Pumping Irony

In her mid-20s, she is attractive, active and intelligent. She only wanted to lose a few pounds, maybe as many as 20. So she did what any novice would do – she joined a health club and put her goals in the hands of a trainer. Not all trainers are created equal.

Her body told her to back off the unaccustomed strenuous exercise on the second consecutive day. Her trainer told her not to listen to her body. Listen to him. You’ve got to push. Feel the burn. No pain no gain. She felt the burn. She felt the pain. After the workout, the trainer turned her out into the 115-degree heat of a Memphis summer afternoon.

She lost the 20 pounds – and more – after spending 14 days in the ICU suffering from exercise induced acute renal failure.

Among the most insidious of unintended consequences, Rhabdomyolysis is the rapid breakdown of skeletal muscle due to injury to muscle tissue. Damage to the skeletal muscles (arm and leg muscles qualify here) causes them to break down and release a cocktail of chemicals into the blood, among them myoglobin (the pigment which carries oxygen in the muscles), creatinin kinase, electrolytes and enzymes. Your hard-working kidneys are downstream from this flood of debris and the renal tubules can become clogged with this flotsam. As suggested by New Zealand researcher C.J. Milne, “the kidney may respond by ceasing its excretory and metabolic functions.”

Boy, Howdy.

Massive rhabdomyolysis, according to Douglas M. Peterson, MD, “may arise with marked physical exertion, particularly when the following risk factors are present:

• The individual is physically untrained (or novice)
• Exertion occurs in extremely hot, humid conditions (been to Memphis in the summer?)
• Hypokalemia (abnormally low potassium content of the blood) from sweating”

Sound familiar? It certainly does to the young Memphis woman and her family.

Rhabdomyolysis comes in three flavors:

1) traumatic or muscle compression: We can thank Hitler’s Luftwaffe for the first modern description of rhabdomyolysis. The relentless Nazi bombings during the remarkable Battle of Britain left many Londoners trapped in the debris of bombed houses and factories, and the “crush victims” often developed renal failure and died within a week. While not clear at the time, the relationship between muscle injury and renal failure began its nascent journey there.

2) non-traumatic exertional: As described in the young woman’s trial above, this consists of “muscle membrane injury as a predictable consequence of extreme exertion, compounded if an untrained individual performs eccentric exercise in a hot environment.” [C.J. Milne]

3) non-traumatic non-exertional; the remaining few whose problems arise from medical, rather than environmental, conditions.

A fast trip to the Emergency Room and a thorough understanding of the hospital environment by her parents were key in saving the young Memphis woman’s life. Treatment, following her admission to the ICU, included aggressive fluid replacement to flush the myoglobin and other harmful substances from her body. But if the kidneys are not functioning, how are the waste materials flushed from the body?

Dialysis. From a couple of catheters placed near her collarbone, the patient’s blood passes through an artificial kidney and releases its waste materials into a dialysate solution which is flowing in the opposite direction.

Imagine two parades travelling down the same street, one marching north and the other marching south. The parade marching south is composed of Wall Street bankers with money bulging from their pockets. The parade marching north is populated with pickpockets and grifters. As the two parades meet and pass each other, the pickpockets deftly remove excess funds from the wallets, pockets and purses of the bankers. In this case, the Wall Street bankers are your blood, and the pickpockets are the dialysate. The bankers notice only that they march with a lighter, more lively step after having been relieved of the weight of the excess funds, while the grifters have no trouble in disposing of the largesse.

We have been trained to put our trust in others rather than in our instincts and the messages that our bodies send us – and more often than not with sound results.

When the auto mechanic tells us that our belts and hoses have 60,000 miles of wear and need replacing, do we argue and insist that we can probably get another 20,000 out of them?

Or when the cardiologist reports that your artery is 70% blocked, do you argue against the placement of a stent in favor of meditation and acupuncture?

We pay trained professionals to render a service based on their training and experience. When the professional says, “Don’t listen to your body, listen to me,” we listen to the trainer.

But the body sends reliable messages from genetic training that spans lifetimes.

Remember your first cigarette? Coughed up your toenails, didn’t you? Did you listen?

How about your first experience with alcohol? Mine involved cherry vodka poured into a bottle of Sprite. Not enough alcohol for a buzz, but enough to send me sprinting from my sleeping bag to the latrine with some astounding diarrhea and no steps to spare. I should have listened.

Had I been the young Memphis woman, I would have followed the same course as she. I would have expected that the trainer knew what he was about, and I would have pushed past the limits my body was telling me should not be transgressed. And I would have ended up in the ICU suffering from exercise induced acute renal failure.

But no more. I learn from her difficult lesson, and I give more credence to my instincts and to a body which has continued to serve me despite myself.

And what of the trainer and those like him, who say “Push yourself,” and “Pump harder”?

To them I say, “Go Pump Yourself,” and I drink a cold lemonade on a cool veranda.

Thanks to Dr. Stein in Nashville and Dr. Moskimus in Memphis for their guidance and assistance in researching this post.