Medication as cause of chronic pain; antibiotics and exercise (some words on side effects)

Posted on June 30, 2014

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It’s no secret America is becoming more and more a pill popping nation. I recently had a good laugh about this when talking with a remote client from Hungary and voicing my recommendations about ibuprofen. He replied, “Oh no, that’s ok. Unlike Americans we can take a little pain here and there without resorting to pills.” Further evidence how ridiculous America is with this stuff.

One of the big revelations for me as a trainer is how many people are taking pills. I’m at the point I assume a person is taking something. Furthermore, Americans have become so relaxed with using drugs. I don’t mean legalizing marijuana, and I don’t mean someone getting high every now and then.  It’s more like, “I stubbed my toe, let me pop a percocet.” “Oh man, I’m sniffly today. Z-Pak? Don’t mind if I do.” Overall, I’m talking heavier, need a prescription like drugs, typically with chronic use. Where I regularly encounter people thinking, “Yeah, it’s no big deal. I take X, Y and Z every day, and pop A, B, C pretty often too.”

An example- This is the list of drugs one client gave me:

  • Glyburide
  • Amlodipine Besilate
  • Lantis
  • Benaziprine
  • Actos
  • HCTZ
  • Furosemide

This person was also taking about 15 other over the counter pills on a “pretty regular basis.”

When I first started working with people I assumed they would make a point to tell me if they were on any medication (supplements too). I quickly learned I always need to ask, often repeatedly, to insure I know what someone is taking, when they change what they’re taking, when they start something new. I used to think only people over 80, or those with cancer, took a cocktail of pills everyday. Not true.

Let’s not forget who writes the prescriptions either,

Doctor “How have you been doing?”

Patient “Well,”

Doctor “Here’s some Xanax.”

A lot of attention has geared around pain killers, as it should be. The things are addictive as hell and kill quite a few people every year. What I want to talk about is not pain killers, but with all the pills people are popping, how sometimes they are actually causing pain and other issues.

Too many side effects to keep track of

As anyone who’s had a prescription in recent memory can attest to, reading the list of side effects of any drug has become comical. The lists basically go on forever, range from “hairy tongue” to “violent seizures,” and are never all encompassing.

I don’t care how good of a memory you have, or how long doctors go to med school for, no person can remember all the side effects of all the drugs they give. Hell, often we’re still in the process of discovering the side effects! Many doctors seem to know the big ones to look for, but I’ve handled enough people on enough pills to know things slip through the cracks fairly routinely. I don’t fault doctors for this, it’s that complex.

The point of this is to remind myself, people who regularly handle patients / clients, and patients / clients to think about the medication they’re taking.

I had a guy who was on Crestor. For about six months he would tell me of chronic muscle aches he was having, particularly at his left leg and back. This guy happened to have a history of a low back surgery and a left hip replacement. We worked on these areas, but there was really no pattern to how he was feeling or when he had pain. He actually exercised very well. He would often have pain just laying around, for seemingly no reason.

Eventually, the discomfort gets so bad he pleads with his doctor to try something new medication wise. Off Crestor was the first move. Practically overnight all these issues disappear. What seemed like lingering issues from a hip replacement and back surgery were really being caused by the medication.

Why did it take so long to go off the medication? I’m not sure. He had been to his doctor regularly, and was on this medication for years. Maybe the doctor missed it? Honestly, I didn’t think of Crestor as a potential factor. This guy is pushing 70, has had multiple surgeries, had a good amount of weight to lose, someone I only see about an hour a week, basically there are a lot of other things going on. Of course, one of the side effects of Crestor is muscle pains and aches. Myself, the client, and the doctor all should have thought of this sooner, right?

For myself, yes. I was naive in thinking a cholesterol drug wouldn’t have a pain affect. That said, this guy’s muscle aches weren’t my first priority either. Making sure he didn’t acquire diabetes or heart disease was.

The doctor, I’m not as sure they didn’t look at the medication. As I mentioned, the guy had a good amount of weight to lose. The risk of going off Crestor may have been too great in the doctor’s mind. It may have only been until the pain got so bad, and the guy lost some weight, which he had, that the doctor was comfortable trying this.

Or, the doctor missed this. Which makes you think there’s a possibility this guy had a left hip replacement and lower back surgery because he was on a medication that, for some unknown reason, gave him more pain at these sites. This is a scary, yet plausible, reality.

First point: Always check the side effects of what a client is taking, and routinely ask them about their medication. I’ve had too many clients change medication without telling me. Over the years I’ve learned to regularly ask, especially when something seems off. By “off” I’ve come across:

  • The person is achey
  • They’re chronically fatigued
  • They get dizzy more easily
  • Personality is different -irritable, depressed, not as talkative.
  • Person is “foggy”
  • They’re having memory issues. They forget exercises or the order of things.
  • Person has trouble with exercises involving balance
  • There’s no pattern to how they feel

Even if it’s not listed as a side effect, don’t discount the medication as the cause

Shortly after my experience with the above person, I brought this up with someone else who was having a somewhat similar situation. Tim had been having an achey right hip for quite a while. It wasn’t anything limiting, it was more of a “I know it’s there” sensation, but it was enough for him to regularly mention it to me.

I mentioned, almost in passing, he take a look at his medication. He wasn’t on Crestor, but high blood pressure medication. Blood pressure medication isn’t as notorious as Crestor with muscle / joint pain, and the fact Tim was having one problem at one location made me think this was really a long shot, but I couldn’t see anything else going on. We’d been working together a few months and I didn’t see anything exercise wise having an influence. He specifically told me many times, “Nothing we do in the gym has any influence.”

Tim modifies his medication -something he’s been on for like two decades- and immediately his right hip issue is gone. Based off the side effects list, you’d almost assuredly never think “Hmm, right hip aching, patient is in his 70’s, has history of being in the marine corp, does a lot of physical activity such as wood working, could be in better health cardiovascularly…Yep, gotta be the high blood pressure medication.” Based off my experience, and the more people I encounter, you would bring this up.

Again, scary thought: At some point this guy could end up having radiology on his right hip. Almost assuredly, due to his age, there is going to be signs of arthritis. It’s not hard to see this guy ending up with his hip replaced.

One of the first people I ever trained got swine flu. We were about two months into working together and this girl was in very good shape. From a workout perspective, things were consistently going great. Even when she found out she had swine flu, you’d have no idea workout wise. For the workouts I timed, things only got better and better.

And then she went on antibiotics.

The day she went on antibiotics I asked her, “Did the doctor say anything about working out?” “He said it should be fine. Nothing to worry about.” I pressed her and she insisted the doctor didn’t see any need to worry. This was something we were both concerned about because I was training this girl to get ready for an album photo shoot, and we didn’t have much time to screw around. We started working out and that day went well.

Two days later it was like I was training a different person. Emily had been doing med ball circuits, lunging more than anyone would ever want to, doing 400 meter runs around the track with burpees every 100 meters, stairs, (we trained outside), we are talking HARD workouts. But two days after the antibiotics she could barely move faster than a walk without being exhausted.

She said a few times she had a hard day with school and work and just didn’t feel like doing anything. I figured I’d covered my bases asking about things a couple days ago, and just needed to push her some more on this day. Often a client will come in dragging ass, but feels great after a small kick in the ass.

Emily gets about halfway into a 400 meter jog, does a couple burpees, gets to the top of one rep, looks at me, her eyes roll to the back of her head, and she immediately collapses on the track. (Luckily, she fell on the infield grass.) I rush to her, her hands are twitching all over the place, but she’s still cognizant enough to speak to me. Emily has a history of fainting, but this was the first time it happened in a workout.

She gets up and I basically hold her hands and just walk with her for a while. Beyond the collapsing, she was actually fine. If i didn’t know her as well as I did, and known about her odd fainting history, I likely would have called 911. Her collapse was that dramatic.

She tells me more about the fainting history, and probably 15 minutes later she’s completely fine. We chalk the day up to an odd happening. As I mentioned, she had a long day prior to working out. Not only that, but she regularly commuted three hours roundtrip, and she was in the midst of some family drama. We both assumed excessive fatigue or something of the like was at fault. If she felt some lingering effects when she got home she could talk to her dad, a doctor, about it.

A few days later we’re back on the track. As soon as she goes above a walk she gets dizzy and disoriented.

Emily was on antibiotics for about a month. Take a guess how long the dizzy spells, wanting to faint, and disorientation lasted? About a month.

In fact, with some thought, it was so obvious the antibiotics were causing an issue, she went off them against her prescription. Again, she was trying to get ready for a photo shoot and had a deadline. Not being able to workout intensely was not on her agenda. I was able to make some creative workouts, but when you’re on a track and can’t go above a walking pace, there’s only so much you can do. Maybe a day after going off the pills she was immediately back to the level she was before the antibiotic prescription.

I looked around and really couldn’t find anything to explain this. I believe the prescription was amoxicillin, and nothing suggested she should have that much trouble exercise wise. There are some words about breathing being a little harder, but “little harder” didn’t come near what she experienced. We’re talking exercise capacity being cut by like 75%.

Second point: You don’t need a randomized clinical trial to tell you what’s obvious to your eyes. If somebody goes on a medication and immediately has a new issue, it’s probably the medication. Regardless whether the doctor thinks it is, regardless whether there’s any peer reviewed research to support reality, and regardless of whether it’s a listed side effect. You may be the only person in the history of that medication who faints when exercising hard, but that still matters to you.

I recently had a guy come to me for help about knee pain. He’s on Vynanse for ADHD. After looking at some pictures of him and watching him move a bit, nothing was really glaringly unusual about him. I saw some small things to work on, but this is a guy complaining of severe pain.

I did a quick google search on his medication, “Vynanse and joint pain” and immediately found a forum where people were saying they started to have random joint pain after going on this med. Is joint pain listed as a side effect? No. Does that mean it’s not a factor? No.

Endocrinology and pharmacology are so complex don’t ever think we know everything about how a particular drug works. Or, we know how it will react to every single person. You may be the only person to ever have a particular side effect. Keep it in mind the next time you or someone you know is having something odd going on. The pill(s) may mean nothing, or they may be that one missing puzzle piece.

In many cases you can switch to a new med, or carefully be taken off and try other avenues to treat the condition. (Non-drug treatments often work just as well or better anyways. Depression is one example: exercise outperforms drugs.) I’ve had a few people on high blood pressure medication who really didn’t want to be. After losing some weight and getting into better shape I recommended they talk with their doctor about going off the med. (This is rarely thought of by the doctor.) They’ll have you go off and do something like come in once a week to see how your blood profile responds. If something like your blood pressure doesn’t shoot up, you can stay off. Or maybe you end up halving the dose.

At the end of the day, you want to be on as little medication as possible. We, especially in America, have become insane with pills. There is a significant fear of antibiotic resistance due to how much we’ve prescribed them. The bacteria is evolving faster than our drugs. You’re not doing society a favor every time you get a prescription for your stupid cough.

And, as this post illustrates, you may gain something from your medication, but you often lose something. That something may be your ability to exercise hard in exchange for lowered blood pressure, it may be controlled cholesterol levels for increased muscle aches, it may be no swine flu in exchange for boring workouts, whatever. But pop enough pills for long enough, and you’re pretty much guaranteed to have something negative happen. Whether that negative outweighs the positive, if there even is any, is up to you.

Side effects extend beyond yourself (a tangent)

I had a footnote I was going to include here but it go so long I figured I’d make it’s own section.

I try to stay away from politics on this site for all the obvious reasons. Not to mention, overall, I don’t know much about many issues. As soon as anything about foreign policy comes up my opinion is “I don’t know.” When it comes to people’s health though, the answers to the debates have become so glaringly obvious I don’t see much room for stirring up shit anymore. So here we go.

A person using drugs can and often does influence other people. Does you popping some Tylenol every now and then for a headache matter? Probably not. But does you chronically taking X heavy drug along with millions of other people matter? Yes.

Antibiotic resistance is a poignant example of how interconnected we all are. People popping Z-Paks all day may not directly influence you, but eventually it very well could. You might not care right now how many people are taking antibiotics when they don’t need to be, but you will care if you die from some remedial disease because basic antibiotics don’t work anymore.

Same goes for other drugs. Drugs can change the composition of your urine. Your urine goes to soil, bodies of water, it evaporates, it’s part of that whole water cycle thing. What you put in your body gets put back into the world, which gets put back into other people’s bodies.

We are all connected. Your health, your lifestyle, whether good or bad, absolutely influences others. Does every single thing you do matter? No. But the other extreme -nothing you do matters; “me getting high or fucked up everyday only affects me”- is also wrong.

This is where Bloomberg missed on his soda ban in New York City. He should have analogized it to secondhand smoke. If a group of people are smoking around a non-smoker, that non-smoker’s health has been put at risk. If a group of people are obese, which soda contributes to, a non-obese person is more likely to become obese i.e. their health as been put at risk.

I could quote you research on this but I would hope this is beyond obvious. Who you’re consistently around matters. When millions, if not billions, of people are engaging in an activity, it affects millions, if not billions, of others.

This is why I know some Californians, including those involved in medicine, who have made convincing arguments to me that vaccines should be legally mandatory. Their argument is rarely about the family choosing not to vaccinate and getting whooping cough. It’s about the kid who gets whooping cough because he or she hasn’t reached an age where they could be vaccinated yet. It’s about the innocent kid being harmed by people trusting Jenny McCarthy as a medical source.

Point is Bloomberg should have made his soda ban about non-soda drinkers health. Just like all the shit smokers get is about non-smokers health. You still want to smoke? That’s fine. But it’s going to be harder to do, it’s going to have a stigma, it’s going to be more expensive, it’ll have it’s own tax, it will have an age minimum, it’s going to have less influence on others. This is largely what we do with alcohol. Rather, Bloomberg came across as, “I know better than you and I’m going to tell you how to live.”

Finally, this is why the vehement opposition to everyone having to have healthcare, or health insurance, -basically, that everyone has to try and contribute to the system (if they can)- baffles me. Whether or not someone has health insurance matters even to those who securely have it. Because even if person X does not have health insurance does not mean they won’t get healthcare. They often will, and it will often be more expensive, which we all eventually pay for. (See how an ignored homeless person costs more than a treated homeless person.)

Health is a unique commodity in that I’m not sure any other has much as of a ripple effect. If a bunch of people buy iPhones then sure, that can influence iPhone prices. But if iPhone prices get too high, one can simply not buy an iPhone. When Starbucks increases prices too high I can go, “Guess I’m making coffee at home now (but I’ll still use their WiFi.)” When it comes to somebody’s health, people don’t go, “Car accident…man, surgery is expensive right now…alright, guess I’ll just die here.” Paramedics don’t go, “What’s that guy’s financial situation?” before they treat someone. Doctors don’t go, “Gotta ignore that guy. Bad credit.”

Third point: When it comes to our health, it is literally our health.

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Posted in: Miscellaneous, Pain