Sunday, September 29, 2013

Rolling With Rhabdo - My Story

There's a lot of buzz about a Crossfit article out there this week.  It exposes a risk that, frankly, is my number one reason for refusing to ever endorse or condone it as a method for people who are out of shape to get fit: Exertion Rhabdomyoliosis (rhabdo to his friends).  But, as revealing as the article is, it left out what I belive should be the most important part of the story:  how rhabdo occurs and how you can identify it.  I mean, without that, the whole thing is just rabble-rousing for people that already have strong opinions on one side or the other.

See, I've been there.  I was hospitalized, near death, with one arm marked in marker "no needles - may need dialysis", just in case.  Today, I'm back.  Fully recovered and training hard.  But the experience has changed the way I approach training for good.  Hopefully, after reading this, you'll avoid this kind of scare, no matter what training regime you choose.

Background: "The best day of my life"
In 2008, I was selected to join a very small club: the ranks of Chief Petty Officer in the US Navy.  The Navy is big on rituals, and this is one of the biggest.  Upon selection, I, along with the rest in my cycle, were put through two months of intense training, supposedly to ensure that we had the mental and physical toughness to fill the role of a leader in this unique fraternity.  There were late-late nights, early-early mornings (even by military standards), lots of memorization and mental challenges.  And then there was the PT, laced quite liberally through all of it.  During this period, every time one of the senior Chiefs conducting the "training" asked the question: What day is it?  We all responded in unison "the best day of my life!"


For me, I was in what you'd probably call "decent" shape.  I made my weigh-ins and passed my PT tests twice a year.  Never maxed out, but I was staunchly in the middle of the pack.  At 37 years old, I felt pretty good about that placement.  I was probably about 15-16% body fat.  This matters because most people that fall prey to rhabdo are not couch potatoes.  People who are completely unconditioned simply lack the physical capacity to push to the point of rhabdo.  

Setting the Stage for Disaster:  The Risk Factors
So I've already mentioned the first risk factor: "decent shape".  People that are prone to rhabdo are somewhat conditioned.  They also have relatively low body fat percentage (compared to the general population).  This sets your body up to hit a point where you can exert past your limits and your body lacks the stored metabolic fuel (i.e. fat) to compensate for the consumption level.

The next risk factor is environment.  Chief's training is conducted in August and September.  For me, it was in south Texas.  Heat and humidity both dramatically increase the risk for succumbing to rhabdo.  They add stress to your body during exertion and limit your ability to recover due to heat stress and dehydration.  San Antonio in August was a virtual incubator for rhabdo. 

The third block in the rhabdo virtual Jenga tower is stress, both in the active accumulation of it and the lack of ability to recover from it.  As if the training itself wasn't intense enough, I was going through a rather disasterous stage in my personal life.  Sleep just wasn't an option.  I was racking up tons of stress every day and doing nothing to recover from its effects.

And the final tipping point that brought it all down: ego. Both mine and on the part of my trainers.  I had a Navy dive master and a Fleet Marine Force Corpsman running the physical portion of the training.  These are two of the tougher professions in the Navy.  And they were merciless.  They set out to "break" each of us.  And I set out to match every challenge.  I can say I was hopelessly outmatched. 

The Tower Comes Down: The Symptoms I Missed
I've had the advantage of participating in some pretty cool training over my career.  One of the coolest things I would never ever want to repeat was the Air Force's combat survival school in Spokane, Washington (and undisclosed points well north of there).  I knew what dehydration looks like.  I knew what the symptoms of severe stress are.  But, in the moment, I glossed over a lot of things that should have set off alarm bells and sent me straight to the hospital.  

After one particuarly tough training session, I noticed that I was producing very little urine.  What I could produce was dark (we're talking almost Pepsi here) and cloudy.  I knew that was a bad sign, but I downed a gallon of water and hoped for the best.  Stupid?  Yes - but between the stress and ego components, I wasn't in a place to make a good decision about it. 

Then I started to notice the swelling.  Hands, feet, belly.  They all got progressively more puffy day by day.  Not normal?  Cause for concern?  Of course.  But I still figured it was just a temporary blip from a tough schedule.  

Finally, I noticed that I felt like I was in a mental fog.  I just could not form a straight thought in my head.  Since my whole adult life has been dedicated to problem solving as an analyst in various fields, strangely this alarmed me more than the physical symptoms.  It was now five days since the training session that had pushed me over the edge (with some additional sessions in between).  I drove myself to the hospital.  

The Diagnosis: Reality bites
Military emergency rooms are notoriously slow.  I checked in at the front desk and settled in for what I was sure would be a four-hour wait to speak to an actual doctor.  Fifteen minutes later, I was triaged by a corpsman.  I explained my symptoms, saying, "I'm not sure I should even be here, but I just don't feel right and I can't shake it."  After taking my vitals, the corpsman got very quiet.  My blood pressure was through the roof (symptom five).  I was admitted and hooked to an EKG in ten minutes.  

They started running diagnostics.  Thirty minutes later, the doctor came in.  "You're in some pretty bad renal failure.  We're going to admit you and see if we need to put you on dialysis."  For the first time in my life, I was truly afraid of dying.  

I spent the next week in the hospital.  I was put on heavy diuretics to flush my kidneys out.  My creatinine levels were checked constantly.  And my diet was regimented to put absolutely no strain on my kidneys through digestion.  No dairy, no sodium, and very little of anything else.  I was put on blood thinners and blood pressure meds to prevent any further cascade effects.  Thanks to showing up at the very end of my possible window and a very good nephrologist, I managed to avoid dialysis.  A week later, I was well enough to leave the hospital.  But I was in for a very long recovery.  Over the next six months, I very gradually returned to a normal diet, began light exercise, and finally weened myself off of the blood pressure meds as my kidney function returned.  I was lucky enough to get back to 100% function.  Not everyone is. 

What Happened to Me?
My nephrologist spent a good deal of time speaking with me.  In that critical training session, I hit the point where my exertion put such demands on my body that my muscle tissue started breaking down in heavy quantities (catabolism in the extreme).  The protein in my blood stream put such a strain on my kidneys that they simply stopped doing their job.  We're not talking nicely digested amino acids from eating meat.  We're talking about a direct injection of muscle protein straight into the blood stream.  I made it worse every day by continuing in the routine and conditions that got me where I was.

I hit that point because I pushed too hard in conditions that were too difficult for the body to overcome and I had no reserves to draw from.  Interestingly, of all the lifestyle conditions we discussed, the doctor was most alarmed by my long-term relationship with NSAIDS (Motrin, Tylenol, et al.) as a routine pain and swelling remedy (risk factor five).  These things are nasty.  I still only take them in times of serious need when I just can't tough it out.  

Crossfit and the Bottom Line
At the end of the day, I did this to myself.  I didn't exercise the maturity and judgement to stop before things got out of hand.  But... I put my trust in the hands of an authority figure who I expected to have my best interests at heart.  Having done that, I wholly gave myself over to the "mob mentality" of the ritual and the culture of the Chief's Mess.  That didn't work out so well.  Since that time, I can tell you that injury and relaps are always a factor that goes into my selection of training methods and intensities.  I don't leave that decision to anybody else. 

I'm not going to say that "all Crossfit is bad".  That is far too broad a brush.  But there is a real risk involved here, given the type and intensity of training involved.  If you have a personal trainer and you haven't discussed where you both stand, you should. 

Crossfit trainers (and any personal trainer, for that manner) take on a heavy degree of accountability when they take on clients.  But, without strong dialog between trainer and client, they can't be aware of the compounding set of risk factors that may be piling up on you.  That gets harder in a group "one size fits all" environment.  Add in a cultish culture of "push til you drop" and the chance that your trainer is keeping a watchful eye on you drops to an alarming low.  Since the vast majority of personal trainers are under-educated on the causes and symptoms of conditions like rhabdo, you simply can't expect them to have your back.  

1 comment:

  1. Wow, that's a scary story! Glad that you survived it and that you had no permanent effects. Thanks for sharing it as a cautionary tale.


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