How a simple set (or two, or more) of pullups turned into a near-death experience for one woman.
Alone in my hospital bed, I watched the IV fluid drip into my arm. Those precious drops stood between me and a host of scary stuff: kidney failure, seizure, heart attack. Death. I’m a strong, athletic, healthy-as-a-horse 38-year-old woman. How did I end up in the hospital, trying to wrap my tongue around the strange word rhabdomyolysis, and my mind around the even stranger idea that I’d done this with a few pull-ups?
Ok, maybe more than a few. Three days before, on New Year’s Eve day, I’d gone to the gym where I worked out with my personal trainer, an educated and experienced bodybuilder. I told him my goals for 2013, one of which was to do a pull-up weighted with an extra 53 pounds, about half my bodyweight. I was so gung-ho to get to work on this goal that I decided to get a head start on it by doing several sets with no added weight for starters.
RELATED: What is Rhabdo?
Set after set, I did as many reps as I could, with increasing assistance from my trainer when my arms and back fatigued. By the last round, all I could do was hang there. Then, we moved on to other upper-body exercises until I could barely move my arms. We typically worked to muscle failure–but this was a bit extreme. I figured I’d be super-sore the next day, but isn’t that the price you pay for working hard?
That one sweat session would cost me much, much more than a few aches and pains, as I would soon find out. That night, the pain and soreness was so intense that it woke me out of a deep sleep. It was excruciating to do anything with my arms, and my discomfort grew over the next few days. It was torture just to try to pull a coat on, or straighten my arms. By the third night, my right arm was grotesquely swollen. I knew something was really wrong.
Panicked, I called my sports doctor, who had already seen me through a knee and back injury brought on by my enthusiasm for heavy weights. When Dr. McKee he examined me the next morning, he discovered that I’d ripped my muscles from the tendons. I’d gone past the point of tearing down the muscle a little bit to make it stronger, as typically happens with resistance training, and instead may have actually destroyed it. All because I wanted to get in a killer workout–one that, it turns out, could have killed me.
The formal diagnosis: rhabdomyolysis, a.k.a. rhabdo, a breakdown of muscle fibers that leads to the release of a protein called myoglobin into the bloodstream. Myoglobin is toxic and can cause serious kidney damage. The day quickly became a blur of words like necrotic muscle tissue, stat, MRI, ICU, liver damage, renal failure, fasciotomy. I spent nine days hospitalized while an IV pumped fluids into my body to get the myoglobin out of my system.
With rhabdo, “It’s put the IV in and turn up the fluid and run as much as you can to wash the myoglobin out,” Dr. Robert Greenwell, chief of the division of nephrology at Mercy Medical Center in Baltimore, explained to me later. “The only way it’s going to get out is through the kidneys.”
And the myoglobin wasn’t the only concern. The muscles also contain most of the body’s potassium, which is also released when muscles break down, Greenwell says. “If potassium goes up enough, we get concerned about the heart stopping.” A sobering fact: Potassium is what’s used in lethal execution. “You sedate the prisoner, and inject potassium,” Greenwell says. “The high level stops the heart, and they die.”
While the condition is more common among military and marathon training than in gyms, Greenwell says, it’s popping up more often in the media as high-intensity workouts grow in popularity. Allison Bojarski, a certified Level-1 CrossFit trainer at CrossFit NYC: The Black Box in New York City, says her gym has seen a few cases over the past several years, “always in the free intro classes.” Newbies, she feels, are most at risk because instructors don’t know them well enough yet to determine when to tell them to scale back. Greenwell also notes that athletes who’ve taken a break, even as short as a Christmas holiday, can be at increased risk of rhabdo. I had just returned from a vacation myself before my souped-up workout, and though my mind believed I was still as strong as before I left, three weeks away from training meant I wasn’t physically prepared for such a strenuous workout.
Dehydration is another risk factor, as it reduces blood flow to the kidneys, increasing the odds of kidney failure, and slows potassium filtering, according to Bojarski. She recommends hydrating well before the workout and drinking water or a sports drink before, during, and after.
While cases like mine are rare, Greenwell notes, rhabdo should be on the radar of most sports and fitness professionals, including coaches, instructors and personal trainers—and it’s typically not. “Even when you query the trainers trying to drive a guy up to his highest levels, they might understand muscular injuries from overuse but they don’t even know what the word is,” he says.
Bojarksi says to ask a potential trainer point blank. “If they can’t immediately spout off a definition of rhabdo and how they avoided it with newbies, then go find another trainer.”
How do know if you’ve pushed yourself too hard—and what should you do about it? The most common symptom, dark urine, means that myoglobin has already filtered into the kidneys, according to Greenwell, so don’t wait for that.
Extreme pain, swelling, being more sore than you’ve ever been—these are all cues to seek medical attention. “Go to the hospital and check it out,” Greenwell says. “It’s a very easy thing to check with a regular chemistry panel.”
And if it’s positive? Don’t panic. I—like most people who get rhabdo—recovered just fine with IV fluids, though some patients require kidney dialysis. You can reduce the risk of acute kidney failure by starting treatment as soon as possible.
I may have escaped without serious complications, but my “killer” workout had other consequences. Because of rhabdo, I missed an international trip I had planned for early January. I hit my insurance out-of-pocket maximum for the year. I missed three weeks of work and three months of training. After not working out at all for two months, I was sentenced to light cardio for an additional month, which I spent bored and frustrated on the elliptical trainer while I watched others enjoy the weightroom. During my first real workout after recovery I felt like a shadow of my former self. When I summoned the nerve to attempt chin-ups, I had only a fraction of the strength I’d had before. My favorite sport, rock climbing, was far more difficult: I failed an ascent for the first time on my initial climb six months after being hospitalized.
Rhabdo came as a complete shock to me, but now I know better than to push that hard. It’s a tough way to learn to take your ego out of a workout, but it’s a lesson I won’t forget. With a healthier respect for my body’s limits, I dropped the idea of the arbitrary pull-up goal and started working out for my health–building strong bones to last a lifetime, for example. But fitness is no fun–for me anyway– without a goal. So now, I’m training for my first adventure race, the Adventure TEAM Challenge in Colorado, as part of a five-person team that will include two people with disabilities—one in a wheelchair. If there’s anything that will help me keep my perspective in the weight room—and in life—this ought to do it.