My 30-something prison patient started doing dead lifts with 225 pounds on Monday, and was in severe kidney failure by Thursday.
Dead lifts and leg squats are great exercises because they use the largest, most powerful muscles (and really boost your overall power, metabolism and energy levels). It’s normal to have a little muscle breakdown and build-up afterwards which is why hydration is important. Overdoing it on the first day is a bad idea though.
I’ve never seen muscle enzymes as high as his were (his creatine kinase enzymes were >40,000, called rhabdomyolysis) for so many days in a row. Yet, he hardly complained of anything other than brown urine and back pain. So I wondered about contributing factors.
“Any colds or flus lately?”
“Nope.”
“Were you taking any supplements? Protein shakes? Creatine?”
“Nah.”
“Any energy drinks?”
“Nuh uh.”
I like having an energy drink after a work out, but I’ll drink a lot of water afterwards. I don’t want Monster Assault to have a literal effect on my kidney function. (Human oil check: If you’re urine is dark yellow, then you need to drink more water.)
“Any other drugs?”
“No.”
Prison patients tend to come in two flavors - the ones who reek desperation (”Do I have to go back today?” or “I can haz moar morphine?”) or those that tell you as little as possible. This guy was the latter.
Neither kind will give you an honest answer to the drug question though, with or without the prison guards in the room. I wanted to ask about cocaine use specifically, but I already knew what he’d say. Cocaine and related drugs can clog or constrict arteries anywhere. In the heart, it will cause a heart attack. In the brain, it will cause a stroke. In the kidneys, uh oh, better get Drano (kidding, don’t drink this!). The urine tox screen* would have been negative by now anyways (*urine tox screen = the physican’s magic lasso, because pee tells the truth even when you don’t).
I had another 50-something patient who went on a 50-mile bike ride the weekend before. A couple days later, his knee gave out walking down some steps due to a torn quadriceps tendon.
“I used to bike a lot, ten years ago,” he said as I examined the post-op incision.
Such are the diseases of summer.
***************************
UPDATE on previous entry: So far two docs in my physician’s group have already found other jobs. This ship is sinking fast.
UPDATE #2: I missed a call today from the group I interviewed with Monday. They want me to come in and sign up.
