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Ask the Doctor – with Prentice Steffen

By Prentice Steffen, MD, FAAEM

Dear Doc;
I have been wondering about how donating blood can affect an athlete’sperformance. Obviously, in the short term after a blood donation, performancewill be hindered, since there is less blood to carry the oxygen around.But what about long-term effects?How long after a blood donation does one’s body typically recover? Isthere any type of “super-compensation” that may occur from continued trainingafter a donation? In other words, will continually putting a high demandon my cardiovascular system after donating cause my body to regeneratemore red blood cells than I had before the donation?Not that I will roll donating blood into my training program as a wayto build more red blood cells, just curious. Will donating via aphaeresis help recovery?I haven’t donated blood for a few years. The last time I did, I wentfor a ride the following day, and really struggled. I would like to begindonating again, I just worry about how it will affect my performance asan athlete, particularly during the racing season. Thanks for entertainingmy question.
Tony McCray
Portland, OregonDear Tony;
What a great question! You are truly a gentleman, scholar, cyclistand all-around altruist. As a doctor, I believe that donating blood isone of the kindest and most generous acts that any of us can perform. Fortunately, your question has been studied to some extent, so I hope I’ll be able to provide you with some useful advice.When you give blood, about 450cc of whole blood is taken. As pointsof reference, a typical bike water bottle holds 600cc and a can of Cokecontains 355 cc. Your 450cc donation represents about 10 percent of allthe blood in you at any one time, so it’s not a lot but it’s not a littleeither. I’ve had riders worry about giving even two or three small bloodtubes for UCI testing!You can expect this donation to lower your hematocrit by about threepercentage points. As you probably know, hematocrit is the measurementof the volume of your blood taken up by the red blood cells. The rest ofthe space is taken up by plasma, white blood cells, platelets, clottingfactors and other miscellaneous molecules.In the best study I found on this topic, a group of researchers took10 male “amateur competitive cyclists” and measured heart rate (HR), VO2max, power output (in watts), and ventilatory threshold (VTh) during a standardized incremental exercise study. They tested each cyclist at four time points relating to a blood donation: One week before; two hours after; two days after, and seven days after. These researchers found that at maximal efforts all performance measurements were adversely affected at all three post-donation time points. For example, at the two hours and the two days testing, VO2max was down about eight percent. Even at seven days post-donation, the average VO2max was only improved to about seven percent down from pre-donation baseline testing. It’s too bad they didn’t test at subsequent 1-week intervals, but it’s reasonable to speculate that a complete return to baseline might take as much as three to four weeks, or even a bit longer.This research also demonstrated another important by showing that all submaximal measurements we not affected by the blood donation. Performance was only hurt at maximal effort. That’s interesting because most of us, and even pros for that matter, spend the vast majority of our training time in submaximal zones.So here’s what I’d advise to different groups of cyclists:Elite amateur and professional: Do not give blood. The detriment to performance is too great. Even during the off-season, you don’t need this. As well an out-of-competition blood test would certainly turn up suspicious results due to alterations of serum EPO levels and reticulocyte counts. You really don’t need this.Competitive amateur: Off-season blood donations would be fine. I’ve long had a somewhat New Age theory that it would be good to donate blood because it would create sort of a cleansing turnover effect. I’ve seen nothing scientific written to support this idea.Serious recreational: There is no reason that I can see not to donate blood on a regular basis. Blood centers advise every eight weeks maximum. Giving blood every 12 weeks might be more reasonable for this group.Casual: Get out there and give every eight weeks to help make up for the fanatic riders described above!General advice about the actual blood donation:On the day before, do whatever you want. I usually time a donation to fall the day after a fairly hard series of workouts.Don’t do any workout the day of the donation.An easy spin the day after should be fine and perhaps beneficial.Hydrate well the day before, the day of and days following your donation.Regular blood donors (more than two to three times a year) need regular ron supplementation. I recommend a daily multivitamin with iron plus an iron supplement. I use iron sulfate 140mg (28mg of elemental iron) three days a week. Also consider a nice steak dinner the day of or after the donation.I found nothing that relates practically or theoretically to your question about a “super-compensation” effect. I can’t think how or why that would occur and I’m fairly certain that it doesn’t.Finally, aphaeresis (aka, pheresis) refers to the taking of only certain parts out of the whole blood and returning the rest to the donor. The big three “pheresises” are plasmapheresis (only the plasma is kept), pateletpheresis (plateletes), and leukophoresis (white blood cells). Since athletic performance is all about the red blood cells, this is a great option for you and any athlete. The most common seems to be plateletpharesis as there is a great need for platelets to be transfused to cancer patients on chemotherapy. While there are medications to stimulate red and white blood cell production in these patients, there is nothing to replace the platelets which are needed to prevent serious bleeding episodes such as a brain hemorrhage. Plateletpheresis takes about two hours compared to the hour or so for a traditional blood donation. My local blood center here in San Francisco has special “e-chairs” (yes, internet connection and DVDs) for platelet donors.So thanks a million for you question. I hope I’ve answered your questions and that you and many others will pursue this very important option. They don’t call blood donation “the gift of life” for nothing.For more information and to find your local blood center, go to www.bloodcenters.org or www.americasblood.org/.
PrenticeDear Doctor;
I was recently diagnosed with oral herpes and am now dealing with myfirst bout of the virus. From what I’ve read, it seems like stress andsun can trigger recurrences. As a road cyclist living and training at highaltitude (in a state where it’s almost always sunny), will the physicalstress of long rides and the overbearing sun doom me for frequent coldsores?Do you have any suggestions to repress future outbreaks for someonein this kind of situation?
Summit County, ColoradoDear EH;
Thanks for your question. It’s a really good one as it both affectsand confuses many people. Oral herpes (aka, herpes labialis, coldsores, fever blisters) is a skin infection of the mouth and lips causedby the herpes simplex virus. This is quite similar to but a little differentfrom genital herpes (aka, herpes genitalis), which is a skin infectionof the genitals caused by the herpes simplex virus.Most of the confusion about the two is because of the similarity ofthe terminology, plus the fact that the two viruses, while happiest intheir body region of choice, can in fact infect their cousin’s usual domain.Once exposed to the oral herpes virus, there may be no symptoms at thetime of exposure or ever. Most people in fact are exposed by the age of20 and never show symptoms. The virus simply lies dormant in the nervesof the face. If symptoms do occur, they do so usually within one to twoweeks of the initial exposure. The characteristic blister lasts usuallya week or so.Prevention is important because oral herpes is contagious. Kissing andoral sex are bad ideas during an outbreak. Also sharing of eating utensils,towels and other personal items is discouraged. Realize also that, likewith genital herpes, there is a phase when the virus can be spread evenwhen there are no blisters apparent. This is early in the course of theoutbreak when the virus has migrated from the nerve to the skin surfacebut before the blister forms.Treatment includes oral anti-viral medicines to shorten the durationand severity of the outbreak. This is usually not necessary due to expenseand possibility of side effects and is probably only a good idea for severeor frequent cases. Acyclovir ointment is an option that may be worth atry.There are only two critical oral herpes related issues that I shouldmention for completeness. This first is that if the virus gets into oraround the eye, an extremely serious infection possibly ending in blindnesscan result. See an ophthalmologist or emergency physician immediately ifyou think this may be occurring. The second is that people who have weakenedimmune systems (e.g., HIV, cancer, infants) are susceptible to having thevirus spread into their blood and/or nervous system. This can be deadly.Triggers for a recurrence of oral herpes include sun exposure, stress,menstruation, illnesses with fever, and other unknown causes. So whileit’s true that you are at risk of recurrences because of your geographicand lifestyle choices, it’s way to early to say that you’re “doomed” toa life of hideous disfigurement and social isolation. With time you mayfind that you have no or very infrequent recurrences. There’s no way topredict at this point. In the meantime I’d recommend a high SPF lip balm.If you do find that this turns out to be troublesome, see a dermatologistfor specialized care.Thanks and good luck,

Dr. Prentice Steffen, board certified in both emergency medicine and sports medicine, is serving as team doctor for the Prime Alliance Cycling team. He has served as team doctor for several teams including Mercury, Spago and U.S. Postal. Steffen has also served as medical director and event physician for major races including the Tour Du Pont, New York City Marathon and the Tour de Trump. Steffen also serves as the sports-medicine section editor for the Journal of Emergency Medicine. His services are outlined in detail at www.pdssportsmed.com Please send your sports-related medical questions to “Ask the Doctor” in care of WebLetters@7Dogs.com. We will forward a selection of questions to one of three physicians currently working with this site.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 medical practice and may not reflect current medical developments or be interpreted as medical advice. Understand that reading the information contained in this column does not mean that you have established a doctor-patient relationship with Dr. Prentice Steffen. Readers of this column should not act upon any information contained in the web site without first seeking medical advice from their personal physician.