Dr. J on Running
My Third Kidney Stone10 December 2014
Two weeks before my 50th marathon, I noticed blood in the urine at mile 8 of a treadmill long run. I stopped running, and my urine cleared up half-an-hour later. Two days later, I noticed blood in the urine at mile 4 of an outdoor run in Albuquerque, so I called off the run. Alas, my urine remained bloody all day. As I prepared to board a flight to LAX, I spoke to Gina, the nurse of my internist who recommended a visit to urgent care.
I spent Monday night at an urgent care facility near LAX. Based on urinalysis, the attending physician diagnosed me with a urinary tract infection, and prescribed 10 days of Cipro. My right kidney felt tender, but he ruled out a kidney stone because I did not appear in enough pain. My urine cleared up and my kidney pain eased within hours of the first Cipro pill, so I drove north to Edwards.
The morning after, I pulled a left groin muscle getting out of the car. The pain was extreme, and walking became very difficult. A couple of hours later, I developed acute left shin splint and left ankle pain. That is when I noticed a black box warning on the bottle of Cipro that its rare side effects included muscle tear, spontaneous tendon rupture and connective tissue damage. A call to my internist brought no relief or peace of mind – he directed me to stay on Cipro to clear the infection. I stopped immediately all physical activity, and prayed that weaning off Cipro two days before my marathon will allow me to finish my 50th state without rupturing an Achilles tendon.
I visited my urologist upon my return to Syracuse. We attended the same undergraduate university at different times – he graduated the year I was born. He conducted another urinalysis, ordered a PSA test, and scheduled me for a contrast CT scan and a cystoscopy for 22 December. My PSA test result was 2.2, my lowest in 3 years and an affirmation of the Paleo diet and frequent marathon running.
With all symptoms gone, I stopped Cipro Wednesday morning after taking 16 pills. I spent the day sitting in a strategy meeting, and felt a gradually worsening discomfort in my right kidney. A massive snowstorm pummeled the region. I returned safely home early afternoon, and hunkered down as my kidney pain fluctuated. At 10pm, the peak pain approached 8, so Marla drove me to the Upstate ER. Four hours later and a liter of IV solution and painkillers, a CT scan showed a 4mm stone lodged in the ureteropelvic junction (UPJ). We left the ER at 3am with a strainer and prescriptions for Vicodin, Ibuprofen and Flomax.
After passing two kidney stones seven years apart, a 2009 CT scan showed a 5mm stone in my right kidney. Circumstances suggest that the 8-mile treadmill run dislodged that stone into the ureter, which might explain the hematuria and the pain. The 600mg Ibuprofen prescription aimed to reduce the inflammation and the pain; the Vicodin is a heavy-duty narcotic painkiller; and Flomax seeks to relax the ureter, prostate and bladder to facilitate passing the stone.
With my flights to Texas 24 hours away at the height of the pain in the ER, Marla and I concluded that a Texas marathon was highly unlikely in three days. I logged onto Delta and clicked on Cancel Flights, but selected No when asked if I was sure I wanted to cancel the flights. Convinced that the devil and the evil eye conspired to prevent me from running my 50th state, I became militantly determined to defeat them and summoned my spiritual strength to resist the temptation to succumb.
I spent Thursday morning doctor-shopping for someone to permit me to travel to Texas and run a marathon with a kidney stuck in my UPJ. Unlike the stern disapproval from my internist, my urologist the marathoner called me back with sound advice – I am not going to tell you not to run the marathon. Stay hydrated, keep up with your electrolytes, and come see me when you return. Game on!
Dr Kamal Jabbour traveled to Texas with a 30-day supply of drugs. Dr. J's RUNNING Column appears in Cyberspace whenever endorphins call.