Ryan Shay

[Sasha Pachev]

I think by now most of us have heard the news of Ryan Shay passing away during the Trials. My first reaction was that he may have been sick at the start of the race, and being an elite runner with a strong nervous system, and finding himself in a competitive situation just managed to push himself too hard. This turned out not to be the case. His coach Joe Vigil reported no signs of health problems whatsoever prior to the race, and he collapsed after running only 5.5 miles while the pack was still going at a very leisurely (for them) pace. The competition had not yet started, it was time to relax, warm-up and wait, which is what they were doing.

This is just completely beyond belief. It makes no sense. If he had collapsed after 15 when he would have had a chance to exert himself and perhaps not listen to the signals of pain very much and override them with a powerful drive, there would be a reasonable explanation. But here you go, we have a very consistent 1:04 half/2:14 marathon guy that has no visible problems, no sickness before the race, is tapered, runs 5.5 miles at a very relaxed tempo pace, then all of a sudden collapses and dies! Statistically, this is next to impossible. I cannot help but suspect some kind of a foul play. I hope they do a thorough toxicology report and a criminal investigation. I would not be surprised if  they discover he was poisoned with the intent to have him die in the middle of a marathon, so as to disguise the true cause of his death.

[Cody Draper]

I agree with you Sasha.  It doesn't make any sense why he would collapse so early in the race as the pace was not terrible, nor were there any heat/dehydration issues.  It is terribly tragic for his family and friends and I hope that they can get some closure as to the cause of death.  I am in shock that something like that has happened. 
My initial thought was foul play, but I also have a theory that it may be some kind of horrible allergic reaction to something.  What, I don't know and it could still be a fluke.  I am interested in learning as much about this as the rest of the world.  My thoughts and prayers go out to his family and friends.

[Maria Imas]

Sasha, I think the theory that he was poisoned is just as unbelievable as his death itself. Who would have wanted that? Of course, anything is possible, but it's just not very probable. It is more likely he had some undiagnosed condition, possibly heart related, that led to a sudden massive heart attack. The fact that it happened after 5.5 mi. on the trials course, could have been just a coincidence. Hyponatremia is another unlikely cause, it usually hits inexperienced runners .

He was diagnosed with Adrenal Fatigue syndrom in 2006, and had a disastrous year, according to some reports. Maybe it had something to do with his collapse, or maybe he was mis-diagnosed. Doctors sometimes make assumptions about healthy elite athletes in their prime, not performing all the necessary tests. Do you remember Russian figure skating champion Alexander Grinkov collapsing in practice and passing away much like Shay? In that case, there was a family history of heart defects and he had back pains before, which he ignored. Perhaps, Ryan Shay had some warning signs, but chose to ignore them and kept training hard? Or maybe it was a blood clot in his leg (sometimes happenes after a plane trip) that traveled to his lungs? Who knows.

One poster on LetsRun has a theory that Shay's sponsor, Amino Vital, is responsible, feeding him anabolic supplements for the last 3 years. I find it also rather improbable, especially without any evidence, but at this point, nothing can be excluded.

In any case, there will be autopsy performed today or tomorrow and we should at least know the cause for sure. Certainly a very tragic event in otherwise great day of running.

[Dallen]

It is very unexpected for a trained runner to collapse and die that early into a relatively easy paced run. If he had some sort of underlying medical problem it would seem more likely that he would have died some other day, or later in the race. That leaves us to think of the possibility of some sort of foul play. Somone could have easily slipped something into one of his water bottles, or he could have taken something form a random spectator. Equally possible is the possibility that he did something dumb like blood doping, which could kill you early in a race. Either way, it is probably really not the most appropriate time to speculate. For now, it is just a tragedy for him, his family, and the running community.

[Chad]

I think Sasha's observations about the low probability of this kind of an occurrence at only 5.5 miles when the pace is still easy are correct and make this very hard to believe.   However, it's also important to remember that this is the Oly trials, with everything on the line and the psychological stress leading up to the start may have also have been a contributor to some kind of cardiac event, even if the pace was leisurely when he collapsed.  In any case, I do hope there is a thorough investigation done so that Ryan's wife and family can find some peace in what happened. It is a terrible tragedy for distance running on an otherwise marvelous day for our sport.

[Lulu]

From ESPN.com:

NEW YORK -- Elite distance runner Ryan Shay, who collapsed and died Saturday during the U.S. men's marathon Olympic trials, had been diagnosed with an enlarged heart but cleared by doctors, his father said.

"The thing that made him such a great runner may have killed him," Joe Shay told The Associated Press.

An enlarged heart like Ryan's is most commonly found in drinkers, smokers or people who are overweight, the father said. But it also translated into extra endurance -- crucial for a distance runner.


My thoughts (Lulu's): I think we need to be sensitve, especially mentioning doping. Let's not even insinuate that someone cheated until it is investigated.

[Ted Leblow]

I agree, no need to speculate on any possibility of him doing something illegal that may have brought this on. However, I do not think the conspiracy theory for foul play is valid either. There has been many cases of athletes with enlarged hearts suddenly passing away during practice or even easy workouts after many years of competitive athletics and after being cleared by doctors to continue, Len Bias is one if I remember right. So it is much more likely that this is the case. Most importantly let us all pray for him and his family and I am sure we will hear the cause eventually. Unfortunatley a great runner has passed away pursuing his dreams but I am sure he probably would not have had it any other way.

[Maria Imas]

A good article about possible causes of Ryan's death: http://scienceofsport.blogspot.com/, focusing on electrical heart abnormalities, including enlarged heart. The authors are sports physiologists, and one of them works in Tim Noakes lab, so this blog in general tends to be credible.

[Ross Tucker]

Hello everyone

Ross Tucker here, I write on that blog quoted by Maria above (http://scienceofsport.blogspot.com).  Came across this thread as a result.

I think that when something like this happens, the impact on us is felt so strongly because even a healthy person should not collapse and die during activity, let alone of the best, fittest and most 'finely tuned' athletes around, in peak condition.  And so as Sacha says, statistically, it's "next to impossible".  HOWEVER, IT'S NOT IMPOSSIBLE, AND THE CHANCES, UNFORTUNATELY, ARE NOT ZERO, and I for one would be incredibly surprised to learn that it was poisoning, though of course it can't be ruled out. 

If I had to put my head on the block, I guess I'd say exactly what was in that article - it's likely the be something along the lines of Hypertrophic Cardiomyopathy, as discussed on that ESPN article, and hopefully explained in a bit more detail at http://scienceofsport.blogspot.com/2007/11/sudden-death-in-marathon-tragic-case.html.  One thing I must point out is that almost all elite athletes have an enlarged heart - it is a consequence of training, a positive adaptation that improves performance.  So simply having a large heart is by itself not a major problem, but when the condition is expressed to a greater extent, then it can become a problem.  As I mention in the post, it accounts for 30 to 40% of all sudden deaths during exercise.

The difficult thing about these events is that when the athlete dies, everyone says "there was no indication, no warning sign", as Shay's coach has been quoted as saying.  However, the point which I make in the above blog article and emphasize here, is that in the elite runner in particular, breathing difficulties, chest pain, even fainting are quite normal events.  If you are training that hard, discomfort and feeling fatigued all the time are part of the game.  And so what often happens is the retrospectively, these symptoms are picked up.  People look back and say "If only we'd paid more attention to X,Y and Z".  But sadly, at the time, people tend to think nothing of it - just a price to pay for being an elite athlete, training hard.

So I strongly suspect that this was nothing malicious, just a very sad event, which does tend to happen in a very very small percentage of people.  But let's see what the autopsy says.

Regards
Dr Ross Tucker

[Ted Leblow]

Dr. Tucker,

Thank you for your insite and thoughts.

[Sasha Pachev]

Some more important details I've caught in the news:

So far the autopsy was inconclusive.

His resting heart rate was as low as 25. This is rather rare. Most elite runners sit somewhere in the 35-45 range.

Apparently he was maintaining pace up until the moment he collapsed. He crossed the 5 K mark in 16:53. Hall clocked 16:51, so they were right there together. Then the pace increased - Hall and a fairly large group of runners hit the 10 K in the 32:25-32:28, so they picked it up to about 5:00 pace shortly after the 5 K mark. News reports list a couple of runners that hit the 10 K in that time (JT Service and Ed Torres) being witnesses of the collapse. I talked to Paul on the phone - he recalls that by the time he got to the spot of the tragedy, it was already cordoned off. Paul would have been no more than 55 seconds behind. I can understand an elite runner collapsing and even dying in a race, but how would one start at 5:25, then pick it up to 5:00, and then with no letting up on pace just collapse and die? Should not be there some kind of struggle with the pace first, slowing down for a couple of minutes and falling behind the pack? There have been a number of precedents of elite athletes' deaths in competition, but I cannot recall anything like that.

[Jon Allen]

http://sportsillustrated.cnn.com/2007/writers/tim_layden/11/09/ryanshay/index.html

Sasha, to answer your question, heart attacks or heart failure due to enlarged hearts often come on suddenly- so you would not necessarily struggle for a while.

[Sean Sundwall]

I asked my dad, a physician, about how I could get tested for what is believed to have caused Ryan Shay's death. He gave me the following information:

You simply need three things for a screen.
    a.   a 12 lead ECG
    b.  a PA and Lateral chest x-ray
    c.  a fasting lipid panel (incl. total cholesterol, triglycerides, HDL, and LDL)
 
If all are normal, you have nothing to worry about.  My father died of a heart attack, from coronary artery disease (blockage of the main heart arteries), and it's why I've stayed active and watched my cholesterol (which has always been normal).  My ECG and CXR are normal.
 
Ryan probably died of sudden cardiac standstill from a rare heart defect called a prolonged QT interval, which would have shown up on any standard ECG....but he never got one.  His CXR showed an enlarged heart, but that was a probable normal variant, as many athletes have enlarged hyperdynamic hearts, and his slow pulse (30's) simply reflected his superb conditioning and cardiac reserve.  My resting pulse is ~40, and I bet yours is too.
 
I'd request those tests, and then relax and not worry anymore.  If your own doctor won't order them, and your coach can't, I'll be happy to phone in orders for all three to a hospital, or clinic of your choice.
 

 

[Sasha Pachev]

I actually had EKG, echo cardiogram, treadmill stress test, and Holter monitor done in 2002.  $700 after insurance. Nothing wrong observed. I even raced Salt Lake Classic 10 K wearing a Holter monitor in 35:06, probably Utah state record for the Holter monitor division.

I became concerned when my heart beat started to feel odd, and my running performance began to get worse at the same time, so I went to the doctor and requested a thorough cardio testing. The problems went away to an extent when I made sure to get plenty of sleep. My energy levels and performance returned with an increase after replacing white flour, red meat, and milk products with whole grains, fruits, and vegetables.

My resting HR is 48, I can get it down to 45 by jogging a bit then sitting down for a minute, but it does not stay there. It goes as low as 42 when hanging upside down on the inversion table. Yes, I am a geek, I frequently take my pulse while hanging upside down. Interestingly enough, my resting HR has not dropped since the age of 16, but my max dropped considerably, from 195 to 175, while the running performance increased on all distances 1500+ with greater margins as the distances get longer.

[adam]

Sasha,
checking your pulse while upside is pretty awesome, but I'd say that there are plenty of us out there that do it at the oddest times. Not many other people than runners will go into the hospital for a checkup and guage the heart rate results like race results.

Nurse: Ok, so your at 42, that's pretty low...
You: Well, with Flat-Sea Level/Ideal Conditions adjustments thats going to really be around a 45. My 44 at Logan Regional in '05 was actually better...