The Show Up Fitness Podcast

Rhabdomyolysis w/ Dr. Chris Perry ER & ICU Physician

• Chris Hitchko, CEO Show Up Fitness • Season 2 • Episode 136

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Ever wondered how muscle breakdown during your workouts could turn deadly? Tune in for an enlightening discussion with Dr. Chris Perry, an ER physician and head of the ICU in Jersey, as we uncover the complexities of rhabdomyolysis. Whether you're a trainer, fitness enthusiast, or just someone keen to understand the health risks of overexertion, this episode promises essential insights. Dr. Perry breaks down the biochemical intricacies and warning signs of rhabdo, emphasizing the importance of recognizing the boundaries between beneficial exercise and harmful strain.

We also share cautionary tales like that of "Rabdo Randy," whose intense workout regimen landed him in the hospital with critically high creatine kinase levels. Learn why hydration is more than just a buzzword and how it plays a crucial role in preventing serious conditions like heat-related illnesses and rhabdomyolysis. Plus, we underscore the importance of lifelong learning in the fitness world, urging listeners to step outside their comfort zones and continuously seek knowledge. This episode is a must-listen for anyone committed to a safe and informed fitness journey.

Want to ask us a question? Email email info@showupfitness.com with the subject line PODCAST QUESTION to get your question answered live on the show!

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Speaker 1:

Welcome to the Show Up Fitness Podcast, where great personal trainers are made. We are changing the fitness industry one qualified trainer at a time, with our in-person and online personal training certification. If you want to become an elite personal trainer, head on over to showupfitnesscom. Also, make sure to check out my book how to Become a Successful Personal Trainer. Don't forget to subscribe, rate and review. Have a great day and keep showing up. Hi everybody, and welcome back to the Show Up Fitness Podcast. Today we are lucky to have Doc Chris Perry. He is an ER physician as well as head of the ICU in Jersey, and we're going to pick his brain on going to the source when it comes to critical conditions. So, doc, thank you for taking the time today.

Speaker 2:

Thank you for having me. It's a pleasure.

Speaker 1:

And we're going to talk about rhabdomyolysis, but before we do, let's talk about how we got connected. So, as a trainer, you don't get a lot of trainers meeting up with physicians like yourself, so how did we meet Doc?

Speaker 2:

Well, I was interested in critical care nutrition because in the ICU we deal a lot with that and I almost always been interested in sports and I kind of saw the connection there too. So for a period of time I had a nutrition supplement company. I spent a lot of time at the conferences and you know we kind of met and interacted. A few of us had some, had a lot of fun at those conferences. Probably don't need to get in those stories but the but we yeah, you know. So we kind of connected over some common interests. That then sports nutrition, and it's kind of stay in touch.

Speaker 1:

I used to use your product all the time. I loved it. But that industry is hard to make it in, huh.

Speaker 2:

Yeah, yeah, but it's a great experience. I met a lot of great people, learned a lot, um, and just uh, really enjoyed the process.

Speaker 1:

So we have Jason, who we met. We also have Mel she's part of the team Ben, he has done some great stuff as a strength coach.

Speaker 1:

Now for Philly. It's funny that little circle all came together with Dr Jose Antonio. The ISSN went there with the intent to network. That was my intent. You were going there to network and also just get your product out there. And next thing you know, we're having a couple of drinks. Now we met up with a couple of them. Did we meet at the original in the Florida one or the Austin one?

Speaker 2:

I think it was probably the Austin one. I went to the Austin one and then I think after that was the Clearwater Beach one. I don't think I ever went to any other ones. If I'm not mistaken, I went to a couple of smaller ones, but those are the big ones I went to.

Speaker 1:

I remember Jason was giving a presentation and we went out and had a couple of whiskeys that night. The next day he was hurting out and had a cup of whiskeys that night and the next day he was hurting. And it's great to have experts who you can consult with. Unfortunately, today, especially with social media, it's like what is true, what is not true. And I give us a lot of credit at Show Up because we are very humble in our methodologies and teachings and if we don't know, we should have the right people you can go to. And that's exactly why we like to chat with you.

Speaker 1:

And so we did a post recently and now we're almost at 2 million views on it, and it was just talking about rhabdomyolysis and there's a lot of bros in the comments and oh, this football coach shouldn't have gotten in trouble. These athletes like five or 10 of them were admitted to the hospital, ended up getting rhabdo. They're being a bunch of pussies. And I was like, well, no, that's actually pretty far from the truth and it just shows that they had no idea actually what rhabdo is. And so I wanted to bring you on here just to educate the listeners on what exactly is it. What are some readings and things we may be looking for. Should we be freaked out, go to the gym, like, if I go to the gym today and do some bicep curls, am I going to get rhabdo? So tell us more about it, doc, and what we can do to make sure we're looking out for our client's best interest.

Speaker 2:

Yeah, great topic to talk about because it's really not probably as commonly known in your field as a lot of other things, but it definitely can be very serious. Yeah, certainly an interesting take on it to call someone pussies for that, because if anything, it's the opposite. If anything, it's someone pushing themselves too hard rather than not pushing hard enough. But kind of answer your last question first, because I definitely don't want people to freak out or think they have to work out less hard, so to speak, probably just have to be more smart in your working out in terms of being reasonable, staying hydrated and working with a good professional like yourself. But it's relatively uncommon in the overall scheme of things. So just kind of keep that in mind. But let's first talk about, I guess, what it is. Rhabdomyolysis is basically when your muscles break down, which happens in any workout and even happens when you're not working out they can release certain enzymes into the bloodstream and some of those enzymes, particularly a thing called myoglobin, can be toxic to the kidneys when it's high enough concentrations in your bloodstream. Now, muscle breakdown. I know it sounds like a scary thing to say, but the reality is it happens all the time. I mean my muscles are breaking down as I sit here. It's just, it's a natural thing your body's do as the part of the normal kind of you know recycling process that your body goes throughout every day. And when you work out they're going to break down a certain amount more. So if I were to measure these tests in your bloodstream at any given time, I'll have some levels of it. That's not alarming. But when they get to a certain high enough level, then your body's ability to kind of protect itself against the higher levels get overwhelmed and you can have problems specifically with the kidney. So rhabdomyolysis happens when you have extensive muscle breakdown. That kind of overwhelms what the body can do and you can develop kidney failure from it.

Speaker 2:

The most common scenarios we see aren't usually in the setting of exercise. The most common scenarios we see are in the setting of trauma, especially with crush injuries, severe crush injuries. I mean a big object falling on you, a car running over a part of your body, especially in the setting of broken bones with that, because that can lead to what I call a compartment syndrome, where swelling of the muscles in a place that can't swell leads to muscle death. So that's the most common thing we see and also the other most common scenario we see is a person being down, immobilized for a long time because the part of the body that's being kind of pressured the muscle can break down in that area over time. So another common clinical scenario we see is an older person that lives by themselves and had fallen down and had been down for a long time and that person often will present with rhabdomyolysis.

Speaker 2:

But exercise-associated rhabdomyolysis, I think probably is going to start becoming a more common thing, especially with hotter temperatures out there, because that's definitely a risk factor for it. You know you hear about it probably a little less more commonly in extreme endurance athletes. That's the case reports I saw prior to this interview seem to be most associated with. But you know you also mentioned CrossFit. I know I've heard of that, but I do want to emphasize though again, the vast majority of people who do CrossFit or endurance exercises are not a significant danger of this. It's just something that you should always be aware of. But when you have a breakdown in your muscle that's again a significant amount of breakdown in muscle. Then you get those high levels of the enzymes in your bloodstream and that can damage your kidneys if it's high enough, and that's something we should remember.

Speaker 1:

I love nerding out on the medical lingo, and so the myo is making reference to the myoglobin, rabdo is making reference, it says, coming from the meaning of rod or wand and formation of compound words with rabdomyoma. What does lysis mean?

Speaker 2:

Oh, lysis just means breakdown. Okay, yeah, cutting something. Lysis just means cutting something open or cut open. So I guess I never really thought about how the term originates from. But lysis in general just means breakdown of something. Lysis if you're breaking down things that are heased together, lysis adhesions, for example. So lysis just means that. So yeah, but I guess that's where the term comes.

Speaker 1:

I never thought about it and the common symptom that people will report is their urine will be almost like the color of iodine. Is that because you're actually peeing out your muscle?

Speaker 2:

yeah, I guess you could get that right. Um, I mean the myoglobin, but yeah, the uh. Yeah, I mean that's the most uh, it's, I don't know that it's the most common necessarily, but it's the most alarming. Because the classic triad is muscle pains what we call myalgias is a medical word muscle pains, muscle aches, weakness is the second part of the triad, and then what you described In fact, yeah, I mean I've heard the most common thing I've heard is people call it Coca-Cola-ola covered colored urine, cola colored urine or tea, you know, iced tea, colored urine, basically dark kind of brown urine.

Speaker 2:

That's, uh, that's the triad. This is pretty uncommon to get all three, um, but the first two I mentioned muscle pains and weakness are probably the things you're going to see after a typical workout anyway. So it's a little difficult to differentiate. But the, the, the, you know, the coca-cola colored urine is something you're not usually going to see and that should be a huge red flag to you. If you do see that in conjunction with muscle pains and weakness, if you notice that your next day your urine looks like you're peeing out iced tea, then that would be definitely concerning. That probably should warrant you to go see a doctor, either the ER or your regular doctor know. See a doctor. You know either the ER or you know your regular doctor.

Speaker 1:

As we were catching up before you're going over in our partnership of Lifetime and how we're getting our certification and more gyms. One of the things that we've leveled up was we have it's called a level two and within that level two we have certain case examples and one of those case examples that we call Rabdo Randy, because there's a case example where I worked with a client who went to a trainer younger trainer and this individual was deconditioned. They worked out for 90 minutes really high repetition and next day woke up and their arms were swollen like they were stung by bees and they were admitted to the hospital and then they had these levels of creatine kinase were at 15,000. So could you tell us a little bit more about what that is? I mean the breakdown it's an enzyme breaking down creatine within the bioenergetics and exercise metabolism. But what is that measurement and what are you actually looking at there?

Speaker 2:

Yeah, so I mentioned, when your muscles break down, it releases enzymes in your bloodstream and I mentioned the myoglobin is the one that, at least after that breaks down, is toxic to the kidneys the heme molecule. But the test we usually measure in the hospital is exactly what you mentioned creatine kinase or creatine phosphocanase, whatever you call it. Usually we abbreviate it to CK or CPK. That's the most common thing and its function has to do with when you've taken creatine supplements. I'm sure, and it's a lot to use that. But creatine in your body when it gets phosphorylated, it's active form and creatine kinase is the enzyme that facilitates that. So it's not creatine. When you take creatine, you're not taking creatine kinase, but it's one of the enzymes that creatine uses in your muscles. So it's a vital part of what your body does. It's just that, um, when your muscles, uh, break down, they release, among other things, the creatine kinase, and that's the one we measure. So I'm not sure the creatine kinase in of itself is the problem. It's just that it's a, it's a measure we use for severity. Um, and if I measured any of you guys, your listeners, you or any of us, you're going to have a CK level. It's usually around 100, maybe a little less. Someone like yourself that's in physical fitness and working out is probably going to run a little bit higher. Someone very elderly and deconditioned is going to run lower. But it's one of the enzymes that we can pick up on the bloodstream routinely and it's released by a lot of things, not just your skeletal. And it's released by a lot of things, not just your muscle, not just your skeletal muscle. It's actually used to be. We would use it a lot in someone that's having a heart attack or considering you have a heart attack and actually cause. It's cause, a form of it is in your heart muscle and when you're, when you have a heart attack, it actually breaks. It actually is releasing your bloodstream too. So that's another situation where you see CK levels being elevated. So, yeah, so CK level is usually going to be around low 100s, usually less than 200. But yeah, when it gets above 5,000, 10,000, we really start to worry, especially at 10,000, we start to worry about the rhabdomyolysis and the risk of damage to your kidney and we tend to trend levels to assess for progression of it.

Speaker 2:

Because the standard care well, the indisputed standard care is a lot of IV fluids. There's other things that some people use that aren't really strongly evidence-based but at the same time it's reasonable. Things like bicarb therapy in the IV Manitol is much more controversial. That generally doesn't get used. But the big thing is fluids and we trend the CK levels to assess how we're doing. You know, a lot of times we'll see patients in the 100,000 range, which is really serious CK. That's usually those. Usually patients will have renal failure, but anything above 10,000, I would worry about the high risk of renal failure and that's the thing we would watch for. So 15,000, you know, as the person described, it was definitely concerning him and it would warrant hospitalization for fluids and monitoring.

Speaker 1:

I had another client who came to me and they went to a soul cycle class and it was kind of an unfortunate situation because the guy went with his girlfriend, who's super conditioned, she does these classes all the time and he went with her to the class and guys, being guys, were a bunch of idiots and so of course we're going to, you know, push through it. But he was hospitalized with levels at a hundred thousand because the class was way too intense for him and it was also in. It was his Houston and so the humidity. So how does water play a big role into that? Because I keep on hearing that with you know it was double days in the summer. You know Texas heat it happens a lot in these areas that are really really hot and humid. So how does water play a role in that?

Speaker 2:

Yeah, absolutely, especially in terms of prevention, which is probably the most important point to get across is staying hydrated, not just for abdominosis but for heat stroke in general and any other heat all times.

Speaker 2:

And kind of like you're saying not being stupid, you have to recognize your limitations sometimes and that's why another common scenario we see in terms of exertional associated rhabdo is in military circles, and obviously military personnel can't be conscientious about it, not if that's the best way to put it but they oftentimes can't limit themselves because in a combat environment it's not like a sports environment where you can kind of check yourself out.

Speaker 2:

So, but you know, part of it is just being sensible in your routine and in terms of being and also recognizing others, recognizing the guy next to you. Maybe that looks too good, so in terms of, maybe get out of heat, get into the shade and cool down. So part of it is, yeah, heat is definitely a risk factor, um, and along with that, lack of hydration is definitely a risk factor, and you know and you, the problem with humidity in terms of heat is you don't sweat as effectively in those situations, uh, and so your body, your body's ability to regulate its heat, gets a little bit more compromised. So heat and humidity is definitely a strong risk factor for it and in terms of prevention, trying to stay cool in those situations, recognizing in others that they may be overheating, and being sensible in your routine and again staying hydrated, that was an important preventative measure.

Speaker 1:

As Doc was saying in the beginning, this isn't to scare anyone. If you're a great trainer which we all are you know how to assess your clients. With deconditioned ones, you stick to lighter weights but you're doing 10, 15 reps. You're not going to by choosing even eight to 10 exercises for 10 to 15 reps. You're not going to get rabbed.

Speaker 1:

It's more seen in the situations where coaches or uneducated individuals use exercise as a form of punishment, where it's like, okay, you're late to practice, go do a thousand burpees. And it's also more popularized today because of CrossFit, but also David Goggins, who's a big military guru and he has this really tough mindset and does thousands of push-ups and pull-ups, and so people are thinking you're being a pussy today. So you have to have more Goggins in you and just go, go, go, go. But you need to be consulting with the right professional so that they don't get into your hands and you have to administer more intensive remedies to help these individuals. Last thing I want to talk to you about, doc, is just from. We're big into networking and I always tell trainers that you should network with doctors and therapists and dieticians. Do you ever have doctors? Sorry, do you ever have trainers reach out to you and try to network or anything along those lines.

Speaker 2:

Or not routinely. It's kind of interesting. I just two days ago the gym one did a local trainer, um, just kind of it was somebody that met, somebody, that knew somebody else who actually was patient in the emergency room and we were and I saw that guy at the gym and then I saw then the trainer kind of worked with me and you know, he's kind of got to talking a bit about um, you know about he's because he actually has physical therapy too and um, but yeah, beyond that it's it's tough. Uh, you know I really enjoyed those, you know that my time working with you guys and in sports nutrition, just because we're so really out of what I usually do and and you know, but it's still science and smart people and you know, but yeah, unfortunately it's.

Speaker 2:

You know, in my field we tend to stick with just the medical side of things and but it's definitely, like I said, the more different people interact with the better. I remember you had, I remember you had a social media post you had or something you said one time where you said that always make sure you're not the smartest one in the room, and that's just such a good piece of advice wherever you are, because you know it's always be looking to learn, always be. You know, every person you interact with is someone you potentially could learn from and become better at something else with, and that's always a good philosophy to have.

Speaker 1:

Yes, I appreciate you taking time on a busy Wednesday. So thank you for enlightening our followers on what rhabdo is and how we can stay clear of it. And you are not a wimp. If you're experiencing these symptoms, make sure to get the proper medical supervision and get in the right hands. So thank you for your time today, doc, and, as I say, keep on showing up. Thank you, thanks so much for having me.