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Rhabdomyolysis: The Elephant In The Room

I’ve gone missing again… for valid reasons this time. Today’s post is about the elephant in the room: Rhabdomyolysis. Specifically, Exertional Rhabdomyolysis.

I’ve had it before, I just know it: the inability to extend or flex my arms, the searing pain in my legs even while at rest. Rhabdomyolysis is what people in the fitness world don’t want to talk about, don’t like to talk about, or (shamefully) are unaware it even exists.

My experience does not reflect on my trainers, my gym, my yoga instructor or studio, or even my friend I went dancing with on Saturday night. I repeat, my illness was not a result of poor training or instruction. My rhabdomyolysis experience was a result of a perfect storm:

  • my lack of hydration all week long & tons of coffee
  • a pretty rough workout at CrossFit on Friday (programmed by Dave Castro, 16.5, aka Thrusters & Burpees for 84 reps each)
  • some beer, even less water
  • a hot yoga session on Saturday
  • more beer & less water
  • and a sweaty (but fun!) 45 minutes of dancing Saturday night

Then on Easter Sunday… I woke up and couldn’t bend my right arm past 90. 

Definition: Rhabdomyolysis is the breakdown of muscle fibers and release of toxins into the bloodstream. In many cases, it may cause kidney damage and sometimes heart rhythm disruption.

I drank a lot of water on Sunday, but the swelling and pain had already set in to my biceps and triceps. I looked “swole”. That was never–NEVER–my intention. I’ve been active regularly for over 6 years now. I’ve never wanted to inadvertently get my swole on… And I don’t want you to, either.

Thankfully I work at the VA hospital and my employee physical was on Tuesday. I asked the doc to run my numbers… he reluctantly obliged… then he called me in a panic. My numbers were not sky high compared to what some of my friends have had before. All of these people were hospitalized.

  • Friend 1: over 100,000
  • Friend 2: 25,000
  • Friend 3: 33,000
  • Friend 4: 6,500
  • Me: 9,523 (170 is about normal for a rested female)

A few super intelligent medical friends and I figured I had peaked on Sunday or Monday, so I opted to hydrate at home and retest on Wednesday. My lab came back at 12,554. Considering the labs went back up after almost 24 hours exactly, and considering the sheer volume of hydration I was getting, it was time to go to the hospital.

Studies show Rhabdomyolysis (I’ve capitalized it to give it the respect it deserves) in athletes may have higher baseline numbers than 170, but no “athlete normal” range has been established. A higher baseline makes sense when you think about what the condition actually is. Athletes who train regularly have muscle breakdown regularly. If I had to take a guess, I’d say that the “athlete normal” is still less than 1000, but no one knows for sure; 12,554 was simply way too high to be ignored.

Sometimes you have to hold your hand up in the air to prevent even more swelling.
Sometimes you have to hold your hand up in the air to prevent even more swelling because of the IV fluids. A necessary evil.
So I went to the ER, where my friend happened to be working. She stormed out of the triage area and sternly wondered why I was there. I showed her my labs, she got me right in, I had an IV hooked up within the hour, and was quickly awaiting admission.

I had 3 full bags of saline in me by 8:30pm. I basically ballooned from all the fluid. Of the few people who knew I was in the hospital, the couple that sat with me can attest that I was going a little cuckoo because of my signs of hypervolemia: shortness of breath, headache, dizziness.

Over the course of 48 hours, my CK numbers were still reluctant to come down. They kept spiking when I was off of the IV fluids. Oral hydration alone couldn’t keep the CK numbers down: it was a frustrating experience. But despite all of the concern, my kidney function was perfect. Being in the hospital when you feel healthy is one of the worst things ever. I knew my blood needed diluted & flushed, but I felt fine. Finally, the number stayed below 5000, and I was released on April Fool’s Day. No joke.

I still had elbows, but I was plump.
I still had elbows, but I was plump.
Why did I go to the hospital? Rhabdomyolysis can be horrible. Kidney function is not something you should gamble with!

And Rhabdomyolysis can happen at any time if the conditions are right. It can happen to anybody. And none of us who has had it should be made to feel like a pariah for it. We should not feel ostracized. It’s not like we were searching to incorporate Uncle Rhabdo into our family tree.

We don’t want anyone to get Rhabdomyolysis. So you need to be educated. Yes, you, Mr. Newbie, and you, Mrs. All Star. Everyone should be educated.

Warning Signs (not all-inclusive):

 Pain (even at rest)
 Muscle Weakness
 Gross Swelling or Muscle Cramping
 Muscle “Tightness”, Difficulty Moving Muscles
 Dark Brown Urine

Prevention Techniques:

 Avoid jumping into high intensity workouts without proper introduction.
 Don’t forget salt! Electrolytes are important.
 Hydration is even more important during hotter temperatures.
 Lay off the booze post-workout.

Activities That Can Cause Exertional Rhabdomyolysis:

Running: hill work, marathons, tough trail runs, etc
 Spinning Classes
 High Intensity Interval Training, CrossFit-Style or Military Training-Style Workouts
 Hot Yoga
 Weightlifting: super sets, bicep curls, high-rep deadlifts, etc

Your best bet for keeping Rhabdomyolysis at bay is to keep prevention at the forefront of your mind and then put it into action. Being mindful of drinking water does nothing for your actual hydration levels if you don’t actually drink the water. And you definitely need to watch for all the warning signs. Please note, though, that 50% of the time you won’t be able to recognize that there’s even a problem. Sometimes you might simply feel sore in a different way than normal.

Be careful with your hydration and training state in long distance running. Listen to your body and stop a workout with any sign of overexertion or hyperthermia. And if you still get Rhabdomyolysis despite being well-hydrated and well-trained… don’t make yourself feel bad. PLEASE–just go get treatment, check your kidney function, and be an ultimate Rhabdo educator for all those around you.

Last note: my pee was NEVER brown, so don’t use that as your only measuring stick.

Resources for you:
Breaking Muscle: A Scientific Looks at Rhabdomyolysis

Recovery Time in Exertional Rhabdomyolysis

The CrossFit Journal’s Take on Rhabdomyolysis

A Super-Old Web Article With Lots of Comments

Another Person’s Account of Her Rhabdo Experience

Almost a Mirror of My Rhabdomyolysis Story: 2014 Edition