Sunday, March 19, 2017

Drink to Thirst or By Plan? The Big Guns Weigh In

How do we reconcile the thoughts of two respected, and usually correct triathlon information sources in this important matter?

Last weeks blog, Drink to Thirst?  Hah!  It Doesn't Hold Water was not only fun to write but one able to bring out a more complete picture of hydration.  In short, what works for one athlete, or one subset of athletes, doesn't necessarily work for all.  In this case, it definitely doesn't work for all.

Triathlete Magazine, recently quoted a study of cyclists where some drank to thirst and others followed a regimented drinking plan. "What they found? Prescribed drinking mitigated the impact of dehydration better than drinking to thirst."  They took that a step further and had the athletes rehydrate "to match their sweat loses, what we call individualized hydration protocol, they performed better, they cycled faster and they had lower body temperatures.” This suggests that prescribed drinking to match fluid loss in the heat provides a performance advantage."

We need to keep in mind that the studied athletes were elite level and other factors or variables may be involved as well.

It's been suggested that drinking to thirst is a recommendation that works for the slower athlete.  If you are going a bit faster it may be better to at least consider a plan.  It is good to use early parts of a race when the GI tract is working fine to absorb both carbohydrate and fluid.  Later in the race, even though you may be thirsty, the gut may not absorb as much. Don't drink excessively and use common sense.

Joe Friel, of the Triathlete's Training Bible, in personal communication noted, "Drinking to a schedule is not supported by the research. And the downside is that people come up with a schedule that is unrealistic and then drink themselves into hyponatremia. There have been several such deaths in marathons by back of packers. Even among those who should know better, i.e., a physician who died over drinking G-ade at Boston a few years ago. It’s dangerous to suggest this to people."

I believe both of these rehydration philosophies right and here's why.

A couple years ago, at the Ironman Sports Med course they have at the Royal Kona Resort in Kona the week before the World Championship, having previously been on the faculty, I was encouraged to attend a cogent lecture on Death in Triathlon.  The hydration issue was presented more like a spectrum rather than a yes or no situation.  

The speaker went through those hyponatremic deaths addressed by Joe Friel and common factors seemed be slower runner, cool day, women slightly more at risk than men, fluid overload thru overhydration - drinking excessively.  A little later, the speaker challenged the audience with a question like this.  OK, you’re supposed to, in one sentence, write the hydration plan for Pete Jacobs and Frederik Van Lierde, both winners in Kona, a 12 hr IM finisher and a 17 hour lottery finisher.  (Oh, on an 80 degree day and a 30 degree day.)

 In my mind, since the energy expenditure/ambient conditions are wildly different for this foursome, so would be their race plans.   Maybe Kona athletes are a subset unto themselves.  Potentially more knowledgeable, better experienced with trial and error of what works for them as individuals, that kind of thing.

Pretty ride for Women for tri (on top tube)

The actual percentages of our Kona hydration survey were as we obtained them in the blog, 86% either using a plan or “both.”  (Their words.)  I plan to repeat this study in October by the way.

So, we can see both sides of our street here.  I suppose that leaning more toward the athlete you’d find on the Kona pier at 6:00 am race day planning a 10 hour or less race, having at least the skeleton of an idea of both nutritional and fluid needs wouldn't be surprising.  However, the "everyday competitor" maybe a little newer to the sport or somewhat slower, hydration guidance would be to let thirst rule the day.

Monday, March 13, 2017

Drink to Thirst? Hah! It Doesn't Hold Water.

While strolling through Youtube recently, listening to a little Juke Box Hero by Foreigner,,  I found this below:

“At my school in 5th grade, some IT guy was leaving the school, so my class wrote a parody of this song called ‘Macbook Hero’ since he fixed the Apple Macbooks my school used.  The entire 5th and 6th grade classes sang it to him.  It was truly epic.” 

Following that, another poster noted, “He was a juice box hero!”

A big vote for originality!


Need a long day 2000y challenging work out?  Try this.  After a good warm up, we'll swim 4 X500, each 500 broken into 125's. Now this can be swum two ways.  The first time you try it swim the first 125 in the first 500 fast, next three easy.  The second 125 in the second 500 fast, 1,3,4 easy.  In the third 500, the third 125 fast, etc.

Then, next time you try this set, and you're feeling frisky, swim buddy Colin says, "In the first 500, swim the first 125 fast, 2-4 easy.  In the second 500, the first and second 125's are fast, 3 an 4 easy.  In the third 500, swim 1, 2, 3 125's fast, etc.  

Easy and fast are relative terms.  You want to be able to finish each 500, as well as finish the 2000y set, so set your pace accordingly.  When you finish, there's a real sense of accomplishment.

Drink to thirst. It's all the rage you know. Maybe they first heard it on American Idol

I could dazzle you with statistics.  Suffice it to say that a single hydration strategy is ineffective in the world of triathlon.  The only way for you to know what works best for you is to try various methods in training.  Try different strategies in shorter races.  I know more than one person who brings a bathroom scale to races, gets an accurate weight before the start of the event and also before the post-race (beer) rehydration recording both. The overly simple drink to thirst may indeed work for many, but it absolutely does not work for all. Two Kona veterans, obviously experienced in the sport, come to mind.  

One athlete, his sixth time in the Hawaii race, got to mile 95 on the bike and it was "either sit down or fall down.  I was dizzy to say the least."  He got this far on the bike, stopped at the mini med tent where Nurse Alice sat him down with a big glass of cool water.  30 minutes later, after his 3rd glass, he felt great, thanked Alice profusely and finished race. The next year he took a bouquet of flowers to the Kona hospital operating room where she worked to say thanks again.

Our 2nd athlete, with only one Kona slot available and a faster runner behind him as he approached the finish of what could be his first ticket to Hawaii, notes "I was pushing hard."  He won the age group and Kona slot.  "You can see that guy in my finisher's photo. He was 11 seconds behind me."  Looking a little grey, then a little light headed, he made the med tent and was immediately hooked up to an IV.

If it's assumed that those that qualify for Kona might be the most experienced in our sport what do the Kona qualifiers do?  It's an either/or question right?  Leave it to triathletes to come up with a third option of course.  So, this past October, 14% said they drank by thirst and 70% use a pre-race designed plan.  This leaves 16% who told us "both."  Thus, despite the teaching and preaching of a number of authorities, this group, which might be the finest and fittest on the planet that particular day have learned - likely though screwing it up - that for them some type plan will give them the highest chance of doing well in the endurance triathlon environment. 

Susan Lacke of Triathlete Magazine wrote the following:

Drink to Thirst or Drink on a Schedule?


"Drink to thirst is a recommendation that works for the slower athlete.  If you are going a bit faster it is better to go with a plan.  It is good to use early parts of a race is working fine to absorb both carbohydrate and fluid.  Later in the race, even though you may be thirsty, the gut may not absorb as much.  Don't drink excessively and use common sense.  The goal should be to lose a little weight (2 to 4 pounds) at the finish line. You definitely want to avoid weight gain, which clearly would be a sign of drinking too much.  In hot environments dehydration can definitely be a very important factor. Don't forget that good hydration starts before the race, and hydrate well in the days leading to your race."

Enough said.

Sunday, March 5, 2017

Exercise More, Drink More Alcohol? They Talking About You?

 Whenever reassembling your bike, you'll get to a part that uses unique fasteners.  You will drop at least one. It will ping, tink and plunk off of 3 or 4 surfaces and then disappear from the space-time continuum!

Later, after you've had a new one FedExed in, at a cost near the value of your LBS entire inventory, the old one will turn up.  Often just after it has punctured your new fifty dollar bike tire.
                                                                                                    Thx, Mike McNessor


For some reason, it never occurred to me that after a swim workout I always put my gear back in my swim bag in the same order.  Seems that way.  Fins first, then snorkel, paddles, shampoo, etc. cause that's the only way all that stuff'll fit.  

BUT, it's become my 4X's/week transition practice.  Really, I hit my watch, stuff the bag and dress, while timing how long it takes me to get the locker room door.  I'm fast, but very orderly, because just like in a race, I've put everything in it's usual place and through practice, practice I know where that is.  It's fun.  Give it a try.  

You know you need the practice, we all do.

I read this last year after we did our no-alcohol January.  After thinking about it briefly, thought it was exactly correct.  Many of my best friend athletes also aren't shy about their relationship with bourbon or beer.  Read on.

People who exercise more also tend to drink more (alcohol)

Michael Bierer, MD

Michael Bierer, MD
I take care of adults in primary care and I treat addictions. So when I was sent a journal article titled “Daily Physical Activity and Alcohol Use Across the Adult Lifespan,” it piqued my interest. This paper describes the drinking and exercise habits of 150 largely white, low-risk, community-dwelling adults (meaning it didn’t include people who were in the hospital or a nursing home) in central Pennsylvania. In this study, volunteers used a smartphone to record their daily drinking and exercise habits in 3-week blocks. This smartphone technique made it possible to get good information and to analyze daily variations for each individual. What is clear from the analysis is that people tend to drink more alcohol on days when they exercise more. This is true whether they’re young, old, male, or female.
This is not a study of problem drinkers or risky drinkers, nor of people with alcohol use disorders (what we used to call alcohol abuse or alcohol dependence). This is also not a study of the effect of an intervention to change lifestyle behavior. That is to say, this study does not tell me what happens if I advise a patient to exercise more or to drink less. The study also does not suggest that if you decide to exercise more, it’s likely you will drink more. It is solely an observational study, not a study of change over time.
These are healthy people in general. The mode and median number of drinks per day was zero. That is to say, among this group, there was no drinking at all on half or more of the days recorded. So the results may have been different in a different population (for instance, a more economically challenged or urban population). The results of a similar study, I expect, would be different were it conducted among a high-risk group; for example, people working to drink less or exercise more might engage in a “virtuous cycle” whereby the enjoyment of a sense of more energy, less fatigue, or better physical strength would provide the power to make further healthy choices. Increased exercise might be linked to decreased drinking in this kind of population.

The challenge of making — and keeping — healthy lifestyle changes

What I’ve observed in my practice is that significant changes in health-related behaviors travel in packs: people who adopt healthier drinking habits (for instance, reducing their intake to one drink per day if female or two per day if male, on average) also get off the couch, walk more, lose a pound or two, and generally pay more attention to their health. The challenge for them — and me — is to sustain these healthy changes.
There is a lot of seriously unhealthy sedentariness among adults in this country. Many people do not move around this planet under their own steam other than to go to the car, fridge, or couch. No joke. Hours are spent every day sitting in front of a lit screen. We come home from work, having been typing and mousing, straining our neck and back and keyboarding muscles, only to collapse on the couch to click around on the remote. Maybe we’re tense, so we have a drink. When it’s time to go to bed, we’re not physically tired, so we’ll have a few more drinks. So we won’t sleep efficiently (because alcohol disrupts healthy sleep cycles). And then we’ll do it all again the next day.
Making even a small sustainable dent in this cycle can be challenging. The positive effects may not be evident quickly. Only patience and commitment are rewarded. But the rewards, accumulating bit by bit, can be great.

A few ways an “exercise prescription” can make a difference

Although this study wasn’t intended to look at addiction, I’d like to mention the role of exercise in the treatment of mood disorders and addiction. There is evidence that aerobic and muscle-building exercise have positive effects on depression; research is ongoing on their effects on addiction. The attractive aspects of a sensible “exercise prescription” include its relative “safety profile” (meaning lack of negative side effects), its known positive effects on brain health, and the ability to customize it to whatever a person’s favorite activity might be. Of course, pacing oneself is paramount so as not to over-train or sustain injury. Some of the changes in the central nervous system due to exercise — for instance, increases in some dopamine activity (similar to the effects of intoxicants) enhanced blood flow, and glial cell proliferation — may also be related to improvements in mood and cognitive function.
People who have substance use disorders often suffer from a lack of joy (other than the chemical high) and from isolation. Isolation both permits the use of drugs or alcohol without bothering others, and may drive the use of them as a salve for loneliness. So combatting isolation is part of addressing addiction. Exercise (in groups) is a pro-social activity: the sense of community, and the positive emotional impact of interpersonal contact (that is, the simple joy of being with others), may be essential ingredients of getting — or staying — on the road to recovery.

Sunday, February 26, 2017

Stupid Triathlon Mistakes, Be Prepared Race Morning

"I've been told that swimming is a wimp sport. I don't see it. We don't get timeouts in the middle of a race, we can't stop and catch our breath, and we can't ask for a substitution."      Dusty Hicks

Just looks fast doesn't she? You bet.

A physicians comment on supplements: "Health food stores are wonderlands of promise.  If people want to burn fat, detoxify livers, shrink prostates, avoid colds, stimulate brains, boost energy, reduce stress, enhance immunity, prevent cancer, extend lives, enliven sex, or eliminate pain, all they have to do is walk in." 
                                                          Paul Offit, MD

This man's job is to prevent female athletes from inadvertently going into the men's changing tent. Despite an orientation the day before, after exiting the swim, at least 20 women tried!  It's Kona.


I was privileged to be in charge of pre-race bike check in Kona.  Maybe next year they'll get someone who really knows what they're doing!  It really went well, mostly thanks to the prolonged efforts of a hard-working group of dedicated volunteers.  We had 6 hours to check-in over 2300 athletes, age groupers and pros alike. 

The desire to race Kona is intense.  So many try for so many years and come up just short in their qualification race.  Each slot in the race is valued.  In fact the Ironman Foundation conducts an annual eBay auction for 4 of them and bids are upwards of $50,000 in some cases.

Thus, this is the most important athletic day of many if not most of these athlete's lives.

So, if it's of such a level of importance, why do some seem so unprepared?  Each receives a many paged set of instructions that has been developed over 38 years of racing leaving little if anything to question.  But some still show up for bike check-in without a helmet, without their bike and run bags, no number on their helmet, in need of bike repair, etc.  I suppose in any large group you'll have a few who make odd choices.  It's just that every athlete who toes the line has put in such effort to get here, it would be a shame to have this opportunity go awry for something so preventable.

Other athletes get nabbed by by the refs for drafting. While the rules are clear, on a rolling course like the Queen Ka'ahumanu Highway course in Hawaii, with so many athletes of similar ability, there's an ebb and flow, speeding up and slowing down, that's it's pretty hard to follow the letter of the law.  Just ask these three athletes I happened to notice toward the end of the race while working as a course guide on the pier.  The dreaded red slash of a violation.

In short, the take home lesson is clear.  Preparation for this race, for any race, is the key to success.  Perhaps like many things in life I suspect.  Check, recheck and then check one more time before you leave home that you have everything. (Have I ever arrived at the race site only to discover that my bike shoes were still at home?  Yes.  But, as importantly, will I ever do it again?)

Can you preview the course the day before?  Maybe a short swim at the venue then drive the run/bike course?  Have supper planned (need reservations?) weeks in advance and get to bed early with everything you'll need for race morning out and ready.  

Get to the event site way early, check in and get your transition situated.  Walk from water's exit to you bike slowly, mentally marking the path, picking a reference for your row of bikes.  Do it again.  Walk from your bike to the T1 exit.  Do it again.  This is enough, making the point that before the race cannon sounds you know everything you're going to do and every place you're going to go.  It will pay off at the post-race picnic when yours is one of the names called for an age group podium finish.  Your reward. 

Sunday, February 19, 2017

Triathlete's, Donate Blood. One Day the Need Might Be Yours!

The Athlete's Guide to Donating Blood

I wrote this for Ironman a couple years ago. With racing season still a ways away for those of us in the northern part of the country, we can still donate a unit and be back to full strength by Spring.  Even if you've never done this, when you walk out the door of the Red Cross or local blood bank after your donation, you have this same sense of pride, self-worth, that you do after a race. President's day is tomorrow and many have the day off. Why not put this at the top of your to do list. You'll be glad you did.
Athletes guide to donating blood
Nurse removing the transfusion

As professional triathlete Jordan Rapp knows, blood on the shelf saves lives. Here's a breakdown of the whys and hows.

Jordan Rapp is a professional triathlete and one of the best long-course athletes in the sport. For those of you who don't know, he had a horrific bike accident when he was involved in a hit-and-run crash in 2010.  He had multiple fractures, abrasions, lacerations and significant blood loss. He was injured so badly that he was initially placed in the intensive care unit and had significant blood loss requiring transfusion. "Two pints of A+," according to a recent email from Rapp.

"Blood on the shelf saves lives," says Beth Hartwell, former Blood Bank Director at the Memorial Hermann IRONMAN Sports Institute. "Each donation can help save three lives." Dr. Hartwell looks upon those who give blood as her "heroes. Their blood is going to an anonymous person in need. How cool is that?"

An athlete's concerns
With our healthy pedigree, triathletes are the perfect candidates for donating blood. It doesn't matter if it's the Red Cross or your local blood service—giving is the goal. Did you know that less than 10 percent of the population gives blood annually, for the benefit of 100 percent of us?

As an athlete, your first concern is how long it takes to return to pre-donation blood levels. That depends on specifically what you donate. For example, scientific studies have shown that if you donate plasma, the liquid part of the blood, or platelets, the cells that help blood clot, but not the oxygen carrying red blood cells, you’ll be back to normal in 48 hours. Even if you give whole blood (including the red blood cells), within a week or two you shouldn't see a difference in your training from pre-donation, although a 100 percent correction in your hemoglobin level will take about five to seven weeks.

There are many reasons not to give blood, such as a needle stick, a few days of sub-maximal training, rumors from the uninformed, to name a few. But there's never a shortage of reasons to give. Blood is used for patients getting dialysis, heart surgery, children with cancer, trauma victims, etc. Think about how frequently you read about one of our own colliding with a vehicle, or another cyclist. And blood is always available when we need it.
Your first time: What to expect 
So what happens when you, an athlete, go to donate for the very first time? You'll register and answer a few confidential questions to make sure the donation is right for them and right for you. They'll take your pulse, temperature and blood pressure. If this were a triathlon, consider that the swim. T1 is getting your arm really clean and prepping it for the blood draw. The bike, actually having the collection bag fill, takes only a few minutes—faster than some of us complete a an IRONMAN transition! In T2 they wrap your arm with a colorful "Why yes I did just give blood, thanks for asking," band. Then you run to the snack area where you can have unlimited Oreos, Fig Newtons, and juice, and in 10 minutes you're back on the sidewalk ready for action—a new PR for sure.

Imagine how good you'll feel doing something for others. And it's only April—many of us aren't even in racing season yet, making it an ideal time to give. Dr. Hartwell says that the infrequent donor will be ready to race at 100 percent in two months, the regular donor in three. And for those of you who are afraid of needles, the small prick of the skin is outweighed by the accomplishment you’ll feel at the end. Did I mention the Oreos?
So get out the phone book and find the nearest place to give. You'll be glad you did. Just ask Jordan Rapp.
John Post is a six-time IRONMAN World Championship finisher and the medical advisor for TrainingBible Coaching

Athlete comments from the website that you may find encouraging.
Karen Lethlean ·
After giving blood on a Monday, I attended my usual intense swimming training on a Tuesday afternoon, and fell very ill. When I next talked to the Red Cross they were adamant that I should have been told that any form of physical training within 3 days of donating blood is not advisable. Now, forewarned I make sure that either I am on a rest phase, or able to take a few days break before committing to donating blood. But aside from taking that kind of precaution donating can be a mini health check you find out how are your iron levels going.
LikeReply2Apr 1, 2014 7:37pm
Katerina Richardson
I did bike/run bricks same day no problem. Yes, slower but it's ok. Weight lifting is a no-no, though.
LikeReplyOct 3, 2016 9:00am
Wayne Jordan ·
Option is to donate plasma rather than whole blood. I am AB+ so they seem to prefer the plasma too. Recover a whole lot quicker too
Denise Hiller ·
Karen, NO strenuous exercise a full 24hrs after donating blood. Remember to hydrate well 3 days prior to your donation
Donald Oswalt ·
Thank you for sharing this. I am in training for the Boston Marathon and triathlon season and opted out of giving blood last week because I did not want it to effect my race performance. Now I know that about the recovery time but, I will wait until after Boston and give.
Katerina Richardson
I have been a regular blood donor for several years. Your body adjusts. Just take care of it.

Originally from:

Sunday, February 12, 2017

What Every Athlete Needs to Know Regarding Pain Relievers

Save the world, win valuable prizes. Be a triathlete.

This months meeting of our County Medical society was on pain relievers.  Things have turned nasty with the current opiod epidemic and each of us can help in some way.  Very enlightening.  Orthopedic surgeons prescribe 7% of all narcotics and have been given tools to head toward 6%.

I wanted to have some kind of reference that triathletes could turn to since pain, and pain relieving efforts, are so common to our sport.  I found this from Harvard to show us the difference between Tylenol (acetaminophen) and anti-inflammatory drugs (NSAIDs), why generic drugs are both cheaper and as effective, etc.

This might be one of those that you'd want to print off for reference, for maybe even next year, should you find yourself looking for information.


The Family Health Guide

11 things you should know about common pain relievers

Understanding the differences between acetaminophen and NSAIDs

Once upon a time, easing pain was relatively simple: take two aspirin and call the doctor in the morning. Now there are many pain relievers to choose from (see "Pain relievers at a glance").
Willow bark was one of the earliest painkillers. Extracts or teas of willow bark have been used to treat fever and pain for more than 2,000 years. Unfortunately, the active ingredient, salicylic acid, is very hard on the stomach. In 1897, a German chemist working for the Bayer Company found a way to modify salicylic acid so it was less irritating to the stomach. The compound he created, acetylsalicyclic acid, was called Aspirin. It remained the premier over-the-counter painkiller until the development of acetaminophen in 1956 and ibuprofen in 1962. Since then, more than a dozen others have come onto the market.11 things you should know about common pain relievers
The two main categories of commonly used pain relievers are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin and drugs known as COX-2 inhibitors. Many are available over the counter; some are available by prescription only.
Picking the right one can be enough to give you a headache! Here are 11 tips to help you navigate the pain reliever aisle.
1. What's the difference? NSAIDs ease pain, lower fever, and turn down inflammation. They can be very helpful for pain arising from inflammation-related conditions such as arthritis. Acetaminophen eases pain and fever, but does not affect inflammation.
2. NSAIDs revolutionized the treatment of pain. But as is the case for all drugs, they have some drawbacks. Regular use of an NSAID has been linked to an increased risk of heart disease. All NSAIDs, including the newer COX-2 inhibitors, can be hard on the stomach, causing ulcers or gastrointestinal bleeding. These problems tend to emerge only after long-term or heavy use. Don't be scared about taking the occasional NSAID for a headache or aches and pains.
3. What applies to NSAIDs doesn't usually apply to acetaminophen. Acetaminophen is not an anti-inflammatory agent, and eases pain in a different way than NSAIDs. Acetaminophen is easier on the stomach than NSAIDs, but has its own set of problems.
Acetaminophen can damage the liver. Three thousand 250 milligrams (mg) a day — about 10 regular-strength acetaminophen tablets — is considered the safe upper limit, but that might be too much for some people. Large doses are the main risk, but there are reports of people developing liver problems after taking small to moderate amounts of acetaminophen for long periods of time. Drinking alcohol while taking acetaminophen can also cause liver damage.
Acetaminophen is an ingredient in many over-the-counter cold and headache medications. Some people may be taking more of the drug than they realize because of these "hidden sources."
4. COX-2 inhibitors — a new addition. A new family of NSAIDs, called COX-2 inhibitors, was developed in the 1990s. They were supposed to be better than "regular" NSAIDs: a new generation of medications that would relieve pain but spare the gut. Although these drugs were a bit easier on the gastrointestinal system, it turned out they weren't especially heart friendly. The first COX-2 inhibitor, rofecoxib (Vioxx), was pulled from the market in 2004 after it was linked to an increased risk for heart attack. Valdecoxib (Bextra) came off the market a few months later. A third COX-2 inhibitor, celecoxib (Celebrex) has stayed on the market. At doses of 200 mg per day or less, it doesn't appear to pose any greater heart attack risk than other NSAIDs.
5. Go generic. Generic over-the-counter pain relievers are less expensive than their brand-name counterparts, and work just as well.
6. Help for NSAID-related stomach woes. If you need to take an NSAID every day for arthritis or other chronic condition, and the drug bothers your stomach or you're at high risk for gastrointestinal complications, taking a proton pump inhibitor can offset this side effect. Proton-pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), or rabeprazole (Aciphex).
7. Take your daily aspirin before taking an NSAID for pain relief. If your doctor has recommended that you take a daily low-dose aspirin for your heart, and you also take an NSAID for pain or inflammation, timing is important. NSAIDs block the ability of aspirin to make blood platelets less "sticky." This helps prevent the formation of clots inside the bloodstream, which can cause heart attacks and strokes. One strategy is to take aspirin first thing in the morning, then wait 30 minutes before taking an NSAID. If you take an NSAID first, wait eight hours before taking aspirin.
8. Beware of blood pressure increases. All NSAIDs, including the COX-2 drugs, tend to boost blood pressure. The effect is strongest and happens more consistently in people who have high blood pressure already and are taking medication to control it, but there's evidence that people with normal blood pressure are also affected. Acetaminophen, in high doses and among women, has also been shown to cause small hikes in blood pressure.
9. Don't go cold turkey. If you take an NSAID regularly, don't stop suddenly. Sudden withdrawal makes blood clots more likely to form, and so increases the chances of having a heart attack or stroke.
10. Beware of kidney woes. NSAIDs, including the COX-2 drugs, can be hard on the kidneys and, in extreme cases, cause kidney failure. Signs of kidney disease include unexplained nausea or vomiting, loss of appetite, fatigue and weakness, changes in urine output, persistent itching, and other so-called nonspecific symptoms.
11. Genes matter. There is a lot of individual variation in how people react to pain relievers. It may take some trial and error to find the one that works best for you.

Over-the-counter pain relievers at a glance

Generic name
Brand names
Anacin, Pain-Eze, Tylenol, and 40 others; also in more than 150 combination products)
Not an NSAID; doesn't cause stomach problems like NSAIDs; common ingredient in headache and cold medicines; large amounts can cause liver damage.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Anacin, Bayer Aspirin, Bufferin, many others; also found in scores of combination products
Technically an NSAID, but its anticlotting properties make it unique; the development of alternatives and high risk of gastrointestinal bleeding mean it's not used as much today as a pain reliever.
Advil, Motrin, Nuprin
Favored because it acts quickly without staying in the body too long, so per dose it has a lower risk of causing stomach and kidney problems.
Aleve, Naprosyn
Longer acting than ibuprofen.

Prescription NSAIDs at a glance

Generic name
Brand name
Available as a generic?
Arthrotec, Cataflam, Voltaren, others
Ansaid, Ocufen
Indocin, Tivorbex