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Ask the Doctor, with Dawn Richardson: Racing after West Nile

By Dawn M. Richardson, MD FACEP

Dear Doc;
I am a 35-year-old Category 2 road racer who just got over a bout with West Nile fever. I was diagnosed thorough the IgM titer and from the week long symptoms of fever, head ache, body aches and dehydration. I was unlucky to get sick but lucky to get over it without any major events besides missing four days of work and feeling totally wasted for a few days after the fever was gone.

I am riding the bike again after a 10 day hiatus. I have lost all my strength and power. But have conserved the aerobic fitness. My heart rates are 10-15 beat higher than before when riding. Resting heart rates are unchanged. During the disease I experienced hematuria and elevated protein and sedimentation rate, as well as high potassium (5.5meq/l). All labs including my hemoglobin are now back to normal.

My questions are:
1) What is the effect of viruses on protein metabolism and what can one do to prevent or fight catabolism?2)What recovery or training strategy should I use to get back in shape considering the road season is over for me and cyclo-cross was in my plans for this fall? Should I skip it and think about next year?

Having such a high incidence of WNV in Colorado and Nebraska I think this is an important topic for riders to be aware of. Even healthy athletes can become victims but with a few precautions such as using bug repellent and staying indoors at dawn and dusk while mosquitoes are most active, one can save oneself a headache (literally).

Thanks and I hope to read or hear form you soon.
Marco Vasquez
Omaha Nebraska

Dear Marco;
It sounds from your description of your symptoms and recovery that you suffered from West Nile fever. Symptoms may include malaise (feeling like crap), fever, loss of appetite, nausea, vomiting, headache, joint and muscle aches, swollen lymph nodes, a rash and eye pain. The vast majority of people infected with West Nile Virus do not become sick or seek medical attention. Rare life-threatening complications of West Nile Virus are encephalitis and meningitis, mostly among people over 50 or with prior debilitating illness. Long-term complications of West Nile Virus are still being researched. Hospitalized patients with West Nile Virus often have long-term complications including fatigue, memory loss, trouble walking, muscle weakness and depression. Statistically, the odds are in your favor that you will not develop long-term weakness because you were not ill enough to be hospitalized. But you could fall into any category between early complete recovery of muscular strength to long-term weakness. I think there is little you can do once infected to reduce the damaging effects on muscular strength and function. Because depression is such a common complication of serious infection, watch for symptoms of depression and get early treatment if you are depressed. Attitude is everything in your recovery.

Treatment for West Nile virus is supportive-IV’s for dehydration, etc. Antiviral agents seem to fight West Nile Virus in the lab but have not been terribly effective in clinical practice.

It sounds like you had excellent medical care from what you revealed in your question. I suggest asking for a referral to a university-based neurologist for evaluation of the extent of your muscular weakness. If your kidney function is completely normal, there may be a role for protein recovery shakes with low dose creatine (5-10 grams) after rides to aid in muscle rebuilding. High rep (15-20) low-weight training (50-percent of max) two to three times per week targeting upper body, lower body and core would be helpful if you are not suffering from excessive fatigue. This should take no more than 30-45 minutes per workout. You will likely need extra recovery days between harder workouts.

It’s painful for cyclo-cross aficionados to forego racing season. Look at your master plan and if you were burned out after road season anyway, think about next year. If you’re chomping at the bit to race ‘cross, skip the October races and look at November. If you’re an A racer, ask the promoter if you can do a B race, etc. Ignore bad results. If you’re not strong enough to race you can perfect your barricade technique during your recovery. You can dress like Der Teufel and cheer on your friends on the run-ups. Do you play the trombone?The cautionary tale for the rest of us is prevention of West Nile infection. West Nile peaks in August and September and has been reported in 27 states and D.C.. It occurs year-round in warm areas and from spring to the first hard frost in colder climates. Dusk and dawn are the most likely times to be bitten. Cyclists face a difficult conundrum: DEET is an effective and the recommended mosquito repellant for West Nile, but it eats spandex. Avon Skin-So-Soft doesn’t damage spandex but may not be a strong enough mosquito repellant. Perhaps you can wear your early 90’s neon spandex with DEET spray until it becomes see-through.Best of luck in your recovery.
Dawn Richardson
With liberal reference to Petersen LR and Marfin AA, “West Nile Virus: A Primer for the Clinician (Review)” Annals of Internal Medicine (August 6) 2002:137:173-9.

Dawn Richardson is a board certified emergency medicine physician in practice at Saint Anne’s Hospital in Fall River, Massachusetts. She is frequent contributor to SG: surf snow skate girl magazine, and is interested in health-related issues for cyclists, and women’s health. She welcomes medical questions pertaining to cycling, bearing in mind that if it ain’t emergency medicine she may have to do some work to figure out an answer. Please send your questions or issues to “Ask the Doctor” in care of WebLetters@7Dogs.com.Important Notice:
The information provided in the ASK THE DOCTOR column does not constitute formal medical advice. The information provided on this public web site is provided solely for general interest of the visitors to the site. The information contained in this column applies to general medicalpractice and may not reflect current medical developments or be interpretedas medical advice. Understand that reading the information contained inthis column does not mean that you have established a doctor-patient relationship with Dr. Dawn Richardson. Readers of this column should not act upon any information contained in the Web site without first seeking medical advice from their personal physician.

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