It starts with a sneeze muffled into the sleeve of a gi. Maybe coughing, or bleary red-rimmed eyes. Usually, though, there are no signs until the people start disappearing and open mats look like early seasons of The Walking Dead — a few still healthy bodies watching in horror as their coach heroically chases the infected out the door.
Cold and flu season is here.
Grapplers are already prone to infections — staph, ringworm, and even MRSA rip through even the cleanest gyms every so often, and seasonal illnesses like respiratory infections sweep in during the change of seasons. It’s a natural side effect of sweatily practicing full contact murder with multiple partners several hours a week.
Unfortunately, this makes grapplers especially susceptible to FQAD, or Fluoroquinolone Associated Disability, a multisystem illness triggered by the fluoroquinoloneb (FQs) class of antibiotics. But unlike colds, the flu, and gym skin infections, FQAD can have long-term and devastating effects.
“Knowing if I’d let myself cough and be miserable for two weeks my leg would be fine now is tough,” says Andy Miller, a 35-year-old FQAD patient. The jiu-jitsu purple belt has been off the mats this year following a tear to his achilles tendon which his surgeons link to the fluoroquinolone antibiotic Cipro, aka ciprofloxacin.
In 2017 Miller picked up a random summer “cold and flu thing.” After three days of wet coughing, chills, and a splitting headache, he dropped by a walk-in clinic and left with a script for Cipro. The doctor on call, like most general practitioners, did not culture the sputum produced by Miller’s wet coughing, opting to blind treat the symptoms caused by bacteria presumably* in his lungs with the popular broad-spectrum drug. He assured Andy he’d feel better in a few days. (*As Miller’s symptoms could have been caused by a virus, which would not respond to antibiotic treatment, there’s no way of knowing whether he actually had the bacterial infection for which he was treated.)
A week later Miller was “miserable.” His coughing ebbed, but Miller felt dizzy and fatigued, had insomnia, and ached relentlessly. “I’m normally a healthy guy,” he recalls. “I never felt so bad.”
Four weeks later Miller was still stiff, aching, and lethargic. “I’d get out of bed in the morning and it would hurt to stand. I’d be doing something simple in class, like sprawls, and this stabbing pain would go up my calf,’ Miller recalls. “I felt 1,000 years old.”
Soon after, Miller bent over to pick up a basket of laundry and felt “the hammer of Thor slam into my ankle.” He had torn his Achilles tendon in the middle of his own living room.
“When I finally got hooked up with a good sports surgeon, he went over my history and was like, ‘You’re a healthy kid, I’m not sure how this happened,’ and I was like, me either,” says Miller. “He asked about my antibiotic history and as soon as I mentioned Cipro he sighed.” Surgery was the only option.
In combination with his newly acquired lethargy and fatigue, the tear was enough for doctors to diagnose Miller with FADS. With the surgery, physical therapy, and “massive diet and lifestyle changes” which target FQ injury, the athlete has been able to heal and regain some of his stamina but still doesn’t feel the way he did before taking Cipro.
“I’m less flexible, have less stamina. The whole thing has been an expensive nightmare,” says Miller today. “I’m angry. The doctor never communicated this could happen.”
Miller is not an outlier. Patients who have been “floxed”—slang for fluoroquinolone-induced illness or injury—report tendinitis or tendon rupture, peripheral neuropathy, kidney damage, chronic fatigue, liver damage, gastrointestinal issues, and prostatitis among the drug’s many side effects, so much so that in 2016 the FDA was forced to establish FADS and warn patients that what was previously one of the most-prescribed drugs in the USA was not actually safe to take.
Studies have shown that iatrogenic aftereffects presented into some patients after only 1-2 rounds of treatment with FQs.
So how do you, person who recreationally shares bodily fluids with other grapplers and is therefore at increased risk of bacterial infections, protect yourself?
- Know what you’re being prescribed. Ciprofloxacin (Cipro), levofloxacin (Levaquin), gemifloxacin (Factive), moxifloxacin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin) are all FQs. Check the script before you fill it.
- Never take anything you’re not comfortable with unless it’s life or death. The FDA now recommends FQ use be limited to life-threatening infections ONLY, MRSA or severe staph being one example. If your life isn’t in danger, ask your doctor to please prescribe a non-FQ alternative. If they balk, either fire them (they work for you, after all) or show them this paper explaining why you won’t be taking it.
- Know what you don’t need to take FQs for. Prior to 2016, FQ’s were the go-to script handed to people with bronchitis, urinary tract infections, and sinus infections. The FDA and Consumer Reports have since clearly stated these conditions shouldn’t be treated with the drug. (Sadly, Andy Miller’s doctor didn’t get the memo.)
- Ask for a culture to determine what antibiotic you should take. Culturing an infection and sending the sample to a lab for analysis can determine exactly what bacteria has hijacked your body and which antibiotics are most likely to kill said infection. Culturing infections can also determine whether you’re dealing with something bacterial, which will respond to antibiotic treatment, or viral, which will not. Unfortunately, lab work can delay treatment and be expensive, so many primary care physicians skip culturing and instead “blind prescribe” broad spectrum bombs which kill many pathogens at once. If you really want to avoid taking antibiotics you don’t need or that may not kill your infection, ask your physician to culture infections before prescribing anything. It costs more than blind-popping a broad spectrum pill, but way less than paying for tendon repair.
- Feel like crap for a few extra days. Yes, it sucks being sick. Being disabled is worse. Studies have long suggested that a “delayed prescribing strategy”—waiting and watching an infection to see if the body clears it on its own—yields better patient outcomes than knee-jerk attacks with drugs. But pressure from patients, as well as appointment time limits set by medical insurers which mean doctors get too little time to actually collaborate with you, have led to the current trend of sick people begging for antibiotics they Googled and doctors throwing the prescription at them with little resistance. “Physicians should understand the motivations of patients who are seeking antibiotics and provide education, empathy and alternative treatments,” write Drs. Richard Colgan and John H. Powers in American Family Physician. If your doctor orders antibiotics as a first defense or fails to educate you on alternative ways to treat your infection, it’s time to fire them and pay someone to do the job correctly.