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