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.