I also use Relafen. It's a prescription anti-inflammatory. I use it for post training/racing but I have taken it before training and it does work without any side effects. However, to tell you the truth I don't think it works any better than ibuprofen.

Half-life of Relafen is ~24 hours.



http://www.drugs.com/...ype_pdr/qx/index.htm

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Thanks. I called the M.D.'s office that prescribed the Relafen and they suggested I knock it off two days before the race. That sounds reasonable to me.

Regarding the difference between Relafen and an over-the-counter drug, I feel somewhat better with the Relafen than with two Aleve, but I'm taking it primarily because it was sitting in the medicine cabinet at home, and I left my bottle of Aleve at the office. I'm sure the Aleve would have helped as well.

Two things...

1) The problem with Kidney issues, NSAID's and endurance sports is that it is not predictable based on other's experiences or your past history of useage.

2) Assuming your uncle is a doctor or simular and noted no threat of potential problems is not that unpredicable. It seems that very few doctors have experience with NSAID toxicity and ultra-endurance activities. The probability of a physician treating an IM triathlete with Kidney issues is just not that common for two reasons: 1) when compared to the general population, there are few IM triathletes 2) and, the problems caused by NSAID's are typically very cause specific - i.e., IM races or simular endurance event.

So, your anecdotal evidence is common... much like having unprotected sex (and, I use that anology very loosely).

FWIW Joe Moya

What jhc post... 24-48 hrs.

Joe

I'm not sure how anyone can confidently make this statement. Why shouldn't is be predictable? Do you have evidence that it is not?

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Based on the discussion on this whole thread I consulted my doctor today.

I asked him to please research the possible dangers of me using Ibuprofen, Advil, or Relafen during a long duration sporting event. He told me that there have been cases in which kidney or liver problems have occurred but that these are extremely rare and that probably other factors were involved (such as severe dehydration or excessive use over a long period of time) and in general if I don't exceed the recommended daily allowance then I should not have any problems at all whatsoever. He told me to use whichever one seemed to work better and that I should think about which lasted longer so that I would not have to take one in the morning and another half way through the day.

Do you prefer the word: spurious? By unpredictable, I take that to mean that there isn't a chart or LD50 or predictability formula or nomogram specific to Ibuprofen and endurance athletic events. (Although, I'm relatively certain there is a published LD50, I trust you know what I mean.)

It doesn't matter what the actual percentage of people have a problem with renal function and NSAID useage during an endurance event...IF YOU turn out to be the ONE in a hundred that takes a gram in an ironman (or whatever the incidence turns out to be), it's your kidneys that are hosed. People should be aware that there is a potential problem with combining Ibuprofen and any activity that has a potential to stress the renal system.

And it takes more than just a cursory layman's glance at it. Many people know alcohol increases GFR (at least, they know it makes them urinate more), so they might surmise alcohol may be good for the renal system. With just a little bit of knowledge, a layman may think since Ibuprofen is not good for the renal system, counter it with some alcohol post-race. Result? Renal damage.

You can get away with alcohol and ibuprofen for years, or not. When the answer is NOT, you're in big trouble. It isn't exactly predictable. You can have unprotected sex for years and not get AIDS. OR, you can get it the very first time. Not real predictable...even if you know the other person is, in fact, infected. Just because it isn't exactly predictable doesn't make it adviseable.

None of this means it couldn't be predictable, but, all the research required to get a complete handle on all the contributing factors that make prediction possible...well, that research isn't being done.

Hurricanes are predictable in one sense: they occur, and they hit land in the USA, and they cause lots of damage. Where, when, and how many hit in a year is not as predictable.

Ibuprofen injestion will result in severe renal damage in some endurance athletes...probably this year. Who, when, and under which particular circumstances will be hit? Not as predictable. Unless, of course you don't take them during the event...then, the prediction is ZERO.

I guess I don't see the reason why you keep trying to attenuate a prudent "heads up" about the potential problem. Sure, some may caution a bit aggessively...so what? That doesn't hurt anyone. Putting doubt on the validity of a warning may cause someone to say...what the heck...I'll take it...it must not be problem at all if so many others do it and don't get hurt and if others point out that there is not a good predictable association. If one person takes this attitude and kills their kidneys because it affected THEM...that isn't ideal, is it?

You don't know the level of danger. Nor do I. Apparently, nor do the commonly available Pub-Med article researchers. I am told by nephrologists that the level of danger is much greater than zero. Like the oath says...first, do no harm...I think that includes breaking down opinions of the level of danger in a public layman's forum.

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Quid quid latine dictum sit altum videtur
(That which is said in Latin sounds profound)

Yaqui, very well put, and if one were to suffer severe renal failure in an attempt to shave of say 1, 10 or 60 minutes off an Ironman time, then one needs to weigh the benefit of those said 1,10 or 60 minutes vs a lifetime of potentially being hooked up to a dialysis (sp?) machine and never competing in Ironman, or triathlon again. I'd rather have another shot at racing and have my organs so that I can walk down the street and get my mail from the mailbox when I am 80.

I personally don't use them for racing, except my daily baby aspirin (I'm an old guy), but I don't consider them 'performance enhancing.' They're for pain. They don't effect VO2max, lactate threshhold, muscle mass or strength or whatever.

The real renal risk with NSAIDS is chronic use (like Kenny Easley), especially over use. The other question is can they cause hyponatremia in ultra long endurance events (read IM and 1/2 IM)? I doubt that a couple of doses would have any effect on your kidneys. Maybe if ou were grossly dehydrated, but even then???

Acetaminophen also appears to cuase renal damage with long term chronic use (kilograms over a lifetime.) The liver effects are with extremely large doses over a short time 100+ mg/kg, or very high doses over a few days.

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Dick

Take everything I say with a grain of salt. I know nothing.

None of this means it couldn't be predictable, but, all the research required to get a complete handle on all the contributing factors that make prediction possible...well, that research isn't being done.

Actually, I think we agree. It appeared Joe was saying the effect of NSAIDs on the kidney were inherently unpredictable. I disagree, although I admit that we don't have enough information at present to confidently predict much. It was more of a semantics question, and I think I phrased it in a way that made it easily misunderstood,

I am told by nephrologists that the level of danger is much greater than zero. Like the oath says...first, do no harm...I think that includes breaking down opinions of the level of danger in a public layman's forum.

So I'm curious to hear what you think of trinow's doctor's advice: "He told me that there have been cases in which kidney or liver problems have occurred but that these are extremely rare and that probably other factors were involved (such as severe dehydration or excessive use over a long period of time) and in general if I don't exceed the recommended daily allowance then I should not have any problems at all whatsoever."

(BTW, just to be nitpicky... "do no harm" isn't in the oath)

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It's easy to make this kind of statement... I just did... and it's not an incorrect statement.

In simpler terms, you can have kidney problems when you take NSAID's. But, you can not have kidney problems when you don't take NSAID's. This is a true statement in static and excessively simple terms.

Unfortunately, I can't control people's free will... which means I can not predict peoples actions... but, can predict with some level of certainty that NSAID's have an effect on the body (both in positive and negative terms). So when I say that predictability based on other experiences or your past history, that is exact what I mean. How you take the medication or how others take the medication doesn't say squat about it's potential effect on the body during all situations. That's all.

Well, that's enough... I think yaquicarbo did a much better job of explaining why it's not predictable. And, it seems that everytime this issue come up... almost invariable, someone trys and place NSAID useage into some sort of natural food like suppliment taken by millions all over the world for the past 2000 yrs. That's being facetious and exaggering the issue (and, I don't believe that you (jhc) falls into this category).... but, the point is simply this...

The association between Kidney issues, NSAID's and endurance sports does exist... but, unlike Russian Roulett it's numerical probabilities are not precisely known. When you play Russian Roulett we know that when the prediction is taken to it's ultimate outcome defined by the fullest extent of it's probabilities (like taking all 6 shots in a 1 out of 6 probability)? Well, yes - the outcome is absolute... but, what the hell difference does it make if the guy in front of you got his head blown out at 4 shots... are you willing to take only 3 and stop?

BTW, I also read a study that also said bullets only kill 1 out of 30 - the rest are just wounded. But, the probability of being killed by a bullet is absolutely zero when no bullets are present. :-)

FWIW Joe Moya

jhc wrote: So I'm curious to hear what you think of trinow's doctor's advice: "He told me that there have been cases in which kidney or liver problems have occurred but that these are extremely rare and that probably other factors were involved (such as severe dehydration or excessive use over a long period of time) and in general if I don't exceed the recommended daily allowance then I should not have any problems at all whatsoever."


I think his doctor's statement would be a common one for any General Practictioner to make. I think it is factual as to the renal problems, probably not the liver problems, but, that would be an acceptable answer to throw liver problems into the statement just to be safe. I think the word extremely is a bit extreme ;), I would prefer to see the word 'rare' stand on it's own, or, use 'extremely' with the word 'uncommon'. When he says, "in general....don't exceed RDA then...no problems...", that's true.

What I'm concerned that some IM athletes just don't grasp well is this: what they are doing isn't just a common, "general" level of exertion/activity with normal renal function/effects. Perhaps because there are 1000 other nuts doing the IM with them that day, it can seem like it is a normal activity. Well, it isn't. It's damn tough on the body and many of it's organs. Chemical markers associated with damage can be elevated for more than a month following an IM effort.

Actually, the IM isn't a Healthy endeavor in and of itself. It's destructive and highly unusual, and stresses the body in ways that aren't beneficial to the athlete's overall health. (I'm referring to the race, not necessarily IM training, although some IM training is damaging also.) Now, take the fact of IM being unusual and actually damaging, and try and stick a recommendation about Ibuprofen use in the original doctor's statement....it doesn't fit.

BTW, sorry if my earlier post was a bit passionate, I had a buddy hospitalized after a race once, and it was very unsettling...it really overwhelms the doctors when one of us presents at the ER after a race, they don't really know where to begin to help...blood work is all screwed up, all sorts of markers of organ damage are elevated, frankly, it scared the doctors. And he didn't take any ibuprofen...I'm glad he didn't.

(Also, having never taken the oath, I don't know the oath! I thought that's what it said, as a surgeon I once worked with often made that statement when trying to decide what to do in a tough call situation.)

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Quid quid latine dictum sit altum videtur
(That which is said in Latin sounds profound)

I can't say I disagree with anything you wrote, and I'm sorry to hear about your friend - that sounds like a frightening experience.

But I thought that trinow explained he would be doing an Ironman and asked about NSAIDs in that context, and that the doctor's response took the physical exertion in account...

(Hippocates is credited with the "do no harm" quote, but it wasn't in his original oath nor any of the modern versions today. But like I said, I was being nitpicky ;)

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