WS Run Ask-a-Medic
Introduction by Linda Lee, Nurse Practitioner
Welcome to the running of the 2007 Western States Endurance run!
My name is Linda Lee and I am thrilled to be the medical advisor to this prestigious event. I am a Nurse Practitioner with a background in emergency and wilderness medicine.
I would like to introduce this informal, interactive resource to the existing WS100 web site. In the upcoming months you will be increasing your miles as well as fine-tuning your training strategy. With this, come the occasional ache, pain and minor injury that can interfere with your plan. You will want to know about heat, snow, altitude, electrolytes and possible environmental emergencies that can occur on the WS trail. As the anticipation of the run grows with each day, I hope to relieve some of the stress by providing available medical information.
High Blood Pressure affects over 60 million people in the United States. The diagnosis is defined as a blood pressure of 140/90. Overall, HTN (hypertension) is more prevalent in older age groups (over 40). HTN remains a major public health burden. Despite the rigorous exercise schedule of ultra runners, you are not immune. I encourage each runner to have a screening medical exam prior to taking on such a physically demanding endurance event.
There are different classes of blood pressure medications, one being the Beta Blockers. These are the drugs that end in “lol”. Common drugs in this class are metoprolol, atenolol, labetalol, and propranolol. If you are one of those on an anti-hypertensive medication, check to see if it is beta-blocker or one of the combination drugs.
Beta-blockers are competitive inhibitors of catecholamines at the beta-adrenoreceptors sites. B1 receptors are found primarily in the heart. B2 are found in the heart but are most prominent in the bronchial and peripheral vascular smooth muscle. So when the beta-receptors are blocked, there is a slowing of the heart rate, and contractility. Rather than dilation of the bronchial, and peripheral vascular smooth muscle, there can be a side effect of bronco-constriction. The blood flow to muscles can be reduced.
What this means to an ultra runner is that when you have to climb out of El Dorado Canyon, you are not able to increase your heart rate to meet the demand of the exercise. Your legs may feel sluggish and some people wheeze. You loose the capacity to exercise to your full ability!
Although beta-blockers can be excellent anti-hypertensive medication, and are very useful in certain kinds of heart failure and heart attacks, they can cause a lot of problems for the athlete.
Another anti-hypertensive drug that is counter-productive in an extreme athlete is a diuretic.
Hydrochlorothiazide is one of the first line drugs for HTN. It does not make sense to use this drug because it can add into the effects of dehydration and electrolyte disturbances during the endurance running events.
Good communication with your health care provider can facilitate fine-tuning your blood pressure. Never just stop your medication, but rather explore the alternative anti-hypertensive that does not have an effect on exercise tolerance.
posted by Natbarn at
5:28 PM
10 Comments:
Thanks for the info on Beta-Blockers. I am borderline Hypertensive. Ran States last year and will continue to monitor my BP hear at work.
tom riley
Linda, currently on Coozar for my BP. Now have good readings around 116-122/64-72. How does this BP medicine stack up as one not dertimental to Ultra running?
Cozaar is what we call an ARB. It is an excellent blood pressure medication for an athlete. It also will not set you up for renal failure
in the face of dehydration.
Linda, I have 3 questions to ask fo you as to:
1. Whats the best treatment ofr blisters?
I hear stories of soaking in saltwater to toughen
skin before races to cover all known hot spots
even before race start? I heard racer used liquid
bandage to cover to prevent flare ups.
Whats the newest and best treatment ?
2. Is Urine color still a good predictor during race to gauge hydration? AND electrolyte balances?
If not, what is the best predictor while running?
Another rumor I heard was runners using Pedialyte in liters to help keep those minerals in balance. Can this work for adults? I gave it to my son when he had bad diarrhea case and he liked it.Its better than ginger ale,etc.. but for running?
3. Is it true that as we run over 50km or so that our body pushes protein (peptides?Aminos?) into our urine which is bad because kidneys dont like to filter big proteins which can lead to renal failure? If so, how do we prevent this during runs? And how long after run is this proteinuria going to last?
Thanks so much to WS100 to put on this special ask-a medic Q&A.Its truly so very helpful.I hope all runners will ask the big new controversial topics in running now while we have LLee .Happy runs.
BLISTERS
Blisters are the thorn in the lion’s paw; they can stop you dead in your tracts. Prevention is the first step in treatment. Calluses build up in areas of repetitive trauma. The skin of calluses is not supple and there will be more shearing of the collagen and elastin with running. Soaking your feet in warm salt water will soften the skin. Rubbing down the callus with pumice stone is helpful, as well as keeping the feet hydrated with moisturizing cream. (Cetaphil cream is great, and Aveda puts out an awesome foot relief cream)
Dr. Bill Hopkins, D.P.M. has informed me that 10% formalin can be applied to your feet prior to the event to prevent blisters. Don’t ask me how it works!?
Wear shoes that fit. Start the race with laundered new athletic socks. Avoid cotton socks. Liberal application of petroleum jelly can decrease the friction that develops. Pay attention to hot spots. Stop and attend to your feet. If a blister develops, there is controversy over weather to drain it or not. The medical community will say to leave it intact because it acts as a ‘natural dressing’. That is impractical when you have another 60 miles to run. When tending to blisters at the aid stations, I CLEAN AND DRY THE FOOT. Dressings do not stick to dirty skin. I drain the blister of fluid and leave the skin on. A lancet or razor blade will work. If the skin is already broken and has been rubbed away, I clean off the unviable epidermis. (The dead crinkle stuff) I then apply tincture of benzoin to the surrounding skin. This must air dry. It only takes a minute. Benzoin is what makes the dressing stick to the skin but will burn if it gets on the raw skin. What you use for a dressing is a personal choice, or what ever is available. Moleskin, Spiroflex, Second skin with either athletic tape or duct tape to secure, are all choices. The goal is to bandage the area well enough, so that it will not have to be redressed later.
URINE COLAR AS A PREDICTOR OF HYDRATION
Let’s keep this perfectly clear! That is one of my mottos when addressing the color of urine. Dr. Lisa Bliss has written an excellent commentary on electrolytes and hydration and your participant guild has a paragraph on renal failure.
During the ultra distance races, there is muscle breakdown and the release of intracellular muscle constituents. The muscle enzyme CPK rises significantly. Damaged cells release myoglobin, a heme-containing protein. The kidneys filter the fluid from our blood and ideally reabsorb the electrolytes we need. The end product is called urine. The arterioles that supply the kidneys are sensitive to hydration and volume depletion can result in renal damage. The filtering system of the kidneys can become clogged with the heme pigment casts and free iron. This can lead to Rhabdomyolisis. It is the myoglobin that can cause the urine to look brown.
Non-steroidal anti-inflammatory drugs such as naproxen and ibuprofen can affect the renal arterials, and in the face of dehydration, add to kidney damage.
The goal is to stay hydrated, become acclimated to the heat, and remember to drink electrolyte-containing fluids. Our serum osmolality is 265. Pedialyte is hypotonic at 250. Gookinaid ERG is 265 (isotonic) and Gatoraid is 305 (hypertonic). I believe GU20 is served at the aid stations.
Linda:
What is the latest info and recommendations for Ostietis Pubis?
Osteitis Pubis can be described as an over use injury. For those of you who do not know, the pubic symphysis is the boney prominence at the base of the belly. It is the anterior joining of the two pelvic bones and has cartilage and ligamentous supportive tissue. Osteitis Pubis is a term for inflammation of the pubic symphysis. It is a joint and prone to slight movement. For pregnant women, there is a hormone called relaxin that relaxes and softens the pubic symphysis to prepare for the widening of the pelvic outlet in childbirth. For the rest of us, it is relatively immobile. When subjected to the repetitive “loading” force of running and movement of the pelvis to and fro, some persons develop an inflammatory reaction. If the inflammation continues, sclerosis (hardening and thickening) of the tissue develops and there can be a loss of flexibility. This can lead a runner to be incapable of sustained physical activity. NOT A GOOD THING for an Ultra runner. The pain can be a dull ache in the groin and a sharp stabbing pain when running.
Like other over use injuries, there is no quick fix. Pay attention to early warning signs. Rest, Ice, and anti-inflammatories. I also would suggest looking at leg length, pelvic symmetry, and physical therapy for stretching, strengthening and stabilizing the supportive muscles. I do not know of anyone receiving local steroid injections to the area, but may be a consideration for chronic cases. I wish you the best. Do back off of running until this inflammatory condition has calmed.
LindaLee
Hi Linda, do you know if the CPK test results will be emailed out this year? I got the blood draw after the race, but never heard any announcements at the awards about high results etc.
question. I have high blood pressure. I have been on med for about a year. dose has been raised 3x When i started i never felt normal.But i figured it was just getting used to the med. But since they upit 3 mon, ago I have been feeling light headed alot, weak, at time feeling like i am going to pass out. Well i went to the doctor friday. and they said that it was still alittle high. (nurse) I talk to the doctor and he gave me prescription for anxiety and told me that the medicinewould not cause me those feelings. The thing is when i monitored my blood pressure i am getting readings like 98/67 the highest it got was 133/87 and that was when i just finished doing yard work. I monitored for over the weekend and readings stared at 98/67 and would gradually go up 113/76 and to 118/70 and to 125/73 and the day i had the 133/87 was the day i decided to not take my med tio see what would happen I felt alittle better that day and i even had a emt come and take it to make sure my monitor was working right. she got a reading of 117/68.
my question is this can my med becausing these symptoms and could i also be dehydrated cause i don't drink a lot of water?
My med is micardishct 80.12.5
Micardis HCT is a combination drug. It has an angiotensin receptor blocker plus a diuretic. Thus, the 80/12.5 dosing.
Not any one blood pressure pill is correct for all persons.
This particular combination can cause headache, weakness, gastrointestinal upset, heartburn, fainting, orthostatic hypotension, electrolyte imbalances among other side effects.
If you are a runner on this medication and also taking ibuprofen or aleve, the kidney function can deteriorate. Along with dehydration, a rare complication is rhabdomyolysis.
On a good note, the blood pressure readings that you have noted look pretty darn good.
Hope this helpped you.
LLee
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