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Rhabdomyolysis, is it easy to get a second time?

Question: Rhabdomyolysis, is it easy to get a second time?

This past September, my daughter got rhabdomyolysis after her first day of high school volleyball practice. She was in the hospital for a week. We thought we were going to lose her to kidney failure. I have never been so scared in my life. She is just a freshman. Her arms had swollen up to over twice the normal size overnight. She could not raise them above her head. We took her to the hospital where she was diagnosed with rhabdomyolysis. Her CK levels were higher than anyone had ever seen before at this hospital. (near 40,000) The doctors asked us if she had been in a plane crash. Then they questioned my daughter, my wife, and myself about the possibility of someone beating her with a large heavy object recently. They just couldn't believe that these injuries occurred from a high school volleyball practice. But they did. Now, there are several factors that may have contributed to the injury. She did not have alot of physical activity in the weeks before the first practice. She was very nervous. She was afraid that she wouldn't be able to keep up with the upperclassmen in the one mile run. So the night before, I took her to the track field to run a few laps in order to put her mind at ease and show her that she would do just fine. And she did just fine that night. It was very hot that next day at her first practice. She did take a sports drink with her and she did hit the water fountain a few times that day. The first half of the practice occurred in the gymnasium. She said her problems started when they were doing the pushups. She said the way they had them do them was very uncomfortable. They had to hold a certain posture. The coach said that if anybody in the group did not complete them, then the entire team would have to do them again. She did not want to be the one to fail and have everyone repeat them. She pushed herself to her limits and beyond in order to complete the task. She has done pushups before, but the way she interpreted the form they wanted made them very difficult. Then later when they went outside to run the mile, after a few laps she got very dizzy and nearly passed out. A few minutes later, she vomited. That evening when she came home, she was completely exhausted and her arms were worn out. Later that night her arms began to swell a bit. By the next day, they had swollen some more. We then took her to the hospital to get checked out. She was diagnosed with rhabdomyolysis and immediately admitted and put into intensive care. The next day her arm had swollen to twice the size. She was put on an IV and constantly monitored until her CK levels finally started coming down. There was luckily no damage to her kidneys. Praise the lord. A few weeks later, she did return to the team and played in a few of the final volleyball games. She barely had the arm strength to get a serve over the net. Now it has been six months since the incident and she has about 80 percent of her original strength back. So now, after all of that, my question is, should I let her play volleyball next year? Is she more at risk of getting rhabdomyolysis because she's had it before? Should I talk to the coach and see if she can be excluded from the pushups or other potential extreme arm excercises? I hate to see her miss out on the sport. She is very good at it. She really wants to be there and the team really wants her to be there. I just want some good advice on what to do. Oh yes, one more thing. A few days before she was released from the hospital, I read an interesting article on a major media site. It was on the national news. About 19 Oregon high school football players were in the hospital at the same time we were for rhabdomyolysis. The players were being accused of possibly taking some kind of performance enhancement drugs or supplements. They assured everyone over and over that they had taken nothing. Now, I did send the athletic department of the Oregon football team an email. I told them that my daughter (in West Virginia) had the same disorder that these boys had. I wanted to talk to someone there and maybe compare situations and see if we had anything in common. I never did get a reply. I am just wondering if there could be a tie with the sports drinks. Gatorade had just launched the new G2. I have doubts about some of the name brand products and the things they tend to add to them for reasons that are rarely good for the consumer. Anyway, there must be something in common here. I wonder how many more cases occurred at that time that never got national attnetion. Any information on that issue would be very helpful as well.

Answer:

Exertional Rhabdomyolosis (ER) is the topic of an upcoming article in SIB. The research on ER shows that more athletes may actually be in a state of ER than those that are diagnosed. In fact, that a whole group of athletes had ER after a common practice is exactly the kind of thing that has been reported in the research. ER may actually be a point along the continuum of appropriate responses to exercise. Many athletes have had a CK level like your daughter's or higher, without renal compromise. What is key is why your daughter may have had the response she did. A sudden increase in exercise or training will trigger ER. A recent viral illness, dehydration, and heat exertion are also all things that leave the body more vulnerable to ER and developing renal problems. To address your question of return two things: 1. The literature shows an extremely low incidence of diagnosed ER and an even lower incidence of recurrence. 2. Try to determine the causative factor to the system's vulnerability. From your story, there are several: de-conditioning, dehydration, and heat exertion. I would enlist the help of a physical therapist because she should have full arm strength by now. I would also enroll her in some sort of off season training program to keep her conditioning level up so that season training isn't such a shock to the system. Keep her hydrated - water is fine and preferable, however, if exercising in the heat or for more than an hour, an electrolyte replenishing drink is recommended. Good luck!