Pissing blood

[jorge]

Rhabdomyolysis involves dying muscle tissue, breaking open muscle cells, with release of the muscle cell contents into the bloodstream. This happens, for example, when someone passes out drunk lying on their arm for a long period of time, cutting off the blood supply and crushing the muscles. It can occur with very severe muscular overexertion, enough to kill muscle cells, but not the level of exertion involved in playing congas. A few medical conditions can also cause rhabdomyolysis but none (except alcoholism) that is related to playing hand drums. The main protein released into the blood is myoglobin, not hemoglobin, and these can be very accurately differentiated with diagnostic blood tests. Rhabdomyolysis can also be associated with serious kidney damage.

Rhabdomyolysis is not what happens when you play congas or djembe too hard and too long. There are no muscles in the fingers, the fingers are moved by tendons controlled by forearm muscles, and the thumb also uses the thenar muscles at its base in the palm, but those muscles don't get damaged when you hit the drum.

James, maybe you can post a link to this thread on the StraightDope website. Cecil and the thread participants are really on the wrong track discussing rhabdomyolysis rather than hemolysis and hemoglobinuria. That is a pay to join thread and I didn't want to get involved in the 30 day free trial etc.

[seisporocho1]

Thank God we have a doctor in the house!! It's great. Thanks Jorge.

I have peed rusty twice myself. The first time happened when i hadn't played extensively for about a year and when I re-joined my old band on stage, we played 3 long, hard hours....full horn section, 2 electric guitars, etc...to say the least, I played ridiculously hard. Sure enough, my first piss after the show (about an hour later), I peed rusty. It was over in one pee but it freaked me out big time. Then I learned it tends to happen to hand drummers. The second time was three years later and was very brief.

Now that we have a doc on this thread, I'd like to ask about another symptom:
I play in a loud band. I play very hard and I am known for it. I have heavy hands. I am aware I am not supposed to be playing this hard but if I don't, I wouldn't hear myself AT ALL. I used to cut my hands all the time (not so much anymore). By now, I have been playing like that for over 3 years. I play minimum twice a week.
Symptoms:
I get numbness of the finger tips throughout the day. My hands fall asleep over night. Most of the time they wake up weak (hard to firmly grip anything at first) On my right hand, I have a black line in the middle fingernail and thumb nail. My fingers are always swollen (something I blame Miami's humidity for).

does anyone suffer from these symptoms? I am particularly worried about the black line on the fingernails.
Jorge, you have any suggestions as to what it could be?

Thanks.
6x8

[taikonoatama]

James, maybe you can post a link to this thread on the StraightDope website. Cecil and the thread participants are really on the wrong track discussing rhabdomyolysis rather than hemolysis and hemoglobinuria. That is a pay to join thread and I didn't want to get involved in the 30 day free trial etc.

Hi George,

Turned out to a be a free signup for the 30-day trial, with only username, password, and email required.

I posted a response based on what you've said, and put a link to this thread.

http://boards.straightdope.com/sdmb/sho ... st10917559

Thanks,

James

[taikonoatama]

I researched The Straight Dope's references and it doesn't add up:

In the answer to the question on The Straight Dope, there's a section referencing a study of Carnival drummers in Uruguay having this issue and TSD writer makes a (strange) leap and erroneously connects it to rhabdomyolysis, a deduction completely at odds with what's actually in the study/article referenced:

The Straight Dope quote:

"Hand drumming is a well-known cause of rhabdomyolysis. A detailed study of Carnaval drummers in Uruguay found that 18 out of 26 turned in abnormal urine specimens after prolonged playing: six samples were rust-colored, and eight contained minute levels of blood, a sign of renal trouble."

This quote had to have been pulled from a study posted on this Clinical Nephrology site:

http://cjasn.asnjournals.org/cgi/conten ... t/3/4/1022

The title of the article is "Rust Urine after Intense Hand Drumming Is Caused by Extracorpuscular Hemolysis."

You'll note, though, that nowhere is rhabdomyolysis mentioned, and in fact, the diagnosis given (even in the title!) in this article is "extracorpuscular hemolysis," which is the break down of red blood cells, not muscle tissue.

Quote from last line of study:

"Conclusions: Taken together, these data confirm that rust urine is caused by extracorpuscular hemolysis."

Hmmm...

James

[jorge]

Seisporocho, I wrote a long description of carpal tunnel syndrome for you and it got deleted by a computer glitch. The bottom line is your symptoms of numbness and weakness of your hands are very suggestive of carpal tunnel syndrome. This can be very serious and cause permanent nerve damage and loss of function of the hands if it is not diagnosed and treated promptly.

You need to go see a doctor as soon as possible. The kinds of doctor that diagnose and treat carpal tunnel syndrome include rehabilitation medicine doctors (physiatrists), neurologists, and orthopedic surgeons. You need to get a careful medical history taken by one of these kinds of doctors and a thorough physical exam of your hands, arms, shoulders, neck, and spine. If the doctor thinks it may be carpal tunnel syndrome, he or she will probably order a nerve conduction velocity test of the nerves in your forearms and wrists, as well as an electromyelogram (EMG). Do not postpone this, find a doctor tomorrow.

This is medical advice I am giving, which I very rarely do over the internet, but I don't know how else to contact you and I will be away from my computer for the next 3 days and can't be sure I could receive a PM. I realize this all sounds very harsh and not what you want to hear. I have not examined you or even talked to you directly but the symptoms you describe sound so much like carpal tunnel syndrome, which I see frequently in my medical practice, that if you were my patient I would immediately refer you to rehabilitation medicine or neurology for evaluation, and call the doctor to request an appointment in the next week if possible. I would tell you to stop playing immediately, and not to play until you have a proper medical evaluation and find out what the diagnosis is. A wrist splint at night might be helpful, but you should not wear it during the day or while using your hands. If you do have carpal tunnel syndrome, the treatment will include changing the way you play congas, plus either physical therapy or surgery. Either PT or surgery will be expensive so if you don't have medical insurance now, get some immediately if at all possible, it will be cheaper than paying the medical bills. If it is not possible, go to a public hospital, is Jackson Memorial still a public hospital in Miami? If you have any questions, call my office at the number below and leave a message. I will be out of town at a meeting until Thursday, but they will relay a message to me.

George Friedman-Jimenez, MD
Bellevue/NYU Occupational & Environmental Medicine Clinic
212 562-4572

[jorge]

James, what you are saying is right. Hemolysis is breaking of red blood cells, releasing free hemoglobin into the blood plasma. If enough is released it overwhelms the plasma's protein binding ability and makes its way through the kidneys into the urine. Thanks for posting the link in the Straight Dope thread.

[seisporocho1]

Jorge,

Thanks for the reply. Alreay left u a message.

6x8