Hospitalized for Rhabdomyolysis

Kelly Warniment · 04-25-2007, 11:18 AM

I am a 27 yr old, white, female. Physically fit and healthy. Easter Sunday (4/8/07)I drove myself to the ER. My main symptoms were: extreme swelling of the right arm, moderate swelling of the left arm. The swelling was so bad in the right arm I was getting tingling sensations (I later found out due to nerve damage in the right elbow) and I had no mobility with my triceps (couldn't even lift my arms up to neck level). I also was beginning to feel nauseous. Once at the hospital, I was admitted, supposedly with a diagnosis of Rhabdomyolysis. They held me for 4 days. A few parts of the story don't add up however:
1. I've done crossfit workouts for over a year. The particular workout I did (the WED before Easter - 4/4/07) was not intense and was not using heavy weight. I modified my own workout (I was traveling and the gym was limited). I did 5 rounds of: Run 400m, 20 no momentum situps, 20 tricep extensions on incline bench (using both arms to support one db). I worked out at a slow pace (overall workout time - between 25 and 30 min). The weight I used for the tricep workout was a 10 lb db for the odd rounds, and 15 lb db for the even rounds. I felt fine when I was finished. Had no problems until the soreness in the triceps started to become severe on 4/6/07 and the swelling started on 4/7/07. The tingling in my arm on 4/8/07 is what prompted me to drive to the ER.
2. My Urinalysis results were completely normal. No coke-colored pee. No abnormal levels. Everything was fine. What caused them to admit me was when my CPK came back at 19,000 and the abnormally large swelling that was occuring in my right arm and getting worse (even as I sat in the ER for 5 hours). The left arm was swollen as well, but not nearly as bad. MY CPK continued to increase and peaked that night at 23,500.

What makes no sense to me is how this occurred. I've since then just not felt the same and have been out on disability at work. I'm feeling stronger every day, and want to try to incorporate workouts slowly back into my daily schedule. What concerns me is I'm wondering if it's possible the rhabdo, rather than a completely direct result of the workout, occurred because of stress levels, the workout, and perhaps an underlying muscular metabolic condition (which is now being investigated).

I just wanted to put this post out there, and see if anyone had any thoughts on the whole story. Or if anyone has any neuromuscular or metabolic muscular disorders. I'm trying to piece together the puzzle and also get some activity back into my life, but wanting to do so without risking any severe repercussions. I'm not sure where to start as far as reps/weight to be effective but not even get close to overworking myself.

Thanks!

Garrett Smith · 04-25-2007, 11:42 AM

Kelly,
Check out this study, w/f safe: http://www.acsm-msse.org/pt/re/msse/abstract.
00005768-199912000-00002.htm};jsessionid=
GvSfTGkSV6y5YlQ2v2ZY6ZttzqhfcpC42jyhHM8p2713
yLYT1hDc!3145886!-949856 145!8091!-1

You may need to cut-and-paste the link.

Based on what they report, it seems to fit your presentation.

High stress levels and lack of sleep could absolutely predispose you to a reaction like this.

Let us know what comes of the metabolic investigation.

Adam Head · 04-25-2007, 01:17 PM

Dr. G, I tried reading the article, but it requires a user name and password.

David Wood · 04-25-2007, 03:15 PM

Full text here, from Google Scholar 'cache':

http://scholar.google.com/scholar?hl=en&lr=&newwindow=1&q=cache:VkN5qW8m2awJ :www .ms-se.com/pt/re/msse/fulltext.00005768-199912000-00002.htm+Adverse+events+assoc iated+with+eccentric+exercise+protocols:+six+case+ studies

(W/FS, won't get the pictures, however).

Garrett Smith · 04-25-2007, 07:30 PM

Nice link, Dave!

I wish they had a PDF of that...

Kelly Warniment · 04-26-2007, 07:25 AM

Thank you guys for the references! Garrett - I actually converted the web page to PDF in case you want to grab it. It's too bad the pictures won't show up though.

Ben Kaminski · 04-26-2007, 07:42 AM

Glad to hear you're doing OK. Nice article, for sure. Scary too, how it can creep up on you.

Garrett Smith · 04-26-2007, 08:20 AM

Kelly,
It would definitely be wise to do exercises that emphasize the concentric/positive/overcoming movements and minimize the eccentric/negative/yielding portions. This obviously would not be forever.

Darrell E. White · 04-26-2007, 09:15 AM

Very interesting link, David. Sounds a lot like what you experienced, Kelly.

This brings up the difference between rhabdomyolysis the phenomenon (lysis of myosites, muscle fibers, with the release of harmful byproducts) and Rhabdomyolysis, the clinical entity resulting from massive rhabdomyolysis. The clinical entity has been discussed frequently at CF. Kelly's experience is a useful cautionary tale that there is more than one type of "Rhabdo" that can harm. This specific localised entity also puts one at risk for a compartment syndrome, hence the nerve damage.

Kelly, thanks for sharing your experience. Probably wise to avoid "negatives" for a time as Garrett suggests.

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04-25-2007, 11:18 AM	#1
Kelly Warniment Member Profile: Join Date: Apr 2007 Location: Columbus Ohio Posts: 9	I am a 27 yr old, white, female. Physically fit and healthy. Easter Sunday (4/8/07)I drove myself to the ER. My main symptoms were: extreme swelling of the right arm, moderate swelling of the left arm. The swelling was so bad in the right arm I was getting tingling sensations (I later found out due to nerve damage in the right elbow) and I had no mobility with my triceps (couldn't even lift my arms up to neck level). I also was beginning to feel nauseous. Once at the hospital, I was admitted, supposedly with a diagnosis of Rhabdomyolysis. They held me for 4 days. A few parts of the story don't add up however: 1. I've done crossfit workouts for over a year. The particular workout I did (the WED before Easter - 4/4/07) was not intense and was not using heavy weight. I modified my own workout (I was traveling and the gym was limited). I did 5 rounds of: Run 400m, 20 no momentum situps, 20 tricep extensions on incline bench (using both arms to support one db). I worked out at a slow pace (overall workout time - between 25 and 30 min). The weight I used for the tricep workout was a 10 lb db for the odd rounds, and 15 lb db for the even rounds. I felt fine when I was finished. Had no problems until the soreness in the triceps started to become severe on 4/6/07 and the swelling started on 4/7/07. The tingling in my arm on 4/8/07 is what prompted me to drive to the ER. 2. My Urinalysis results were completely normal. No coke-colored pee. No abnormal levels. Everything was fine. What caused them to admit me was when my CPK came back at 19,000 and the abnormally large swelling that was occuring in my right arm and getting worse (even as I sat in the ER for 5 hours). The left arm was swollen as well, but not nearly as bad. MY CPK continued to increase and peaked that night at 23,500. What makes no sense to me is how this occurred. I've since then just not felt the same and have been out on disability at work. I'm feeling stronger every day, and want to try to incorporate workouts slowly back into my daily schedule. What concerns me is I'm wondering if it's possible the rhabdo, rather than a completely direct result of the workout, occurred because of stress levels, the workout, and perhaps an underlying muscular metabolic condition (which is now being investigated). I just wanted to put this post out there, and see if anyone had any thoughts on the whole story. Or if anyone has any neuromuscular or metabolic muscular disorders. I'm trying to piece together the puzzle and also get some activity back into my life, but wanting to do so without risking any severe repercussions. I'm not sure where to start as far as reps/weight to be effective but not even get close to overworking myself. Thanks!

04-25-2007, 11:42 AM	#2
Garrett Smith Member Profile: Join Date: Apr 2005 Location: Tucson AZ Posts: 2,264	Kelly, Check out this study, w/f safe: http://www.acsm-msse.org/pt/re/msse/abstract. 00005768-199912000-00002.htm};jsessionid= GvSfTGkSV6y5YlQ2v2ZY6ZttzqhfcpC42jyhHM8p2713 yLYT1hDc!3145886!-949856 145!8091!-1 You may need to cut-and-paste the link. Based on what they report, it seems to fit your presentation. High stress levels and lack of sleep could absolutely predispose you to a reaction like this. Let us know what comes of the metabolic investigation.

04-25-2007, 01:17 PM	#3
Adam Head Affiliate Profile: Join Date: Apr 2007 Location: Athens GA Posts: 293	Dr. G, I tried reading the article, but it requires a user name and password.

04-25-2007, 03:15 PM	#4
David Wood Moderator Emeritus Profile: Join Date: Oct 2002 Location: Lebanon NJ Posts: 3,310	Full text here, from Google Scholar 'cache': http://scholar.google.com/scholar?hl=en&lr=&newwindow=1&q=cache:VkN5qW8m2awJ :www .ms-se.com/pt/re/msse/fulltext.00005768-199912000-00002.htm+Adverse+events+assoc iated+with+eccentric+exercise+protocols:+six+case+ studies (W/FS, won't get the pictures, however).

04-25-2007, 07:30 PM	#5
Garrett Smith Member Profile: Join Date: Apr 2005 Location: Tucson AZ Posts: 2,264	Nice link, Dave! I wish they had a PDF of that...

04-26-2007, 07:42 AM	#7
Ben Kaminski Member Profile: Join Date: Apr 2004 Location: Cincinnati OH Posts: 873	Glad to hear you're doing OK. Nice article, for sure. Scary too, how it can creep up on you.

04-26-2007, 08:20 AM	#8
Garrett Smith Member Profile: Join Date: Apr 2005 Location: Tucson AZ Posts: 2,264	Kelly, It would definitely be wise to do exercises that emphasize the concentric/positive/overcoming movements and minimize the eccentric/negative/yielding portions. This obviously would not be forever.

04-26-2007, 09:15 AM	#9
Darrell E. White Member Profile: Join Date: Apr 2006 Location: bay village OH Posts: 792	Very interesting link, David. Sounds a lot like what you experienced, Kelly. This brings up the difference between rhabdomyolysis the phenomenon (lysis of myosites, muscle fibers, with the release of harmful byproducts) and Rhabdomyolysis, the clinical entity resulting from massive rhabdomyolysis. The clinical entity has been discussed frequently at CF. Kelly's experience is a useful cautionary tale that there is more than one type of "Rhabdo" that can harm. This specific localised entity also puts one at risk for a compartment syndrome, hence the nerve damage. Kelly, thanks for sharing your experience. Probably wise to avoid "negatives" for a time as Garrett suggests.