[shr7]

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.