Should you be worried about rhabdo?
Twenty-four-year-old Lewisberry, Pennsylvania native Rachel Apa was supposed to have a good first marathon. She was feeling great, and she was running to raise funds for the Parkinson’s Foundation, all in honor of her late grandfather who suffered from the brain disease. He taught Apa to “stay active, push my limits, and embrace challenges, shaping my love for sports and movement.”
But at around Mile 24, tragedy struck—a “medical episode” happened to Apa. Details about the episode are scarce, but it’s likely she suddenly collapsed; race spectators who happened to be medical professionals tried to administer CPR to no avail, and eventually an emergency team arrived with defibrillators.
She was then taken to Mount Sinai Hospital in critical condition, and despite the doctors’ best efforts, she was pronounced dead hours later.
Despite still currently being assessed for the official cause of death, Apa’s father said the doctors told them it was rhabdomyolysis.
What, again, is rhabdo?
It’s been a while since I’ve discussed rhabdomyolysis—and it’s been quite a while since the last reported case that was close to me, which was that of a powerlifter who had come to a meet lacking sleep.
For those encountering the medical term for the first time with Apa’s story, rhabdomyolysis, colloquially known as “rhabdo,” is essentially a rapid and intense muscle breakdown that releases damaged muscle fibers and electrolytes into the bloodstream and kidneys, causing substantial kidney damage. This is why most reported cases will see dark-colored urine, which is the most tell-tale sign.
Your muscles will tear and break when you exercise them—and that’s normal, as that is the process in which they are built back up and made bigger and stronger. Rhabdo is just that, but done much too fast for comfort. It mostly happens when you exert too much, far beyond your usual physical activity; it’s happened to runners, lifters, and even spinners. Heat also plays a huge role, as hotter body temperatures and dehydration force faster muscle breakdown.
According to data from the Cleveland Clinic, around 26,000 people in the US end up developing rhabdo, mostly from overexertion, and sometimes from injuries. While Apa was confirmed to be a collegiate field hockey player, and I’m certainly not casting doubt on her preparation for the marathon, her first time running it could lend credence to the rhabdo theory; due to the very long activity time and the demands of the race, marathoners and other endurance athletes stand at a higher risk of getting it.
Not a common cause of death
What is unfortunate about the case, however, is that rhabdo rarely ends up being fatal, especially if treated immediately.
“This death is extremely tragic,” said Dr. Jonathan Kim, founding director of Emory Sports Cardiology, to CNN. Kim has studied multiple cases of deaths from half and full marathons in the US.
In fact, Kim notes that a more common killer during runs is the human heart—and even then, a cardiac episode is still pretty rare, at 0.6 deaths per 1,000 runners according to a study by the American Journal of Managed Care.
“A young woman dying running a marathon is not common. When you think of common causes of sudden cardiac arrest in young athletes, certainly rhabdo is not on the list,” he says.
What should you look out for?
With running being popular in the very warm Philippines—and a few Filipinos on social media sharing their milder stories of rhabdo during runs—watching out for it and overexertion is still very much necessary.
According to the Cleveland Clinic, the four main symptoms you need to watch out for are muscle swelling, muscle weakness or stiffness, tenderness and soreness, and dark-colored (red or brown) urine. The most obvious sign you’ll likely encounter is the dark urine, as that means the muscle waste has already reached your kidneys.
Other symptoms may be nausea, decreased urination, fever, confusion, rapid heartbeat, and a loss of consciousness.
Once you feel any of these symptoms, especially after lifting, running, or otherwise exerting heavily, seek medical attention and hydrate if possible. Doctors and medical professionals can issue a biopsy on your muscles to check if you have rhabdo, and the faster you do it, the chances of surviving are better—you don’t want to be put in a position of literal life and death.
But there’s no need to be scared of potentially developing it, especially if you do not overexert in your exercise or sport. You just need to be mindful of your exertion levels, especially according to your experience level, your hydration, and if you can control it, the temperature and humidity wherever you’re doing it.
