Bad Luck or Antibiotic-Induced Tendon Rupture?

April 28th I suffered a Distal Bicep Tendon Rupture. I had surgery to reattach the tendon and as I write this, I am in the midst of the 16-week recovery process. If I am lucky, this will be the end of my tendons issues, although I am anxious that this could just be the beginning. Let me explain. 

How/Why Did This Happen?

This is up for debate and the most troubling part of this entire situation. When I met with the surgeon to get some clarification on the cause of my tear, he told me ‘bad luck.’ He’s performed approximately 300 distal bicep tendon tears. After 25 years of experience and working my butt off in the gym, people around were convinced that my injury was due to me lifting weights incorrectly or doing something careless and/or stupid. It has been suggested that I get ‘proper training’ to learn how to lift correctly and have even been asked if I’m using steroids. After several conversations and emails with my doctor (imagine that, an orthopedic surgeon that takes time to personally answer emails – if you an orthopedist, I highly recommend Concord Orthopedics), here is a summary of what he believes (paraphrased):

• the reason I tore my biceps is bad luck
• my injury is not related to lifting too much weights or improper technique.  It is usually caused by just an event where the biceps eccentrically contracts against a larger force. 
• out of the approximately 300 distal bicep tendon tears he’s repaired, I fit about 99% of the cases … males (almost exclusively), dominant arm, and around the age group of 40
• my biceps tendon is of good quality. Steroid users often have poor quality tendons and the number of steroid users he’s operated on only make up around 5% of his patients. This is a very common injury in non-steroid users. 

After my injury I spoke with a friend that happens to be a nurse. He brought up an important circumstance that no one else had thought of. Late fall/early winter, I was treated for pneumonia. He followed this up by saying, “they gave you Levaquin, I know it. We don’t prescribed it anymore because of tendon problems.” I did not know what I had been prescribed, but I called the pharmacy the next day to find out.

I was prescribed levofloxacin (500 mg) and prednisone (20 mg) at the same time. Reading about these medications online I’ve found: 

• Levofloxacin is used to treat a variety of bacterial infections. This medication belongs to a class of drugs known as quinolone antibiotics. Taking levofloxacin increases the risk that you will develop … a tendon rupture (tearing of a fibrous tissue that connects a bone to a muscle) during your treatment or for up to several months afterward
• Prednisone belongs to a class of drugs known as corticosteroids. Rupture of tendons has been previously described in association with corticosteroids. Prednisone may also increase the risk of tendon rupture in patients treated with fluoroquinolone type antibiotics. Examples of fluoroquinolones include ciprofloxacin (Cipro) and levofloxacin (Levaquin).
   

Learning this brought up many questions, concerns and thoughts to light, including:

• Did Levaquin cause my injury?
• While I was at the clinic, the doctor said something about my prescription being flagged because of a drug interaction. The doctor said not to worry about it because I did not have a history of tendon problems. Why did the doctor combine these drugs without really explaining the side effects?  
• Am I at risk for further injury? There are multiple accounts of people suffering from side effects years after taking the medication. I didn’t work out from Oct through March. I stuck to dumbbell bench presses, rows, deadlifts and shoulder presses until a couple weeks ago.  At that point, I started doing chin-ups and I did notice new/different pain near my elbows and into my forearms. I just figured it was due to the long break or getting older.
• Is there a way to tell if my injury was caused by the antibiotics? Studies have shown that Cipro and Levaquin. can cause permanent DNA damage … is mtDNA sequencing a realistic for my situation?

As I continue to look into the possibility of Fluoroquinolone-induced Tendinopathy and Tendon Rupture, here are some links:

• Fluoroquinolones Overprescribed Despite Dangers
• Could Taking That Antibiotic Have Serious, Long-Term Consequences?
• The Dangers of Fluoroquinolones
• Cigna – FLUOROQUINOLONE ANTIMICROBIALS: Are they worth the risks?
• Studies/Scientific
  • Dr. Joseph King
    • academia.edu
    • Powerful Antibiotic Could Be A Prescription For Danger
  • The Risk of Fluoroquinolone-induced Tendinopathy and Tendon Rupture 
  • Medication Guide Levaquin
  • Fluoroquinolone Trouble Untangled
    • “Fluoroquinolone drugs cause continued and lasting damage to the body because it alters and damages DNA — basically permanently changing the structure of your DNA. This is precisely how and why fluoroquinlone victims can experience continued tendonitis, tendon ruptures, and vision damage, and other crippling and permanent effects weeks, months, and years down the line.”
    • “a common antibiotic can cause an acute adverse reaction AND various permanent damages: persistant neuropathy, tendon weakness and spontaneous rupture several months out, depression, etc.”
• PERSONAL  ACCOUNTS,  SUPPORT  GROUPS
  • Floxie Hope 
  • My Big Levaquin Adventure

MY RECOVERY PROCESS

Since this is still ongoing (I’m currently 8 weeks out from surgery), I will update this post periodically. I had planned to take some notes along the way to make writing this post easier, but with trying to keep up with work, doctor appointments and getting stuff done around the house, I never did it.

WEEK 1
MAY 5 – MAY 11, 2019
With the opioids epidemic in this area, I was very wary of taking the medication prescribed to me. I honestly thought I would just take OTC meds and deal with the pain. We had not even made it home from the hospital before I knew that was not going to be the case. Even with the medication, the aftermath of the surgery was much more painful that the injury itself. For the first 3 days I took the max dosage, then started reducing my weened myself off of the medication.

Items of Note:

• Sleeping was horrible.
• The weight of the cast was causing a significant amount of shoulder pain (I have a SLAP tear in that shoulder).
• May 9 the cast was removed and replaced with a splint, which is much lighter, but still causing a significant amount of discomfort.

WEEK 2
MAY 12 – MAY 18, 2019
Items of Note:

• Back to work, but thankfully was able to work the entire week from home. With the cast, working was very difficult.
• May 13 I started PT, which basically consists of stretching the tendon.
• May 14, the sutures were removed.

WEEK 3
MAY 19 – MAY 25, 2019
Items of Note:

• Another work week from home.
• Now that I’m doing more typing, frequent breaks are necessary, which makes for a long day. Typical schedule:
  • 4 to 6 a.m. – wake up, work
  • 6 to 8 a.m. – break, get kids ready for school
  • 8 to 10 a.m. – work
  • 10 to 11 a.m. – physical therapy/break
  • 11 a.m. to 1 p.m. – work
  • 1 to 2 p.m. – physical therapy/break
  • 2 to 4 p.m. – work
  • 4 to 8 pm. – break
  • 8 to ~10 p.m. – work
• With the injury, I am still working much slower than normal. As such, I’m usually “on the clock” for about 10 hours per day

WEEK 4
MAY 26 – JUNE 1, 2019
Items of Note:

• First week going in to the office, but only two days per week to cut down on the amount the driving I had to do.
• I’ve been gaining about 1lb per week since the injury, I need to start HIIT or something to stop the slide.

WEEK 5
JUNE 2 – JUNE 8, 2019
Items of Note:
…

WEEK 6
JUNE 9 – JUNE 15, 2019
Items of Note:

• weaning off of splint
  • no splint at home or at work
  • only use when in public places where people don’t know I have an injury
• quality of sleep greatly improved

WEEK 7
JUNE 16 – JUNE 22, 2019

I finally purchased a stair-stepper. It is much older than I had hoped for (the display makes me think it’s probably the same model I used 20+ years ago ), but for $100 I’ll survive.
June 16 was my first day of HITT and I had horrible DOMS, which I should have expected since it was my first cardio since September 18.

Over the last couple of years, I’ve had too many ‘false starts’ when it come to getting back to working out consistently and changing the way I eat. I believe that this has happened partially due to me trying to make too many changes at once. I decided to try making small changes each week, to ultimately get where I want to be the week that I am able to start lifting. Since I associate most of these habits/lifestyle changes with LeanGains, I am going to call it LeanGains Prep (LGP).

LeanGains Prep : Week 1

• No carbs for 10+ days
• Skip breakfast, push first meal of the day until I’m really hungry
• 50+ ounces of water per day
• High Intensity Interval Training (HIIT) Level 1 , Week 1

WEEK 8
JUNE 23 – JUNE 29, 2019
Items of Note:

• No more splint!
• June 28 I was cleared to start strength training – I can’t do much, but I am very excited to get started. For bicep exercises I am using 1 lb.
• I started physical therapy for my shoulder/upper back, which has been more painful than the bicep lately
• Met with a physical therapist at work to setup my workstation. I am mimicking the setup in my home office.

LeanGains Prep: Week 2 – In addition to Week 1 goals, I added:

• Using a standing desk at home and at work, trying to limit sitting at work to 2 hours or less per day. Why?
  • history of piriformis/sciatic nerve pain
  • condition feet for hiking
  • health benefits associated with limiting sitting
• High Intensity Interval Training (HIIT) Level 1 , Week 2

WEEK 9
JUNE 30 – JULY 6, 2019
Items of Note:

• First full week of strength training

LeanGains Prep: Week 3 – In addition to Week 2 goals, I added:

• Push first meal of the day until 2pm or later. Last meal 10pm
• 100+ ounces of water per day
• High Intensity Interval Training (HIIT) Level 2 , Week 1

WEEK 10
JULY 7 – JULY 13, 2019
Items of Note:

• Vacation/camping July 12 through 14, some slippage on nutrition

LeanGains Prep: Week 4 – In addition to Week 3 goals, I added:

• Mindfulness Meditation
• OMAD
• High Intensity Interval Training (HIIT) Level 2 , Week 2

WEEK 11
JULY 14 – JULY 20, 2019
Items of Note:

• Vacation/camping July 19 through 21, will be tough to eat well

LeanGains Prep: Week 5 – In addition to Week 4 goals, I added:

• limiting soda/carbonated drinks
• conscientious of protein intake; will start tracking next week
• High Intensity Interval Training (HIIT) Level 2 , Week 1

WEEK 12
July 21 – July 27
Items of Note:

• First week that I have not made “progress” since my injury

LeanGains Prep: Week 5 – In addition to Week 5 goals, I TRIED TO add:

• limit soda/carbonated drinks
• conscientious of protein intake; will start tracking next week
• High Intensity Interval Training (HIIT) Level 2 , Week 2

Since my injury, this surprisingly has been the most difficult time period I’ve had both physically and mentally. 

• Physically
  This is probably surprising to hear, since I am so far out from surgery and did not reinjure myself, but man, what a tough week. I had several days that I woke up in a ton of pain. In my experience, the closing thing I can equate it to is waking up the day after hiking ~20-ish miles with a heavy backup … sore joints, body aches all over feeling like I’m about to get very sick. After talking to my physical therapist and some family members, I am going to ask about being tested for Lyme’s Disease again. I asked about this in the past (tracking to track down the date), but was told that a test would not be ordered because I have never had the bulls eye rash.
• Mentally
  I realized that I have been really hoping that my tendon rupture was not due to fluoroquinolone toxicity and due to “bad luck”. While my initial reaction to learning about levaquin was relief and a “see, I didn’t do anything wrong” attitude, the more I have learned, the scarier all of this is. I’ve started piecing together some of the other things that have happened over the last few months and the more I learn, the more it seems that I have a classic case of FQ toxicity. It’s bad when you’re hoping that you have lymes instead of something else. More on this later. 

Understandably, the above caused some stress and anxiety last week. Typically, I’d cope with this by working out or going for a hike … with the possibility (likelihood?) or another injury if I do have FQ toxicity, I’m not sure this is a great idea. 

For the first time since planning out the steps I need to take to get “back on track,” I did not reach my goals for the week: 

• I only had two HIIT sessions. My goal has been 3+ per week
• I had planned to start tracking protein intake. I did this for 2 days. 
• I did not complete all of my physical therapy workouts for the first time since my injury

Part of the reason that I did not do the above is fear (my right knee and left achilles are constantly hurting .. I am afraid another tendon rupture is imminent) and because I’ve been obsessing over some designs that I’ve had in my head.

WEEKS 13, 14 & 15
JULY 28 – AUGUST 17

It’s been a tough couple of weeks. I don’t think much has changed with me physically, but mentally I’m struggling even more with the reality/possibility of being floxed and what the recovery could entail. I was tested for Lyme’s Disease August 14 and am waiting for the results. If it comes back negative, I’ll need to gather some info to bring to my doctor to help me explain FQ toxicity. I’ve been thinking about the things that have happened health-wise since I took levaquin and it’s a little crazy: 

• Random/unexplained joint pain – I associated these aches and pains with the pneumonia I was being treated for, but after the pneumonia was gone, the pain persisted (October ?). I figured it was just me getting older and not being active
• I was seeing physical therapy prior to taking levaquin. I was being treated for shoulder and back pain, but was getting better. A few weeks after taking Levaquin my physical therapist determined that I was no longer making progress, maybe even regressing. An MRI with contrast that showed that I had a torn labrum (right shoulder). I had a cortisone shot after this was discovered. (Late November).
• Marked increase in anxiety levels (mid-to-late December)  
• Started having major issues with reflux and was put on medication (January)
• Tinnitus and hearing seemed to be getting worse (I’ve had hearing aids for a few years, but have only used them sparingly). Wearing hearing aids to all meetings at work is an absolute must now (end of January)
• Started exercising again. The level of DOMS and joint pain was very surprising and concerning to the point that I started to wonder if I should get a test for Lyme’s Disease or other illnesses. (mid-March)  
• Torn bicep tendon (end of April)
• Originally attributed insomnia to having a hard time with the splint and only slept ~4 hrs per night even though I was exhausted.  (May through July)
• Exhaustion, body aches and joint pain getting worse (June)
• Nerve pain on face (mild tingling or burning sensation) – feels similar to when I needed a root canal (June)
• IBS-like symptoms persisting through the writing of this entry (started mid-June, it’s now mid-August) 
• Right knee pain making it difficult to walk at times, occasional left achilles tendon pain (July)
• Random “buzzing” or vibration sensation in quads. I’ve woken up in the several mornings feeling horrible – I’d compare it how I’ve felt after a 20+ mile day on the trail (early-to-mid August)
• I have had tinnitus for about 7 years, but it has also been much worse lately

I have been stress eating due to the stress brought on by this situation as well as my work schedule. I’ve decided to be mindful of what I’m eating this week, but not to worry about IF or getting my workouts in. I feel like I’ve laid a good foundation to jump back into this with both feet next week. Work should get easier and I’ll hopefully start to get some answers about what is (or isn’t) going.

As far as planning goes, I hope to do some meal planning/recipe creation – I want to come up with a few different options for lunch. If I stick to a recipe, I’ll know what the macros are and it will be easier to track. 

Workout-wise, I’ll experiment some with figuring out how I want to combine my PT, HITT and weight training. I have a follow-up with my surgeon next week. If things go well, I’ll be able to start weight training soon. 

WEEKS 16, 17 & 18
AUGUST 18 – SEPTEMBER 7

Items of Note:

• Being treated for a possible tickborne illness
• Just dealing with symptoms and trying to keep up with work. All other goals are on hold. 

Read more here: Antibiotic Toxicity or Lyme Disease?