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  1. #1
    CEO, Rx Muscle huge285's Avatar
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    Default Q&A With Sports Medicine Physician Dr Anthony Human!

    Ask all your Sports Medicine-related question for Dr Anthony Human! Ask about steroid-related side effects........ blood work.........and other issues or problems!
    Watch #askDave on RxMuscle.com. Catch previous episodes HERE


  2. #2
    Sports Medicine Physician Tony Human, DO CSCS's Avatar
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    Glad to be here at RX Muscle. I'm a General Practice & Sports Medicine Physician. I have been specializing in issues unique to bodybuilders for several years, co-manage a contest prep company in Atlanta, and am an NPC Competitor. Feel free to ask questions related to sports medicine, injuries, gear-related medicine, or medicine in general.

    Let's go.

  3. #3
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    Hi Dr. Anthony just signed up to ask you some questions after reading your article.


    I recently had blood work done and some levels were elevated

    I don't have the print outs with me at the moment so I can't quote exactly what levels were high specifically, but...

    I do remember my iron levels were elevated

    I'm putting the elevated iron levels down to eating steak 3 times a day maybe?

    Any advice on what to do to lower these levels?

    I was thinking of giving blood at a local donation center, should I give a regular blood donation or should I give a blood plasma donation instead?

    Could you go into more detail on this



    Is it safe for someone to give blood when on AAS?



    I also had elevated folic acid & B12 levels, are they anything to worry about? They were both elevated. I haven't taken a multi vitamin in months.



    I also had elevated urea BUN (i think) levels which need to be retested in a few months doc said he want to recheck he said I might have been a bid dehydrated coming in and this can throw off the levels.

    Possibly related to the pro hormones I took?
    I ran epistane (methylepitiostanol) at 30mg for 4 weeks with organ support supplements

    If I could go back in time I would not have run it and jumped straight on the injectable based testosterone.

    I have had tests done on my kidneys before the blood work and pro hormones but they found nothing wrong something along the line of they saw some possable cysts growing on my kidneys when doing an ultra sound so they stuck a camera up my wang to see whats going on. They said everything was fine lol.


    Next

    I have recently found out I have cholinergic urticaria it's starting to effect my driving and lifting. I get this crazy itchiness just before I start to sweat it's like my body is allergic to my own sweat. So I have to stop what im doing and itch like a mofo. I have tried oral antihistamines and nothing works. I heard that it can be as a result of depleted adrenals and progesterone, which effects my body's ability to produce corticosteroids to fight the inflammation. Could this be a result of the pro hormones messing up my endocrine system?


    Sorry for the wall of text


    Looking forward to your reply!

  4. #4
    Sports Medicine Physician Tony Human, DO CSCS's Avatar
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    PZZK,

    Good questions. First, the elevated iron levels. Definately try to bring this down. Some recent studies have brought to light a link between elevated iron levels and increased risk of heart disease and some forms of cancer. The best ways to reduce iron are giving blood as you stated (there is no reason to give plasma, just straight blood donation works best), and a low iron diet. Beef, pork, liver, and many iron fortified cereals can be the culprit. And, yes...it is safe to give blood while on AAS.

    B-12 and Folic acid. Some of the food sources that are high in both include liver, fortified grains, breads, cereals, eggs and milk products. Interestingly, only about 10% of Americans get enough Folic acid from their diet. Are you sure it was elevated? High Folic acid levels are rare and generally not concerning, some naturopaths even recommend super high doses. High B-12 can cause neurologic symptoms. If you are not taking a multi-vitamin, are you injecting b-12? Or is it possible you eat a ton of green leafy veggies?

    BUN. Yes, dehydration is a cause. In fact in bodybuilders, the three most common causes of elevated BUN are dehydration, excessive protein intake, and kidney damage. Since your kidney tests were fine, I'd assume one of the other. It is wise to stay below 1.5g of protein per pound of body-weight. Either way, drink as much water as you can tolerate in a day, atleast 64 ounces, preferably more.

    Cholinergic urticaria. Wow. I have seen this be very debilitating. You mentioned exercise and sweating, but it can also happen with heat, hot water (showers), or even when eating spicy foods. Antihistamines are the logical first step but most docs just try the H1 blockers like benadryl, Claritin, Zyrtec, etc. Of these usually zyrtec is the best. But, I have had success using the H2 histamine blockers like pepcid, tagament, and zantac. Often combining these with zyrtec will do the trick. If not, there is a drug called Doxepin that blocks both h1 and H2 and works fairly well. Then, we have Xolair which is an asthma drug, and very expensice but works well when others fail. Interestingly, Danocrine or danazol a synthetic testosteron has been used with success because of it's effect on protease inhibitors. Another product I have used is scopalamine, the motion sickness drug. It has worked in some difficult cases. Good luck.

    I would not attribute this to pro-hormones, but unfortunately we just don't know. We usually say we may never know what triggered it, but we can do our best to treat it.

    Thanks for the questions.

    Tony Human, D.O.



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    Dr. Human,

    Is it possible that eating Puerto Rican food on a regular basis could actually lead to loss of appetite, depression, weight loss and a general feeling of ill will towards others?

  6. #6
    Sports Medicine Physician Tony Human, DO CSCS's Avatar
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    Brent,

    I have not seen any medical studies on the matter but I do have a case study of one, where a patient and close personal friend became very depressed, lost his appetite and could not gain weight over a period of time where he had chronic exposure to Puerto Rican food. Interestingly, I pointed out the link several times over the time period before he realized it for himself.

    Doc

  7. #7
    Managing Dir., Rx Muscle Forums Curt James's Avatar
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    Someone mentioned in the other thread that they couldn't access your article. I posted it in that thread at their request. I hope you don't mind my posting it here in your Q&A thread as well.

    Written by Tony Human, D.O., C.S.C.S.
    Thursday, 21 October 2010 00:53

    If you've been lifting weights in any form for any length of time, you have undoubtedly encountered injuries or setbacks. It's possible that you've been very lucky, or might even possess superhero qualities, but most of us have had to deal with setbacks or injuries at some point. As a competitive bodybuilder, contest prep coach, and Sports Medicine physician, I see them daily. My office is next to the gym and lifters make up 75% of my clientele. I am a primary care physician and non-surgical sports medicine physician. In the future, we will discuss many of the most common musculoskeletal injuries or biomechanical issues common to bodybuilders, but today I want to address the most common issues I encounter in bodybuilders.




    The most common irregularity I witness in our subgroup is not injury per se, but issues related to the use of supplements or anabolic steroids. There's a pretty famous doc who writes for another muscle magazine (it rhymes with Pustular Envelopement) that claims he's the only physician in the world who treats these so-called problems. Well, just for the record, I've being doing it for years as well; I just don't toot my own horn on a regular basis. In the following paragraphs I'll focus on the top three risks to anabolic steroid-using bodybuilders.

    (1) Far and away, High Blood Pressure is the side effect I see most. As, a licensed physician with a regulatory body looking over my shoulder, I can't prescribe or recommend AS (other than Hormone Replacement Therapy), but I can say that high blood pressure doesn't mean you have to stop a cycle right then and there, and run screaming. Often times, increasing our water intake, decreasing salt, or adding cardio can bring it down. In addition, a baby aspirin a day can work wonders by thinning the blood. What has more pressure in a closed system, honey or water? Lastly, there are many blood pressure medications on the market with minimal side effects that can be employed. Some are even cardioprotective and/or renoprotective. A blood pressure medicine is not a lifetime curse. Complete your steroid cycle, monitor the BP, and wean off the meds. End of problem. If the problem persists, maybe it wasn't the AS in the first place; maybe your extensive family history of high blood pressure is the problem. Maybe you need to take the medicine long-term. Either way, if it persists, testing should be performed. Any primary care doc can order such tests. However, they may and probably will tell you to stop your AS. If you chose to continue taking them, we in the medical community can still help, and can reduce your chances of a cardiovascular event.

    (2) The next most common side effect would be elevated hemoglobin/hematocrit. Thick blood. An elevation in hemoglobin is usually via one of two means: (a) increased red blood cell production or (b) contracted plasma volume resulting in an appearance of greater red cell volume. In the case of AS use, it's increased erythropoiesis or red blood cell production. AS were formerly used for this purpose in medicine to treat anemia. The other reason for elevated hemoglobin could be dehydration. So, increasing your water intake, donating a pint or 2 of blood, or taking a baby aspirin could help. For longer cycles, give blood regularly. If you smoke or live at high altitudes, you are also at increased risk...plan accordingly.

    (3) Elevation of liver enzymes. ALT and AST are two blood tests you need to be familiar with. They indirectly tell us how hard our liver is working. An increase means the work the liver has to perform has increased, often resulting in inflammation of the liver. I generally only get concerned if both tests are two times the upper limit of normal. In other words, if the normal range for AST is 5-40, then the value would have to be above 80 to concern me. If the normal value for ALT is 7-56, I would be concerned if it were 112. These will need to be monitored, if they rise to these levels, monitor them more often. If they continue to rise, stop your cycle. If they continue to rise or do not resolve after a cycle, further testing is warranted. If you do a cycle, don't drink alcohol, avoid Tylenol, and stop any statin-type cholesterol drugs or oral anti-fungal meds. I should also note that cases of liver damage have been reported independent of elevations of these enzymes. So, while they are important, you should not make them your sole indicator of liver stress/damage. Make sure you're not turning "yellow" (jaundice) either. There are plenty of supplements known to have protective effects on the liver that could be of benefit during a cycle. The most popular natural liver protector is milk thistle but NAC (N-acetylcysteine) and gluthionine may also be of value. A popular supplement with bodybuilders is Liv-52.

    Now, unless you come see me in my office, these are only guidelines. I provide this information to let you know that it's ok to seek care, and you should. But, it also may be possible to continue your cycle to completion. I don't know; every case is different. Be aware, be careful, be smart, don't panic, and see your doc. And if they can't help, or won't, call me for a phone consultation......or feel free to ask all your questions on my new Q&A Thread on the RX MUSCLE forums.


    Anthony F. Human, D.O.
    General Practice/Sports Medicine
    Human Wellness Group, LLC
    678-689-6888

  8. #8
    Sports Medicine Physician Tony Human, DO CSCS's Avatar
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    Thanks for posting the article here. I just found the other thread....was not aware of it. Thanks again.

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    Team Provo, Chem Moderator Provo82's Avatar
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    hi Dr. Anthony,

    Do you often come across bodybuilders with mild left ventricular hypertrophy? I was recently diagnosed. My doc thinks its from not properly controlled blood pressure which is possible. 2 months ago my doctor changed my medicine from lisinipril to valturna 320-300. The valturna 320-300 does a much better job as my blood pressure was consistently between 119-130/60-80 . The recent diagnoses has given me lots of anxiety and ive decided to take a break from bodybuilding to expedite the regression of my lvh. I still train but not as intensely and have lost 12 lbs and am trying to lose atleast 10 more. In response my bp has dropped significantly im now getting reading of 102-115/60. Id like to eventually either reduce or eliminate my meds and more importantly reverse my lvh as soon as possible. Ive changed my diet where i am consuming much less protein probly only 4-5 meals a day of about 6 ounces of meat and have added in alot more fruits and vegetables. Do you have any advice or insight into better acheiveing my goals and opinion on my situation. Thanks in advance

  10. #10
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    Quote Originally Posted by tonyhuman View Post
    PZZK,

    Thanks for the replies doc it means a lot

    Good questions. First, the elevated iron levels. Definately try to bring this down. Some recent studies have brought to light a link between elevated iron levels and increased risk of heart disease and some forms of cancer. The best ways to reduce iron are giving blood as you stated (there is no reason to give plasma, just straight blood donation works best), and a low iron diet. Beef, pork, liver, and many iron fortified cereals can be the culprit. And, yes...it is safe to give blood while on AAS.

    Thanks for the info
    I will be giving blood before the retest


    B-12 and Folic acid. Some of the food sources that are high in both include liver, fortified grains, breads, cereals, eggs and milk products. Interestingly, only about 10% of Americans get enough Folic acid from their diet. Are you sure it was elevated? High Folic acid levels are rare and generally not concerning, some naturopaths even recommend super high doses. High B-12 can cause neurologic symptoms. If you are not taking a multi-vitamin, are you injecting b-12? Or is it possible you eat a ton of green leafy veggies?

    Nope I have not been taking any b12 shots

    It might have been some some multivitamin orange juice I drink the odd time, both levels were definitely above the normal grade but I think the levels which are considered acceptable had recently changed.


    BUN. Yes, dehydration is a cause. In fact in bodybuilders, the three most common causes of elevated BUN are dehydration, excessive protein intake, and kidney damage. Since your kidney tests were fine, I'd assume one of the other. It is wise to stay below 1.5g of protein per pound of body-weight. Either way, drink as much water as you can tolerate in a day, atleast 64 ounces, preferably more.

    Good to know thanks

    Cholinergic urticaria. Wow. I have seen this be very debilitating. You mentioned exercise and sweating, but it can also happen with heat, hot water (showers), or even when eating spicy foods. Antihistamines are the logical first step but most docs just try the H1 blockers like benadryl, Claritin, Zyrtec, etc. Of these usually zyrtec is the best. But, I have had success using the H2 histamine blockers like pepcid, tagament, and zantac. Often combining these with zyrtec will do the trick. If not, there is a drug called Doxepin that blocks both h1 and H2 and works fairly well. Then, we have Xolair which is an asthma drug, and very expensice but works well when others fail. Interestingly, Danocrine or danazol a synthetic testosteron has been used with success because of it's effect on protease inhibitors. Another product I have used is scopalamine, the motion sickness drug. It has worked in some difficult cases. Good luck.

    Yep it's truly a curse
    It's funny because the itching only ever seams to happen I exercise, it seams when my heart rate/blood pressure is increased I get this wave of itchiness.

    Which feels like my body trying to push sweat out of the sweat glands causing a reaction of itchiness but once I get a sweat going im fine.

    Never happens when eating spicy food/showering etc it seems that the water stops the reaction

    I took 20mg of cetirizine hydrochloride last night before training and it seemed to help greatly, I had used it in the past but it didn't seem to help back then, strange.

    I will keep note of the other medications you mentioned on my tong for the next time im near a chemist

    thanks


    I would not attribute this to pro-hormones, but unfortunately we just don't know. We usually say we may never know what triggered it, but we can do our best to treat it.

    true we never do really know exactly what chain of events may have happened inside the complex systems of the body

    Thanks for the questions.

    Tony Human, D.O.




    Anything you would recommended for acne spesefic to my middle back and posterior deltoids only

    Back in the day

    I have tried the green/nettle teas/showers everyday (hot&cold)/B12 (bit of a contradiction to my blood work problem but I haven't taken this stuff in ages)/Benzoyl Peroxide/Scrubbing brushes and dettol

    Is the next step going to a doctor or dermatologist?

    Would it be advisable to go to a clinic that does these type of treatments (below)



    Dermabrasion

    The surface of the skin is removed by abrasion, a form of sanding. This helps remove the sun-damaged skin and lessen scars and dark spots on the skin.




    Laser Resurfacing


    Laser resurfacing is a fairly new treatment that helps to reduce blemishes and acne scars. With this technique, skin is removed layer-by-layer using a laser.



    Chemical Peel


    Chemical peels are used to improve the texture of the skin after scarring has occurred. A chemical solution causes the skin to blister before peeling off, which revitalizes the skin cells and leaves you feeling refreshed and blemish free.


    or would an oral anti bacterial acne medication be better

    My acne is not severely bad but gets itchy and leaves blood on my sheets and of course is unsightly


    When I used pro hormones they were not highly estrogenic and acted almost as an anti-estrogen in itself and I almost noticed an improvement in my acne.

    Is it true that keeping the estrogen at bay using an aromatase inhibitor when on an injectable cycle of aromatizing compounds can help with acne.


    Thanks for giving back to the community

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    Team Provo, Chem Moderator Provo82's Avatar
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    My doctor said he is not terribly worried and that i will be fine but i dont like to sit on something while it gets worse. I like to act to fix things asap.

  12. #12
    Sports Medicine Physician Tony Human, DO CSCS's Avatar
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    Quote Originally Posted by PZZK View Post
    Anything you would recommended for acne spesefic to my middle back and posterior deltoids only

    Back in the day

    I have tried the green/nettle teas/showers everyday (hot&cold)/B12 (bit of a contradiction to my blood work problem but I haven't taken this stuff in ages)/Benzoyl Peroxide/Scrubbing brushes and dettol

    Is the next step going to a doctor or dermatologist?

    Would it be advisable to go to a clinic that does these type of treatments (below)



    Dermabrasion

    The surface of the skin is removed by abrasion, a form of sanding. This helps remove the sun-damaged skin and lessen scars and dark spots on the skin.




    Laser Resurfacing


    Laser resurfacing is a fairly new treatment that helps to reduce blemishes and acne scars. With this technique, skin is removed layer-by-layer using a laser.



    Chemical Peel


    Chemical peels are used to improve the texture of the skin after scarring has occurred. A chemical solution causes the skin to blister before peeling off, which revitalizes the skin cells and leaves you feeling refreshed and blemish free.


    or would an oral anti bacterial acne medication be better

    My acne is not severely bad but gets itchy and leaves blood on my sheets and of course is unsightly


    When I used pro hormones they were not highly estrogenic and acted almost as an anti-estrogen in itself and I almost noticed an improvement in my acne.

    Is it true that keeping the estrogen at bay using an aromatase inhibitor when on an injectable cycle of aromatizing compounds can help with acne.


    Thanks for giving back to the community
    PZZK,

    All decent options. In my experience with acne in bodybuildrs....the best thing is to go buy Nizoral Shampoo in the dark blue bottle at wal-mart. Use it as a soap daily with a brush on your back. Leave it on for 5 minutes and wash off. Do this daily for 2 weeks, then use it once a week. Works 75% of the time. If this does not work. Apply it like a lotion at bedtime, and sleep in a shirt. Shower off with brush in am. Do every other day times 3 and you should see results. Good luck.

  13. #13
    Sports Medicine Physician Tony Human, DO CSCS's Avatar
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    Quote Originally Posted by Provo82 View Post
    hi Dr. Anthony,

    Do you often come across bodybuilders with mild left ventricular hypertrophy? I was recently diagnosed. My doc thinks its from not properly controlled blood pressure which is possible. 2 months ago my doctor changed my medicine from lisinipril to valturna 320-300. The valturna 320-300 does a much better job as my blood pressure was consistently between 119-130/60-80 . The recent diagnoses has given me lots of anxiety and ive decided to take a break from bodybuilding to expedite the regression of my lvh. I still train but not as intensely and have lost 12 lbs and am trying to lose atleast 10 more. In response my bp has dropped significantly im now getting reading of 102-115/60. Id like to eventually either reduce or eliminate my meds and more importantly reverse my lvh as soon as possible. Ive changed my diet where i am consuming much less protein probly only 4-5 meals a day of about 6 ounces of meat and have added in alot more fruits and vegetables. Do you have any advice or insight into better acheiveing my goals and opinion on my situation. Thanks in advance
    Provo,

    If you treat any weight-lifters, such as bodybuilders, power lifters or strongmen competitors, you will see LVH. Some list it as a side-effect of AS, but it is more a side effect of heavy-lifting and resistance. Very difficult to reverse LVH, but you can prvent something called "remodeling" of the cardiac musculature. The meds you were and are on a great, the ACE Inhibitor/ARB class work well. However, Beta-blockers can be helpful in preventing remodeling and reducing the effects of stress hormones on cardiac muscle. Problem is your BP is already low enough. It may be of benefit to lower the dose of your current med, and add a low dose beta blocker at bedtime. Continue your cardio....low intensity, and I think you'll be just fine. Perhaps follow-up echocardiograms to measure LV size and ejection fraction. Best to you.

    Doc.

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    Team Provo, Chem Moderator Provo82's Avatar
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    Thanks doc, is there a reason you suggest low intensity cardio? And do u thnk it is safe that I am still weight training although not nearly as extreme as before and with no aas.

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    Sports Medicine Physician Tony Human, DO CSCS's Avatar
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    Quote Originally Posted by Provo82 View Post
    Thanks doc, is there a reason you suggest low intensity cardio? And do u thnk it is safe that I am still weight training although not nearly as extreme as before and with no aas.
    Provo,

    I just prefer low intensity cardio (as does Dave Palumbo) for bodybuilders. my reasoning is two-fold: 1) some of you guys carry a ton of mass and it will be hard on your joints over the long-haul. 2) if done first thing in am on an empty stomach, i personally believe low intensity stands a less chance of burning muscle. Weight training is fine. Increase your rest periods. And even going real heavy is fine, but cycle it....something like Kevin English's C.A.M.P. program. Your heart would do fine with high intensity cardio as well...try adding in one HIIT session per week.

    Lastly, saw you copied the same question onto the "anabolic doc's" Q&A. Always a good idea to get info from as many sources as possible. If I'm wrong, I'll say it....but I but his response is "come see me" or "contact the office" or "go get checked out". Sorry, just my experience with the guy.....no meat and a lot of self-prop.

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  • showthread_post_start
  • showthread_query_postids
  • showthread_query
  • bbcode_fetch_tags
  • bbcode_create
  • showthread_postbit_create
  • postbit_factory
  • postbit_display_start
  • reputation_power
  • reputation_image
  • bbcode_parse_start
  • bbcode_img_match
  • postbit_imicons
  • bbcode_parse_complete_precache
  • bbcode_parse_complete
  • postbit_display_complete
  • memberaction_dropdown
  • pagenav_page
  • pagenav_complete
  • tag_fetchbit_complete
  • forumrules
  • showthread_bookmarkbit
  • navbits
  • navbits_complete
  • build_navigation_data
  • build_navigation_array
  • check_navigation_permission
  • process_navigation_links_start
  • process_navigation_links_complete
  • set_navigation_menu_element
  • build_navigation_menudata
  • build_navigation_listdata
  • build_navigation_list
  • set_navigation_tab_main
  • set_navigation_tab_fallback
  • navigation_tab_complete
  • fb_publish_checkbox
  • fb_like_button
  • showthread_complete
  • page_templates