Health4 min(s) read
Cause of death for 'perfectly healthy' New York marathon runner, 24, explained - it can affect anyone
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The cause of death for a 24-year-old woman who collapsed just two miles short of completing the New York Marathon has been revealed by her family.
Rachel Apa, 24, had reached mile 24 of the marathon in Central Park, close to 85th Street, when she collapsed at around 1.30PM on Sunday.
Her father, Steve Apa, told the New York Times that his daughter had been in "perfect health" before she embarked on the race.
According to the family, Rachel died from rhabdomyolysis, a rare and life-threatening muscle injury where your muscles break down due to overexertion.
Her devastated father, who'd been tracking Rachel on the marathon app from his home in Lewisberry, Pennsylvania, when he saw she'd stopped moving, told the outlet: "It’s unfathomable. Perfect health, perfect shape, 24 years old."
What is rhabdomyolysis?
Per the Cleveland Clinic, rhabdomyolysis - also known as rhabdo - can happen after an injury or excessive exercise without rest.
The condition causes the muscles to break down and disintegrate, leading to muscle death. When this happens, toxic components of the muscle fibers enter the circulation system and kidneys, which can lead to kidney damage as they try to flush the toxins out.
The condition can be caused by overexertion, trauma, medications, or an underlying health condition, and while it can happen to anyone, it is relatively rare, affecting around 26,000 people in the United States each year.
What are the symptoms of rhabdomyolysis?
Common signs of rhabdomyolysis include weakness to the muscles, muscle stiffness or pain, muscle swelling, and a change in your pee color to brown, red or tea-colored.
The symptoms can range from mild to severe, with some people not even noticing muscle soreness. The symptoms usually develop between one and three days after a muscle injury.
In severe cases, some people also experience dehydration, decreased urination, nausea, and a loss of consciousness.
What increases the risk of rhabdomyolysis?
Rhabdomyolysis can affect anyone, but there is a heightened risk for endurance athletes, marathon runners, people who take spin classes, and those that do high-intensity interval exercises, per the Cleveland Clinic.
While occasional endurance activities are unlikely to cause the condition, the risk is higher if you push yourself too hard without resting.
It's not just exercise that can increase the risk, as working in hot environments - such as firefighters or foundry workers - who are in a hot environment and doing physically demanding jobs can develop rhabdo, as overheating makes it easier for it to happen.
Military personnel, especially those in boot came or intense training also have an elevated risk, as do people over the age of 65, as extended periods of inactivity can also lead to rhabdomyolysis.
How is rhabdomyolysis diagnosed?
A doctor will examine the patient and ask about recent physical activity, any medications they may be taking, and substance use, which can also increase the likelihood of rhabdo.
A urine sample will check the levels of myoglobin (a component of broken-down muscle), while a blood sample will measure creatine kinase (CK) levels, a protein that muscles release when they break down.
The doctor may also order a muscle biopsy test, where a small piece of tissue is taken from the affected muscle to be sent for testing.
Is rhabdomyolysis fatal or can it be treated?
While rhabdomyolysis can be fatal in severe cases, there are treatments if it is caught in time.
Treatment an include intravenous fluids and electrolytes to flush the toxins from the system, physical therapy to strengthen the muscles following an initial period of rest, and dialysis if severe kidney damage has already occurred.
Many people recover after treatment, but most have lingering muscle weakness for several weeks after the injury.
Around half of people diagnosed with rhabdo have acute kidney injury, and some will need dialysis for an extended time if their kidneys can't function.
Can rhabdomyolysis be prevented?
While it can't always be prevented, especially if it is caused by an underlying condition or accident, one way to reduce the risk of exercise-induced rhabdo is to start an exercise program slowly and listen to your body for cues to stop and rest, and never push yourself past your own limits.
Staying hydrated is crucial, as is taking regular breaks to cool down, especially when doing physical activity in a hot environment.