Melanie McQuaid’s NSAID Cautionary Tale
In 2016, I dislocated my foot, which
resulted in a trimalleolar fracture with dislocation. It was a hideous injury requiring two surgeries to install and remove a bunch of hardware. Almost three years later, I’m still regaining strength. In the 2016 and 2017 seasons my ankle was swollen, weak and inefficient. My efforts during both training and racing created constant irritation, so I was using some different nonprescription NSAIDS (non-steroidal anti-inflammatory drugs) like Advil (ibuprofen) and Voltaren (diclofenac) to manage inflammation.
In nearly 20 years of racing professionally, before I broke my ankle, I never used NSAIDs for any reason. Without a major or chronic injury for nearly my entire professional career, I had no use for them. The ankle fracture is the first injury I experienced having chronic pain and swelling.
The period of training leading up to 2017 Ironman Arizona represents my highest use of NSAIDs. Three weeks out, I raced Ironman 70.3 Austin and the rough, offroad sections of the run course irritated my ankle. I was advised to try bigger doses of Advil to knock down the swelling. I took large doses of advil and at the same time I was massaging Voltaren on the swollen parts of my leg.
Eight days before Ironman Arizona, I did an indoor bike session, had a shower, ate a snack and prepared for a walk with my dog, Stevie. Suddenly, I felt like I was having an anxiety attack. My heart was pounding in my chest in a weird way. After putting my heart rate monitor back on, I saw my heart rate was above 180 bpm. I called my doctor, describing the incident, and we decided I would go to emergency if I didn’t feel normal in the morning.
The next morning, I got up to walk to the door to let my dog out and after 30 steps I could feel I was blacking out. I lay on the ground and put my feet up. When I thought I was OK, I got up to walk back to the bedroom and collapsed again. I ended up in an ambulance headed to emergency. Before I got there, the ambulance attendant had already taken an EKG indicating I was in atrial fibrulation (AF), a heart rhythm abnormality where the upper and lower chambers are out of sync.
I was assessed for stroke risk and, luckily, I was a candidate for cardioversion. This means they stick electrodes to your chest while you are under a short-term general anesthetic and restart your heart in sinus rhythm. It was successful, but for weeks following the event, my heart was not completely normal. I had burns on my chest and back from the electrodes, so it is not surprising my heart took time to recover. It took about six weeks for me to completely recover, and I haven’t had an episode since.
In the weeks following, I performed a stress test and wore a 24-hour Holter monitor. Intense training did not trigger any rhythm abnormality. The conclusion was I lowered my threshold with age, long-term exercise habits and excessive caffeine. I also haven’t used NSAIDs since the incident because, after six weeks off, I no longer needed to control any swelling.
I can’t be sure that the NSAIDs caused my AF event. Researchers believe endurance exercise increases the risk of AF and, given I have Continued on p.61…
Jano Schmidt/ITU RIGHT Melanie McQuaid wins the 2011 ITU Cross World Championships