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Running Doc: Tips before getting your annual physical

If you are a serious runner, you should take a little time off from training before your physical.Seth Wenig/AP

If you are a serious runner, you should take a little time off from training before your physical.

Dear Running Doc:

I’m about to have my annual physical. Since I work out regularly and take good care of myself, I’m optimistic the news will be good; I am training for the New York City Marathon, so my mileage has just increased without any injuries or problems. But somewhere, in a magazine, I now remember reading about a lot of people who felt that way, had a good workout, went for the exam, and got alarming false reports once the lab work came back. The magazine is long gone. Can you help?

Richard W., New York City, NY

Thanks, Richard, for a very interesting and important question. It’s true some of the fittest athletes walk out of their doctors’ offices scared out of their wits, but it’s usually because nobody asked the right questions.

A patient recently came to me nearly hysterical, having been told after her physical that everything was normal except for microscopic blood in her stool — something commonly tested for in people over 40. She was supposed to schedule a battery of tests next: a G.I. series and a colonoscopy. It might be a tumor or just an ulcer, her doctor said, and she needed to find out which.

And a 50-year-old racewalker casually mentioned in the course of a sore Achilles exam that his internist thought he might have bladder cancer, because of evidence of microscopic amounts of blood in his urine sample. Even though the rest of his physical had been fine he was being sent for a bladder biopsy, and an intravenous pyelogram to check his kidneys.

All it took to prove that they were both perfectly healthy were a couple of days of rest and an understanding of what happens to athletes’ insides when they train hard. Six studies around the world have shown that about five percent of marathon-ready runners had evidence of microscopic G.I. bleeding before the race. After the marathon it zoomed to 21 percent. The leading theory says that since up to 80% of the bowel’s normal blood flow gets diverted to hard-working leg muscles during intense exercise, microscopic areas of oxygen-starved digestive-tract tissue could let blood seep through.

All you do is take three days of rest, and call the doctor on the fourth. If a retest is positive, it’s time to get moving on additional procedures. But if it’s negative, it was your workouts.

Same with “bladder cancer,” which can be exercise-induced hematuria. One in five marathoners has trace amounts of blood in the urine, and surveys show six out of ten football players seem to have the same thing. Again, how it gets there is speculative. We know that in long-distance running, the kidneys get short-changed by as much as 80% of their usual blood flow, damaging a small number of cells enough that they leak. But it doesn’t take something like a marathon to bring the condition on, and in shorter distances it may simply be a problem with the bladder, which injures itself as its parts flap together.

Both conditions are harmless, but since they are easily mistaken for illnesses that are not, they can do serious damage to your mind—not to mention your wallet. Taking 72 hours off before your physical should eliminate the confusion.

Enjoy the ride.

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Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is Medical Director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.

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