Mild liver worris post exercise

[DollyOblong]

Hello

I wonder if anybody can help with advice or an educated guess as to what might have happened.

I am a keen long distance runner and recently completed a 48 mile race in the Swis Alps. Two days after the race I experienced symptoms whch strongly suggested that my liver was not producing bile. This lasted for four days and after everything returned to normal it took me about three weeks to fully recover from the fatigue that accompanied it.

I have seen my GP who has sent me for blood tests and I am awaiting a scan of my liver to make sure that everything is in good working order. My concerns are: why did this happen? Will it happen again?

I plan to continue long distance running but at the moment I am worried that I am harming myself further. I am 30 years old, I do not drink (gave up around two years ago) and live a very healthy lifestyle. Any ideas?

[Bolly]

Hi Dolly. You don't tell us what the symptoms were that made you suggest lack,of bile?

What did the GP test for based on how you presented and your medical history?

What reason did the GP give the hospital for requesting a scan and what scan is it? - ultrasound, CT, MRI.

[DollyOblong in reply to Bolly]

Hi Bolly

Thanks for the reply. My stools were grey in colour, I had extreme nausea and loss of appetite for four days, as well as complete physical exhaustion. The day before these symptoms began I had experienced vomiting and fever.

The GP did an examination and I felt some tenderness on my lower right side. The blood tests were looking for amylase (?), thyroid problems as well as some other things but I'm not 100% sure. The scan will be an ultrasound. My GP didn't seem overly concerned or make it seem like it was an emergency, but I am very keen for it not to happen again if it's something I brought on myself.

I am otherwise very fit and healthy.

[Bolly in reply to DollyOblong]

Sound like you may have had a virus (fever, vomiting) and done the race when your body had not recovered. This would have put a strain on your body and organs in particular your heart and lungs I would have thought. Sounds like the GP is ruling out a digestive problem (pancreas) with the amylase and checking thyroid in case that explains the fatigue. Hopefully they checked iron levels too.

[findasolution]

Hello Dolly,

I have some understanding of the problems you seem to be encountering based mainly on my own experiences as a participant in endurance sports events and challenges during a period of 55 years plus. Many of the events were between 50 and 100 miles and after some of them I occasionally experienced the same kind of things that you mention particularly during the immediate post event period of some of the longer distances.

I am now well into my 70's and have decompensated cirrhosis which has developed from Autoimmune Hepatitis which was diagnosed about 5 years ago but I do still participate in marathons,cycling and walking events although obviously my physical capabilities are now greatly reduced because of the liver disease and the normal ageing process.

Unfortunately I chose to ignore the post events symptoms and pains which with hindsight was the wrong path to have followed and I shall now never know what part, if any, the excessive intense exercise over such a long period of time had to play in the development of the liver disease I now suffer from.

You are right not to have ignored the pains and adverse symptoms you encountered and have consulted a doctor to investigate. It is of course very important that your doctor is made fully aware ,if he /she is not already, that you participate in endurance sports. This knowledge is essential when biomechanical and liver function and blood clotting tests are carried out because the results can be affected quite significantly in the short term after prolonged exercise ( a 48 mile mountain race certainly fits into that catergory). Elevated ALT and AST and CK levels etc are often detected in the blood and evidence of bleeding and protein in urine tests which means they need to be treated cautiously to avoid incorrect diagnosis unless adequate time has been allowed to pass between the time of the prolonged exercise and the time when the tests are done.

Running brings many health benefits if done sensibly and in moderation and in particular Ultra marathon running is always an exciting challenge.

It is however extremely demanding on the body and adequate time for full recovery must always be allowed. Current thinking is that not more than one or two ultra marathons should be undertaken in any calender year with plenty of time allowed between each for muscle, bone and tissue recovery to occur.

You express concern as to the likelyhood of it occurring again and in my view it probably will if you do not allow time for adequate recovery between the events you take part in. After an ultra event such as the 48 mile one you mention it is probable you should refrain from running at all for at least a full month afterwards and then when you resume to

do so on a slowly slowly basis. I used to run in a 100 mile event every year for about 12 years consecutively (plus many other shorter but still long distance events) and always refrained from running for about two weeks afterwards although if I knew then what I know now I would say that was far too short a period for a full recovery to occur.

I hope the tests you are undergoing will not reveal anything sinister and that your liver as well as your heart are working normally. Further that you will be able to continue and enjoy your marathon running.

Meanwhile can I mention to you that an extremely valuable source of information and reports on medical research relating to most types of physical exercise and sport and how it affects the body is The British Journal of Sports bjsm.bmjjournals.com

Additionally as a long distance runner you will probably also find that an extremely well researched text book on the affects of sport and in particular ultra marathon running is 'Lore of Running' written by Timothy D Noakes MD ,Health Professor of Exercise and Sports Science ,Cape Town University and that this will provide you with most of what you need to know about the sport you are involved in and what its good and bad affects on your body are likely to be etc etc.

If you are already familiar with these then all well and good but if not then in my view it may be worth your while seeking them out in order to have an improved understanding of any pains symptoms etc you may suffer after excercise in the future.

Regards

[DollyOblong in reply to findasolution]

Hello

Thank you so much for such a thoughtful, informative and helpful response. I have had to read the post a few times over to really absorb everything you have told me.

Firstly I am sorry to hear about your liver disease but so pleased you are still taking part in events and leading such an active lifestyle. Your long distance running achievements are incredible, so thank you for finding the time to share with me the benefits of your experience and knowledge. I have found that bridging the gap between medical understanding and ultramarathon running has been difficult and feel that guidance and insight from the ultramarathon community will help me to understand more what could have happened to my body.

This year I have participated in more races than combined over the past ten years, ranging from 10-50 miles. Your advice about allowing adequate recovery time between events is very sensible and something I shall take on board going forwards, as my mindset this year has been "I need to start training for the next one".

Next year I will be running my first 100 mile event and am worried that I will experience the same symptoms again, and possibly cause damage to my body. I only have one body and I am very keen to look after it, I also enjoy the challenge and health benefits of running and need to make sure I can find and understand the balance between the two.

So far my blood tests have come back normal, a relief but not entirely unexpected as the tests were done around a month after the symptoms were experienced and everything seems back to normal now. I am awaiting an ultrasound at the hospital, but will certainly make sure my doctor is aware that I participate in endurance events.

I have "The Lore of Running", a very helpful book and usually my first port of call when anything seems amiss, however I have not used BJSM before so thank you for giving me that link.

Thank you once again for taking them time to share your advice with me.