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Anthony Klagenberg
10-15-2007, 06:40 PM
This is my first week as a CF and I give 120% in everything I do. I have been in the Army for 10 years and work out at least three days a week sometimes more. I am in shape, but not to the standards of CF. I heard about this web site from my brother-in-law and new this was the next step for me. As of right know I hospitalized with Rhabdomylosis. My urine looked like coffee. They are taking care of me and my kidneys are in good shape. Luckily I'm still young. I just don't know when to stop and I push myself until I can't physically do anymore. All I can think of is when can I get back to it? My question is, has anyone had this before (my first experience) and how long I should wait before I get back into it. One other thing I learned was that I should not have been taking NSAIDs for the soreness. It only mad it worse. I was supposed to take Tylenol.

Derek Maffett
10-15-2007, 07:24 PM
Rhabdo has been known to be more probable in people who are more fit (I believe that means other fitness type, eg. powerlifting, not metcon), so that would be a factor.

Send a PM to Eugene Allen. One of the people at his affiliate had rhabdo so he can probably tell you more or maybe even let you talk to the guy. There was an article that talked about the case which mentioned him doing the workouts again in six months. Whether he was out for all those months I don't know.

David Wood
10-15-2007, 07:26 PM
Anthony:

My deepest sympathies for the rhabdo. It seriously sucks, and can be life-threatening. I'm glad to hear you're OK.

If you have time and computer access, search these boards for the term "rhabdo". You'll find it's been discussed many times, with heavy warnings about not going too hard. There are a handful of known cases of folks giving themselves rhabdo from going at CF too hard, and another handful of "suspected" (very mild) known cases.

You'll also find, if you spend any time on the "Start Here" links on the main page, that we provide many, many warnings about ramping up slowly, starting with a scaled workout, etc. Those warnings are there for a reason (as you have learned (the hard way)).

Rhabdomylosis occurs when muscle tissue is broken down faster than the kidneys can clean it up (hence, the kidney failure). Usually, this occurs only in rare muscle-wasting diseases, or for victims of major crushing injuries (think long falls, or motor vehicle accidents) (and those folks usually have more immediate problems than the rhabdo; that comes later). And it *can* occur, as in your case, from self-inflicted exercise.

It takes a heck of a lot of motivation to push yourself hard enough to do that . . . while I can't exactly admire the outcome, I do admire your drive.

Actually, you were probably the prime candidate for going so hard you hurt yourself . . . you're still young, in pretty good shape when you started, and you were capable of pushing yourself very, very hard (you must have already known something about extreme efforts). That's pretty much the profile of an "at risk for rhabdo" guy . . . a rank beginner is actually very unlikely to get it, simply because he's not in shape and can't push himself that hard.

So, your questions: yes, a few people have gotten it before, mostly guys like you (young, strong, and motivated). All have gotten better, and all have returned to CrossFit (as far as I know). I don't know exactly how long you should wait . . . but I would assume the docs will tell you. My first guess is 3 or 4 weeks, then LIGHT workouts (not full-on WODs!) for a couple more weeks. But I would defer to your doctors, who've seen your specific kidney condition.

Also, you might want to treat your body like a temple for a while . . . cut way back on any alcohol or other "pollutants" that add to what the kidneys have to deal with.

Derek Maffett
10-15-2007, 07:32 PM
David, I'm wondering about the possibilities of a person used to Crossfit getting rhabdo. Would it be possible for, say, Greg Amundsen to push himself so incredibly hard as to get rhabdo? Or do we simply adapt after about a month and then the possibilities are gone?

Anthony Klagenberg
10-15-2007, 07:44 PM
Thank you guys for the reply back and I will diffidently listen to the docs and scale it back for a while. I was just so motivated to do this and learned the hard way. I am looking forward to getting back to CF (after my recovery) and reading up on Rhabdo so it doesn’t happen to me again and so I can educate the people that work out with me about it.

Thank You

David Wood
10-15-2007, 07:51 PM
David, I'm wondering about the possibilities of a person used to Crossfit getting rhabdo. Would it be possible for, say, Greg Amundsen to push himself so incredibly hard as to get rhabdo? Or do we simply adapt after about a month and then the possibilities are gone?


Interesting question, but I have no idea. I'm inclined to guess that the body adapts, or maybe we just get smarter and don't push *that* hard over that long. I've seen Greg train, and we've all seen him in videos; it would seem that he *could* give himself rhabdo (unless maybe he's an android?) But as far as I know, he hasn't.

Steven Low
10-15-2007, 08:01 PM
It's more common in people who have had previous experience with training so they know they can push themselves but they've been out of it for a while or they're not used to high intensity work and their muscles can't keep up with them.

It's incredibly difficult if you've been training constantly for years to give yourself rhabdo. I'm sure its doable if you've been doing say metcons and then decide to run a marathon.. but other than that even if you did a couple WODs in a row you'll probably just be sore rather than something like rhabdo.

Anthony Klagenberg
10-15-2007, 08:46 PM
That’s what I thought it was for the first few days, I thought I was just sore because the work outs are more extreme than I am used too. So, I marched right on through the soreness and continued my work outs. Which I know now I should not have done, because I am new to CF. Than my urine was extremely dark and I went straight to the emergency room. To me it was hard to differentiate between muscle soreness and muscle damage. I guess every time you work out you cause some type of damage to your muscles and I just didn’t give my body time to recover? This is only because I am a newbee to the program and my body is not used to the program yet. Does this sound correct?

I only drink on the weekends and I do not take any kind of supplements at all. I will take the advice and treat my body as a temple and cut back the drinking, insure I am well hydrated before work outs and eat healthier.

Thank You Again

Derek Maffett
10-15-2007, 08:59 PM
Yes, you damage your muscles when you use them. Which would be really, really bad if it weren't for the "repair and make the muscles better than ever" function. As for soreness, it's okay, just frustrating. Unless, of course, (as in your case) it's rhabdo.

If you come out of this with simply a much greater mental discipline, then your time away from the workouts isn't in vain. Take this time to read up on CF materials and such. When you get up to the point of light workouts, you could take the time to learn the movements. Make the best of every moment you've got.

Edit: I think I understand you're question there. No, I don't think that inadequate recovery after the workout was why you got rhabdo. What I've heard about rhabdo has led me to believe that it is a one-shot deal. You pushed too hard on a workout and that's what did it. I've never heard of rhabdo from cumulative over-working.

Steven Low
10-15-2007, 09:54 PM
Rhabdo can be cumulative since it takes along the lines of a couple days to "fully" repair muscles. Although you should generally see color changes in the urine over the course of said days which can be blunted if you're drinking a lot. Generally speaking though, it's a one shot deal since most people are too sore to move the next few days.

John Frazer
10-16-2007, 04:24 AM
BTW rhabdo isn't just a CrossFit phenomenon. A guy who retired from my office a couple years ago is a longtime ultra-runner and got it about 90 miles into a 100-mile race. So much for long, slow distance being safer.

Bill Pontius
10-16-2007, 07:47 AM
I agree with Steven about possible cumulative effects. I recall an East German study on track and field athletes training to near maximum repeats on the track needing 72 hours to fully rid their muscles of all lactic acid (blood tests used as indicators). "Active rest" was more efficient at speeding recovery than full rest.
From the experiences of others, rhabdo can clearly happen after one workout. It
can also, I suspect, happen after a second or third workout--though I don't want to find out from personal experience.
Since one of the serious side effects is damage to the kidneys, I wonder if anyone is aware of research on the effects of hydration in alleviating or at least ameliorating rhabdo symptoms? Or of dehydration promoting rhabdo?

Steven Low
10-16-2007, 09:41 AM
72 hours to remove lactic acid? That study is wrong then cause lactic acid is removed within hours of completing workouts.. If it's other indicators maybe like kinases in the urine I would understand.

As it is being hydrated to a point would probably help. Being dehydrated makes the kidneys work hard regularly which you can see if you're taking a lot of protein or creatine then you'll see detrimental effects on the organs. I would speculate that its more damaging up to a point and then from there is just damaging linearly.

Bill Pontius
10-16-2007, 11:32 AM
Unfortunately, most of my Track and Field Journals were in a box that failed to make a move with me and my family several years ago, so I can't site the work. The study measured the lactate in the blood and--as anyone who has worked out experiences--the bulk of lactic acid does go quickly. The point of the study was for them to understand better and more fully recovery and the "tail" that lasted for up to 3 days. I'll see if I can dig up the reference. And of course, I'm not suggesting lactic acid is the cause of rhabdo, merely that full recovery is more than a 24 hr process. Thus, rest days. And the adaptation to work loads before moving on to greater loads. (For anyone undertaking new exercises or routines, especially those of us who know how to push, recovery is even more important than for the athlete experienced and trained at the exercises and load involved--though for this I am siting opinion rather than a study)

Matt DeMinico
10-16-2007, 12:33 PM
72 hours to remove lactic acid? That study is wrong then cause lactic acid is removed within hours of completing workouts.. If it's other indicators maybe like kinases in the urine I would understand.

As it is being hydrated to a point would probably help. Being dehydrated makes the kidneys work hard regularly which you can see if you're taking a lot of protein or creatine then you'll see detrimental effects on the organs. I would speculate that its more damaging up to a point and then from there is just damaging linearly.

I'm going to go with Steven on this one. Of course I have no references, but I understand that lactate is cleared from the muscles within 30 minutes of a workout. Maybe it takes longer to clear from the blood as the concentration diminishes, but at such low levels it's inconsequential?

Bill Pontius
10-16-2007, 01:57 PM
I would generally bet on Steven's answer,too. In the future i'm not going to post using 30 year old neurons that I can't back up with either hard copy or a web link. I'm still looking. . .

Anthony Klagenberg
10-16-2007, 02:24 PM
RECOVERY UPDATE

DAY 1 – Went to the ER and was diagnosed with Rhabdomylosis. My Creatine Kinase was 102,000 U/L (normal for a male is 17 – 148 U/L). They gave me about 4L NACL fully open (about 1L/HR), about 50mL of Sodium Bicarb and admitted me.
DAY 2 – With about 10L of NACL on board at 150 ML/HR and starting to fill a lot better my Creatine Kinase was 75,000 U/L
DAY 3 – With about 15L of NACL on board at 175ML/HR mixed with Sodium Bicarb my Creatine Kinase went up to 90,000 U/L. It went up because there were residual proteins left in my muscles and was released because of walking to the bathroom every 30 minutes :). My urine is back to normal color now.

I am expected to be here for about 2-3 more days. That’s a lot of pee :). I will keep an update for reference in the future for anyone who would like to see.

Before anyone asks me again, NO, I am not taking creatine. I have not and will not ever take the stuff. I have been asked by every doctor I have seen and I understand why, because my levels were so high.

Thank You Everyone

Brandon Oto
10-16-2007, 02:48 PM
So treatment seems to consist of NACL, sodium bicarbonate, and fluid.

I wonder if we can formulate a reasonable plan of attack for home "first aid" for rhabdo. Salt and baking soda in water doesn't sound that daunting, although the volume does.

I'd never suggest this just to avoid a hospital visit, but there may be cases where it would be beneficial to begin treatment before you reach advanced care, or in the worst scenarios, in lieu of it altogether. Examples would be if you're a long way from the ER, or indefinitely far (a remote location -- mountaineering, say).

Possible someone's looked at this already, but I'm not sure exercise-induced rhabdo has gotten much attention from anyone but CrossFitters.

Anthony Klagenberg
10-16-2007, 03:02 PM
I found an excellent paper on Rhabdo in athletes.

http://www.sportsinjurybulletin.com/archive/rhabdomyolysis.html

Lincoln Brigham
10-16-2007, 03:07 PM
Anthony, I'm not sure that the docs didn't ask you an ignorant question about creatine supplementation. Creatine (Pcr) and Creatine Kinase (CK) are not the same thing. High CK levels are an indicator of a problem, but high CK levels are not the problem itself. Just an indicator.

Creatine (Pcr, phosphocreatine) is a fuel.
Creatine Kinase (CK) is an enzyme. It is a catalyst. It is not a fuel.
They both use the word "creatine" but they are not the same thing.

Creatine Kinase is the fire used to light the fuel called Phosphocreatine.

I'm no biochemist, but I'm not sure the excess of CK is directly related to an excess of phosphocreatine supplementation. I even wonder if an excess of CK is an indication of a recent depletion of Pcr stores. In other words, a bunch of matchsticks (enzymes) looking for a woodpile (Pcr) that already burned up in a big firestorm. That firestorm could be a heart attack (which is a lack of fuel to the heart muscle) or it could be Fight Gone Bad.

There is some compelling evidence that Pcr supplementation is good for heart attack victims. Why? Because local Pcr supplies in the heart have probably been exhausted. Pcr levels in heart tissue are usually depressed in heart attack victims.It has also been determined that the exogenous administration of PCr during cardiac surgery and as a treatment for acute myocardial infarction has the ability to provide effective myocardial protection from acute ischemic injury and preoperative ischemic damage (52). When examining chronic heart failure patients, it has been demonstrated that PCr significantly improves left ventricular systolic and diastolic function (52). The administration of PCr has also been found to exert antiarrhythmic properties (19, 34, 55). The benefits associated with the infusion of PCr have led some to speculate on the potential benefits of oral creatine administration in the treatment of chronic heart failure patients (2, 24). This speculation centers on the fact that increasing creatine concentrations can lead to increases in the availability of PCr through the actions of the CK reaction.Strength and Conditioning Journal: Vol. 21, No. 4, pp. 13–23. Haff, Kirksey, and Stone.

I wonder if creatine supplementation would be a good thing for Rhabdo victims.

Steven Low
10-16-2007, 03:24 PM
Lincoln:

I would have to agree that the question about creatine supplementation is pretty ignorant.

The body generally starts to rid itself of enzymes and other biological molecules if you're supplementing them. For example, you see that if you constantly supplement creatine in the diet or even things like testosterone that natural production drops and is usually depressed when cycling off. Too long and there's permanent inhibition of the pathway much like insulin resistance in type II diabetes.

Generally, enzyme concentration is increased due to metabolic demand.. so high CK levels would indicate that you've been active in depleting at the very least phosphocreatine stores in the muscles.

Er, a little off topic but I'd "speculate" about sarcoplasmic hypertrophy being that it's higher reps than myofibrillar hypertrophy would mean along with the increase of sarcoplasmic fluid in the muscle due to increased production of metabolic enzymes and mitochondria. But I don't have anything to back that up. Sarco seems to be a weird phenomena where some people don't believe it exists, and there's not much information on it out there other than that people can get "bigger" muscles without much increases in strength.

Lincoln Brigham
10-16-2007, 03:54 PM
I'm not sure about linking testosterone production and supplementation with PCr storage and supplementation. One is a hormone, the other is a fuel. There are hormonal feedback loops in testosterone and insulin production that tries to limit serum levels. But excess testosterone and insulin (through exogenous supplementation) stays in the system. There is a simple storage limit in the muscle cells for PCr - the excess is simply dumped into urine.

Steven Low
10-16-2007, 04:16 PM
True.. although creatine supplementation does decrease engeneous creatine production through feedback loop.. just as test and insulin can suffer from the same thing. Here's another example... non-essential amino acid production is also regulated such that if you're getting it through your diet the body reduces the amount of enzymes to produce such amino acids.

That's kind of what I was getting at mainly... along the lines of if you're supplementing something like creatine, the enzymes required to make creatine from the urea cycle will probably be reduced rather than elevated along with the various kinases. Although elevated creatine levels with high energy output can mean increases in CK levels. I wonder if there's any studies on this.

Andy Shirley
10-18-2007, 01:10 PM
A few questions:

What was your admission Potassium(K)? Peak?

Same for BUN and Serum Creatinine?

Coags? (PT, PTT/INR)

They didn't give you a catheter? That's kind of odd.

The best thing you can do if you suspect you have Rhabdo is to start drinking fluid(on the way to the ED). Lots of it. Water is good, pedialyte is good, gatorade, whatever. The point is to keep your kidneys working at such a rate that they don't get backed up by the crap. This is also where the IV BiCarb comes in. But I'm not sure if taking bicarb by mouth would have a similar effect.

Steve York
10-26-2007, 02:25 PM
My experience with rhabdomylosis. Three years ago I put my team through a navy mud run which consisted of 100 metre run through a drain from an estuary. The mud consistency was thick, wet and sticky. The mud was waist deep and progress was very slow and arduous. Clothing consisted of long john wetsuits, booties and flippers on the hands.

Needless to say, the run became a crawl with some guys requiring to be dragged along or withdrawing altogether. One particular guy had been out drinking the night before and was wearing a rash vest underneath his wetsuit. Consequently, he collapsed and was absolutely wrecked. He ended up in hospital for 10 days as his internal organs had shut down.

I now have a big worded description to give to exercise induced dehydration.

Combination of a statin with a fibrate or with nicotinic acid also carries an increased risk of rhabdomyolysis.