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View Full Version : Another Rhabdo victim - long post


Alison Burke
06-22-2012, 09:49 AM
I've been doing Crossfit for almost two years - 44 y.o. female, only known medical issue is being hypothyroid (controlled). Prior to crossfit I did weightlifting for about 20 years (and I'm not talking about that circuit training stuff - I mean squats, deadlifts, bench etc). I'm always cautious at the gym mostly because I'm fearful of injury and figure that it just isn't worth it. I want to be fit and strong but I'm not 20 nor do I plan on going to the games. I'm Ok with using a band, OK with a smaller box, OK with 10 pound less that I could probably do.

Despite all this I developed a case of rhabdo after this past weekend's workout of Angie (which for the record I've done before). In my usual cautious way I used a thick green band for the pullups but that clearly wasn't enough. Neither my abs nor my legs even got sore but three days after the workout my left arm/bicep area swelled up. I knew something wasn't right about that and played intenet doctor and saw a post with pictures of a trainer who got rhado and her arm looked exactly like mine.

Got in to see a doctor (not my regular guy) day 3 post-workout. First doctor did not believe I had rhabdo,( I asked specifically) didn't even test but sent me for an ultrasound to check for blood clots. Day four I decided to call my regular dr and ask for CPK test. Came back at 27000. BTW -for anyone not having experienced this, I never had the tell-tale brown pee.

Luckily for me DR. didn't send me to hospital but was OK with my drinking significant amounts of water and gatorade. Found out yesterday (day 5 post-workout) that no other blood tests were done to check kidney function. By this point I've lost all shyness in calling in for more tests. I won't get those results until Monday but fingers crossed everything will be OK. I just don't think many doctors expect to see this trauma from exercising and I have to say I was embarrased to have to admit that I exercised myself into this state.

I keep wondering what I did wrong - should I have known better? What was different this time? If anything, I was more hydrated than usual. I am usually terrible about drinking water but was involved in a paleo challenge at the time and water counted, so I was getting at least 72 oz per day. Same goes for sleep. Did being on paleo diet have anything to do with it? I doubt that because for the last 8+ years I've been more or less following an Atkins diet. I had also done paleo challenges before. That leads me to think that I was just not as conditioned as I thought I was. Possibly my immune system was taxed from fighting something I wasn't aware of - that seems to be a theme I see in other posts. Dr said usually follow-up test don't show any real cause or underlying state.

This is a crappy thing to happen. I don't wish it upon anyone. Instead of spending my summer working on the Wendler Plan I had *just* set up to start July 1 I will be doing basically nothing for at least a month and from what I understand it will be a slow road back. Add this experience to my already cautious nature, I don't know if I'll mentally be able to do Crossfit again. I was truly frightened for about 72 hours.

Not sure what the point of this post it - even if one person reads it and doesn't wait to pee brown before seeing a doctor I'll be happy. And if that same person is willing to demand blood tests when they ordinarily wouldn't question a doctor, I'd be happy as well.

That's it - thanks for reading.

Vickie Ellickson
06-22-2012, 09:58 AM
I'm curious as to how many pull-ups and push-ups you typically do in a given week? You did this workout before without issue...how long ago was that?

I'm guessing that all of the water, sleep, and nutrition in the world isn't going to help if the volume of exercise is significantly more than what your body is used to doing.

As a result of stories like this, I have a very healthy respect for rhabdo and either scale or make sure I gradually work up to 75% of a high volume workout.

Someone else mentioned in a similar thread that a good option would be to ditch the assistance (bands), which would result in a forced (and needed) scaling of the rep count.

Alison Burke
06-22-2012, 10:24 AM
Hi Vickie-

I could go back and look at Beyond the Whiteboard and see when the last time was that I did a lot of pull-ups and push-ups. It probably was quite some time ago - the reps of 100 don't come up that often, even less so in that combination. I did Angie over a year ago and realize that a lot could be different now. I've done a hundred reps at a time of things before (thinking of the wall-balls this year at the games opens) without having necessarily focused on gradually working up to a high number of reps of one specific exercise. I figure, perhaps incorrectly, that the conditioning for basically anything is worked into the programming. I am however assuming that the fault is my own and I just wasn't conditioned for the toll on my arms - although my legs and abs were obviously fine.

I thought I was scaling by using the green band but in fact think that may have been part of the problem since from what I've read the eccentric movements are more likely to cause problems. So I agree that maybe the bands can do more harm than good sometimes.

Thanks for your response. This has been quite a though-provoking experience.

Sefton Hirsch
06-22-2012, 08:03 PM
Hey Alison,

I'm sorry to hear about your experience. My wife is just recovering from Rhabdo from about a week ago. She was in the hospital for 2 nights getting an IV. She is new to crossfit and her athletic background and current state of being deconditioned were significant factors in her experience.

I am curious if during the workout you noticed any extreme fatigue in your arms and just fought through it. Or was it like most other workouts where you pushed yourself but did not feel like it was more than normal?

Since my wife's experience I'm really trying to learn as much as I can about preventing rhabdo for others. If you have any other thoughts or details I would love to hear them.

Good luck on your recovery, how did your coaches respond to this?

Alison Burke
06-22-2012, 08:50 PM
Hi Sefton-
I read your post earlier. I hope your wife is recovering well. What an unfortunate experience.

I do recall being tired but not so much that I felt something was wrong or that I needed to stop. I'm often the one at the gym stopping to rest as I see fit. I really can't explain why this happened now and not with other workouts. Vickie is probably right in that I was physically unprepared for the pull-up/ push-up combination in that high number of reps. Dont think there is any other explanation. Why one arm was so affected and the other was OK I don't understand either. Doctor said we'd talk in a month about possible other causes. In the meantime, I'm just left guessing.

So far only 1 trainer knows and has inquired as to my recovery. I haven't seen anyone else since the workout. I don't expect much from them, they are always clear about "modify as necessary" and don't push (me anyway) to do crazy things. I figure this is really my fault. How I'll know in the future to avoid this I haven't figured out. I've got some time now to think instead of working out now.

Best wishes to your wife.

Michael Mantione
06-23-2012, 06:15 AM
I've been doing Crossfit for almost two years - 44 y.o. female, only known medical issue is being hypothyroid (controlled). Prior to crossfit I did weightlifting for about 20 years (and I'm not talking about that circuit training stuff - I mean squats, deadlifts, bench etc). I'm always cautious at the gym mostly because I'm fearful of injury and figure that it just isn't worth it. I want to be fit and strong but I'm not 20 nor do I plan on going to the games. I'm Ok with using a band, OK with a smaller box, OK with 10 pound less that I could probably do.

Despite all this I developed a case of rhabdo after this past weekend's workout of Angie (which for the record I've done before). In my usual cautious way I used a thick green band for the pullups but that clearly wasn't enough. Neither my abs nor my legs even got sore but three days after the workout my left arm/bicep area swelled up. I knew something wasn't right about that and played intenet doctor and saw a post with pictures of a trainer who got rhado and her arm looked exactly like mine.

Got in to see a doctor (not my regular guy) day 3 post-workout. First doctor did not believe I had rhabdo,( I asked specifically) didn't even test but sent me for an ultrasound to check for blood clots. Day four I decided to call my regular dr and ask for CPK test. Came back at 27000. BTW -for anyone not having experienced this, I never had the tell-tale brown pee.

Luckily for me DR. didn't send me to hospital but was OK with my drinking significant amounts of water and gatorade. Found out yesterday (day 5 post-workout) that no other blood tests were done to check kidney function. By this point I've lost all shyness in calling in for more tests. I won't get those results until Monday but fingers crossed everything will be OK. I just don't think many doctors expect to see this trauma from exercising and I have to say I was embarrased to have to admit that I exercised myself into this state.

I keep wondering what I did wrong - should I have known better? What was different this time? If anything, I was more hydrated than usual. I am usually terrible about drinking water but was involved in a paleo challenge at the time and water counted, so I was getting at least 72 oz per day. Same goes for sleep. Did being on paleo diet have anything to do with it? I doubt that because for the last 8+ years I've been more or less following an Atkins diet. I had also done paleo challenges before. That leads me to think that I was just not as conditioned as I thought I was. Possibly my immune system was taxed from fighting something I wasn't aware of - that seems to be a theme I see in other posts. Dr said usually follow-up test don't show any real cause or underlying state.

This is a crappy thing to happen. I don't wish it upon anyone. Instead of spending my summer working on the Wendler Plan I had *just* set up to start July 1 I will be doing basically nothing for at least a month and from what I understand it will be a slow road back. Add this experience to my already cautious nature, I don't know if I'll mentally be able to do Crossfit again. I was truly frightened for about 72 hours.

Not sure what the point of this post it - even if one person reads it and doesn't wait to pee brown before seeing a doctor I'll be happy. And if that same person is willing to demand blood tests when they ordinarily wouldn't question a doctor, I'd be happy as well.

That's it - thanks for reading.

So you don't know if you have Rhabdo? The tests haven't come back and you said it yourself that you didn't have the brown pee so what makes you think that? Hopefully they tell you you're alright, to train hard and drink water! :super:

Alison Burke
06-23-2012, 08:01 AM
Sorry if I wasn't clear. Dr.only did the CK test which was 27000. It's supposed to be around 100 I believe. He hadn't ordered kidney and liver function which is what I'm waiting for. I think that the high levels of CK even without the brown pee, it is still considered rhabdo.

Steven Low
06-23-2012, 01:55 PM
Even if you are fairly fit, if you haven't performed exercise(s) in a while, you will lose some of the resistance to muscle damage that you have had previously to working such a muscle. Then doing them in high reps again can be a recipe for a lot of muscle damage and potentially rhabdo.

Regardless, good luck on the recovery.

I wrote this a while ago that may be somewhat informative

wfs
http://www.eatmoveimprove.com/2010/09/looking-at-rhabdomyolysis/

Alison Burke
06-23-2012, 08:10 PM
Thank you for taking time to respond Steven. I actually read your page prior to my post when I was frantically searching for info (your page came up in a Google search) and I found it extremely informative, albeit too late for me this time. Hopefully there won't be a next time.

I hadn't stopped to think "how many pull-ups have I done lately". I don't think I've ever eliminated something because I hadn't done it in a while. I do scale things though. At the time I thought the large band was being smart and scaling the workout. I think the eccentric movement was a contributor in this instance so I'll have to rethink the bands. I'm also curious as to why 1 arm suffered and the other didn't. It's hard for me to think I was that deconditioned only on one side. Any insight there?

Sean Smith
06-23-2012, 08:41 PM
Here's a question for why one arm swelled and the other didn't...are you right handed?

I know it doesn't do much good now, but that workout tears your body up. First, you are basically maxing out multiple times on pull ups. Then, after your upper body is destroyed you do the same things for your chest. Third, you hit 100 air squats which most people fly through compared to the pull ups and push ups which spikes your heartrate. Finish it off with 100 sit ups that destroy the stomache and your entire body is in shock.

Most doctors won't even test for Rhabdo because it doesn't make sense to associate it with exercise. It's a crush-related phenomen. You need to specifically ask for CPK and myoglobin tests.

Steven Low
06-24-2012, 04:15 PM
I would guess something along the lines of what Sean said....

Your dominant arm will typically put up more resistance when you're tired which leads to more eccentric damage being accrued in the eccentric portion of the movement.

Alison Burke
06-24-2012, 07:00 PM
Thanks Sean and Steven - it does seem obvious now that the non-dominant arm would be the worse hit. Hadn't even thought of it. Meanwhile, legs and abs weren't even remotely sore. I will probably say goodbye forever to anything with 100 reps. Not worth it.

Jon Gray
08-08-2012, 12:31 PM
Don't worry about your kidneys they are fine. If you are peeing clear you are ok. Severe rhado would start with brown urine and progress to anuria within 24-48 hours. CK of 27,000 is impressive but not too bad from a renal stand point. 300,000- 500,000 would be a big deal. Asymptomatic marathon runners can be in the 15,000K range, granted the muscle mass of their legs is much larger then your arm. In terms of adjusting volume, if you scale things so that your finishing time is in the top 25% of crossfiters you'll be safe.

Alison Burke
08-11-2012, 07:09 PM
Thanks Jon - I appreciate that info - I was never really sure how "bad" it was. That puts in into perspective.