, as far as I know, there is no solid research supporting such treatment. However, a certain physician/researcher, whose name escapes me, has written a book, "Low Dose Treatment with Cortisone," which provides information from his clinical studies using 1-2mg/day when mainstream medicine would prescribe 10-20mg/day.

In any case, ITA with Kwanford Wife:

I would assume that doctors could hold a symposium in Irina's front living room & explain just how dangerous her current plan of work, work, work is to her long term health and she would simply smile, put on her skates & hit the rink. Irina is a woman on mission & it will take more than medical advice to sideline her... she's a soldier. I didn't get that until the other night when she was doing that interview... Irina skates to win & winner takes all. All one can do is pray for her & root for her... You gotta respect that & love a champion with heart & guts..

I agree "You gotta respect that & love a champion with heart & guts"; however, I think guts have to be balanced with an intelligent approach to training, whether one has an illness or not, but especially when one has an illness.

But you're right. All we can do is root, pray, or whatever for Irina and hope that she does not have a recurrence of the vasculitis or if she does, it's a very minor one at least six weeks before the Olympics so she has time to recover.

Anyway, when people talk about "Just give the OGM to irina now," that's why I say, "There are icebergs out there."

Rgirl

 

[julietvalcouer]

I haven't read the entire article in detail, but looking at the second line you highlighted--it sounds like they're saying intense activity releases a chemical that *shuts down* the immune response.

Understand I am speaking as someone with a chronic incurable autoimmune illness (that also is most commonly treated with prednisone, though it's not foolproof and if/when it fails, other options include a splenectomy and chemotherapty.) For someone like me, and, if vasculitis is like ITP for Irina, a low-funtioning immune system can be a good thing. In my case, when my immune response is triggered, sometimes the Th1 cells never shut down and instead target my platelets (the clotting factors in my blood.) The normal platelet count on a CBC is about 120,000. When I was diagnosed mine was down to 4500. (No, that's not missing a zero.) I required transfusions and massive doses of Prednisone to shut down my immune system enough so that I could start producing platelets again.

No, you do not want Prednisone. While it does give some people energy, it's usually manic-type energy bursts, like waking up at 3am and vacuuming the entire house because you can't sleep at all. Other people end up bloated and lethargic. I gained weight, some people lose it. Take enough, and it can cause heart attacks, strokes, and psychotic episodes. (In my case I did experience severe and violent behavior swings, including cursing out a poor innocent bystander of a ticket agent, because it was like the control switch on my temper was just wide open.) I know of at least one professional athelete, speed skater Nick Thometz, who had ITP and quit taking prednisone while training because he simply couldn't perform while on the drug. I now carry it for allergy emergencies but I hate taking it. Definitely something you only take because there's nothing else. (Benadryl doesn't act fast enough or as a bronchial relaxant, and my thyroid issues make an epi pen a last-resort strategy.)

So if Irina's condition is caused by excessive immune activity, her skating may be HELPING rather than hurting her treatment. Not to mention that the research the article is talking about would be hope for people like her and like me--a treatment besides a chemical that helps, but leaves you feeling almost worse than before. That second sentence is talking about using this stress reaction to find a way to shut down the Th1 reaction, without having to resort to corticosteroids. I would eagerly volunteer to test that therapy if it meant I might not have to take prednisone again, and I bet Irina would, too.

 

[R.D.]

Anyway, when people talk about "Just give the OGM to irina now," that's why I say, "There are icebergs out there."

Sure there are.

But go ahead, schedule the Olympics as planned. You will just owe me $500 if Irina wins, and $1000 if she wins by more than 20 points.

That's right, I'm comfortable betting on irina to win. I wouldn't mind placing a SECOND bet that if Irina does NOT win, the winner will be from Japan. No Cohen or Kwan to speak of.

 

[Lanie]

I hope Irina remains healthy. It's worrying, but she's got the right medication now it looks like!

I've been on Prednisone (I'm pretty sure that was it!); doctors gave me lots of anabolic steroids as a child to try to combat a lung disease I've got to deal with. It made me so manic and frightening that my mom took me off of 'em. I was young but I remember just being so weak and tired, then having moments of energy, and generally just feeling BLAH. I doubt Irina's taking Prednisone, she wouldn't be skating like she has if she was on it!

 

[rigel434]

Irina is definitely still on prednisone and most people with her condition take it indefinitely.

http://www.boston.com/sports/other_...rlwind_year_has_skaters_head_spinning?mode=PF

Slutskaya's roller-coaster ride with her health has taught her that much. She still takes prednisone for the vasculitis, an inflammation of the blood vessels, and uses an inhaler to help control her asthma. Some days, she still feels as if she's 18. Others are a struggle.

"Every day it is changing," Slutskaya says. "You never know. I don't have one day the same."

- end quote -

 

[kyla2]

It Really Isn't Relevant

I don't think irina is on high doses of steroids. I am sure she is being managed on the lowest dose possible to control her symptoms. Any physician with a brain knows to do that. High doses of prednisone make you feel awful, and produce significant short and long term side effects. I know I have been there. But there are always exceptions. My friend with the M.S. was one of them. They increased her energy, but she was on whopping doses of Prednisone. Her situation was quite bad and she needed them to survive. Irina actually looks healthy and fit. I suspect that she is getting very good health care and the best advice available.

 

[rigel434]

"However, Irina would not be allowed to compete with any traces of Prednisone in her system"

She has gotten medical waiver from the skating federation to use it. That's how the Chicago Tribune broke the news about her having Churg-Strauss syndrome, they got a copy of a permission slip from her doctor in Moscow to allow her to use prednisone.

"There is a chance that Irina may be on an extremely low dose of Prednisone, e.g., 1 or 2 mg/day or less in an attempt to ward off a recurrence of vasculitis."

.Google "Churg-Strauss" and you'll see that most people with it take prednisone indefinitely.

http://www.cssassociation.org/about_the_syndrome.asp#4

Once diagnosed with Churg-Strauss Syndrome (CSS), systemic steroids are usually the initial therapy. Prednisone, and Medrol are the most commonly used steroids for treatment. Initially, high doses of oral steroids (e.g. 40-80mg) are given in an attempt to get the disease into remission as quickly as possible. Once improvement is seen, the steroids are very slowly tapered down to a lower dose for maintenance. Much of the literature on CSS states that most people are able to completely wean off steroids. However, in our experience that seems to be more the exception than the rule. Most people seem to require a maintence level of steroids indefinitely.

- end of quote -

The term "vasculits" might make you think of just an acute inflammation of the blood vessels, but it's a chronic auto-immune condition, similar to lupus.

 

[R.D.]

Thanks for the info and links. Very informative and sheds light on the situation.

 

[Vash01]

Fascinating discussion. My concern for Irina has always been (since last year) that her health can go south anytime. I hope she gets through the Olympics OK, hopefully with an OGM, but most important with her body in good health.

Vash

 

[euterpe]

Last year, the doctors had gradually weaned Irina off prednisone and she was fine until the end of December, when she started having vasculities symptoms again and she had to go back on heavy doses of prednisone to get back into remission. You could see at Cup of China and Cup of Russia last year that she wasn't on steroids, because there there was no trace of puffiness in her face. At Europeans, she was definitely showing the effects of prednisone, and she didn't skate well. She looked better at Worlds: she still was a little puffy, but by then she had re-adjusted to being on the steroids.

She is probably not on prednisone now, as she looks very lean with no trace of fluid retention. Last year, it may have been the stress of all those competitions--GP events, cheesefests, GPF that brought on the relapse. Who knows what will happen this year with the pressure of the upcoming Olympics.

 

[wvgal57]

What a relief to finally see a balanced discussion regarding Irina's illness. It so sad that some would rather stoop to the she's juiced" rather than read up on this illness and the obstacles she faces.

It comforted me to read the article posted not too long ago in which one of Irina's specialists said that although he was not happy that Irina had chosen the lowest level of therapy to control her illness, he did feel that combined with her good diet, good conditioning practice and destress methodology, she could do it. Moreso, he thought it her attitude and determination to fight this had helped tremendously.

She is making the best of a terrible situation and I sure hope she continues to beat it.