Rhabdo Is Not A Joke.
Rhabdomyolysis, often referred to as “Rhabdo”, is the breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream. Myoglobin is harmful to the kidney and can cause kidney damage if not treated properly and promptly.
Cause: Non Traumatic, Severe Exertion (fancy way of saying working out too hard)
When: Monday, January 12, 2015
My Rhabdo Story:
My choice of exercise programming since 2012 has been CrossFit. I love this sport. I decided to subject myself to the perils of local competition since mid 2014. I ignored many warnings regarding the dangers of CrossFit. Quite frankly I found the warnings ignorant, naive, and unfounded. After my 6 day bout in the hospital with Rhabdo, the warnings continue to pour in from every direction: friends, family, doctors, nurses, clients, etc.
I’m going to pull a page from the Aaron Rodgers Playbook and tell everyone to:
- The reason I suffered from Rhabdo is not because of my size. (Ectomorph)
- The reason I suffered from Rhabdo is not because of my diet. (Paleo Zone)
- The reason I suffered from Rhabdo is not because of my training. (CrossFit 3-5x / Wk)
I suffered from Rhabdo because I took a four week hiatus from CrossFit and then did an extremely high repetition workout as if I was in competition condition. Four weeks is the longest amount of time I’ve been away from the gym since starting CrossFit a few years ago. I competed in early December 2014. Immediately after the competition, I took a week off. Then I went to Mexico for nine days for vacation. When I got back on December 25th, the holidays were still in effect and family outranks the gym. I didn’t make it back into the gym routine until post NYE.
The WOD I’ll Never Forget: A.K.A “Rhabdo WOD”
-10 KB Swings (Left)
-10 KB Swings (Right)
-10 AM KB Swings
-10 KB Press (Right)
-10 KB Press (Left)
Mobility: Pass Throughs & Overhead Squats
Strength: Strict Press
5 Rounds for Time:
30 Double Unders <– Click To Learn How To Go From Zero to 60 [UNBROKEN] Double Unders in 30 Days or Less!
Max Effort Pull Ups
Rest 1:1 between rounds (Time)
During and immediately after the workout I felt great! I knew I’d be a little sore the next day but that didn’t bother me. I did not stretch or “cool-down” after the workout. I did not hydrate properly after the workout. I simply had a protein shake, a glass of water, and some dinner between the workout and going to sleep.
Upon waking up I felt like T-Rex. Zero ability to extend or flex my arms. My arms were stuck at 90 degrees. Pain was bearable but the limited mobility was annoying.
The pain increased. This was an odd feeling. Pain usually subsides two days after the workout. Hoping it goes away in time to do tonight’s WOD. I text messaged my coach in the morning to let him know how I was feeling. He suggested drinking more water, adding Glutamine to my morning shake, and targeted stretching: all to no avail. I decided to add Ibuprofen to the mix and skipping tonight’s workout if necessary.
The swelling increased. At this point I sent a text message to my healthcare friends (nurse and physical therapist). They advised me to see an urgent care specialist immediately after I told them I think this is more than delayed onset muscle soreness (DOMS), and it could possibly be Rhabdo. After explaining my situation to the Physician’s Assistant at the local urgent care center, they sent me home with extra strength anti-inflammatory and a muscle relaxer. Oh yeah, they also reminded me to call them or pay them a visit if my condition worsened.
My urine is brown. Not once, but twice. I raced over to the Emergency Room. After two quick tests (urine & blood) they confirm I have Rhabdo. They hook me up to a standard saline IV at a rate of 200ml/hr. My next visit to the bathroom, around 4:00pm, produces clear urine. The nurse swings by to tell me about my results.
Creatine Kinase is an enzyme found in the heart, brain, skeletal muscle, and other tissues. Increased amounts of CK are released into the blood when there is muscle damage. The small amount of CK that is normally in the blood comes primarily from skeletal muscles. Normal CK Levels are ~250.
Nurse, “I’ve never seen levels this high… you’re CK didn’t register within our standard blood test, which identifies CK levels up to 21,000. We ran further tests to find it’s at 67,000. (For those of you still paying attention: that’s ~250x normal levels!!) Buckle in, you’ll be here for the weekend.”
The treatment from this point forward would be simple: saline drip through IV and rest.
The blood test reveals CK levels of 57,000.
The blood test reveals CK levels of 72,000. After dropping 10,000 in one day, they jumped 15,000. I mentioned before that the CK levels were so high they were not registering on the initial blood test. After taking my blood, the lab ran a test to get all pertinent information regarding the kidneys, liver, salts, proteins, etc. After that information was obtained, they took the blood sample and diluted it to run a second test to calculate CK levels. I asked the Doctor if there is a possibility the test was wrong and he said the standard deviation was + or – 500 units max. In other words, No, the test was not wrong. At this point, I was ordered to strict bed rest. I could only get out of bed to pee, no other reason. This is also when the Heparin injections began, to prevent blood clots from forming.
The blood test reveals CK levels of 53,000. Awesome! Still ridiculously high but on the right track!
The blood test reveals CK levels of 32,000. The doctor is confident in my recovery. Despite the high CK levels, everything else has been in check since Saturday (kidney function, liver function, etc). The doctor lets me know going home is an option at this point. However, I would need to rest and continue taking fluids. I decide against going home because I am not the sedentary type. I tell myself if I’m at least within the test’s range tomorrow I’ll go home.
The blood test reveals CK levels of 16,000. 9 Days after the workout, my levels are finally on the radar of the standard blood test. I decide to go home with the support of my Doctor and nurses. I have a follow up on Monday (2 weeks post WOD), for another blood test. I’m hoping by then I’m significantly closer to the ~250 range. I’m drinking a bit more than a gallon a day and resting as best as possible. However, like many of us, I use my hands for work.
Rhabdo is a dangerous condition that can cause acute renal failure if not properly and promptly treated. Rhabdo can happen to anyone, even experienced athletes. Actually the largest demographic for non-traumatic Rhabdo is marathon runners. These are some of the fittest people walking around.
Hydration, stretching before and after the workout, and proper nutrition are all good ways to prevent this condition from knocking on your door. Being conscious of your capacity in any given moment is most important.
If you are ever in a situation in which pain & swelling increases day by day, do yourself a favor and get blood work done, with a focus on CK levels. My research shows CK levels raise for 24-48 hours, and then decline over 5-7 days. However, my CK levels peaked on Sunday, six days after the workout that caused this condition. A short three days later, I was ready to go home. A blood test four days after that revealed CK levels were normal again. I’m hopeful to make a full recovery and return to CrossFit: cautiously & intelligently.
For Video Format, check out WodDoc episode 202 of Project 365.
CrossFitter’s Guide To Rhabdomyolysis
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