Rhabdomyolysis Update (And Lessons You Can Learn From What I Did Wrong)

How A Healthy Man Ended Up In The Hospital -- My Mistakes:

I hike and do martial arts training regularly, and consider myself in reasonably good shape. However, on Monday I started an exercise program with a local Crossfit affiliate, Team Crossfit.

This was an intense workout, but I've done intense (worse) workouts in the past, with no ill effects other than soreness. We did jumping pull-ups (where you jump up to a "completed" pull up position, then lower yourself as slowly as you can. This did a fair bit to blow out my arms and upper back, as those muscles were not used to that kind of exertion. After about 20 minutes doing jumping pull-ups, they switched from the skills portion to the "timed workout" portion, and added wall-balls (I then threw a 14-pound medicine ball 10 feet up a wall) and staying in the plank position for a while.

(The routine was supposed to be 20 jumping pull-ups, 20 wall-balls, and 1 minute in the plank position -- with the whole sequence repeated five times.)

My trainer saw that I was straining, and cut the routine in half for me. (Ten pull-ups, ten wall-balls, and 30 seconds in plank position.) I ended up stopping at the end of round 4.

I want to emphasize that this did NOT seem like a dangerously high amount of exercise to either me or the Crossfit trainer. I lay no responsibility for this on Team Crossfit. This is actually the second time I've taken Crossfit (I went for a month or two over the summer) and I had harder workouts then that left me more sore than this one, with no ill effects. Nevertheless, it's obvious to me now that I should have started up this exercise regime more gradually. That's mistake number 1.

Mistake number 2 was insufficient hydration. I drank what I thought was enough after my workout on Monday, and then stopped -- after about 25 ounces of water. After that I just drank normally. On Tuesday, I didn't work out, and I had a cup of coffee, and about five cups of tea -- that's it. In hindsight (hell, even at the time had I bothered to think about it) this was vastly insufficient hydration.

Mistake number 3 was taking Advil for my muscle pain. This would normally be a good thing, but I learned that Advil has an inhibiting effect on the kidneys -- it closes down the tubes in the kidneys through which liquid flows. This is perfectly fine if you have a headache, but if the kidneys are trying to remove the poisonous effects of excess exercise at the same time you're taking Advil, it compounds the problem.

The result of those three mistakes was at least one night in the hospital for me, as the doctors struggle to treat my Rhabdomyolysis.


Tuesday night, after work, I urinated when I got home and saw that my urine was very dark in color, like a flat can of cola.

The materials that CrossFit gives out when you start includes a warning that, if your urine looks like Coca Cola, you should go immediately to the emergency room. I called @dakimjerry, hoping that he would talk me out of it, and he told me to go to the ER. Shit. I called Kate S., hoping the same, and she told me to go to the ER. Shit. I went to the Providence-Tarzana ER.

There they found blood in my urine (not actually blood, but myoglobin, a result of muscle cells dying and breaking up). Microscopic examination of my urine showed no blood cells, so it wasn't blood, but muscles breaking down. They ran my levels of Creatine kinase (a muscle enzyme you would only see in the blood if muscles were breaking down) and they came back abnormally high. (The test didn't specify the level.)

The ER doctor ended up giving me two liters of intravenous (IV) saline, and sending me home with instructions to see my own doctor.

Just when I got home at 2 AM, the ER Dr. called, and said he'd changed his mind and would like to see me at UCLA Medical Center ER the next morning. He'd run some tests, and if they showed my levels getting better, I'd be fine. Otherwise I'd be admitted to the hospital.

This seemed like a good plan, and I showed up at the ER the next morning.

There I was immediately plugged into another IV saline drip, and they got blood and urine for testing. The results of these tests were ... interesting.

My kidney function was fine -- A-OK -- but my Creatine kinase level, which should be between 60 and 400, was at 136,000.

Holy fucking shit. Really?

A doctor told me that normally this level of Creatine would mean a transfer to intensive care, but because I seemed to be suffering no discomfort, pain, or ill-effects, they would simply put me under observation.

They admitted me to the hospital, and began pumping a liter of IV through me an hour. The idea is to wash the myoglobin and Creatine kinase out of my system before they can damage my kidneys.

As of about 8 PM, my Creatine kinase level was down to about 122,000 -- still insanely high, but better -- and I'm peeing like crazy (and collecting my pee so they can measure it).

That's the news so far -- I still feel fine -- other than muscle soreness have felt fine throughout this whole thing -- and am staying in a nice hospital with decent food and free wifi.

You Learn Who Your Friends Are:

I have to say I have been incredibly touched by the outpouring of support from friends and family and coworkers. I've been entirely clear-headed and rational about this the whole time I've been writing this, but now that I'm talking about the people who've reached out to me, I'm getting teary-eyed and emotional.

Kate brought my Mom (who can't drive) down to the hospital, and came with far more water and juice and cliff bars and good chocolate than I need; Jon made me the best geek care-package ever, including a laptop and an iPhone charging cable; Tegan delivered it and stayed to talk and tell me funny (and sometimes slightly disturbing) medical stories.

People have been calling, texting, and emailing to wish me well; the outpouring of support from old friends and new has been far more than I expected; I'm incredibly lucky in far more than a medical sense.

My phone doesn't work (I may be in a basement) but the regular phone by my bed is ~~310-267-9533~~ 310-267-9423. Feel free to call or stop by.

Right now I'm just a machine for turning IV fluids into urine, but I'm a damn lucky urine-producing machine, and I'm honored to be friends and loved ones with all of you.

Update Thursday, December 17, 6:15 AM:
In the middle of the night I started having shortness of breath, and we figured it was because we had put so much liquid in my body so quickly it was entering my lungs. From 11 AM to midnight I was on 1 liter an hour; at midnight they switched me to 500 milliliters an hour. After my shortness of breath, we slowed the IV down to 0.2 liter an hour, and put me on oxygen and a oxygen sensor (on my finger at the moment) and I'm now feeling better and my oxygen level is back up in the high 90's. (It dropped as low as the high 80's.)

Update Thursday, December 17, 8:10 AM:

Saw my doctor (one of them) just now; my Creatine is down to 90,000, which is good, but they can't run the IV through me as quickly as they'd like because of the fluid in my lungs. (Fluid is MUCH better since they slowed the IV, and I now have very minimal shortness of breath. Biggest problem is the damn O2 sensor on my finger keeps me from touch typing.

I asked if I'd be out today; his answer was that if it was today, it would be late in the evening. Sounds like a "no" to me. Crap.

Update Thursday, December 17, 9:10 AM:

Now I have a target -- they'll release me when my Creatine level is below 10,000. Also, my lungs are clear, and I've ditched the oxygen and the O2 sensor. Sweet! I can touch-type!

Update Thursday, December 17, 8:15 PM:

OK, we've got a correction, there was some confusion with what the earlier doctor told me. The original ER Dr. called to see how I was doing (I think he's a genuinely nice guy, but I also think I'm an interesting case to him; most people with my CK levels present much worse.) and mentioned it was too bad my CK levels had gone back up. Say what?

I later confirmed what he told me with a nurse in the observation ward. At 1 AM this morning, I had a 90,000 CK level. (Again, under 400 is normal, and under 10,000 lets me go home.) However, about that time, I started getting fluid in my lungs, and we reduced me from 500 milliliters per hour to 200. That allowed my body to move the water out of my lungs, and made me breathe better. But it also allowed my CK levels to creep up. They were measured at 103,000 at 5 AM this morning.

I've been at 350 milliliters per hour of saline IV drip most of the day, and my 5:30 PM CK reading (I'm now getting blood drawn twice a day instead of every four hours) was 89,000.

I'm definitely not going home tonight. I'm kind of doubtful I'll get home tomorrow, and this may mean we're moving to something more aggressive than IV fluids. (This is me saying this; no doctor has said so.)

Good news is I'm moving to a private room, still in Observation, but I expect I'll sleep better without people being moved into and out of beds right next to mine all night long. (Not that I'm eager to move, but I'm all packed up - all belongings in bags and etc. except this laptop.)

Update Thursday, December 17, 10:50 PM:

I'm in the new private room. This is excellent. (New phone is 310-267-9423.)

My left arm is swelling up like Hellboy (maybe there's something to this super-hero theory after all) so they switched the IV to my right arm. This is not excellent. I used to be a phlebotomist's dream; now I'm apparently a nightmare. Took two RNs and 40 minutes to get an IV in. My whole body is swelling up with fluids. I'm the fucking Pillsbury doughboy. (OK. Not quite that bad, But they estimated this morning that they've given me 14 liters of IV fluid and I've urinated 7.) They figured that I'd put on about 10 pounds of water weight. (Leaving the "period" jokes to those more qualified.)

I'm going to CLOSE THE DOOR and go to sleep -- what a wonderful concept. Goodnight, all.

Update Friday, December 18, 8:17 AM:

Just spoke with my doctors and got my CK results. CK is 68,118; plan is the same -- flood me with IV fluids until it goes down. Doctor said I may be here a few more days.

Update Friday, December 18, 9:12 PM:

Lovely day in the Observation suite -- got to walk outside twice (got my car from temporary parking and drove it to the hospital parking, and did not have a ticket!) and took a shower.

You would not believe, by the way, the looks you get while walking down a public street in a hospital gown. I think people thought I was an escaped mental patient -- at least one person asked me if I was one, and lots of others stared.

Vanessa stopped by with snickerdoodles, Heather L. stopped by with a get-well card from everyone at work, and more Gatorade and candy than any sane man needs, and then Kate S. stopped by with my Mom to visit for a while. All of that was wonderful; a great way to spend a Friday evening (if your Friday evening had to be spent in a hospital). (And I gave Kate my house key; she'll be coming back tomorrow with movies and clothes.)

All that's the good news. The CK results from my 6 PM blood draw were 54,574. Yesterday I went down 20,000; today I went down 13,500. It's good that I'm going down, but I'm frustrated that it went down less today than it did yesterday. We'll see what tomorrow morning's reading is. I was thinking I'd be out of here by Sunday or Monday; now I'm not so sure.

Update Saturday, December 19, 8:19 AM:

Great news! CK results from 4:42 AM this morning were 32,147. That's a loss of 35,971 in the last 24 hours, and means that I'll almost certainly be going home tomorrow.

Haven't spoken with doctors yet; I'll update when I do.

Update Saturday, December 19, 3:26 PM:

Went for a walk this morning; a one-hour walk around the UCLA campus. It was beautiful. I did get stared at a lot and asked if I needed help. What? You've never seen a man in sneakers and a hospital gown with an IV in his arm going for a brisk walk?

@dakimjerry came by and visited for a while; it was great hearing about his recent adventures on the road.

Kate S. is coming by later today after stopping of at my house; she's going to bring CLOTHES. And SOCKS. And DVDs. And my TOOTHBRUSH. (I've been using a flimsy one from the hospital that bends; it's bristles on the end of a drinking straw.)

Because I'm swelling up with liquids the doctors have given me a diuretic; my "output" was about 1.8 liters in an hour. Think about the size of a 2-liter soda bottle for a second...

No idea when I'm leaving. I'm getting closer to the magic 10,000 number, but the doctors say this won't be linear -- some days I'll drop a lot, and some days I won't. I handled my parents' Medicare Part D drug plan selection over the Internet, and ordered some groceries to be delivered for them. (They can't drive, or lately, use a computer.)

Update Saturday, December 19, 6:15 PM:

My CK level from 4:30 PM today was 27,221! Getting down there!

Update Sunday, December 20, 10:20 AM:

Just got back from a one-hour walk to the UCLA sculpture garden, and then a shower and fresh clothes. Heaven!

Even better, I spoke with a doctor, and my CK levels are down to 14,000! Wohoo! They're taking me off the IV and testing to see whether it continues to come down by oral hydration. (They're not, unfortunately, taking the IV out of my arm yet -- they're just not hooking it up to the bag.)

The doctor thinks it's likely I'll go home tomorrow!

Update Sunday, December 20, 5:22 PM:

My 4 PM blood test came back with a CK level of 11,096! I should be out of here tomorrow for sure! I'll probably be under 10,000 by my 5 AM blood draw!

Update Sunday, December 20, 7:14 PM:

Just spoke with my night nurse; he said all the nurses are really excited about my case -- they've never seen a rhabdomyolysis case with numbers this high. Normally there's serious kidney damage at around 50,000 -- my kidneys are fine, and my highest level measured was 136,000. Still crossing my fingers I'll go home tomorrow.

Update Monday, December 21, 10:30 AM:

I was just told that my CK level from this morning was 6000. I'll be released as soon as the attending physician sees me and signs off on it, and I'll need to drink a liter of water a day.