Tales from the medical tent

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I helped provide medical coverage at two races over the past two weekends. First, for the high school portion of the Roy Griak Invitational cross-country races at the University of Minnesota, and second, for Twin Cities in Motion Race Weekend, which included the Medtronic Twin Cities Marathon, 10K, 5K, family mile, and kids' half mile. Here are some medical tips from the potpourri of races.

Pace yourself

Kids are always fun to watch, but their enthusiasm at the start leads to trips and falls resulting in skinned knees and hands. What adults and high school racers can learn from kids is to curb that enthusiasm. Not that adults and high schoolers trip each other at the start, but they often forget about pace. Abandoning pace early in the race can lead to disaster in the second half of the race, often leading to a DNF or a much slower than anticipated race time. Better to start a little slow and kick it in the end, than to crash and burn midrace.

Bring your inhaler

If you have asthma, you should have your inhaler with you tucked in a pocket and available if you need it. You should not rely on the chance that you will need it and be in front of a medical crew with an inhaler in hand. I saw lots of runners with “asthma” at all the races. The interesting thing from my perspective was that none of them were wheezing and their lungs were clear. Shortness of breath can be caused by vocal cord dysfunction, which occurs when the vocal cords come together rather than separate during inspiration. It is common in stressful situations like racing and is often mistaken for asthma. It is possible to have both asthma and vocal cord dysfunction. If you have not had asthma documented with pulmonary function testing, it is possible that you may not have the correct diagnosis. Meet with your doctor to have your asthma tested.

Take your meds

If you normally take prescription medication, especially medication that controls your heart rhythm and rate, do not skip it on race day, unless your doctor instructs you to do so. You can end up with your abnormal rhythm breaking through during the race. This can be dangerous for you, and it forces medical providers to care for a preventable problem.

Feeling ill? Stay at home

Aaron Baggish, a cardiologist who works with Boston Marathon Medical and is an accomplished runner, says it best: “respect the virus!” Viral illnesses produce an inflammatory response throughout the body and that includes the blood vessels. Inflammation in the heart's blood vessels can lead to cell changes that affect your future health. If you are ill with a virus, don’t run. One of the common findings in exertional heat stroke victims is a viral illness in the week or two preceding the race. We had a heat stroke case at Twin Cities this year even though the start temperature was 4ºC and the temperature at noon was 10ºC - beautiful conditions for a marathon, not the temperatures you expect to see exertional heat stroke at. Again, if you have been ill with a virus in the days leading up to the marathon, you should consider not starting or at a minimum slowing your pace.

Don't ignore pain 

While you can get away with running injured some of the time, the time you do not get away with it can be disastrous. We are taught early in medical training the hip pain radiates to the knee and knee pain radiates to the hip. The learning point for us was to check the joint above and below. We had a runner with thigh pain that was attributed to iliotibial band syndrome. Unfortunately, it was not iliotibial band syndrome. The runner suffered a complete hip stress fracture that had to be surgically repaired. All turned out well in this case, but I have seen stress fractures go to complete during competitions with some hard falls leading to collateral injury that could have been avoided with a proper diagnosis for the pain. Many of these completed stress fractures end up in surgery that could have been avoided by taking the time to get a diagnosis and allowing the stress fracture to heal.

On the good side, 99-plus per cent of those who started the races finished uneventfully. Some faster than anticipated, some slower, but lots of fun for many runners of all ages. As we approach the end to the autumn racing season, good luck to all and listen to your bodies.