Beginner Ultra Runners - Medical Conditions in Ultra Running

This episode of Tales From The Midpack is with a Trauma Nurse Manager at medical centre who has also worked in ICU, and a GP who works for Royal Flying Doctors. They are both experienced runners. Below is a break down of the information from the episode about the medical conditions trail runners can fact running ultra marathons. Link to Episode

Thumbnail for medical episode of beginner series for ultra runners.

Remember:

·      There can be other causes of these conditions; just looking at ones connected to ultra running.

·      Learn your body’s comfort level, and what gets sore normally when you run. A red flag is something that feels different for you.

·      Everyone arrives at the start line in a different physical state. Age, fitness, level of training, temperature of the day, what medications you’ve taken, where you are in your menstrual cycle, your level of hydration, recent illness, life stress, undetected preexisting medical conditions, etc all affect the speed at which a condition can affect you.

·      *Most symptoms overlap with other conditions.

·      The seriousness of the condition is also affected by how remote you are, how long it would take for medical assistance to reach you, how risky it is for others to reach you, how long it would then take to get you to an appropriate medical facility, what safety gear you are carrying. Think about all of that before leaving an aid station.

·      Be experienced on the trails, and learn about your body.

Exertional Rhabdomyolysis
What It Is	Break down of muscle cells from over exertion. The proteins and other bits and pieces inside the cell are released into the bloodstream, which has downstream effects. It’s the myoglobin protein component that gets leaked out of your muscle cells. It’s a really big protein so it can’t filter through the normal kidney filtering system. It essentially blocks it, so you don’t get good blood flow to your kidney, then you can go into acute kidney failure.
Things To Know	Often have no baseline diagnostic creatine kinase level, and that can rise for other reasons such as dehydration. It is variable between people. There’s a couple of other things released from muscle cells as well. Particularly potassium, which is important for regulation of heartbeat so you can get arrhythmia as well with rhabdomyolysis because you’ve got all these other things that aren’t supposed to be in your bloodstream circulating around, which is really dangerous.
Key Symptoms	Reddish brown urine (like tea, and when really bad like dark tea, coke, coffee) – stand out symptom *Muscle pain beyond what you normally experience *Muscle weakness beyond what you normally experience *Fatigue beyond what you normally experience *Swelling in feet beyond what you normally experience *Muscle swelling *Confusion / altered mental state
Prevention	·      If you had a recent illness, particularly one that has dehydrated you, question whether you should run. ·      It takes several years to train your body to tolerate that short of stress; make sure you are well conditioned before going into an ultra. ·      In stage races there is a build up of fatigue and there can be trouble rehydrating in between or being at a well hydrated and balanced level. ·      Don’t take NSAIDs (Non-steroidal anti-inflammatory drugs) even topical ones. Eg ibuprofen, aspirin, voltaren, diclofenac, nurofen. More cumulative effect of insults on the kidney. They reduce prostaglandins, which are really important in inflammation, healing torn muscles, and protecting our gastrointestinal tract, sodium and water balance, blood flow. NSAIDs reduce the blood flow to the kidneys a bit more, and it might be enough to tip you into an acute kidney injury. If you need pain relief, use paracetamol.
Treatment	·      Rest ·      Drink fluids
Call For Help	When you see dark red/brown urine that is late stage (dark tea, coke, coffee): stop running and call for help.

Heat Exhaustion / Heat Stroke
What It Is	Both are a form of hyperthermia. In heat exhaustion participants collapse after exercise and are likely suffering from post exercise drop in blood pressure. Heat stroke is those who show signs of altered mental function, loss of consciousness, or collapse during exercise and their core temperature is now over 40°.
Things To Know	Only reliable source to measure temperature in someone who's suffering from heat stroke is with a rectal thermometer. Heat stroke is severe and life threatening. Core temperature changes the way your body cells work and the chain reaction inside your body is catastrophic. So organs won't function properly anymore. People need to be in hospital to cool down properly.
Key Symptoms	Heat Exhaustion Collapse after exercise Heat Stroke *Confusion / altered mental state / irrational behaviour *Loss of skill / coordination / steadiness Collapse during exercise *Seizures Cessation of sweating *Shivering Both *Light headedness / dizziness *Nausea *Fatigue beyond what you normally experience *Ash and grey pale skin *Vomiting *Gait change / staggering
Prevention	·      Heat acclimation during training ·      Keep up hydration ·      Train in the conditions you’ll experience ·      Pre hydrate (not too much) ·      Stay cool prior to running ·      Prevent sunburn ·      Allow convective heat loss through skin (without sunburn) ·      Cool self during event
Treatment	·      Mild heat stress is where you feel hot, your heart rate might go up, your skin goes red, you feel really thirsty. It can be reversed by stopping activity, having a drink, and getting in the shade. ·      Heat exhaustion might be recoverable with those things plus taking in salts. ·      Ice packs in armpits, groin, around the neck.
Call For Help	If heat stroke is suspected. Stop. Dump them with water or anything else that will cool them down, put them in the shade, call for help.

Hypothermia
What It Is	The body loses heat faster than it can produce it and core body temperature drops too low.
Things To Know	You shiver between about 35.5 to 36 degrees. When your core temperature drops below 35, you don't shiver anymore and that's really, really dangerous. Shivering burns a lot of oxygen and energy in your muscles to keep you warm, so you're also spending a lot of your remaining energy on shivering and you can't afford to do that. If you get too cold your thermoregulator changes and you might feel hot if you’re under 35 degrees.
Key Symptoms	*Altered mental state *Drowsy *Stopping shivering *Blue lips *Muscle incoordination Fingers and toes aren’t working normally
Prevention	·      Run with extra layers ·      Get in to warmer clothes when needed ·      Avoid getting wet
Treatment	·      Find shelter ·      Strip off wet clothing ·      Layer up with dry clothing ·      Get out of the cold ·      Warm up slowly (use warm fluids) ·      Replenish energy
Call For Help	When you’re not shivering and you think you should be. Real difficulty keep awake. Altered mental state. Feeling hot when you shouldn’t be.

Snake Bite
Things To Know	You don’t need to have seen the snake to take it seriously that you’ve been bitten by a snake. You don’t need to find out the type of snake. Do not assume the bite is a dry bite. It doesn’t need to be a poisonous snake to experience envenomation (you don’t know what you’re allergic too until you’re bitten). Don’t wash or wipe the area.
Key Symptoms	Sudden whack Puncture holes
Prevention	·      Give snakes a wide berth. ·      Carry a snake bandage ·      Wear gaiters ·      Avoid rocky sunny areas / tall grass
Treatment	·      Stop. Stay still. ·      Pressure immobilise from the end of the limb, working all the way up. If you have another bandage, put that on too.
Call For Help	Immediately

Hyponatraemia and Hypernatraemia
What It Is	Hyponatraemia - There is not enough sodium in your blood. Hypernatraemia - There is too much sodium in your blood.
Things To Know	If you're if you're just drinking water, which is a hypotonic fluid (it has no salt in it or no electrolyte in it) you are going to get hyponatremic, you have low sodium. When we sweat, we sweat out salt. Just because you've lost sweat, it doesn't mean that you've lost sodium in the same proportion as in your sweat. Between people there's wildly different rates at which they lose sodium with their sweat, but within themselves people stay quite consistent with that. What causes problems with hypernatremia is brain swelling (cerebral edema).
Key Symptoms	Hyponatraemia *Headache *Nausea Swelling in hands, feet, face Hypernatraemia *Thirsty Both *Altered mental state *Vomiting
Prevention	·      If you're going to be sweating for hours on end, you've got to replace the salt. ·      Hydrate based on your own biometrics, the conditions you're running in, and the training you’ve done. ·      Learn your sweat rate in a range of conditions. ·      Find out your sodium loss rate. ·      Practise hydration in training.
Treatment	Hyponatraemia ·      Take electrolytes Hypernatraemia ·      Reduce intake ·      Body may urinate and sweat to bring back balance
Call For Help	Altered mental state, a lot of vomiting where you can’t replace the loss of electrolytes and water)

Returning Post Childbirth
Things To Know	What’s shown in social media isn’t the reality for all women. Being pregnant and giving birth is a massive medical and physiological and musculoskeletal change that takes a long time to recover from.
Key Symptoms	A lot of injuries Urinary incontinence
Prevention	·      Work with a women’s physio
Treatment	·      Work gradually on reconditioning.

Running Ultras On Medication
Medications	NSAIDs Aspirin Statins Diabetics Diuretics Fluoroquinolones Medication that affects blood pressure / heart rate
Action	Talk to your GP about what that means for you.