Rhabdo Interview: Rhabdo From Spartan Race

Spartan races are basically obstacle course events. They are tough. While Spartan events are fun and there's nothing inherently wrong with challenging yourself, those who do intense exercise should remember there is some risk of injury. In this interview, you will learn how Ashlee Beck, a healthy, fit woman, developed rhabdomyolysis after a Spartan Race and how this significantly impacted her ability to take care of her children. Her story is proof rhabdomyolysis is NOT a badge of honor and NOT something that's is no big deal. It can affect how you live your life.

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How did you get rhabdo? 

Ashley. On June 22, 2019, I ran to Spartan AT&T Stadium race in Dallas Texas. Running obstacle course races is not new to me.  I started probably two years ago and generally, I run them every three months.  I had run this exact same race the year before. This year however they intensified it. By the time I got my ticket, all the morning waves had been sold out and I was running at 2 PM.

Even though the building is air-conditioned there would be obstacles outside and in the stairwells which were not air-conditioned.  Also about two weeks prior to this the doctor told me I had a dairy allergy so my eating habits had changed right before a race and my training was a little bit different this time around as I focused more on running.

Another thing I should mention is in January of this year I was diagnosed with hypothyroidism. I do not know for sure if any of these played a part in what happened to me, that day but I believe they did and it was the perfect storm.

What happened during the Spartan Race?

Ashley. The race included 10,000 stairs and some of these stairs you had to carry a 40-pound pack around your neck up and down up and down. The stairs were probably 80% of this race. I noticed that in my left calf I started to have a little bit of pain. Normally I am super in tune with my body and I know when I’ve had enough but I was determined to finish this race.

I kept pushing through the pain and when I crossed the finish line an hour and 42 minutes later I knew something was wrong. Every time I race I feel like $1 million after the race. The adrenaline rush, the victory in finishing, the really really good work out – but not this time.

I was in pain.

I felt defeated.

I didn’t understand what was going on with my legs.

Again I brushed it off I figured it was the stairs and that the next day would probably hurt and then after that, I would be fine. Fast forward two days later and I am in so much pain and my calf is three times the size it should be. I cannot bear weight on my legs, the right leg hurt but not as bad as the left but this pain was like none other.

 

What symptoms did you have? 

Ashley. I had swelling of my left calf and intense pain in my calf to where you could not touch it, not even a sheet could touch it without me biting my tongue in pain. I should mention I have an extremely high pain tolerance so this was scary to me.  The pain showed up at the end of the race but like I said it wasn’t as intense the intense pain and swelling came two days after the race.

Did you go to the hospital?  

Ashley. Yes, I did. I had a physical therapist and my chiropractor r look at it first. The chiropractor and the PT both agreed that this is bad and it could be compartment syndrome or God forbid a blood clot and I need to go to the ER immediately. My chiropractor gave me a note to give to the doctor at the ER that said to check for compartment syndrome and deep vein thrombosis.  The tests were excruciating. Even the x-ray was so painful.

I went to the ER and they did a sonogram for a blood clot and they did x-rays and bloodwork and a urinalysis.

In the end, they diagnosed me with rhabdo.

They also insisted on giving me morphine for the pain, which I declined at first, but towards the end, the pain was really intense and I ask if I could have something like a Tylenol or ibuprofen but they injected morphine into the IV. I was not happy about that because I don’t like to take pain medication and the morphine did not help – it actually made me feel worse.

While at the hospital, I had two IV bags full of fluid and they sent me home telling me I needed to rest and drink a lot of water.  They did not tell me what rhabdo was or how serious it could be.

Did the doctors recognize you had rhabdo?

Ashley. Yes, after all the tests came back he told me that’s what I had. He explained it to me like this, “you pissed off your muscles so bad that you basically tore it to shreds and dangerous proteins were released to attack your kidneys.”

How did the doctor treat you? 

Ashley. The doctor was very nice. He insisted on pain medication from the moment I got there until the moment I left and I did not really care for that. I allowed him to persuade me towards the end because I was exhausted and the ultrasound hurt so bad that I just wanted to take the edge off. I left there without a prescription for pain meds because I felt like I could handle it at home without people touching it.

Honestly, I feel like the reason the ER visit went well was because my chiropractor gave me that note to take to the hospital. He said they would have to check specifically for the compartment syndrome and the blood clot because I had mentioned it. If they didn’t they could get in trouble. I feel like had I just walked in there complaining without any clue that maybe they would’ve said a muscle spasm or thought I was a drug seeker.

Did you get any recovery advice?

Ashley. The only advice the doctor gave was to drink a lot of water and listen to my body. He said in a couple of days if I feel like running then run but if I don’t. Obviously, this was not good advice.

What were your CK levels?

Ashley. In the ER my CK level was 8,887 U/L. I know my liver enzyme levels were elevated as well. I don’t have exact numbers on that until about three weeks after and AST was 82 and ALT was 83.

Also, something showed up that was never there before CK-MM and is was at 93 L and said this “Presence of atypical electrophoretic band consistent with macro – CK Type I, 7 % of total CK. ”

This was not explained to me.

What made your symptoms worse?

Ashley. If I would bear weight on my left leg at all I would get intense pain. In fact, I couldn’t even flex my foot; it was almost like a ballerina on point. There was no flexing there was no laying my foot flat there was no bearing weight at all.

How long did your muscle pain last?

Ashley. The pain was only if I touched it. So as long as I was laying in bed and had it rested on a pillow I wasn’t feeling any pain. If I got up to go to the bathroom and transitioned from the bed to the wheelchair there was pain and that lasted about two full weeks.

What was the scariest part of all this for you?

Ashley. The scariest part for me was hearing from the chiropractor and the physical therapist how dangerous rhabdo is. At one point I was told a workout right now could very well kill me. They said that this was nothing to scoff at and I needed to make sure that I was doing everything that I should be doing so that this didn’t get worse and give me permanent kidney damage.

I was told that I may not race for the rest of the year which upset me. I was afraid when I couldn’t bear weight on it and was in a wheelchair for two weeks. I have had injuries in the past but nothing like this.

The ER doctor very much downplayed how serious this was.

Has rhabdo impacted your ability to work?

Ashley. Absolutely. I am a stay at home mom with eight children and four of those have special needs so I need to be able to get up and give medicine and change diapers and meet the therapist and take my children to doctors' appointments and my other children to sports activities, etc.

I am constantly on the go.

I had to cancel so many appointments because I could not figure out how I was going to get in and out of the car and into a wheelchair and take children into doctors' appointments by myself.

Had you heard of rhabdomyolysis before this happened?

Ashley. No. Never.

Did you tell the Spartan Race organizers you got rhabdo? 

Ashley. No, I didn’t. That may be a good idea though. Throughout this entire month, I have been wondering if there were other people that perhaps got rhabdo from this race as well. I know that during my heat I saw several people quitting the race. I also heard from other Spartans that this was a very intense race perhaps the hardest stadium race that Spartan has put on.

 

How are you doing now? Are you better?

Ashley. No, I’m not all better and it’s frustrating. I feel like had I gotten proper treatment and was in the hospital five days on IV fluids flushing my kidneys that I may be allowed to work out by this point. I am frustrated at how slow this process has gone. I am frustrated that I am still getting bloodwork and urine tests done every three days because my levels are still not normal.

I did go to an independent IV place and got myself a 1 L IV full of vitamins and minerals to help flush the kidneys and hopefully bring my numbers down into the normal range.

What advice for people who have rhabdo now?

Ashley. I would suggest that you read everything you can about rhabdo and find people who know what it is and know how to treat it properly. I would also advise people to get bloodwork after they start working out just to make sure that their CK levels and liver enzymes aren’t increasing again. I have a doctors appointment tomorrow and I plan to ask for just that.

When I am cleared to exercise again I hope that I won’t be afraid and will not have to start from square one. I plan to insist that the doctor do labs after certain workouts to make sure that my numbers stay down. Also always remember to listen to your body. It’s ok to rest. The gym will still be there when you are ready and your body will bounce back.

Any Comments or Questions?