On my recent brush with rhabdo

First off: thank you to everyone who sent their thoughts and well-wishes. It was extremely heartening to open up Twitter or Facebook and see people hoping that I’d be OK.

OK, so a bit more information on my ill-timed hospital stay. After a hard (but not unreasonably so) Crossfit workout on Tuesday and being sick with a fever on Wednesday and Thursday, I went to the doctor on Friday to get checked out. As it turned out, the levels of creatine kinase in my blood were slightly elevated – normal is 20-300, whereas mine were over 60k (we don’t know the exact level I had because the lab’s scale only went to 60k). I got the call and went to the ER that night, missing the last few hours of Morgan’s birthday.

Extremely high CK levels are the calling card of rhabdomyolysis, which is the result of severe muscle damage. There are a lot of potential causes for rhabdo, including crush injuries, burns, a number of viral infections, and overexertion, among others. Basically, the damaged muscle cells spew their contents into the blood. This can be bad for the kidneys (which can’t filter muscle proteins and can fail as a result) and other organs (as various chemical balances can get thrown for a loop).

In many cases, rhabdo itself is untreatable – the muscles are damaged and you can’t undamage them. (Some of the potential causes result in ongoing muscle damage, but those are very rare.) What you can do is treat to prevent the other problems, the kidney damage, etc. So, once I was in the ER (and for the duration of my stay at the hospital), I was pumped full of IV fluids to keep the kidneys from getting damaged by the muscle proteins in my blood. Luckily, my blood tests showed no evidence of any kidney or other organ damage; all I had were the high CK levels. The hospital was able to be more specific about those levels, though, which was good. On admittance, I was at 65k (200+ times the normal level).

The doctors pretty rapidly agreed that the workout on Tuesday was not the sole cause of the problem given my description of it and the next few days. What they weren’t able to do, however, was settle on the other contributing causes. I might have been predisposed to rhabdo by a viral infection (which are very difficult to detect and basically untreatable anyway), by the flu (takes a while to detect and also untreatable by the time they were looking for it), electrolyte imbalances (impossible to detect after the muscle damage, because the rhabdo itself hides the original issue), or something else entirely. One doctor told me directly that I was a “confusing case,” and several expressed frustration that they weren’t able to narrow it down more fully.

That said, by this morning my CK levels had dropped into the low 30k-range, indicating that the muscle damage wasn’t ongoing. Given that and the excellent condition of my kidneys and other organs, they determined that it was safe to send me home (with the proviso that I drink a ton of fluids and avoid intense exercise for a couple of weeks). I’m to follow up with my primary care doctor for bloodwork on Tuesday and again the following week to confirm that my levels continue to drop – and potentially to see if an electrolyte balance or anything else becomes visible as the rhabdo itself recedes.

So, there you have it: my rhabdo journey. I had a mild-to-moderate case, with no complications and almost no visible symptoms, so I count myself lucky despite the lack of a real explanation about how I ended up with it.

Will I be going back to Crossfit? Absolutely. It seems pretty clear from talking with the doctors that the workout itself wasn’t enough to cause this, and the best way to guard against exertion-caused rhabdo in the future is to continue to improve my overall fitness. I love the people and the supportive atmosphere at Crossfit 919, and I can’t wait to get back there once I’m cleared to exercise again.

Will I be more careful about how hard I push myself and how I eat and drink when I’m sick? Definitely. Even if the respiratory crud I’ve had for the last several weeks or an electrolyte imbalance didn’t contribute to this, it’s a wakeup call that those things are even more important when you’re ill.

Would I eat the grilled chicken caesar salad at this particular hospital again? Nope. The chicken was heavily spiced with cumin, giving the whole dish an unwelcome Tex-mex taste that didn’t go well with the dressing.