Original Writings

Tribute to Nick ; Anabolic Blood Clots

Ok, lets roll!
This month's Anabolic Doc preaching will be in dedication to the spirit of a very special man named, Nick Winters. For those of you, "out of touch" with the happenings deep inside the "lifter world", Nick was a very strong, sweet dear man who died at the ripe age of 29, on November 2, 2010. I did not know Nick personally and my deepest sympathy goes to his family. Of course, everybody wants to know how he died and what happened. I have no idea what really happened to Nick and this write up, in no way has any relations to what Nick did in his life; it is simply a very good opportunity to discuss a very important medical topic. The cause of Nick's death is none of our business, but the "talk on the street" was that he died from a "blood clot". In the days after his death, I received so many emails and calls about this, that I decided to write up a comprehensive document on the nature regarding the relations of anabolic steroids (AS) and blood clots. This topic is not esoteric to me, but to the average bear (including well trained physicians) it is. It is a sad truth that millions of people are using AS and yet, the medical community continues to ignore this fact! We know a hell of a lot more about the retina of the common fruit fly, than even the basic mechanisms of how AS work - not too mention how they cause disease!


This is why you all have me and it is very clear that God has placed me in this position to end this ignorance. He said to me last week, "I will let you bench big, as long as you stay humble and take care of the "lifters" of the world." He reminded me of how "jacked up" all of Michael Angelo's characters were and that he wanted Michael to be the Anabolic Doc, but thought the world was not ready yet!! Then, he sighed and said he let the Nazi's invent Anabolic Steroids, so he could blame all this shit on them and then he closed with, "You are the Anabolic Doc, go forth and get huge and stay healthy!!" I swear, he said this to me and then he let me bench 510lbs for a new PR at 46 years old!!! NO JOKE!! So, I will ask you to strap in, crank up the I.Q. and if you are ADD, ask your doc for a tad more Ritalin! Here we go!!! Pay attention!!


You all know that I hammer on staying as healthy as you can during your quest for "hugeness" and I have made a medical career out of caring for "lifters only". It's been a few years now, and the more I practice this special type of medicine, the more I realize how limited we are as physicians and just how fascinating it is to be a healer this day and age! I want to disseminate as much "healing" as I can and this document should be copied and spread all over the world, so please tell everybody you know about this data, especially your Doctor!!


The term, "blood clot" refers to when our blood clumps together and then causes a blockage somewhere in our body's blood vessels. The medical term is called, "hypercoagulability" and this can happen in the arteries or the veins. When clots form in the veins, the term is known as Deep Venous Thrombosis (DVT), you may have heard of this after someone flies on a plane and has a swollen lower leg, sees a Doc and is diagnosed with a DVT. The risk is that the "clot" will progress up to the lungs and cause a "pulmonary embolism" (PE). This is a deadly medical condition and we also see a lot of PE in our hospitalized patients. This may have been what happened to Nick, but again, I have no idea; but, when I heard the "blood clot" rumors, the first thing that came to mind was a massive PE!! I have not seen this in the "lifters" I care for; however, when it comes to "hypercoagulability" and AS, we have to think of the more common, arterial clot (aka-Thrombosis) heart attack or stroke! Now, this is my "bread-and-butter" and I will attempt to elucidate the common mechanism-of-action relating the various factors that unite both venous and arterial clots.

Still with me???

The mechanism of DVT/ PE and arterial thrombosis is very well studied; but, the relations to AS, are not; so, I will discuss what I have seen and studied in my practice and try to make the recommendations very straight forward. Remember, THERE IS NO SINGLE COMPREHENSIVE DOCUMENT ON EARTH THAT I COULD FIND DISCUSSING THE RELATIONS OF AS AND HYPER-COAGULABILITY, SO THIS WILL BE THE FIRST!!!!

The hyper-coagulable state is reached through different means when it comes to the arteries and veins; but, we know for sure that on the arterial side, the basic components of the Metabolic Syndrome- hypertension, diabetes and lipid abnormalities play the main role.
Have I mentioned these issues to you before?? LOL...
In addition to this and for AS users we see additional and synergistic medical issues such as; here we go!!!!
...polycythemia (too much red blood cell mass-see 'Heavy Duty Blood" Anabolic Doc column in past), low HDL, high LDL, worse and labile hypertension-causing adverse sheering forces on the endothelial lining, an increase in "pro- inflammatory" cytokines (blood products produced in the liver and the endothelial lining of the blood vessels)- including an increase in hypercoagulable factors- and a reduction of natural anti-coagulants, increased oxidative stress to the endothelial lining, adverse renal function; nephrotic syndrome and loss of protective blood proteins (see Anabolic Cardio-Renal Syndrome Anabolic Doc column in past), elevated estrogen (when on AS, one's Estrogen levels are proportionally elevated in a dose dependent fashion-which has been shown to be a well known cause of blood clots-- this we know from studies on women and HRT!!, in Men, AS abolishes FSH and LH and there is literature that clots can be created, direct adverse affects on the endothelial lining and myocardial tissue by AS and what I call "mass affect" on the body-which means that when you are "big", the hemo-dynamic physics all get worse and all the above variables are more heavily weighted!!! For example, left ventricular hypertrophy is a classic known risk for MI and CVA (heart attack and stroke)....and let's not forget to mention Obstructive Sleep Apnea (OSA) - did you realize that AS can cause and worsen OSA!!! WoW, there it is.


Now, what can be done about all of this?? First of all . . . DON'T USE AS, IF YOU DON'T WANT TO TAKE THIS RISK!!!! And if you do decide to use AS, BEWARE!!!


And now, I will list what you should do:
SEE A DOCTOR AND BE HONEST, HAVE A GOOD HISTORY AND PHYSICAL EXAM - including a detailed family history regarding "hyper-coagulability" as it relates to your mother, father, sister, brother and children. There are well known "family conditions" and genes that contribute to clotting, such as: deficiencies in Protein S, Protein C, antithrombin and Factor V Leiden is the most common, prothrombin gene mutation. If you are not sure your Doc is on the ball with all of this, see a Hematologist.


As far as what you can do to reduce the natural risks discussed above: keep doses down, treat hypertension, poor lipid profiles (lipids are fats, they thicken the blood (imagine the bulk of grease at the top of the leftovers in the fridge)

...any of you who know what I do, realize that I am the GURU in regard to treating lifters for hypertension and adverse lipid panels!! And I can get almost anyone to goal!!!
Stop bragging Dr O. Ok—sorry...

Next, check your labs for polycythemia!!, liver and renal function, lipids, and low Vit D. And I am not your Doc, but consider low dose aspirin (very controversial now and not simple!!! Needs to be done on a case-by-case basis!!), treat low Vit D, try Co Q 10 and fish oil....increase your cardio!! Stop wining and just do it and as for wine... consider having a glass or two daily!!! HA HA.....
Well that's it!! and God Bless Nick-RIP my sweet brother of Iron. Hope this helps save lives!! Next month, I will respond to one of the many great emails we receive here at MD and to the attention of the Anabolic Doc. I think after all this "heavy medicine", we will discuss something equally important: The BALLS. I will try to make sense of the HPTA and all those men out there with the "shrunken ball syndrome". Most importantly, I will give you my medical secrets on this topic and spill the medical beans on what you can do about your BALLS... get ready for another interesting "real" dialogue with the wild, one and only ANABOLIC DOC...... Until then, my dear Muscle-Heads...


Stay Strong and healthy, Dr O

 

Metabolic Doc- The Luckiest Doc on Earth!!
(Sept 2010)

As there is no time, I thought it was time to submit another original piece for my post at Power Lifting Watch.

I dedicate this to those who “don’t understand or know what I do” Maybe this will help you.

I am so busy now caring for “lifters” in my unique medical practice. No physician has ever launched anything like this ever!  At least not in over a hundred years!!  I have created a monster!!  It was not long ago that I submitted my first article to you all, “Big Medicine” and I hope it at least caught your eye. I am not here to show off, prove any points, nor “get in any one’s face” about what I do and today was  one of those days that I consider - deeply, what I do. A day of poignant memory and gratitude as I was presented  with two gifts. The first gift was another “lifter patient” from the Mid-West who makes the trek to see me and the other,  by an old friend, a picture of me, back in the day , circa-1984, when I was about 230 + lbs, 20 years old and ripe with the Adonis Complex. Boy, I looked like shit! My face was so fat that I almost could not believe it was me and what the hell was I thinking!! But I remember exactly what I was thinking…  all I was thinking about was being big !!!  And lifting BIG!!  back then, up at the Old School “Townie” gyms I trained at  out side Syracuse University. It was there I remember, I was an impostor student on “The Hill,” because all I really wanted to do was to go to the gym and squat more or at least weigh more that day!! Forget the nights waking up to eat half sticks of butter, not to lose weight!!! Boy was I ill. I wanted to be a “lifter” and I would do almost anything to be accepted and respected by the ones I trained with. These were the days when I spent a hell of a lot more of my day in the gym than the library. Over the years, that behaviour has changed. At least on most days!! 

 And today, as I examined my new patient, (just like me, back in the day although much larger, stronger and better looking  than I was then- Ha  ha), I had the sober sensation of, “heal thy self.” 
WOW!!!!!
Hench the gifts!!!

As I was wheeling out my ECG   machine to check his Heart, I had to stop in the hall for a moment and take a deep breath and shake my head!!!

Get it!

Now I have balanced my days in doing what I love and what I have been trained to do, with the same passion and with the same people!!  And I spend it with mostly men (more woman coming!!  Thanks), the likes of who I used to train with back in the day and we talk about lifting, share stories and  I get to heal !!!  The brothers and sisters of Iron!!  Finally, I get to give back to my people!! 
Because its not about steroids (jack ass) or what any one thinks is right or wrong….
Its about healing those you truly love and respect. 

Stay Strong and Healthy,

Dr  O

 

Big Medicine
Metabolic Doc

Power Lifter’s are the poster boy’s and girls’ of the proverbial;
“never enough, never say die, bigger-stronger.”

Who cares why! It is-what it-is. This is no simple sport! And not for the light-hearted. We all know that this is an “extreme” sport and “under culture,” to say the least.
By, definition, the goal is to lift heavier and heavier weights.
There are obvious medical/physiologic consequences associated with “lifting Big”, yet, due to our “extreme” nature, we have never had proper attention from the medical community. And I’m not talking about orthopedic surgeon’s –who have done a great job on re-inserting our ruptured biceps tendons! I am referring to basic Internal Medicine, the clinical study of our hearts, blood vessels, kidneys and livers! Lifter’s are known to have shortened life spans secondary to untreated hypertension, enlarged hearts and metabolic derangements seen in “big people”. This does not have to be! As a lifter/physician, I have dedicated my professional life to the medical care of weight lifters. I have developed medical protocols for the management of high blood pressure and adverse metabolic states and at the same time, not cause weakness!  This has come after years of being an Internist and a “heavy lifter”. Now, I offer my services to the greater lifting community as the “Metabolic Doc.” A doctor, who understands you and lives the “lifting under culture.”

The Metabolic Doc, will see you now!