Weight Changes in First 20 Finishers, WHWR, 2008
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Weight Changes in First 20 Finishers, WHWR, 2008. Comparative scatterplots of Body weight change (%) v. Total performance time (minutes), WHWR2008 and SA Ironman2000/1. Adverse Medical Consequences of Prolonged Exertion Dr Chris Ellis, Kinlochleven Medical Practice.

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Weight changes in first 20 finishers whwr 2008

Weight Changes in First 20 Finishers, WHWR, 2008

Comparative scatterplots of Body weight change (%) v. Total performance time (minutes), WHWR2008 and SA Ironman2000/1.


Weight changes in first 20 finishers whwr 2008

Adverse Medical Consequences of Prolonged Exertion

Dr Chris Ellis, Kinlochleven Medical Practice.

So, when Persia was dust, all cried, "To Acropolis!Run, Pheidippides, one race more! the meed is thy due!Athens is saved, thank Pan, go shout!" He flung down his shieldRan like fire once more: and the space 'twixt the fennel-fieldAnd Athens was stubble again, a field which a fire runs through,Till in he broke: "Rejoice, we conquer!" Like wine through clay,Joy in his blood bursting his heart, - the bliss!

Robert Browning, 1879.

Pheidippides-First reported running related death, 490 BC


Purposes of this presentation

Purposes of this presentation:

1) To heighten awareness of serious medical problems that may arise.

2) To enable early recognition and treatment.

3) Prevention (of some).


3 categories of serious adverse medical disorders of endurance exercise

3 categories of serious adverse medical disorders of endurance exercise.

1) Sudden death (usually cardiac).

2) Rapidly but not immediately (within hours to days) life threatening , which may be specifically exercise associated e.g. exercise associated hyponatraemia, rhabdomyolysis, exertional heatstroke, or non-specifically exercise associated, e.g. brain haemorrhage.

3) Limb, but not life-threatening , disorders which are usually musculo-skeletal, eg. compartment syndrome and fractures.


Sudden death

SUDDEN DEATH

1) Rare.

2) Usually (but not exclusively) cardiac.

3) When cardiac, cause usually governed by age:

Under 35 years-Inherited cardiac defect.

Over 35 years-Diseased arteries

Marc-Vivien Foe (Deceased)

Jimmy Fixx (Deceased)


Rapidly life threatening disorders specific to exercise within hours to days

RAPIDLY LIFE-THREATENING DISORDERS SPECIFIC TO EXERCISE.(Within hours to days). 

1) EXERCISE ASSOCIATED HYPONATRAEMIA (EAH).

2) RHABDOMYOLYSIS with COMPLICATIONS.

3) EXERTIONAL HEATSTROKE.


Exercise associatedhyponatraemia eah

EXERCISE ASSOCIATEDHYPONATRAEMIA (EAH).

  • EAH is low blood sodium.

  • Cause is too much fluid NOT lack of sodium.

  • EAH symptoms.

  • Confusion, fits, coma, death, others.

  • EAH is real.

  • Boston marathon study 13% runners, 0.5% critical. 9 known deaths worldwide. 4 known cases in WHWR since 2005, 1 life-threatening, 1 with fits .

  • EAH risk factors.

  • Drinking more than need, weight gain, female, slow pace, over 4 hour event, anti-inflammatory medication.

  • EAH is substantially avoidable.

  • Drink by thirst. Avoid NSAIDs. Weight monitor during race.

  • EAH has low incidence in NZ and SA.

  • Reduced incidence in countries where “keeping ahead” with fluids and “maintaining weight” no longer advocated.

David Rogers (Deceased), London Marathon, 2007


Weight changes in first 20 finishers whwr 2008

RHABDO

MYOLYSIS

Disorder of muscle breakdown with liberation of cell contents into body.

Everyone has this to some degree, but complications are the problem.

Rhabdo symptoms.

Muscle pain. Dark urine. Lack of urine. Lack of well-being. Vomiting.

Rhabdo complications.

Affect some people. Kidney failure, death (and others).

Rhabdo is real.

Four cases from WHWR since 2005, two with kidney failure.

Rhabdo prevention.

Less preventable than EAH. Anti-inflammatories and viral illness are risk factors.

Suspect early to minimise complications. Report dark or reduced urine, inordinate muscle pains.


Exertional heatstroke elevation of core temperature above 40 degrees plus brain impairment

EXERTIONAL HEATSTROKEElevation of CORE temperature above 40 degrees, PLUS brain impairment.

  • Heatstroke is rare. Not seen so far in WHW race.

  • Heatstroke symptoms are initially vague.

    Non-specific confusion/lack of well-being. Mortality, once established, is high.

  • Heatstroke cause.

    Overproduction of heat from muscles with which body can’t deal, probably due to combination of, exercise, inherited disposition and further unknown trigger.

  • Heatstroke is NOT same as “hot”.

    Exercise can cause the core temperature to rise without symptoms or significance.

  • Exertional heatstroke prevention.

    Suspect disposition if previous problem or severe “heat reaction” to anaesthetic or other drugs. Measure “core” temperature. High suspicion needed. Treat early and aggressively and accept unneccessary treatment. Emergency hospitalisation often needed.


Significant musculo skeletal disorders

SIGNIFICANT MUSCULO-SKELETAL DISORDERS

Numerous-too many to mention individually.

Either sudden (e.g. fracture), or overuse (e.g.”shinsplints”, stress fractures, ITBFS).

Tibial stress fracture

Metatarsal stress fracture

Except...................................


Acute compartment syndrome

ACUTE COMPARTMENT SYNDROME

Swelling of muscle group within enclosed sinew (fascia), following injury or overuse. May be associated with constricting bandage or plaster cast.

This is an emergency, take off bandage if applicable, if not, needs urgent surgery.


Exercise associated collapse eac

EXERCISE ASSOCIATED COLLAPSE (EAC).

RULE OF THUMB:

Collapse shortly after finishing the race or a stage is usually trivial if the runner finished symptom free.

Collapse while running, or considerably after, is usually serious and needs medical assessment


Conclusions everyone involved in the whwr should know of and suspect appropriately

CONCLUSIONSEveryone involved in the WHWR should know of and suspect appropriately:

1) Exercise associated hyponatraemia

2) Rhabdomyolysis

3) Exertional heatstroke

4) Compartment syndrome.

5) Causes of collapse, serious or trivial, on the basis of timing.

6) Risk reduction strategies by avoidance of overdrinking and NSAIDs


Weight changes in first 20 finishers whwr 2008

FURTHER READING:

WHWR website, Medical Guidelines

THANK YOU and QUESTIONS.

This Camelbak’s killing me!

This camelback is killing me!


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