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Most Paralympians inspire, caught doping, they receive the same penalties — including disqualification but others cheat and withdrawal of medals — as busted Olympians. The testing itself, however, aralympians are often described is more complicated at the Para- as inspirational, even heroic. But lympics, especially for athletes who Pas the Paralympics has grown urinate through catheters. and become more competitive, some “At the Olympics, everyone pees the advantage-seeking athletes are follow- same,” says Tardif. “At the Para- ing the lead of their less scrupulous lympics that is not entirely the case. able-bodied peers: that is, they cheat. Doping control officers have to be bet- Canada sent 143 competitors to the ter trained.” the Beijing 2008 One form of cheating, called boost- (Sept. 7–18) and like the Olympians ing, is unique to the Paralympics and who recently ran and jumped and swam has nothing to do with steroids or stim- and dunked in the same facilities, each ulants. Athletes with spinal injuries is a driven athlete with a goal: victory. sometimes follow this practice, which “These are more than feel-good sto- could involve sitting on thumb tacks or ries,” says Dr. Richard Goudie, chief clamping a catheter to bloat the blad- medical officer for Team Canada. der. “That painful stimulus will drive “These are full-on, super athletes.” blood pressure up and drive heart rate Though rare, doping does occur in up and that will improve performance,” parasports. Eleven athletes were busted says Nancy Quinn, chief therapist for Photos.com at the 2000 Paralympics in Sydney, the Canadian Paralympic team. Paralympians file more therapeutic use Australia. Prior to the 2004 games in To discourage boosting, officials exemptions than Olympians. Athens, Greece, Canada’s best-known monitor athletes’ blood pressure at disabled athlete, single-amputee events. Athletes who test high are given sprinter Earle Connor, received a 2- time to lower their blood pressure and “For a number of , getting to year suspension after testing positive are disqualified if they can’t. the Paralympic podium is a very diffi- for testosterone and nandrolone. Elite athletes, disabled or not, are al- cult thing,” says Tardif. “Once you “The methods of doping are similar ways looking for an edge. With more could be a big fish in a small pond, but between the Olympics and the Para- nations sending teams to the Para- now the pond is much bigger.” — lympics,” says Dr. Gaetan Tardif, assis- lympics, there are bound to be more Roger Collier, CMAJ tant chef de mission for Canada’s Para- athletes willing to cheat to get ahead. DOI:10.1503/cmaj.081279 lympic team. “It is still a question of increasing your endurance and increas- ing your strength.” Disabled athletes suffer unique injuries Because of their complex medical conditions, Paralympians file more aralympians train just as hard as able-bodied athletes and get injured therapeutic use exemptions than just as often. But the types of injuries and the rehab that these entail are Olympians. Athletes disabled due to P different. Injuries also have a greater impact on everyday life for a Par- trauma, for example, may have suffered alympian. nerve damage. One of the best treat- Athletes with spinal cord injuries or missing limbs often have a dramatic ments for neuropathic pain is mari- muscular imbalance. This asymmetry results in predictable injury patterns. juana, a banned substance. “We see more overuse injuries of the upper body for athletes,” “A number of these athletes have says Dr. Richard Goudie, chief medical officer for Canada’s Paralympic team. been smoking pot for their pain for Other physical problems unique to disabled athletes are frictional injuries quite a while,” says Tardif. (where skin contacts a ) and equipment-related trauma — fingers bro- Paralympians seeking exemptions ken in wheelchair spokes, legs punctured by spikes on sticks. have to file the same applications as Disabled athletes also have unique rehab struggles. “It’s hard to rest a shoul- Olympians, but unlike the International der injury if your means of locomotion is your arms,” says Nancy Quinn, chief Olympic Committee, the International therapist for the Canadian Paralympic team. Paralympic Committee doesn’t demand Injuries are becoming less of a problem as interest in the Paralympics in- pulmonary function tests. creases. More funding means athletes can now afford to take a long-term ap- Once in China, Paralympians can be proach to training and have access to better equipment. tested without notice at any time. If

524 CMAJ • SEPTEMBER 9, 2008 • 179(6) © 2008 Canadian Medical Association or its licensors