Me­lanie McQuaid’s NSAID Cau­tion­ary Tale

Triathlon Magazine Canada - - Features - BY ME­LANIE MCQUAID

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

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