Thanks, that's very helpful. so in LCW's case, dexamethasone would only be administered intramuscularly, and not intravenously?
Cilic's case. Read paragraphs 69 to 76. http://www.tas-cas.org/d2wfiles/document/7764/5048/0/Award203327-333520(FINAL)20internet.pdf
Well, pharmacokinetics is difficult for someone like me to understand but not for a medical practitioner, pharmacist, medical scientist/researcher and,least of all, to the people in WADA who are the top watchdog for anti-doping in sport. However, if LCW's case is proven to be an anomaly of dexa staying in the body much longer than normal, he will be absolved of all blame, the first of its kind. But, frankly, I won't dare hope for it because we're talking about medicine, not exotic food, such an incident is extremely rare and it would indicate that dexamethasone is not safe for use healthwise and should be removed from all pharmacies for further study and rigorous testing (eg, for other unknown adverse effects when taken together with other drugs).
Dexa can be given both Intravenous (IV) and Intramuscullar (IM) depends on the indications and therapeutic effects that the Medical Practitioner desire. Since administrating through an IV route is a more direct way in introducing Dexa into the body system via the blood vessels (systemic administration), it has a far greater and faster GENERAL therapeutic effect and this is why such administration is chosen to treat life threatening allergic reaction such as drug hypersensitivity reactions that require a fast therapeutic drug response. While in Dato' case, since he has a local injury (thigh injury) and stem cell was given also at the site of injury as part of the reconstructive - healing process, Dexa was given IM as a mainstream route as to benefit it's LOCAL effect.
Thanks. Very helpful. One last question: if it was a tendon injury, then definitely IV, right? But since it was the thigh, it is very likely to be a muscular injury, i suppose.
Intramuscular (IM) was the correct route in introducing the treatment into Dato' thigh muscle since the injection was administered directly into the injured thigh. What is for sure there is no medical terminology such as Intratendon route ( hahahahaaha). No my friend, IV would not be the right choice since it is still a local injury, in this case an injured tendon. If it was a tendon injury and since tendon is part of the vital connective tissue that support the joint anatomical structure, if an injection was to use as a route to introduced whatever form of treatment modalities to treat the injured tendon then such administration is define as an Intra-Articular route (injection to the joint).
Thanks. I think I understand now. World Squash Federation has this requirement: "Athletes are no longer required to apply for an abbreviated TUE for non-systemic glucocorticosteroids but must declare to WSF when glucocorticosteroid use begins. Routes of administration that require a declaration of use A declaration of use is limited to glucocorticosteroids that are administered by: -Localised injection (intraarticular, periarticular, peritendinous, epidural and intradermal) -Inhalation Athletes are reminded that: (1) A Therapeutic Use Exemption is still required for glucocorticosteroids administered by oral, intravenous, intramuscular or rectal routes. (2) Topical preparations (e.g. eye drops, nasal sprays, creams, & ointments) containing a glucocorticosteroid are not prohibited and DO NOT require either a TUE or a declaration of use. " World Squash Federation only requires athlete to declare if it was used within the last 4 weeks. But if intramuscular, athlete still needs to apply for TUE. http://www.worldsquash.org/ws/wp-co...Guidance-Notes-for-TUE-Declaration-of-Use.pdf
"Non systemic" means external use like skin creams, eye drops, nose sprays, etc So anything internal, like oral, injections of any form, rectal, etc will require TUE
The injury sustained by Dato' in his match against Peter Gade in the Thomas Cup 2012 was of the ankle. Even if glucocorticosteroids were used then, it would be administered intraarticularly. So I guess no need to apply for TUE. Besides, the Olympics was still two months away. Everything is fine. But if glucocorticosteroids were administered intramuscularly in July 2014, surely the KL Sports Medical Centre would know whether there was a need to apply for TUE. They know the WADA code and the TUE protocol very well. People at the KLSMC will be very important witnesses for Dato'. He must remain on good terms with them. Make them happy.
I can imagine whoever the stem cell therapist is treating LCW must be fuming mad at being blamed for negligence or dereliction of duty. In fact (from one of the articles posted earlier), Dr Ramlan who recommended to LCW the stem cell therapy at the private clinic has already warned everybody not to jump to conclusions and incriminate him. Btw, the Malaysian Dr M. Jegathesan sits in one of the WADA boards (the Health,Medical and Research Committee) as I've mentioned before, I'm sure he knows more or less what will be the final outcome for LCW, I supposed, just that he is not allowed to speak about it, I should expect.
I am not an expert on the pharmacokinetics of glucocorticosteroids. But I am quite sure the stem cell doctor has done his best. Although Dato' is angry, it would be unwise for him to think he can sue the doctor. Luckily, I think he has stopped saying so in the past few days. The doctor is now his best chance of getting a lenient sentence.
I'm not sure if Cilic's case is relevant here, there's a more relevant case of a Russian biathlon player Moiseyeva who was tested positive for dexamethasone during the World Championships in 2008. She was eventually cleared of all accusations. http://in.reuters.com/article/2008/03/16/idINIndia-32519320080316 (other sources: http://eng.tatar-inform.ru/news/2008/03/17/13925/ http://www.besttopnews.com/news/style/sport/16-03-2008/58012-0/) Russia's Moiseyeva cleared of doping charge MOSCOW Sun Mar 16, 2008 8:26pm IST (Reuters) - A doping charge against Russian biathlete Tatyana Moiseyeva, who failed a drugs test at last month's world championships in Sweden, has been dropped, the sport's world governing body said on Sunday. The International Biathlon Union (IBU) said on its Web site that although Moiseyeva's A sample had tested positive for dexamethasone, a steroid hormone, it closed the case after the athlete and her doctor had submitted their explanations. The IBU said on www.biathlonworld.com that the explanations were analysed by its vice-president for medical issues, Dr. James Carrabre, who came to the conclusion that the substance was used as topical preparation for ophthalmic disorders. Former world junior champion Moiseyeva, 26, tested positive following the women's relay, in which the Russians finished fourth, on Feb. 17 in Ostersund.
@Mods Can we start a poll on how much time he should or will be banned? Or would that be too divisive and controversial? As if this topic isn't already that...
Dexamethasone is a useful drug if it is prescribed carefully. As we don't have complete information, it is for hard for us to work out what is going on. The team doctor was told by the stem cell specialist that dexamethasone would be clear from LCW in10-14 days (hopefully it is back up by some valid study). If it is the case, there was additional thing happened which prolonged the duration of the drug in the body. I wonder if the treatment was complicated with haematoma (clot) which contained dexamethasone which was injected on 17.7.2014. While haematoma started resolving, dexamethasone start getting into the blood stream. This is a slow process may explain why dexamethasone is still in the body.
There's no hematoma or abnormal metabolism, it's just dexamethasone controlled release... imho of course.
Of course controlled release can perfectly explain this phenomenon as well but it sound like the specialist has taken this into account unless he just quoted 10-14 days without evidence based
Enough have been said about the banned substance. Please refrain from voicing your opinion if you are not an expert on doping. If you are, please tell us your qualification.
