2009 ULTRA RUNNING ADVENTURES

 

   
 
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  BYE BYE, VITAMIN I??
ANOTHER CAUTIONARY TALE

WEDNESDAY, NOVEMBER 11

 
"It well becomes a man who is no longer young to forget that he ever was."
~ Seigneur de Saint-Evremond
 
 
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 Virginia.

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 bridge

Now I had something new to research. I mostly relied on the National Kidney Foundation, 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 failure.

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 causes that made sense to me.

"VITAMIN I"

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 (Celebrex) 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 recommendations.

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 three months.

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).

According to 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 arthritis sufferers.


Pretty roses along the greenway -- in mid-November!!

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 chance.

And wouldn't you know, acetaminophen has its own list of risks, including liver and kidney damage!! Everything in moderation . . .

GRANNY KNEES

All of this is directly related to my deteriorating knees and future in ultra running. That's the topic of the next couple entries.

Happy trails,

Sue
"Runtrails & Company" - Sue Norwood, Jim O'Neil, and Cody the Ultra Lab

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2009 Sue Norwood and Jim O'Neil

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