Yeah, he's moving to Miami. I would be doing the same thing if I were him.
I've done a few echos on fully juiced guys. It's kind of surprising how some of them look. Many of them have echos that would look like they belonged to a renal patient. Renal patients tend to have VERY clear echo pictures. I'm assuming due to subcutaneous water retention speeding up the sound waves. AAS abusers seem to have the same view quality (even when their renal panel is 100% normal)
They also appear to have diastolic dysfunction, even though the measurements don't show it. Many of them have decreased ejection fractions, that would appear to be below normal for an athlete. This is where I was introduced to Dr. Carabello's work on the subject. I talked to our chief cardiology fellow, who I've been friends with since we were kids. Appearantly Dr. Carabello is finding things with athletes hearts that don't fit the mold at all. Things like low EF, appearant Dilation, to the point of wanting to diagnose ischemic cardiomyopathy, etc.
This is where I was talking about the tri-level adaptation to increased workload. It starts with LVH, then moves to a dilated ventrical through the frank-starling mechanism, then finally moves to cellular level trauma. With LVH caused by HTN, there is more cellular damage to the myocardium. The heart muscle becomes "sick," and there is increase fibrosis, etc. But, with the athlete, it never reaches this point. So, with the LVH, and even the dilation (this is really only relative to endurance athletes) what would otherwise appear in every way to be problematic, is 100% normal for what that heart has to accomplish.
He could get into it MUCH better, as I'm just a hack, but it was very interesting. I would really be interested to see what kind of results could come out of research studies on the topic. The problem is, as I stated before, we only really see a very small deviation of the norm with patients. In the bell shaped curve of patients, we only see right in the middle. Athletes are obviously on one end of the curve, but the medical profession doesn't really deal with them. So, I think there is much to be learned still as to how the body adapts to exercise. Especially the heart.
Very cool. Are you out of Houston or by chance Michigan, where O'Neill was from. Apparently, he is moving to the fun and sun of Miami to the University of Miami School of Medicine...my alma mater. Good move and a pretty cool city. Get your PhD and then you can go on the lecture circuit to all the academic institutions. Regardless, since you are an exercise physiologist, have you personally done any echos on athletes who were obviously juiced to the gills.
