Dominick Cruz’s Cipro-Induced Tendon Rupture

https://www.youtube.com/watch?v=l7L-KB__GxM

Dominick Cruz, two-time UFC Bantamweight Champion, was floxed by Cipro. He describes his experience in episode #921 of Joe Rogan’s podcast, The Joe Rogan Experience.

Starting around minute 53 in the video above (and 1:02 in the downloaded podcast), Dominick Cruz states:

I did research later, I’m now basically a doctor to figure all this stuff out because of all the injuries I’ve been through. But 3 weeks before I fought Mizugaki I had a staph infection on my right thumb that popped up. So I took an antibiotic called Cipro. Now, me trusting the doctors and me not – it’s my own fault, not the doctors fault – I should have read the hazards of the antibiotic. But you kind of trust the doctors and assume, why would he give me something bad, right? Well, Cipro has an after-effect for six months after you ingest it that it weakens your tendons, so it makes them soft like real putty. And so I took it three weeks before the fight – that made it about 2 months after I ingested the Cipro – I was throwing a left high kick – I’d never had a problem with my right knee ever in my entire life, and it just popped throwing a high kick. I pivot on my right leg, throwing my left leg high, and it just popped and I knew right away, obviously, ’cause I’ve done it twice, that I’d blown it out. I remember literally, blowing it out, sitting on the floor, and the guy that I was drilling with was like, “What’s up?” and I was like, “I just blew my knee out.” He’s like, “What? Nothing happened!” It was crazy. It was a weird feeling. What was even weirder was the peace I had sitting there – not even caring. I literally was just – I remember blowing it out and sitting on the ring like, I told Eric, “Come here – You ready for another 9-month ACL reconstructive surgery?” and he’s like, “What? What are you talking about? Your knee’s fine.” I’m like, “No, I blew it out just now.” He’s like, “no you didn’t.” I said, “yes, I did.” And, that was it. So, I start again. I started the rehab again.

The good news for Dominick Cruz, and the hopeful take-away for all of us who have been hurt by fluoroquinolone antibiotics, is that after he went through surgery to reconstruct his blown-out ACL, and after 9 months of rest along with physical therapy, he returned to fighting and won the UFC Bantamweight Championship in January, 2016. Being able to fight in the UFC after experiencing a Cipro-induced tendon injury is huge, and we should all be inspired by Dominick Cruz’s comeback.

I have never talked to Dominick Cruz, nor have I heard anything about his story other than what he shared in episode 921 of The Joe Rogan Experience, so, what follows involves some conjecture. With that disclaimer noted, here are some thoughts about Dominick Cruz’s experience.

Why did Dominic Cruz’s doctor give a professional UFC fighter, an elite athlete, a fluoroquinolone prescription???? What is wrong with his doctor? Is his doctor not aware that tendon ruptures are a well-documented effect of fluoroquinolone antibiotics? He or she should be. It’s on the black box warning label for Cipro, and all other fluoroquinolones. The first sentence of the black-box warning for Cipro, in 2016, stated, “Fluoroquinolones, including CIPRO®, are associated with an increased risk of tendinitis and tendon rupture in all ages.” Did Dominick Cruz’s doctor think that healthy and strong tendons weren’t necessary for Dominick Cruz to do his job as a UFC fighter? Did Dominick Cruz’s doctor think that it was okay for him to experience tendinitis and tendon ruptures? Maybe Dominick Cruz’s doctor is under the impression that UFC fighters don’t need healthy, strong, flexible, and durable tendons. It absolutely blows my mind that an ignorant fool of a doctor could give a UFC fighter, an elite athlete, and a man with a history of tendon injuries, a drug that has the documented effect of destroying tendons. It is unacceptable for a doctor to prescribe Cipro, a drug that has been shown to cause disabling tendon injuries in thousands of people, and which permanently alter the structure of rat tendons and causes permanent lameness in beagle puppies, as well as permanent disability in humans, to a man whose entire livelihood depends on his ability to use his tendons. That doctor is a dangerous ignoramus, and he should be fired then sued for every penny he’s got.

Every doctor who works with athletes, especially professional athletes, should read the article “Musculoskeletal Complications of Fluoroquinolones: Guidelines and Precautions for Usage in the
Athletic Population” where the first guideline for use  of fluoroquinolones in the athletic population is: “Athletes should avoid all use of fluoroquinolone antibiotics unless no alternative is available.” DON’T PRESCRIBE ATHLETES FLUOROQUINOLONES. It’s not that hard. In Dominick Cruz’s case, he was prescribed Cipro for a staph infection. There are a dozen other antibiotics that treat staph infections, and, according to this list, fluoroquinolones aren’t even the recommended treatment for staph infections. So why was Dominick Cruz given an antibiotic that has the effect of permanently weakening tendons and causing tendon ruptures? What an ignorant, foolish, awful doctor.

Even if the doctor who prescribed Cipro to Cruz wasn’t aware of the recommendations in “Musculoskeletal Complications of Fluoroquinolones: Guidelines and Precautions for Usage in the
Athletic Population,” he or she should have at least been aware of the black-box warning on Cipro which states, in the first sentence, “Fluoroquinolones, including CIPRO®, are associated with an increased risk of tendinitis and tendon rupture in all ages.” It’s inexcusable for a doctor not to know about the black-box warnings on the drugs that they prescribe. And, assuming that he isn’t ignorant of the black-box warning, why is he prescribing a tendon-destroying drug to an athlete like Dominick Cruz??

In the podcast, it sounds like Dominick Cruz isn’t angry with the doctor who prescribed Cipro. He states, “it’s my own fault, not the doctors fault – I should have read the hazards of the antibiotic.” He’s obviously more generous than I am. Though generosity, even generosity toward those who hurt you, is a virtue, I don’t think he’s right. According to the Learned Intermediary Doctrine, pharmaceutical manufacturers have no obligation to inform the consumer/patient about the dangers of drugs. Dominick Cruz, as the consumer/patient, wasn’t even supposed to be told about the dangers of Cipro. However, his doctor, the “learned intermediary,” WAS supposed to know about the dangers of Cipro. His doctor should have known that it isn’t appropriate to prescribe a tendon-destroying drug to a UFC athlete, and he should have known that there are safer alternative antibiotics that treat staph infections. His doctor should have known better, and his doctor should be held responsible for making such a terrible prescribing decision.

As much as I respect how Dominick Cruz has come to terms with his injuries and found peace and surrender that helped him to recover (described throughout the video/podcast), fighting is what he does for a living, and I’m a little disappointed to hear that he’s not interested in fighting the system that poisoned him and destroyed his tendons. It is not his fault that his tendons were weakened by Cipro (and maybe other fluoroquinolones). It is the fault of the pharmaceutical companies that produce these dangerous drugs and the doctors that prescribe them inappropriately and flippantly. He shouldn’t have been prescribed Cipro for various reasons (staph should be treated with other antibiotics, he has a history of tendon injuries, and he’s an athlete) and the people who endangered him by giving him these drugs should be held accountable. Dominick Cruz probably has the clout to actually fight the people who poisoned him (unlike most of us, who struggle to gain justice for various reasons), and I hope that he does.

The tendon rupture that Dominick Cruz attributed to Cipro was his third tendon rupture, and earlier in the podcast you can listen to him describe his other tendon injuries (both of which he attributes to getting hurt while fighting, not weakened tendons from Cipro or any other fluoroquinolone). I wonder if he had taken Cipro, Levaquin, Avelox, Floxin, or one of the generic fluoroquinolones prior to his other tendon injuries. He thinks that the effects of fluoroquinolones on tendons only last six months, but, unfortunately, he’s wrong. Fluoroquinolone antibiotics can permanently alter the structure and strength of tendons. If he had taken a fluoroquinolone prior to his other tendon injuries, maybe they’re due to the drugs too, and he just hasn’t connected those injuries to the antibiotics. (Or, it’s entirely possible that those injuries were from fighting and training as he asserts.) A young, fit, well-conditioned, athlete like Cruz shouldn’t have weak, easily injured, tendons though. For his tendons to be so prone to injury, something is going on – maybe his tendons were weakened and changed by Cipro, Levaquin, Avelox, Floxin, or generic fluoroquinolones.

Since Dominick Cruz won back, and defended, his Bantamweight Champion title, it’s tempting to assert that he has fully recovered from his tendon injuries. However, if you listen to the whole podcast/video, Cruz goes on to describe how he now has debilitating plantar fasciitis. His tendons are messed up. His fascia is messed up. I certainly hope that he recovers from the plantar fasciitis, and I hope that he never has another tendon injury again. But I’m betting that he’ll battle tendon and fascia injuries for a while, and that the musculoskeletal destruction caused by fluoroquinolones will end his UFC fighting career. I hope I’m wrong about that.

Another thing that Dominick Cruz mentions in the podcast/video is that the UFC is in constant contact with injured fighters’ doctors. Why is the UFC allowing their fighters to be prescribed fluoroquinolone antibiotics???? Seriously, these drugs are dangerous, they can cause permanent disability, and there is a black box warning on them that notes that they can increase the risk of tendinitis and tendon ruptures. What is the UFC thinking allowing their fighters, the people who make them money, to be prescribed drugs that can injure, disable, and even kill them? There are hundreds of articles about the dangers of fluoroquinolones RIGHT HERE. They’re not difficult to access. It’s not difficult to see that fluoroquinolones are more dangerous than other antibiotics, especially to athletes who need to have properly-functioning tendons in order to do their job. Yet, the UFC is standing by, watching, while doctors prescribe tendon-destroying drugs to UFC stars–making them miss fights and costing both the athletes and the UFC massive amounts of money. It’s absurd. The UFC has the clout to stop this, and to tell their athletes, and the doctors that work with them, that fluoroquinolones shouldn’t be used on UFC athletes unless there are no viable alternatives. The adverse effects of fluoroquinolones are too severe, and the risk of injury after taking fluoroquinolones is too high, for UFC athletes to be taking these dangerous drugs.

I’m willing to bet that infections are rampant within the UFC, and that there are a lot of “floxed” UFC athletes. Open wounds occur often, mats and other equipment may be cleaned as well as possible, but they’re probably still swimming with nasty bacteria. It’s an environment with a lot of person-to-person contact, sweat, blood, and, inevitably, infections. If Dominick Cruz’s doctor threw Cipro at him to treat a staph infection, I bet the UFC doctors generally throw fluoroquinolones (Cipro, Levaquin, Avelox, Floxin, and their generic equivalents) at the UFC fighters whenever they get an infection. Fluoroquinolones are powerful, broad-spectrum, antibiotics. They’ll kill the bacteria. They’ll also ruin the tendons of the athlete, and cause disability in those who are unlucky.

Strong, athletic, young, capable, people can get hurt by fluoroquinolones. People like Dominick Cruz, who are at the peak of their fitness and athletic career, can experience weakened tendons, tanked testosterone, and worse, after taking fluoroquinolones. If the UFC thinks that their fighters are too strong to get hurt by these dangerous chemotherapeutic concoctions that destroy mitochondrial DNA, well, they’re wrong–and the athletes/fighters who are taking these drugs are being victimized by the willful ignorance of the doctors who prescribe these dangerous drugs.

I hope that all athletic organizations, coaches, sponsors, and athletes get together and put pressure on doctors to stop prescribing fluoroquinolone antibiotics to athletes. The dangerous and disabling effects of fluoroquinolones are well-documented, and there is no reason to prescribe them to athletes when there are other viable alternative antibiotics. Ruining an athlete’s career with a dangerous drug, when there are safer alternatives, is unacceptable. I hope that more people will wake up to the dangers of fluoroquinolones, and that fewer people generally, and specifically fewer athletes, are hurt by these drugs in the future.