Monday, April 7, 2014

Rhabdomyolysis is no joke!!! Here's my story...

This week I was diagnosed with Rhabomyolysis.  Some of you have never heard of that term.  I don't blame you... it's actually very rare and affects maybe 0.06% of the population.  If you do CrossFit, maybe you have heard of it.  One of my friends said that out of the 3 years of him doing CrossFit, he's never met anyone who got it and was beginning to think it was a myth until me!  I'm here to tell you that it's REAL!  It can happen and it's serious!!!  What's crazier is that CrossFit even makes fun of it with a cartoon mascot "Uncle Rhabdo"!  He's depicted as a cartoon clown connected to a dialysis machine with his kidney, large intestine, and blood spilled onto the floor.  Funny?  I don't know. :/

So, what is Rhabdo?!?!  Let me explain!  It's a true medical emergency.  Rhabdo is a kidney condition that occurs when a large amount of muscle damage occurs usually induced by excessive exercise.  When muscle fibers break down, they release substances into the bloodstream.  One of these is a protein called myoglobin which can kidney damage.  Other substances released by the damaged muscles can cause chemical and fluid imbalance in the body.  Because of the damage and imbalances, the kidneys stop working correctly which can sometimes be fatal!

Now you're wondering, how did I get it?  First off, if you know me, I'm a pretty fit chica!  I workout 5-6 times a week.  I do CrossFit, Krav Maga, weightlifting, hiking, yoga, kickboxing, etc... I'm a coach, fitness instructor, personal trainer... Of all people?  Me?  Rhabdo?  You would think that someone who works out as much I do would be more conditioned and not have this happen to them.  While this is true that consistent training can protect you, it does not mean that it cannot happen to you!  What's even crazier is that actually, the fit athletes are the ones who are more susceptible to it.  This is because they are used to pushing through pain more than the average person.  I mean it's kind of hard to be an athlete and not push yourself so I hope that all of you athletes reading this, take this in and learn from my experience.  I want to tell you my story because no one should have to get to this state.  With enough knowledge, hopefully you can train safe and prevent this from happening to you.

Although rare, Rhabdo is commonly seen among military pushing their bodies to exhaustion or ex-athletes coming from from a long break and coming back too intensely.  It is common in CrossFit as well, hence the cartoon Uncle Rhabdo, and is even addressed in the CrossFit certification.  Does this mean that we all shouldn't work out too intensely?  No!  But it does mean to train smart!  If you are training and just getting back into working out hard, you should slowly build up your strength and stamina.  For someone like me who actually does consistent training, listen to your body.  Pay attention to your workouts and the muscle groups you are stressing.  This last week I pushed my triceps past a normal sore state and I'm paying for it now.  You may have heard of DOMS (Delayed Onset Muscle Soreness).  This is when you feel the soreness two days later.  The pain may last 2-3 days which is normal.  What is actually happening is that your muscle fibers have microtears from your workout and the rebuilding actually causes growth and strength.  This is normal.  If you've gone too far where the muscle tears are excessive so that you've caused too much muscle damage, you've hit a point where proteins like myoglobin get released into the bloodstream at high enough levels which can lead to kidney failure and possible death...  That is Rhabdo!!!  I like to think of Rhabdo as DOMS' super evil cousin!

So what happened to me?  A lot of factors come into play on my theories.  It had to have been the perfect storm to cause such a serious condition.  I'm pretty damn healthy and take care of myself but just like anyone, things happen.  I didn't know at the time but looking back, I can see where things went wrong.  The last workout I did was the CrossFit Open WOD 14.5 last Saturday.  What a crazy workout!!!  I'm actually not the only one to have gotten Rhabdo from this workout and I'm not surprised.  This workout consists of 21 thrusters (95/65), 21 bar facing burpees, 18 thrusters, 18 burpees, then 15 of each, then 12, 9, 6, 3... for time!!!  A total of 168 reps!  Holy Triceps!!! A ton of eccentric load which is what causes the most muscle damage.  Rhabdo is often seen in workouts with a lot of eccentric load such as a ton of push ups or pull ups like in Angie, Chelsea, etc.  Okay, mind you... although it sounds awful... this is my kind of workout.  Both movements I feel pretty confident that I can move quickly and efficiently.  It's a lot of reps, but I have an engine.  And I'm burpee queen.  Although most of the world hates burpees, me on the other hand... that's my jam!  So I was kind of excited.  However, when this workout was announced, my triceps were already sore... so I was a bit sad.  The thing about the CrossFit Open is that you only have the weekend to complete the workout and submit your score.  Had this just been a normal workout on the weekend, I probably would have passed on it and saved it for another day since my triceps had already been overworked earlier that week.  Remember this!!!  Do not push yourself on a workout if you feel that your muscles need to recover.  Don't risk it!  I know I know... but we are always sore!  LOL... especially if you CrossFit on a regular basis.  I'm talking about a soreness that lasts longer than 2-3 days... that's not normal.  Like I said DOMS is normal, healthy, and you're getting muscle growth through it.  I was to the point where my triceps were sore for 5 days!  That's a bit excessive so who knows, I could've already been on the verge of Rhabdo but since I'm young, healthy, and train so hard anyways, my body didn't hit that state yet.  But doing 14.5 on top, just put me over the edge.  

Let me just give you an idea of the work my triceps went under that week.  So on Monday prior to my last workout, I did - for max reps, 4 min double unders, 4 min clean and jerks (115/75), 3 min double unders, 3 min clean and jerks (125/85), 2 min double unders, 2 min clean and jerks (135/95).  Now that is a lot of volume and the weights were increasing here!  It's a great workout, don't get me wrong.  I loved it.  I died after and I love that feeling.  But you can imagine the amount of stress done on the muscles.  Still safe and healthy as long as you don't pair it up with more stress on the same group too soon.  Buuuuut... what did I do the next day... stupid KHO... so on Tuesday, I did a 15 min AMRAP of 9 burpees, 7 shoulder to overhead (95/65), and 5 front squats.  Again, lots and lots of reps... same muscle group... my triceps were fried after two days in a row of a ton of pressing.  I was so sore that I rested Wed, Thurs, and Friday.  Like I mentioned earlier, I typically workout 5-6 times a week.  Resting more than a day is usually unheard of for me so you can imagine how sore I was.  So it's the last week of the CrossFit Open and then this ridiculous WOD of 168 reps of thrusters and burpees gets announced.  I think I can do it, I'll be fine, I'm just sore and I can push through the soreness.  I didn't know better I guess.  I always workout sore.  I've never had a problem yet.  But now I know that was probably not the smartest thing to do.  I gave into peer pressure.  One of the things I hate and love about CrossFit is that it pushes you to do things you would never do but sometimes it's probably better off that I didn't do it.  Well like I said, I thought I was just sore and can push through the pain... I'm sure you all have done this before.  

Let me add another part of my theory to how this Rhabdo hit me.  I remember not being properly hydrated before the workout.  Hydration is crucial and being dehydrated can also increase your risk for  Rhabdo.  I was worried of having water sloshing around in my stomach since there were so many burpees going on, so I didn't drink enough water before.  I also took an epsom salt bath the day before which although helps with relieving soreness, it dries you out!!!  My efforts to relieve my soreness and treat my triceps actually didn't help me out here!  I know... super sad, right?  So it was a double whammy of dehydration right there!  I completely didn't think of it at the time.  But looking back... wow... so many factors that created that perfect storm.  This is good news for all of you though.  I'm feeding you with knowledge right now.  You can help prevent Rhabdo by staying properly hydrated and listening to your body!  :)  Oh how my future training is going to change.  I am going to drink so much more water now and I'm going to pay extra close attention to my programming as well! 

I need to tell you what happened after the workout.  This is where it gets scary and maybe after you read this you'll really take this seriously!  So, I do the workout on Saturday.  I feel fine during it and after.  The next day I feel fine as well.  Okay now it's Monday... two days later... kinda like DOMS, I am really stiff... not that big of a deal.  It should go away.  I have a pretty big pain tolerance.  Although I couldn't bend my arms past 90 degrees, I should have been more worried but I wasn't.  Yes, I'm nuts!  My left arm was worse than my right.  My left was actually more sore and the one bothering me before I did the workout on Saturday so it made sense. As the day went on, I noticed it not getting that much better and the easiest daily tasks were so difficult.  I couldn't reach my face with my left arm.  I couldn't put my hair up.  I couldn't scratch my head or my neck.  I couldn't feed myself.  How frustrating and annoying.  Hmmmm... should I be worried?  I thought I was just sore still and just hoped that the next day it would get better.   That night, it was painful to sleep.  I couldn't roll over without being so uncomfortable.  The pain is something so hard to describe.  It was as if both arms were on fire!  I woke up noticing my arms swollen and still really stiff and unable to even get to 90 degrees... yikes!  As the day goes by, my range of motion gets slightly better (still not past 90)... I'm still in pain, yet still hopeful that it's only soreness and it will go away soon.  I told my coach and she helped to mobilize it and started to massage it.  That hurt like hell but I figured was good for me.  I'm not sure if this actually helped because later that night, the pain in my arm was 20 times worse than the previous night.  I couldn't move my arm even an inch without wanting to scream.  I couldn't roll over without wanting to cry.  I don't even think I slept that night to be honest because the pain was so bad.  I felt like I just wanted to chop both arms off, it was that bad!  I remember waking up Wed morning crying and sad because I had to go teach a class but I couldn't move my arms.  So I get up (not sure how I put my clothes on),  I go teach my 8:30am class (having one of my students demo everything) and right after head straight to my doctor.  I tell him about my arms and the pain and even say, "I think I have Rhabdo!"  He didn't believe me.  He said, "I don't think you would be sitting in front of me smiling and talking like this if you had Rhabdo."  I insisted on blood work and he sent me to the lab anyways.  He also recommended me to see an Orthopedic Surgeon in the meantime to get my arm checked out.  He thought maybe it was a muscle tear, a tendon tear, a fracture, etc.  So I make an appointment with my Ortho.  First available appointment was the next day, Thursday at 2pm... that felt so far away!  The day goes on and my arm is swelling up even more.  It actually felt like it was going to burst.  I have read that with Rhabdo, sometimes people get Compartment Syndrome where the muscle swells so much and the only way to relieve the tension is to make incisions in the muscle!  After reading that and feeling like a water balloon ready to burst, I'm very serious about getting this arm checked out.  My arm felt useless.  Moving it was painful so it was basically like deadweight hanging from my shoulders but with ridiculous pain to go along with it.  

Wednesday night, the pain gets worse!  There is for sure something wrong with me.  This is not normal soreness.  My head goes through a viscious cycle of expecting the worst.  Maybe I did tear something?  What if I'm never going to be able to touch my face again?  What if my arm stays swollen and I can't do any upper body exercises forever?!?!  I know I know I'm crazy and retarded for thinking like that... but hey, you would do the same!  By now it's Thursday and I try to stay positive.  I'm just so happy that I get to see the Ortho today.  All I want is to know what the hell is wrong with me so I can fix it already.  2pm seems so far away though!!!  In my efforts to stay positive and not focus on the negative, I try to think of the stuff I can do that don't involve my arms.  In the event my arms are useless forever, what can I do to make me happy right now?  I haven't worked out since Saturday and working out is what makes me happy... So what do I do?  I decide to make the best of it, go for a jog around my block, do some lunges and squats.  Another thing about me... I make the most out of every situation.  I work with what I got.  It's the best and happiest way to live!  So after my mini workout, I'm the happiest I've been all week.  I actually think that getting the blood flowing helped because my range of motion in my arm improved so much that this was the first time I was able to touch my face all week!  Huge gains!!!  Although the normal person seeing my range of motion would still think something was terribly wrong, I was just amazed and ecstatic and happy since this was the first time I was able to put lotion on my face!  LOL  It's kinda of ridiculous how that small increase in range of motion got me so excited.  Things were looking up for me! Ha!  I swear things always get better before you see the doc.  At this point, I feel a bit dumb and think that maybe it was just muscle soreness after all.  I see my ortho at 2pm and he says that I have nothing to worry about.  Hooray!  He said I just need to keep drinking water and that I was probably on the verge of getting rhabdo but didn't because I'm so young and healthy.  I have nothing to worry about.  I leave the office feeling stupid yet so relieved at the same time.  

An hour after leaving my Ortho, I get a call from my primary doctor.  The lab results are in from the blood work taken the day before.  He tells me "I can't believe it!  You were right!  You're CK levels are in the 5000s.  I've never seen anything like this.  Normal levels are in the 100s.  You need to go to the ER right away and stay overnight so they can monitor your kidneys!" A part of me thinks "I knew it!  I knew something was terribly wrong!"  CK stands for Creatine Kinase and the CK levels in the blood correlate to the amount of myoglobin in the blood.  This means since my CK levels are so high, there is a significant dangerous amount of muscle damage which can lead to kidney failure.  At this point, I already felt so much better... I mean I can touch my face today... so my CK levels must have dropped, right?!?! Ummm yeah, I was wrong.  I go to the ER thinking I'll get hooked up to an IV for a couple hours, flush it out... no big deal.  To my surprise, my CK levels have increased from 5000 to 15000 in only one day!  I'm shocked! 15000?!?!  But I feel a hundred times better than yesterday, how is this possible?  How I feel apparently does not correlate to the danger happening to my kidneys. Super scary stuff.  They admit me to the hospital so I can stay overnight.  I'm thinking that in one night, they can flush it out of me.  They hook me up to an IV and start with 200cc per hour of sodium bicarbonate.  That's a lot for my little body but I wanted them to do as much as they can so I can flush it out as soon as possible.  I really thought I would be good to go by the next morning.  Friday morning, my levels drop to 11000 so I need to stay the day, I can't leave just yet.  The doctor tells me if my CK levels drop later that evening, I can go home.  So now, I'm on a mission to flush it out.  I make it into a little game.  I get competitive like that.  I start drinking water in addition to the IV fluids getting pumped into me.  I peed, no joke, 8L that day!  I was on a fucking mission to get healthy and better so I can go home!!!  I didn't want to stay at the hospital another night.  I was so sure that there was no way my levels would increase that day.  To my surprise again, they went up to 12000!  I'm telling you, it's scary because you feel like you're okay but your CK levels say otherwise.  There must have been a lot of muscle damage in my tricep area.  I mean... my arm was swollen and in pain and useless!  I end up staying at the hospital for 5 days!!!  I forgot to mention that even with the vicodin they gave me, the pain was still there.  Trust me, you don't want Rhabdo... it's awful.  I'm so glad I got myself checked out and am currently on the way to normal levels.  I left the hospital with my CK levels still not back to normal but they were trending downwards so they let me leave.  The doctor said I can't workout for a week... not even a jog.  I guess that jog I did on Thursday caused my levels to go from 5000 to 15000 so yeeeaaaah I'm a bit scared to do any exercise at the moment.  For those of you who know me, not being able to exercise for a week is VERY difficult for me.  But at this point, I'm actually too scared to even do it.  I left the hospital with my CK levels at 7000 which is still scary high considering normal is below 100.  I'm just going to be super cautious this week and take it easy.  Lots of hydration, no exercise whatsoever!  And then maybe in a week from now, slowly start back up and not go too crazy.  

This is really hard for me.  It's a bit annoying because everyone is telling me that I need to slow down.  As if I'm some crazy, out of control, dumb workout freak.  I'm not stupid.  I'm actually very intelligent and I do care for my body!  I have a sports medicine background, I'm a coach, I take health seriously and I know how to take care of myself.  This just happened to be an awful experience but I will learn from it and share it with all of you so you can learn too.  I'm here to spread love, health, happiness, and positivity and if I can help you learn and prevent such a thing, then I've done my job.  I don't wish Rhabdo on anyone!  It's a serious medical condition and it's painful and scary and not fun one bit!  So that's my story.  Sorry it was so long and if I bored you, I apologize.  I just had to get it all out and since I've been asked a hundred times "what happened?"... now I'm glad I can just say, "READ THIS!" :) 
So what now?  I'm on the road to full recovery.  I'm hopeful and positive.  I've read so many horror stories of permanent damage to the kidneys and muscles.  Luckily my kidneys are working just fine!  I forgot to mention earlier that a common symptom of Rhabdo is brown colored urine.  So if your pee turns brown, go get medical attention right away.  I actually never had brown pee and that's probably why both doctors didn't think I had Rhabdo so I'm guessing my kidneys are just really healthy, thank God!  And now you know you can have Rhabdo even if your urine is a normal color!  It's been over a week and my left tricep is still swollen.  There's so much bruising as well because I got poked by needles all week.  My entire body has swelled up actually from all of the IV fluid.  I gained 8lbs this week!  Holy crap!  Today is my first day at home and some of the swelling in my limbs have gone down, but my left arm remains like a huge sausage.  Fingers crossed and with enough praying and well wishes from all of you, I'm sure it'll be back to normal in no time!  I will keep you all posted with my progress though.  To finish this off, I just really have to say that I'm so thankful for everyone who has reached out to me during this crazy, scary time.  You have no idea how much that means to me and I truly believe it makes the healing process go by so much faster.  I'm blessed to have such great family and friends.  The hospital visits made the time pass by faster as well.  You all know who you are who have sent me a healing message... THANK YOU!  Okay... I'm on my way to becoming a better, smarter, stronger KHo!  Just you watch!  If you have any questions on Rhabdo, feel free to ask.  I've read a ton about the subject this week and after first hand experience, I'm happy to spread my knowledge and make you guys smarter and Rhabdo-free!  May you all learn from my pain and never have to endure it! :)  KHo loves you!!!