DrJosh Splenomegaly-Hepatomegaly&Running

[Vitodelapata]

Hello, first let me say that I saw you post to the rec.running group so I thought I would take a
chance with this post.

First I am 46 years old. I have been running for about ten years now, 28 miles a week with a 10
mile long run. My diet is mostly vegetarian, although I do take in lots of low-fat diary products,
for protein. In February of last year, I developed chronic diarrhea and went to a doctor for dx.
The dx was HCV. To my knowledge, this was contracted 29 years ago, using IV drugs. My blood tests
showed genotype 3, the least aggressive geno and a viral load of 97,000 per milliliter of blood,
very low for HCV. My liver biopsy showed stage 2, grade 2-3 fibrosis and minimal scaring.

TX began in June with 24 weeks of Pegylated interferon and ribavirin. Very nasty stuff!! Upon
completion I was tested and the HCV was below 10,000, the lowest possible test for HCV. However,
I was having pains in both my right and left sides. An ultra sound revealed splenomegaly-
hepatomegaly. The radiologist dx was minimally enlarged. Right now we are waiting on some blood
tests to determine the cause and possible tx. Right now the pain comes and goes.

Now my question is related to running and these conditions. I am currently up to 20 miles a
week, at about a 7:30 pace on long runs and plan on going higher. All of my runs involve hills.
There is not a flat street in the mountains where I live. My goal is to enter a marathon and
complete it. The pain in my sides comes and goes. Nothing serious. Am I doing harm to myself by
continuing my exercise program? You being a doctor and a runner I am sure could relate to my
condition. Having been sedentary for almost six months of tx, I could not even walk up the
stairs in my house with out running out of breath and now I am ready to run again. My doctor
seems cautious about recommending such a vigorous exercise program. Running has been a life
saver for me and helps me stay focused. During my runs I feel fine, no pains, not out of breath
and strong as a 20 year old. My decision is to continue running, unless I developed severe pain.
Of course, I am just asking for the pros and cons of running in this condition, not your advice
or council. That costs money. :-)

--
R.R
rrockslide"at"earthlink.net

[Josh Steinberg]

VITOdelapata wrote:

> Hello, first let me say that I saw you post to the rec.running group so I thought I would take
> a chance with this post.

Well, I'll give it a try, but this is a very tall order!

>
> The dx was HCV. To my knowledge, this was contracted 29 years ago, using IV drugs.

A sadly common route. Glad the drugs are in your past, sorry the Hep C virus is in your present.

> Treatment began in June with 24 weeks of Pegylated interferon and ribavirin. Very nasty stuff!!

Y'got that right! Sorry you had to endure it.

> Upon completion HCV was below 10,000. However, I was having pains in both my right and left sides.
> An ultra sound revealed minimally enlarged splenomegaly-hepatomegaly.

Who is to say the minimally enlarged liver and spleen are causing the pain? Maybe, maybe not.
Frustrating that there is not a lot of certainty in medicine.

> Right now we are waiting on some blood tests to determine the cause and possible tx. Right now the
> pain comes and goes.
>
> Now my question is related to running and these conditions. I am currently up to 20 miles a
> week. The pain in my sides comes and goes. Nothing serious. Am I doing harm to myself by
> continuing my exercise program? You being a doctor and a runner I am sure could relate to my
> condition.

Ha! I can relate to the absolute craving to return to activity when laid up with an ailment -- on
that I'm with you 100%. BUT I have no experience with the truly unique combination of a Hep C
patient, vague upper abdominal pain of unclear origin, enlarged liver and spleen after interferon,
and a strong desire to run! I'm sure your liver specialist, who has dozens of Hep C patients in all
stages of treatment and health (whereas I have but a handful), would have more advice, yet would be
advising you purely from logic, caution, and guesswork, since I'm sure he doesn't have 30 others
just like you to know exactly how all those factors work together. I doubt any world expert would
have 30 such patients either, although you never know.

However, you and your doctor could and should discuss the issues at hand and negotiate a way to go
forward. I bet he (or she -- I know 3 female gastroenterologists) might make a plan such as to see
how your body handles escalating exercise. If I were your doc and had all of his/her advanced
knowledge special for Hep C, we might plan to let you exercise at escalating levels of duration and
intensity and figure out a way to monitor how your body handles it, such as following your pain
level, your liver function test levels, your abdominal sonogram pictures of the liver & spleen
swelling, etc. I can't think of a reason why running would be bad for you, but I may be way off.
Your doc may know something very crucial and clear about why not to exercise vigorously. But if not,
you may be able to work out an approach to see if your individual body can go forward with the
exercise you desire (which the doc probably desires as well for your overall health).

Hope that's somewhat helpful.

-- Josh Steinberg MD, Syracuse

[Vitodelapata]

Thanks for the response. My next appointment is in February and my gastro, a very knowledgeable and
understanding lady, has encouraged my running. Of course, she might not recommend so many miles, but
I feel great. My concern was that something might be injured from the constant pounding on the
pavement. So far nothing has ruptured yet. Using restraint, I may just stay on the course I am on,
until I get my blood work back. The uncertainty of medicine is understandable. But at times, the
weight of all the patients on the medical system is to much for doctor and patient alike. It is easy
to fall through the cracks. No disrespect intended. Truly, I am thankful for medicine and the years
it has added on to my life. Thanks, again for the response.

--
R.R