127. FOR ATHLETES ONLY

If you were an athlete or very active young or middle aged person, you will resume your trajectory only if you have experienced a mild reaction. Endurance will be severely curtailed by an intermediate reaction. After a severe reaction your athletic activities are completely wiped out for the next five to seven or more years, and only then will you be in the position to attempt very physically demanding activities depending on the level of permanent damage in joints and tissues that you have sustained. In any case a severe reaction means the abrupt end of an athletic existence.

If your activities prior to the floxing were endurance athletics or vigorous professional sports, you will likely not be able to resume them ever again without any joint pain at all if you experience an intermediate or severe reaction.

There are very characteristic musculoskeletal injuries caused by quinolones. Some times they are not the worst side effects, but are big limitations for sports/physical activity and cause enormous distress in young and healthy athletes.

Cartilage is always affected. In intermediate reactions it becomes softened and some get inflamed or start causing problems; for instance in the spine, hips and knees. In severe reactions cartilage becomes very eroded, and show up as different stages of osteoarthritis, from mild to advanced. Most affected areas are the shoulder joint, hips, knees (patella, meniscus specially), and ankles, but also neck and spine.

Look at some of the musculoskeletal injuries that young and athletic floxed persons developed after unnoticed reactions to short courses of quinolones. In all cases it has been demonstrated that they were quinolone-induced toxic reactions, because after re-exposure to quinolones they increased ten to a hundred times-fold in intensity, whereas no one had had any of them before.

Epicondylitis in tennis or racquetball players. Diagnosed as an overuse syndrome or defective techniques or equipment. In fact is a toxic tendinitis. Can become permanent.

Trochanteric bursitis (pain in the very tip of the hip bone). Diagnosed as tight belt syndrome or resting-on-the-side pressure. Another toxic bursitis (inflammation of the bursae, a sort of synovial bag present in most joints to help with the movements.

Dull pain with stabbing pain episodes on the medial (inner side) or lateral (outer side) tibia, or ankle. Diagnosed as shin splints in runners and tennis players. In fact it is a neurologically rooted, tendon collapse due to the dysfunction of one or more of the tibialis muscle complexes. It is a motor nerve neuropathy (toxic).

Very commonly athletes are diagnosed as having plantar fasciitis (pain in different sections of the sole of the foot), due to supposedly hyper- or over-pronation or supination, shoe defects, leg length discrepancies, overuse, etc… It is always a toxic degradation of the muscle-tendon complex of the fascia, especially caused by neuropathic dysfunction of the anterior and posterior tibialis tendon groups.

Hamstrings pulls or sciatica are diagnosed when pain inside the hamstrings is present. This pain is not responsive to any conventional form of therapy. It is a toxic femoral neuritis (sensory-motor type). Frequently, femoral neuritis takes places in the same leg as the lower leg neuritis (ankle, tibialis). In intermediate reactions, hamstrings get involved, and to a lesser extent the antagonist muscles of the thighs. But in more severe reactions, both hamstrings and quads are affected equally and profoundly.

Posterior tibial and toe flexor tendon insufficiency is in reality a result of nerve dysfunction coupled with overuse and neuropathic lack of peroneal function. It is far more frequent than achilles tendinitis.

The lack of flexing strength in some toe flexors is always a cause for concern, because it can indicate a partially irreversible injury in the peroneal and tibialis nerve (axonal).

Achilles tendinitis is diagnosed hundreds of times. It is unnecessary to describe the real kind of injury this is, as it is a very, very distinctive class effect of all quinolones. It can cause ruptured tendons quite easily. In most cases of intermediate reactions, nodules along the tendon can be palpated and well-trained operators can diagnose scarring, tearing, engrosing and fibrosing of irregular tissue from MRI images. According to some doctors, less than one in ten tendon ruptures caused by quinolones are linked to the antibiotic, because most of the ruptures take place some months after completing the treatment. The floxed persons whose experiences have formed this report, met doctors that had treated four physicians with ruptured tendons caused by quinolones. Only one bothered to report it to the surveillance system, or MedWatch.

A cause of total collapse of one or both legs with inability to walk in severe reactions is peroneal nerve toxic motor neuropathy, very difficult to detect on the electromyograms. The lack of function of the peroneal-tibial nerves causes the surrounding muscles to experience an underperformance of their tasks, and therefore submit the tibialis and flexors tendons to increased elongation and stress, ending up in very severe injuries that normally take more than 3 years to heal. They are incorrectly diagnosed as anterior tibialis tendinitis/atrophy.

Knee pains: lateral, medial and backside. Pains in the knees caused by quinolones are of many different kinds. Neuropathic pains with a throbbing nature, increasing at night; more diffuse generalized pain due to cartilage deterioration and general tissue necrosis; localized and migrating pains due to enthesitis (tendon insertions), tendinitis and inflammation of bursaes and synovial membranes.

Back problems are innumerable. The lack of strength in all muscles, the loss of cartilage integrity, and the nerve inflammations cause myriad symptoms and pains that can be confined to the back, shoulder and neck areas or radiate and refer to other parts of the body.

Some of the most debilitating lateral upper leg pains are diagnosed as iliotibial band syndromes. In fact they are a truly mixed toxic condition that causes: enthesitis (irritation of the end attachments), neuropathy of the femoral nerve lateral branches and gluteus nerve that control the band, a fibrotic myositis with muscle damage that loses flexibility and a fascia disorder that causes the band to adhere to the adjacent muscles due to deterioration of connective tissue.

Iliopsoas tendinitis is diagnosed as the result of overuse because it becomes weak in most upper leg motor neuropathies. It is perceived as pain in the anterior groin, and tenderness at touch, along with some gluteus atrophy- causes an abnormal gait of being bent forward at the waist.

The damage to all the collagenous tissues of the body can also affect all the inner joints in hips, knees and ankles. Hips are targeted by quinolones in a lot of cases.

For the same reason as stated above, many floxings end up with torn or ruptured rotator cuff tendinitis (shoulder) as well as osteoarthritis of the shoulder joint.

At the presentation of the floxing symptoms and the uselessness of conventional protocols, the most well trained sport physicians will suspect that something abnormal is going on. Then the floxed person could be referred to a rheumatologist and diagnosed as suffering from myopathies of several types, myositis, polymyositis and other disorders that have already been mentioned before.

The acute muscle pains and joint stiffness after exercise can lead to an incorrect diagnosis of lactic acid building up, that can be dismissed after the corresponding tests do not indicate this.

The worst musculoskeletal reactions are always accompanied by muscle atrophy, difficult to see aparently, save for the sheer lack of strength that appears.

A floxed person with an important intoxication cannot get muscle mass irrespectively of how much he/she works out at the gym.

If you have been a strong, endurance athlete and are in your thirties or forties, your doctors will not be prone to listen your complaints about this sudden and strange intolerance to exercise, lack of recovery, increased pains after exercise, loss of strenght, inabilitiy to gain muscle and will try to argue that it is due to the natural aging process--something that you clearly know is not the case.

128. FLUOROQUINOLONES AND SPORT ARE NOT COMPATIBLE

Every athlete with a tendinitis, multi-focal muscular or neuromuscular pains or overuse syndrome, should be asked whether he/she has taken quinolones at least during the last year, in order to assess the diagnosis properly.

With normal fluoroquinolone treatments of one-week’s worth or so, the strongest athlete will only experience a progressive diminished capacity to recover after exercise. He will feel some soreness and stiffness some hours after his exertions. He will tend to think that it is normal since no other symptoms bother him and his soreness clears up in a day or so.

With a few such short treatments of quinolones over the years, the athlete will become markedly rigid, especially in his legs. Unless he practices stretching too, he will not pay much notice either and the problem will remain unnoticed.

If an athlete takes a prolonged course of fluoroquinolones, one of his main groups of nerves (mononeuritis) can become affected, for instance the tibialis anterior and the peroneal, or the whole sural nerve (please consult an anatomy text if you have difficulty in identifying some parts of the human body that are used in this report). Then, the corresponding muscle gets wasted in a matter of a few weeks. The athlete does not realize it but his plantarflexion and his ankle dorsiflexion, respectively, become impaired. So all the stress needed to stabilize the ankle is posed on a specific group of tendons (the tibialis posterior and flexor hallucis longus for the pronators), that suddenly become completely crippled and on the verge of rupturing. The athlete and their doctors become alarmed. The doctor orders some 3-phase scans and other diagnostic procedures and reaches the wrong conclusion that the athlete suffers from asymmetries, overuses, leg length discrepancies, structural flaws and/or others, that perhaps do exist, and have existed always in the floxed patient, but they are not the cause of his/her sudden pathologies. Conventional treatments are instated. The only thing that baffles everybody is the strange and disturbing long duration of the pains and limitations. Nobody has a clue about the real cause and the quinolones once again are not considered as the true cause of this toxic debilitating physical damage.

Notice that intermediate reactions predominantly affect distal motor neurons (the parts that are more distant from the trunk of the body) like ankles and wrists plus all the joints submitted to overuse, obviously. Severe reactions also affect proximal muscles and nerves (knees, hamstrings, quads, gluteus, biceps, triceps, shoulders, neck).

If an athlete has suffered a severe reaction, he loses the functionality of several joints or muscles. During the first months he can feel pains and the inability to exercise due to failure of one or two joints. But as the months pass by, more joints add to the list of incapacitating pains and limitations in range of motion. The athlete gets shocked because the list of joints involved is continuously increasing for up to 18 months and includes joints that he always had considered rock solid, without a single complaint of the slightest entity in the past. Normally, ankles, knees, hips, elbows, wrists, back, neck and shoulders are involved.

It is a tragedy for the athlete. All his joints snap and make a lot of noise when moving. Soon his knees and/or hips start grinding, clicking and cranking, normally a sign of the erosion and destruction of the cartilages. MRI’s prior to and post quinolones in several athletes have shown those changes clearly, even in athletes that have refrained from exercise post-floxing.

In severe reactions there is a marked weight loss, mainly muscle. Workouts can do nothing to help recover the muscle mass, nor can any supplement help, because the cause is neurological. If workouts are especially unable to recover or build up muscle mass as they were before, and this situation lasts for long, you can be facing permanent sequela in terms of physical damages.

In severe reactions sports in cold temperatures are not advised because most likely the athlete has some toes or fingers affected by a sort of occlusive vasculitis (non auto-immune issue in floxings, but rather a problem with vessels), and the tip of some of his fingers/toes become abnormally irrigated, so with temperatures hovering around freezing his tips can turn numb, pale, and blue and he risks losing some of them to frosbite (necrosis). Again, if the floxed person experiences some repetitive hits to his affected fingers, recovery can take a few additional years because of the superimposed damage to the vascular system caused by quinolones, and subsequent mechanical injuries.

After a severe reaction it takes between 3 years (for people in their thirties) and more than 4 years (for people in their forties) to feel that their body is starting to recover. For some others this time will never come. You will notice that the time has come when all your muscles gain strength when you exercise them. At the peak of neuropathic damage, exercise does not invigorate muscles because there is an axonal neuronal injury not yet re-enervated. But, if one is lucky enough, at around the third year, neurological pains in joints (hips, knees, gluteus, hamstrings, ankles) can be diminished if the athlete works out the antagonist muscles. Few people realize this key fact. Some times that can only be done by means of electrical stimulators at the beginning of the recovery, followed by isometrics and ending with full-scale workouts.

Only by then will the athlete be able to start a slowly progressive program of exercises as long as he feels that his flexibility returns and also his overall recovering capacity and level of pains are improving. The athlete will also have to fight to survive the rest of symptoms affecting the heart, eyes, sinus, digestive system, insomnia, neuropathies of all kinds, etc…, because as you have read above, nearly all the organs of the body suffer disabling toxic injuries.

Every trainer, orthopedist, coach, physiotherapist and professional whose activities are related with sports should be aware of these devastating effects of the quinolone antibiotics, and advise their pupils to ask doctors for safer, less toxic alternative antibiotics. Fortunately, there are already many coaches and sport professionals that avoid quinolones at all cost and it is common to encounter precautions about the risks of taking quinolones for people that practice sports frequently. This should become general practice now that popular fluoroquinolones like cipro are widely prescribed, because the generic form has already being released, after the expiration of the twenty year long exclusivity of manufacturing it by its discoverer (Bayer).

129. PHYSICAL DAMAGE TO MUSCLES AND JOINTS

If you were an athletic person and have taken quinolones with the end result of a floxing, then the scenario that your athletic body is facing is as devastating as described below:

Joints with cartilages experiencing partial necrosis, therefore softened and with less mechanical loading capacity. Cartilages possibly eroded depending on the severity of the reaction.

Tendons and ligaments floxed. A floxing of a tendon is a severe illness on its own. It is explained in detail throughout this paper.