Update (or why not to consume NSAIDs like candy)

In my last post (in September of 2017) I wrote that I hoped to get through a year uninjured for once and maybe back to regular training. Well… not quite mission accomplished there.

I was a bit reluctant to write this update for a variety of reasons. Mostly, I’d hate for this blog to turn into just a chronicle of my health woes. Also, I am more than a little cringey about talking about some of them. Partially, because of stigma but mostly because I don’t want to make it seem like I am glorying or wallowing in this. Nonetheless, because it may help someone out there I will write a bit about my recent experiences. If you just want to skip to the potentially helpful part, read the last paragraph.

In the past 12 months, I’ve had three surgeries. The ankle tendon repair at the end of August last year, a shoulder surgery in May and most recently, a partial nephrectomy.

The shoulder surgery was simple and successful. Fraying labrum cleaned up, AC joint arthritis cleaned out and bone spur removed. I can now put on t-shirts again without wincing in pain. Can’t lie on that side yet but almost there.

Immediately prior to that surgery, my ortho wanted me to get my spine checked out. I’d had some weird neurological symptoms for about two years that had been getting more frequent. I’d been having spasms and involuntary movements mostly in my left arm. Some of them were just minor twitches, some were painful involuntary contractions that left me sore afterwards. I mentioned them to my ortho at my pre-surgery appointment in hopes that he might tie them to the shoulder issue. He said no chance of it being shoulder but worked to get me in to see a spine specialist in the same practice. The spine doc didn’t think it was likely the spine either but nonetheless wanted me to get a stat cervical and thoracic spine MRI prior to the surgery just to make sure there wasn’t some problem that could be made worse by the positioning during the shoulder surgery. All of this happened fast – saw the shoulder doc on Thursday, saw the spine doc on Friday, got the MRI Saturday morning.

The day before the shoulder surgery (and the Monday after the MRI), I went back to the spine doc to discuss what they saw. “I have good news and bad news” he said. The good was spine was great, the bad was they saw a mass on my kidney in the MRI.

I got the all clear for the shoulder surgery, so proceeded with that and about a week later began a series of additional MRI’s. Both of these were with contrast (big needle, not awesome). A brain MRI (to see if the weird spasms had a visible cause there) and an abdominal MRI to take a closer look at the kidney mass. Brain MRI was clear, kidney still had mass and it was identified as a Bosniak 3 mass. This means it was indeterminate – they couldn’t say for sure whether it was just a benign cyst or cancer but the chances were a bit better than average that it was malignant (55-60%). Bosniak 1 and 2’s are mostly just followed or ignored, 4’s are usually malignant and always removed. Bosniak 3’s, because of the relatively high risk of malignancy are also almost always removed and I was recommended for surgery.

After a long delay to let my shoulder heal (I would need to be on that side for several hours for the surgery), I had a robotic, laparoscopic, partial nephrectomy at the beginning of August. I woke up in recovery high on opiates (initially fentanyl and later morphine) and with 6 holes in my side. 5 of the holes had metal staples, one had a drain tube coming out of it. Also two IVs (one just for backup) and a catheter which was lovely. All but one of the scars are small (an inch or so) except the one that they cut to remove the tumor and 20% of my right kidney (that scar is about 3 or 4 inches long). Spent two days in the hospital before finally getting all the tubes removed and being sent home with a prescription for Percocet.

Pathology report came a week later. My doctor called and left a message with the results (which was itself a bit of a let down, I always thought I’d get the sit down in the office where they break the bad news). Clear Cell Renal Cell Carcinoma of the cystic variety. Basically I had a cluster of bubbles (about 4cm across) growing on the top (ie upper pole) of my kidney. Inside the bubbles was blood and fluid, the tissue that made up the “skin” of the bubbles was cancerous.

The good news was that there was no evidence of it elsewhere (margins in the kidney tissue they removed were all clean).  The even better news is that the type of cancer I got is a rare type (accounting for ~1-2% of all kidney cancers) that tends not to metastasize and rarely comes back. 5 year survival is 100%, 10 year surivival is 97%.  Recurrence rate at 25 years is only 13%. Basically like winning the jackpot in the world of kidney cancer. So essentially, unless I am unlucky (or the pathologist fucked up), I am likely cured of cancer with the surgery. My only reminders will be a few scars and some yearly scans just to make sure nothing else is around for the next few years.

Bad news is no lifting more than a few pounds for 6 weeks post-op (4 weeks to go), so despite my shoulder feeling ready, I can’t touch a barbell yet. But after that I should be able to start slowly lifting again (though still unlikely to ever compete again). I will be more likely to tire and get exhausted for the next couple of months as my body repairs itself (walking a block results in needing a nap right now). I still have some pain but, in general, getting back to normal.

The one lesson in all of this is that, regrettably, the kidney cancer could have been related to weightlifting and more specifically my frequent injuries and the pain relief used to mitigate them. There is no way to ever prove it on an individual case, but there is a lot of evidence that regularly taking NSAIDs increases the risk of kidney cancer (also here and here). There are numerous studies (and some big meta-analysis) that show this, and some (but not all) that also show a risk with acetaminophen as well. This is particularly true in men and older populations. “Regularly” is defined as taking the drug two or more days a week. From December 2016 to June 2018 I probably averaged 5 or more days a week with one or more doses of NSAIDS. Frequently 7 days a week. These ranged from regular ibuprofen PM to get to sleep with the shoulder pain, to prescriptions from my orthos for large doses of naproxen, etodolac (Lodine) and meloxicam (Mobic). These prescriptions more or less worked and kept me functional when the constant pain would’ve left me drained and depressed otherwise. But the price I may be paying now is not at all worth it. Again, I don’t know and never will know whether taking those drugs was causative and the studies themselves are not conclusive (they are epidemiological studies so by very nature, cannot be entirely conclusive). I could just have been unlucky and honestly I have some of the other risk factors for kidney cancer (obese with high BP). However, I do know I will never be taking NSAIDs again. I’ve already lost 10% of my overall kidney function, I don’t need to risk anymore loss and I am not at all eager to go through abdominal surgery again to remove another mass if it comes back (abdominal surgery sucks majorly). So, despite the fact that I am still getting some stabby pain from the surgery (not surprising really as I was essentially stabbed repeatedly by a robot), I am now limiting myself to just aspirin. Not going to tell you to throw out that bottle of Aleve, but you might want to think about some of the potential consequences if you are using like I was.

Giving Up?

Yes, I may be giving up. I appreciate all the continued visits here as I’ve let the site languish over the last year. I started this in late 2014 while recovering from hip labrum repair and FAI surgery not realizing that recovering from one thing or another was going to be pretty much a constant state for me for the next several years.

I competed in my first weightlifting meet in 2013 and got my first injury driving me to see an orthopaedist on December 24th of that same year. That first one was a minor quad tear that resolved with some PT and rest in early 2014. I went on to compete in another several meets that year until I began to fall apart again after the hip labrum tear in September. The labrum tear was ultimately operated on in December of 2014. After about 6 months I managed to get my strength back and begin competing and making PRs again. Then in December of 2015 I again had a minor tear, this time rotator cuff. After ignoring it and training around it for a couple of months, again went to ortho and got prescribed PT and a cortisone shot into the joint. I managed to keep going into early 2016 with some shoulder improvement and was able to return to heavy lifting.

Then in April of 2016, after a period of hard training, I went down with a bad case of pneumonia in both lungs.  I had a hell of a time recovering from this and went down repeatedly with further upper respiratory infections (strep, bronchitis twice, sinus) up until a final 30 day dose of antibiotics at the end of the year got me back to normal. So nearly 8 months of very sporadic training as I recovered.

In 2017, I finally managed to get back to regular training and competed in a meet in February to get back on the horse so to speak. The following Monday I began a new training program focusing on fixing my jerk (which has always been my worse lift). Early in my first session of this new program, I managed to drop a 10kg plate on my ankle causing me to cuss loudly in the nearly empty gym. It left a deep painful bruise but I ignored it and kept training (and made progress) for several more weeks. About 2 months later I realized my ankle still hurt and seemed to be getting worse, especially with any extended walking, driving or squatting. I went to a nearby ankle specialist and was diagnosed tentatively with an ankle stress fracture and given a boot and instructions to stay off of it as much as possible.  Four weeks of the boot, some custom shoe inserts and some PT and things just seemed to be getting worse. Went back to my ortho for yet another MRI and found out the stress fracture diagnosis was wrong. Instead I had a partially torn posterior tibial tendon with a recommendation for surgery to repair (as I’d already not been helped by immobilization, rest and PT).

I am now nearly 3 weeks post surgery. My stitches came out last week so I got to see the 7 inch scar on my foot and up my calf. It was truly horrifying. I have pictures but I won’t inflict them on you. You really don’t want to see it. My surgeon said my tendon was in even worse shape than he thought with a long ragged longitudinal tear from the insertion point to around my medial malleolus (ie the knobby inside ankle bone that I dropped the plate on 7 months ago) in addition to tons of scar tissue. He scraped the tendon clean of scar tissue, stitched up the tears and transferred a tendon that normally helps one flex their toes over to support the PT tendon (and anchored it in bone). I have another 3 weeks of no weight bearing in a partial cast, so crutches or knee scooter to get around and no driving. After that I will have another few weeks in a boot and will be in PT once again. The far worse news is that the recovery from this surgery will go on for months more after I am able to walk freely again. I’m likely to be limping for 3-4 months and will not be able to go on any extended hikes until the 6 month mark. It’ll be 9-12 months before I will be able to support any heavy barbells on my shoulders or overhead again.

So in five years of weightlifting, I’ve had two surgeries to repair tears,  two other minor tears that didn’t require surgery and a nearly 8 month period of my immune system letting me down and hitting me with repeated serious infections. Are all of these attributable to weightlifting? Probably, in one way or another that’s a yes. I can’t really deny that my body does not seem to handle the stress of training well. Hard training inevitably seems to lead me to injury and illness (I rarely got sick prior). Probably this is due to genetic factors (genotyping I’ve done seems to indicate susceptibility to inflammation and injury) in addition to 44 years of relative inactivity before I threw myself into weightlifting.

So am I giving up? Maybe. I know my wife and daughter would murder me if I went back to training next year and end up getting injured again. I’m hopeful there are some modifications to my training approach that can help prevent that. I believe that I will continue lifting, but really not sure that I will continue training seriously for Olympic weightlifting meets or even do another clean & jerk. I’d much rather spend a year uninjured and not sick at this point.

I suspect I will focus on losing fat and regaining function for much of the next year and not worry about making PRs. Losing fat because I gained weight (to go up a weight class) in 2015 have not been able to shed it again. This most likely did not help my ankle when it started going down hill. Maybe after I’m back and more healthy I will resume training snatches and clean & jerks but I really don’t know. If I do, it will likely just be one or two days a week and light.

I will periodically update this site as I progress through my latest recovery and I will keep up the twitter feed  covering masters news but will kill the Fb page. I’m likely to continue to stay away from more interviews and general weightlifting posts for now. I honestly have a hard time posting on weightlifting when unable to do it – selfish I know but it feels a bit like torture to think about weightlifting when I am so far from being able to do it again (if ever).

Yes, still here. Sorry, big project (at job that pays bills) and a torn rotator cuff (minor, no surgery luckily) have had me stepping back a bit from weightlifting and the site temporarily. Be back with more soon. Lots of stuff happening for masters this year and next that looks interesting (American Open series, World Games, etc.)…