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How The Stress Of Running A Startup And Some P90X Led To A Week-Long Stay In The Hospital With Rhabdomyolysis

Calling attention to a little-known issue.

I simply wanted to get back in shape. I could have killed myself in the process.

I spent the past week in the hospital battling a little-known condition called rhabdomyolysis, brought on by excessive strenuous exercise. I wanted to leverage the College Spun platform to share my experience and call attention to the issue. Hopefully this can help to educate athletes about the condition and potentially save lives. 

A bit of background:

I've always been an athlete. I played soccer and baseball in high school. I currently play basketball at least once per week. I play in an intramural soccer league and two intramural softball leagues. I'm obsessed with sports - heck, I quit a well-paying finance job and launched a website dedicated to sports. 

But since launching College Spun just over a year ago, I've gained a few pounds. While I wouldn't classify myself as "fat", I did gain a modest amount of weight - going from 175 pounds to 195 pounds (I am around 6-foot-1). Why? Because I log 16 hours in front of my computer, seven days per week. Fellow entrepreneurs - you understand.

The weight gain bothered me. I wanted to get back into shape. So I figured - why not buy one of those exercise programs?

I have a large television in my home office, along with space to exercise. I went out and bought dumbbells, a pull-up bar and a yoga mat. I bought everyone's favorite fitness instruction video, P90X. I thought I was making a healthy decision.

It only took one workout session to put me in the hospital and leave doctors scrambling to save my kidneys.

What is rhabdomyolysis?

I'll be honest - P90X has a number of "warnings" about what strenuous exercise can do to your body. But if I'd specifically known about rhabdomyolysis, I don't think I'd have ever even taken the plunge. 

Rhabdomyolysis is a condition that occurs when your muscles release too many "toxins" into your bloodstream - namely a protein called myoglobin. It can happen after a "crush" injury from something like an earthquake. It can happen if you take a statin in combination with another drug or medication. But most of the time, it happens because of strenuous exercise. 

The main worry with rhabdomyolysis is that your kidneys can fail because of the excessive amount of myoglobin circulating in your blood. To put it simply - it can clog your tubules, leading to renal failure. As you probably know, renal failure can lead to other organs failing as well - and possibly death, if doctors can't get you on dialysis quickly enough. 

How and why this happened to me:

As mentioned above, I've always been athletic. In this case, it actually worked against me. Why? Because I was able to complete a large portion of the exercises in the video.

I started the program last Monday. If you've done P90X, then you know that the first day (chest & back) is really, really difficult. You're asked to do push-ups, then pull-ups, then push-ups, then pull-ups. I lost count of my how many of each I did - but it was a lot. Eventually, my muscles just shut down. All in all, I probably completed half of what I was supposed to do - so around 30 minutes of continuous, hard exercise.

Tuesday morning, I woke up incredibly sore - but hey, I hadn't worked out like that in forever, so I figured it was normal. As the day went on, I started to notice that my triceps, deltoids and pectorals were swollen. Still, I did day two of P90X - plyometrics. The workout wasn't nearly as difficult as the first day - though my leg muscles were burning afterwards. 

Wednesday morning, my muscles were in such pain that I could barely use them at all. Getting out of bed was extremely difficult. Lifting my arms more than a few inches was nearly impossible. Clearly, I couldn't do another day of the workout routine. Annoyed but concerned, I decided that I probably needed a few days off. Lame. I couldn't even do two days of P90X without having to call it quits.

Thursday morning, things got real. When I got up to go to the bathroom, I noticed that my urine looked like Coca-Cola. In an attempt to self-diagnose (usually a bad idea), I Googled my symptoms. Ten seconds later, I knew I had "rhabdo" and that I was in serious trouble. 

I went on ZocDoc and made an emergency appointment with a kidney specialist (nephrologist) in New York City - I had doubts that a GP would even know what rhabdo was, so I figured that I was better off skipping that step. Thankfully, I was right - my doctor told me I had rhabdo immediately and sent me for a blood test. Since the results wouldn't be ready for a day, he told me to go home and take it easy, but to call him if my urine got darker. It did. And when I couldn't reach him to let him know, my mother and I decided it was time to go to the ER.

At the hospital, I was immediately hooked up to a 200 ml IV in an attempt to flush out the toxins. The doctors did a urine test and a blood test to see what kind of shape I was in. They weren't concerned though - they'd seen worse, supposedly. I was hopeful that an overnight stint in the ER would be the outcome.

Friday morning, I was admitted to the hospital. At around 10 a.m., two doctors came in, clearly worried about my condition. My urine contained blood and myoglobin. My blood test came back with a CPK (creatine phosphokinase) level of over 16,800 (the max they can test for). Normal CPK levels, I was told, usually run between 10-200 micrograms per liter. These levels are a huge indicator of severe rhabdomylolysis.

My nephrologist called me, asking "where are you right now"? When I answered with "the hospital", he said "good, because your CPK levels tested at over 50,000 yesterday - the max our machine can read". 

I was put on two bags of IV fluids. I was given a catheter. The doctors were trying to make sure my kidneys didn't fail. Amazingly, they hung on. By Saturday, the protein and blood in my urine subsided, but my CPK levels were still unmeasurable - five days after the initial workout. 

Unfortunately, my liver enzymes were also high. Though they were slowly decreasing with each blood test, I was ordered to have an ultrasound of the organ done on Monday. After what the doctor described as "echogenicity" on a portion of my liver, they ordered an MRI. I had that done on Tuesday and still await the results.

Tuesday morning, my CPK levels finally came back down to earth, registering in at 12,000. The doctors discharged me, said I need to stay hydrated and told me to follow up on my liver examination. I can't exercise for a few weeks and need to ease back into anything involving sports or exercising. While I'm still concerned about my liver, I'm honestly just happy to be out of the hospital - it was not a fun six days.

Why I feel lucky

There are conflicting studies on rhabdo, but many cite a 20% mortality rate if you suffer renal failure. Thankfully, things didn't get to that point in my experience. And while I still need to follow up on the condition of my liver, I feel fortunate that my kidneys held up and that I'm back at my desk writing this article.

Throughout the process, my friends and family - namely my girlfriend and my mother - stuck with me in the hospital room. I had numerous visitors who helped to take my mind off of the situation. One even brought me a "1 million page views" memento, since June was our first month hitting the always-important traffic goal. Trust me, that kind of stuff matters when you're worried about your health.

It's not just me

In January of 2011, 13 Iowa football players were sent to the emergency room with rhabdomyolysis after the first intense workout of the year. In 2008, seven swimmers at South Carolina suffered the same fate. These are D-1 athletes we're talking about. It can happen to anyone.

The one constant in most of the stories I've read about rhabdo from strenuous exercise is that it strikes when you haven't worked out in some time and "overdo" it the first time you start back up. Your muscles simply aren't ready for what you're throwing at them. 

Moving forward

Hopefully, my story can help to save others. If you're reading this and see that you have the same symptoms I described, go to the doctor or a hospital immediately - time matters. Rhabdo is at its worst around 12-to-24 hours after the initial injury, so the sooner you take action, the better. I'll never know for sure what would have happened had I ignored my symptoms, and that scares me. 

Hopefully, my muscles will recover and I'll be able to resume normal activity - including the numerous sports that I love to play. And of course, I have to make sure everything with my liver is alright as well. But again, I was fortunate compared to others who have been in my situation.

My two biggest takeaways from the entire ordeal? You can't put your muscles through a strenuous workout without leading up to it, and you need to recognize when your body is telling you that there is something wrong. The first could have killed me, while the second may have saved me.

Stay safe out there.