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Old 12-21-2008, 08:37 AM   #1
Adam Harris
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Post Surgical Rhabdo

Sorry for the long post, but I think a thorough explanation is necessary.

I'm not sure if the title of the thread is the correct terminology, but the rhabdo was not due to exertion/exercise. It is likely more similar in nature to a compression injury or something seen in a trauma patient that survived being pinned in one position with lots of pressure for a long time such as a car wreck, surviving a collapsed building, etc.

A good friend of mine, we'll call him Robert, had back surgery two weeks ago his Tuesday morning. Specifically, he was fused at L4-L5. The procedure was considered minimally invasive. Everything was inserted and completed via 4 small incisions. The physician was a neurosurgeon, not an orthopedist. The surgeon commented that the back was far more compacted then he had thought based on the MRI from 8 weeks prior. The surgery was to correct spondylothesis, or instability in the aformentioned vertebrae. He also had pars fractures, or spondylolysis. See WFS link for a far better explanation than I can provide(http://www.hss.edu/conditions_16351.asp). It was not due to an acute inury. Robert is 50 years old and has battled back problems off and on for a long time.

That is the background. Now for the real issue. Robert was diagnosed with rhabdomyolysis in his quads post surgery. Apparently this was a due to many variables coming together at once, but the main ones are that the surgey lasted nearly 6 hours instead of the 4 hour predicted time, low phosphorus levels, and the positioning during the surgery. An Andrews table of some design was used. WFS link to a jackson table, http://www.erothitan.com/radiolucent..._state_en.html. Apparently the style used during this particular surgery contained a wide thigh strap to stabilize the position. This is what caused the pressure and resulted in the trauma.

Robert was in the hospital for 9 days, the normal length of stay is 4 days post fusion. The first 5 days no one could explain the severe swelling of the thighs and tremendous pain he was in. Just as mentioned in the rhabdo articles, the pain meds couldn't touch the pain. Robert was on morphine, then dalaudid, and finally neurontin. All given to him through a continous drip pump. By the time he was on neurontin, they had diagnosed the rhabdo and were flushing his system with IV fluids and diuretics. His CPK levels were extremely high and his urine looked like coke. All of the blood work indicates his kidneys are functioning very well now.

Recently he was finally able to get some relief and the swelling subsided for the most part. He is obviously extremely weak now and can hardly support his body weight. He can take a few steps with the assistance of hiking poles or a walker. He has been discharged and is trying to recover at home. However, he continues to have knotted muscles or charliehorses. During the day it is manageable, but at night Robert says his quads cramp and the huge knots don't allow him to sleep. He is still in pain, 4-5 out of 10, but the sleepless and more uncomfortable nights are the big challenge now.

Does anyone out there who has battled rhabdo personally or has encountered it in a clinical setting, have any ideas, suggestions, or things that worked for you/the patient? Heat, light massage, more or less activity, anything?

He is going to PT and will continue to do so. He's a fighter and was in very good shape going into the surgery. He did not crossfit, but certainly for his age was extremely active which will hopefully help.

He is still on oral pain meds and valium to help him sleep. The physicians have apparently told him outside of pain management, there is nothing they can do. Sure, his body needs to repair itself, but what can be done now to promote recovery outside of the aformentioned physical therapy.

The good news is his back is doing great.

Thanks for reading.
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Old 12-22-2008, 01:15 AM   #2
Frank E Morel
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Re: Post Surgical Rhabdo

let me guess... your his lawyer?
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Old 12-22-2008, 09:24 AM   #3
Adam Harris
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Re: Post Surgical Rhabdo

Far from it, I work in Human Resources. I've worked with this man for years, he's a mentor. He is a good man and I hate to see him writhing in pain, especially given how active he was before the surgery. Mentally and physically he is in a tough place.

He has seen well over 5 physicians of all different specialties now, and besides assisting with pain management, they have pretty much told him they can't help him. I thought this board may provide some insight because of personal accounts people have posted about bouts with exertional rhabdo.

I don't post much, but I do read the forums religiously. I scoured the previous personal accounts of rhabdo but none were like this situation, post surgical. Also, I didn't see anyone mention the extreme muscle cramps and knots that he has in his quads now. They are like baseballs. There seems to be no correlation between the good moments and any drug or treatment. One thing he also mentioned is the nights are the worst while the days are more manageable.
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Old 12-22-2008, 12:21 PM   #4
Darrell E. White
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Re: Post Surgical Rhabdo

Adam:

The Rhabdo that your friend experienced is a secondary effect from what is, in effect, a crush injury. Localized "Rhabdo" is actually localized muscle trauma from crush or gross overuse ( in the absence of contributing factors such as alcohol abuse, severe dehydration, sickle cell, and others).

What your friend is suffering from now is the residual effects of the crush injury, the localized injury to his quads from 6 hours of compression, compromised circulation, etc. The two most likely beneficial treatments are gentle, progressive PT and "tincture of time." The overwhelming majority of these injuries heal with minimal to no long term redual effects over time.

Best of luck--bingo
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Old 12-23-2008, 12:11 AM   #5
Frank E Morel
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Re: Post Surgical Rhabdo

where did he say the surgery was " localized injury to his quads from 6 hours of compression, compromised circulation, etc."

spinal fusions are generally done under two hours from the time he is put to sleep then flipped on to his belly to being flipped on his back to wake up after being extubated.

sorry there is more to this story than a simple spinal fusion and developing rhado post op.
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Old 12-23-2008, 08:00 AM   #6
Joel Chapman
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Re: Post Surgical Rhabdo

Quote:
Originally Posted by Frank E Morel View Post
where did he say the surgery was " localized injury to his quads from 6 hours of compression, compromised circulation, etc."

spinal fusions are generally done under two hours from the time he is put to sleep then flipped on to his belly to being flipped on his back to wake up after being extubated.

sorry there is more to this story than a simple spinal fusion and developing rhado post op.

Right here:

Quote:
the surgey lasted nearly 6 hours instead of the 4 hour predicted time, low phosphorus levels, and the positioning during the surgery. An Andrews table of some design was used. WFS link to a jackson table, http://www.erothitan.com/radiolucent..._state_en.html. Apparently the style used during this particular surgery contained a wide thigh strap to stabilize the position. This is what caused the pressure and resulted in the trauma.
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Old 12-23-2008, 10:01 AM   #7
Frank E Morel
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Re: Post Surgical Rhabdo

stand corrected.
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Old 12-23-2008, 02:04 PM   #8
Tom Woodside
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Re: Post Surgical Rhabdo

I have exactly 2 cents worth of thoughts on this as I have no experience with rhabdo, nor am I any kind of doctor. Far from it. But, my Dad had spondolythesis and had the surgery about 15 years ago for it. As I recall, the only real rehab for that surgery is walking... a lot of walking. Which your friend may have trouble doing for a while. My Dad fell and broke his hip not long after the surgery and was unable to do the walking rehab. His back never really recovered well from the surgery. You might suggest to your friend to walk as much as he can once he has recovered form the rhabdo. However, I suppose his doctor's advice is better than anything some idiot (read: me) is going to tell you on an internet forum.

Was "Robert" a football down lineman in high school or college? Supposedly, spondolythesis is fairly common in former football players. Just a thought.

I wish him the best of luck.
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Old 12-23-2008, 07:10 PM   #9
Adam Harris
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Re: Post Surgical Rhabdo

Thanks Tom. You memory is spot on. The rehab discussed for fusion was indeed a lot of walking and one of the major concerns is just what you pointed out with you fathers recovery. It seems as though the two recovery methods don't overlap well, rest post rhabdo, walk post fusion. I will be sure and mention your fathers experience.

Robert did play football in highschool and college, free safety I believe.
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