Interview with Doctor Patrick Basset

Doctor Patrick Basset is medical director of Dokever, a company specialising in coordinating medical assistance. This company assures the management of all things medical for the Ultra-Trail du Mont-Blanc%uF0D2, and notably the organisation and management of the medical teams on the terrain. Here he explains the risk you take with excess self-medication.

Could you describe the phenomena of self-medication in the field of trail-running?

« Self-medication is the taking of non-prescriptive medicines to treat or prevent symptoms. This practice, implemented in an inappropriate way, can be dangerous for one’s health. As a study carried out on the Ultra-Trail du Mont-Blanc%uF0D2  runners showed, the most frequent type of self-medication seen is to treat two types of symptoms: osteo-articular pain and digestive problems. As a consequent, the main medicines concerned are non steroidal anti-inflammatory (NSAID), anti-diarrhoea or anti-vomiting medicines. »

What are the risks relating to the taking of these types of medicine?

« In the context of long lasting endurance effort, the taking of anti-inflammatories could be toxic for the kidneys and provoke rhabdomyolysis which is the destruction of the muscular cells complicating more, or less, severe renal insufficiency. We noticed that the acute renal insufficiency is a pathology which is started most often when five factors are united: rhabdomyolysis (destruction of muscle cells) + dehydration (Insufficient or unsuitable hydrate contributions) + hypoxia (insufficient oxygen connected to altitude and effort) + the taking of NSAIDs + hypotension (fall of blood pressure).
As for taking anti-diarrhoea or anti-vomiting medicine, the blocking of the intestinal transit (caused by these medicines) can result in certain cases in septic shock, that’s to say acute circulatory insufficiency bound connected to a bacterial infection.
In a more general way, it is necessary to remember that taking these medicines (whether freely available or not) to calm pain can contribute to the aggravation of a pathology or existing injuries, and in the long term delay their healing or cure. They can also be to the detriment of the progression of the athlete’s performances in the long term. »

What good practice should be followed?

« Above all, pay attention to signs of pain, if necessary adapt your behaviour by choosing to decrease, or to stop, training or to abandon a race. In the case of self-medication, it is vital to respect the stated dosage.  Finally, you must be aware that just because a medicine is available over the counter it is devoid of danger or side effects. I am thinking, in particular certain anti-inflammatories which are available without prescription. »

Faced with self-medication, how do you react?

« During the races, runners treated by our medical teams are systematically questioned about the medicines they have taken. We make our recommendation and treat them based on all the information given. Using computer software this information is transmitted, during the race, to teams at other medical posts, so that they can efficiently advise and treat a runner who has stopped several times at different medical posts (obviously, this information is subject to medical confidentiality).
Outside of the races, we work with the organisers to put a prevention policy in to place with, in particular, information programmes to raise awareness among those who join within the framework of a more global action in favour of the athletes’ health. »

Auto-medication

Many of you participated in a big study on auto-medication in 2010, the subject of a pharmacy thesis supported by Dr Mélanie Arnaud.

Concerning oral medicines used, there are 3 types in the lead:

1. Paracetamol with 12 to 13 % of users
2. Homoeopathy with 12 % of users before the race and 9 % during the race
3. Anti-inflammatory drugs with more than 10 % of users before the race and more than 12 % during the race.

Moreover, aspirin is used by 7% of runners before the race and 4% during the race, corticoids by 0.44% of runners before the race and 0.38% during the race.

Medicines treating digestive symptoms also represent a not insignificant part of the auto-medication.

In total, paracetamol is thus the most used analgesic before and during the race, which is logical because it is the medicine which presents the best profit-risk rapport.
We note however the important use of anti-inflammatory drugs and aspirin, the analgesic power of which is often considered by the runners as superior to that of paracetamol but the consumption of which can produce numerous risks.
Finally, it is necessary to underline that corticoids figure on the official drug products list and that their use must be reserved for emergencies under prescription from the race doctor and that the result for a runner so treated is the termination of his race.

Our advice:

• Generally, do not give in, at all costs, to all pains which are signs of alert from your body and must be respected. Analgesic medicines can mask a serious problem, for example those runners presenting a rhabdomyolysis (muscular destruction which produces a renal deficiency, in some cases severe)·
• In case of aches, for preference take paracetamol. It is the analgesic to choose to put into a first-aid kit during the participation in a race of this kind. Please, however, respect the dosage and the interval between 2 doses.
• It is desirable to avoid taking an anti-inflammatory which can be toxic for the kidneys (and favour the occurrence of rhabdomyolysis), the stomach, but also have noxious effects on the muscular-skeleton structure when consumed regularly.
• Taking aspirin (which also is part of the family of anti-inflammatories : above all don't mix the 2 !) is, also not advised during the practice of ultra-endurance, because it increases the risk of digestive problems, of haemorrhaging in the case of a fall or a wound and can equally give rise to rhabdomyolysis.
• Corticoids are classed as drugs and as such are forbidden in competitive sporting events.
• Concerning digestive problems : we would like to remind you the prevention of these disorders during the race rest above all on training and an adapted diet
  • Anti-diarrhoea medicines : it is better to use a diosmectite in the first instance or an intestinal anti-secretory, and to keep stronger blockers for the acute and invalidating episodes
  • Anti-vomit medicines : domperidone is the preferred medicine due to its good tolerance and its anti-reflux
  • Anti-reflux medicines : appropriate food will allow for good gastric draining from the beginning of the race, but if necessary it is possible to take an anti-secretory.
• And homeopathy? Numerous homeopathic substances can be used in prevention or in treatment of the osteo-tendinous, articular, muscular, digestive disorders … They are not disapproved of.

And above all : If you have to consult a medical post during the ultra - trail du Mont Blanc, do not forget to specify, to the doctor or nurse, the names and doses of medicines which you might possibly have taken: it is indispensable so that we can, indeed, look after you!