View Full Version : Rhabdomyolysis
Does anyone have experience with rhabdomyolysis, either from a treatment standpoint or have suffered from it? Specifically, rhabdomyolysis in combination with a heat injury. If so, please PM me.
Thanks in advance.
PM sent
Would suggest utilizing the knowledge and education on this board by asking your question in public.
Below are the facts related to my incident. I'm hoping there is someone out there who has encountered (not experienced) a similar case and can provide me with advise related to recovery. Be advised that I have zero medical background so if my description is limited or sounds "off", I will track down the relevant info which might help to explain the situation more clearly.
- Summer 2007, mid-day training activity.
- Heat injury (NOT heat stroke), hyponatremia, rhabdo, electrolyte deficiency, etc. resulting in a 48 hour coma.
- I took a few weeks off immediately following the incident and then began to work out a few days a week at soccer mom pace but over time began doing "bodybuilding" workouts (two muscles a day, lots of rest between sets, essentially the "anti" Crossfit).
- Blood work looked good at my three month check up.
- Gradually increased workout load back to pre-injury levels (at least one workout but often two a day to include Crossfit, more intense runs, boxing with days off as needed but at least one full day a week).
- Blood work at six month check up was bad. Day prior to blood work I took an APFT (as required) and boxed for an hour. One of my levels (forgot what but will find out) was in the 800's where 700 is a signal to a medical professional that rhabdo exists.
- During the second three month period where I increased workout load back to pre-injury levels, I felt pretty good, which is to say I was tired due to what I thought was a decreased level of overall fitness from the extended layoff of intense exercise.
- I have not and do not take supplements.
My questions are:
- Did I go too hard too soon?
- Is there anything that can be done from a nutritional standpoint?
- Since the intense workouts brought the rhabdo back, should I sit on the bench completely or go back to a less intense workout program?
- What's the prognosis based on your experience with a similar situation? Most of the cases I have seen on internet were with people who a) were probably not at my pre-injury level of fitness b) were not in a similar environment as I was when the injury occurred and c) are not looking to achieve similar goal.
I hope I presented the facts clearly enough for someone to get the jist of what occurred. If not, please let me know and I will clarify.
Again, I appreciate your time and thanks in advance.
FMA,
I would have to say from my experience dealing with guys in the pipe that a 48 hr coma would have most likely been caused by HEAT STROKE. I'm not your Dr., however, and that is obviously their diagnosis so it stands.
Sounds to me like you might have been over training. Mid-day in summer activities can be a bad idea, especially in NC. I've been there for 6 yrs now, not including deployment to where it's much hotter and far more dry, but it's hot! Use some common sense and don't try to be superman. You could die. Hope that's plain enough for you.
Obviously there was some imbalance between your level of activity and nutritional spectrums. Otherwise you would not have gone down so hard.
As you have no medical background, start from the end-state...the incident and coma and work your way backward and see which "building blocks" you can find missing from your routine...too much lifting, not enough rest, not enough high protein foods, working same muscle groups too often, especially lower body, by lifting and a lot of running without enough rest in between?
The article in question listed below mentions "Severe exertion such as marathon running or calisthenics" as a plausible cause to the disorder. I say over training again. Beyond that, good luck with everything. I have no other answers at this time.
I do have a link which describes your issue in detail. As for your physical level of activity, that's up to you and your doc.
I hope things work out for you. Stay safe.
http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm
Hope this helps.
Mick
To follow up, the part where you say "My questions are..." onward, those are the questions you want to ask your physician. He/she is the one who has seen your lab work, and has followed up with you over the last six months, I am assuming.
I think it would be incredibly presumptuous and borderline inappropriate for anyone who has not seen your lab work, or dealt with you, to offer their opinion of your specific situation, especially when it comes to what is safe for you.
That said, I think sofmed made excellent points dealing with your condition, while not delving too deep in making any sort of prognosis. Military Medicine is chock full of case series relating to heat stroke and heat exhaustion. This is not outside of a military physician's area of expertise. In fact, I am sure that they see this sort of thing all the time, to varying degrees, or course. I would not pass up on the opportunity to ask your questions to an clinician experienced in these matters.
The best that any of us can do, I think, would be to try and generate some discussion points that you can talk to your physician about.
What is rhabdomyolysis? "An acute fulminating and potentially fatal disorder of skeletal muscle that causes the release of muscle contents into the systemic circulation and may be manifested by myoglobinuria." Book definition. In other words, you break down muscle, contents of cells leak out into your veins and arteries. This stuff is not supposed to be there, it causes damage. It is particularly bad for your kidneys, the organs that clear that crap out of your blood. So while all your broken cells and their contents are going into your blood, the fluid in your veins and arteries is going back into your muscle. This is called "third-spacing", and it results in hypovolemia. Meanwhile your muscles are working so hard the oxygen demand exceeds the supply that is being delivered, you run out of glycogen, or "fuel", they start working without oxygen and produce lactate as a by-product. This can cause your blood to become too acidic, worsening your condition.
Keeping all this in mind, what can you do to prevent this? #1 best option: HYDRATE!!!! It keeps your volume up, it dilutes out all that bad stuff and makes it much easier on your kidney to get rid of it. This is so important, I just have to say it again. HYDRATE!!!! Also, try and minimize the water you lose. If its 100% humidity and 100 degrees out, maybe practice your swimming. I know you will be operating in those conditions, but if you kill yourself today, it won't matter. And you better believe that when you are in those conditions, you will be drinking A LOT of water. Another important factor is to make sure you are eating enough carbs, and getting enough rest to replenish your glycogen stores to help prevent the lactic acidosis. Finally, you break down more muscle doing short, intense activity, than prolonged lower intensity workouts. Perhaps it would be to your benefit to recover doing less of those "bodybuilding exercises" and making sure you have a good cardio base to work on.
Your rhabdo is *probably* not a genetic condition. Your blood work was fine at three months, but elevated again at six, one day after a workout. This *probably* rules out any kind of chronic elevation in your enzymes or proteins (not sure what they measured). I would talk with my physician to be sure to rule out any other possible reasons for your funky lab work. You don't want to be hanging around worrying about heat injury when those elevated enzymes were caused by your heart breaking down. I'm GUESSING that this was ruled out on your first visit to unconscious-land, but it is something you should check with your physician about. Also, if you are an african-american male, the sickle cell trait can predispose you to higher risk. Not sure if this applies.
Moving on, assuming you and your physician have ruled out any genetic or structural abnormalities/injuries, you want to do exactly as sofmed has said. Thinking about what causes rhabdo, and how to prevent it, can you think of any necessary steps in your preparation that were overlooked? I would hate to tell you that you are working too hard if you haven't been hydrating sufficiently. On the flip side, marathon runners and professional bodybuilders have suffered the same fate as you, some worse. You could be over-training. It happens to that Kenyan guy who runs 20 consecutive 6 minute miles, it could happen to you. Again, this is something you should discuss with your physician. Do they know the last time they did lab work, you had just exercised strenuously the day before?
If genetic factors and pre-existing conditions have been ruled out, and your lab work at six months was still high, even considering the recent work out, then it is probably user error. You are either doing something, or not doing something that is resulting in this pattern. I do not know you, or your condition, so I can not begin to tell you what that is. However, consider this, you have zero medical background, but you have 100% knowledge of how you have been working out. Your physician has a medical background, but 0% knowledge of how you have been working out. Bridge that gap. You know the basics now: what rhabdo is, what it causes, how to prevent it. See if you can "work your way backwards" and work with your physician to find what you have been missing, or doing wrong.
I look forward to hearing some of the advice offered by those in military medicine, as I am sure they have seen this many times.
I'm sorry if that was not of any help, but it is a very serious condition and very difficult to offer much advice on a personal level. Also, I just got back from the bar.
Good Luck
EDIT: Just to stress: By writing this I am hoping you can go and generate some discussion with your physician about some of these points. I am NOT trying to diagnose/treat you, or make a prognosis.
Thanks to both of you for your responses. I'm in the process of trying to get in with a kidney specialist here at Bragg for some additional advice. I'll pass on what I hear.
Stay safe.
Summer 2004, EIB Roadmarch. I was cocky and got smashed the night before and went into the march severely dehydrated. My camelback blew leaked out in my ruck and the only water I had was the 2 cups available at the 8 and 10 mile checkpoints. Ended up going down across the finish line, although I lost all clarity of thought or conscious control a good mile before the end.
In-field core temp was 108, temp taken at Womack was 105.8. They said I suffered a full heat stroke, rhabdomylysis, Acute renal failure, and a enzyme issue called hyper-something- I can't recall the exact word. I was in and out of consciousness for 2 or more days and only vaguely recall what my squad leader relayed to me. They had me in the hospital for a week and a half and it took 3 or 4 days for my kidneys to resume functioning. After I got out of the hospital I bitched until I got permission to continue with the EIB stations, wasn't too hard with the CSM and 1SG were parading me around as their guy that wouldn't give up on the footmarch.
Long story short, I have no real information other than within a few months of the heat stroke I was back on my feet training for PRC and felt like I was back at 110%. I have noticed my bodies tolerance for cold temperatures is much worse than it previously was, and my physician stated it could potentially be a result of the heat injury but beyond that I have no noticeable long-term effects 3 years after the incident. I tell you what though, I never forget to stay hydrated.
optactical
02-12-2008, 14:04
The folks from Crossfit have a pretty extensive understanding of this condition and have some good info on their site www.crossfit.com. It's mainly because their workouts tend to cause it in people who are not used to their system or cross training. They even have some of their top athletes who live in a constant partial state of rhabdo (their words from seminar) and are fine. Go to their site, check the forums, the journals and they should have some good stuff about it.