Extreme athletes face extreme risks

As if last month’s 135-mile Badwater UltraMarathon wasn’t grueling enough, the winner reached the finish line only to throw up, then collapse from exhaustion. In extreme competition, it seems, the discomfort does not stop when the race is over.

For even some of the best-conditioned endurance athletes, nausea, vomiting and the inability to keep down fluids are hazards of extreme competition. Now these symptoms, when accompanied by changes in vital signs, have a name: post extreme endurance syndrome.

The term was coined by Dr. Hilary Ann Petersen, a third-year resident in emergency medicine at the University of Arkansas for Medical Sciences. The syndrome includes a drop in body temperature, low blood pressure and elevated heart rate, and may sometimes require intravenous fluid replacement. It affects endurance athletes, such as participants in ultramarathons (races longer than a 26.2-mile marathon), Ironman triathlons (in which participants swim 2.4 miles, bike 112 miles and run 26.2 miles) or Eco-Challenges in exotic locations.

“We’re documenting the number of people who are actually having these difficulties,” said Petersen, who has monitored ailing competitors at the 2001 Ironman Florida triathlon in Panama City Beach , Fla., and at the Ultramax Triathlon in Lake of the Ozarks, Mo., last September.

She found that 20% of the more than 1,800 Florida competitors and 30% of the 300-plus Missouri competitors appeared to have the syndrome. She reported the Florida results in April at the 32nd annual Sports Medicine Symposium of the American Medical Athletic Assn.; the Missouri findings will be presented at an American College of Emergency Physicians meeting in October.

Petersen, a two-time Ironman finisher, suspects that some cases are caused by hyponatremia, an over-hydration problem in which the blood becomes diluted and depleted of important salts like sodium and potassium. Others may be caused by dehydration or by a phenomenon in which the body shunts blood first to the muscles and then to the skin for cooling but doesn’t send enough to the kidneys and intestines. This cuts off the organs’ blood flow, creating injuries such as the bowel ischemia suffered by a 1995 Hawaii Ironman competitor who collapsed 100 yards from the finish line and later had inches of his bowel removed.

Dr. Paul D. Thompson, director of preventive cardiology at Hartford Hospital in Hartford, Conn., said that similar complaints, especially over-hydration and dehydration, occur among people finishing regular marathons in four or five hours. The popularity of marathons, he noted, has prompted participation by athletes who may not be as fit or as well-trained as they need to be.

As medical director of the Ultramax event, Petersen sent 15 race participants to the hospital.

“I think they’re suffering some really significant injuries,” she said. Previous studies showed some endurance athletes develop the elevated blood enzymes associated with heart muscle damage, but seem to recover. Similarly, some race participants suffer brain swelling from depletion of important salts from drinking too much water or too little.

Endurance events have the potential to be deadly, she said. “We’ve only seen fatalities in a number of marathons,” she said, “but with more people participating and those participants having less experience in the sport ... you have to question whether or not we’re going to see more and more of this.”

As for Pam Reed of Tucson, winner of the 2002 and 2003 Badwater UltraMarathons from Death Valley to Mt. Whitney Portal, she recovered and is contemplating a return in 2004.