Friday, June 10, 2016

Rhabdomyolysis

A friend texted me this reminder:  "The hotter the fire, the harder the steel."  Isn't that the truth, and I know that God is with me through yet another trial.

Although Rhabdomyolysis isn't related to cancer, breast reconstruction or my recovery, it does seem to be a part of my journey.

I'm not quite sure exactly what caused my Rhabdo, but do have some suspicions.  With having had breast reconstruction surgery in October, a breast revision in January and another breast revision in April, I haven't been able to exercise like I'm used to doing.  Finally finished with all of those surgeries, and with school out for the summer, I decided to jump back in last week and begin a regular workout schedule.  I started with my usual 3-mile treadmill walk since I still can't quite run yet and added P90X 3.  Friday I completed the workout called Challenge with 100 pushups and 70 something push-ups (assisted).  I felt pretty good through most of the workout, but pushed myself to finish strong.  I felt great and proud of myself for knocking out 100 pushups!

Saturday I was a little sore with arms like Jell-O, but that was to be expected.  I did a light workout and walked on the treadmill.  I spent a fabulous afternoon with friends and family.  We went to Nitro Circus and I felt pretty good, just a little tired.

James and I went for a mountain bike ride on Sunday.  We rode the single track Mighty Bikes at Kincaid and completed about 6 miles.  I felt really sluggish and sucked wind, but just contributed it to being tired.  I hadn't slept well because my arms were sore. 

On Monday I completed a 3-mile walk on the treadmill and a P90X that didn't use arms.  Still feeling sluggish and having sore arms, I felt like I could push through and would start feeling better by Tuesday.  After Tuesday morning's workout, I knew that it was more than just some sore arms from working out.  I couldn't really bend my left arm to touch my nose and definitely couldn't straighten my arm.  I looked at my arms in the mirror and thought Pop-eye!
No funny mirrors were used for this picture!

I Googled "swollen and sore arms after workout".  What came up was "Rhabdomyolysis".  After a quick read of the causes and symptoms, I was pretty sure that was what was going on and I headed in to see a PA at primary care.  The PA said she'd seen Rhabdo before and was sure that all I did was strain my muscles.  She sent me home and told me to take 500mg of Naproxin every 12 hours.  I went home and took the Naproxin, but after two hours, knew that there was more going on than strained muscles.  The pain reliever wasn't really touching the pain either.  With that, I called James and then had Jared take me to the ER.

The ER is always such an adventure.  There's such a range of medical needs:  someone intoxicated, another lady with some nerve damage causing half of her face to go numb, a young girl miscarrying, a kid arriving by ambulance with a broken limb.  Made me feel like my medical needs were minimal, so I waited patiently for 2 1/2 hours before they got me back to evaluate me.

I let the doctor know right away that I thought I had Rhabdomyolysis, and that it probably drove him nuts that patients Google their symptoms and diagnose themselves, but he didn't seem to mind.  He did however give me an ultrasound of my arm to make sure there were no blood clots and an x-ray of my arm before taking a blood sample.  The blood sample came back an hour later with creatinine kinase levels over 20,000 which meant they were admitting me to the hospital.  Normal CK levels should be nearly undetectable. 

What have I learned?  Rhabdomyolysis is the rapid breakdown of muscle caused under extreme conditions, usually from trauma to the muscle like an accident or by chemical means like toxins or drugs.  The breakdown of the muscle causes the protein myoglobin to leach into the bloodstream.  The kidneys try to clear the harmful protein out of the bloodstream, however they can clog the kidneys causing damage or kidney failure.  Although Rhabdo is considered rare, exercise induced Rhabdo is considered extremely rare. 

The symptoms that tipped me off that I had Rhabdomyolysis were
  • weak muscles
  • intense pain at the affected muscles on my arm
  • swollen arm
  • inability to straighten my arm
  • fatigue
There are many other symptoms such as bruising, tea-colored urine, fever, vomiting or nausea, and confusion or agitation.  I didn't experience any of those, unless you perhaps ask James and he thinks I was agitated.  


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