Heart of the Matter

Attention Road Race Runners : Need to Beat That Heat!

Heat injury. What do you do with a temperature of 109?

Yikes! Can your temperature actually get to 109? Amazingly about the highest temperature you can get from an infection is about 105 in kids and about 103 in adults. If you have been unfortunate to have such an illness you can probably remember how awful you felt. However running in hot, humid weather can get your temperature up over 109! We see it all the time in the Falmouth Road Race with somewhere between 10 and 60 runners affected each year depending on the weather.

These folks not only feel awful but are at risk for permanent injury or even death. Each year nearly 500 people in America die from heat stroke. Most of these are elderly folks with chronic illnesses living in Arizona in the summer but some are fit, young and healthy individuals who die in the Grand Canyon while hiking or in road races in hot weather. A larger group won't die but wind up in hospital for days or weeks and have permanent kidney or brain injury. Not something to trifle with.

Because it is run in August and because the temperature and humidity can both be high, the Falmouth Road Race has seen a large number of affected people. The medical teams at the race are well versed in care of individuals with heat injury and can quickly diagnose the problem, its severity and treat people on the spot. Prompt diagnosis and treatment are essential to prevent complications. It is our experience that high humidity is the biggest contributor so when the humidity is above 70% we expect trouble. Over the 35 years of the Falmouth Road Race we have learned how to diagnose and treat heat injured people quickly and efficiently. Happy to say that despite treating nearly 1000 runners we have not had a serious complication or death. Knock on wood!

So of the 10,000 runners who are the 50 who will become ill? The short answer is that it is unpredictable. We have had runners who won the race and collapsed (Alberto Salizar in 1978) a Russian woman who was leading at the 6 1/2 mile mark and back of the packers. One key element is that people are pushing hard whether to win the race or break an hour and the weather is hot and humid. A disproportionate number of people are young, less than 25, male, relatively out of shape, went out drinking the night before and are trying to beat their friend's time. The combination of the poor judgement of youth, a sense of invincibility and dehydration from too much alcohol is a bad combination.

Typically, the medical teams stationed over the last 2 miles of the course will get a call on the radio from spotters that someone has collapsed. A key sign of heat stroke is delerium (confusion) and weak legs. The team quickly gets the person on a stretcher and rushes them to one of the three medical tents. There vital signs are taken including a rectal temperature. If they are confused, passed out and have a temperature over 106 they are unceremoniously dumped in a bathtub sized pool filled with ice. To anyone with normal body temperature this would be uncomfortable to say the least but to someone with heat stroke they usually lie back oblivious to the intense cold. We monitor blood pressure, pulse and temperature continuously and when the temperature reaches 102 we take them out. Usually by that time the entire tub of ice has melted! If people regain their bearings and feel OK we can get them on their way within an hour. If not they may need a few hours or overnight monitoring in the hospital. The key to this approach is to get people in the ice within 10 minutes of collapse and to get them out before they get too cold. (For a more thorough discussion of this topic see the excellent article by Douglas Cassa, et. Al. In July 2007 in Exercise and Sport Sciences Reviews) I am happy to say that the experience at the Falmouth Road Race over the years has helped to define this illness and its treatment.

So unless you want an ice bath and a rectal temperature, drink a lot of water, cool off during the race and slow down or stop at the first sign of dizziness or weakness. Mostly, just run within your limits and enjoy the scenery.

The wellness program will be well represented at the Falmouth Road Race number pick up and expo on Saturday August 9 from 10am to 3pm. We will have Dr Sbarra there to answer questions and will be continuously raffling off free Carotid Intima Media Thickness determinations. We will also perform CIMTs for all those who want to understand their risk of heart disease. There will be a special expo price of $175. Gift certificates for future tests will also be available. On your way to buy a tee shirt, stop by to visit our booth.

If you are running on Sunday, GOOD LUCK and don't forget to stay cool and hydrated. If you start feeling dizzy and weak, don't just keep going, pour water on your head, walk a bit and cool off. We don't want to see you in the medical tent. I will give a report of the race in my blog(at Capecodtoday.com) next week. You don't want to find your case of heat stroke described there