Because I can’t seem to find any information about what to do about rhabdo once you have it, I’m documenting my experience to maybe help someone else.
In April I started attending a local gym that offers Cross Fit-like workouts without the pressure of competition. I had been going at least once a week and supplementing with BodyFlow, BodyPump, BodyJam and running. I liked seeing the quick changes my body was making along with a new type of workout that was challenging and making me stronger. I quickly learned that in order to finish the WOD I had to use mind-over-matter techniques. My friend who had come with me a few times would make comments about how impressed she was with my endurance.
However, in June, I hadn’t been sticking with my diet or exercise plan very well so after yet another weekend of indulgence (LOTS of sugar) I was looking forward to a good workout. Last Tuesday, July 5th after we finished the workout, the first activity was 5 pull-ups on the minute for 10 minutes. Do the math. That’s 50 pull-ups. We weren’t “allowed” to use the rubber bands which is what I had been depending on to help with my pull-ups in the past. This time I was instructed to modify by kneeling on a box and pushing up off the top of my feet while pulling up. After the first two sets I remember my arms feeling especially tight around the biceps and I was having a hard time straightening my arms. I would stretch them out after each set and keep going. When we were done with the 50 pull-ups we went on to 5 rounds of the rowing machine (15 calories), 21 wall balls and 9 toe-to-bars.
When I got home I was still having a hard time straightening my arms, but I didn’t think much of it. The next day, I traveled to Dallas for work and by 8pm, my left arm was swollen around the elbow and looked almost disfigured. The next morning I awoke to my right arm also swollen. I was taking ibuprofen (HUGE no no – only take Tylenol) and not drinking much water (another huge no no). My husband asked the owners of the gym if they knew why I was swelling. They asked if my urine was dark (no, it was clear) and they were relieved that they didn’t think I had rhabdomyolsis. That was the first time I had ever heard of it.
Flashback: When I was a sophomore in college (Fall 2004) I was in a strength training class and on a day I didn’t feel well I decided to do a bunch of calf raises. I don’t remember how many in each ballet position I did, but I guess I did a ton because that weekend when I went home to visit, I could barely walk. The backs of my knees swelled and I couldn’t straighten my legs. My Mimi rubbed tiger balm on them and I soaked in an apple cider vinegar bath. Knowing what I know now, I wonder if I had rhabdo and didn’t know it was a condition to look out for.
Back to the present: I returned home Thursday, July 7th and tried taking an Epsom salt bath which made my arms swell even more. While I soaked, I read an account from another person saying her urine had been clear the entire time, but still had rhabdo. So I went to the ER to get checked out. Here’s what my right arm looked like before I went to the ER. You can see the swelling below the elbow.
At the ER they took my blood pressure (higher than normal) and had to wrap the cuff around my forearm since I had so much swelling. When the nurse was about to draw my blood I said, “I hope you can find the vein with all this swelling. Usually nurses love my veins since they’re so big.” He laughed and I had met my goal of cheering up the poor late night ER nurses 🙂
Pretty soon they got me into a room where I put on a gown and they hooked me up to the machine to measure my blood pressure and oxygen levels. It was pretty uncomfortable every minute when the cuff would tighten around my huge arms. I waited for about 2 hours for blood results and before I even got a chance to see the doctor, the nurse came in and put an IV in my hand for fluids. Shudder. It was a fast-drip and was gone by the time the doctor came in to tell me I indeed did have rhabdo, but no kidney damage. Hoorah! – kinda. My CK levels were at 3,300 when normal is 400-500. I was shocked! Sidenote: I’ve since read other accounts of people having levels up to 40,000 so 3,300 doesn’t sound so bad!
My orders were to drink lots of fluids and make an appointment with my primary doctor within 48 hours. This was a Thursday night. I was worried I wouldn’t get in on a Friday. Luckily, my doctor is only about 5 years older than me so he’s living within the times and has an online portal where patients can request appointments. He had an opening for 2pm the next day and I took it. When I went in he told me about his friend who had done P90X for the first time ever and got rhabdo all over his body and couldn’t move for 3 weeks! Yikes. I was miserable with just my arms. I couldn’t imagine having it all over my body! They took a urine sample and I heard back hours later telling me there was a little blood so they wanted me to come back on Monday for blood work.
When I went back in on Monday, my doctor peeked his head in to check on my swelling. There had been no improvement, my arms were now super tight and I was nervous to move my arms. He said it was good to move my arms and use fish oil supplements to help with inflammation. As soon as I got home I took two capsules of fish oil and started trying to use my arms more. They were very stiff at first and protested when I’d try to straighten them, but from Monday to Wednesday, my arms were significantly less swollen and more flexible. In fact, I was finally able to bathe myself (carefully, slowly) Wednesday morning! I had found out that ice or hot water made the swelling worse, only supposed to take Tylenol for any pain, elevating the arms doesn’t seem to help much, but moving and using fish oil do make a big difference in reducing swelling.
My urine results from Monday were clear, but my CK levels in my blood had spiked to 9,908! My doctor ordered me to come back on Wednesday morning for more blood work. I was notified this morning that my CK levels are back down to 3,000 and my urine is still clear so my doctor told me I look like I’m on the mend.
After asking what the timeline will be to get back to exercise, my doctor said, “At this point I’d say you should be able to do light exercise, but no more pull-up challenges until you feel like you’re back to 100%.” HA.
I’m back at work today and all this typing fatigues my still slightly swollen arms. They jiggle when I walk which is discouraging (not to mention gross) and I’m drinking a bottle of water every hour to stay hydrated. I’m so used to seeing results very quickly so the fact that the swelling is still here over a week later feels like there will be no end and my arms will never get back to normal.
Update: I woke up this morning (Friday, July 15th) with hardly any swelling in my right arm and I was able to straighten it completely! My left arm was still slightly swollen and unable to straighten all the way, but I’m working on it. They both swelled a little more throughout the day, but not much. Luckily, there’s still some tone on my biceps, but I have noticed that they are smaller than before. I don’t know if it has anything to do with how weak they are so I can’t actually flex, or if I have actually lost muscle (which I think is the case). It’s so sad!
Second update: It’s Tuesday, July 19th (two weeks from the day I injured myself) and I can finally straighten my arms all the way! I have no swelling in my right arm and my left still has a tiny bit of swelling, but not enough for anyone else to notice. I’m still avoiding alcohol and caffeine so my muscles can fully heal before I start trying to build them up again. Yesterday I was able to complete this leg exercise and it felt great to get my heart rate up again! I plan to take it slowly on the arms, but I’m eager to get back to some kind of movement.