By Mike Wise
When an N.B.A. trainer recently doled out a weeklong dose of an anti-inflammatory medicine called Vioxx to an ailing player, the player shot him an incredulous glance. "I'm not taking these anymore, especially after what happened to 'Zo," said the player, according to the trainer. "Give me something else."
Since Alonzo Mourning, the Miami Heat's All-Star center, was found to have a kidney disorder more than a year ago - the same disease that caused the San Antonio swingman Sean Elliott to undergo a kidney transplant and eventually forced him to retire - many players in the National Basketball Association have grown acutely concerned about the use of anti-inflammatory drugs.
Medical experts say that use of the medication does not cause the kidney disease, which is called focal segmental sclerosis. But many doctors say that prolonged use at excessive levels of anti-inflammatory drugs, from over-the-counter medicine like ibuprofen and aspirin to prescription drugs like Vioxx and Indocin, may lead to other kinds of kidney problems.
Shaquille O'Neal, worried that his use of the anti-inflammatory drug Naprosyn over the years could lead to the disease Mourning has, refused to take the drug for most of last season.
Rick Fox, O'Neal's teammate on the Los Angeles Lakers, launched an awareness campaign on his Web site to alert players to the potential risk of taking anti-inflammatory medication; Fox asked whether players were essentially risking the health of their kidneys to compete for championship rings.
The appeal of the medicine is clear: it helps alleviate the aches and bruises that are a daily burden for elite athletes. The medication, known as nonsteroidal anti-inflammatory drugs, can ease the soreness of things like back pain and arthritic knees. It helps players withstand the rigors of their long seasons, of playing as many as five games in a week.
Pro basketball players, like athletes in professional football, baseball and hockey, have long felt pressure to play in pain, to distinguish between serious injuries that require them to sit out and minor injuries that can be overcome, often with medication.
"I think the whole N.B.A. takes these," said Dr. Gerald Appel, the director of the nephrology division at Columbia Presbyterian Medical Center in Manhattan and has been treating Mourning. "I know the whole N.F.L. does."
Pro athletes more commonly use nonsteroidal anti-inflammatory drugs. Since Mourning's condition was diagnosed in October 2000, many players have had to be convinced by their team and personal doctors that taking anti-inflammatory drugs for a short time will not harm their kidneys; players also needed reassurance that they were not predisposed to coming down with Mourning's disease, which studies have shown is contracted disproportionately by African-Americans.
"You literally have to sit down and tell a guy that if he's on it for a week, nothing will happen," said a veteran N.B.A. trainer, who spoke on condition of anonymity. "'Zo's condition has had a widespread effect in that way."
Fear Leads to Precaution
Many doctors say that if someone uses anti-inflammatory medicines in excessive amounts over long periods of time - as some N.B.A. players apparently have, taking three or four times the recommended dose - it can affect kidney function.
Despite medical opinion, some N.B.A. players continue to fear that Mourning's disease was caused by the medication. O'Neal underwent a kidney test earlier this month to check for any sign of the disease. When O'Neal is in excruciating pain, he now takes three Indocin pills for a short period of time.
"My body got used to Naprosyn and Orudis," he said of two anti-inflammatory drugs. "I used to pop that stuff like Tic Tacs, but I'm a lot more careful now."
Fox, O'Neal's teammate on the Lakers, was so disturbed by what happened to Mourning and Elliott that he began speaking out about N.B.A. players abusing anti-inflammatory medication. On his Web page, Fox said he used to walk around the locker room doling out medication to anyone who wanted it.
"I would literally shake up a big Advil bottle and deal it out," he said in an interview.
"Pain is something we've always dealt with," Fox said. "No one sees the behind-the- scenes things we do that go into getting our bodies ready to play every night. Alonzo and Sean played a lot of games. To stay on the floor at some point and time, they have had to take something.
"But the bottom line is, how far are we going to go? If you ask Alonzo and Sean, they probably wouldn't find it funny that I was walking around the locker room with an Advil bottle. Here they are dealing with situations in which, possibly, their decisions may have come back to haunt them."
Mourning said he still believed that long-term use of anti-inflammatories over his 12-year career contributed to his disease. "When I was first diagnosed, they said that some of the possible causes may have to do with all the anti-inflammatories I took early in my career," he said in a recent interview.
"Modern medicine, yeah, it's effective," Mourning said. "But if you're playing the game at a high level, a lot of athletes have a tendency to sometimes kind of abuse their bodies with that medicine in order to be effective.
"I'm not saying that was the case for me, but I do know, based on the conversations with my doctors, they feel that some of that has contributed to it. So I'm definitely left with that. The damage has been done. I just got to learn how to deal with it and make the proper adjustments."
In one of the more remarkable stories of this season, Mourning has overcome many of the problems with stamina and fatigue associated with his disease to lead the Heat's recent resurgence. The Heat lost last night in Utah, 101-89, but Miami had won seven of its previous eight games.
Mourning, who is 33 and missed 69 games last season because of the disease, has done this without being able to take anti-inflammatory medication. "I can't even take Advil anymore," Mourning said. "Anything that has ibuprofen or any anti-inflammatory agent in it, I can't take. It affects your kidneys."
Appel agreed that anti-inflammatory drugs would affect Mourning's health, "in the sense that it decreases his kidney function in his current state."
"But there's no evidence to suggest his condition was caused by the medication," Appel said. "The vast majority of these cases are idiopathic; we don't know what the cause is."
Dr. Gerald Chodak, a clinical professor of urology at the University of Chicago. said "Decreased kidney function is a known side effect with almost every anti-inflammatory you can think of."
How High a Price?
Elliott, a former All-Star with the Spurs, received a kidney from his brother Noel after the 1998-99 season. Elliott returned to play near the end of the next season, but he retired after last season.
To compete, Mourning needs to take eight pills a day to deal with focal segmental sclerosis, in which a portion of the nearly one million filters in each kidney begin to scar, recede and leak proteins into the urine. The regimen includes an immune suppressant, blood-pressure medication and a drug to reduce his cholesterol.
"Because of my condition, I'm slightly anemic," Mourning said. "My concern is this: not having to get to the stage of transplantation or dialysis. If I am playing, is it a deterrent toward me healing? They have reassured me that the stress I'm putting on my body on a basketball court does not affect my kidney disorder."
Appel said that Mourning's comeback should give hope to people suffering from kidney disorders and reassurance to N.B.A. players. "If Alonzo had stayed away from basketball and retired and went on to a transplant, I think the fear level would have been much greater," Appel said. "The fact that he did come back and we could treat this disease gives us great hope."
New York Times January 29, 2002
About 15% of the people on dialysis today are there as a resultof the damage that Tylenoland/or aspirin did to their kidneys.
Twenty percent of those with heartfailure are due to them taking NSAIDs.
These drugs may also be associated with diverticular disease of the colon.
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