Ep 50: Rhabdo is Real (and so is P90X)

“Since the start of the summer, I’ve gotten at least one case of Rhabdo a week,” shared my workout partner and wife, Chelsea, as we were wrapping up our workout. “And most of it is from Crossfit. A lot of patients are half our age.” I’m turning 48 soon, so it was a good reminder to keep hydrated and take it easy, and not bow to the peer pressure that this group-oriented exercise engenders. 

Chelsea’s a doctor of internal medicine at Northern Westchester Hospital, so I’m fortunate to have someone like her at my side to check my pulse as we push ourselves to the limit. Besides my age and her professional insight, with five children in tow, we also know that remaining cognizant of ourselves is crucial to not having to cash in on our term policies all too early. 

“The motivational loud music, the coaching, and the 'subtle' peer goading are designed to help you push pass the pain. However, they also  intrude on our ability to listen to our bodies,” she waxed, as we drove home. “The unforgiving pace of the workout also contributes to the spike in Rhabdo among Crossfitters,” I added. “Most other sports don’t induce such risk, because there are pauses or the pace is even-tempered enough to facilitate endurance.”

Having been inspired by Ahr-nold when I was a young man of 21, his Encyclopedia of Modern Bodybuilding, guided me during my daily 3-4 workouts for a full year. For the only time in my life I actually had a six-pack and I developed muscles I had never seen before (and have never seen since). Five years later I ran the New York City Marathon as one of three guides to a pack of blind Russian runners. With our feet literally on the starting line and 27,000 other runners behind us, we ran across the Verazano Bridge at 6:45 and covered the first 12 miles at that same pace. And we were on pace to cross the finish line in under three hours,  but, ultimately, we averaged only 7:20 because our tethered friends had been training in Siberia and had decided not to drink water for the first half of a slightly humid race. In turn, our comrades had to stop 22 miles in and we walked for half a mile, killing our goal.  Point is, I know pushing the limits, I know going the distance, I know intense training, which is why half my life later, I'm well aware (and concerned) of the real risks of these intense Crossfit workouts.

In addition to my wife’s experience, as soon as I read about Rhabdo when we began Crossfit a couple of weeks ago, I was reminded of a former colleague or ours (she recently left our company) who had Rhabdo as well. She is only 28 and she had relayed the traumatic experience of enduring Rhabdo and the recovery required. It had not occurred to me until we began our own workouts, that this is likely how my friend had been stricken. 

“Recently, a patient came in with Rhabdo at the same time that his wife was going into labor,” relayed Mrs. Doctor. “For three days he had to wheel around an IV to the delivery room because we were pumping in the equivalent of three small water (12 oz) bottles of liquid into him every hour.” Apparently, the kidney malfunction that Rhabdo causes does not allow you to exorcise the breakdown of muscle protein that occurs when you workout and your pee turns brown. Ewww. 

If you’re a layman like me, who does not understand half of what his wife is saying most of the time, trying to read and understand what Rhabdo is via all the medical literature is virtually impossible. Luckily, healthline.combreaks it down for us in simpler terms, “Rhabdomyolysis is breakdown of muscle fibers. Muscle breakdown causes the release of myoglobin into the bloodstream. [Too much] myoglobin can cause kidney damage. Symptoms include dark urine, muscle weakness, and fatigue.”

That’s why it’s vital to always drink water before, after and even during your workouts. The hydration helps your body take out the trash.

“I’ve also gotten two cases of P90X Rhabdo as well. Ever heard of it?” Chelsea asked. I hadn’t, nor had she. P90X, x is for Extreme and according to Wikipedia, “is a commercial home exercise regimen on DVD designed to take 90 days, and consisting of an intense training program (designed for those who are already fit) that uses cross-training and ‘periodization’ and is combined with a nutrition and dietary supplement plan.” Ugh. 

Such programs (or regimens like Crossfit) present a problem in a society like ours that values and promotes get-fit, lose-weight, and get-rich quick schemes. Those who fall prey to them are usually those at the greatest levels of risk and most in danger of serious harm.

So, if you’re anything like me, either on the brink of 50, or stretched and taxed and worn to the max by a sticky web of obligation—accepting that you’re going south on that slippery slope of life and listening to what your body tells you, will allow you to enjoy that steep climb back toward youth and rejuvenation.  In other words, just do it, but just don’t over do it. And at our age you've got to also remember that its often wiser to enjoy the journey, rather than to reach a destination.

In closing, if only for our amusement, I must say that intense workouts like today’s Partner WOD, not only effectively breaks down muscles (so that we may build stronger and bigger ones), but it can also break down communications and relationships. 

Admittedly, Chelsea and I almost got into a fight (how apropos, in a gym) because we were doing our relay reps differently. She started doing them in sets (I do 15, you do 15), where I was doing the relay one at a time (you do 1, I do 1). The latter method allows you focus on form and is more difficult because the minute(my-noot) delay conveys a greater burn. Whereas her way, let’s you get through the workout faster, so that you are more likely to finish it. 

After some tense misunderstanding, nudged by the fact that we are falling behind the others, I cajoled her into doing it my way.  If I have to drink a glass of yucky-icky organic-but-quite-bitter kale each morning, take a baby aspirin each day, and eat an inordinate amount of vegetables, I think it’s only fair that for onceshe follows my lead.

Related

Severe Rhabdomyolysis Associated With a Popular High-Intensity At-Home Exercise Program
(Case report from the Journal of Medical Cases documenting a 23-year-old athlete, who after two sessions of the extreme workout known as the “P90X” developed rhabdomyolyis.)

Ep 49: The Terror of The Toddlers (at a restaurant, in Cold Spring)

Last night, Chelsea and I took the toddlers to the Tots playground in Cold Spring, and then to Whistling Willies for dinner.

All was going quite well until the very end when both our toddlers had to go to the bathroom. 

I should have taken it as an omen, but I dismissed the fact that my sandal strap broke as I got out of the car right before entering the restaurant as merely the inevitable. They were my favorite abused sandals from Walmart in Atlanta that I purchased almost ten years ago, so the time had come.

Anyway, I was wrong. The broken strap was definitely a sign that something else would snap later on.

They were small restrooms, kind of grungy, especially the Men's room, so I thought best that Olivia go with Mama and Milo with me. Of course, neither would have it. Each wanted to go with the other parent. 

Acting quickly I deceived Milo into seeing "the BIG" porcelain urinal. Alas, I could hear Olivia screaming as if her mother was torturing her, so I opened the door and took them both in. Crouching on bare knees to hold Olivia while holding onto a broken sandal with my toes and simultaneously ensuring Milo did not touch anything was a stretch for my multitasking-ass. 

Of course, Olivia did not really have "to go," so I tried to put on a new diaper while she was standing (not easy) and then had to scrunch each kid under my armpit, one at a time, so they could wash their hands - another challenge, especially as each child became impatient and upset and began screaming to demonstrate that they were not happy. 

Now, it was apparently the parent abusing our kids. 

By the time we had emerged, Olivia was a raging mad toddler and she made sure that everyone within the town limits of Cold Spring knew. 

Chelsea asked "Did you pay yet?" Perplexed, I simply nudged Milo to his mother and tried to dig out my wallet as I handed it, more like tossed it, to Chelsea, while I tried to escape with Olivia, so that her screaming tantrum would no longer be amplified by Willes four walls, but rather be complemented by the breeze of the temperate summer evening. 

Once outside, the fresh air seemingly only invigorated Olivia and gave her the oxygen she needed to take her lovely tantrum a pitch higher. 

With my ears ringing I quickly opened the car door and strapped her in her car seat, while hushing her with promises of a big stuffed bird we had in a big box of toys that we had just acquired from Tamsin. 

Still sobbing, with cheeks wet with the frustration that her parents could not meet her needs for whatever mysterious reason, the big bird saved the day. She half-slept on the twenty minute ride home.

Relieved, Chelsea and I ignorantly thought it was over, as we plotted, agreeing to each take a sleeping child up to their beds. 

When Olivia awoke she announced in no clearer terms that our troubles had only begun, and began to scream bloody murder as her mama tried to put on her princess pajamas. 

After seeing that Milo was placated and ecstatically preoccupied with playing with his new noisy monster truck from the hand-over ("here, now it's your turn to clean up the clutter") box, I ran upstairs to see if I could help tame the beast.

Upon opening the bedroom door, Olivia came over to her Papa and placed her weeping head on my shoulder, as I carried her over to the bathtub to rinse off the residual playground sand and dust, and more importantly, to run warm soothing water over her. 

It worked. Yay. We got her dressed, brushed her hair and teeth, while Chelsea did the same for Milo. 

Finally, I rocked Olivia in my arms, while Chelsea laid down next to Milo and we sang the nightly Christmas songs that the kids require as lullabies (Santa, Rudolph, Frosty). 

Within in a minute of the last refrain, both of our little monsters were out cold and we escaped exhausted ourselves, although, well knowing we could not yet go to sleep, because there was much work to be done, even though it was 10 pm on a Sunday night and we could barely keep our eyes open. Ugh. Double-ugh.

Hence, this presentation of a very special Toddlers edition of parenting memes. Parental discretion advised.

Ep 48: I got beat up last night (by my WOD)

I took this screenshot from my Wodify app last night after a grueling work-out that was not for the faint-hearted. I truly felt like I had been beat up after I barely-barely finished. At 24 minutes I still had 10 (ring) pull-ups to do, so I cut the killer Burpees in half and finished the work out. 

Admittedly, 20 minutes later at home I texted my younger sister in California who has been doing Crossfit for two years now -  "I'm still feeling woozy and weak." As bothWendy Yee and my sister have assured me, once you get in the grove, its all well worth the pain. 

At 47, soon to be 48 (i.e. 2 years from 50), I'm willingly taking up the challenge, but we'll have to see how long my dedication lasts. Being out of shape is one challenge, having the time to work out is a much greater one. And although I've been religiously taking my baby aspirin on a daily basis, my workout partner and Dr. spouse still worries about how the stress might ultimately affect me. 

Not to discourage anyone, but she did say that she imagines there might be a high risk of heart attacks, especially among those in their 40s, because the instructors do not seem to be certified as physical therapists or have degrees in physical education or fitness, and therefore don't seem to be fully conscious of individual's limits. When we joined Crossfit Peekskill, there was no health assessment and a minor read on your athletic ability. And by having everyone do the same WOD, you're unduly upping the ante for those at risk for heart failure or Rhabdomyolysis, which causes death of muscle fiber and kidney failure - yikes!

So, fellow Crossfitters although I encourage you to push your limits, I also suggest you have a good idea of what those limits are and to allow yourself to cut back when your body simply says you just can't do it anymore, even if everyone else can. 

As Dr. Richard Besser, chief health and medical editor for ABC News, says in the following story, "No pain, no gain is the worst approach to exercise." Instead, listen to what your body is telling you, lest you want to "fry your kidneys and kill your muscles." Ugh.