Madina Alam knew she should have stopped.
But like many fit and healthy people during a workout, she figured she could push through the intensity of the pullups she was struggling to complete.
Moments later, her body made the decision for her, as both of her arms began swelling to cartoonish, Popeye-like proportions.
“It was a very intense workout, but I did sports growing up. I did bodybuilding competitions. I was used to pushing myself,” the 34-year-old told The Post. “But I didn’t realize what was going on.”
What Alam dismissed as typical post-workout soreness would land her in the emergency room four days later — with the same condition that killed 24-year-old marathoner Rachel Apa just hours after she ran the New York City Marathon on Sunday.
A workout gone wrong
In 2022, Alam was working out weekly with a personal trainer in Charlotte, North Carolina.
A licensed mental health counselor, she wasn’t preparing for a competition. “I just like to work out,” she explained.
The trouble started after she completed a set of eccentric pullups, also known as negative pullups. Despite being fit and in shape, she hadn’t yet mastered the exercise.
“I obviously did way too many,” she recalled. “My arms were swollen immediately after.”
She remembers telling her trainer she couldn’t fully straighten her arms, but says “he didn’t really think much about it.”
The pain and swelling only got worse throughout the day.
Unable to move much, Alam stayed home for several days, not even changing her shirt so as to avoid raising her arms. Still, she hadn’t taken any over-the-counter painkillers.
“Looking back at it, I’m like, ‘Madina, why did you not go [get medical help]?’” she said. “I thought it was gonna go away.” On FaceTime, even her trainer agreed.
But a friend raised another possibility: “Oh, you might have rhabdo,” he told her, referring to rhabdomyolysis, a rare, life-threatening medical condition that can occur after excessive exercise without rest.
However, he brushed off the thought after learning her urine hadn’t changed color — a common but not universal warning sign of the condition, in which urine typically appears dark, tea-colored, red or cola-colored.
Four days after the workout, Alam’s swollen arms had become so uncomfortable that she couldn’t sleep, waking up every few seconds. After she described her symptoms on a call to an urgent care clinic, the staff urged her to head to the emergency room.
At the hospital, “they took me back immediately” to get examined, Alam said. By that point, her arms had puffed up an additional 12 pounds.
Blood tests soon revealed that her creatine kinase levels, a marker of muscle damage, had reached 80,000. Normal numbers are under 200.
This confirmed Alam did, in fact, have rhabdo, due to damaged muscle tissue breaking down and releasing proteins and electrolytes in her bloodstream.
Alam was admitted and given an IV with fluids and electrolytes to help her kidney flush the excess muscle proteins and other substances from her system, while morphine helped manage the pain.
“Trainers will look at me and go, ‘What’s rhabdo? Oh wow!’ and that makes me honestly cringe.”
Madina Alam
“I even remember one morning they had brought in a group of student doctors just because it’s kind of rare to see,” said Alam.
After a week in the hospital, she was discharged, her arms having returned to their normal size.
When rhabdo turns deadly
When Alam learned about Apa’s death, the news “felt like a gut punch.”
“It was just like, ‘Oh my God, I can’t believe someone passed away from that,’” she said.
While Alam recovered, rhabdo can be fatal. As muscle tissue breaks down, the kidneys can become overwhelmed by the sudden influx of proteins and electrolytes, potentially leading to acute kidney failure.
Excess potassium in the bloodstream can also disrupt the heart’s electrical signals, triggering potentially fatal arrhythmias or cardiac arrest.
“It just makes me sad,” said Alam about Apa. “It makes me also appreciate that I caught it in time. As horrible as the story is, it will shed light on this, so more people will be aware of the symptoms.”
“Hopefully, this doesn’t happen to someone else.”
Alam is also urging personal trainers to learn about the condition. While she doesn’t blame her trainer for her rhabdo development, she believes his lack of awareness contributed to her not recognizing the warning signs or immediately seeking medical care.
“I’ve shared [my story] actually with a lot of trainers,m and trainers will look at me and go, ‘What’s rhabdo? Oh wow!’ and that makes me honestly cringe,” she said.
For others who look and feel fit and healthy, as both she and Apa did, Alam has one piece of age-old advice.
“It sounds corny, but just listen to your body,” she urged.
