WS Run Ask-a-Medic
Talk to me, Babe
I like to think of this blog as a medical consultation. No appointment necessary, no white coat, and the opportunity to explore issues related to the run and your health.
If you hit this, read this, please comment! I want keep it up and ‘running’.
I was fishing through an old blog and found a great question that I never responded to.
It was written on 6/26/07. Isn’t that two days after the race? So, I would like to address this question now, and ask that you also go back to read the blog on altitude sickness.
Marti said “I have always heard that if you can’t get there several weeks ahead to acclimate, that you should run your race within 3 days of arrival. Can you say more about your recommendation?”
There is an INITIAL acclimatization to altitude and there is the LONGER TERM acclimatization that occurs over weeks. Again let me say that the initial response to altitude is based on rate of assent, absolute altitude and individual predisposition. The physiologic response is very complex. In the initial response, ventilation increases in response to hypoxia. This blows off the carbon dioxide and results in an alkalosis. Then the kidneys kick in to correct the alkalosis by excreting bicarbonate. This happens in the first 24-48 hours. There is a 12% reduction in plasma volume in the first 24 hours (your peeing it off) and the heart rate and the blood pressure go up. Also, the pulmonary artery pressure goes up. The blood flow to the brain increases and returns to normal in 3-5 days. The long term acclimation over weeks is the development of an increased red blood cell mass and improved exercise tolerance.
Arrival the day before the event is adequate, although AMS may be a problem. The headache is an unpleasant symptom and accompanied by nausea, fatigue and sluggishness, …. NOT my ideal way to start a major race. The symptoms of AMS have been described as feeling like a hang over.
The WS race peaks at just under 9000 feet, but if I was one of the 20% of persons who will get AMS, I would opt to stay in Tahoe for 3 days prior to the race, before I climb an additional 2500 feet.
Hope you’re out there Marti and I hope I answered your question.
Left, right, left, right,
Linda Lee
If you hit this, read this, please comment! I want keep it up and ‘running’.
I was fishing through an old blog and found a great question that I never responded to.
It was written on 6/26/07. Isn’t that two days after the race? So, I would like to address this question now, and ask that you also go back to read the blog on altitude sickness.
Marti said “I have always heard that if you can’t get there several weeks ahead to acclimate, that you should run your race within 3 days of arrival. Can you say more about your recommendation?”
There is an INITIAL acclimatization to altitude and there is the LONGER TERM acclimatization that occurs over weeks. Again let me say that the initial response to altitude is based on rate of assent, absolute altitude and individual predisposition. The physiologic response is very complex. In the initial response, ventilation increases in response to hypoxia. This blows off the carbon dioxide and results in an alkalosis. Then the kidneys kick in to correct the alkalosis by excreting bicarbonate. This happens in the first 24-48 hours. There is a 12% reduction in plasma volume in the first 24 hours (your peeing it off) and the heart rate and the blood pressure go up. Also, the pulmonary artery pressure goes up. The blood flow to the brain increases and returns to normal in 3-5 days. The long term acclimation over weeks is the development of an increased red blood cell mass and improved exercise tolerance.
Arrival the day before the event is adequate, although AMS may be a problem. The headache is an unpleasant symptom and accompanied by nausea, fatigue and sluggishness, …. NOT my ideal way to start a major race. The symptoms of AMS have been described as feeling like a hang over.
The WS race peaks at just under 9000 feet, but if I was one of the 20% of persons who will get AMS, I would opt to stay in Tahoe for 3 days prior to the race, before I climb an additional 2500 feet.
Hope you’re out there Marti and I hope I answered your question.
Left, right, left, right,
Linda Lee
posted by Linda Lee at
12:12 PM
5 Comments:
Hello, Linda:
Thank you very much for hosting this blog.
I would love to get your opinion on the following article:
http://www.asthmasignsandsymptoms.biz/ExertionInducedAsthma.asp
I found this article in the course of researching severe breathing problems I encountered during this year’s Diablo 50 (April 12, 2008). I am 48 and a reasonably experienced ultrarunner at the 50k and 50m distances. Western States this year will be my second 100m event. I live near and train on the course. I do know what I’m getting into.
The recent Diablo was the first reasonably hot day of the year, and a lot hotter than anything so far this year. There was an enormous amount of pollen in the air. I could feel at about mile 20 that my air passages were starting to close up. I do not suffer from allergies (at least I have no history of it). Throughout the run, my nose was running constantly. I am used to that in colder weather, like most people. My theory on this (on which I invite your comment) is that my air passages were filling up with mucus, so much that it ran from my nose, almost faucet-like. I was feeling quite good otherwise, happy to be running where the cars can’t go on such an incredibly diverse trail system.
By mile 35, conditions had worsened quite a bit and continued to deteriorate, even though my legs continued to feel fine. What a strange experience, coming off the summit at mile 42, to have willing legs but such unwilling lungs. Twice during the final two miles, while hiking up what I would normally hardly consider a hill, or even a bump, I had to stop, just to breathe at all, because to combine breathing with any kind of exertion at all at that point was not possible. More than shallow breathes were simply not possible without causing major coughing. I guess this sounds like asthma? More on that in a minute.
I can describe the symptoms. The pain is not in the lungs. The pain is directly in the throat. In the process of trying to get more air down than I can pull in, the whole process sharply “catches,” right at the throat. The passage way is not big enough, and to force more air through than can fit causes quite a bit of pain in the throat.
I have had similar but much milder symptoms in other events. It used to bug me but I have adjusted (or so I thought). A few years ago, I went through a battery of asthma tests. The doctors found mild symptoms and I tried an inhaler for a few months. It did not help. I guess that sometimes it takes a more extreme reaction to get you to pay attention to something. Part of me was calm enough during the Diablo to step out of the immediate circumstances and just observe what was happening (we are our own best laboratories). I could tell that I was reduced to rapid, shallow breathing in order to take in as much air as possible. I had a little dizziness, but I think such breathing might cause that. I didn’t have other symptoms.
I understand the concept of blowing off more CO2 than you take in and creating an alkaloid condition in the body. Would it be true to say that the body’s response to such a condition would be to close the air passages in order to preserve as much CO2 as possible?
I like to garden, and I have been thinking of my body as soil, trying to get the right balance of acidity and alkalinity. My body was in alkaline deprivation. Have I provided enough information for you to assess that conclusion? If true, then during the Diablo I was in sore need of restoring the acidic balance. I eat what most people would consider a lot of “leafy greens,” mustard greens in particular, because I have read that they help break down histamine, which people who suffer from breathing problems have in overabundance.
Two mornings after the Diablo I awoke with a pronounced “catching” feeling in my throat again. This condition has never lasted nearly that long after an event.
My request of you is for input on the article I have cited above and any strategies for restoring the body’s breathing balance during crisis. Does it stand to reason that significant altitude could worsen the symptoms? I have not had any serious altitude problems over the years. Is there such a thing as late-onset asthma? I am most interested in coping mechanisms and in improving the situation without prescription drugs.
I really appreciate your help!
Sincerely,
Thomas C Williams
Hi Linda,
Do you have any thoughts on how to prevent corneal edemna at altitude? I experienced it (cloudy vision) in my right eye during Western last year. It started about 10 miles into the race, probably when we were over the summit of Squaw. It did not clear up until about 4 hours after the finish. It made night running very difficult...
Thanks,
Kami
Thomas. I am so.... sorry not to have caught this until today. I usely get an alert that there is mail on the blog. My appologies.
The runny "faucet nose" is from capilary leakage, from a complex histamine response. This is most likely an enviromental allergy that you are experiencing. The cough, sore throat, and inability to catch your breath with exertion is an extention of the allergy, with bronchospasm. You can call it, enviromental induced asthma, by the sound of it. Yes, adults can develop asthma and allergies! The altitude at States should not compound this, but there are different allergens at different altitudes (ecosystems). In you case, I would listen to your medical practitioner and at least carry a "rescue" beta agonist. ie: ALBUTEROL inhaler. I am hesitant to recommend a antihistamine, because that drug can interfere with your ability to handle the heat. The heat is going to be a bigger problem for you than the altitude.
Best of running! Linda Lee
Linda,
I recently fainted while at work, and was taken to the ER. Multiple blood tests, an EKG, and chest x-rays were taken. Everything looked fine. The doctors could not figure out why I had fainted. This was the first time I had ever fainted.
When an experienced ultra-running friend of mine (he has buckled at WS 10 times) found out about this, he said I may have fainted due to my running a 15 mile trail race up in altitude 8 days prior to my fainting episode.
I live at sea level, and the race I ran was the Holcomb Valley 15 Miler at Big Bear Lake. The start/finish is at 6750', and the peak is at about 8200'. During the highest points of the race I felt nauseous and had headaches. But then I felt fine towards the end of the race as we decended. And I felt extremely good after the race (probably due to slowing down so much due to the altitude).
So my question to you is: is it really possible for me to feel the effects of running a race at altitude (I was up at altitude for only 2 days) a week afterwards?
I felt fine for the 7 days immediately after the race, but on the 8th day I had my fainting episode, so it's not like I was feeling sick for the days after the race.
If it is possible for the fainting to be a result of the race at altitude, what causes it?
Thanks,
Ari
Ari. I do not have any medical reason to support the relationship to high altitude, and your faint one week later.
I know we are always looking for the answer as to why someone has a loss of conciousness!
LL
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