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Tom Kirchner
(ouzel) - MLife

Locale: Pacific Northwest/Sierra
Ibuprofen risk on 12/10/2012 20:53:43 MST Print View

A friend sent me this article, and I found it interesting enough to put it out here for those of you who routinely take Ibuprofen before and after exercise. Maybe time to reconsider....

http://well.blogs.nytimes.com/2012/12/05/for-athletes-risks-from-ibuprofen-use/

Brian UL
(MAYNARD76)

Locale: New England
Re: Ibuprofen risk on 12/10/2012 21:05:34 MST Print View

If you need to take Ibuprofen to exercise you need to reconsider your exercise! thats crazy

Luke Schmidt
(Cameron) - MLife

Locale: The WOODS
Re Re Ibuprofen Risk on 12/10/2012 21:24:51 MST Print View

I don't use pain killers long term, I see them as more of a one shot deal do get me out of a situation. If I'm taking them often I'm doing something wrong.
I can't prove it but I'm pretty sure pain killers saved my bacon on two different occasions. In one case various factors conspired to where I really needed to do a long day. It was going to be a suffer fest one way or the other but I really think a hefty dose of Ibuprofen helped. Another time I'd pulled a muscle, or a rib or something but I had a very sharp pain in one small area of my back. Since my pack just happened to make contact there it was about to ruin a trip. I took a dose of Advil and about 30 minutes later I felt much better.

Rex Sanders
(Rex) - M

Locale: Central California Coast
Re: Ibuprofen risk on 12/10/2012 21:27:31 MST Print View

Briefly mentioned in that article:

"Animal studies have also shown that ibuprofen hampers the ability of muscles to rebuild themselves after exercise."

Ten years ago, I was training for a 500 mile hike, and taking Aleve (naproxen sodium, another NSAID), before and after hikes for muscle soreness, but couldn't get past 13 miles per day.

I read about the muscle rebuilding problem, so stopped taking Aleve.

In two weeks, my hiking strength increased, and my soreness decreased. Along with other changes, I was hiking 20+ mile days a couple of months later.

I still get sore after hiking, but I've learned that stretching immediately *after* hiking, prevents soreness the next day.

"No pain, no gain" is true for me!

Now, I take Aleve or related drugs only for injuries or illness.

YMMV.

(Edit for typo)

Edited by Rex on 12/10/2012 21:30:56 MST.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Ibuprofen risk on 12/10/2012 21:57:29 MST Print View

The other risk is that Ibuprofen and Tylenol require you to drink a fair amount of water with the pills. Most distance runners do not carry such a huge amount of excess water, so they simply take the pills with a mere sip. That causes distress in the kidneys. If you are taking a lot of Ibuprofen and Tylenol during some event, you can cause your kidneys to shut down. Competitors in the Western States 100 Miler routinely run into this problem. Intravenous fluids generally don't fix it, and kidney dialysis will. Through-hikers surely don't want to get into this mess.

--B.G.--

Alex H
(abhitt) - MLife

Locale: southern appalachians or desert SW
Re: Ibuprofen risk on 12/11/2012 06:02:24 MST Print View

In this related article from a few years ago it basically says what Rex discovered as to it not letting the body actually rebuild itself. I now only take it when I actually hurt.

http://well.blogs.nytimes.com/2009/09/01/phys-ed-does-ibuprofen-help-or-hurt-during-exercise/

Hiking Malto
(gg-man) - F
Advil and training on 12/11/2012 08:26:12 MST Print View

I have taken way more advil then I probably should especially during my thru hike. On my thru it was the only thing that made the pain in my feet bearable, and it in a similiar situation I would likely do it again. I don't take any Advil during normal routine training. If you need to take it to train it likely means your body needs a rest. The times that I still take it is late into a long mile day generally if I know I have to make it a certain distance by days end. I no longer take in just to get miles, again it means that I'm pushing myself harder than I should. I also will take a single dose if I feel inflammation in my feet or ankles at the end of a long hike. I view this as preventive and since the frequency is less than once a week I'm not too concerned with it.

I am not a bit surprised at the high percentage of serious runners that take Vitamin I daily. Excersise for many of these folks, and me included can be an addiction, though generally a healthier addiction than most. If popping a couple of pills allows us to get their fix then so be it. Hopefully I will avoid doing it again.

Eugene Smith
(Eugeneius) - MLife

Locale: Nuevo Mexico
Re: Ibuprofen risk on 12/11/2012 09:27:52 MST Print View

I'm surprised by the survey figures. 70%!?

That seems steep. Who knew so many people treated ibuprofen like a maintenance drug.

A few years ago I habitually took ibuprofen to bring down the pain from an ongoing IT band injury. It was in desperation and impatience to get back to running that I resorted to NSAID for pain management. Eventually, the ibuprofen didn't help much with the pain, nor the inflammation, even popping 800-1000mg at a time to get through a short run. It was all very stupid and dangerous. I eventually resorted to cross training, rest, and time, which helped me get back to running when my body was ready.

So many recreational endurance participants treat themselves like elite athletes, biting off more than they can chew, taking on too large of a training volume too quickly, and their unaccustomed bodies take a beating. Ibuprofen as a training tool is just foolish.

Sarah Kirkconnell
(sarbar) - F

Locale: In the shadow of Mt. Rainier
Re: Ibuprofen risk on 12/11/2012 15:50:14 MST Print View

I rarely, rarely take painkillers. Of any kind.

Partially why is for 4+ years I was on blood pressure meds that were not compatible with Ibuprofen (how many people go the gov'ts website and actually read up on what meds to not mix??) So I got used to sucking it up. And I found that most pains were better once I got moving - or if a migraine, rest.

Being sore is something I can deal with - I developed carpal in BOTH hands in my last 2 months of pregnancy last winter, with my 3rd son. My hands/arms hurt nearly every day still. You get used to it. I work out through that pain and do get very sore...but again, I know the soreness of working out fades quickly.

Then again....I have delivered 2 sunny side up babies so I know what true pain feels like. Nothing and nothing will block that pain. Muscle soreness from walking or running too many miles is like nothing compared to a 10.5 lb baby!! Really. I cannot think of ANY outdoor activity that even came close to that in my life. Even a 30 mile day would be easy compared to that.

Marc Eldridge
(meld) - MLife

Locale: The here and now.
Re: "Ibuprofen risk" on 12/11/2012 16:38:29 MST Print View

I did hard physical labor for quite a few years of my life. Sore muscles were just part of the game and I never took anything for it. It really didn't hurt that bad and after you went back at it the next day the soreness went away. Soreness in the muscles was one thing but the aches I developed in the joints, particularly the knees, as I got older was another. The orthopedic surgeon suggested some options one of which was 600 mg ibuprophen 3 times a day. I started this as a regimen and was amazed how at first it almost completely took away the pain. I did this for quite a few years usually only taking it 2 times a day. I kept hearing about gastric distress as part of taking it and after some more years decided I would only take it at need when I was actually doing something physically demanding. This is how I use it now and I feel the benefit outweighs the risk at this point. As an aside, at the same time I started the Ibuprophen I started glucosamine/chrondroitin which I have been taking continuously and feel it helps.

Edited by meld on 12/11/2012 17:02:57 MST.

Mike M
(mtwarden) - MLife

Locale: Montana
Re: Re: Ibuprofen risk on 12/11/2012 16:41:57 MST Print View

I very infrequently take ibuprofen, the study they did w/ some of the Western States runners was convincing enough that it wasn't worth taking as a preventive measure, I will take some occasionally if I'm really (really) sore from a long run

it's a staple in my first aid kit, but they don't get used much

Franco Darioli
(Franco) - M

Locale: Melbourne
Ibuprofen risk on 12/11/2012 16:50:19 MST Print View

"how many people go the gov'ts website and actually read up on what meds to not mix??

Doctors are having problems with patients not disclosing they are taking herbal medicine.
A popular fallacy is that because herbs are "natural" they can't hurt...
well...they can

Sarah Kirkconnell
(sarbar) - F

Locale: In the shadow of Mt. Rainier
Re: Ibuprofen risk on 12/11/2012 18:59:17 MST Print View

Yep on that Franco.....

I love that my Doctor is part of a large system and everything is online - so no matter who I see, they see what I take. And every visit I am given a print out of my meds (prescription and other) to go over and update. They actually ask about pain killers as well!

jeffrey armbruster
(book) - M

Locale: Northern California
"Ibuprofen risk" and arthritis pain on 12/11/2012 18:59:38 MST Print View

I used Ibuprofen for what I now realize is arthritis pain. Geeze, I can deal with muscle soreness. Arthritis pain in my left ankle and right knee is what I was hoping to treat and alleviate. So I've finally tried acetomophin, the over-the-counter arthritis drug. It seems to work. Now I'll wait to hear about the side-effects of acetomophin!

And yes, I'm doing exercises to strengthen those areas of my body, and indeed they've helped a lot!

Actually, there are certain drugs with millions of users over decades of use--the statins come to mind, which treat cholestoral--that don't have red flags all over the place telling you to stop. Sometimes pharmaceutical drugs can be safe and beneficial.

Maybe the problem is that the pharmaceutical industry and it's often disgusting and profit-driven practices has so lost the trust of the general population that even long-standing products seem suspect. We hate and distrust the industry as a whole because we so often see that they effect great harm to people without any compunction if it means that they turn a profit. We know that they're gouging us; how can they have our well-being in mind?

Sorry for the drift.

obx hiker
(obxcola) - MLife

Locale: Outer Banks of North Carolina
Altitude, ibuprophen and digestion. on 12/12/2012 12:24:57 MST Print View

My most persistent symptom of "altitude adjustment" is a pronounced lack of appetite. I couldn't help but notice this paragraph from the NY Times article linked by Tom K.

"Physiologically, it makes sense that exercise would affect the intestines as it does, because, during prolonged exertion, digestion becomes a luxury, said Dr. Kim van Wijck, currently a surgical resident at Orbis Medical Center in the Netherlands, who led the small study. So the blood that normally would flow to the small intestine is instead diverted to laboring muscles. Starved of blood, some of the cells lining the intestines are traumatized and start to leak."

This part was intriguing: So the blood that normally would flow to the small intestine is instead diverted to laboring muscles. Starved of blood,

And might that be compounded by the effect of altitude on the transport of oxygen by the bloodstream...... exaggerating the effect....... with the blood "diverted to laboring muscles" lacking in oxygen?

Might be a good idea to forego the vitamin-I as a prophylactic against altitude adjustment headaches.

Edited by obxcola on 12/12/2012 12:40:23 MST.

Lynn Tramper
(retropump) - F

Locale: The Antipodes of La Coruna
More bad news for ibuprofen on 12/12/2012 13:13:32 MST Print View

Ibuprofen also reduces your ability to repair and make new cartilage. So people who are advised to take it for osteo-arthritic pain get a two-edged sword. It temporarily makes the pain more bearable, but longer term can make the disease worsen. Some of the newer COX2 inhibitors are less likely to have this effect, so I would suggest those needing pain relief for arthritis consider swapping to one of these.

jeffrey armbruster
(book) - M

Locale: Northern California
"Ibuprofen risk" on 12/12/2012 13:36:37 MST Print View

Thanks Lynn I'll look into the cox2 inhibitors. AND into the whole prophylactic use thing. I've heard contradictory things about this concerning ibuprofen.

Roger Caffin
(rcaffin) - BPL Staff - MLife

Locale: Wollemi & Kosciusko NPs, Europe
Re: "Ibuprofen risk" and arthritis pain on 12/12/2012 14:34:58 MST Print View

> We know that they're gouging us; how can they have our well-being in mind?
It puzzles me that you should ever imagine that they have any other objective than making a profit for the executives and their shareholders. That is what the law requires.

HOW they make that profit - that varies from industry to industry. Some make drugs, some make weapons, some make cigarettes, some ...

Cheers

Tom Kirchner
(ouzel) - MLife

Locale: Pacific Northwest/Sierra
Re: "Ibuprofen risk" on 12/12/2012 16:56:37 MST Print View

"Thanks Lynn I'll look into the cox2 inhibitors. AND into the whole prophylactic use thing."

I'd avise approaching COX2 inhibitors very carefully, Jeffrey. Celebrex, the most popular one now comes with a "black box" warning, due to troubling indications of sudden death from heart failure as well as its potential for serious GI bleeding. I was on Celebrex for 8 years, and finally got off it as the data started coming in and my stomach started reacting. It is also very expensive. That said, it is very effective as a pain killer and anti inflammatory. At the very least, have a good heart to heart with your doc.

Jennifer Mitol
(Jenmitol) - M

Locale: In my dreams....
Cox-2 inhibitors and NSAIDs on 12/12/2012 20:22:32 MST Print View

First of all, no NSAID will "interfere" with cartilage healing or worsen osteoarthritis, because cartilage doesn't heal...it has no blood supply and once it is damaged that damage is permanent. We don't even have good ways to surgically repair it yet.

And COX-2 inhibitors burst onto the market a few years ago (Celebrex, etc) with great fanfare because we thought they would not harm the stomach lining (which is COX-1). The newer class of NSAIDs would supposedly block inflammation without harming the proteins that create the lining of your stomach. Unfortunately it didn't work that way...the COX-2 NSAIDs were just as bad for your stomach as the older versions, and seemed to actually have worse cardiac risks.

As for acetaminophen, be VERY careful. Is is NOT a safe drug actually. One of the pharmacists I work with says today it would never be granted over-the-counter status because of its side-effect profile. It is the leading cause of non-alcoholic related liver failure. Watch how much you take and do NOT go over the 2g/day limit. Ever. It can kill you.

And statins?? Of course they have serious side effects, one of which is a very serious condition called myositis. In fact, many of my patients are hospitalized for severe muscle pain reactions to taking them.

There is no such thing as a drug without serious side effects. You can't expect to alter your physiology in one area of your body's ecosystem and not have an effect elsewhere. Sometimes it's not a big deal and you won't notice it...but many, many times you do. Everybody's different...

That will be your medical/physiological/pharmacological lecture for today.

Edited by Jenmitol on 12/12/2012 20:29:21 MST.

Roger Caffin
(rcaffin) - BPL Staff - MLife

Locale: Wollemi & Kosciusko NPs, Europe
Re: Cox-2 inhibitors and NSAIDs on 12/13/2012 02:12:54 MST Print View

> As for acetaminophen, be VERY careful. Is is NOT a safe drug actually.

And don't go around handing out NSAIDs to other people either. Read the fine print on the packet for a basic Aspirin: it is contra-indicated for some people.
Translation: two tablets can kill some people by inducing an allergic reaction which can shut down the air channels to the point of asphyxiation and death.

It happens.

Cheers

John S.
(jshann) - F
Re: Ibuprofen risk on 12/13/2012 04:14:33 MST Print View

Prolotherapy paper about NSAID risk
http://www.journalofprolotherapy.com/pdfs/issue_05/issue_05_10_nsaids.pdf

American College of Rheumatology guidelines
http://www.rheumatology.org/practice/clinical/guidelines/ACR_2012_OA_Guidelines.pdf

Jennifer, what does the PT world think of prolotherapy?

Edited by jshann on 12/13/2012 04:56:51 MST.

John Donewar
(Newton) - MLife

Locale: Southeastern Louisiana
Re: Re: Cox-2 inhibitors and NSAIDs on 12/13/2012 04:53:42 MST Print View

A little pain can be a good thing. All of these OTC and Rx meds have their different side effects. I had never heard of Cox-2 inhibitors before this thread and when I read up on some of the side effects and possible complications I decided to stick with what has worked for me in the past. I have also decided to try and let my body's natural endorphins handle any discomfort as much as possible. I'll save the "meds" for when I really hurt!

Click the link below and then scroll down to the area describing the side effects and complications.

http://www.aws-law.com/cox-2.asp

I expect nothing short of a few good natured jokes about the source of this link.

And now here for your entertainment is a short video clip to illustrate the first line of this post.

http://www.youtube.com/watch?v=g1Bd5DhItKQ

Don't you just love the white socks and the shorty shorts? L O L

Party On,

Newton

Jennifer Mitol
(Jenmitol) - M

Locale: In my dreams....
Prolotherapy on 12/13/2012 07:30:33 MST Print View

What does the PT world think of prolotherapy??

Well, that's a bit of a loaded question with many answers ;)

First of all, there are no good, peer-reviewed (in high-impact journals) randomized controlled trials that show that it is effective. This is why insurance companies won't cover it.

Many people and clinicians swear by it...but so far I have yet to be convinced. Treating tendon pathologies is very difficult, again because of a lack of good blood supply and a rather significant lack of understanding as to what is actually wrong with the tendon itself. We used to like to inject cortisone into them (and unfortunately some clinicians still do that...) thinking that it was "inflamed," which it is not. Numerous biopsies and histological studies have found NO inflammatory cells...the tendons seem to degenerate for some reason.

The idea behind prolotherapy is to actually induce a bit of inflammation into the tendon to kick start a healing process...which in theory is still somewhat iffy because we don't know why the tendon degenerates in the first place. PTs used to use aggressive, painful massage to try to increase blood flow for the same reason, with no demonstrable effects (except for my favorite: I KNOW it works...)

I think there is a lot of work going on to figure out how to deal with tendinopathies and if you can easily afford to pay for prolotherapy, and none of the other treatments (particularly eccentric loading exercises) have helped, then by all means give it a try. Its certainly better than having sie orthopod hack away at your tendons. I'm a little skeptical that the big prolotherapy groups haven't submitted their work to high-impact journals for good peer-review though.

And I have to point out, as a strong evidence-based practitioner, that the placebo effect can be as much as 75%, which only increases if you paid a lot of money for a treatment (just as people think higher priced wines taste better, they think the more they paid for a treatment the better it must be...)

There is a reason randomized controlled trials are the basis for evidence-based medicine. It is very easy to see "your" patients getting better with a treatment, or you had a good result, or your friends did...but until you compare it to good controls you really can't know if it really is more effective than that wonderful placebo.

John S.
(jshann) - F
Re: Prolotherapy on 12/13/2012 09:46:32 MST Print View

That is what I thought, possible snake oil injections ; ). That paper by the prolotherapy "journal" looks all official (and the content may have some truth) but sorta comes across as a commercial since it is not in a mainstream journal. The placebo effect is an amazing thing.

spelt the enigmatic
(spelt) - F

Locale: SW/C PA
Re: Re: Prolotherapy on 12/13/2012 11:45:34 MST Print View

A cortisone injection did greatly improve my carpal tunnel. It is now just a weak hand and not throbbing stabs up and down my arm. Although it's my understanding that the cortisone actually decreases inflammation OF the carpal tunnel and doesn't affect the tendons and nerves running through it. That may be completely not how it works. But at least I won't need surgery for a couple more years (hopefully more).

Jennifer Mitol
(Jenmitol) - M

Locale: In my dreams....
Inflammation and cortisone on 12/13/2012 14:04:59 MST Print View

Cortisone certainly has a role to play in terms of fighting inflammation; it is a very powerful drug with good uses. The issue is directly injecting cortisone into tendons themselves to fight "tendinitis." I actually went to a talk last year titled "can we please stop injecting tendons?"

There is a ton of documented evidence that injecting cortisone into a tendon will rapidly accelerate the tissue degeneration and tissue breakdown. The problem arises in the timeline: the injections generally feel great! The patient thinks they are better, the physician feels like he or she helped the patient, and everyone is happy. Then 6 months later the pain returns, probably worse than before, and the patient is none the wiser. There are several good studies of tennis elbow (lateral epicondylalgia)...one in particular had people get cortisone injections, another group got PT (exercise and manual therapy, NOT crap interventions like ultrasound or electrical stimulation), and a third group did nothing. The cortisone group improved immediately, the other two groups slowly improved. By 6 months the cortisone group was worse than before, and the PT group was only slightly better than the watch and wait group (both of which were quite a bit better). The point being that you are better off in the long run sitting around watching Oprah than getting your tennis elbow injected. The rate of recurrence or even tendon rupture in folks who have tendon cortisone injections is frighteningly high. But it doesn't happen right away...right away you feel like the injection was a miracle!

Anyway, another reason why randomized controlled trials with good follow ups are so important. That's where this type of information comes out.....

Tom Kirchner
(ouzel) - MLife

Locale: Pacific Northwest/Sierra
Re: Prolotherapy on 12/13/2012 17:21:34 MST Print View

"What does the PT world think of prolotherapy??"

While we've got your attention, what do you think of platelet rich plasma therapy?

Jennifer Mitol
(Jenmitol) - M

Locale: In my dreams....
Platelet rich plasma therapy on 12/13/2012 20:50:06 MST Print View

Honestly, my opinion is probably quite similar to the prolotherapy, with the only caveat that at least theoretically there is a bit more oomph behind this one than simply injecting hypertonic saline into a degenerated tendon.

The proposed mechanism here is that you take the body's platelets and inject them into the degenerated tendon, then use the healing properties of the proteins in the blood to spur healing.

There are no good randomized controlled trials, only small cohort studies of patients who self-select (meaning they'd already decided to have the therapy...which means they approach the treatment with a bias).

My personal thought, as both a biomechanist and a pain scientist (my post doctoral work has been in the neurophysiology of pain), is that it isn't going to pan out with further scrutiny...and neither will prolotherapy. My reasoning is that histologically we see the tendon actually becoming disorganized as it degrades: instead of nice, neat parallel fibers that should pull in relatively uniform ways, we have a disorganized glob of tangled collagen that cannot pull effectively, and without triggering an overwhelming pain response. Think of tarp lines and how awful of a pitch you'd get if your guy lines were all tangled up and you tried to pitch anyway.

Simply inducing an inflammatory response, or in the case of platelet- rich plasma therapy actually trying to induce a "healing" response directly, is not going to reorganize those collagen fibers. There is a well-known maxim called Wolff's Law that the body responds to stress by strengthening and reoranizing along the lines of stress. A medical intervention for a mechanical problem doesn't strike me as imminently successful. Surgically you can cut out the degenerated part; mechanically you can induce a noxious eccentric loading to force a reorganization of the collagen (actually rather successful for many people, good RCTs for the knee, Achilles, and lateral epicondylalgia); and from a neurophysiological perspective we are finding some amazing changes in the central nervous system that may affect muscle behavior...which might be why the tendinopathies are happening in the first place. But that's a whole different and way more complicated conversation. But one I love to talk about, by the way. I am a nerd in more ways than my gear closet!

My long, beleaguered point here is that tendinopathies are terribly complicated, we have no really reliable ways to treat it, don't ever allow a clinician to inject cortisone into any TENDON of your body (it can be injected elsewhere...at least for now), caveat emptor in medicine (oh how much ripping off goes on in the doctors - and PT - office!!!!), and there are tons of great research projects going on that will give us more tools in the near future.

I'm guessing several of you have some tendon issues...if you PM me I can send along some descriptions of the eccentric loading protocols for you to try (if you haven't already...) for your particular body part. I'm happy to help...and it costs you nothing but your continued advice on how to lighten my pack ;)

William Segraves
(sbill9000) - F - M
cartilage on 12/16/2012 18:38:50 MST Print View

Lots of great stuff in this thread. One thing about cartilage regeneration - while there's no evidence that the hyaline cartilage that's at many joint surfaces can regenerate, there is evidence that small meniscal tears do seem to heal with appreciable frequency. That leaves open the possibility that drugs could potentially interfere with that healing process.

Mike W
(skopeo) - F

Locale: British Columbia
Ibuprofen risk on 12/17/2012 01:33:43 MST Print View

>> exercise and manual therapy, NOT crap interventions like ultrasound or electrical stimulation <<

Oh, I really smiled at that one :)!

I've long been a believer that if you injure yourself there is no magic to recovery... just hard work. I think the modern age magic in PT (electronic gadgets) have been an easy sell because we are very much a lazy society that doesn't want to exert ourselves to get better (backpackers excluded of course :).

That said, I may take (Ibuprofen, Aleve, Acetaminophen etc.) if I think it will help relieve the pain of my injury while I work out with strengthening and stretching exercises. I like to get back to activity as fast as possible after an injury. If these drugs allow me work out harder and more efficiently while recovering, then I use them but I never take anything for my usual aches and pains (my normal aches and pains remind me I'm alive... and have had some fun times in the past).

I will however mention that much to my surprise, I have recently tried Intramuscular Stimulation (IMS) and have had unbelievable results treating what I call "Fly Fisherman's elbow" (serious fly fisherman will no what I'm talking about, but for others it is a nasty combination of tennis elbow and golfers elbow...repetitive stress injuries). After suffering terribly for 20 years my PT suggested I try IMS. I refused the treatment (don't believe in magic, just hard work), so I continued stretching and strengthening with minor success.

My PT finally convinced me to try IMS and in only a few treatments, I had lost about 80% of the pain! This pain reprieve allowed me to work hard at the gym (strengthening and stretching) and I'm still doing well considering I've just finished another rather intense season of fly fishing. I'll probably go back in the spring for a "tune-up" (IMS) before the next fishing season begins but I'm still in pretty good shape considering how much I abused my arm in the past six months (and no drugs needed for pain and inflammation). I now believe in MAGIC!

Lynn Tramper
(retropump) - F

Locale: The Antipodes of La Coruna
Re: Cox-2 inhibitors and NSAIDs on 01/06/2013 19:15:03 MST Print View

"First of all, no NSAID will "interfere" with cartilage healing or worsen osteoarthritis, because cartilage doesn't heal...it has no blood supply and once it is damaged that damage is permanent. We don't even have good ways to surgically repair it yet."

Maybe my wording was poorly chosen. Ibuprofen causes thinning of joint cartilage, even in people who have no initial cartilage problems but are taking it for other problems. Adding this drug on a chronic basis to joints that are already compromised is even worse. And rather than using the words 'cartilage healing', it is more correct to say cartilage maintenance and turnover. Cartilage CAN heal, though when it does happen, it is a very slow process, but cartilage is normally actively maintained, and Ibuprofen interferes with this maintenance. The COX-2 inhibitors don't seem to have this side effect, so are probably better if you absolutely need an anti-inflammatory for muscle/tendon/joint/bone pain. Agreed, they can all have nasty gastrointestinal side effects, but I assumed everyone knew that by now...? The NSAIDS are also pretty hard on your kidneys. Also agreed that acetominophen is a poor choice, as it is hard on your liver and has no anti-inflammatory properties. It is a pain killer and lowers fever, not a lot more. However, as pointed out all drugs (in fact anything you put in your body, even food) can have side effects. Caveat Emptor...

zorobabel frankenstein
(zorobabel) - F

Locale: SoCal
ibuprofen on 01/21/2013 15:59:47 MST Print View

I started carrying Ibuprofen last year to deal with altitude headaches I sometimes get. I try to stay away from all medication and deal with pain, but for this scenario I though taking Ibuprofen is safer than AMS. I only took one pill so far - in the evening at camp, it helped with the headache, and I got a great nights sleep as a side effect (no more back pain).
I'm trying to change my breathing habbit (more breathing) and it's working. I realized on some of the trips with headaches, I was actually breathing less - it felt like I was expending less energy (just strolling with a lighter pack while waiting for my wife to catch up).
What would be a safer alternative for fighting the brain swell? - beside acclimatization of course.
I ask this more out of curiosity than need, as the Ibuprofen container will most likely expire with 90% of it's content intact.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: ibuprofen on 01/21/2013 16:17:02 MST Print View

First of all, you might consider ordinary aspirin rather than the other drugs.

Secondly, I've seen lots and lots of people at altitude with symptoms. In my opinion, 80% of the problem comes from dehydration. So, you might consider attacking that as a root cause.

Then, think about what you are doing with the pills. Are you merely trying to block the headache pain, or are you trying to alleviate the root cause of the pain? That's why I mentioned aspirin.

You mentioned your breathing. For the average person, when they reach a high elevation, the first two things that adjust are the respiration rate and the heart rate. In some people, perhaps you, the body does not react to the thin air very quickly or very fully, so the respiration and heart do not adjust much. This is what may be creating the problem for you.

If you can't work this out by ordinary means, then you ought to see a physician who knows something about altitude sickness, and they can prescribe Diamox (acetazolamide). Yes, I know that you don't like pills. Diamox works pretty good, assuming that you are not allergic to sulfa drugs. You take it for a day or two before you get to the mountain, and it sort of forces your body to start the adaptation more fully and quicker than it would on its own.

I know a guy who consistently got sick above 11,000 feet, and he had huge headaches and all that. Then he started taking Diamox starting one day before he started up into the mountains, and he has had no symptoms since then.

--B.G.--

Edited by --B.G.-- on 01/21/2013 16:18:37 MST.

Tom Kirchner
(ouzel) - MLife

Locale: Pacific Northwest/Sierra
Re: ibuprofen on 01/21/2013 17:41:06 MST Print View

"What would be a safer alternative for fighting the brain swell? - beside acclimatization of course."

Diamox

Lynn Tramper
(retropump) - F

Locale: The Antipodes of La Coruna
Re: ibuprofen on 01/21/2013 17:47:40 MST Print View

Bob's recommendation is worth a try. But I think that the few times you will likely need to use an NSAID, if it works for you then fine. Occasional use is not going to do you any harm. It is not yet clear that aspirin (also an NSAID) is any less detrimental to cartilage than the likes of Ibuprofen. The jury is still out on aspirin, but it is a very good anti-inflammatory as long as your stomach tolerates it.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Diamox on 01/21/2013 18:02:24 MST Print View

I wouldn't put it as the Diamox fights swelling in the brain. Diamox is carbonic anhydrase inhibitor. Say that fast three times. What that means is that it makes some subtle changes in your blood chemistry, and it causes the body to start the altitude adaptation earlier, or more fully. So, it isn't really doing much that your body couldn't do on its own... assuming that your body had a normal response to altitude. But, some percentage of people have this "blunted response," so they take Diamox to speed things up.

1. Assuming that you are not allergic to sulfa drugs, it can't hurt much to take Diamox. Although the standard dosage is standard for moderate elevation travel, some people I know take a half dose and find that it works for them. I also know a guy who takes several times more than the standard dose, and he claims that it works even better for him. The problem is that the bigger the dosage, the more likely that you will have more side effects.
2. What are the side effects? For most people, you get a bit of tingling in the fingers and toes, and that can be mistaken for frostbite if you aren't paying attention. Also, it ruins the taste of carbonated beverages, since the carbonation comes from carbonic acid, and this is a carbonic anhydrase inhibitor. So, you have to hold off that beer celebration for a couple of days after your trip so that the drug washes out of your bloodstream first.

--B.G.--

Tom Kirchner
(ouzel) - MLife

Locale: Pacific Northwest/Sierra
Re: Re: Diamox on 01/21/2013 18:14:42 MST Print View

"I wouldn't put it as the Diamox fights swelling in the brain."

It is a diuretic, and has everything to do with preventing swelling in the brain, which is caused by a build up of fluid.


http://www.medicinenet.com/acetazolamide-oral/article.htm

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Re: Re: Diamox on 01/21/2013 18:40:24 MST Print View

This always seems like a contradiction to some users. They hear one person claim that dehydration causes 80% of the high altitude symptoms. Then they hear another claim that a diuretic flushes excess fluid out of your system. Those seem contradictory on the surface.

Somebody might claim that they will intentionally dehydrate themselves in order to minimize the chance of any edema anywhere. Well, it just is not that simple and I can almost guarantee that'll get poor results.

Diamox changes your body's "set point" for where the water balance should be. Then, you can continue to drink lots (as you should for a dry environment), but your body has a different balance on when to discard the excess fluid.

--B.G.--

Jennifer Mitol
(Jenmitol) - M

Locale: In my dreams....
Diuretics and altitude on 01/22/2013 21:49:06 MST Print View

The reason your brain swells (cerebral edema), or your lungs fill with fluid (pulmonary edema), and you get dehydrated at altitude is that the water in your system is maintained by pressure gradients: as the air pressure at altitude decreases, the pressure inside your blood and organs is now out of balance with the environment and the fluid begins to seep into other spaces...your brain, your lungs, your face, your hands...any tissues that are lower on the pressure gradient (which is basically everything outside your blood vessels).

The reason you are dehydrated is that the fluid is seeping into spaces that cannot use it, thus you do not have enough available water to maintain blood volume.

Now, you take a diuretic in order to flush all that extra fluid from your body...because once it seeps into the interstitial spaces it does no good, or just can harm you if it seeps into your lungs or brain. But, even though you are taking a diuretic you still need to continue to drink lots of water in order to maintain as much fluid in the blood as possible. Sort of like pouring water into a leaking bucket...but you've got to just keep pouring....

Interestingly, since ibuprofen was mentioned again, a great study just came out last year that showed regular prophylactic doses of ibuprofen taken just prior to ascending, then continuously while at altitude, had the same effect on reducing altitude sickness as the group that took Diamox. The regimen studied is 600mg every 6 hours starting one day prior to ascending, then continuously while at altitude.

Interesting, eh?

zorobabel frankenstein
(zorobabel) - F

Locale: SoCal
Diamox on 01/23/2013 01:59:18 MST Print View

Thanks Bob, Tom, Lynn and Jennifer. It's all clear as mud now :). Really, I think I get it, thanks!

Fortunately I don't consistently get a headache at altitude; I also never had to change a trip because of altitude sickness.
Bob, you're probably right, dehydration surely is a factor in headaches for me, altitude or not, especially if I'm not wearing a hat while exposed to the sun. Sleeping 2-4 hours and driving another 5 hours mostly in the dark before a trip surely doesn't help...

The reason I was considering Ibuprofen was not for blocking the headache, but for its anti-inflammatory properties. I was reading that persons affected by HACE are not usually aware of the symptoms, and was thinking it's safer to prevent HACE than sustain injury, if I suspect myself of HACE. Unfortunately taking Diamox has to start a few days before the trip it seems... not the quick fix I was looking for.
I had no idea aspirin had anti-inflammatory properties (like I said, I'm not a pill fan), thanks for opening my eyes!
Jennifer, about the leaking bucket... would one make things worse if drinking a lot of water without a diuretic?

HK Newman
(hknewman) - MLife

Locale: Western US
Re: Ibuprofen risk on 01/23/2013 08:38:40 MST Print View

Never have taken it unless prescribed but with the muscle/cartilage problems written about, I'll go with the pain and try to remember to stretch it out properly.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Diamox on 01/23/2013 13:56:52 MST Print View

People who are completely healthy and go to high elevation without any symptoms can drink a lot of water without a problem, and it just keeps the kidneys working. People who are taking high doses of Tylenol and things like that need to drink a lot of water to avoid a kidney problem. They rest of us just drink as much as we need, and experience has taught us about how much that is. If I don't urinate at least twice per day, then I am probably dehydrated.

I understand that you report headaches, but it might be from the simpler forms of altitude illness. Full-blown HACE is kind of uncommon except at very high elevation (like 18,000 feet and above). The only person that I saw with HACE symptoms had been to nearly 23,000 feet. However, just last summer one friend got sick around 10,000 feet, and it was thought to be some combination of HAPE and HACE, or at least the symptoms were a combination.

Yes, if you do take Diamox, you need to start it a day or two before you start going high. Exactly what elevation that is will vary from person to person. A bunch of us were going up very high (nearly 23,000 feet), so we started a half-dose of Diamox the day before we started from a 9000 foot trailhead. Then we went to a full dose when we went above 14,000 feet.

Last year when I was descending from a 14,000 foot peak, I saw a large military group starting up from 12,000 feet. Apparently some were taking Diamox, some were taking some new secret drug, and probably some were taking a placebo. I would love to see the results from that test. The military people were headed to Afghanistan.

--B.G.--

Jennifer Mitol
(Jenmitol) - M

Locale: In my dreams....
You really can start Diamox anytime on 01/24/2013 14:44:47 MST Print View

Ideally you take it before you are symptomatic, but you honestly don't have to. You can start Diamox after onset of symptoms...the only time I ever took it was during a trek to the Everest base camp. I started getting loopy at about 12,000 and started then...my friend started at 16,000'. We were both fine...the symptoms went away.

Yes, if you are healthy just keep drinking...your kidneys will do the diuresis for you. But if you see how puffy your face gets at altitude, or your hands...it's a great visual to see what is happening to your tissues when the ambient pressure goes down.

The point of taking a diuretic such as Diamox is to quickly rid your brain and lungs of excess fluid that can lead to HACE and HAPE. Otherwise your body should be able to keep up with everything...when it can't, THAT'S altitude sickness.

Tom Kirchner
(ouzel) - MLife

Locale: Pacific Northwest/Sierra
Re: You really can start Diamox anytime on 01/24/2013 14:50:42 MST Print View

"The point of taking a diuretic such as Diamox is to quickly rid your brain and lungs of excess fluid that can lead to HACE and HAPE. Otherwise your body should be able to keep up with everything...when it can't, THAT'S altitude sickness."

This post and your original post on Diamox provide the best explanation yet of what causes AMS/HACE/HAPE.

Thanks for posting, Jennifer.