Death of a runner: the rare condition that tragically claimed his life

Before dawn one February morning, 260 runners crowded behind the starting line of a race that would push its limits.

The nearby Pōhutu geyser engulfed them in steam, and a haka from Ngati Tarawhai sent chills through nervous bodies. Ahead was a 165km search through the forest and hills surrounding Rotorua, the Tarawera Ultra. A grueling challenge for mind and body, but one that they had trained for.

Thirty-four hours later, as the competitors continued to advance, one collapsed, barely a kilometer from the finish. People ran to help.

Three days later, despite intensive treatment, he died in Auckland Hospital.

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His death shook everyone who had run an ultramarathon, especially those who lined up with him in his last race.

I was one of those runners; one of the lucky ones; one of the 199 finalists.

But the death of my fellow runner haunted me, I couldn’t stop thinking about what I had endured. And a question burned: what killed him?

Months later, I found an answer: a condition that we had all been warned about, but we didn’t think much about.

After all, no deaths had been recorded among the runners anywhere.

The 52-year-old Japanese runner was a seasoned competitor. He had raced in Tarawera before, finishing in the top 20 in 2018. Those who knew him respected him and said how much he loved the trails.

His family requested privacy and asked that his name not be used.

When I called Dr. Marty Hoffman, an internationally renowned ultramarathon medical expert in California, he understood the desire for privacy, but believed it was important to establish what happened, in case he could help others.

Hoffman said deaths in ultramarathons were rare, even rarer than in marathons.

“In marathons… the intensity is higher and you can get a different crowd, on average probably not as fit or well trained [as ultramarathons]. “

Globally, deaths from ultramarathons were due to accidents, falls and heart problems. As for other conditions, such as one of the often talked about dangers, exercise-associated hyponatremia (EAH), where low sodium levels cause harmful reactions, no deaths were recorded.

“There have been deaths from hyponatremia in other endurance events, an ultra endurance canoe race and Ironman, so it is probably only a matter of time, unfortunately.”

However, without further information, Hoffman was in the dark.

The race organizers noted the family’s request for privacy, but I was able to speak with one of the event doctors, Dr. Tom Reynolds.

Reynolds reminded me that before the race, they offered some simple tips to avoid risks to my fellow competitors, including drinking until thirsty and not using ibuprofen or other NSAIDs.

And we had been warned about the dangers of EAH, dehydration, hypothermia, hyperthermia, and another condition called rhabdomyolysis (rhabdo), where muscles break down, sending protein into the bloodstream and overwhelming the kidneys.

Many people will have experienced mild rhabdo, for example, overexerting themselves in the gym and suffering pain days later.

At the race, a medical team monitored the runners, including weighing us before and after to monitor for fluid loss or retention, possible signs of various conditions. Seventeen doctors roamed the course and the doctors were stationed at two points. At the finish line there was a medical center. During the weekend of the race, seven doctors and five nurses were on duty.

Each year, Reynolds says, about 70 people need medical help, and about four require hospital treatment.

Troubled runners can be difficult to spot, he says.

“Really sick people, if anything, are easy because it’s obvious and we know where to go.”

Runners should listen to their bodies, but that can be difficult when you’re tired.

About 24 hours after my nearly 29 hour Tarawera, I hallucinated, swearing that I saw a robot on the road and the ground turned to liquid glass. It was weird.

Reynolds says weird things happened to your body when you ran that far.

I still wanted to know what had happened to my running partner. So I got his death certificate. He listed multi-organ failure and respiratory distress among the causes of death, potential signs of various problems.

But it was the last thing on the list that caught my attention: rhabdomyolysis, the condition of muscle breakdown. No death has ever been reported among runners, Hoffman says.

The first signs are fatigue and pain, but that may just be exhaustion from running an ultramarathon. Urine can be a gift.

“Medical textbooks say urine the color of Coca Cola, this type of brown urine, which is myoglobin that makes its way through damaged kidney tubes into the urine,” Reynolds says.

But that’s hard to detect if you run at night.

Reynolds couldn’t talk about the racer, but he wanted to say this: “It’s really tragic and sad, and we really should take a grim pause to think about the true risks of the ultra race.”

Knowing that, I was curious if Reynolds recommended ultramarathons.

“When it’s 3am and we have a backed medical tent, you wonder, ‘Why is everyone doing this? But no, we are talking about a relatively small proportion here. With the right preparation and a little knowledge, you can do these things safely. “

But knowing that the risks increase exponentially the further you go was an important consideration.

“I think there is a danger that people will try to see the 100km as the new half marathon, and it certainly is not.”