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Pain medication during race: do you?
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Just before I get off the bike in an Ironman distance race I pop a couple Aleve and then do it again at about mile 10. It really takes the "bone on bone contact" sensation out of the experience. Do any of you guys take pain medication during an Ironman?

Tom Demerly
The Tri Shop.com
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Watch out for dilutional hyponatremia, Tom [ In reply to ]
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Ibuprofen, Aleve, and a number of analgaesics can affect your kidneys, and greatly increase the risk of dilutional hyponatremia.

As I am sure your already know, it seems like everyone worries about dehydration during an Ironman, marathon, or other endurance events. Yet virtually no-one has ever actually died of dehydration, yet people have died of hyponatremia. It isn't something to fool around with.



--

~~Bob
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Re: Watch out for dilutional hyponatremia, Tom [Bob] [ In reply to ]
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That's a good point. I've heard of that. What are the indications? How do you avoid it? What other info do you have on this? Sorry to be a burden, but this is very interesting information.

Tom Demerly
The Tri Shop.com
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Re: Pain medication during race: do you? [Tom Demerly] [ In reply to ]
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I figure that taking any kind of medication during a race is risky because I never do it while training. Also, since ironman racing is so much fun, I wouldn't want to dull the experience..... they don't hurt do they? :)
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Re: Pain medication during race: do you? [Allan] [ In reply to ]
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I use the stuff in training too. After a broken back and several knee surgeries it takes the edge off.

Tom Demerly
The Tri Shop.com
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Re: Ditto on dilutional hyponatremia [Tom Demerly] [ In reply to ]
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Also, this would apply to prescription NSAID's. (if my memory is correct) It is suggested that you not take NSAID's some 24-48 hrs. before a lengthy athletic event such as Triathlons.

Joe Moya
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NSAIDs use and renal function [ In reply to ]
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Volume depletion of any kind will decrease the amount of blood going to the kidneys. This in turn will lead to an increase of the secretion of hormones such as Angiotensin II adn Norepinephrine. However NSAIDS wil inhibit the release of these hormones leading to acute renal failure. It has been suggested that the NSAID sulindac (Clinoril) MAY be safer than the other NSAIDS for reasons that are not well understood. (Summarized from Rose, B "renal pathophysiology" 1994)

The point being if you are volume depleted beware of taking a NSAID, similarily for the same reason you should be careful when you are taking ACE inhibitors

You should be concerned if you have marked decrease in urine output (after rehydration) You notice changes in your heart rhythm (palpitations / racing heart beat etc.) mental confusion, flank pain (lower back, butt area) non muscular...

In reference to the dilutional hyponatremia. The hyponatremia that triathletes commonly refer to is caused by sodium loss greater than water loss caused by excessive sweating with inadequate salt intake... Key symptoms would be mental confusion, reaaaaly bad headache, and coma... (if you are in a coma you already know that something is wrong) Having said that the renal failure can also cause hyponatremia...

point being consult your physician if you are taking NSAIDs or ACE inhibitors and are planning on doing events where you are likely to become severly volume depleted. They will be able to make specific reccommendations on changing your medcial regiment and or change your medications.

Be carefull out there a DNF is bad but DOA is worse... listen to your body its the only one you got
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Re: NSAIDs use and renal function [taku] [ In reply to ]
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Not to detract from Tom's NSAID question, but you mentioned ACE inhibitors. I was just placed on Prinivil. I always have a Nalgene bottle of water near, but could you expand the precautions for athletes with hypertension such as myself. Thanks.


Sean
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Re: NSAIDs use and renal function [taku] [ In reply to ]
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Any contraindications to acetaminophen (tylenol) during Ironman distance races?

I have used it successfully during a half ironman and a marathon. I've not used it in an Ironman but I carried a couple of pills strapped to my salt tablet container a couple of times just in case.
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Re: NSAIDs use and renal function [Richard_M] [ In reply to ]
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I use a homeopathic pain reliever called Arnica. No side effects. Works well. You just dissolve a few little tabs under your tongue several times during your bike and run.

You can get it at health food stores.
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Re: NSAIDs use and renal function [haystack] [ In reply to ]
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Disclaimer: I am a medical student so I can only talk about things theoretically... you should thus take everyhting with a grain of salt and confer with your physician before making any changes in your medical care!!!!

I say this not becuase I am worried about litigation but becuase it is impossible to give good medical advice without knowing you and your condition better.

having said that ACE inhibitors are very good drugs. The studies have shown that they are effective i preventing many of the long term remodeling of the cardiovascular system... They are also effective at slowing the progression of the hypertensive effects on the kidneys.

The contraindications with ACE inhibitors I was speaking about arise within the context of hypovolemia (dehydration). Such a situation can arise in the context of strenuous exertion such as seen in racing in the a ironman.

Blood pressure is dependant on plasma volume. Plasma volume decreases with water loss. Decrease in plasma volume results in a drop in blood pressure. An excessive drop in blood pressure can lead to all sorts of bad things to your organs... one of which is an acute form of Kidney failure... The bodies way of dealing with drops in blood pressure is through the renin angiotensin system. The ACE inhibitors directly inhibit this system... therefore it is inhibiting the compensatory mechanisms and may exacerbate the problem of volume depletion...
This sort of thing is often only seen in extreme circumstances (ie. an arm is severed and you bleed a lot) The volume depletion is not extreme on the grand scheme of things, the combination of volume depletion and greater load on your kidneys can be cuase for concern.
this especially a cause for concern when dealing with extreme

The precautions I would suggest is to pay especially close attention to proper hydration and to consult with your physician about any plans to increase the duration / intensity of your training... your physician MAY want to change your dosages depending on what you are doing...

There is a reason why people are always warned to consult your physician before starting on a new exercise program...
The more your physician knows about your activites the better he/she is going to be able to treat you...

hope this helps
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Re: Pain medication during race: do you? [Tom Demerly] [ In reply to ]
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Look, people, DO NOT take ibuprofen or other NSAID's, prescription or not, when doing something as big as an ironman. It is not worth the risk of renal damage. If it hurts too much to do that distance without loading up on Aleve, or Motrin, or Advil, etc., DON'T DO THAT DISTANCE!

Sure, confer with your doctor (but who is REALLY going to call up their doctor and ask them about this?)...almost any doctor will advise you that "there are certain risks involved with taking NSAIDS blahblahblahblahblah and you should limit their use during long events because of the issue of hypovolemia and renal damage, etc." But let me remind you, almost NONE of them really know what an ironman really demands of your body. Let's face it, most aren't Sports-Medicine trained.

Also, combining NSAIDs and alcohol can wipe your renal function out, or severely decrease your kidney's ability to do it's job, causing acute and/or chronic Renal insufficiency. Can you stand to be on dialysis the rest of your life (or until you get a transplant) because you chose to take NSAIDs, do an ironman and knock back some celebratory brews after the event? Make no mistake about it, you are at risk of killing your kidneys.

I have a good friend whose spouse took 4 advil (equivalent to one old-prescription strength Motrin) after a very hard workout day, went out drinking that night, and ended up on dialysis. The risk is REAL.

Acetaminaphen (tylenol) is cleared by the hepatic system instead of the renal system, but don't let that relax your guard. Acetaminaphen overdose was a big suicide choice a few years back in certain teenage groups, because it didn't take a lot of guts to do, and the pitiful victim got lots of attention as they lay in the hospital their last few days dwindling away after they fried their livers on the stuff.

I know I'm being a bit dramatic here. But, I'll say it again, the risk is REAL. Don't do it.



Quid quid latine dictum sit altum videtur
(That which is said in Latin sounds profound)
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Re: Pain medication during race: do you? [ktalon] [ In reply to ]
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Do I? Absolutely not. I've got an arthritic knee that would like me too but I choose not to risk the obvious. That risk-responsibility thing keeps popping-up. I do not think the risk here can be overstated -- although I've never been called to the bedside of a an endurance athlete who has torched their kidneys/liver I have been invited to be there for others. Be safe.
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Re: NSAIDs use and renal function [taku] [ In reply to ]
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I'm 30 years old and have had rheumatoid arthritis in my ankles and knees since I was 16. For the past 14 years I have been on NSAIDS daily and more recently (past 3 years) have been taking NSAIDS (Voltaren XR) and DMARDS (disease modifying anti-rheumatic drugs). This year marks my third year doing triathlons, and in June I will be doing IMCDA (my first IM).

Throughout my training I have been taking my regular meds. Without them the simple task of walking becomes very difficult, so really I have no choice if I wish to be active. Obviously, doing triathlons helps, because my weight is down (from 180 pre-triathlete to 160 now) and the cycling and swimming are very easy on my joints.

I have not experienced any health problems from my triathlons, at least that I know of. My longest distance is a half IM, and in every race I do I am going very hard (like all of us!). I have read other discussions about the effects of NSAIDS and have become somewhat concerned. I have regular blood tests which are normal, and a few months ago I had an ultrasound of my kidneys, which looked normal. My doctor is aware of my involvement in triathlons, and has not mentioned any concern. She seems very knowledgeable and works/teaches at georgetown, so I would presume she has some familiarity with the effects of NSAIDS.

My question is, does the fact that I take NSAIDS on a regular basis help or hurt my chances of having an adverse effect during endurance events? Of course, I will be talking with my doc prior to the IM as well.

thanks
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No. The pain is part of the experience... [ In reply to ]
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I find it interesting that everyone is sticking to the long-term damage and avoiding the ethical questions this poses...

In 1993, the Chicago Marathon was sponsored by Nuprin...I assumed it was for AFTER the race.

A few years back, an out of contention (and very popular) Pro took a beer at IMH. He was subsequently disqualified and not invited back. Why? The rules are clear about outside assistance and illegal substances. While I'm sure many will turn this into a "grey area," I simply don't agree. Taking medication during the race shouldn't occur.

1. It defeats the spirit of sport (it artificially improves performance)

2. It prevents athletes from actually experiencing the pain (decreases the mental toughness required to compete AND could lead them to underestimate injuries)

3. Has risks in itself (as mentioned in other posts)

I guess it's a personal choice, but where do you draw the line? Steroids/EPO could be therefore viewed as a personal choice...

I know a few will jump on the "well then we shouldn't take Cytomax..." I don't know what to say...The line needs to be drawn somewhere...

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"If you are gonna charge... CHARGE HARD!"
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Re: No. The pain is part of the experience... [puskas] [ In reply to ]
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puskas makes a valid point. I rationalize taking Aleve or ibuprofin during a race because of some nagging back injuries and knee surgeries. I also take it during the week a couple times for the same thing. Is it a performance enhancing drug? For me, Absolutely- it is. I can go faster, farther with less pain. Truthfully, I haven't felt I was "cheating" per se', as I would if I had used EPO or steroids, but where you draw the line is an interesting question (I have never, nor would ever consider using EPO, steroids or other banned performance enhancing substances). However, at the 2002 Raid Gauloises in Vietnam I used caffeine (strong coffee- lots of it, no-doz, etc)and several other stimulants such as ginseng to "manage" fatigue. I used a lot of it, as did most all of the teams. At drug testing I told them "I'll tell you right now, I am going test positive for something- I've taken a lot of stimulants..." All the test results came back negative. There was no way. I was so heavily wired on this stuff I can't imagine testing negative. Puskas is right- where do you draw the line? Interesting question. Did I cross it in Vietnam?

Tom Demerly
The Tri Shop.com
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Re: Pain medication during race: do you? [Tom Demerly] [ In reply to ]
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Nope. As Anatoli Boukreev once said about not using oxygen on climbs (I think it was him) I want to be able to feel all of my pain so I know exactly what is going on. I worry that if aI dull any of the sensation that I might not be getting the best feedback (good or bad) from my body.





"To give less than your best is to sacrifice the gift." - Pre

MattMizenko.com
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Re: NSAIDs use and renal function [zig] [ In reply to ]
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Zig,

First, way to tough it out! Since you are able to go hard, and have completed a 1/2IM your real-world and laboratory testing seems to indicate you've managed this challenge well. If you were able to "race" the 1/2 it would seem that if you were to have a problem with dehydration and kidney functioning it would have shown up. Where you might want to raise questions is how to manage volume depletion, rehydration, and electrolyte replacement for the IM distance. The upside to IM is that you will not be going at your 1/2IM pace (tip!) so mangement of this can be easier. The race, however, is longer and so more opportunity to get in trouble. I would think knowing your sweat-rate would help. Calculating fluid and electrolyrte replacement from that along with comparing those numbers to your 1/2IM intake of same should give you ballpark what you will need. The one thing you could do, just thinking out loud here, if you needed the peace of mind and with your Dr's support of course, is to do a longish brick at IM race pace, hydrate and replenish according to the plan, and ask the Dr to run the appropriate panels to test kidney, electrolyes, or whatever else might be a concern. It would seem to me that if there were issues you would know. Lastly, I would ask the doc what are the signs/symptoms that would indicate I'm headed for trouble and what to do about them.
Last edited by: Chappy: Jan 9, 03 10:25
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Re: NSAIDs use and renal function [zig] [ In reply to ]
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Your NSAID use does not preclude you from doing an Ironman or anything else you may want to do... it is however a cause for concern and you should take extra precautions, ie. speak to your physician, monitor your renal (kidney function) carefully and come to a conclusion before you start on your race what risks you are willing to take.

Your condition puts you in an at-risk category which simply means you have to be more cautious...
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the difference between an NSAID and EPO [ In reply to ]
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I think that the line that is drawn by the governing bodies of most sports is illuminated by the difference between these drugs

An NSAID can enhance performance (I would debate this unless I saw some hard scientific testing) for someone with an injury or something like that... but it will not enhance performance in a normal person. Another way of putting this is it will not enhance the physiological potential of a competitior

On the otherhand a drug like EPO will definately increased the physiological potential over not taking it... that is where the line is drawn

Coffee on the other hand presents a very interesting situation. It has been shown to actually increase you performance in physiological tasks such as running to exhaustion, running a mile, etc. As soon as this study came out the IOC (international olympic committee) limited the amount of caffeine ingested before a race. (this is actullay one of the things that they test for)

The grey area comes in when comparing apples to oranges. Bronchodilators are used as a treatment for asthma. The same drug has also been shown to increase athletic performance. Asthmatics are allowed to take a physiological dose for their condition. I see this as evening the field... maybe some of you would agree... pretty much why I see no problem with taking a couple of advil for an injury... just evening the playing field

I kind alost track of my point... but curious to hear all of yoru replies
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Re: NSAIDs use and renal function [zig] [ In reply to ]
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Zig: way to go! You are doing what you have to in order to compete while doing what you should to make sure you aren't hurting yourself. MOST people just don't get the testing/attention/advice and think "if it's over-the-counter, it must be OK". Then, if they further think that "if a little helped, a lot will help a lot more, besides, I have an iron stomach, and it isn't hurting my stomach, so I must be OK."

Keep getting good advice, and follow it. You may find an IM is too much risk for someone with your condition, OR, maybe you just have to go easier at that distance than your muscles are willing to work...your limiting factors may be different than mine, but we all have limiting factors. Just make sure you know what the ramifications of your decisions entail...it sounds like you've got a good handle on it.

I'm just worried about people like the knuckleheads I train with that just don't take what they're doing drug-wise seriously...by the way, lots of them are in the medical profession!



Quid quid latine dictum sit altum videtur
(That which is said in Latin sounds profound)
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Re: NSAIDs use and renal function [ktalon] [ In reply to ]
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Just a couple of additional thoughts on what we should or shouldn't be allowed to take during athletic competition: that is why the IOC and USAT and other organizations have a comprehensive list of drugs which you can and can't take and the limits of how many mg. or micrograms/liter of blood you can test negative or positive. This is all completely hypothetical for most of us, because as amateurs we will never be tested anyway.
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Re: NSAIDs use and renal function [ktalon] [ In reply to ]
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Just a couple of additional thoughts on what we should or shouldn't be allowed to take during athletic competition: that is why the IOC and USAT and other organizations have a comprehensive list of drugs which you can and can't take and the limits of how many mg. or micrograms/liter of blood you can test negative or positive. This is all completely hypothetical for most of us, because as amateurs we will never be tested anyway.
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Re: Pain medication during race: do you? [Tom Demerly] [ In reply to ]
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Before long run events I take an Alleve the night before and another in the morning before the race. I also take extra precaution in staying hydrated.
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