Name Time (mins) Start A’tyre K’leven Finish % change

Jens Lucas 1026 67.7 67.3 62.4 62.2 -8.1%George Cairns 1060 75.6 74.6 71.0 69.2 -6.0%Ritchie Cunningham 1107 67.2 66.4 62.4 62.0 -5.7%Alan Reid 1144 75.3 74.6 70.9 70.9 -5.8%

Murdo McEwan 1148 74.2 74.8 72.6 72.2 -2.7%Mick James 1148 69.8 69.6 67.2 67.1 -3.9%Phil Mestecky 1154 94.4 93.8 88.4 87.9 -6.9%

Donna Utakis 1178 52.2 52.2 49.5 49.2 -5.7%Ernest Fink 1193 72.9 73.9 70.5 69.6 -4.4%Gavin McKinlay 1194 81.8 80.2 75.8 78.2 -4.4%John Kynaston 1199 80.2 80.4 79.2 78.5 -2.1%Hugh Kerr 1220 79.2 79.0 76.3 76.2 -3.8%Craig Liddle 1228 69.4 70.1 67.3 67.4 -2.9%Dave Atkinson 1230 76.5 76.2 72.9 73.1 -4.4%Colin Hutt 1234 76.2 76.6 72.3 72.5 -4.9%Brenan Morgan 1236 71.7 71.8 68.8 68.9 -3.9%Lynne Kuz 1239 66.1 66.0 63.0 63.2 -4.4%Marco Consani 1247 77.2 78.6 75.1 76.5 -0.9%Andrew Coulhurst 1254 74.8 74.6 72.0 72.3 -3.3%Tommy Hepburn 1256 78.0 78.3 74.3 74.8 -4.1%

5.02.50.0-2.5-5.0-7.5-10.0-12.5

1300

1250

1200

1150

1100

1050

1000

Body weight change (%).

Tota

l perf

orm

ance

tim

e (

min

ute

s).

WHWR 2008 Weight change (% ) v. Finishing time (mins), first 20 finishers.

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 ExertionDr 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 shield

Ran like fire once more: and the space 'twixt the fennel-field

And 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

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

2) To enable early recognition and treatment.

3) Prevention (of some).

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.

1) Rare. 2) Usually (but not exclusively) cardiac.3) When cardiac, cause usually governed by age:

Under 35 years-Inherited cardiac defect.

Marc-Vivien Foe (Deceased)

Over 35 years-Diseased arteries

Jimmy Fixx (Deceased)

1) EXERCISE ASSOCIATED HYPONATRAEMIA (EAH). 2) RHABDOMYOLYSIS with COMPLICATIONS.3) EXERTIONAL HEATSTROKE.

David Rogers (Deceased), London Marathon, 2007

•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.

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.

• 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.

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...................................

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.

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

1) Exercise associated hyponatraemia2) Rhabdomyolysis3) Exertional heatstroke4) Compartment syndrome.5) Causes of collapse, serious or trivial, on the basis of timing.6) Risk reduction strategies by avoidance of overdrinking and NSAIDs

 

FURTHER READING:WHWR website, Medical Guidelines

THANK YOU and QUESTIONS.

This camelback is killing

me!

This Camelbak’

s killing me!