Rhabdo Rad Torque? Woman Suing Cycling Studio in New York

A woman is suing SoulCycle after attending just one class at their studio in Rye Brook, New York.

Kaila Cashman is claiming the cycling workout caused her to be hospitalized for a week and that now she has a permanent condition.

Kaila Cashman claims she attended a SoulCycle session in 2014, and while she was an exercise participant, her instructor, who was aware it was her first session, continued to increase the torque on her indoor stationary bicycle, and says she was told to keep pedaling.

Cashman claims what followed was a condition caused by damaged skeletal muscle from overexertion that required she stay in a hospital for a week as she was diagnosed with rhabdomyolysis. Rhabdomyolysis has also been known to occur following extreme CrossFit workouts. In addition to overexertion, rhabdomyolysis can result from trauma, but it can also be caused by a wide range of conditions: certain muscle diseases, malnutrition with electrolyte imbalances, viral or drug infections, severe hypothyroidism, alcohol intoxication, and drug abuse (e.g., cocaine). Rhabdomyolysis is one of the known side effects from prescription statin medications for high cholesterol — including simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), or lovastatin (Mevacor). Rhabdomyolysis is also a known side effect for medications prescribed for Parkinson’s Disease, psychiatric conditions, anesthesia, HIV infections, and gout (colchicine). Defense attorneys would probably be searching for any possible contributing factors that may have caused the plaintiff to suffer rhabdomyolysis, especially since rhabdomyolysis is not commonly caused by exertion, but is known to be involved in the approximately 26,000 cases of rhabdomyolysis that occur per year.

The telltale signs of rhabdomyolysis

Maple syrup or tea-colored urine, with or without the following …

extreme muscle pain and soreness,

swelling, and

difficulty moving affected muscles.

A quick test contributing to the diagnosis of rhabdomyolysis is a urine test strip that is positive for blood, while no red blood cells are detected under microscope in the lab. Blood levels of muscle enzymes that detect organ damage (especially heart muscle damage) — including CPK (creatine phosphokinase), SGOT (Serum glutamic oxaloacetic transaminase,), SGPT (Serum glutamic pyruvic transaminase), and LDH (lactate dehydrogenase), as well as blood and urine myoglobin — are used to diagnose and monitor rhabdomyolysis.

Creatine kinase (CK), which is involved in chemical reactions that deliver energy currency known as ATP, is highly elevated in rhabdomyolysis — greater than 1,000 U/L indicates the condition exists, and greater than 5,000 indicates the condition is severe.

CK is also elevated after a heart attack, so doctors have to make sure they are not misdiagnosing one condition or the other.

Complications of rhabdomyolysis can cause electrolyte imbalance, such as elevated blood potassium (hyperkalemia) and low calcium (hypocalcemia). elevated potassium can cause dangerous heart rhythms to occur. Calcium regulation is critical for normal cell function, neural transmission, membrane stability, bone structure, blood coagulation, and intracellular signaling.

The swelling of damaged muscle occasionally leads to compartment syndrome. Swelling causes compression of surrounding tissues, such as nerves and blood vessels, that can be permanently damaged by the compression inside fascia that can’t expand. Symptoms of this complication include pain or reduced sensation in the affected limb.

Another complication is disseminated intravascular coagulation (DIC), a severe disruption in blood clotting that may lead to uncontrollable bleeding and death. DIC is commonly the end irreversible stage during shock from multiple traumatic injuries.

Treatment

Patients with a suspected rhabdomyolysis diagnosis are admitted to the hospital to receive intravenous (IV) fluids that help maintain urine production and prevent kidney failure. Dialysis treatment might be administered to help the kidneys filter waste products while the patient is recovering. Management of electrolyte abnormalities (potassium, calcium and phosphorus) helps protect the patient’s heart from dangerous arrhythmias, and also protects other organs. If swelling is so severe that compartment syndrome has developed, a surgical procedure that cuts the fascia membrane around muscles (fasciotomy) is performed to relieve the pressure that can cause loss of circulation, muscle and tissue death (necrosis) and nerve damage. Patients are often admitted to the Intensive Care Unit to allow continuous monitoring and to be prepared for immediate advanced life support measures.




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