Information for Endurance Athletes
Optimal Hydration - Establishing a Hydration Plan for Marathons
My letter to Santa Rosa Marathon runners
July 24, 2012
Dear Santa Rosa Marathon Runners,
I expect that you are every bit as excited about the upcoming race as I am, although for different reasons. Volunteering to help at races is fun, more so when it is a good race, and especially when I can make changes to make it even better. This one is going to be special.
This email is to inform you of some of the changes we are making to improve your experience, pass along advice to keep you out of the finish line medical tent, and to recruit you into a program that makes athletic participation safer for us all.
You have hopefully prepared thoroughly for the race, just as we have as a medical team. Our hope is to be entirely bored that day, with nothing to do but cheer every one of you as you sail through the race and set a PR with a smile on your face. We all know better, though so the medical crew have to be prepared for the worst. One of my colleagues and the “godfather” of marathon event medicine, Bill Roberts - Medical Director of theTwin Cities Marathon, has popularized the phrase “planned disaster” as a model for marathon medical preparations.
Since last year’s race, I worked at the Marine Corps, Houston and Olympic Trials Marathons as well as spending many days meeting with the medical directors of the big marathons. I am proud to be helping to develop a new organization (World Road Race Medical Society) to improve medical care at races. Those experiences, especially seeing how the staff at one or another race has learned to provide better care to their runners, bring me back to our race with many ideas to improve what was already good care and make it exceptional. We will be incorporating the best practices from those races that are suitable for our race. Just like you, we always want to get better. I have recruited an excellent medical team, including a diverse range of health professionals with extensive experience assisting injured runners.
A few changes will be readily visible to you. Besides the paramedics patrolling the course on bicycles, we will have first aid coordinators at the aid stations. Their responsibilities will be to identify runners needing medical assistance, provide some minimal care as necessary, and in consultation with me at the medical tent, arrange additional medical services for runners as required. Like the finish line medical tent staff, the first aid coordinators will be readily identifiable by their brightly colored t -shirts.
At the aid stations we will post flags indicating the risk posed by the weather, so that you can pace yourself accordingly. We will follow established guidelines for those flags (green, yellow, red and black). As our course is flat, largely shaded and graced by the practically idyllic climate of Santa Rosa, I cannot imagine you will ever see a black flag. A black flag means that the weather conditions are so dangerous that we need to cancel the race. There is an excellent chance that you will only see green flags, but if you see yellow or red ones, recognize that the conditions are less than ideal, potentially threatening, and adjust your pace accordingly.
Following guidelines established at the Twin Cities Marathon, we have an Impaired Runner Policy posted on the race website. It is as follows:
Medical personnel are authorized to remove from the race course any runner deemed medically impaired without an automatic disqualification. To be allowed to continue the race a runner must:
a) be able to proceed in a straight path toward the finish line;
b) be able to explain who they are, where they are on the course, and what they are doing;
c) look clinically fit to proceed, with good skin color and body appearance;
d) be able to maintain a reasonable running posture
Running a marathon poses an extreme physical and mental challenge. That is probably why you are running it. However, a few simple preparations will improve your performance, your overall experience, help you recover faster and keep you out of the finish line medical tent.
Day in and day out in my office I nag my patients about drinking enough water. That is because I have seen inadequate water intake create major health impacts on hundreds, if not thousands of patients. Many runners begin a race dehydrated, putting themselves at a competitive disadvantage. Hydrating in the days leading up to the race is wise. That will help you perform better, make you more resistant to the heat and lower the risk of some of the most serious problems that marathon runner experience. Alcohol dries you out and weakens your muscles. We are proud of our local wine industry, but even our magical wine will dehydrate you. Limit your wine tasting the day before the race.
Race day is different. Under the physiologic stresses of a marathon, your kidney function drops. While that conveniently limits your need for rest stops, it is also potentially extremely dangerous. If you drink a lot during the race and your kidneys have slowed down, the water content of your blood will rise, diluting the electrolytes essential to life. Drinking water or drinking a sports drink appears to have the same effect. After running 26.2 miles and burning off thousands of calories, these runners usually gain weight. This problem, exertional hyponatremia, kills a small number of marathon runners every year. The longer you are on the course and the more you drink, the more you are at risk. Drink by thirst during the race. For other reasons, a sports drink is the better choice during the race.
Another factor increases the risk of hyponatremia and other serious medical problems in marathon runners. That is using ibuprofen. As I told dozens of runners last year, we do not hand out ibuprofen at the race for this reason. That is now the standard at the major US marathons. We know better.
If you hurt yourself, straining any muscles in the week or two prior to the race, be careful about how fast you run the race. That is not just because of the risk of re-injury or another injury because your stride will be different from before. An injury also increases your risk of other, more serious problems. Go ahead and run if you are up to it, but avoid getting caught up in the excitement and running faster than you anticipated.
That advice is actually wise for every runner. When you are very near the limits of your ability, pushing harder is potentially dangerous, even life threatening. If you want to run another day, do not overdo it. There is truth in the tale of the first marathon runner, Pheidippides, with the heroic but unhappy ending. Don’t go there.
Although I am excited about all of the elements of our race and enjoy my involvement, something came up at the meeting of the World Road Race Medical Society held in conjunction with the Olympic Trials Marathon, which is even more important and exciting.
As you are unfortunately aware, we know that all of us, even marathon runners, eventually die, and heart disease, the biggest killer in the US, is a likely cause. Your running will probably delay it for years, but if you are going to have a heart attack, it is likely to hit while you are running. Most people who die of heart disease just collapse and are gone. We call it Sudden Cardiac Death (SCD). 85% of those who collapse from a cardiac die. That statistic has not changed in a generation. We now can change it though.
When a person has a sudden cardiac event and someone calls 911, the victim has less than a 10% chance of leaving the hospital alive. If that same bystander calls 911 but then provides the simplest form of CPR, using chest compressions alone, that victims chances jump up to 30%. In a way, the BEST CPR, the kinds provided by EMTs, doctors and nurses, isn’t. Waiting does not work. If YOU give it a try, that victim has a chance. If you don’t, they don’t.
In the last year, the Chicago and Boston Marathons both started Hands Only CPR programs at their races. With the support of our medical staff, Medtronic Foundation, our ambulance company (AMR) and Save Lives Sonoma, so are we. All of our volunteers will be going through HO CPR training in their orientation. During both days of the expo we will have HO CPR training available at no charge to you, your family and friends. At the finish line festival, we will have HO CPR training again available at no cost to you, your family and friends. We will also have survivors, including runners, speaking at the expo and at the finish line.
You can see who has gone through our HO CPR training by looking for the orange wristband they will be wearing. The wristbands say “I CAN SAVE A LIFE”. PLEASE consider attending one of the sessions. Please ask your support team to do the same. Wear your wrist band on race day. If you just can’t give up the 15 minutes the HO CPR will take, go to our website and check out the HO CPR links. The videos are fun and SHORT, like two to three minutes. There are even apps for iPhones and Android.
I will be giving a short talk at the prerace expo. I hope to see you there and not in the medical tent. Keep on eye on the schedule for these events.
Best,
Michael Carlston, MD