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Hospitalized with Rhabdo After Break from CrossFit
My workout was 4 rounds for time:
400m run
20 burpees
The running, I hoped, would help bring back some cardiovascular fitness and the burpees would prime my upper body for climbing and hanging obstacles. The workout certainly challenged me - like workouts at CPC had before - but not extraordinarily so, I thought. I rode my hard-earned endorphin high all the way home, to my leftover Thanksgiving dinner.
Sat. 11/24 Cue Rhabdo Symptoms
The next morning, consciousness came sooner than the courage to leave the comfort of my covers. I awoke to extreme soreness and muscle weakness in my triceps and shoulders. The burpees laughed at me like Nelson at Bart Simpson’s latest blunder. My neck and arms swapped teeth brushing duties that day - my head circling my stationary toothbrush in place of my arms making the toothbrush circle in my mouth. Reaching my head to wash my hair was harder than it should ever be. CrossFit workouts made me sore on the regular; no tingles from my spidey-sense.
I joked to my girlfriend:
After gassing up my car, I started my drive to Valencia where I was meeting my best friend for lunch and attending my 10 year high school reunion. In hindsight, driving 1.5 hours was a poor choice in my condition. Between the trouble I was having trouble raising my arms and the need to shift my manual transmission, it would have been bad news had I encountered anything other than the light traffic that I did.
At lunch with my best friend I made light of how hard lifting food to my mouth was. My tactics improved by evening; I ordered only bottled beers since they required slightly less range of motion than a glass. I caught up with some old friends and enjoyed the reunion before retiring early to my hotel.
Sun. 11/25 Diagnosis Rhabdo
Around 4 a.m. Sunday I woke up achy. “Usually, when I’m sore,” I thought, “it hurts when I move. I’m not moving and I hurt.” My brain-hamster rubbed the sleep out of his eyes and reluctantly started on the wheel until I remembered Crossfit Pacific Coast’s blog about rhabdomyolysis (more affectionately known as rhabdo in the CrossFit community).
Per the NIH - Rhabdomyolysis is the breakdown of muscle fibers resulting in the release of muscle fiber contents (myoglobin) into the bloodstream. Some of these are harmful to the kidney and frequently result in kidney damage.
What we’re talking about here in regular language is tearing enough muscle fiber to overwhelm and ultimately damage your kidneys. Your kidneys are one of your body’s main filtration systems and are responsible for separating waste out into your urine (among some other jobs). Myoglobin will breakdown into substances that will cause blockages in and therefore the possibility of tissue death within your kidney. In other words, you don’t want this happening. Your kidneys are your friends.
Based on the symptoms Traver describes in the blog - dark urine, severe muscle soreness, unintentional weight gain, seizures, etc. - I concluded that I wasn't suffering from rhabdo. I was just really sore. Harry the hamster and I went back to sleep.
At 9 a.m. I woke up again. When I went to the bathroom, my urine was a dark, tea-like color. Panic set in. I was an hour and a half from home and I was pretty sure I needed to go to the emergency room. I called my girlfriend and maybe, there’s a chance, I might have freaked out, just a little bit, perhaps, depending on how you look at it.
Having never been, the thought of going to the ER terrified me, so I compromised with myself and went to a local walk-in clinic. Inside I told them I thought I had rhabdo. I gathered that the nurse practitioner had not seen or treated rhabdo before. Eventually, they took my blood and sent it to the local hospital for analysis “stat.” They asked me to return to their office in 2-3 hours.
When I returned, the nurse practitioner confirmed rhabdo based on elevated creatine kinase (CK) counts in my blood. According to the hospital lab, my CK count was ~16,000. For perspective, normal CK values are 60-400 units/liter. They hooked me up to an IV and administered 2 liters of saline. Then they asked me to return the following day, Monday, for another round of bloodwork and more fluids as needed. It was an inconvenience for me to book another night at a hotel, miss work and return the next day, but I had dodged a trip to the ER, so it felt like I was getting off easy.
I drove back to my hotel and checked back in to the same room I’d slept in the night before. The drive was sketchy because of my soreness and weakness in my triceps and shoulders. Just turning and shifting my VW had become difficult. Now that a medical professional had diagnosed rhabdo, I did what I probably should have done long ago - I called my parents and asked them to drive 3 hours from Grover Beach so that one of them could drive me and my car back to Goleta the following day.
Sleep.
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Mon. 11/26 Take Rhabdo to ER
Return to Doctor’s Office
My parents reached my hotel at 9 a.m. Monday. I was barely out of the shower, but I’m sure Mom was so worried that she’d insisted they leave Grover Beach at 6 a.m. She brought 4 jars of her very own cure-all, Raw Food Betsy's green juice. If only that could have fixed me!
My parents drove me back to the local walk-in clinic where they drew blood for analysis and administered 2 more liters of saline. The saline would take a couple of hours and we expected to have the results of this second blood test shortly after. We hoped to see the CK count falling.
Before we got those results the doctor asked me to invite my parents in to hear what I thought would be our debriefing. Instead, he told us that while reviewing my case he discovered the hospital lab had updated my results from the day before without informing anybody of the change. My CK count was not 16,000 the previous day, but was instead 160,000! The look on his face communicated before his words that I was (my kidneys were) in more danger than he had thought. He had already called a renal specialist and secured me an appointment 45 minutes later.
Here's a graph of my CK counts over time:
Kidney specialist
When the kidney specialist received the results from that day’s blood test and learned the CK count was 165,000 (higher than Sunday), he instructed me to go to the ER. We asked if we could drive back to Santa Barbara and go to the ER there, but he said no, that minutes mattered.
Waiting at ER
This was the first time in my adult life that I’d been to the emergency room. I hope I never have to go back. From the waiting room, there seems to be little urgency. It was extremely frustrating to hear the kidney specialist tell us that minutes mattered and then to wait 2 hours just to get from the waiting room into treatment. We were all worried that my kidneys would be permanently damaged while I waited.
I had heard the term “triage” before, but I don’t think I ever bothered to understand what it meant until then. Per wikipedia, triage is the process of determining the priority of patients' treatments based on the severity of their condition. That night, to me, it meant that I would have to wait and hope that my kidneys stayed strong while all the people worse off than me were called in for treatment. In honesty, from what I could infer about other people’s conditions I couldn't disagree with their prioritization - the pregnant woman clutching her stomach and the girl whose foot was run over by a car got in before me. But, I really wanted to get out of the whole situation with two fully functioning kidneys. So I just waited and hoped that the ER would die down and I would get seen.
After two hours I got into the ER and they started me on more IV fluids.
Tue. 11/27 Admitted to Hospital
Sometime in the early hours of Tuesday morning, I was transferred out of the emergency room to a section of the hospital for patients needing less intensive treatment.
From this point on, my hospital stay was a waiting game.
Wed. - Thu. 11/28-11/29 Waiting Out Rhabdo
Being in the hospital sucks; there’s not a lot to entertain yourself with, the food’s not very good and there’s an infinite number of other, more awesome, ways that one could spend their time.
I was on IV fluids constantly. They would help my body flush out all of the junk my muscles had released into my blood. I wheeled my IV pole with me everywhere I went, including the bathroom (a lot). This wouldn't have been so bad, except they gave me squeakiest, worst-rolling IV pole in the whole place. Damn it.
They monitored my condition and took blood for analysis daily to ensure my condition continued to improve.
On Thursday I was ecstatic when my general doctor suggested I’d be able to leave that day. Unfortunately, morale would only fall when the kidney specialists overruled and kept me another day. He wanted my CK levels to be lower still before I was released.
Friday 11/30/2012 - Released from Rhabdo
By Friday morning I was accustomed to a nurse waking me at 5 a.m. to take my blood. This was the first time it was worth it, though, because when the kidney specialist made his round he said my CK count was approximately 24,000 - low enough for me finally be released!
I texted my girlfriend in Santa Barbara, who was “on call” to pick me up. A few hours later I was released and we beelined to Red Robin for some delectably not-from-a-hospital food.
Despite some drizzle, the outside air between the hospital and the car, and the car and the restaurant reminded me how much I take the outdoors for granted. After 5 days trapped indoors, the air tasted fresher and cleaner than André 3000 and Big Boi could have ever described.
Rhabdo Aftermath
When I left the hospital Friday, my health was no longer in danger. But, man, rhabdo did not stop making my life difficult. Here's a summary of rhabdo's aftermath:
Dozens of medical bills totaling ~$3,400 (after insurance) through February
No strenuous exercise for one month
I was refused private health insurance because of my treatment. I had a gap in coverage because of a new job so I had to elect COBRA for $1,200 over 2 months.
Follow up blood test to make ensure CK counts continued to drop
This very attractive bruise:
Cool Story. Tell it Again.
My point is: being in the hospital for 5 days and spending thousands of dollars on medical treatment sucks. Rhabdo is real and it can happen to you in just 18 minutes, even if you're not a hardcore CrossFitter (I’m certainly not).
So, here’s some advice for avoiding rhabdo from someone who has been there:
Don’t stop CrossFitting/exercising in the first place. I put myself at higher risk for getting rhabdo when I stopped exercising as often and at as high of an intensity. Had I jumped in at a CrossFit gym immediately after my move to San Luis Obispo, I probably would have never given myself rhabdo.
Ease back into it if you do take a break from CrossFitting/exercising. I made the mistake of pushing myself too far after taking a break fro high-intensity workouts. If you are training for an event like I was, start training early so you have time to ramp up your workouts leading up to the event.
Beware movements including negatives such as GHD sit-ups, pull-ups and push-ups. In my case, I’m confident that the push-up portion of my burpees, where I lowered my body to the ground, was my rhabdo-inducing poison of choice. Traver explains this in the CPC blog:
Anytime that you have your body weight being supported through a movement by an ever fatiguing muscle through a workout, it’s going to cause damage. We are all able to lower ourselves downward from the pull up bar long after we are unable to pull ourselves back up – it is this physiological ability that will allow us to continue to damage muscle tissue in one direction far more often than in the other. This is why eccentric movements, like a negative (where you lower yourself downward slowly – think of slowly lowering yourself in a ring dip or from the top position in a pull up) are dangerous.
Hydrate. I'm not sure if this is scientifically proven or not, but I figure if it takes 5 days of IV fluids to treat rhabdo, then making sure you are hydrated before, during and after your workout should help your body continue to flush out any harmful junk in your bloodstream.
Should prevention fail and you find yourself with dark colored urine that resembles cola or tea, seek medical attention immediately. Do not pass go. Do not collect $200. No matter how tough of a battleship, fast of a race car or stylish of a top hat you think you are, do not try to tough it out. Permanent kidney damage is not worth the risk.
Shout Outs!
Thanks Mom, Dad, Em, Joe and Richard for helping me through this one and visiting me in the hospital. Also, thanks CrossFit Pacific Coast for teaching us about rhabdo so that I knew I needed medical attention.
By Marc Asmus
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Coheed and Cambria - The Afterman (lyric video)
October 9th can't come soon enough.
Enjoy your burrito.
Chris Hardwick, Nerdist
A man should never be ashamed to say he has been wrong, which is but saying in other words that he is wiser today than he was yesterday.
Alexander Pope via my Honest Tea cap
My body is a bomb A big ol' bag of bombs
Prorate Your Last Month’s Rent of a Month to Month Lease in California
In July of 2012 I was preparing to move from Santa Barbara to San Luis Obispo for a new job. I personally delivered written 30 day notice to my landlord on July 28th. My notice informed him that I would move out of my rented room on or before August 27th. A few days later my rent was nearly due, so I wrote my landlord a check for what I believed I owed him (why this calculation is incorrect later): (# days I’d occupy in August / # days in August) * my monthly rent (27/31)*$795 $692.42 I slipped the $692.42 check under his door and emailed him, explaining how I calculated the amount. He replied: Marc, The rental agreement you signed started on June 1, and is month to month, due on the 1st of each month. While I appreciate advance notice of your departure, you are bound by this agreement. The entire rent payment of $795 is due on August first. Thank you.
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I’m no lawyer, but intuitively this seemed unreasonable. By his logic, if I had given him notice on July 5th, saying that I’d vacate August 4th, I’d be responsible for paying him all $795 in August rent when I’d only occupy the rental for 4 days, valued at $106. That seemed unfair. I was disputing $103 and believed it worth my time if I could figure out what was right in less than 3 hours. I was confident I could. I turned to Google, finding many partially resolved threads where someone had asked my question. Unfortunately, many of the threads were not specific to California and what I had read indicated that rental law varies state by state. I needed to determine who was right and, if I was right, I needed a credible source my landlord would believe so he would accept my prorated rent check without the issue escalating. I remembered that when I signed my lease my landlord assured me that the rental agreement was legit because it is the agreement the Santa Barbara Rental Property Association uses. Surely they would know who was right, but I worried they wouldn’t want to risk upsetting one of their members (my landlord) by helping me (a tenant) pay only what they were obligated to. I called them. I was wrong to have worried; the woman who answered graciously confirmed that I was correct and even went out of her way to calculate the amount that I owed my landlord for prorated August rent, $715.50. This amount differed from the $692.42 I had figured because prorated rent is calculated based on an average of 30 days in a month, regardless of how many days there actually are. Here’s the correct way to calculate the prorated August rent I owed: (# days I’d occupy in August / average of 30 days in a month) * my monthly rent (27/30)*$795 $715.50 I wrote my landlord a second check for $715.50 and emailed him back, explaining that I’d called and confirmed with the Santa Barbara Rental Property Association that I owed only prorated August rent calculated based on that average of 30 days in a month. I invited him to call the association himself and provided him with their phone number. The next time I spoke to him he had called the association and learned that I was correct. He accepted my prorated rent check for August. Victory! I stood up for what I thought was right (even if my motivation was money), even when there was a risk the disagreement could escalate and become a legal matter. I successfully found a way to diffuse the situation and retain the money belonging to me without exacerbating the dispute. I hope this post helps you do the same.
By Marc Asmus
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So I’ve been thinking about this whole “being happy” thing and I feel like people get lost when they think of happiness as a destination. We’re always thinking that someday we’ll be happy. You know, we’ll get that car or that job or that person in our lives that’ll fix everything. But happiness is a mood, and it’s a condition, not a destination. It’s like being tired or hungry, it’s not permanent. It comes and goes and that’s okay. And I feel like if people thought of it that way, they’d find happiness a lot more often.
Julian Baker (via soul-surfer)
This St. Patty's Day I skipped the corned beef and cabbage and went straight for the good stuff - a delectable interview with Maria and Gabe of Arizona folk rock quartet Bears of Manitou. Ride the link over to Music Passion Magazine for the read.
While my beautiful Tama Starclassic acoustic drum kit patiently awaits my return to small time rockstardom in my parents' garage, I'm taking my passion for music to the interwebs. My review of States' "Line 'Em Up" impressed the staff at Music Passion Magazine and they asked me to take part. My first assignment: to interview Seth Williams of Details Details. Dust off your spectacles and let me know what you think. You might even discover your new favorite musician - especially if you're into Mega Man 2, delicious synth-pop, and The Postal Service.
States “Line ‘em Up” EP Review
The Skinny:
Unless you’re a Mindy White fan (and with her looks and voice, what’s not to like?), pass on this EP and hope for a more mature Mindy and States sound on a future release.
The Thick:
How to Find a Room to Rent Fast
Resources
Craigslist
Craiglist, in my opinion, is the best resource for finding a room for rent in a new city. The interface doesn’t leave your retinas begging for more, but you simply can’t beat the volume of listings. I hope you like blue hyperlinks, because you’re going to be spending plenty of time with Craigslist. Also, you will meet some crazies through Craigslist. I met one woman with four 100 lb. bull mastiffs that grew medicinal marijuana in her backyard. It’s the nature of the beast. Rest assured there are normal people who use Craigslist to find roommates. It’s up to you to find them.
Facebook Marketplace
Facebook has a new-ish (or at least new to me) app called Marketplace. It allows you to buy, sell, rent or whatever from your friends or friends of friends. It’s a great idea - I would definitely prefer to rent from a friend of a friend, but when I went looking for rentals in Santa Barbara, Facebook Marketplace came up empty-handed. For a moment I wished that I’d been more of a friend whore, then I went back to Craigslist. In short: give it a shot, but don’t hold your breath.
Roomster
Like Match.com (not that I would know), but for rooms for rent. Tell Roomster all about your living habits and it’ll help match you up with similar roommates. It’s a great concept, but it hasn’t reached critical mass, so the $14.95 that I shelled out for 14 days of service was of no help in finding a room for rent. Also, I believe that Roomster sends out auto-generated messages of interest on users behalf in order to make it look like people are interested in you as a roommate. I recommend against using Roomster in your room for rent hunt.
Decide and Conquer
Decide what you’re looking for. What’s your price range? What kind of a living situation are you looking for? Are you willing to live with a family? Or do you want to live with people your age? Can you stand pets? Do you have your own pet to accomodate? After you have an idea of what you want, dive into those Craigslistings. The old adage “beggars can’t be choosers” holds true here. If you can’t find anything suitable, consider loosening up your criteria.
If you’re savvy, consider creating an Excel or Google Docs spreadsheet or Access database to track listings. I pulled every listing I was interested in into my spreadsheet and recorded a hyperlink, room price, title, contact name, email, phone number, status and outcome. That way I could keep track of who I was talking to about what and not contact the same renter multiple times. This may seem a bit over the top, but I found it extremely helpful after the 48th renter I contacted.
Phone Calls Beat Emails
I highly recommend calling the renter if they’ve provided their phone number for a number of reasons. Calling gets you in touch with them faster, instead of waiting for them to check their email and reply. This in turn gives you an opportunity to set up more viewings faster (don’t rent it until you’ve seen it in person). It shows them that you are serious and you also get a glimpse into who they are. Trust your instincts; if someone sounds crazy on the phone, they’re probably even crazier in person.
Go See the Rooms
Viewings lead to renting. See as many places as your time allows for before committing to a place to live. After I accepted my job offer in person in Santa Barbara on Monday, I drove back down to Santa Barbara on Tuesday, again on Thursday and yet again Saturday. Yeah, gasoline was expensive, but I think seeing as many rooms as you can is that important. You don’t want to commit to the first place that you view, unless its perfect. The more places you view, the better understanding you will have for how much room you can get for your price range. Also, if by viewing more rooms, you’ll experience less cognitive dissonance after you commit to a place - that is you will rest easy knowing that you got the best room you could find. Prepare for viewing rooms by bringing your checkbook and being ready to write the renter a check for first month’s rent plus a security deposit if you find the right place to live. Remember, you are competing with other people looking for a place to live. You don’t want to miss out on your dream room because you were moving too slow.
Ask Questions!
When you go see a room, ask questions. Lots of them. Here are some questions that helped me determine whether or not I wanted to live in the houses and rooms I saw. Your questions will probably different depending on what you’re looking for, so don’t take these as the gospel. How much is rent? Are utilities included? How do you feel about overnight guests like my girlfriend sleeping over? How often do you drink alcohol? Is this a party house? Do you smoke marijuana? Pets? Are we allowed to have them? Is anyone allergic? Laundry? What kind of hours do you keep? What kind of storage space is available? How does the landlord treat tenants? Who am I sharing a bathroom with?
Found It
When you find something you want to live in, politely ask if the renters are interested in having you as a roommate and, if they are, when you can write them a check for a security deposit or sign a lease.
Bonus Tip
Starbucks has free Wifi. When you’re out there road warrioring and looking for a place to live, bring a laptop and stop by Starbucks during downtime. You can open up your spreadsheet of potential rooms and continue finding listings and contacting renters to set up more viewings. There are seriously 10 Starbucks in the Santa Barbara/Goleta area and there’s probably just as many where you are. Its a good place to grab a drink and get back to maximizing your time scouting your new city. Best of luck finding your new digs!
By Marc Asmus
When I became a man I put away childish things, including the fear of childishness and the desire to be very grown up.
C. S. Lewis
When I was 18, I was in this band called Suburban Affect. This is a video of a personal favorite, "Map to the Derby", live from Melanie's tennis court in Newhall, CA.
Declaration of (SEO) War Against Marc Asmuses of the World
So I’ve done what name SEO combatants, including Natalie Kuhn, have done before me; I’ve registered my name’s domain, www.marcasmus.com. I’m also writing this first blog post and chocking it full of my name, kind of like lighting a huge signal fire on a deserted island when the Google-copters are out looking for you.
What will marcasmus.com become? Aside from becoming the number one result in Google for “Marc Asmus”, I’d like it to become a place where someone can learn about me; a way for me to learn about creating and developing my own website, constrained by my limited coding skills; a concise and memorable URL on my business card; somewhere I can share and discuss my thoughts and ideas with the world using more than 140 characters and without Facebook claiming ownership.
It’s not just about me though, you’re a part of this. I want to know what you want to know about me. Want to see my résumé? Hear the music that I’m mesmerized by right now? Peep the latest photo that inspires me?
Anyways, welcome! Let me know what you think and please, help me identify any bugs with my site.
By Marc Asmus