Western States Doc

Saturday, I spent most of the day as "medical director" of the Foresthill aid station at mile 62 of the Western States 100 Mile Endurance Run (I always wonder why they put "endurance" in the title, as if there could be a 100 mile sprint). I showed up just as they were setting up the aid station, the first medical person to arrive.

Luckily, a bit later some more help arrived, including 2 ED nurses, who had a number of years experience at this and other ultras, thereby knowing much, much more than me about what to do and expect.

I had made a list of all the really bad things that we could see (syncope, seizure, mental status changes, chest pain, respiratory distress, etc) and what we should do about each. Luckily the list was unnecessary. The temperatures were relatively cool (highs maybe in the upper 80s, 15-20 degrees cooler than typical) so runners did well. We didn't start a single IV and had to have very few people sit and rehydrate.

Runners are weighed the day before the race and then at various aid stations. For 3-5% weight loss they are encouraged to drink more, from 5-7% they have to drink more before leaving and for 7+% they must drink and regain weight over 20-30 minutes before leaving.

We had several runners who came in >5% down, sat, drank, rested and were able to continue and finish. There were a couple who just couldn’t keep fluid down and had to drop.

Mostly we just checked weights and encouraged the runners to keep eating and drinking. Foresthill is right after the toughest and hottest part of the course, with most runners coming in in the late afternoon or evening, so if they didn’t look too bad we figured they’d do okay.

As it got later, the runners looked less well, but I was glad to watch the final couple of hours at the finish to see that many I thought wouldn’t make it (there is a 30 hour cutoff) actually rallied and finished under the cutoff.

We had two moderately interesting cases. One was a woman with blurry vision. Her husband let me know about her before she showed up, and from his story it sounded like allergies (red eyes, history of allergies, etc) but she didn’t look that allergic when I actually saw her (eyes not really red or puffy). She mentioned corneal edema, as she’d had the same problem at altitude in the past, but had attributed it to contacts then (this time she was wearing glasses).

I told her my impression was that corneal edema was usually only seen at high altitudes (WS elevation profile here) and that she would probably do better as she got lower. She had a bit of blurred vision which she found annoying, but otherwise was running well. Her husband had bought her some Claritin. I don’t know if it helped but she went on to finish sub-24 hours, so I guess she did okay.

The second was a woman who dropped at an earlier aid station “vomiting black.” Someone from that aid station wondered if we’d like to see her and we said yes, the worry being that this was degraded blood. Of course it is rare to vomit broken down blood, usually it is black stool, or melena that we worry about. Blood in vomit is almost always fresh and bright red. She had apparently eaten a lot of red grapes and looked great with stable vital signs so we sent her home (with her husband) to seek medical care if it recurred.

After our station closed at about 11:45, I hightailed it to the 80 mile checkpoint and picked up my runner to pace him in for his first 100 mile finish. Nice job, Gord.

My colleague, Geoff Kurland also finished, overcoming cancer, old age and trouble with the heat on Sunday morning. Nice job, Geoff (Geoff’s book is here)

I was so tired after staying up all night I had to stop on my drive into Reno on Sunday afternoon for a ½ hour nap at a rest stop. After that I felt much better, although I did go to sleep before 8.