One woman shares her scary experience with rhabdomyolysis
I work out, I'd say, four or five days a week at least. I'm usually running 20 to 30 miles weekly, but I do barre, I do yoga, and I try to take a restorative day. So it's not all super hardcore.
I ran the 2016 NYC Half Marathon in March, and afterwards, I was going to the gym every day. I was in good shape, but I told a new trainer I was about to start working with that I felt like I'd plateaued a bit, and that my goal was to get to that next level and maybe to trim up a little bit too.
In April, we had our first session, a full-body workout, which my gym offered for free as a promotion. I don't always work out with a trainer. I did before my wedding, though, and sometimes I felt like that trainer wasn't pushing me hard enough; it was a lot of core work, and a lot of holding—just very controlled movements.
The thing that was different about this workout was I felt like I was kind of losing control. I've worked out before on my own, in classes, and with trainers, and I know something about proper form. But in some of these exercises, especially the negative pull-ups she had me doing (where you jump off a box or up from the floor to the top of a pull-up and slowly lower down), I felt like I was either dropping too hard or just losing the slow controlled movement I was used to. I was jumping up, grabbing the bar, and instead of lowering myself back down, I was just dropping back down, over and over. And I felt like it was shocking me, shocking my body.
And I remember I said to this trainer, "I'm failing." I was going into muscle failure, that point where my arms were shaking and I was literally collapsing over and over again. But she was saying, I guess to motivate me, "One more, two more, you can do it!" So I pushed through. You know, you're motivated, someone's standing with you, you don't want to quit in the middle of an open gym in front of everyone.
Within the next two or three hours after, I was at work and I was like, I'm really sore. It was very intense soreness, the kind that ususally hits a day or two after working out, but this was within two or three hours after the session. I felt ridiculously sore and I couldn't even open these heavy doors at work; I couldn't fully extend or bend my arms. They were kind of stuck in the middle. I texted my trainer and said, "I'm really sore, my arms kind of feel like noodles." She just said, "You did a great job, it'll be better in a day or two!"
So I went about my day and just thought, Maybe I haven't done a lot of upper-body work lately. But I think that was one of the first warning signs, that I was so sore so quickly and lost range of motion too. (Unlike immediate, intense pain, check out five post-workout aches it's okay to ignore).
The next day was a Saturday, and I was still really sore. But I actually went running that day because sometimes that helps loosen me up a bit. I finished the run, but I definitely felt the stiffness and soreness in my arms, shoulders, and into my chest and upper back too.
That night I went out and as I was getting ready, I put on a cropped sweater. And it was inches shorter than it should have been, to the point where I thought the dry cleaner might have shrunk it—until I remembered I hadn't brought it to the dry cleaner yet. So that was the second weird red flag moment. I was obviously at that point swelling, but I just thought my clothes were riding up.
That night I had some wine and a cocktail with dinner, maybe four or five drinks over the course of six or seven hours. Then the next day I had lunch with a friend, and I still couldn't really straighten or bend my arms, now two days after the workout. Back at home I changed clothes, and that's when I looked in the mirror and I was just like, "Oh my God." I looked like the Michelin Man.
I Googled "really swollen arms after workout" and I started seeing results about this rhabdo thing—rhabdomyolosis, which is basically when you have so much muscle tissue breakdown that it dumps a damaging protein into your blood, and it can be really dangerous. It happens after intense workouts, but really any form of muscle damage that's severe enough can cause it. My husband started Googling it too and he said, "Well, it's so uncommon, and your urine isn't Cola colored," which is what he was reading was the main symptom. But I still decided to go to emergency care anyway because of the swelling.
So I went and I didn't even bring up rhabdo, but I told them, "I worked out, I'm really sore, it hurts." They did a urine sample and blood test immediately and while I was waiting they hooked me up to an IV because they figured I was dehydrated. And they came back with the blood test and said, "Yeah, it's rhabdo, and we're admitting you to the hospital." That's when I thought, okay, this is really serious.
They admitted me to the cardiac wing because my potassium levels were very high, which is super scary because it means you can have a heart attack. I've always been healthy; now here I was sitting in the cardiac wing with an IV with just continuous fluid—which is the only treatment for rhabdo—in my hand because my arms were so stiff and swollen they couldn't find a vein in my arm. The doctors weighed me, and I was nine pounds heavier than my normal weight from the swelling. I thought they must be wrong. You don't gain nine pounds in one day!
The doctors had to test my blood every four to six hours; they'd even wake me up during the night. They were testing levels of a muscle enzyme called CPK. The CPK level for a normal person should be between 10 to 120 IU/liter. I was admitted at 38,000 IU/liter.
Of course I said to my husband, "I told you!" He read that is was so rare, but I told him every single doctor I saw, and I saw five or six M.D.s at different points during all this, every one said they'd seen a case within the past week. And they kept saying, "Oh, yeah, you know, with CrossFit and SoulCycle, it's more common. And after the marathon we saw a bunch..."
The good news was that I didn't suffer any kidney damage. The big issue with rhabdo is that all the muscle enzyme that gets broken down into your blood has to exit your body, so it goes through your kidneys. And when it's at such a high level, if you're not diluting it with tons and tons of water—more than you can just drink, I was on a continuous IV for four full days until they were satisfied with my CPK levels—it can put you into kidney failure. (Another woman shares: "I Gave My Dad a Kidney to Save His Life.")
Later, when I Googled rhabdo more, I noticed that some blogs and certain fitness communities like CrossFit tend to speak about the condition casually—I read about people talking about "meeting Uncle Rhabdo," or whatever. They spoke about it like it was akin to getting a cramp or almost like a badge of honor. That's dangerous; it's serious, people die. It's not something to push through or shake off.
But my doctors told me they saw no indication that I was ever in that kind of trouble. My urine never changed color, which is that scary sign. Usually, one doctor said, people only come when they're at that scary point and it can be a lot worse.
Still, at first I thought I'd spend a night in the hospital and then they'd send me on my way. But I wasn't released until four days later, and even then it was just because I caused such a commotion; I was desperate to be home. What was so frustrating was there's no time period they can give you. Every day, I asked, "How much longer?" And they said, "We don't know. It depends on the person." I learned that the more muscular you are, the worse it can be, since you have that much more muscle to break down.
Even after four days, my CPK was only down to 17,000 IU/liter. They let me go home as long as I promised to follow their treatment plan: drink tons of water, no salty foods, no caffeine, no alcohol, no exercise or sweating at all—I could only walk 10 or 15 minutes at a time. You can't risk getting dehydrated at all. They said to do that for at least three weeks. It was so frustrating to be so active and then to do nothing.
Two or three days after leaving the hospital, I was down to 13,000 IU/liter, which was reassuring. And a week after that, my levels were completely normal again. The crazy thing is that throughout all of this, I felt totally normal. Except for the swelling; I felt bloated from the IV, but that's it. I didn't have a temperature, nothing.
My doctors told me I have to wait a month to exercise again. The thing is, there's not a lot of information on what to do fitness-wise after rhabdo. One doctor said, "don't do any upper-body exercise," because that's what triggered mine. So now I've been running again, and I do yoga—yoga has never hurt me. (It's one of the 30 Reasons We Love Yoga.) I do more lengthening classes and restorative classes, like barre. But I used to do boot camp or HIIT classes once a week, and I haven't been back to those classes. To be honest, I'm afraid of pushing myself. I kind of don't trust myself; I know that at least once, I pushed myself so hard that I ended up in the hospital. And doctors don't know whether this is more likely to happen again now that's it already happened.
I also refuse to go back to a trainer for now. I kind of think I have no one to blame but myself; I didn't stop, and I'm sure it didn't help that I ran and drank the next day, since I got dehydrated. But at the same time, every doctor I saw said, "You need to tell the gym, and tell your trainer what happened." I didn't want to get anyone in trouble, and I know it was my fault too, but the trainer does need to know the signs. Their actions contribute—how hard they push you and what they say after if you're complaining about being sore.
So I did call my gym and it ended up being a complete cover-their-ass kind of call, even though I was clear that I knew I played a part and I wasn't trying to get anyone fired. They told me my nutrition must have been not great to cause this, they asked whether I even told the trainer I needed to stop, they said that she'd done nothing wrong. They said they even looked into my correspondence with her, which got me—I looked back at our texts, and I saw that within two hours after the workout I'd told her I was very sore. During the workout, I used the words, "my muscles are failing." The head trainer, who was on the call, said in her 15 years as a trainer she'd only seen one other case of rhabdo. But my doctors all said they'd just seen someone last week. It's not some super rare thing that only happens to CrossFit addicts or body builders.
A few weeks ago I ran into an old trainer I used to see. I told him everything, almost like a funny story. And you know what? He'd never even heard of rhabdo. These are trainers at a designer, luxury gym that prides itself on its "science-fueled" approach. But obviously the gym isn't telling its trainers about rhabdo. That's frustrating, and it's scary—because it can happen to anyone.