Water, Water Everywhere…
Like most of you, I’ve had my share of running-related injuries over the past 40 years. Without exception, the relatively few I’ve had were of the musculoskeletal variety – tendinitis, muscle strains, joint sprains, plantar fasciitis, etc. I’ve been fortunate: only twice have I been forced to cease all running for more than a week or two, and on both occasions patience and six weeks of rest (as well as treatment, of course) were sufficient to allow me to heal and get back to my usual routine quickly without complication.
A week ago, I suffered an “injury” of sorts that I never thought I would ever experience. Shortly after getting out of bed and pouring my cup of coffee in preparation for my usual 6 AM run, I began to feel some discomfort in the middle of the right side of my back. At first, I thought I must have twisted my back somehow, though I couldn’t remember doing that. Within 10 minutes, I knew this was no ordinary back pain due to a muscle pull, disc herniation, or the like. It quickly progressed to extreme pain that soon caused nausea and vomiting. It then began to move into the lower right abdominal area, which felt even worse!
By this time, I strongly suspected I was experiencing a kidney stone, as did the triage nurses in the Crouse ER when I arrived. After an IV of meds to get me comfortable, a CT scan confirmed that a 2 mm stone was in fact the culprit. I fortunately passed the stone within a few hours and felt complete relief. But the 2 hours of the worst pain I’ve ever felt is something I never want to experience again. (Many people have likened it to having a baby, so I’ve started taking birth control pills. I know what you’re thinking, but I’m not taking any chances!)
By now you’re probably asking, What does this have to do with running?
As many people know, kidney stones are usually thought to be caused by dietary factors. Folks who eat large amounts of animal protein, spinach, nuts, or take calcium supplements, for example, have a higher risk of developing a stone. There are other factors, such as infections, heredity, or certain medications, that do likewise.
After taking my history, the ER physician realized I did not have any of these risk factors. But after I told her that I had run a race the day before, she quickly zeroed in on another risk factor that I had not been aware of: dehydration. The urologist I saw later focused on that as well. When I told both that I had not felt dehydrated after the race (it was a cool day) and that I had been urinating regularly for the rest of that day, they both said the problem was more likely chronic dehydration.
Now that that rang a bell.
One of the things I’ve always considered to be a benefit of running is that, after my morning run (even in winter), I could go to work and not have to be running to the rest room all morning and interrupting patient care. In fact, I usually would not have to go until noon, despite having two cups of coffee after running. Turns out, while that may have been a benefit to my patients, it may not have been so good for me.
Chronic dehydration is thought to be a risk factor for kidney stones because it leads to low urine volume. Normal fluid volume is needed to dissolve the salts we all eat too much of (it’s in everything!) and that form the crystals the stones are made of in many cases. So, given my lack of fluid intake, combined with my caffeine intake and affinity for Cajun seasonings, there’s a high probability this was a self-inflicted wound in some sense.
Both doctors strongly recommended I make sure I drink a good amount of water (not sports drinks!) immediately after running. Several years ago, I made the case here [Therapy Corner 66] against the widely-advised dictum that everyone needs to drink at least eight, 8 oz. glasses of water per day. Citing the lack of scientific evidence to support this quantity of fluid intake, I recommended listening to your body and its natural thirst mechanism instead and not being obsessed about this amount.
While I still think this 8×8 rule is an arbitrary “medical urban myth,” I do plan to pay more attention to listening to my body and making sure I’m not risking my health for the purpose of saving a few minutes a day by not having to visit the little runner’s room.