A version of this article appears in The Times, London, today.



Jo Jackson, Olympic and world championship medal winner over 400m freestyle for Britain in the past two years, is awaiting news from the British National Health Service that could save her swimming career.



The 23-year-old from North Yorkshire suffers from a form of asthma that this winter developed into a "truly severe and brittle" condition, according to doctors treating her. However, the drug that is vital to her remaining one of the host nation's big medal hopes in the pool at the London 2012 Olympic Games, is only available in Britain to those who have a record of regular emergency hospital visits.



As a member of the British swimming team, surrounded at Loughborough University by health experts who monitor her daily, Jackson, who is forbidden from taking steroids under anti-doping rules, does not need to rely on accident and emergency services.

 That alone precludes her from being prescribed a relatively new oral asthma treatment that costs up to £8,000 a year.

 Partly on cost grounds, Xolair is prescribed in Britain by special permission of a primary care trust to those in critical need. In Jackson's case, the decision rests with Richmond, Yorkshire, where she is registered with her family general practioner.

 Beyond that, there is the private care avenue, which carries its own complexities, not all cost-related.

A week out from British Championships, which get underway next Monday in Sheffield and doubles as trials for the Commonwealth Games and European Championships, Jackson has every intention of racing, though she will do so with no expectation at a time when her prospects are uncertain. 

A European short-course champion in 2003, a world record holder and on a superb 4:03 in a textile suit in domestic 400m free competition in 2009, Jackson added the 800m free to her schedule last year and collected a medal in the midst of the Rome suits circus. In Sheffield she faces two of the toughest opponents to be found anywhere in the world: Rebecca Adlington, Olympic champion ahead of Jackson’s bronze in Beijing, and Jazz Carlin, the teenage challenger from Wales who beat both Adlington and Jackson, bronze and silver medal winners respectively at the world championships last July, at the duel against Germany in Swansea last month.



A tall order at any time, and much more so if you have spent the winter struggling so hard for breath in training that you popped ribs out of their place and had to have daily physiotherapy to push them back in again.

"It's been quite scary because I've never been through anything like this before,” Jackson told The Times. 

"I've had asthma but before Beijing (2008) it wasn't as severe. I'm not used to it, especially having such serious asthma attacks and then having a panic attack because I don't know how to handle it. I’ve been seeing Carl (Butler) for physio twice a day some days because of popped ribs, and he’s been great,” Jackson added. “I'm just not used to not being able to finish sessions. That’s the hardest thing: it really hurts when you train like I do with great swimmers and you can see them doing the work. I don't know how things will go at trials. I have no expectations on myself this year. I'm more focused on getting back to some proper training."



Jackson’s case is supported by Dr Ian Gordon, the national team doctor, and a recommendation from Dr Neil Martin, the senior expert looking after Jackson at Glenfield Hospital in Leicestershire, England.



Dr Gordon said: “Rapid intervention therapy precluded her visits to hospital, steroids would not be possible, and this girl is a real chance for the London 2012 podium. Yorkshire will doubtless be proud to have her there.”



Jackson’s condition, complicated by the onset of winter, 'flu season and persistent sinusitis, ruled her out of the Duel in the Pool against the US in December and has worsened since.

 “Jo has done something like 30 to 40% of what we wanted her to do in training this winter,” said Kevin Renshaw, her coach at Loughborough University. “We have had to abandon what we’d planned."



So why race at trials? "That's what Jo is like. She is a tough young lady," said Renshaw. "At trials she’ll be going in to do her best without a time target or expectation level. We have to pick up the pieces after that.” Jackson has just one chance of making the Budapest team but can qualify for Delhi at an event in August should she still need to.



Renshaw explained the frustrations of a winter of setbacks: "One of problems related to her condition is the pure and simple issue of how hard it is to breath. In training she has severe pain in her ribs. She had an MRI scan in Birmingham this past week to see if there is deep damage to muscles and her diaphragm from her trying to get the air that she needs." Jackson has been on anti-inflammatory medication for the past two weeks and cannot dive into the water or undertake gym work because her rib cage is too sensitive.

Neither Jackson nor Renshaw appear defeated by events. Indeed, both swimmer and coach are counting hidden blessings. “Rather now than next year when we have world championships, and then there’s 2012 …,” said Jackson.

"She is having a tough time but she understands that the big picture is two years from now," said Renshaw. "If she is going to have glitches then this is the best year to have it. If we're going to take a hit of having a few problems and struggling to find correct medication to control her condition, then this year is the best one."

 He paused before adding: "But that is still hard to accept ... Jo wants to be the very best she can be every time she gets in the pool. That's not possible right now. 


After trials next week, Renshaw will sit down with Dennis Pursley, head Britain coach, Michael Scott, the Britain performance director, and Dr Gordon to work out a long-term and "complete management" plan for Jackson. Dr Gordon outlined two of the most critical first steps to London 2012 when he said: “We need to get her onto the right medication and then minimise the chances of colds and infections by placing Jo on warm weather training camps at critical times of the year.”

 

In Sheffield next week, the mission is to "make sure we do the job of qualifying", said Renshaw. If that means a 4:10, that'll be good enough. Times are irrelevant for Jo right now. It will be about making the team. She's not going to be competitive with someone like Rebecca (Adlington)."

And by that, he meant the team for Delhi: Carlin is Welsh and therefore no impediment to Jackson making the England team. In current circumstances, Budapest is the lesser priority. "One of the things that has bothered Jo a lot is Budapest and the Euros," said Renshaw. "The main competition in that event is in Europe so we wanted to go there and do well. But if that is not to be, its not to be." 

Britain can enter up to four swimmers per event at the European Championships, while two per nation may progress to finals in a format recommended to the European Swimming League by former British performance director, Bill Sweetenham to promote domestic competition and make the meet tougher in a way that might help Europeans cope better with the might of the aquatic United States.

Jackson, said: "It's better to race the best in the world so I was looking forward to the Europeans because most of the best in the world over 400m and 800 will be racing there and it would have been great to be in there with them."

She was happy, however, to do what she needed to do for the longer term and was full of praise for the support team around her. "I've had tons of support: therapies at the EIS (English Institute of Sport), the team at Glenfield (hospital) have been brilliant and its just great in Loughborough with all the people there. Kev (Renshaw) has  been a massive help and a great support and he has got no expectations, which takes a load off me. I do feel a bit sorry for him - because I've been so ill so often and we just haven't been able to do what he'd planned."

As for Sheffield she would "get in there and see what I can do to make the team - it's the only thing I can do". Besides Renshaw, Jackson's aquatic Butler will be at her side: to push those ribs back in should they pop. A case where no pain, no gain takes on added meaning for an athlete and support team seeking a solution that would ensure survival in the race pool in which Jackson excels.