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Paralympic athletes face risky boost in competition

Banned by IPC, 'boosting' involves self-harm by causing elevated blood pressure

This past Saturday the Hockey Canada and Canadian Paralympic Committee announced Canada’s National Sledge Team roster heading to the Sochi 2014 Paralympic Winter Games in Russia this March.

James Gemmell is one of the 17 players who made the cut, and it was a long hard road to get there.

He was in a car accident in 2004 and lost his right leg above the knee. A formerly avid hockey player in his hometown of Quesnel, for years after the accident he thought his life in sports was over. Then one day everything changed.

“I was flipping through channels and I saw a gold-medal game at the Paralympics on TV and ever since then I have been playing sledge hockey,” said the 34-year old defenceman and proud family man who lives in Delta.

After years of training, Gemmell was disappointed not to make the Canadian team for the 2010 Games in Vancouver.

When he spoke with the Courier prior to the Sochi announcement, he said he has worked twice as hard since 2010, sometimes spending up to six hours a day at the gym, for the chance to go make the Paralympic team heading to Russia.

“If I get to go, I think there will be no feeling that will match it, I don’t think, in my life,” Gemmell said prior to Saturday’s announcement.

Immediately after the Paralympic Committee released the roster Gemmell took to Twitter. “Biggest accomplishment in my life, truly honored to represent this great country,” he tweeted.

Gemmell is an example of the pure hard work and dedication of Paralympic athletes and his passion demonstrates what making it to the Games means for so many.

But for some Paralympic athletes with more severe spinal cord injuries, hard work and dedication aren’t enough.  

A small but significant percentage of Paralympic athletes will likely feel forced to “cheat” at the Games for a competitive advantage. This is the darker side of the Games and one many medical experts are trying to combat.  

“Boosting,” sometimes known as natural doping, involves self-harm to the lower part of the body. This is done in order to increase heart rate and improve performance capabilities.

Medically known as inducing autonomic dysreflexia, it is one of the worst kept secrets of Paralympic sport and has been banned at the Games since 2004.

However, evidence suggests it continues. A survey at the 2008 Beijing Paralympics by the International Paralympic Committee saw 17 per cent of athletes admit to boosting.

Not all athletes at the Paralympics would want or need to boost, but for some it puts them on a level playing field. The need for the boosting has to do with the type of injury. Athletes with injuries high on their spine often can’t regulate their blood pressure and heart rate in response to exercise.

Essentially, they don’t get the strength boost of a person without injury, or with an injury lower on the spine.

Applying painful or non-painful stimulation below the injury site by clamping off a catheter to allow the bladder to over fill, sitting on tacks, or even breaking a toe, for example, tricks the body into elevating blood pressure and heart rate and improves performance.   

Vancouver’s Brad Zdanivsky, 37, while not involved in Paralympic sports, is an elite rock climber who, in 2005, was the first quadriplegic to reach the summit of the Stawamus Chief.

His spine was crushed in a car accident in 1994, and since then his heart rate fails to increase as it should when he exercises, so he boosts. He is one of the few people who will talk candidly about how and why he does it.

His chosen method of raising his heart rate is to administer electric shocks to his testicles.

“If I exercise without doing something like that, I just get dizzy and pass out,” he said.

Zdanivsky said boosting is most effective for sports where quick acceleration is needed. “Anybody that is doing a speed sport,” he said.

Research shows boosting works. Dr. Yagesh Bhambhani, a professor in the faculty of rehabilitation medicine at the University of Alberta, was on the International Paralympic Committee sports sciences committee for the Beijing Paralympics.

In 1994, he did a study with 10 wheelchair marathon racers who did a 7.5-kilometre wheelchair race on rollers.

For one race they boosted (some chose to clamp off their catheters, some pricked themselves with pins) and for one race they didn’t. In the boosted state, performance improved by 10 per cent. A significant increase in performance, said Bhambhani.

However, in many incidences, their blood pressure rose to fairly dangerous levels.

Boosting is risky — if an athlete’s blood pressure gets or stays too high, it can cause a heart attack, stroke or even death, which is why it has been banned by the IPC for over a decade.

“There is no way of controlling it. You can’t say OK, if I am going to clamp off the catheter for 10 minutes, my blood pressure is going to go up by a certain per cent. Because blood pressure is controlled by the autonomic system and it is very, very difficult for a person to regulate their blood pressure,” said Bhambhani.

“The message should be to try to avoid this under all conditions and compete safely and on an equitable basis with other athletes. That is where the IPC is coming from.  Because they feel that they have a responsibility, a fiduciary responsibility, in ensuring the safety of the athletes.”    

The IPC, the governing body for the Paralympic Games, sent the Courier a statement about the practice of boosting.

“From the Canadian perspective, we are informing all athletes of the dangers and illegalities of the practice and advising them that random testing will be conducted by the IPC,” it read. “Every team will be made aware of the specifics of the testing procedure.”

Zdanivsky finds it unfair that athletes who boost are banned from Paralympic sports.

“You are basically calling the person a cheater for getting back what they already had,” he said.

He believes of the classification system within the Paralympics needs to be changed to recognize the different levels of function among athletes to make the Games fairer and safer for all athletes.

Zdanivsky’s spinal cord doctor, Andrei Krassioukov, is working towards doing just that.

Krassioukov is a renowned researcher at International Collaboration On Repair Discoveries, Vancouver’s spinal cord research centre, and has done extensive research on boosting. He is also a UBC professor.

With a team, Krassioukov set up and ran a health research clinic at the 2010 Games in Vancouver and at the 2012 Paralympic Games in London where athletes were provided educational information on cardiovascular health.

Krassioukov also began work with the IPC to design a new cardiovascular classification system.

He will continue this work at the Games in Sochi.

Krassioukov is encouraged by the IPC’s openness to his work.

“Being allowed to conduct research in the Athletes’ Village is an exciting milestone for me,” Krassioukov said in a 2010 University of British Columbia media release.

“It suggests the IPC will consider how differences in autonomic function create inequities in performance and fuel the risky practice of boosting.”

Other experts also find the idea of athletes resorting to boosting extremely troubling.

Edward Nieshoff is an expert in spinal cord injuries and a quadriplegic who said he has worked with thousands of injured people over two decades at the Wayne State University School of Medicine in the U.S.

In a phone interview with the Courier, he expressed dismay at media reports of quadriplegic athletes harming themselves.

“When you have a spinal cord injury, presumably your brain is still functioning and I think the vast majority of people with cord injuries, like the general public, would never do something like that,” Nieshoff said from his office in Detroit.

“Boosting is a cry for help, from patients suffering from an under-recognized and seldom treated symptom of [spinal cord injury].”

Nieshoff recommends athletes use midodrine, a medication he studied extensively, which he found safe and effective for athletes who need to elevate their blood pressure while exercising.

The drug is banned from the Paralympics, something Nieshoff and Bhambhani want changed.

Medicine can be traced, while boosting can’t, so athletes boost, said Bhambhani. They should be able to take the medicine they need to help them, he added.

Back at Vancouver’s G.F. Strong Rehabilitation Centre, where Zdanivsky spoke to the Courier over the phone after a workout, he said he doesn’t use existing medications to boost his heart rate because it stays in his system longer than he needs.

He just wants a quick hit to help him pull a bit harder to get over a large rock or to get up the mountain quicker. With electric shock he can control his blood pressure simply by turning his apparatus on and off.

He understands the risks but still says athletes should be free to boost.

“The issue is that it could kill someone,” he said. “[But] if you want to see the pretty horse run fast, let them do what they want.

I mean you can have really exciting sports or really boring sports, take your pick.”

The Paralympic Winter Games run March 7 to 16, 2014 in Sochi, Russia.

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