Tuesday, July 12, 2011


A few emails I received combined with some of the chatter over on Craig's blog has impelled me to share a bit of my thoughts about renal failure, ibuprofen, training, and running 100 miles. So, in that order, here goes:

In the 2004 AC100 after finishing 2nd to G Medina I peed brown, had flu like symptoms for 5 days following the race and ended up spending 8 days in the hospital getting IV's and blowing up like the Stay-Puff Marshmallow man. Turns out my CPK had been 145,000 and my creatine upwards of 8.0. Dangerous stuff. After recovering and doing a bit of soul-searching I met extensively with a nephrologist at Kaiser in Oakland. The end-game of the conversation went something like this:

Me: Doc, I want to keep running these things. What do I need to do?
Doc: Well, the muscle damage you did here means you ran beyond your body's ability to handle the pain. So, what you need to do is pretty simple; you can either slow-down or stop the next time the pain gets this bad or you can train harder so that the pain never gets this bad again.

You can guess which option I chose.

I also swore off Ibuprofen on that day because of this little exchange:

Me: Some people have said I got this because of Advil. You think that's true?
Doc: Look, Ibuprofen is an anti-inflammatory, therefore, it's job is to basically shrink things in your body. The last thing you want to happen in your kidneys is for the tubules that process the waste out of your body to shrink.
Me: OK, so if I don't take Ibuprofen the tubules will stay open.
Doc: Yup

So, I started training harder, racing less, and getting my blood tested after every 100 miler I ran. So far, it's worked.

I'll try to dig up the extensive report I wrote after my 2004 experience but, in the meantime, if anybody out there wants to discuss please drop me a line.

Finally, if you're keeping score at home my CPK's for the last 6 WS100's I've run have been 18,000 (2nd place, cool day), 42,000 (hot year, went in injured), 5,000 (4th to Koerner, Skaden, Cooper), 14,000 (scrapped out a 10th place after coming in under-trained), 18,000 (steady 9th on a benign day), 15,200 (PR on a very good day)


Jeremy said...

Amen! It's amazing to me how many people take NSAID's during races to help dull the pain. Most don't realize just how dangerous of a situation they may be creating in their body. I swore off Advil and such years ago, even in everyday life, as there are better ways to control pain and inflammation. Thanks for the PSA and congrats on WS!

GZ said...

The CPK values seem to be highly varied from person to person - or even within a single person effort to effort. I don't know jack about that measure but given its variance, it seems it takes at least a sample like the size you mention to make any sense out of it for a single person. That and the fact that I have never encountered any race that does this makes it improbably that people will use this test ...

But yeah, on the general spirit - screw Advil and train smarter.

Derrick said...

Thank you for this.

Tim said...

I'd like to say thanks as well. As a younger runner getting into ultras, this information is immensely helpful so that I don't get started on the wrong footing.

Paul said...

Thanks for the advice. I’ve only got one kidney so need to be extra careful with it (or maybe not…I guess in this kind of situation if it’s going to hurt one, it’s going to hurt them both). I never touch NSAIDs in or out of a race.

Interesting about getting your CPK checked – that’s something I might start doing. I agree with GZ – I think a CPK of x is to some extent meaningless (except in extreme cases). It’s like saying my average HR was 150 – that could be high for one person and comfortable for another. I think the meaning comes in trends – and that’s the point of keeping the record. If after one race your reading is say 5x the usual post-race reading, then you probably want to get checked out (note: all my own imaginings, not based on any medical knowledge and the 5x is a random number I picked out of my head, not a recommendation!)

Jamie said...

I'd love to read your complete 2004ARF account. After my 2010 HR, I am a student of CPK and renal failure. Enough has been said/written about me but I think this is an important conversation to keep going and get out there. I don't take NSAIDs either (though my nephrologist says to swear off them is unnecessary).

Fairbanks said...

AJW, have you had any differences in you Blood Pressure since then?

My kidney doc at the university hospital in denver has attributed my acute higher BP readings (back to normal now) with lots of high altitude miles and NSAID use last year.

I ran 150's over 100's (BP) for 4 to 6 months after last year!

NSAID's and ultra running do not mix!

ed runs said...

Can't sleep so I thought I'd post my bout with Vitamin I, Ibu.

I was beginning a new job a couple summer ago on a Monday and the baby was to begin going to child care for 6 hours a day. Obviously, two stressful things going on. I may have been cycling but nothing to intense.

Monday came and went uneventfully but I wasn't eating or drinking well that day because of the new things.

I also was sleep deprived. So Monday night I take a couple Ibu's in an attempt to get rid of a headache caused by lack of sleep and no food/drink consumption.

Tuesday morning I awake and I can't move. I get out of bed and lie on the floor. That is when my wife walked in and asked if I was going to work. Second day on the job, new job. I said I'm in pain. Stomach pains ... She saw that I was immobile and said "you're going to the ER".

The pain was about 6 on a 10 scale. They gave me an IV and some Morphine. They said better to have no pain while trying to get better. It burns going in your vein but then the pain leaves you.

I felt mostly vulnerable, going into the ER I saw the ambulance staff pumping some guys chest as they pushed him into the hospital, not a good sight.

I was diagnosed with gastritis, the inflammation of the stomach lining. They gave me a Gastro Cocktail to drink and then had me rest in the hospital for about 3 hours. I was much better then.

I too stopped taking Ibu. Since then I may have take 1 Tylenol or Advil with food.

I can't say that I'll forever stop, bc once I was told to take 4 pain pills regularly for a dental issues that bothered me over the weekend; but I've definitely stop for the time being.

Becareful out there.