The Scan by 2 Minute Medicine®: Competition and COVID, Anti-Anaphylaxis, Pulling the Plug on Psychedelics and POTS in the Pool:

The Scan by 2 Minute Medicine® is a pop-culture medical newsletter and exclusive benefit for 2 Minute Medicine Plus subscribers.

We begin with a discussion about COVID-19, asthma, and exercise. Then we take a closer look at new treatments for life-threatening allergic reactions. After that, we examine the recent FDA rejection of MDMA for patients with PTSD. Finally, we discuss POTS, and how some individuals have overcome their diagnosis to achieve greatness.

Competition and Covid:

The Story: After becoming the fastest man in the world through an Olympic 100m win, Noah Lyles set his sights on the 200m. He finished in 3rd place, not only facing off against his fellow competitors, but also COVID-19

Running with Asthma?

Lyles, who has a diagnosis of asthma, opted to run the race despite his medical condition. Asthma is a respiratory condition, where the airways constrict and it becomes difficult to breathe normally. Symptoms include wheezing, shortness of breath, and chest tightness, and asthma may manifest with variable severity. Some individuals may experience worsened asthma symptoms with exercise, making it very difficult to continue exercising. In the case of Noah Lyles, it didn’t seem to be an issue as he cruised to victory in the 100m, running it in under 10 seconds!

Where does COVID-19 fit in?

After running the 200m race, Lyles required wheelchair assistance to leave the track. He later disclosed that he ran the 20-second race after testing positive for COVID-19. Some doctors feel that strenuous exercise should not be undertaken with COVID-19, due to the negative effect that COVID-19 has on the lungs and the heart. Some feel that racing with COVID is a risky decision, not just for the racer but for the other athletes competing. Understandably, an Olympian would want to compete after all their hard work, but putting oneself and others at risk must also be considered.

Jumping with Injuries:

Lyles isn’t the only Olympian willing to compete at all costs. Just days before he was set to take the stage and defend his high jump gold medal from 2020, Gianmarco Tamberi was in the hospital. After coughing up blood, and experiencing stabbing pain, Tamberi was diagnosed with renal colic due to kidney stones. Renal colic is a term used to describe the pain felt due to obstructions in the flow of urine from the kidney to the bladder. This is most often caused by kidney stones, which occur when insoluble crystals form inside the kidney and block the exit of the kidney. Once diagnosed, a variety of treatment methods exist, including surgery, medications, and specialized procedures that apply shockwaves to the body in an attempt to break down the stone.

In Tamberi’s case, his stones were treated, however, the stay in the hospital may have significantly impacted his ability to jump. Tamberi qualified for the finals and competed well, but did not make it to the podium. These stories underscore the importance of keeping health and safety in mind, both the safety of others and one’s own safety.

Anti-Anaphylaxis:

It is estimated that 1 in 20 children may have food allergies, and unfortunately in some children, food allergies can result in anaphylaxis. Given the life-threatening nature of anaphylaxis, solutions are of the utmost importance. The US Food and Drug Administration (FDA), approved the first-ever nasal spray, designed to treat anaphylaxis.

Neffy, the new nasal spray, works to administer epinephrine, the same drug used in Epi-Pens. Epinephrine is a naturally produced hormone, that stimulates the body to increase blood pressure and heart rate, as well as open up the airways to increase the amount of oxygen that is taken in. This is because severe allergies that induce anaphylaxis, can reduce blood pressure, and cause constriction of the airways. While Epi-Pens work by injecting epinephrine directly into the muscle, Neffy works by allowing epinephrine to be absorbed through the nasal membranes, and eventually into the bloodstream.

This new formulation is very attractive to individuals who may hesitate to inject themselves, and may also make it easier for untrained individuals to administer the drug if they are not familiar with injectable forms. Although they may be priced similarly to Epi-Pens, having an alternative form of epinephrine treatment may serve to reduce the risk of shortages, of this vital medication. With millions of Americans seeking emergency room visits due to anaphylaxis, it is critical to ensure that everyone has access to life-saving epinephrine treatment, and the approval of Neffy is one step closer to that goal.

Pulling the Plug on Psychedelics:

Psychedelics have been investigated with great potential for treatment in many mental health conditions. In 2023, Australia took the step to legalize 3,4-methylenedioxymethamphetamine (MDMA), a known illicit drug that produces psychedelic effects, for therapeutic use. Also known as ecstasy, MDMA has been tested in patients with post-traumatic stress disorder (PTSD), a condition that hasn’t seen new treatments in two decades. The data from clinical trials looked promising, showing that patients treated with MDMA and therapy together experienced very positive outcomes.

PTSD is a condition experienced by individuals following an extremely stressful event, which results in dysregulation of the brain. Symptoms may be difficult to notice but may include changes in behavior, disturbing and intrusive flashbacks, and extreme responses to loud noises or startling events. While the exact changes aren’t fully understood, PTSD seems to cause changes to the brain in areas responsible for memory and thinking, while also increasing stress responses.

MDMA is known to increase the release of neurotransmitters such as dopamine and serotonin, which may increase the positive response from interventions such as therapy. MDMA has also been shown to increase levels of a compound in the brain that helps with learning.

Despite these potential benefits, the FDA did not approve MDMA for patients with PTSD. They found that there may have been methodological flaws with the study and that there may be safety concerns due to the compromising nature of mind-altering substances. Although this represents a disappointment for the field of psychedelics, there is much to learn from this instance. Many researchers still feel that despite the FDA asking for further research, there is potential for psychedelics, and that these drugs may be used in a beneficial way for patients with PTSD.

POTS in the Pool:

Though much of her time is spent horizontally in the pool, Katie Ledecky, the 4-time Olympian and world record swimmer, has experience with a condition that affects people when they are upright. Postural orthostatic tachycardia syndrome (POTS) is a condition that affects individuals when they are upright, and results in an increase in heart rate.

Although it sounds relatively harmless, POTS can have a severe impact on a person. Symptoms of POTS involve feelings of dizziness or becoming lightheaded when standing upright, because gravity causes the pooling of blood in the vessels below the heart, leading to less blood in the head. This causes the body to compensate by increasing blood pressure and heart rate. With POTS, the blood pressure does not compensate enough, leading to increases in heart rate without increases in blood pressure.

Women are more likely to develop POTS, but the exact reasons are not understood. It is also thought that nearly 25% of individuals with POTS experience life-altering severity, and are unable to work. Treatment for POTS relies on many lifestyle factors, such as increasing salt intake and wearing compression gear. As well, medications may help if lifestyle factors are ineffective on their own.

Although she has POTS, it has not stopped Ledecky from winning gold medals in every single Olympic Games that she has taken part in, and she isn’t alone. Brittany Bowes, an American speed skater, suffered a concussion and subsequently has been living with POTS. Although it was initially very difficult, she has been able to continue training and even represent the USA in the 2022 Winter Olympic Games. It isn’t limited to athletes either. Musician Halsey has been diagnosed with POTS, after years of dealing with this condition and others, and one of the characters from the children’s TV show, The Wiggles, was diagnosed with POTS. Since then, Greg, better known as the “Yellow Wiggle” had to leave the show, though he has been able to receive treatment for his condition. The strength of these individuals shows that this condition can be overcome in some cases, and with research continuing to advance the knowledge of POTS, treatments will only get better.

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