Rhabdomyolysis

[Tom Hollis]

I'm 30 years old and up until recently I was extremely physically active. I would run for at least 45 minutes everyday, lift weights for at least an hour 5 days a week immediately after as well as play basketball and do extra basketball-related cardio on top of that 2-3 days a week. This was all part of an exercise regime I had done for years with the purpose being to not only improve performance (which it did) but also allow me to indulge food-wise as I like to eat (which it also allowed).

Over 9 weeks ago now I sprained my foot to the point of suffering two avulsion fractures. For the first 8 days I couldn't do much physically although I was cleared to weight-bear comfortably. My physio cleared me to do non-impact exercise to the foot after the first 8 days as he was that happy with the progress and I worked with a trainer at the gym in order to maintain a certain level of fitness over the recovery period. I was eventually cleared to begin running again 2 weeks later (Monday 2nd July) but rather than ease myself back into the running as I had been told I threw myself into a 30 minute run in hot weather having not eaten or drank much that day and then my normal weights routine afterwards.

The next day I experienced extreme soreness in my thighs and to a lesser extent my calves and I noticed one bout of dark coloured urine after forcing myself through another run that night thinking I just had to shake off the pain and recondition the muscles. I continued to run and exercise on that soreness throughout the course of the week until I noticed dark urine again on Friday 6th July. At this point I went to hospital where they diagnosed me with rhabdomyolysis and said I had C.K. levels of 1780. They hooked me up to 2 bags of I.V. fluid and allowed me to go home the same night. The following Monday 9th July, my doctor had my blood tested again and my C.K. level was down to 385 with normal renal function. I was signed off work (which is also physical) for 2 weeks and told to rest and hydrate until my bloods were taken again the following Monday 16th July. where my C.K. level was down to 60.

The doctor cleared me to begin light exercise under the supervision of a trainer. We did some light upper body lifting as well as some light running to end hour-long sessions Tuesday through Sunday of that week. I definitely did too much walking on the Tuesday afternoon and did feel a lot of soreness throughout the night. I could also feel the onset of the rhabdo sensation in my legs even during the minimal time we attempted the light running to the point where the trainer decided it was too risky and advised me to get my blood tested the next day (Monday 23rd July). My C.K. level had gone up to 175 and the doctor advised no exercise and only admin/light duties at work until the Thursday of that week when I got tested again. She also advised I up my calorie intake as this would help with the muscle repair? I'm already struggling to eat what I already am as I'm not active enough to work up an appetite. I feel bloated all the time due to the water and food intake. That C.K. level was before I threw myself into a full day's work on Monday that included a lot of walking and lifting. My legs on that night were sore/tired/appeared to be slightly swollen so I assume that C.K. level would have gone up even further.

More recently, with the limited activity and hydration My C.K. has consistently come down to around the late 90s, early 100s but my bilirubin and other liver enzymes such as ALT and AST continue to be high as well as my urea. A liver scan is in the process of being arranged. From what I understand, elevated liver enzymes are a known aspect of rhabdomyolysis, with ALT and AST leaking from muscle damage. One doctor told me my bilirubin is raised in a fasting state and that the only way to feel better is to continue resting at my current limited activity rate(no exercise, only admin and light duties at work) and again to increase the amount I'm eating to aid with muscle recovery before I get tested again next week. Do you think this is sound advice? Will eating more really help the muscles recover or is it more rest-based?

My legs continue to swell and be painful even after light walking around my flat for short periods for example. Any increase in walking/activity on the legs will make that sensation worse. I'm concerned this is permanent damage. It will be 5 weeks on Friday that I came out of hospital. Is it normal to still have my legs feel like this? Do you know of any timeline I can expect the sensation to dissipate within? I haven't been able to run for even a very short period without that same sensation of pain in my legs coming on very quickly.

Even during the times where my legs recover, I have this tingling sensation in them as well as mini-spasms in them, my arms and hands. I also have dry skin on my arms and legs. Aren't these symptoms of hypocalcemia related to rhabdomyolysis? I also have several symptoms related to chronic kidney disease such as having to urinate every 2 hours during the night, a weird taste in my mouth, the aforementioned muscle twitches etc. I've had an abdominal scan where I'be been told it would appear there is no visible structural damage to any of the organs including the kidneys.

I've had several doctors tell me that it's impossible for me to get back to the complete regime I had before as I was over-training in a deficit a lot of the time anyway and that they wouldn't recommend that schedule for anyone. Now that I've got rhabdomyolysis, I'm much more susceptible to it happening again so the best I can hope for is a much reduced exercise schedule that allows for rest days, proper nutrition and hydration etc. Although I would definitely take that over the current situation, I'm extremely worried and anxious about everything that's happened as far as whether my legs and readings will ever allow me to get back to some level of exercise as well as allow me to properly fulfill my role at work which ordinarily involves physical work on a daily basis. What concerns me the most is I didn't get the rhabdo looked at straight away, I ignored the first instance of blood in my urine and ran and exercised through rhabdo for 5 straight days. This makes me think I've done permanent damage and that my body will never respond. One doctor told me last week that she just doesn't know as to what will happen and likened the situation to someone being told they'll never walk again but they do.

I suppose my main question to you is do you think it's physically possible for me to get back to my full regime as ideally that is where I would like to be. I understand I'll have to start extremely slowly and it will be a gradual process but can I ever get back to days where I'm working out for 2 and half to 3 hours because that is what I enjoy. Is the damage I've done to my legs and potentially anywhere else never going to allow for intense exercise of that length of time everyday again. I know every case is individual and you can only advise me to begin slowly and go off of how I feel but there is such a lack of information out there in general with it being such a rare condition that I wanted to ask for your opinion as you obviously know what you're talking about. It's just the thought of my life changing this dramatically really scares me. I feel like my identity as an athlete has been taken away from me and I'll never get back to the level I was, especially as far as playing basketball and running. Any information would be greatly appreciated.

Thanks.

Tom Hollis

[Mark Rippetoe]

Rhabdo is not a permanent condition. Height/weight/lifts/diet?

[dfclark68]

CK of 1780 is not actually very impressive. I've seen cases of 20K+ with full recoveries. The first part of your account sounds like it was the perfect storm of running too long while dehydrated and relatively deconditioned. The follow up CKs less than 200 are basically normal, or may be normal for you. The more muscle mass you have, the higher the baseline is going to be. But it sounds to me like whatever has happened after is not rhabdomyolysis, but something else. Bilirubin levels have nothing to do with rhabdo and AST/ALT to CK ratios are about 1:40, so with CKs under 200, your current AST/ALT levels are not elevated meaningfully by muscle contributions. Also, if your creatinine is normal, your kidneys are not failing.

It sounds to me like either the doctors you've seen don't know what's going on or you're leaving out something. If you don't have a diagnosis other than overexercise/dehydration-induced rhabdomyolysis, then you absolutely should be able to return to your previous regimen. Are you taking a statin?

Finally, a pet peeve of mine:
regime - a government, especially an authoritarian one
regiment - a permanent unit of an army
regimen - a prescribed course of medical treatment, way of life, or diet for the promotion or restoration of health

[FatButWeak]

Jaysus, Rip. Do not reply to this moron.

[Andy Baker (KSC)]

Tom,

Have you considered ceasing the activities that are causing you to get Rhabdo? Or at least scaling back. What’s the point of the “full regime” if it’s making you worse, not better. This seems the logical course of action.

“Being an athlete” is about performing athletic activities with competence. It isn’t defined by aimlessly running around for hours at a time until your body literally gives out on you. That’s not the definition of an athlete, that’s the definition of someone with a compulsive psychological disorder that has an addiction to running.

I think you need to rethink how you spend your time exercising, how you eat, and what your long term goals are.

[Mark Rippetoe]

The OP has not responded, even after the enormous wall o' text. I am beginning to doubt his mental health.

[franklie]

The OP has not responded, even after the enormous wall o' text. I am beginning to doubt his mental health.

I'm guessing that he thinks that you are still connected with crossfit and as you are aware the crossfit mascot is Uncle Rhabdo.

but crossfit is not all bad, it is how I came to learn about you and Starting Strength.

Or maybe he is trying to troll the members here into sh!t-talking about crossfit.

[Mark Rippetoe]

I think the guy is just confused.

[Sparky]

“Being an athlete” is about performing athletic activities with competence. It isn’t defined by aimlessly running around for hours at a time until your body literally gives out on you. That’s not the definition of an athlete, that’s the definition of someone with a compulsive psychological disorder that has an addiction to running.

AMEN!

Sparky