That quote is from 1696. You read that right -- more than 400 years ago!
How true it remains for me in 2009.
I could have called the next series of entries "Sue's Health Update"
but readers might think it was related to my memorable bike
crash back in early
August. You know, the simple little totally-unrisky-appearing bike ride that
dern near killed me!
Nope. I healed up
rather quickly from that. I'm pretty resilient physically for my age but I still have
to remember that I'm 60, not 35. Things don't heal like they used to.
They don't work like they used to, either! < scowly face
READ THE REPORT, DUMMY
The only thing
related in this entry to my wreck is the scare I got in late September
when I thoroughly read the results from the basic metabolic panel that
was done in the emergency room in Durango almost two months earlier. When we left the hospital that night they gave me a
copy of my blood test results, brain and spine CT scan images and
written results, diagnosis, and treatment plan but I didn't pay much
attention to the blood test results.
Roanoke River Greenway
construction near Roanoke Memorial Hospital
After the wreck I was preoccupied with healing and internet research of
my new problems (concussion, amnesia, rib fractures, lacerations, etc.) for a week, activities in
Leadville the next two weeks, exploring Logan Canyon and Teton Canyon another
couple weeks, traveling to
Ohio for a family medical emergency, then finally settling in (temporarily) at our house in
Who had time to read the results of a blood test?? Everything was normal when I had my annual physical and blood/urine tests in early
April, so what could have possibly gone wrong over the summer?
A GLOOMY GLOM RATE
Uh, possibly my kidney function. There on the report I was given on
August 3 -- in black and white, clear as day -- under the category "estimated GFR" (glomular
filtration rate) it said that a reading less than 60 units indicates
"chronic kidney disease if found over a 3-month period."
I was at 49 a few hours after my wreck.
Chronic kidney disease??!!
To my knowledge I've never had kidney problems
in my life nor do I have any family history of it. In fact, because of all the
ibuprofen I've been taking the last 15-20
years for osteoarthritis and running-related aches and pains, I specifically ask my doctor(s) every year if my kidney and liver functions are normal.
So far, so good. At least until August 3.
I quickly dug out my test results from April and compared them.
The glom filtration rate was normal: more than 60. (If it's more than
60, a specific number apparently isn't listed -- only if it's under 60.) What happened in the ensuing
four months to make my GFR go down to the point that the hospital warned me it
could be "chronic kidney disease if found over a three-month period?"
Greenway construction under a pedestrian
Now I had something new to
research. I mostly relied on the National
NIH (National Institutes of Health), and
Mayo Clinic websites for information about how
the kidneys function, why they are so critical, what can go wrong, how to tell
if something's wrong, and how to treat the problem before you end up with renal
Ultra runners definitely need to know how to avoid renal failure! (More
about that below.)
Among other things, I
learned that my blood urea nitrogen (BUN) and creatinine levels were also out
of normal range in August, far above what they were in April. Those are also
warning signs of kidney disease. I either didn't have or don't know if I had
the other four warning signs on the day of the wreck: high blood pressure,
more frequent urination, puffiness/swelling (none of them present) or blood or
protein in the urine (urinalysis not done at hospital).
I was a little baffled
about what caused these blood markers to be out of whack so suddenly. I don't
have diabetes or high blood pressure, for example, or know of any inherited
conditions that would cause kidney problems. But there were two other potential
that made sense to me.
At first, the only cause I
suspected was my chronic, sometimes heavy, long-term use of ibuprofen, fondly
called "Vitamin I" by athletes. Chronic
use of over-the-counter NSAIDs (non-steroidal anti-inflammatories)
like ibuprofen are known to adversely affect the kidneys, liver, GI tract, and heart
in some people.
I had already been taking "Vitamin I" off and on for several
years for running aches and pains when I was diagnosed with osteoarthritis 12+
years ago. Since my pain wasn't excessive, the rheumatologist recommended
(among other things) that I use ibuprofen regularly to relieve the pain,
tenderness, swelling, and stiffness in my hands, which were the first joints to
be problematic for me. Ibuprofen worked so well, I've used a prescription NSAID
only briefly a couple of times in the intervening years, such as during my grueling AT Adventure Run.
I've been real happy that
something as cheap as generic ibuprofen worked so well for so long. What's that
saying about all good things coming to an end??
Continuation of greenway toward Wiley Drive
My primary care physician
in Roanoke has recommended several times that I get off the stuff but
each time I tried his recommended alternative, acetaminophen, for several weeks it just didn't work as well
for me -- and I'd go back to buying inexpensive, bulk bottles of generic
ibuprofen and pop two (sometimes three) every four hours during the day.
The recommended dosage of
ibuprofen (brand names are Advil and Motrin) is a maximum of 1200 mg per day,
unless under medical supervision -- then folks may be able to take as much as
2400 mg/day for short durations. As far back as I can remember, I've taken at
least 1200 mg/day and oftentimes 1600 or 2000 mg with no apparent GI or kidney
or liver distress -- until now.
Maybe. Or maybe not!
THE ROLE OF DEHYDRATION
At the Hinson Lake 24-hour run in September one of my running friends, who is a nurse, suggested
my blood results could
have been a result of being dehydrated after my bike wreck. She suggested that I
might be OK continuing to use ibuprofen (preferably in lower doses) as long as
I stay well hydrated, but encouraged me to follow my doctor's
Well, duh! I kind of live in a state of dehydration most of the time,
especially all summer at altitude in the Rockies. And without having any water
to drink for several hours before my blood was drawn in the ER
in August, yeah, I
was probably dehydrated.
My friend told me that dehydration, combined with my use of ibuprofen,
easily could have caused the low GFL and high creatinine/BUN results.
Too bad this won't be done before we
leave on our winter trip.
My primary care physician confirmed this in early October but he ran
another basic metabolic panel just in case. All three values were within the
standard range. Crisis averted. He wants me to get it rechecked in another
DON'T WANNA GO THERE
I decided to get off ibuprofen even before this appointment. Reading all
the information about kidney disease was a factor. So was talking about the
issue with my nurse-runner friend and my knee guy (orthopedist) in September. And hearing about yet
another ultra runner's renal failure definitely got my
attention . . .
Near the end of August, Erik Skaggs broke the course record at Where's Waldo 100K
in Oregon by almost an hour. Two days later he was hospitalized for kidney failure, racking up a
huge bill during his six-day stay (about $25,000, I read).
newspaper and internet ultra list reports, the problem
was most likely caused by a combination of dehydration and use of ibuprofen after the race.
It's hard to get enough fluids during such long events and not everyone
sufficiently hydrates their bodies after the race either. Adding ibuprofen to
the mix exacerbates the harm done to the kidneys. They simply can't filter
waste products properly.
This is by no means the first time a dehydrated ultra runner has taken too much
ibuprofen before, during, and/or after an endurance event. I've heard and read various
accounts of renal failure for as long as I've been running ultras. This time I paid more
attention, however, since I'd recently discovered my own (much less serious)
problem with "Vitamin I" and dehydration.
Colorful trees along the greenway in Smith Park
Erik was not adequately insured to cover his enormous medical bill so
friends solicited funds to help him. The ensuing discussions on the ultra list about
the use of ibuprofen in endurance events (a recurring thread) and runners with no or inadequate
health insurance was both lively and enlightening.
The original question re: insurance was whether we
ultra runners take more risks if we have good health coverage. No one admitted to doing that, of course.
I never even consciously thought about it before. Upon reflection, however, I
joked to the list that because I'm so doggone clumsy I might be afraid to go
out the door if I didn't have good medical insurance! Sometimes I feel
like I'm an accident waiting to happen.
By the end of September, I had switched from ibuprofen to acetaminophen for
my arthritis aches and pains.
MASKING THE PAIN
So what's it like to wean yourself off ibuprofen after many
years of effective use and start using an entirely different
class of pain relievers?
Within a few days, I realized how much soreness and pain I've been masking for
so long! I soon became aware of just about every joint in my
body: hello there. And that's with the higher 650 mg
extended-release version of acetaminophen that is marketed to
Pretty roses along the greenway -- in
I'll do my best to stay off ibuprofen but I'm not making any
guarantees that I'll never use NSAIDs again. Besides the abnormal
kidney readings back in August, I've also been experiencing
occasional unexplained rectal and/or vaginal bleeding for a while. Either or
both may be attributed to my long-term use of ibuprofen,
adequate reasons to get off the stuff for a while and give acetaminophen a
And wouldn't you know, acetaminophen has its own list of risks,
including liver and kidney damage!!
Everything in moderation . . .
All of this is directly related to my deteriorating knees and
future in ultra running. That's the topic of the next
"Runtrails & Company" - Sue Norwood, Jim O'Neil,
and Cody the Ultra Lab
© 2009 Sue Norwood and Jim O'Neil