Rhabdomyolysis, Too Much of a Good Thing
As I sit here typing this I’m listening to the pumping of my compression boots. Unfortunately it’s not the type of compression boots I’d like to be wearing (those after a hard endurance workout). I’m unfortunately in the hospital and because of my lack of movement, I’m wearing them. I was hesitant to write this, but as so much of what I’ve tried to write here is to help others, I knew I must. It is yet another “you’ve got to be kidding me, not something else” in addition to the potential for feeling slight shame that your body couldn’t handle what you were having it do. On a side note, this is eating disorders awareness week and I was working on a separate blog about that. But we’ll throw this one in for good measure.
My journey starts here: after my hamstring surgery I had a long long road back to full hamstring health. And along the way I had some awesome physical therapists help me. I’d like to write another post on those two specialties (women’s specific/pelvic floor and PRI-postural restorative institute) because I believe they can be of help to others as well. But coming back to my hospital visit, here goes.
For the past 5 weeks I’ve worked with a great strength coach (Bobby Allison at Hustle Fitness) to rebuild my hamstring strength. Along the way we’ve been working on Olympic lifting and more basic lifting like bench press, some kettle bells, body weight exercises, etc. I had made great progress and I had been feeling really strong, like I was becoming an athlete again. And I thought my body was ready to graduate to a traditional strength class vs the 1:1 that we had been doing. But because of my recent strength improvements I believe I was susceptible to a condition called Rhabdomyolysis.
Rhabdomyolysis (From Google Doctor Web MD): is a serious syndrome due to a direct or indirect muscle injury. It results from the death of muscle fibers and release of their contents into the bloodstream. This can lead to complications such as renal (kidney) failure. This occurs when the kidneys cannot remove waste and concentrated urine. In rare cases, rhabdomyolysis can even cause death. However, prompt treatment often brings a good outcome.
- Using illegal drugs- nope
- High doses of antipsychotics/statins- nope
- A crash/fall- nope
- Extreme muscle strain- Yep!
Symptoms: (exercise ones)
- Extreme muscle pain-like 9-10/10 pain, much worse than DOMS
- Swelling-your muscles will swell up like balloons
- Stiffness-you won’t be able to move the body part-I couldn’t lift my arm…at all
- Joint pain- I didn’t have this
- Coke colored urine-I didn’t have this although after drinking copious amounts of fluid my urine is still apple juice colored. But just because you don’t have very dark urine, don’t think you don’t have Rhabdo
- Vomiting- I didn’t have this either.
Exercise that can cause it: (any)
- Eccentric exercises mainly
- Specifically I’ve seen the most reports on pull-ups/negatives, abs-specifically a hamstring/back machine that you can do abs off of and leg exercises.
- Body weight exercises: those that mean you can do a lot of them before getting fatigued. It’s actually better to do heavier lifting because the heavy weights will not allow you to do so much that this happens.
Psychological Mindsets that Play into It:
- Those that have been athletes in the past, but have taken say the past 6 months off.
- Those that have the mindset to push through pain.
- An athlete who may have a bigger aerobic engine then strength-so they can go for much longer than someone who was more out of shape
- Women-no seriously the ER doc told me this. We’re just stronger mentally 🙂
This isn’t a one size fits all kind of thing. Some people take a week, others take several months. For me I think this was a more mild form and I expect to be out of the hospital in a day, and hopefully back exercising (lightly) in a week. This can be deadly, require dialysis or a transplant. So just don’t mess around. Listen to your body and seek help.
So in my first full strength class we were doing pull ups. But because I can’t do full pull ups, I did negatives, which are really just the eccentric part of the pull up. Imagine you are at chin level to the bar, then you lower yourself down. As stated above, eccentric exercises are one of the main reasons you can get Rhabdo.
I’m not sure if it’s still thought to be cool, but those doing Cross Fit used to joke about “Uncle Rhabdo” and even had tee-shirts made of a cartoon character of someone hooked up to dialysis. Let me tell you anyone that jokes about Uncle Rhabdo is not cool and neither is it a badge of honor. It is something that is very scary and requires immediate attention. Let me say this again, if you think you might have Rhabdo, go to the ER. Do not go to urgent care and do not go to your general doctors. Go to the ER. There is a specific type of blood test they run (CMP-complete metabolic panel) that they need to run to check you CK-creatine kinase levels. In addition to checking a kidney panel- BUN, potassium, sodium, myoglobin, etc. I thought that urgent care’s ran those tests, and I went to one on Sunday. After waiting two hours, they got some blood and urine, they came back and said, well your red and white blood cell count came back normal. No kidding, I didn’t think I was sick, I thought my kidneys might be failing. Turns out the urine did have blood and protein in it, but they said it would take 2 days to have the blood work done. So I went home.
After 1 full day of stressing thinking “am I sitting at home damaging my kidneys just to wait on a test.” Brett was away in Houston, so I took myself to the ER. As when I went to urgent care, when I told the nurse/assistant I thought I had Rhabdo, they looked at me blankly. For as serious as it is, it appears not that many people know about it. I told them I just needed a CK blood test and to test my kidneys. They took me back, took blood, a urine sample and the doctor came in amused (in a good way) that I had self diagnosed myself. The nurses and doctors have been great by the way (Alliance Medical Center-Fort Worth) and I am so thankful!
The CK tests take 90min to run, and if you get a high reading, they run again, and then again. And they ran mine 3x.
A normal CK (I believe) is around 100. My CK today was 56,000. Yes, that’s thousand. And kind of humorously, the urgent care people called today to tell me that my CK was 45,000 on Sunday. I told them I was already in the hospital but I’m glad they called. Unfortunately it’s not good that my numbers have been going up since Sunday. I’m not 5 days out from injury and my numbers should be going down. All we can do is give fluid and take blood. Last check my myoglobin (what leaks from the muscles and can’t pass through the kidneys) is high and they are re-running my CK. Tomorrow they will run the same tests again. The nephrologist said that with a level of 15,000 I can go home.
Let me be blunt. Do not push your body more than you should when you are coming back from injury or just being a bit out of shape. Don’t try to keep up with others when they can do 50 pull ups. Work at your own pace and don’t feel competitive to match them. If you do think you have Rhabdo, go to the ER right away. Even if you have DOMS, it’s better to be safe than sorry. And you may not have all the symptoms, so don’t think just because you don’t have coke colored urine you are ok. Go, don’t be ashamed.
I can tell you it’s so strange sitting here in my bed hooked up to an IV, my compression boots pumping along, IV humming, hospital noises all about, and I’m working on my computer. I don’t feel great, but I don’t feel bad. I’m probably the most positive hospital patient. I don’t have a fever, not vomiting, not cranky, etc. I’m in pain and scared, but I know that I’ll be ok. I listened to my body and I came and sought help. It’s a waiting game, but I’m confident my next numbers run will be slower. I’m several liters of fluid in and I’m drinking as well.
So get out there and train, but be careful. Listen to my advice from above. Push yourself, but there is no need to push yourself until you reach this point. Supposedly this is rare, but I’ve known others who have had this, and my nurse today has seen 3 people in the past year-all 30ish or under, athletes who love exercise. Time for another blood draw.