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Weakest Link

19 07 2010

My Observations and Insights on Running and Heatstroke:

1. In the summer of 1971, two of my classmates died due to heatstroke after participating in a 10K run in Fort Magsaysay, Palayan City (Nueva Ecija) as a “fun run” with the Special Forces of the Philippine Army where you don’t see any Water Aid Station along the route. The race started late in the morning as most of my classmates finished under the heat of the sun. I saw with my own eyes while two of my classmates convulsed and crawled on the edge of the road, few kilometers from the finish line until they were picked up by the Camp Hospital’s Ambulance. Four of my classmates were evacuated at the Fort Magsaysay Hospital but the two of them were able to recover after a day of rest at the hospital. One of my classmates won the “fun run” as he had been a seasoned runner before he entered the Academy.

2. I saw how my two classmates convulsed and sedated inside the hospital. After a few hours, one of them died. On the following day, the remaining serious patient was transported to V. Luna Medical Center using the Ambulance but after his arrival in Manila, my second classmate died also. The doctors and medical staff at the hospital informed our Tactical Officers that our classmates died due to heatstroke! I don’t have any information if the said incident was fully investigated by the Philippine Military Academy and AFP authorities then. However, my deceased classmates were brought by the PMA authorities in their respective places/towns and they were buried with full military honors and their respective parents received death benefits due to a dead soldier/officer of the AFP. Case closed!

3. Two of my classmates who recovered with the case of heatstroke on that fatal day in the summer of 1971 were very lucky. One of them retired from the PNP two years ago as a two-star General/Police Director while the other one was dismissed when we were on our second year due to failure in Academics but had pursued/finished his College studies, worked in one of the telecommunication firms and now resides in the United States with his family. Both of them had never attempted to train or run in any of the road races since this incident.

4. Fast forward to the last week of January 2009 (last year). Jerry Karundeng, an Indonesian studying in the Philippines, joined the “50K test run” in preparation for the 1st edition of BDM 102. He is a strong runner but he is also a “hard-headed” runner that he did not follow my advise and “tips” while we were running on the course. He was wearing a black shirt, did not drink in every hydration station, was not carrying a hydration belt, and his pace was too fast in relation to the hot condition of the day. His mind was so conditioned to use Pocari Sweat as his sports drinks while my staff was serving Gatorade as I believed, they have the same use for hydration in endurance sports. Jerry finished the “test run” but on his way to Manila while aboard a vehicle, he started to experience “signs & symptoms” of heatstroke. Thus, he was brought immediately to a known Medical Center in Makati. According to my interview with Jerry, the Doctor/Medical Staff who attended to him did not believe that he just finished a 50K run under the heat of the sun! He was given with IV fluids immediately with the thought that he was dehydrated. Jerry was lucky that his body systems stabilized and had undergone some blood test in the said hospital. He was released on the same day that he was brought to the hospital and he was able to commute from Manila to Silang, Cavite. A day later, he consulted their resident doctor in their school and showed him the results of his blood test, the resident doctor explained to him that his blood sodium content was way below the average level. It was a conclusive evidence that Jerry was on the verge of being a victim of heatstroke. (Note: You can read more of the details of Jerry’s experience in his blog at www.highaltitude.wordpress.com)

5. On August 23, 2009 after the CAMSUR 70.3 Ironman’s last athlete reached the Finish Line, the Race Organizer admitted to media reporters that one of the participants, a Senior Executive and Owner of a Corporate entity, died during the triathlon event and he admitted also that a thorough investigation was being conducted. The news was reported on line and in the printed edition of the Philippine Daily Inquirer as soon as possible and it was featured at TV Patrol a day after the event. (Note: This is the exact opposite of Remus case where PDI reported his case on line and its printed edition exactly 14 days after the marathon event!!!). However, up to this time, nothing had been officially published if the casualty was a victim of heatstroke that resulted to a heart attack. 

6. In the 34th MILO Marathon Manila Elimination last July 4th, Remus Fuentes died two days after he was diagnosed as a victim of heatstroke which led him to succumb to a fatal heart and organ failures that resulted to his death. After a few days, Alexander Landera from Cebu City fainted or collapsed in the middle of a road race held in the same City where the race was held in the evening. He was brought immediately to the hospital to be treated. Unfortunately, when he regained consciousness, he started to be incoherent, confused, hallucinating, and thought that he was still in the race. Due to multiple wounds and loss of blood as a result of uncontrollable actions on his part, he died. Both runners were victims on separate road races, belong to different ages and running backgrounds, races held in different locations, different race distances, different weather conditions, and different parts of the day when their respective races were conducted (Remus’ race was in the morning while Alexander’s race was in the evening) and despite such factors, both runners died due to heatstroke! However, in Remus Case, the father was able to document his observations on what the Doctors/Medical Staff had done for his son’s treatment in the Hospitals where his son was admitted.

7.  So, what am I trying to say in this post? With my observations, researches and interviews, I firmly believe that our Doctors/Medical Practitioners could not distinguish if an endurance athlete (runner, ultrarunner, cyclist, triathlete, swimmer or hiker/mountaineer) is a victim of heatstroke or dehydration. Anybody could say that he or she is a “running expert” and say to high heavens and to all the media and Internet outlets/sites all the things and advises as preventive measures from being a victim of heatstroke and dehydration but what should be addressed is on the correct and appropriate treatment of heatstroke. I think, the problem lies on how our Doctors and Medical Practitioners in Hospitals react and treat endurance athletes who are victims of such mentioned heat-related injuries. This is the “weakest link”!!! Correct me if I am wrong, our Doctors (who are not seasoned/competitive runners) do not know how to deal with such cases!

8. In the book “Lore of Running” by Dr Tim Noakes on page 235 states that, “the major factors causing heatstroke during races are: environmental conditions; the speed at which the athlete runs; and individual susceptibility, including whether or not the athlete has preacclimatized to running in the heat. If longer distances races (5K and above) have a prevailing temperature condition of greater than 28 degrees Centigrade, heat injury will occur to a significant number of competitors, regardless how much amount they drink and sponge during the race or how they are dressed. Adequate fluid replacement during racing is only one of the many factors that reduce the risk of heat injury; it is certainly not the only factor and may not even be a very important factor. Aside from “hot and humid” temperature as one of the factors that determine the rate at which an athlete loses heat, clothing is also considered because the more clothing people wear, the less heat they will lose by convection and sweating. The athlete’s state of heat acclimatization (training to heat exposure) and state of hydration (not allowing yourself to be dehydrated) also determine the rate an athlete loses heat from his body.” It could be weird but Dr Noakes believes that only certain people are prone to heatstroke and it could be hereditary, too!

9. In Dr Noakes’ book (which I consider as my “Bible” in Running), a heatstroke victim has a body temperature of more than 40 degrees Centigrade; he/she breathes heavily; and has a rapid pulse rate of 100 or more beats per minute. A heart attack victim has a weak heart beat & pulse rate and the patient does not breath. In a heatstroke patient, a rectal temperature reading should be administered first to find out the exact body temperature of the victim. If the temperature readings indicate a result of 40 degrees and higher, the victim’s torso should be submerged in a tub or container full with ice or ice-water for the duration of 3-6 minutes until the temperature decreases to the normal level of body temperature. After the body temperature has dropped to its normal condition, IV fluids and other blood tests can be administered to check if the victim is dehydrated or if there is kidney damage or organ failure.

10. In simple layman’s term, diagnosing and treating heatstroke is very simple. But according to my favorite author and strategist On War, Carl Von Clausewitz, “The simplest things are the hardest things to do”! And be always safe and careful from the dangers of the sports and way of life that we love and enjoy but always remember that, “Shit Happens” when you least expect it from happening.

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19 responses

19 07 2010
jetpaiso

nice post sir jovie! thanks for sharing!

20 07 2010
kingofpots

i hope more of our runners would be able to read this post. thanks

19 07 2010
fanaticinformant

The real issue here is not the lack of knowledge, but often it is that of “pride” that gets in the way, as the case with Jerry of the BDM run. He wanted to do it his way, and did not follow the advise of those who know the environment better than him.

The death of Remus and other runners due to heatstroke could have been prevented. Basic knowledge. Just because one doesn’t feel anything doesn’t mean that one does not have any condition. In fact, isn’t that what doctors tell us that the easiest sign of dehydration is that of thirst?

20 07 2010
kingofpots

i hope jerry would be able to run with us in our PAU runs. he has the makings of being the “karno” of indonesia..running experts and studies suggest that every runner should not wait being thirsty during the race.

19 07 2010
gingerbreadrunning

Excellent ,well-researched article Sir Jovie, thanks for posting. I guess this all shows us the frailty of life, and we never really know.

20 07 2010
kingofpots

you are right..life has its start and end. just like a road race but we have to enjoy the journey in-between these points.

19 07 2010
Dunk??……………..? | Freestyle Dunk

[…] Weakest Link « Bald Runner […]

19 07 2010
lonerunner

It is good that there are blogs like this to spread important info about running. Cheers!

20 07 2010
kingofpots

where have you been? we missed you!

20 07 2010
runnerforchrist

Thank you for sharing these facts to the running community…We can survive a 102 and perhaps a 151 but moderation and simply listening to our body is the key.

furthermore, Death comes to us all, even while running. The question is, are we ready?

20 07 2010
kingofpots

for me as a senior runner. i’ve done this and that…and i am fulfilled, i guess, i am ready as i accept the fact that there is always an ending/destination to a journey

20 07 2010
i2runner

Sir Jovie, this is probably one of the best post I’ve read in your blog. I agree with you that doctors could have a hard time diagnosing a real heatstroke from a heart attack. And small mistake is usually fatal. I also agree with Milo that Remus may have had a better chance of survival if the official ambulance was able to get to him first. However, we do not know the real story of what happened. We also cannot judge if Remus has trained well or not for the event. During a race, we often run our best and we experience all kinds of pain and try to mask all of them mentally, including heatstroke. Looking at Remus’ pictures in Photovendo (he has a lot more in there), he doesn’t look tired or exhausted at all. He looks great. No signs of heat exhaustion or heatstroke. That scares me.

21 07 2010
kingofpots

you are right. from the pictures of remus during the run, he was fine and did not look stressed out. so, there might had been something that happened when he was given a immediate medical attention. that is the point i am trying to drive at.

20 07 2010
i2runner

Sir Jovie, add ko lang…. By the way, to be honest with you, I was expecting some runners to actually die of heatstroke in your BDM race. But thank God everybody survived. Looks like you did a great job of preparing everybody in the race. 🙂

21 07 2010
kingofpots

that’s the beauty of a race organizer who really runs and had experienced what it takes to run such distance.

21 07 2010
Tin

I agree, PAU at Sierra Madre was a killer also. But other than runner’s support vehicles (which are mostly runners also), the aid stations are manned by the elites who know exactly what to do.

Natz, kinabahan tuloy ako sa BDM. =)

Sir, just curious – in other countries, do they have an accreditation for Race Organizers? Probably that would help standardize things and ensure that certain regulations are followed, esp the basics.

20 07 2010
beeps0503

Sir Jovy,

Thank you very much for sharing your insight and observations. I really appreciate the education and information you provided us. It will always boils down to each and everyone of us. It is a sole responsibility of a runner. It is the runners ultimate mindset on every road runs he run. Challenges are great & this great challenges should be well planned & prepared off.

Btw sir, me & John will be joining the PAU this coming Aug29. I hope Sir Mark Parco is still in the Phils to join us. He is now base in Indonesia.

Beeps/APL

21 07 2010
kingofpots

thank you very much!

27 07 2010
docchester

an addendum, if i may tio, that aside from familiarizing about heatstroke and dehydration, runners especially ultra runners must also acquaint themselves of hyponatremia (low blood sodium) or water intoxication. reading from the same “bible”, i got more scared of this than heatstroke or dehydration. Based on Jerry’s blood test result, i might deduce it was hyponat. I think this is the reason why they get a blood sample every so often at the ultramarathon in jeju -to check blood sodium level.

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