She went all out ...

She went all out ...

During a Spartan race in June, Janet Stroud faced a new challenge about every quarter-mile throughout the 9-mile course.

She climbed over 8-foot walls, carried buckets filled with stones, raised a weighted ball to the top of a pole and carried a sandbag. If she faced a challenge she couldn’t do, she did 30 burpees instead. She had never worked so hard.

“At the time, I thought, ‘Awesome, I really pushed myself,’” said the Bismarck woman, who is an ultrarunner.

Blog PhotoBut by the end of the race, she knew something was wrong.

“It wasn’t that my muscles were tired. There was just nothing left of my energy,” Stroud said. “My last set of burpees, my muscles just didn’t want to work. It was not just that it was hard for me. They were so weak, there was nothing left in them.”

Blog PhotoDuring the next three days, her arms throbbed and she couldn’t lift them above her shoulders. About five days after the race, the soreness was better but her arms started getting tight from swelling. The next day, she couldn’t straighten them.

Blog PhotoStroud is a nurse, and she knew what she was experiencing was more serious than just muscle soreness. She suspected rhabdomyolysis -- a condition in which muscle cells are destroyed very quickly and release their contents into the bloodstream, and the kidneys may be unable to process the byproducts of the muscle breakdown. She called a friend who is both a doctor and a runner, and the friend agreed with Stroud’s assessment. Stroud went to the emergency room and was hospitalized for two days.

Blog PhotoDr. Nathan Walker, a doctor of internal medicine at Christie Clinic, doesn’t commonly see rhabdomyolysis in athletes. In nine years of the Christie Clinic Illinois Marathon, he’s seen only one case. He more commonly sees the condition in someone who has had a seizure or compression or crush injury, or in someone who is severely dehydrated.

But, he said, rhabdomyolysis can occur with extreme exertion in athletes. It usually happens with anaerobic activity and when other factors such as dehydration or extreme temperatures are also present, or when an athlete is doing an exercise he or she isn’t used to doing, he said.

The symptoms are similar to heatstroke, he said.

“You feel an overwhelming sense of fatigue in every muscle,” he said. “You just feel terrible. It’s usually not just the muscles involved. The whole-body effects of the (by-products of the muscle breakdown) also can cause you to feel really lethargic and fatigued.”

Another symptom is tea-colored urine.

Kidney failure is one of the risks of rhabdomyolysis. When the muscle cells are destroyed, they spill their contents into the bloodstream and “it becomes just an avalanche of cell destruction,” Walker said. The protein myoglobin can build up in the kidneys and the kidneys can shut down if they can’t clear the myoglobin. A patient with rhabdomyolysis can end up on dialysis to clear the kidneys of waste products.

Stroud was given large amounts of fluids during her hospitalization and was told to keep drinking a lot of water after she was released. Both her kidney and liver enzymes were elevated, but their levels have returned to normal and she didn’t suffer any permanent damage.

Another risk with serious cases is compartment syndrome, in which the swelling from the damaged muscles can compress the muscle compartment and limit blood supply.

The June Spartan race was the second Stroud has done, but she entered the competitive division this time and pushed herself much harder. She worked on her upper body strength before the event by doing pushups, pullups and burpees. But as the race got closer, family obligations prevented her from continuing her training. Stroud did the race anyway, because she’d entered it with her brother as an experience the two could share.

“My doctor said, ‘Why didn’t you just quit?’ My mind doesn’t work that way. I think there are lot of athletes like that, that just push it,” Stroud said. “I think the more extreme people get in their sports, (rhabdomyolysis) is something you’re going to see.”

She posted about her experience on Facebook and found that many people had no idea about rhabdomyolysis.

Stroud said she’ll eventually do a Spartan race again. She’s working with a personal trainer to strengthen her upper body and be better prepared the next time.

“I’m going to be careful,” she said. “It was scary. It’s so dangerous. I don’t ever want to be in that situation again. I just want to be smarter.”

 

Jodi Heckel, a writer for the University of Illinois News Bureau, is a runner, swimmer and triathlete. You can email her at jheckel@news-gazette.com, or follow her at twitter.com/jodiheckel. Her blog is at www.news-gazette.com/blogs/starting-line/.

 Photos: After competing in a Spartan race in June (top three photos), Janet Stroud had pain and swelling in her arms (bottom photo), which turned out to be rhabdomyolysis. Photos provided by Janet Stroud.

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