Hiking Illness Danger -- Rhabdomyolysis

[jedishrfu]

I found this article online about an illness that few people are aware of that can strike you while doing strenuous hikes

https://thetrek.co/this-illness-could-end-your-hike-or-your-life-and-youve-never-even-heard-of-it/

When planning for a thru-hike, there are so many things to consider. Many people find it comforting to consider the worst-case scenarios. Working through these problems in your mind beforehand may make them easier to overcome if the situation ever arises.

If you are planning for a thru-hike you likely have heard of norovirus, giardia, or tendonitis. Perhaps you’ve researched major gear failures and studied how to avoid blisters heat stroke, frostbite, dehydration, etc. All problems you might face while thru-hiking.

But what would you say if I told you there was an even more dangerous ailment that could plague your thru-hike? Something that could end your thru-hike, or even your life, if you didn’t diagnose it soon enough. Would you be surprised to learn that such an illness exists — and that you’ve likely never even heard of it?

Back in June I set out on the 3,000-mile Continental Divide Trail. This trail stretches from Canada to Mexico and goes across Montana, Idaho, Wyoming, Colorado, and New Mexico. I decided to hike southbound in hopes of avoiding deep snow in Colorado’s San Juans.

Just like any other thru-hike, I considered and planned for all the pitfalls I mentioned above. I’ve gotten norovirus on trail before and dealt with tendonitis. I’ve also ridden the risky edge of hypothermia, dehydration, and heat stroke. Over the last few years, I’ve hiked 10,000+ miles across the United States and Canada.

If you had asked me what my biggest concern was when embarking on my latest thru-hike, I probably would have told you tendonitis or something similar. But over the last few weeks, I have gained a new worst fear when it comes to thru-hiking.

And its name is rhabdomyolysis.

 

[Astronuc]

I read a story recently about a 37 years-old hiker who was found dead in a national park. The cause was not given at the time, although I suppose there will be a coroner's inquest.

I believe this is the story
https://people.com/backpacker-37-di...r-experiencing-sudden-medical-episode-8696039
https://ca.news.yahoo.com/backpacker-37-dies-remote-michigan-210114609.html

Cause of death is described as a 'sudden medical episode'. The article states, "An investigation into the woman's death is still ongoing, the Park Service added. A cause of death has not been disclosed at this time."

• Rhabdomyolysis (rhabdo) is a serious medical condition that can lead to permanent disability or death.
• Workplace risk factors include heat exposure and physical exertion.

https://www.cdc.gov/niosh/rhabdo/about/index.html

So it is a concern for those involved in outdoor recreation and work involving heat and exertion.

 

[berkeman]

Yeah, very dangerous and emergent. I dealt with a Rhabdo patient one time at a big annual SWAT competition where I was on the medical team. The officers compete in various scenarios for 48 hours straight with only three 20-minute catnaps at the medical checkpoints. That year the weather was pretty warm, and I was stationed at the medical checkpoint right after the big PD obstacle course.

We were checking out the patient and he was complaining of significant pain and weakness in his muscles. We had him pee for us, and sure enough it was dark brown. That was an immediate 911 call and emergent transport to the local hospital for treatment. Luckily we had an ER doc and several ER nurses on the medical team at that checkpoint, and we were in an urban setting and not out in the boonies somewhere.

I imagine that if you notice somebody with those symptoms out on the trail, it's an immediate activation of whatever helo evac/transport is available (LifeFlight, etc.).

https://my.clevelandclinic.org/health/diseases/21184-rhabdomyolysis

 

[Laroxe]

This occurs when there is significant muscular damage occurring, so it's when people are seriously exerting themselves and often in the presence of other risks like heat and dehydration. Its interesting that viral infection was mentioned, this would be an additional risk and quite a few drugs might also increase risk.

The risk to people engaging in recreational hiking at a level they are used to in reasonable weather should be quite low. Like so many things, the more competitive people are, the greater the associated risks, in one study they identified around 400 cases in active duty US soldiers per year. The condition was first recognised following crush injuries during WW2 but it appears to have become more common as extreme physical exercise has become more fashionable.

The main problem is that when a large number of muscle cells die, they release a range of harmful chemicals that cause adjacent cells to die causing a self-sustaining cascade effect and severe muscle pain. When they enter the bloodstream they cause vomiting, confusion and heart beat abnormalities, over a slightly longer time they also cause severe kidney problems. Despite it representing a serious medical emergency, its causes are known and predictable and with good management deaths are rare.

 

[DaveE]

This occurs when there is significant muscular damage occurring, so it's when people are seriously exerting themselves and often in the presence of other risks like heat and dehydration.

Also a rare side effect of statins. A more likely risk for most of us sitting in front of computers all day.

 

[pinball1970]

My friend went to the gym after a year out from COVID, he did legs and went for a swim.
Next day he said he couldn't move with the pain.
His GP said Rhabdomyolysis was most likely given the severity.
Luckily he has never smoked or drank and is an excellent swimmer, in great condition.
However, a break of months from heavy leg press, extension (he does not squat) still damaged his muscles even though he was off on poundage and reps to ease himself back in.

Months later he was saying he still did not feel right in his legs.
Bloods and urine came back ok for follow up so no damage to his kidneys.
He is 57 and one of the strongest guys I have ever met, he was benching 220 lbs as a teenager and had a decent marathon time as a 17 year old.
Good genetics as his dad was a county cyclist.

However a big break from exercise one has to be careful especially with age, different stress/weight plus heat all contributing.

 

[jim mcnamara]

General anesthetic agents and overdosage with central nervous system drugs, such as narcotics, cyclic antidepressants, benzodiazepines, antihistamines and barbiturates, cause rhabdomyolysis by pressure-induced ischemia due to prolonged immobilization.
https://www.annsaudimed.net/doi/10.5144/0256-4947.1998.525#:~:text=General anesthetic agents and overdosage,ischemia due to prolonged immobilization.

Drug-Induced Rhabdomyolysis | Annals of Saudi Medicine​

Annals of Saudi Medicine
https://www.annsaudime
[/quote/

Medically inducedhttps://www.annsaudimed.net/doi/10.5144/0256-4947.1998.525#:

 

[DaveE]

Also compartment syndrome as either a cause or effect of Rhabdo.