HYANNIS – Three days before Paul Houle Jr. went back to Tabor Academy to start his pre-season training for football his senior year, he bought an Apple Watch. It might be the best money he ever spent.
Luckily, the 17-year-old Houle had already tested the heart rate monitor at home and knew his normal heart rate was between 60 and 70 beats per minute. During two football practices in one day on Tuesday, Sept. 8, his heart rate climbed to 145.
That would be expected after such rigorous exercise. According to the American Heart Association your maximum heart rate during strenuous exercise is about 220 minus your age. But three hours later, Houle’s resting heart rate was still at 145.
“It was the first day of pre-season,” he says. “The first practice was from 10 until 12 and the second practice was from 3 to 5. During my second practice, I started to have problems breathing and I had pain in my back, which turned out later to be my kidneys failing.”
Houle finished practice and went back to his dorm to take a nap. At 7:30 that evening, he went to a meeting for all the pre-season athletes, where he mentioned his elevated heart rate to Tabor head trainer Brian Torres.
“I didn’t think it was anything serious,” Houle says. “When I saw the trainer I just mentioned it to him, not expecting him to do much about it.”
Torres thought Houle’s Apple Watch must be wrong, so he took the teen’s heart rate manually. It was still 145 beats per minute.
Torres rushed Houle to the school’s health center, where nurse Elizabeth West confirmed that both his blood pressure and heart rate were too high. She called Houle’s father, Paul Houle, MD, a neurosurgeon at Cape Cod Healthcare.
They decided Houle needed to go to the emergency room. West drove him to Cape Cod Hospital herself, keeping a heart monitor on him to make sure he was OK.
“When I got there, they first tested me for a blood clot which they thought was in my leg and had traveled to my lung, but then they diagnosed me with rhabdomyolysis,” he says.
“The combination of how hot it was last week, the two football practices in one day and dehydration caused my muscles to start to break down and release a protein into my blood stream which shut down my heart, my liver and my kidneys.”
Rhabdomyolysis is a syndrome caused by muscle injury, says Craig Cornwall MD, the Cape Cod Hospital emergency room physician who treated Houle. “It happens for different reasons. It’s relatively frequent but for most of us it’s relatively mild.
“Paul’s case was a little unusual, but you do see it in athletes like the weekend warriors who do something extremely strenuous and their muscles aren’t used to it.”
In Houle’s case, the hot weather, the two football practices in one day and dehydration had started to break down his muscle tissue. That leads to the release of a muscle protein called myoglobin into the blood stream.
Rhabdomyolysis can lead to many complications, especially to the kidneys, which become overwhelmed and cannot remove the body waste and concentrated urine caused by myoglobin.
In extreme cases, a muscle will actually die, which can lead to amputation.
Houle stayed in the hospital for three days and could barely move. As of the writing of this story one week after the incident, he still had not been cleared to return to football practice. He still has trouble just walking across campus without getting winded and noticing a raised heart rate on his Apple Watch.
“At the hospital they told me that if I had gone to practice the next day that I would have lost all control of my muscles and there was a good chance I would have fallen down on the field and died right there,” he says. “I’m very grateful for that heart rate monitor.”