A 15-year-old boy got in trouble at football practice. As punishment, his coach sentenced him to do 150 pushups over the weekend. His mother was assigned to monitor him and make sure he was compliant.

On Monday, he was unable to move his arms, which were in severe pain, and he noted that his urine was darker than normal. All of this concerned his mother, who brought him to the emergency department. This story of over-exercising, followed by excessive muscle pain and dark urine was worrisome to me. Quick blood and urine tests confirmed my suspicion. He had rhabdomyolysis.*

The excessive use of the muscles of his arms and shoulders caused enough muscle damage that a protein, myoglobin, was released from the muscles in such large amounts that it turned his urine dark. If not treated, that same protein could be toxic to the kidneys. This patient had to be admitted to the hospital to get pain medicine and IV fluids until his muscles healed and the myoglobin was cleared from his blood and urine.

Over-exercising is one of the more common causes of this condition. As far as I know, I have never seen it just from over-use of the upper extremities. Since your legs have so much more muscle mass than your arms, it is a lot more likely for this to develop after over-use of the legs. For example, we often see prisoners who do squats over and over until they develop rhabdomyolysis. They come in from jail with leg pain and dark urine and have to get admitted to the hospital.

I wonder if my patient’s coach will assign 150 pushups as behavior modification again.

*I posted a case previously about rhabdomyolysis. Please see Dancing with the Stars in a previous post.

Also, for more information, check out this Wikipedia article: https://en.wikipedia.org/wiki/Rhabdomyolysis

This is one of those recipes that is all over the Internet. It seems weird to call them “peanut butter” when there is no peanut butter in them at all.

For some reason, I have always referred to the chunky ingredients added at the end of the cookie recipe as “floaties.” Don’t ask me where that came from. Maybe it is because I just can’t think of a better word. Anyway, this recipe has more floaties than any other recipe I have ever made. Seriously, packed with nuts and chips.

Recipe By:

All over Internet

Yield:

36

Ingredients:

6 tablespoons unsalted butter
12 ounces semisweet chocolate chips, divided
2 ounces unsweetened chocolate
2 large eggs
1 tablespoon instant espresso or coffee powder
2 teaspoons pure vanilla extract
¾ cup sugar
⅓ cup all-purpose flour, plus 1 tablespoon
1 teaspoon baking powder
¼ teaspoon kosher salt
1 cup walnut halves, not chopped
1 cup pecan halves, not chopped
⅔ cup peanut butter chips

Directions:

1. Heat oven to 325 degrees. Line baking sheets with parchment paper.

2. In a bowl set over simmering water, melt butter, 6 ounces of chocolate chips, and unsweetened chocolate, stirring occasionally, until just melted. Remove from heat and cool for 15 minutes.

3. In bowl of electric mixer fitted with paddle, beat eggs, espresso powder and vanilla until combined.

4. Add sugar. Raise speed to medium-high and beat for 2 minutes, until the batter is thick and falls back on itself in a ribbon.

5. With  mixer on low, slowly stir in  chocolate mixture.

6. Combine ⅓ cup of flour, baking powder, and salt in a small bowl. Stir into chocolate mixture with a rubber spatula.

7. In another bowl, combine walnuts, pecans, peanut butter chips, remaining 6 ounces of chocolate chips and 1 tablespoon of flour. Fold into chocolate mixture.

8. Scoop 2 tablespoon balls of dough, 1 inch apart, onto prepared baking sheets. Bake for 15 minutes exactly. Cool on baking sheets.

I have not had a lot of success with three colors in one bag. Here is the latest try. I kind of like it.