Rhabdo is linked to NYC marathoner’s death. What is the condition and how worried should you be?

The Independent's journalism is supported by our readers. When you purchase through links on our site, we may earn commission. Rhabdo is linked to NYC marathoner’s death. What is the condition and how worried should you be? There are 26,000 cases in the U.S. each year and anyone can be impacted, doctors say - Bookmark - CommentsGo to comments Become an Independent member to bookmark this article Already a member? Log in A rare and sometimes deadly muscle condition known as rhabdomyolysis is back in the headlines this week after the death of a healthy 24-year-old New York City Marathon runner. Rachel Apa, a Pennsylvania native and former Division One field hockey player at Bucknell University, collapsed two miles short of the race’s finish line Sunday, her father Steve Apa said. Doctors spent over six hours trying to save her life but were unsuccessful. Her father said her cause of death was rhabdomyolysis. Rhabdomyolysis, often referred to as “rhabdo,” occurs when muscles break down and can poison the body. It is typically triggered by overexertion, physical trauma, certain medications or an underlying health condition. The condition is relatively uncommon with about 26,000 cases recorded in the U.S annually, according to the Cleveland Clinic. Some cases can be fatal, and Vanderbilt University research shows there are around 1,500 annual deaths. "It's a problem, and it's very dangerous," Jacque Crockford, a college athlete turned personal trainer who suffered from rhabdo, told US News in 2017. What happened to Rachel Apa? Apa, who was running her first marathon, was feeling strong before she collapsed near the mile-24 marker at 1:33 p.m. EST, The New York Times reported Tuesday. She had texted her father that she had “never felt this good” earlier in the race but he told her repeatedly not to “overdo it,” Steve Apa told NBC News. When she collapsed, spectators ran to help her - including two doctors - and performed CPR before emergency medical crews arrived with a defibrillator. She was taken by ambulance to the Mount Sinai Medical Center at 1:50 p.m., which one spectator claimed was “was an unacceptable amount of time.” After continued efforts trying to resuscitate Apa, she was declared dead at 9:40 p.m. EST. “It’s unfathomable,” her father told The Times. “Perfect health, perfect shape, 24 years old.” Have there been other cases? Cases of rhabdo has been widely reported in college football players. More than a dozen University of Iowa players were hospitalized in 2011 after a strenuous squat workout, according to The Daily Iowan. In 2017, three Oregon football players were hospitalized with the condition following grueling strength and conditioning workouts. Other people have spoken out about developing the condition, including a Virginia man who was doing pull-ups. “It was just kind of a shocking thing,”Justin Urban, then 41, told The Washington Post in 2021. “Forty pull-ups put me in the hospital for a week.” Joseph Henson, who ran Alabama’s Mercedes Half Marathon in 2019, went into cardiac arrest after developing rhabdo. “My takeaway from all of this is it can happen to anybody, I’m pretty young for cardiac arrest and consider myself pretty fit,” Henson, then 34, told Runner’s World. What happens to the body? Rhabdo occurs when a person’s muscles break down during extreme exercise. This breakdown releases the contents of the muscle into the bloodstream, including proteins called myoglobin and creatine kinase and the essential mineral potassium, according to the Cleveland Clinic. A build up of myoglobin in the body can damage the kidneys, while high levels of potassium can cause a deadly heart rhythm. That’s how half of people with rhabdo develop a kidney injury, the clinic notes. Other common causes of rhabdo include heat stroke, drug abuse, crush injuries and medications, such as statins and antidepressants. In high temperatures, muscle breaks down rapidly, and taking drugs can have a similar effect. The rare genetic conditions McArdle disease and Duchenne muscular dystrophy can also lead to rhabdo. Both cause muscle weakness. How concerned should you be? It doesn’t matter whether you’re a weekend workout warrior or a professional athlete, you can be impacted by rhabdo. While the likelihood of developing the condition is slim, people who drastically increase their exercise training intensity or length are at a higher risk, Dr. William Roberts wrote in Runner’s World in 2017. “At The Ohio State University Wexner Medical Center, we see rhabdo most associated with endurance sports, such as cycling or running,” Dr. Bryant Walrod, a family medicine physician, said. People who work in active jobs are also at risk, including firefighters, police officers, outdoor workers and military service members, the Centers for Disease Control and Prevention says. Symptoms of rhabdo can be varied and range in severity, but typically occur within 1-3 days of muscles degrading. People should seek medical attention if they experience muscle pain, weakness, dark urine that looks like cola, an inability to pee, nausea or loss of consciousness. Rhabdo can be treated using IV fluids and electrolytes, though people may need dialysis if their kidneys fail. People without complications from rhabdo can feel better within a few weeks, but doctors may recommend waiting months before resuming exercise. To lower risk for rhabdo, experts advise people build up their exercise tolerance slowly, stay hydrated to the point their urine is clear and skip hard workouts when sick or in high temperatures. Listening to your body is the key, Walrod stressed. “If you’re used to running 5Ks and now you’re ramping up to a marathon, listen for warning signs when determining the length and intensity of a run,” he said. “You can make gains in the long-term and not just in the short-term.” Join our commenting forum Join thought-provoking conversations, follow other Independent readers and see their replies Comments