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Rhabdomyolysis part 2.


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#1 sandymere

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Posted 18 June 2012 - 02:31 pm

Rhabdomyolysis part 2.


I’m not a vet but I am involved in human health and some problems are cross species to the extent of having a similar presentation and treatment, Rhabdomyolysis is one of these. My interest started some years ago when a number of well respected running dog owners asked my opinion of what was happening when, in the parlance of the time a dog ‘ran it back off’, the excepted knowledge of the day was that it was due to a build up of lactic acid. This theory did not sit well, lactic doesn’t build up to such damaging levels as the muscles reduce their output well before it reaches this stage. Along with the muscle wasting another commonly reported symptom was blood in the urine, this was put down to, amongst other things, bursting a blood vessel in the bladder through over exertion, again this didn’t sit well but it was to be the symptom that led to my finding the real answer.

A few days later a gentleman had spent the night on the floor having fallen late evening, this had resulted in a condition I knew well, rhabdomyolysis. It was whilst I was discussing the treatment with a junior member of the team that I had a eureka moment, they said “his urine is getting lighter, less like blood”. I could have kicked myself, why hadn’t I got it straight away, after all how many times had I seem this, especially as another classic presentation with rhabdomyolysis is younger individuals, such as service personal, who have over exerted themselves in hot weather.

I did a quick search and found it was well known in horses and documented in greyhounds but seemed to have been passed by in the world of lurchers. With this in mind I decided to try to publicize it better. I admit it was a year before I actually got round to it but in 2008 I did a piece called “A Run to Far” and posted it on a number of forums. It was greeted with some derision at the time, lactic acid was the excepted culprit and many would swear black was white that lactic was the culprit. It took a few years of posting to slowly beat back the nay sayers until today rhabdomyolysis is pretty much accepted in the world of lurchers.

I take a little pride that I had helped to get this subject brought to a wider audience but alas there still seems some confusion about why running dogs are prone to this and what to do when it happens. With this in mind it is perhaps time to re visit the subject and challenge a few of today’s nay sayers who still cling to the old lactic acid treatments in spite of the general acceptance of the true cause of the problem.

When sighthounds run they create heat and there is a well documented link between exertional hyperthermia (increased body temperature), and rhabdomyolysis, when running greyhound types reach temperatures that would be well into the realms of heat stroke in the average do. The heat increases the muscles cells use of energy at a time when they are already under stress, basically the hotter the dog the more likely it will develop rhabdomyolysis, link this with what I said in the original piece, one can see why unfit dogs starting with poor muscle condition are particularly at risk.

What I didn’t discuss in the original article was that the muscle damage is not just confined to the skeletal muscle of locomotion, the running muscles, but also those used in breathing such as the diaphragm and the intra costal muscle between the ribs along with the heart muscle itself. These unseen effects are potential problems in that owners don’t t see a problem so don’t allow for it when considering recuperation.

The acute phase sees the bodies fluid and electrolytes being shunted out of their normal areas and ranges which causes extra strain on the heart along with the damage to the kidneys. In basic terms fluid gets pushed from the blood stream into the cells so the blood pressure drops causing the heart to work harder to pump the remainder. At the same time chemicals from the cells, potassium being one, get dumped into the blood stream. The result is that the heart muscle having suffered damage to its own structure is having to work harder due to the drop in pressure whilst being poisoned by excess potassium!

There is not much the owner can do at this stage other than cooling the dog and getting to the vets asap. The extra fluid in the cells can cause severe side effects whilst as said not enough in the blood stream can also have dire results. Drinking to much can just increase the shift whilst not enough is equally as bad. Thankfully the vet can give appropriate fluids and medications to minimize the damage whilst reducing the side effects of treatment. The good news is that evening those with extremely raised blood markers can, with good care, have very good longer term outcomes. Alas those with a less severe presentation that do not get proper intervention may well go on to suffer longer term harm such as kidney failure.

So what to do when a dog has run itself to a standstill and has the potential to suffer with this problem, cool it down and give a small drink, then it’s a matter of judgment. If it’s severe then straight to vets for emergency help, if not than straight home, a light meal and allow more water to drink as it cools down. Closely monitor urine and water, if drinking excessively or producing dark urine then straight to vets. As ever if the owner doesn’t feel experienced enough to make a judgment on the severity then going to the vets is best.

If rhabdomyolysis is confirmed and muscle wastage noted then we need to remember the unseen damage to the heart and breathing muscles as well as the kidneys. The internal damage will take time to repair so a very gradual process of re conditioning needs to be undertaken. This can only really commence after a couple of weeks of rest, good food and a bit of luck has brought about recovery from the acute phase. Personally I would hesitate to put the systems under the stress of work until the dog has had at the very least 6 weeks of conditioning during which no further symptoms have been noted and, as stated, the 6 weeks begins after the acute phase has fully passed.

To conclude, kidney damage, heart damage, brain damage, death not things to be taken lightly, certainly not things for home made remedies or over the counter treatments for mild dehydration. Rhabdomyolysis is best avoided as far as possible by endeavoring to only run dogs as fit as they need to be, avoid hard running in warm weather, and feed a diet that maintains energy stores at optimum. My last thought, if worried about the cost of a visit to the vets take up flower pressing as your hobby.

#2 skycat

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Posted 18 June 2012 - 03:31 pm

Very well put indeed :thumbs: :thumbs: :thumbs:

Unfortunately, some owners don't recognise the symptoms until the dog is in a state of collapse.

#3 sandymere

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Posted 19 June 2012 - 12:19 pm

Very well put indeed http://www.thehuntinglife.com/forums/pub... http://www.thehuntinglife.com/forums/pub... http://www.thehuntinglife.com/forums/pub...

Unfortunately, some owners don't recognise the symptoms until the dog is in a state of collapse.


Thank you, if i remember right you were one of those interested in the subjects back in the noughties. :thumbs:

Mrs s picked up the CMWs from the last few weeks yesterday so I flicked through a couple and I saw your article on cooling dogs, excellent timing, reference to the article would be sensible for many owners..









Note to self spell check lol :icon_redface:

Edited by sandymere, 19 June 2012 - 12:21 pm.


#4 paulus

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Posted 19 June 2012 - 01:46 pm

just a few points sandy, you say unfit. this condition is suffered by dogs in the care of some of the best greyhound trainers in the country, i dont think they would field an unfit dog in a race and as you say it is also suffered by some of our service personel. my own view is an unfit dog would go down/pull up with something else long before it got to the stage of onset Rhabdomyolysis. heat, i go along with this as again my own opion is its to do with the dogs temprement, if the dog is by nature excitable then it will pant more(cooling down) it carnt just be pure temprature or all the dogs in the same race as a dog that suffered from Rhabdomyolysis would be expected to suffer aswell and as we know they dont, identifing the signs is not as simple as some may say, as in my own case it was about 20hrs after the incident that the first signs appeared (dark urine). infact within 10 mins of the incident the dog looked ready to run again and showed no signs of anything untoward occuring. i think but you will probably be able to answer this but at that 20hr point theres no stopping it and it has to run its course.

#5 paulus

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Posted 19 June 2012 - 01:57 pm

Very well put indeed http://www.thehuntinglife.com/forums/pub... http://www.thehuntinglife.com/forums/pub... http://www.thehuntinglife.com/forums/pub...

Unfortunately, some owners don't recognise the symptoms until the dog is in a state of collapse.

dogs suffering from onset Rhabdomyolysis dont normally callapse, infact when it kicks in fully they still dont, as the pain is to much for them to even move, most adopt the standing position as they seem to find this more comfatable.

#6 skycat

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Posted 19 June 2012 - 02:10 pm


Very well put indeed http://www.thehuntinglife.com/forums/pub... http://www.thehuntinglife.com/forums/pub... http://www.thehuntinglife.com/forums/pub...

Unfortunately, some owners don't recognise the symptoms until the dog is in a state of collapse.

dogs suffering from onset Rhabdomyolysis dont normally callapse, infact when it kicks in fully they still dont, as the pain is to much for them to even move, most adopt the standing position as they seem to find this more comfatable.

Sorry: just a figure of speech, and I know what you mean: having had a bitch suffer the same problems as your dog many years ago.

The thing is, no one know EXACTLY the combinations of factors which trigger 'running the back off'. In my case, it was a bitch who was out foxing: averagely fit, but not fit enough for a course on a hare as she'd been in season a few weeks before hand and was soft muscled and not in hare running condition. The weather wasn't hot either: middle of winter, and she didn't over heat as such. Like yours, it was over 24 hours before she showed signs of a problem.

But I've also seen very fit dogs who just did that bit too much, like getting on yet another hare when coming back from a long course. In all the cases I've seen of dogs running their backs off they were dogs with a lot (3/4 or more) of Greyhound in them, and none or very little Saluki, but a lot of drive. One of the most severe cases was a dog that was hyped up to a silly state: we took it with us for the owners in our vehicle as they didn't have room: the dog must have panted over a pint of saliva in the van on the way to the meeting, and it stayed in that state all day. The dog was nearly all Greyhound as well.

#7 mintstick999

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Posted 19 June 2012 - 02:22 pm

I found that a very interesting read by both of you and one i will certainly be aware of now. :thumbs:

#8 sandymere

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Posted 19 June 2012 - 03:48 pm

Any dog can suffer with exertional rhabdomyolysis, some are more likely than others but any given the right incentive will push their bodies just a littler to far. Being unfit or running in warm weather although not necessary will increase the risk. Excessive panting will pre heat the muscle even before the run (as in Skycats experience) which again adds to the risk.

Greyhound types being heavily muscled are a high risk type just because the more muscle the greater the capacity to create heat, which would go with the bull crosses as well but any sighthound type can develop this problem.

As to recognition, as I say it can be difficult, of course any that show distress need to be considered, the distress is likely to be due to overheating in the first instance especially in fit dogs as it is the added pressure of heat that pushes them over the edge, the rhabo will show later when muscle stiffness and dark urine present, perhaps hours later.

Unfit dogs will have a lower threshold so may not need to be as hyperthermic to push them over the threshold and so can be more difficult to recognise due to the delayed symptoms in the first instance. All hard run dogs are worth keeping an eye on, especially the urine output/colour for a day or so after the run.

ps
If the dog had drooled a lot the fluid loss could cause a degree of dehydration which would put extra pressure on the system, especially the heart, as one would expect this reduce the circulatory volume and to concentrate the electrolytes. In theory it may have lost some sodium which would possible complicate fluid resuscitation. The concentration of things like potassium in the reduced volume just before the damaged muscle dumped theirs into the blood stream is not good either.

From a discussion back along

If the greyhound becomes dehydrated, its body retains more fluid to keep the important brain and kidney cells supplied, so less moisture is available to be evaporated for cooling. Temperature regulation spirals out of control, and by the time its body temperature gets to 41º, the life threatening changes of heatstroke are well established, resulting in staggering, blindness, disorientation, stupor or coma. By this stage many metabolic changes have taken place and specialised veterinary treatment is urgent if the greyhound is to be saved.


Prevention is always best:

Every greyhound should be well hydrated before travelling. Although the taste of electrolytes encourages Greyhounds to drink more, the presence of any excess of electrolyte over actual requirements will tend to dehydrate without any of the other causes coming in to play. A splash of milk will work just as well to encourage water intake. Greyhounds are rarely electrolyte deficient unless they have had severe gut upsets, as food is full of electrolytes and the body takes what it needs, excreting the excess. Plain water is the ideal drink for hot weather as it replaces exactly that which has been lost. Once dehydration has set in, electrolytes will contribute to excessively high salt levels in the brain which are dangerous
Link to subject
http://www.thehuntin...up#entry2296373





links on bloods in greyhounds
https://greyhound.os...bwork/index.cfm

Edited by sandymere, 19 June 2012 - 03:51 pm.


#9 paulus

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Posted 19 June 2012 - 04:04 pm

i think you are correct ,as i am of the opinion that very heavily sight hound saturated crosses and bull type crosses :whistling: exhibit the classic over excitable behavior,i do believe this coupled with extremly high prey drive is what makes certain dogs more susceptible to Rhabdomyolysis. where heavily bull influenced crosses are used they also have a tendency to gas out or even fit before the point that overheating takes place, i believe this again is caused by pure excitment,

#10 budgie123

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Posted 19 June 2012 - 11:12 pm

Hyperacute Exertional Rhabdomyolysis
This form of the disease is seen following a race or trail of an unfit greyhound.During the exercise there are 3 products of muscular activity:heat,energy output,and hyrogen ions(metabolic acids).The heat is carried away from the muscles by the blood flow and the energy output is seen as the work that the muscles perform during the run.Finally ,under normal circumstances,the hydrogen ions produced during exercise are neutralized by buffers within the muscle cells and the blood streem.

When the unfit greyhound is subject to excessive fast work there is an enormous production of hydrogen ions in the form of lactic acid.This is because the greyhound primarily uses anaerobic metabolism(energy production using little or no oxygen) in the short races or trail distances upto 700 to 800 yards.The energy source used by the greyhound ultimately is derived from glucose and glycogen breakdown into lactic acid in the muscle cells.This production of lactic acid and associated hydrogen ions far exceeds the neutralizing ability of the intracellular buffers of the cell,and subsequently, the cell wall enzyme system becomes affected and inefficient.This allows water to be drawn into the cells which swell to the piont of cell wall disruption.Cell contents of muscle protien(red coloured myglobin) and electrolytes now leak out into the general circulation(blood) from whence they are filtered and excreted by the kidney.In addition the swelling of the muscle cells puts a direct pressure on the small vessels that supply their blood and oxygen.The result is a decrease in the essential blood flow to the damaged muscle fibres.This swelling of the muscle cells also precipitates a lack of heat dispersion due to the reduced blood flow, which aggrevates the existing process of destruction.

Acute Exertional Rhabdomyolysis
This form of the disease also follows a race or trail.Predisposing factors are Greyhounds that are either highly strung and tense or travelling,kenneling or racing under hot conditions.

With a tense highly strung greyhound prolonged barking and deep panting may result in a condition of respiratory alkalosis(increased blood PH) in which the greyhound lose very large amounts of carbon dioxide from the lungs.The kidneys tries to compensate by excreting bicarbonate into the urine to lower the blood ph.This is detremetal for a greyhound going into a race because bicarbonate is one of the major buffers of the lactis acid and hydrogen ions produced by exercise.It is not the greyhound lacks fitness or the muscles are deficient it is the reduced ability of the blood fluids to buffer the excessive hydrogen ions produced by the exercise.This results in muscle cell membranes dysfunctioning leaking and even disrupting.

When environmental conditions are hot and humid the greyhound has an increased difficulty disapating heat since it is primarily an non sweating animal.Loss of body temperature is dependant to a small degree on conduction(contact with cool surfaces) and convection but mainly depends on evaporate cooling from respiratory system.Greyhounds in trailers or hot humid kennels will pant a great deal.This adds to the humidity of the area.With increase humidity cooling by evaporation from the lungs by panting is markedly diminished.In such situations one observes markedly rapid increase in rates of respiration.This may be accompanied by considerable drooling.The result is that prior to the race the greyhound has an elevated body temperature and a lowered bicarbonate reserve-both due to panting as described above and both of which contribute to the development of Acute Exertional Rhabdomyolysis.

Subacute Exertional Rhabdomyolysis.

I have posted the information about this form of the disease and the reasons it occurs previously.
This form is braught on due to a deficiency in potassium braught on by too stressfull racing programme.
Also stated is that this condition does not reach a peak for 24 or 48 hrs and it may take upto 72 hrs for muscle soreness to be detected.

My personal opinion of mr sandymere and his waffelling is he talking rubbish and his theories are misguided The best advice i have is go on abe books and purchase care of the racing greyhound by blythe gannon and craig and educate youself instead of talking rubbish.
The information provided is from the above book i hope it is helpfull to people.
The best advice

#11 sandymere

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Posted 20 June 2012 - 12:04 pm

Ah there are still a few who cling to lactic acid in spite of all the evidence to the contary.
A brief look
From a critical care Journal

"Three important mechanisms maintain the distinction between intracellular and extracellular molecules. The first of these is the cell membrane, which physically contains the larger particles of the myocyte. Damage to this essential structure allows intracellular contents to escape and extracellular contents to enter.10 Direct injury to the cell membrane can occur as a result of crushing, tearing, burning, pounding, poisoning, or dissolving.3,12

Second, the sodium-potassium pump plays an important role in preserving essential intracellular-extracellular distribution of electrolytes. However, this pump is energy dependent, fueled by adenosine triphosphate (ATP).9,12 A steady supply of oxygen is required to produce sufficient quantities of ATP. Therefore, under anaerobic conditions, both the pump and the cell membrane it is designed to maintain, quickly break down.3 Hypoxia can be induced in muscle cells by a number of conditions, such as shock states, vascular occlusion, and tissue compression. Additionally, in patients experiencing excessive use of energy, due to such causes as seizures, strenuous exercise, hyperthermia, or prolonged sympathetic stimulation, oxygen delivery and ATP production may simply be unable to keep up with demand, and pump dysfunction swiftly ensues."
( http://ccn.aacnjourn...nt/23/6/14.full )

Lactate metabolism: a new paradigm for the third millennium
here a look a lactic acid.

L. B. Gladden
Department of Health and Human Performance, 2050 Memorial Coliseum, Auburn University, Auburn, AL 36849-5323, USA
For much of the 20th century, lactate was largely considered a dead-end waste product of glycolysis due to hypoxia, the primary cause of the O2 debt following exercise, a major cause of muscle fatigue, and a key factor in acidosis-induced tissue damage. Since the 1970s, a ‘lactate revolution’ has occurred. At present, we are in the midst of a lactate shuttle era; the lactate paradigm has shifted. It now appears that increased lactate production and concentration as a result of anoxia or dysoxia are often the exception rather than the rule. Lactic acidosis is being re-evaluated as a factor in muscle fatigue. Lactate is an important intermediate in the process of wound repair and regeneration. The origin of elevated [lactate] in injury and sepsis is being re-investigated. There is essentially unanimous experimental support for a cell-to-cell lactate shuttle, along with mounting evidence for astrocyte–neuron, lactate–alanine, peroxisomal and spermatogenic lactate shuttles. The bulk of the evidence suggests that lactate is an important intermediary in numerous metabolic processes, a particularly mobile fuel for aerobic metabolism, and perhaps a mediator of redox state among various compartments both within and between cells. Lactate can no longer be considered the usual suspect for metabolic ‘crimes’, but is instead a central player in cellular, regional and whole body metabolism. Overall, the cell-to-cell lactate shuttle has expanded far beyond its initial conception as an explanation for lactate metabolism during muscle contractions and exercise to now subsume all of the other shuttles as a grand description of the role(s) of lactate in numerous metabolic processes and pathways.
(Received 25 November 2003; accepted after revision 29 April 2004; first published online 30 April 2004)
Corresponding author L. B. Gladden: Department of Health and Human Performance, 2050 Memorial Coliseum, Auburn University, Auburn, AL 36849-5323, USA. Email: gladdlb@auburn.edu
More to follow!

#12 reddawn

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Posted 20 June 2012 - 12:07 pm

my eyes hurt, an my brain is makeing a buzzing noise :cray: :cray:


could somebody please put an idiots summary at the bottom when yous grown ups have finished talking science :icon_redface:
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#13 paulus

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Posted 20 June 2012 - 12:41 pm

my eyes hurt, an my brain is makeing a buzzing noise http://www.thehuntinglife.com/forums/pub... http://www.thehuntinglife.com/forums/pub...


could somebody please put an idiots summary at the bottom when yous grown ups have finished talking science http://www.thehuntinglife.com/forums/pub...

:laugh: depends who`s version/thinking your reading. my thoughts in a nutshell, a fit over excitable dog is more likely to run its back of than an unfit level headed one and the more bull in the mix the more chance of the dog being over excitable (or high prey drive as we know it) :thumbs:
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#14 sandymere

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Posted 20 June 2012 - 01:09 pm

Exertional rhabdomyolysis is caused when a dog runs beyond its capabilities.


In simple terms muscles breakdown when they run out of oxygen/energy, muscles need more when they get hot, dogs running to the point of collapse may get so much muscle destruction that it can threaten life or damage the kidneys.
More heavily muscled dogs create more heat when running.

non exertional Rhabdomyolysis can also be caused by medication, poisons, electrolyte imbalances or a genetic predisposition. The latter are uncommon as working sighthound types are rarely on the medications that are risky, they have few inherited problems and are unlikely to have an electrolyte imbalance as their bodies are very good at maintaining the right balance.

Edited by sandymere, 20 June 2012 - 01:11 pm.


#15 reddawn

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Posted 20 June 2012 - 02:04 pm

Exertional rhabdomyolysis is caused when a dog runs beyond its capabilities.


In simple terms muscles breakdown when they run out of oxygen/energy, muscles need more when they get hot, dogs running to the point of collapse may get so much muscle destruction that it can threaten life or damage the kidneys.
More heavily muscled dogs create more heat when running.

non exertional Rhabdomyolysis can also be caused by medication, poisons, electrolyte imbalances or a genetic predisposition. The latter are uncommon as working sighthound types are rarely on the medications that are risky, they have few inherited problems and are unlikely to have an electrolyte imbalance as their bodies are very good at maintaining the right balance.




iv actually understood the last 2 posts :boogy:
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