For physicians who are trained and dedicated to practicing high levels of patient advocacy, becoming a pro cycling team doctor offers many the possibility to apply their professional skills to something they are equally passionate about. A pro cycling team doctor largely steers clear of any perverse sponsorship arrangements or scoreboard objectives that might compromise patient care.  Generally speaking, caring for athletes shouldn't be reactionary, as is common, but rather proactive, which means the team doctor may take command of racers' health before they even swing their legs over a bike for the first training ride of the season.  Here are some tips and comments from three team physicians.

The racing season for ProTour team, Movistar, began this year on January 15 in Australia with the Down Under Classic, which would prove a test to how well the team had prepared during pre-season training. For team physician Dr. Jesús Hoyos, it was a chance to see if his careful planning for the health and well-being of the team would pay dividends.

"I have many responsibilities as the team doctor: caring for the health of all team members, not only racers but staff as well; helping to plan out the race season with respect to specific races; supervising racers' training plans; organizing periodic health examinations to insure racers' maximum performance potential; and providing psychological support as necessary," Hoyos said.

Optimize your cyclists' health

Optimizing cyclists' health prior to the racing season starts with obtaining an assessment of athletes' baseline neurologic function so that — in case of a concussion — the information would allow for accurate diagnosis in the event of future injury. Athletes with a history of prior concussion are at an increased risk of repeat injury, so it is particularly imperative for these athletes to have a baseline cognitive assessment. This data will also be invaluable to racers who have sustained a concussion, since the team doctor can compare pre and post-concussion data to assess whether a racer is fit to return to competition.

"This year I have brought on board a neuropsychologist who will perform baseline neuro psych concussion testing on the team at team camp," said Dr. Kristin Wingfield, a primary care sports medicine specialist who works with the Exergy Twenty12 pro women's team. "Then we will use this as a baseline for each athlete and they can re-do the test post head injury on the road. We will then receive their scores and can make decisions about return to play (training and racing in this instance) without being there."

Evaluate each racer's health individually

The team doctor should take the initiative to evaluate each racer individually since athletic performance is keenly linked to a racer's health.

"A lot of times the athletes don't have their health optimized. For example, an athlete with asthma may be overly reliant on a rescue inhaler," explained Dr. Dawn Richardson, team physician for Champion System Pro Cycling Team. "Maybe they just don't know any differently or, for financial reasons, they didn't have access to preventive medicine. I explain that if they're using a rescue inhaler, their airways are inflamed and they don't want that. Just getting on maintenance medication for an asthmatic can make a huge difference in preventing airway inflammation and this in turn improves performance."

Dr. Richardson raced professionally until she retired in 2002; she had already completed her training and board certification as an emergency medicine physician. Her experience as a racer affords her a familiar perspective of the stresses of racing so, in addition to being available to the athletes without being disruptive to their routine, she assists in many ways above and beyond the call of duty.

"It's obvious fairly quickly that the mechanics and soigneurs are working very long days, so if I can do simple errands for them like supermarket runs, gassing up the team vehicles or run the athletes' laundry bags through the laundromat, I do it," Richardson said. "Something as simple as going to the pharmacy for an over-the-counter medication is way too much hassle for the athletes during a stage race, so I end up going on pharmacy runs at least every couple days."

Plan, monitor, and maintain racers' health regularly

Stage racing, especially a Grand Tour like the Tour de France, places heightened demands on a team doctor, like being "on-call" for 21 days straight. In addition to overseeing the team's health, Movistar's Dr. Hoyos maintains a daily routine that starts with waking the racers and recording their heartbeat, blood pressure, weight, sleep quality etc. He then follows up with racers who have suffered wounds that require specific treatment and continues to work with racers on mentally preparing for the day's stage. Following the stage, he records the same data as in the morning and notes each racer's state of health. He also supervises the racers' nutrition and monitors dietary supplements, such as vitamins, protein, and adequate hydration. Lastly, he administers treatments specific to incidents outside the norm (such as lesions, road rash etc.).

Unchecked injuries that can lead to serious health problems run counter to cutthroat competition, which has led to serious medical problems long after the athlete has retired from the sport. Sports like football and basketball are learning this the hard way through federal lawsuits filed by players who say that brain injuries have left them struggling with medical problems years after their playing days ended.

By comparison, doctors — like Dr. Richardson — who are cyclists as well are bringing their professional influence to bear on the sport, which sets a precedent for unparalleled athlete care. Of course a racing career isn't obligatory to becoming a pro cycling team doctor; a successful team physician doesn't need to produce results, just healthy racers.

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