A young and otherwise healthy New York City marathoner died hours after completing the race due to a dangerous condition that can develop from exercise.
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that → die → exercise
Rachel Apa was running her first marathon when she collapsed in Central Park, just two miles from the finish line.
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she → run → line
The 24-year-old was rushed to Mount Sinai and died at 9:40 p.m. from a condition called rhabdomyolysis, her father, Steve Apa, told the New York Times.
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father → rush → Times
This is when muscles break down, flooding the blood with proteins and electrolytes, damaging critical organs.
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muscles → break → organs
How could this happen to someone in “perfect health, perfect shape,” as her dad described?
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dad → happen → health
Apa had been training for months for the race, he said.
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he → train → race
But that’s exactly why she was at heightened risk for the life-threatening disease.
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she → ’ → disease
Here’s what to know about rhabdomyolysis, aka “rhabdo.”
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Here → ’ → rhabdomyolysis
Rhabdomyolysis is the rapid breakdown of skeletal muscles — those attached to bones, as opposed to muscles in the heart and other organs.
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Rhabdomyolysis → attach → heart
That releases a deluge of compounds into the blood that the body isn’t equipped to process, the most notable of which are the protein myoglobin and the electrolyte potassium.
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notable → release → which
The kidneys try to filter myoglobin out, but the large molecules clog it up, poisoning the kidney tissue and leading to renal failure.
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molecules → try → failure
Damaged muscle cells burst and dump potassium into the blood, disrupting signals in the heart.
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cells → burst → heart
This can cause fatal cardiac arrhythmias and cardiac arrest.
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This → cause → arrhythmias
Any muscle injury, like a car crash, burns, electrical shocks, and even medications, can cause rhabdomyolysis.
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injury → cause → rhabdomyolysis
Endurance athletes like marathon runners are at higher risk, as are those who do similarly intense activities, like spin classes or CrossFit.
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who → do → classes
Authors of a 2021 study on exertional rhabdo noted that the condition predominantly strikes young, healthy women — and wanting to keep up with others in a fitness class could be increase their risk.
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wanting → note → risk
“While participants in a class are allowed to tailor the level of intensity, cadence and resistance to their fitness level, it is easy to succumb to peer pressure and overexert during the activity,” they wrote.
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they → allow → activity
Those undergoing military training or who work in hot environments while also doing a lot of physical work (firefighters, foundry workers) are also at risk of developing rhabdo.
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who → undergo → rhabdo
Dehydration doesn’t cause rhabdo, but it can make it much worse and increases the risk of deadly complications.
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it → cause → complications
The key is that occasional endurance activities don’t cause rhabdomyolysis.
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activities → cause → rhabdomyolysis
Your risk increases if you push yourself too hard without resting, according to the Cleveland Clinic.
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you → increase → Clinic
The authors of the 2021 study recommend that if you do spin class, make sure to properly hydrate, avoid any medications or supplements that can increase your risk, and gradually build up exercise volume and intensity.
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that → recommend → volume
Rhabdo can also happen if you don’t move for a long time, cutting off normal blood flow and causing cell death.
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you → happen → death
People over 65 are at increased risk of this.
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People → increase → this
Symptoms usually appear a few days after the muscle injury, and some people may not even notice muscle soreness, according to Cleveland Clinic.
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people → appear → Clinic
Top symptoms to look out for are the “classic triad” of muscle pain, muscle weakness and dark urine the color of tea or cola.
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symptoms → look → tea
But a vast majority of people will not get all three symptoms — in fact, only about 10% of people experience all three, according to the American Academy of Physical Medicine and Rehabilitation.
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% → get → Medicine
More than 50% of patients do not report muscle pain or weakness, but that’s still the most common symptom.
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that → report → pain
Other potential symptoms include fever, nausea, vomiting, malaise, dehydration, infrequent urination, confusion and loss of consciousness.
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symptoms → include → consciousness
If you suspect you might have rhabdo, it’s important to seek medical attention immediately.
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it → suspect → attention
Treatment involves IV fluids, which can stop the condition from progressing to severe kidney damage.
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which → involve → damage
When that happens, patients might need to go on dialysis.
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patients → happen → dialysis
In up to 50% of cases, damage to the kidneys require continuing dialysis for an extended time.
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damage → require → time
Many people totally recover after treatment, but most people have lingering muscle weakness that lasts for weeks.
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that → recover → weeks
And while patients might feel better at that time, it’s important to listen to your doctor before going back to exercise.
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it → feel → exercise
They may advise several weeks or months off before returning, Cleveland Clinic said.
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Clinic → advise → weeks
The Aporia
