Q&A Episode - TRT for Women, Resting Heart Rates, and First Time Competitions | Starting Strength Radio #142
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Meeting women at blockbuster video on a friday night...god damn that's brilliant.
Mr. Rippetoe and SS Crew,
Can you elaborate on the mechanism and practical advise around healing a bulged disk? I have been told by my PCP and surgeon that these things don't heal (surprise surprise) so I should just manage it and in my research have seen lots of contradictory opinions (some say since the disks lack blood supply it won't heal while others say motion over time will cause re-modeling) and I am a bit lost. I have a bulge in the disk between C7 and T1 with symptom onset about 15 months ago with up and down symptoms since (usually I can map it back to overdoing an activity in general life or two fast a pace on titrating back up my training) but generally a very positive trend over that time to minimal to no symptoms effecting day-to-day life after following Nick's previous advise for management (THANK YOU AGAIN NICK!). I'm back benching 2 plates, which ain't shit around here but from where I was during this injury I'm happy as hell with it...for now. Long term if there is a possibility and practical non-surgical means to re-model this thing I'd love to understand how if functions so as to best facilitate it. I'm 36 if that is an important variable here.
Related and also briefly touched on in this Q&A was the creatinine level question in blood work. Around this same time I got some blood work that indicated high creatinine levels (1.61 mg/dL) and thus low GFR, we retested about a month later and was still high but falling (1.53) and was referred to a specialist. The first reading with the specialist about 6 months later it was still high but was still falling (1.44). He also took a urine sample which was all fine and did a kidney ultrasound which was all fine too. He had me go away with a diagnosis of early stage chronic kidney failure and to come back to do more labs 4 months later to see how quickly my death procession will be. On this final trip my creatinine level was ( 1.34) still reads high but my GFR is now just in the reference range. He said he's never seen creatinine levels drop so much and didn't know what to make of it but I don't have chronic kidney failure anymore and come back in 6 months for more blood draws to see what happens. Here is my hypothesis that I'd like to get your feedback on; I was taking a ton of NSAIDs early in this process trying to manage my nerve related disk bulge symptoms and my training went from balls to the wall to very low volume and essentially half weight of pre-bulge (giggity) symptom onset (literally couldn't bench 135 since right tricep didn't fire). Over this time I lost about 10 lbs due to lower training ability (probably a good bit of muscle off and added some lard due to aforementioned training interruption) and gradually moved off the NSAIDS, this combined I am thinking would explain the drop in creatinine blood levels? In your opinion should I be worried with the creatinine levels (especially since I think they will start creeping up again as I continue to train properly and cultivate mass), I have seen previous advise around doing a Cystatin C which I didn't read until after the last labs, would this be advisable or unnecessary since we did the urine inspection and ultrasound already? I'm of the mind currently not to entertain any further labs and associated psychological baggage of being told I'm terminally ill unless there is a good reason to subject myself to this for the lab values and peace of mind they may bring if I understand them properly.
In my early reading on creatinine levels in lifters it appeared that this was an abnormally large (muscular) lifter issue or a supplement user issue. I'm only 6'0" 200 lbs (~17% bf) and don't use any supplementation so I didn't think I was big enough for the muscle turn over in me to explain the blood work (am I wrong?) thus leads me to think I'm particularly sensitive to NSAIDs? Either way it scared the piss out of me for a while, please advise?
Sounds like it's already remodeled. It happens: Back Rehab: A Case Study | Mac WardQuote:
Originally Posted by randomuser
There's your first problem [emphasis added].Quote:
Originally Posted by randomuser
Thank you for your reply Mr. Rippetoe and Stef.
Stef,
To clarify; that level of creatinine is fine for my height, weight, age? I understand how the GFR formula works but seems from my other research that I'm pretty small for such an out of "normal" level of creatinine...like I should be ~240 at my height for such a high level, am I just misinformed?
Rip,
Thank you for the article, it sounds very familiar except it sounds like LtCol Ward healed much faster. I'm still having symptom onsets over a year latter when I step slightly out of line. Are these inflammatory responses the mechanisms by which this thing will remodel? Should I be pushing into the symptoms? Why is my remodeling taking so much longer? Just trying to understand the mechanism to see if I can move this thing along.
Thanks Again for all the info and guidance.
Why do you think that high creatinine levels indicate a low GFR? Who told you that? The nurse? What else might affect that number?
And your post said that. So what's the problem? You want things to be like they were when your were 24? So do I, but it cannot happen. Virtually every adult on the planet has imageable disc "pathology" that may or may not be symptomatic. If Mac healed faster than you did, maybe it was because he rehabbed it harder than you did, TRTed it harder than you did, or any number of other variables different than you did. Be happy with the trend.Quote:
generally a very positive trend over that time to minimal to no symptoms effecting day-to-day life after following Nick's previous advise for management
I believe the formula is:
GFR:GFR (mL/min per 1.73 m2;1.21) = 186.3 x Serum Creatinine (exp[-1.154]) x Age (exp[-0.203]) x (0.742 if female) x (1.21 if african american)
Age would play a role, sex and race. Sex and race are fixed as was my age for most of the tests. Looks like Creatinine is the primary mover in the formula as I understand it.
UPDATE:
I found in researching where you were going with this question and think I may have found my answer in this post from stef. Kidney function test, eGFR results of concern
If I use the calc on that post I'm 84 mL/min...so I'm just fine. Thanks Rip and Stef.
Mac rehabbing it harder = no symptoms earlier...I should be pushing into symptoms harder for a faster trend or since I'm older I am just gunna have to live with this, thanks once more for clarification?
It seems to be healing. IOW, what you're doing now is working.
