What the hell is rhabdo? Or, shouldn’t you be in Zambia?
I should be on a plane bound for Lusaka, Zambia, right now – a work assignment, followed by a weekend of thrills at Victoria Falls, and four days in my favorite place in the world, Paris. Why am I waking up in a hospital bed for the fifth morning in a row then, tethered to an IV pole that’s my lifeline, bewildered and shattered?
All I wanted to do was get stronger at pullups. I’m pretty badass with chin-ups, if I say so myself, pounding out 10 (see janky video here) after that inane NYT article came out that said women can’t do pullups. But pullsups are a lot harder. Not even similar, really, and I got the idea that I wanted to train to do a 53 pounds weighted pullup this year.
Training commenced Monday morning, new year’s eve. Not unlike every other workout with my trainer, whose approach is to go to complete muscle failure, I pulled — doing pullup after pullup, some unassisted, then with spotting, till I couldn’t do anything more than hang there, then seated rows, lat pulldowns, tricep extensions, curls, and more until I couldn’t even straighten my arms. I knew I’d be hella sore. I could barely get my coat on or off the rest of the day. But that’s just par for the course for the way I trained in 2012. It’s how I developed the arms that I’m, I know, inordinately proud of.
That was it. I thought. Then I woke up that night, arms screaming sore, back and abs also incredibly sore. My arms were so sore it felt more like a charlie horse in the bicep. Tuesday was the same. I couldn’t straighten either arm. Wednesday I was in agony. I pulled off my sweatshirt before bed because my arm felt puffy, and no lie, almost passed out. My ears started to ring and my vision went dark around the edges. I don’t handle shock well. My right arm looked like a textbook case of elephantitis. My husband packed it in ice and convinced me to see a doctor the next day instead of go to urgent care immediately.
I debtated in the morning going to my family doctor, urgent care by my office (to be quick) or my sports doctor, Paul McKee. The others wouldn’t even know what a pullup was, but he is notoriously behind schedule. I called though, and had to good fortune to get in on a cancellation.
Talking about this bizarre happening on Facebook, a friend asked if I’d ruled out rhabdo. My heart froze. I didn’t know much about it but had heard of it from my days at Crossfit. It was bad news.I went early for my appointment and got right in. “I’m worried about a couple of things,” Dr. McKee said. “Don’t say rhabdo,” I pleaded. “I’m worried about rhabdo,” he said.
“The thing is, I’m going to Africa. Monday.” I replied. Things started happening quickly then. A “STAT” blood test, immediately followed by an MRI. Once out of there my bloodwork was back. McKee was admitting me to hospital. He met Brian and me at his office. His words were sort of one big scary string. CK levels of 41,000 (normal is one hundred). Liver damage. Danger of seizing. Of acute renal kidney failure. ICU. Heart attack. I couldn’t even cry it was so surreal. I had only done a few pullups. You don’t die from doing pullups.
I spent my first night in the hospital, breaking down the moment Brian shut the door behind him.
My body’s job was to take in massive quantities of fluid and flush out the toxins the damaged muscles were flooding into my bloodstream. McKee was playing a delicate balancing act. Not enough fluid and the myoglobins (the toxic proteins from the breakdown of the muscle) would damage my kidneys. I already had liver damage. Too much water and I’m in equal danger. I assured him repeatedly that I drink a *lot* of water. Up to a gallon, most days. I can handle it. I lay in the hospital bed in the dark room and in the glow of the IV pole watched the fluids flow into my arm. I pictured the liquid flushing out the goblins (that’s what I like to call them). And in the morning, the number was down by almost half. I might still be able to go to Africa. We had a long talk about blood clot risk, and about what to do if I had a relapse in Zambia (get off the continent, he said).
But in the afternoon the numbers had risen 50%. “I’m taking the decision from you,” he said. “You’re not going anywhere.” Five minutes later a nurse arrived to take my blood pressure. It’s usually about 100 over 65. Now it was 212 over 100.
That was Friday. It’s Tuesday now. We’ve been chasing down the goblins (the CK) and the liver number, balancing sodium and potassium, and he’s pounding me with as much fluid as he would a college athlete twice my size. My kidneys are rock stars. I wish I could get them a present. They are taking every once of fluid and pushing it on out, carrying the toxins with it. My level was 10,000 last night. When I get to 1000 and hold for 6-12 hours I can go home. The amount of fluid he’s giving me would put most people into ICU, McKee says. I can’t begin to express how grateful I am that for years I’ve been such a heavy water drinker.In fact, if I hadn’t been drinking my usual copious quantities all last week I could well have gone into kidney failure before even seeing the doctor. Even still, I saw my doctor just in time – my body was already shutting down when I got to him, he tells me now. “I think I was in a lot more danger than I realized at the time,” I said. “You were,” he says.
So what the heck is rhabdo anyway? and how does it take you from this:
Here’s how I understand it. When you work out, you tear your muscle down a bit. It rebuilds, and that’s how you get stronger. The small amount of myoglobins pass through your system and don’t hurt anyone. When you completely decimate a muscle, like I did to my bicep, bracchii and lat, your body is infested with the stuff.
This LA Times article has some good information:
It’s difficult to know when vigorous strength training has crossed the line and athletes are at risk of rhabdomyolysis, Clarkson said. Tiny tears occur in muscles after any strenuous workout. The healing of these micro-tears, which causes the soreness people feel after hard exercise, is what prompts the muscle to become stronger.
But the tears release a protein called myoglobin into the bloodstream. If too much myoglobin is released, it can build up in the kidneys and impair function. Treatment includes intravenous fluids and sometimes kidney dialysis.
Dehydration increases the risk. Eccentric exercise, in which muscle fibers are lengthened as they contract — such as with squats and push-ups — is usually involved in triggering the syndrome, Clarkson said.
However, some cases of rhabdomyolysis also appear to involve a coach’s or trainer’s enthusiasm for working athletes to the brink of collapse, Hawkins said.
It seems it’s a tricky little monster. It’s not like there’s a barometer in your body that indicates when you’ve crossed the line from killer workout to actual killer workout. I didn’t know, my trainer didn’t know, that we’d crossed that line.
I want to be furious and devastated and sick and full of regret, and feel foolish, but I can’t take the energy away from recovering to do any of that. I know the time will come, when I start physical therapy with two pound dumbbells, and I lose my popeye muscles, and I dwell on the travel opportunity of a lifetime that I’ve lost, to feel all of those things. But for now, my job is to rest, let the water do its job, and take comfort where I can in my friends and family and dogs (I got to sneak a little visit with my Alba outside the hospital last night)