Beyond Blisters: Working on a Medical Team

I just got back from my third year volunteering on the medical team at the Badwater Ultramarathon.

It's almost as much fun as running the race. Almost.

But in some ways it's even more fun because I get to watch and learn from the runners and the other medical team members.

When people ask what I do in that capacity, they often think I treat blistered feet. That is actually only a small part of what I do, we actually have foot care specialists for that and I rarely have to do any more than a minor thing involving blisters. Mostly what we treat are varying forms of heat illness, but we see a lot of other problems, too.

I am going to share some of my observations with my readers, with the intention of improving runners' and crews' future experiences at Badwater or other races in the heat.

I consider volunteering at Badwater an honor and a privilege, it certainly is not something I take for granted. I am thankful to Chris Kostman, the race director, and medical director Dr. Megan Dell, and I hope to continue to volunteer on medical at Badwater in the future.

It's a huge task that Megan takes on as medical director. She needs to make sure that all the runners and their crews are safe so that Chris can focus on his duty as race director to oversee it all. The goal is for everyone, runners, crews, and staff, to arrive at the finish line intact and keep anything from happening that endangers their safety, lives, and the future of the event.

Given the unpredictable factors: weather, judgement of the runners and their crews, the presence and behavior of several hundred people involved with the event, in addition to spectators, tourists, the general public, and highway traffic spread over 135 miles, that's a huge responsibility.

Before I go any further, I'll state that what I write here is my opinion and does not necessarily reflect the opinion of anyone else on the medical team or associated with the Badwater Ultramarathon. I'm not writing as a representative of the event, this is solely my own personal opinion from my experiences and observations.

My background

As a registered nurse, I have a certain type of training and background complemented by my 20+ years of ultramarathon experience, and two Badwater finishes, including a double road crossing of 270 miles in 2011. I have worked in critical care nursing in the past and now I'm an oncology nurse in a hospital-based clinic. Both of these nursing backgrounds have been amazingly helpful at Badwater. And I'm not even giving chemotherapy. Let's just say I'm used to treating really sick people.

I also have a background in exercise science and behavioral science from my academic training in natural resource recreation. So I'd say I'm pretty well-rounded in the various aspects of running as a recreational and human performance event. At the same time, I'm certainly not an expert on any one particular thing and I rely heavily on the judgement of the other medical staff at the race.

I see some common themes every year and those are what I'm going to discuss in this blogpost, along with how I view the runners' decisions and what I think about when I am out there on the course or seeing runners in the medical area.

What nurses do

First it might be helpful to explain what nurses do, since a lot of people don't really understand what our role is. Then you can understand how I look at my role on a medical team. Nurses act as patient advocates. We do everything possible to ensure that the patient we are caring for has the safest and best possible outcome from their treatment for a certain condition. Normally this occurs in a health care setting.

We don't diagnose or prescribe, we carry out orders from a physician when it comes to medications and medically indicated treatments, but in terms of total, holistic care of the patient, we act independently and have our own practice.

We educate patients, which is a huge part of what we do. We teach them how to manage their condition, about the medications they are taking, about the treatments or tests they undergo, what complications to look out for, and what symptoms to report to a doctor.

We look out for the safety of the patient, provide hands-on care, and help the patient access resources that will help them restore their well-being, and lead to the best outcome.

You might ask, How does that differ in a setting such as running a race under extreme conditions?

I ask, Why should Badwater be any different from the health care setting?

The answer to both of these questions is, at Badwater, not only are we paying attention to things like heat illness, we act in a preventive role and as safety educators. And safety is the number one, overarching thing we look out for.


What I do at Badwater

So when you come to me in the Badwater medical room and I weigh you, and you're down 8 pounds from your starting weight, your clothing is all full of salt, here's what I'm going to look for: First, are you making sense when you talk to me?

I'll say, Tell me how you're feeling. I'll ask questions like: Have you urinated? How often, how much, what color? How much and what kind of fluid and electrolyte replacement are you taking? Have you been eating? How's your stomach? Are you swelling anywhere?

I will take a set of vital signs if you feel "off" at all. I will help you regulate your body temperature. You'll be hot and sweaty when you come in and then you'll get cold as you sit there in the air conditioning.

We have to assess how dangerous the runner's condition is: low sodium can progress to seizures, coma, death. Dehydration by itself is usually easy to fix if it hasn't progressed too far. A cardiac condition can be life-threatening, especially in this heat.

The medical room gets jammed with people so we have to kick them out if they don't have a legitimate reason to be there. We can't listen to patient's lungs, heart, etc. with all the noise. So we have to be the bad guys sometimes and throw everyone but the runner and one crew member out. Sorry, but it's in the runners' best interest.

As long as you can keep fluids down, I will make you drink and eat something, I'll keep you there until you have to pee, if you haven't been peeing. Your kidneys and brain and gut and other organs need blood flow to keep functioning and if you're hot, all the blood has gone to your skin to keep you cool. Your body produces stress hormones that can make you retain fluid and make you puffy. After you sit there cooling down, you might start to feel better: mentally, and by eating, drinking, and urinating.

Once you're feeling better mentally, I am going to talk to you and your crew member about how to keep you out of the trouble you got in that brought you in here in the first place. And what to look for, if and when to follow up or come back to us at medical.

I'm going to explain to you what's going on with your body, electrolytes, fluids, about the blood flow, about heat stress, and why you need to stay cool. How you're more susceptible to blisters when you're not hydrating properly.

So when you're peeing, have regained some weight, and you're functioning better, plus keeping fluids down, we're going to let you go. And the time spent will more than pay for itself, because by fixing the things that slowed you down in the first place, you will perform much better.

There's a lot of education to be done in every case, both with crew and runners. They need to be more careful about intake and output. We try to pat them on the back for coming in to see us, because it was probably the best thing they could have done at that point- gives them a chance to turn things around when they're going bad.

You might ask...

Should I have a medically trained person on my Badwater crew?

Well, it's not a bad idea, but don't let that give you a false sense of security. That person also needs to have some idea of how this event differs from the setting in which they practice medicine.

I can tell you that even if a person has medical training, until they have experience working at some of these endurance events in hot weather, and know what's the reality out there, they don't really know how to treat the runners.

I say that because we get a lot of runners who have medical personnel on their crews, but they don't necessarily have experience themselves racing in the heat, or have no prior Badwater experience, and they really have no idea how to manage their runner.

I can't even tell you the number of times I've heard some version of this statement from a runner: "My wife is a doctor and she's on my crew". Well, if she's not an athlete, has no experience at endurance events in the heat, hasn't been to Badwater before, her telling me how much urine output you've put out on the average over 8 hours is not going to help me determine the integrity of your kidney function when you're catatonic and dehydrated 40 miles into the race.

"Well he's been averaging 30 cc an hour of urine output" the wife says.

REALLY.

This tells me nothing. He might have peed the entire 240 cc (1 cup) an hour into the race and hasn't peed since. Which ain't much of a pee. This isn't the air conditioned hospital, folks. Sorry, but 30 cc an hour at Badwater doesn't cut it.

The same parameters we use in emergency and critical care for the general unwell population in hospital settings doesn't apply here in this group of people and in 120 degree heat and physical exertion. The runner is also power breathing and power sweating out there. The runner had better be processing a lot more fluids than that through their kidneys or they're in big trouble. That means they need to be taking a lot of fluids in, and peeing a good portion of them out.

What gets runners in trouble most often is not taking the time to cool down so they can do a better job of processing fluids and calories.

What can I do to make the medical team's job easier?

1. Fill out your racer medical history form accurately, honestly, and completely. Don't omit any of the medications you take, including supplements or herbs. You would be surprised how many people in general, including endurance athletes, take things like high blood pressure medications or anti-depressants. These things can sometimes affect your ability to tolerate the heat or exercise, and we need to know about them, especially if you get into trouble out on the course. You'd also be surprised how much we find out when runners come into us, and they start talking, we learn a lot and then we go back to their medical form and they have left out a lot of important information.

2. Use us when necessary, but appropriately. We are there to ensure the runners' and crews safety. Don't occupy a medical team member's time and resources by asking for things like massages, special visits by the roadside for non-emergency situations, looking for a place to take a nap if you don't have a motel room, or in chit-chat if there are other runners around who need help.

3. Choose your crew wisely. I'll talk more about this in a later section, but it's very important. We treat a lot of crew members for heat illness and other issues out on the course.

4. Crews, when your runner is done with the race, have a blanket ready because they will cool down rapidly. After the medal ceremony and photographs at the finish line, get your runner off the mountain. The rapid ascent to 8300 feet makes altitude sickness a complicating factor with dehydration and electrolyte imbalance, sleep deprivation and exhaustion. Take them down to Lone Pine so they can begin recovering as soon as possible.

Safety on the course

This is the other thing we do when we're roving between medical stations.

I'm interested in preserving the runners' safety and the race itself. The importance of the rules becomes even more apparent when the sun starts to go down the first day. The biggest mistake I see crews making on the road is not paying attention to oncoming traffic. They park too close to the edge of the shoulder so when they open their drivers side doors, they are obstructing the roadway.

I'm going to pull over and talk to the crew if your door is open into the road even if there's only a couple of inches to spare when you pull all the way off the roadway. That's why those vans with the doors on both sides are so useful- the crew can use the passenger side to do their business in those narrow areas instead of the side facing the road.

Look both ways before you cross the street! Wear your reflective gear. Use the lights on your vehicle appropriately and according to the rules. Remember there are lots of people not associated with the race on the road. When it's dark outside, visibility is poor, even with your lights and reflective gear.

The later it gets in the race, the more tired everyone is, and it gets harder to be alert and aware of your surroundings. That's why crews need to rest and rotate shifts, and take care of themselves as well as the runner.

About crews

Since it seems like we treat almost as many crew members as we do runners, this is important to mention.

Runners, please think about your crew members when you choose them. Not only is it important for the runner to have their own head screwed on straight to run this race, but they need reliable, healthy crew members to help them do it. Physically and mentally healthy.

Not only does it affect your performace as a runner when you have crew issues, but it affects the other people on the course, runners and everyone else.

If a crew member is not physically fit to withstand 48 hours in extreme heat, sleep deprivation, heat stress, and can't manage their own stuff- meds, food, drinking, proper clothing, and they become incapacitated and do something that endangers everyone, it's not only a safety issue for the runners and everyone else, this is a threat to the future of the race.

Runners really need to be the gatekeepers when they choose their crew members. Know your crew well: do they have medical conditions that make it inadvisable for them to be out in the extreme heat? Can they adequately prepare for the conditions they will be exposed to for up to 48 hours at Badwater, with sleep deprivation to top it all off?

Let me repeat that in different words. (Because I can't emphasize this enough.)

When a runner makes poor choices as to the crew members he or she chooses for an event such as Badwater, the runner is not only endangering their own ability to finish the race safely, they are also endangering their crew members, other runners and crews, and the future of the event.

If one person becomes ill, they have just compromised the health and safety of everyone else on the crew. There are fewer people to cover the roles needed, less rest, everyone is more stressed and tired, on top of the already demanding event. Crewing for Badwater isn't like any other race. It's constant, it's intense, there is no break. The crew is heat stressed and needs to take care of themselves. As the event goes on, people become more tired, less alert, it's harder to keep on top of things like hydration, food, etc.

Do I need to say it again?

Psychological Issues

Nurses often joke about how much of what we do is psychiatric nursing. I think the same thing applies in ultramarathons.

If a runner is struggling, sometimes they just need to talk, to talk out loud through their decisions, or to see if what they're doing makes sense. And sometimes we just need to let them cry, and sit there with them as they process their disappointment, when they realize the best option is for them to quit.

I always observe how the runner is interacting with the crew. Is that an added source of stress for the runner? What I want to know is, is the crew doing anything that is hindering or endangering the runner? And if they are, can it be fixed through communication or just a little education on the spot?

Some crew members forget that the reason they are out there is to crew their runner and help them successfully and safely get to the finish line. That is what a crew is for. Being a crew member is not so you can get a training run in, or wield control over other people. We see a lot of interesting dynamics out there. Occasionally, the best thing a crew member can do is leave. See my blogposts "So ya think ya want to run badwater" and "Big Bad and Superhot".

What The Medical Team Does, and Does Not

The medical team is there to help runners and their crew members in the event of some physical problem such as dehydration or heat illness that can be turned around or fixed so the runner can continue the race, or to keep such a problem from developing into a serious or life-threatening emergency which would require full medical attention and transport to a hospital.

If someone has a minor injury that is in no way life-threatening or endangering their runner's safety, they can come in to see the Medical Team at the nearest station. Sometimes people just need to talk and we are willing to listen.

We don't do IVs. An IV is only done when medically necessary and it always means the racer will be disqualified. If you're of the mindset of some of the triathlons and other races out there that provide IV rehydration to participants at the finish line, you're in the wrong place. Placing an IV, especially in non-sterile conditions such as a race medical tent, increases the risk of infection or bacteremia from contamination.

If the race is over and you're feeling like you need IV rehydration, there's always the emergency room of the local hospital. I don't encourage this unless the runner is unable to keep food and fluids down. The best thing to do is to rehydrate and recover by drinking, eating, and resting.

I'm not a shrink. Roadside psychiatry is not really one of the things I do. If anyone has a concern, they should feel free to come to one of the medical stations, but unless someone is in danger, we generally don't make roadside visits for non-medical issues like massages, pep talks, and hand-holding.

What's it like working on the medical team?

It's a good mix of physicians, nurses, first responders, an exercise physiologist, and foot care experts. (I think we could use a clinical psychologist too.) We're all professionals who are committed to our areas of expertise in our real jobs, and the combined level of education, experience, and skills make this particular bunch of people top notch.

We don't get a lot of sleep. We share duties like covering different stations, the finish line (where we all freeze), getting sleep and naps, getting food or short run breaks. We have to do inventory and keep organized for all the equipment year after year, making sure supplies don't expire, having enough of certain items and discarding what we really don't need. Also, we need to be anticipating runners' needs at each station and being ready for that.

In a successful year like this one, there were no IVs, almost all the runners we saw were able to go back out on the course and finish with oral fluid and electrolyte replacement.

During the post-race party, we always get runners who come up and thank us for our care. We were able to help them turn the problem around, get them back on the road, to a successful finish. Sometimes they amaze us, someone who looked like death coming in to Stovepipe Wells spends a couple of hours cooling off and rehydrating, and they blast off to the finish line. Nothing makes us happier than to see the runners we treated 90 miles down the road cross the finish line with a big smile on their faces and their crews faces too.

It's really fun, we're a big bunch of nerdy people, and we all have a sick sense of humor. Yes, almost as much fun as running the race.

As you can see, we do a lot more than blisters. And we wouldn't come back year after year if we didn't love it.

BIG, BAD & SUPERHOT!

Badwater runners, CREW and anyone else planning on being in Death Valley this summer for the Badwater Ultramarathon, if you haven't started your heat training by now, that should be a BIG priority.

Don't wait any longer. The race is only 2 months away and this year is shaping up to be a hot one...

Last year in May and June I went down to Arizona to do some heat training in the desert and the temperature was only into the 90s in May and barely cracked 100 in June. This year, it's already been 112 in Death Valley, and it's only mid-May.

I'm not only referring to the runners here, I'm talking about the equally important CREW. Runners need to be diligent about heat training, but they usually do their homework. It's the crews who have often been less prepared for the conditions.

A Hot Year

In 2003 I crewed and paced for my friend Ken Eielson. That was the year it was 133 degrees. I also crewed for Josh Miller in 2002, when it was was 127 degrees. I remember how intense the heat was, and yes, there really is a difference between 115, 120, and 130. Those two years I was living in the Arizona desert and one of the things I did to prepare myself was a 30 mile run on a 117 degree day in Phoenix, where I stayed overdressed most of the day.

I didn't have access to a sauna back then, but I'd park my car in the driveway, roll the windows up tight, and sit there baking for up to an hour with a magazine, a good supply of ice water and electrolyte replacement. My neighbors thought I was nuts, and it was uncomfortable, but I paced Ken the whole way from Furnace Creek to Stovepipe Wells that year and I had no problems with the heat.

Sauna training, overdressing and running in the heat, cranking up the heater in your car, attaching a hose to your clothes dryer and a hot suit and running on a treadmill, or whatever contraptions you use to prepare for the heat, make sure you're doing plenty of it.

Crew Preparation

I can't emphasize enough to runners that they insist their crews be prepared for the heat. Crews are the ones who tend to be less heat-trained, even if they are endurance athletes themselves.

Being in a hot car and staying busy tending to the runners needs makes it easy to neglect your own needs as a crew member- staying hydrated, cooling down, getting out of the sun, eating enough, getting enough electrolyte replacement.

Crews, you have to be on top of things in the extreme heat for your runner's sake. To function well under such intense conditions you are going to have to take of yourselves. Not only do you need a plan for the runner, but you need an equally important crew plan. You won't be running the A/C in your vehicles, so you'll be exposed, too. Inside a vehicle is hotter than outdoor air.

If it's your first time, if you can get out there to experience that kind of heat before the race, along with any or all of your crew, it would be a good reality check. Everyone on the crew should be doing some kind of heat training. Especialy if they aren't normally exposed to hot conditions. Even people who live in warm climates can easily be overpowered by the intensity of a 130 degree day.

If a crew member is new to intense heat and hasn't experienced anything like Badwater conditions, it's a good idea that they check with their own physician before jumping into a heat training program or just showing up in Death Valley in mid-July. If you have some undetected medical condition, it could become a serious, even life-threatening problem out there. I can't emphasize this enough. Don't assume that being a healthy, active person, or even a well-conditioned runner, under normal conditions, qualifies you to physically tolerate 130 degree heat.

Crew Supplies

Crew supplies include sunscreen, hats, clothing to protect them from the sun like those Sun Precautions suits, ice bandanas, towels for covering up hot vinyl like steering wheels, seats, and other items that heat up in the vehicle, towels for placing over the body with ice and ice water, enough ice for the crew to use for themselves, enough electrolyte replacement, water, and drinks for crew members, cotton gloves for touching hot metal on the outside of the vehicle, shadescreens for the windshield when the vehicle is parked for a period of time.

You'll need sunscreen, hand wipes and ways to keep the sunscreen from getting into the runner's drinks and drinkable ice, be careful keeping any food that could spoil. I advise avoiding thing that spoil altogether- certain fruits such as melons, anything with mayonnaise in it, anything with a short shelf life or that needs constant refrigeration under normal coonditions. At least one person on each crew or crew shift should be taking extra care of the crew, making sure everyone is getting adequate fluids and breaks from the heat.

Be Prepared for The Worst: A Backup Plan

You need a backup plan in case something happens. What if Furnace Creek, Stovepipe Wells, or Panamint Springs run out of ice? Where will you go? Lone Pine, Beatty, Pahrump? A backup plan includes a cooler large enough and enough extra ice that in an emergency, everything could be dumped out and the person can be cooled down in it. Have an emergency plan of what to do if someone does get sick. Plan for the worst, and keep the evil spirits away!

Knowledge is Power

For information on heat illness and how to prevent it, the Badwater website has great information. Check out all of those articles on heat training. Read every single one.

Everyone is going to suffer some degree of heat discomfort out there. The key is to stay on top of it, get ahead of it before it becomes serious heat illness, and know when your body is starting to heat up. It's time to cool down before you get uncomfortable, don't wait until you feel really bad. See my post on "Lessons Learned" about my cooldown breaks.

Stay Away From Me!

I'm looking forward to being on the medical team again this year and as much as I love seeing the runners and their crews at Badwater, I'd rather pass you on the road seeing you moving forward, smiling, or giving a thumbs-up. Other than that, I don't want to see you until the post-race party.

With just two months to go, it's enough time that you can adequately prepare for the heat. But don't wait any longer. Even if you follow a formal training plan such as Art Webb's excellent sauna training program that lasts 4 weeks leading up to the race, some extra preparation is a smart idea this year.

Be safe, and make your Death Valley experience a successful and enjoyable one.

photo credits: Nathan Nitzky

Irreverent, Pain in the Ass, and Proud of It!

I went on my truth-seeking mission this past weekend in Iowa. The simple truths revealed: I'm irreverent and a pain in the ass, capable of running over 100 miles in 24 hours, absolved of blame, and there's more than just pork in Iowa.

I could end the blogpost right here. But I'll add some stories and pictures to fill in the details. It was fun, it was a great event, great race, I got everything I could have asked for: nice weather, good competition, a challenge, met lots of great people, got to hang out with Doug & Marji from Fort Collins, and other than having to drive so far, it was perfect.

In Colorado they say if you don't like the weather, wait a minute. In the midwest, you can have totally different conditions that change almost instantly, from foggy and humid to hot and humid, to overcast and humid, to windy and raining, to thunderstorms, or tornadoes. Fortunately on race day the weather gods smiled on us and we only had foggy, hot, overcast, and windy. There was a brief, barely noticeable sprinkle of rain a few times at night. And of course, humid all the time. But I can't complain about heat and humidity. I've set my last two 100 mile PRs in hot, humid conditions.

I slept well the night before the race. Slept through the night, and woke up 5 minutes before my alarm went off. I threw some clothes on and went down to the little breakfast area in the hotel, and mixed up my coffee: Starbucks Via instant, which is better than any hotel coffee except for maybe the Ritz Carlton. Not that I've ever stayed at the Ritz Carlton.

I got my stuff loaded in the car and went to McDonalds for my 1000 calories grease bomb, then to a gas station to top off the ice in the coolers. It was 62 degrees and foggy, with a breeze. It looked like it could rain, or maybe not.

At the track I started carrying my stuff over and set up my table in lane 1. Doug and Marji showed up soon after me, and I sat there in my chair, relaxing. It was so humid that my socks and shoes were already damp, so I changed my socks before the start. That was one thing I should have done differently- worn a different pair of shoes over to the track than the ones I would run in. I learned a lot about humidity- it gets into everything. My foot box and first aid kit were full of condensation and I had to dry everything out later.

Karl gave a brief pre-race briefing, and that's important- a briefing is supposed to be brief. And it was. That's another nice thing about these homegrown, low-key, unsullied by corporate sponsorship and frills. You get what you need, and no bullshit. These days, races like this are becoming rare, and that's why they are the gems to seek out.

We met our first shift lap counters, and I asked each of my successive lap counters throughout the day to confirm my total number of laps with me each time I came around, that way there was never any confusion or a missed lap, and it could be addressed right away if something got screwed up. Fortunately it never did.

There was this wooden runner dude on the track with a bright yellow Cornbelt Running Club shirt who was always faced in the direction that the runners were going, to keep us from getting confused if we left the track and they switched directions.

We would switch directions every 3 hours after the first switch which was at 4 hours. This was done to facilitate lap counter shift changes, so it avoided the confusion of having a new lap counter coming on at the same time that we were switching directions. Very smart idea.

There was a major timing system failure at the NC24 in Ohio the same day, and I felt like I picked the right race. That would have been a horrible disaster. When the old lap counting system is done right, and with a reasonable number of runners present and plenty of volunteers available, it's actually more fun than using the chip timing. I haven't run a 24 hour race without the chip timing in a long time, and I forgot that having the human beings at the timing table adds a nice touch.

From the beginning I stuck to a plan. I ran 4 laps, then walked one. I was completely methodical about it and stuck to this pattern through 50 miles. I reached 50 in 10:40, which was only slightly faster than I'd planned. I figured on 11 hours. I found that I was running a fast pace during my running laps, maybe because of the low altitude, the cool temperatures early in the morning with the fog, but I've been working on my running pace so it didn't surprise me. I was struggling with the walk pace, though, because I haven't done much walking in training. I was managing 14 minute mile walk pace without working too hard, but I knew it would make me sore.

I stopped every 2 hours to eat a sandwich and some good calories, and even though it was foggy, it was warm, and I kept adding 2 S caps to my drinks. I didn't get puffy, I was peeing every hour, and my hydration seemed to be perfect all day. I forgot to take off my wedding ring before the race, something I normally do because my fingers get swollen, but I never got so puffy that I couldn't twist the ring off.

The sun came out at 11:00 and stayed out all day until about 6 pm when the clouds moved in again. According to the weather reports, we only had a high of 76 degrees, with 71 % humidity most of the day. It felt a lot warmer in the direct sunshine. I never needed ice on my body, I drank my cold drinks and I felt fine with the temperature. A lot of people were grabbing ice and complaining about the heat. It felt comfortable to me.

After 50 miles I reminded myself not to go over 55 miles in the first 12 hours, so I took a break, changed my socks, took a look at my feet, which were great- no issues, just a little damp. Things don't dry in the midwest like they do in Colorado. I wiped my feet off with alcohol and it took a minute or so to dry. I'd been having problems getting track dust in my shoes so I finally put my gaiters on.

I wasn't super hungry but I knew I needed the calories. I tried some pretzels but they were too dry. I didn't feel like another sandwich yet. I tried a chocolate covered donut, and that was okay but one was all could eat. I got back on the track and was stiff and slow. I knew I needed calories, but nothing sounded good. I kept drinking and started taking in some drinks with sugar to get a few calories. I tried a banana. Too sweet.

I kept moving but I'd slowed down a lot and I knew it was all about getting my blood sugar back up. I was having a bad patch and I needed to eat my way through it. Finally, about the time I hit 100 K, I managed to get enough calories in that I was feeling better. Then I started moving well again. I changed my pattern to running 2 laps out of every 5. I concentrated on the walking pace and was able to get down to 13 minute per mile pace on that.

I also started taking in the caffeine, with iced tea, and then Starbucks doubleshots. I didn't feel that afternoon weariness that I often feel, even when I'm not running. I was still peeing, getting plenty of hill repeats in with the bathroom across the track. It was closer to the track than the other bathroom, but necessitated a hill climb and descent on the grass. It was getting more difficult to descend the hill each time, but it as a nice break from the flats.

At 50 miles, Bonnie had about a 3 lap lead on me. By the end of my bad patch, she had gained 20 laps on me. I wasn't concerned about place, it was still early and my goal was really about making 100+ miles. Soon I narrowed her lead to 17 laps, then 14, then 11 by the end. Bonnie is strong and consistent. It was fun to watch her on the track, and we spent a good bit of time talking too.

There were some other women in the race who looked strong. Danielle from Iowa was moving really well in the first half. We talked for a while and ran together. There was also Karen, from Minnesota, who was a strong walker, but was also running a lot. She was moving along, too.

A few hours later Danielle came to me and told me she hadn't peed and her stomach was sloshy, and she'd been vomiting. I suggested that she get in the shade and cool down for a while and see if that helped things. A few laps later I saw that she was back out on the track, and I asked her what happened. She said she peed a little but not much, but I knew she couldn't have cooled down very much, either. I explained to her about what happens at Badwater when people get into a cool environment and things start working again. Then she did get off the track for a while.

She never started feeling better, though, and she was really disappointed in herself. She came back to the track trying to put in a few more laps, not wanting to give up, but she knew better. I told her it wasn't her day, that there are so many lessons to be learned, and that her health is more important. I told her the story of Lisa Smith-Batchen at Badwater last year, how any runner, even the most experienced, can run into problems in the heat, and what happened with Lisa going into acute renal failure. I told Danielle that there will be so many other races, and that she learned an important lesson here, and it's not worth it to risk your health.

I continued having my own struggles but my hydration wasn't an issue. I just couldn't get interested in food all afternoon, and I knew I needed the calories to get through the night. Once I hit 100 K, I decided it wasn't worth it to stop anymore for any real breaks, because it was too hard to get started again once I stopped. I'd end up wasting more time doing two laps of waddling through my stiffness than if I just slowed down and ate or drank while moving forward.

At night when it was cooler, I did a little better with the food, but I was still struggling. I tried to eat the pizza they brought to the track but the cheese gagged me. I did have a baked potato. I ate all the yogurts I had, I should have thought to stock up on those since they worked so well at Badwater. But I only had 4 in the cooler and I went through those. They would have been perfect. Lesson learned.

Doug struggled with the heat at mid-day too, I think everyone did. He continued to look strong. I had no idea he was in the lead, though. I didn't know where anyone's overall places were until morning.

Around 6 pm some clouds moved in and the sun was no longer beating down on us, but it didn't cool off at the track until around 8 pm. I was not happy to see the clouds for two reasons: one was that they could mean rain, and the other was that it would block our view of the "super moon", the full moon that was supposed to be huge. But during the night the clouds moved away enough that we got a great view of the moon and some stars, too. I was too busy concentrating on running by that point and never took a picture.

It did get windy a few times and I put on a long sleeved shirt, and then a jacket at times. Other people were still in tshirts. I was freezing. My feet were holding up well, my hands weren't puffy, and other than trying to stay ahead of a calorie deficit, things were going extremely well.

We switched lap counters and directions every three hours, and that was the mental focus- getting through to each direction change. When we only had about 8 hours to go, I knew I had my goal, as long as I could keep everything together. I cranked up the tunes and got focused, and the laps flew by. I had great lap counters all day. I wish I could remember all their names. They cheered for the runners each time we hit 50 miles, 100K, or whatever other milestone: 200 laps, 300 laps, etc.

I never got sleepy at all. I drank iced tea and only two doubleshots all night, it didn't take much caffeine. The more I run these 24 hour/100 mile races, I realize that the struggles I used to have, years ago, with staying awake must have been from my thyroid. It's fun to re-discover the distances I used to struggle with.

When I hit 90 miles, I knew I had my goal in the bag. I started moving a little faster, doing a little more running. I had stayed on the 2 out of 5 lap pattern of running and walking, and it was working great.

Paul was my last lap counter and he cheered me on through my last 10 miles or so. He got all the lap counters to cheer for me when I passed my old PR of 90.4 miles. He was funny, he kept making these wisecracks every few laps, so I would give it back. When I hit 100 miles I still had time to go to make at least another whole mile, so I kept going, but I did ask him if it would be irreverent if I Tebowed.

As soon as I said it I realized how silly that was, it would have required bending and kneeling, which are impossible at that point in the race and for the next several days. Maybe it wasn't so irreverent, Iowa is the Cornbelt, but not so much the Bible Belt.

My 100 mile split was 23:47:17. Mission accomplished. Finally, after 22 years of running ultras, a sub-24 hour 100 miler. That took long enough!

I flew through the next mile and had time to spare, I passed 101 and there were still a few minutes on the clock, and I picked it up. I ran 400 meters in what felt like 6 minute pace but I'm sure it was more like 10. I passed the next lap before the gun went off, and made it about a quarter of the way around the track before Karl shot the gun and we had to stop and wait for him to measure the portion of the final lap we did.

Afterwards everyone helped break stuff down and helped me carry all my stuff to the car, I broke down the tent with Doug's help, and we all headed back to the hotel to shower before breakfast. When I was getting out of my car, I happened to notice two pieces of metal in the tread of my left front tire. I looked closer and realized I had two nails in the tire! Crap.

The tire didn't seem to be deflated, but I wasn't about to try to kneel down with the pressure gauge then. I figured I would go find a garage in town and have them look at it before I left town in the morning, and hopefully my tire would stay inflated until then. I was too brain-dead to deal with it.

When I took off my racing clothes, all I had was some heat rash in my armpits, and all over my feet. Very little chafing anywhere, and no blisters whatsoever. My feet held up so well, and they really haven't been sore, just swollen from gravity.

We went to the post race breakfast and ate huge amounts of food, and Doug got a nice hourglass trophy for his win. I guess he can't blame me now, he said he should be thanking me, but I'm not sure his body was thanking me.

Bonnie was funny. I told her I was so impressed with her, she's so strong. I was so glad I had the competition, so many of these races don't have much in the way of people who are close enough to you to give you a challenge. She jokingly said, "You're a pain in the ass!" I guess I made her work for it. I'll be seeing her at Badwater this summer, she's crewing another runner this year. I hope I get to run with her again in the future, she was awesome.

I stayed in the hotel on Sunday, uploaded photos, and took two naps, managed to make up 5 hours of sleep in the afternoon. I went out to get a hamburger and a beer at Lancers around 5 pm and it was the greasiest burger I've had in maybe all my life, but it tasted damn good! I skipped the fries, that would have put me over the edge in grease tolerance.

I slept through the night again. We had thunderstorms and lots of rain. The weather gods definitely liked us this weekend, we managed to catch the hole in the storms. Monday morning it was drizzly and overcast. I took the car over to the local auto shop and they inspected the tires. There were little tacks in the tread of just that one tire, but they didn't puncture the tire. They didn't charge me anything to do it, either. They were so nice, and I was on the road by 8:30 am.

Driving back was another long haul and Nebraska was forever. But I cranked the tunes again and looked at the farmland, cursed the road work, stopped for gas in various armpit-like places along the way, and I don't know what I thought about, but somehow I eventually made it through Iowa, Nebraska and back home in 12 1/2 hours.

One thing I did notice in Iowa, is that I saw absolutely no Romney or Santorum or Gingrich or any other bumper stickers other than Obama, except for one: Cain. Yes, I saw a Herman Cain sticker on a car in Iowa. I did see lots of Obama stickers, and people wearing Obama t-shirts. Interesting.

Tuesday I spent the day unpacking and then went to visit a friend, talked all afternoon, and then I came home. Dennis and I went out for sushi, and I was in bed by 7:30. My feet are still swollen but the stairs are easier. I'll get on the bike today and do some walking, get rid of the swelling already so I can get back to running soon! Only 6 weeks to the Double Mick!

End Needless Suffering in the Heat

Why is this runner sitting down?

This is called competitive advantage. Click here to read my guest post on John Vonhof's blog:

John Vonhof's latest blogpost

If you're a runner or just spend a lot of time outdoors on your feet, the biggest favor you could do for yourself right now is to get yourself a copy of John's book, Fixing Your Feet, 5th edition.

Yesterday I watched a good-sized group of runners doing a low-key, ultra "fun run" locally here. The temperatures reached the mid-90s. I rode my bike up to watch for about an hour. It was noon and getting hotter by the minute. Many of the runners in this group are new to ultras, and they were challenging themselves to this event. I went up to cheer for a few people I know, and was observing as the runners came down the hill to their turnaround point.

I heard the runners commenting about how hot it was and how they'd just like to chew on some ice, but none of them were wearing ice on their necks or heads, a few were not carrying enough water, and some didn't have hats on. I suggested these things to a few of them, and at their aid station I saw some wisely take breaks to sit in the shade in between repeats of the hill they were running.

I saw a few who were obviously feeling pretty miserable. Running is supposed to be fun, especially in an event like this, but being unprepared for what were predictable conditions was the number one mistake these few made.

It's a good thing to challenge yourself, and when you get a group of young, new ultrarunners together they push each other to see who can be the "craziest", but some common sense and sanity are in order here.

The problem is that heat exhaustion can rapidly progress to something more serious, and when you don't routinely run in those conditions, it's even more dangerous. Being prepared can save your life, or someone else's. Be careful out there.

Lessons Learned

I am still going through pictures and stories but I thought I'd post some practical information for the runners who are looking for heat training advice and aspiring Badwater runners.

On my 2011 Badwater Double Crossing, here is a list of some of the things I did and learned. Like anything else in running, this is what worked for me. As they say, YMMV (your mileage may vary).

What went right:

1. Hydration I am not kissing Karl King's backside here, I am telling you that I used S caps exclusively, day and night. Under the conditions of Death Valley I can't imagine using anything else for electrolyte replacement, it is absolutely a superior product. I used two S caps per bottle in the daytime, then when the temps got cooler at night I cut back to one S cap per bottle or alternated with plain water.

I used Crystal Light Pure as my drink mix- a packet of it, contents of 2 S caps dumped in, and ice, with just enough water to mix it up. This worked the whole time, I got tired of a few flavors, but had no problem tolerating it. I checked my hands frequently for swelling. The only time I had puffy hands was in the evening, when I'd be making the transition from hot weather to cooler temps. Once I backed off on the sodium, my hands went back to normal. The morning transition of increasing the sodium never seemed to cause problems.

I was peeing a lot- at least once every 2 hours during the hottest part of the day, and more frequently during the cooler times.

a. Stomach: Because my fluid/electrolyte level was regulated so well, I was able to avoid nausea and stomach sloshing. I absorbed all the fluid- evident from my urination and non-puffy hands. See more about this under cooldowns.

b. Feet: You have to remember that whatever is going on in your hands is also going on in your feet. Avoiding the swelling that comes with fluid/electrolyte imbalance means your feet are not going to swell causing friction against your shoes, the layers of skin and tissue in your feet are not going to swell and separate, which means you avoid blistering.

My biggest problem in 08 was the blister under my left foot. I had a blister in the same spot but over the past year I read John Vonhof's book Fixing Your Feet and learned how to tape properly, and how to reduce the callus in my problem areas. In 08 the blister was so deep John was unable to drain it with a scalpel, he taped it the best he could to prevent further blistering, and the blister finally popped from repetitive trauma on it's own at mile 127, which hurt like hell.

This year, it was easy to access the blister pocket and drain it, which was much less painful and much easier to manage. Other than that blister, I developed only a few small, minor blisters which I was able to easily drain as soon as they developed, and they never became a repetitive problem. At the end of 270 miles, I only had one blister left, the big one under my foot, which didn't get any worse after 80 miles.

Keeping your feet dry is another requirement. Checking your feet for moisture is critical. I use Drymax socks exclusively and they do very well, but no sock is blister-proof. There are seams, movement in the shoe, and moisture builds up eventually no matter what sock you wear.

Changing your socks frequently is important, and you have to be very careful not to disturb your tape job. Don't let your crew mess with the lacing on your shoes or pull your socks and shoes off unless they know exactly how to do it right. The runner is better off doing this is they can.

Speaking of shoes, I run in Brooks Addictions and I used only two pairs of shoes, one during the race and the other on the return. I never needed to change shoes or go to a bigger size because my feet never got very swollen and they stayed dry.

2. Cooldowns- I planned to take forced 10 minute cooldown breaks every 60 to 90 minutes during the hottest part of the day, every day. I stuck to my plan. I would sit down in a chair, put my feet up, in the shade of the van if there was shade, and my crew would cover me with two ice towels- one on my thighs and the other wrapped around my shoulders, reaching into my armpits.

I would take the time to drink something and eat. This would always result in having to pee afterwards. What these cooldown breaks do is allow your body a break from the heat stress it is undergoing. Your muscles get a break and you get more blood flow available to the stomach, kidneys, and other organs, so you're able to process food and fluids.

Every time after my cooldown, I felt much better and was able to pick up the pace immediately. Also, the cooldowns allowed my feet a break from being on them, which was heaven!

3. Preparation- supplies, plans, food choices: A wide variety of food choices has to be available because you never know what you will want to eat. Your body will tell you when it needs protein, quick energy, salt, or whatever. In 2008 all I could eat was jello and baby food. This time yogurt was my staple. I used a good quality greek yogurt, with lots of protein and little sugar. (Chobani). I was able to buy this in Las Vegas and Lone Pine.

Other than that the ham and cheese sandwiches I relied on in training did not appeal to me at all after the first day, and pretzels and crackers were too dry to eat in the heat. I ended up eating fig newtons and Pringles, which are easier to chew and swallow. At the checkpoints I had a special "Ice Cream Bag", an insulated bag for the crew to run to the store as soon as I approached the checkpoint, and then they would bring me fruit bars and ice cream sandwiches.

I had coke, 7 up, and iced tea for variety from my usual drink mix. During the cooldown breaks coke on ice tasted so good!

When we were close to Lone Pine, the crew would go into town and get pizza to bring back. That was awesome, a real treat for everyone, and good calories.

Having done Badwater before, and having crewed twice, I knew it was important to have everything you think you might possibly need, that you can't get while you're out there. I had a huge foot care/first aid kit and lots of hardware, bungee cords, duct tape, electrical tape, tools, etc. We never needed most of it but when we needed something, it was great to have it.

It is very important to teach the crew to put things back in their proper location- everything needs to be clearly labeled and marked, because I promise you, you will never find it again if you don't. As the days go on and everyone becomes more sleep deprived, this becomes more of a challenge.

4. Crew Dynamics- You have to have the right mix of people. Avoid having any crew member who is overly controlling or domineering. I heard horror stories about this on other crews. Assertiveness is very important, along with good, direct communication skills, and a sick sense of humor.

Sometimes it is necessary to confront a crew member on their behavior or a mistake, and they need to be able to take the criticism without taking it too personally. Crew need to have good people skills and to be able to work with each other under difficult conditions, stress, and fatigue. Being able to think critically, anticipate the runners and other crew members' needs, having empathy and patience are crucial to the success of a crew.

Crew need to listen to the runner and the crew chief, and there can't be any power struggles between the crew chief and the other crew members. I don't know what the magic solution is for this, but do your research well. Know your crew members before you pick them and trust your gut feelings. On our crew things went very smoothly, with a few little hiccups, which I attribute to crewmember fatigue. When a crew member gets dehydrated and hasn't taken care of themselves adequately, they don't have as good judgment and that's what happened briefly on the last day.

Having a crew chief who knows the runner well is also critical. Steph and I have been together through 3 Badwaters, and we have gone to other ultras together, and she knows me and my habits well. As a result she is able to predict how I'll respond to a given situation and what I would want. That is priceless.

5. Pacing yourself- During the hottest part of the day it is difficult to maintain a fast pace so it's important to take this into consideration. Save it for night time. There is nothing better than running under the stars. Keeping cool and steady during the day pays off.

Things that slowed me down:

1. Blister/tape management- This is almost a given for anyone running across Death Valley in the summer. It is rare for someone to have no foot issues whatsoever, but it does happen. This was especially important for me this time because I wanted my feet to be intact at the end of the race so I could make the return trip comfortably. I spent the extra time looking at my feet, changing socks, draining small blisters, and retaping as needed. It was well worth it. I am sure I checked my feet a dozen times during the race itself.

2. Sleep deprivation- this has always been a problem for me as of the second night. I seem to do well for the first day and a half and then it catches up with me. I took 3 naps during the race of 40, 30, and 15 minutes. My crew said I snored and snorted like a freight train. I was out instantly. It was always refreshing. The second night I was hallucinating and weaving, and this is a sign that it's time to get a nap. When you're not making good forward progress, a nap pays off. I drank coke and iced tea to get some caffeine, and I usually use Starbucks doubleshots but the milk in the doubleshots was not agreeing with my stomach as well as the coke was, so I only did a few doubleshots this time. The doubleshots went right through me. Not fun.

Things that surprised me

1. (Caution: possibly TMI) Body functions- I guess when you are consuming a lot of extra calories, it makes sense that you would poop more often. Most of the food you eat in ultras is of very low fiber content and can be constipating. For me, on my rest day Wednesday, I ate a lot of salads, and as a result, on Thursday, it was like my body experienced a giant detox. I pooped 8 times total on Thursday, and this was serious poop.

It's important to keep your butt from chafing if you're having to wipe frequently, and baby wipes help to keep things clean. I would use toilet paper, baby wipes, and we also had preparation H wipes, a tip I learned from another ultra friend. These are very soothing when your skin gets raw from wiping multiple times. Following this with hydropel, and then HAND SANITIZER will keep you, your butt, and everyone else happy!

The silver lining in this is that I got to stretch my glutes and hamstrings a lot with all that squatting!

2. achilles/peroneal tendinitis did not bother me at all- I have had mild tendinitis in my right leg for nearly 2 years, which mostly bothers me on uneven surfaces, but when it gets fatigued, it can also hurt on roads. Going into the race I was worried about this, since I aggravated it in a training run about 6 weeks before the race. I taped my achilles for extra support the whole time. I never heard a peep out of my tendons the whole way.

Things I'd do differently

1. Lose weight (if I can)- This is not coming from someone with an eating disorder. It was hard to carry nearly 130 pounds on my frame back and forth across DV. My body is in the awkward transition of middle age, perimenopause, and to top it off I have thyroid disease. But mostly, I think it's because I don't train with intensity anymore because speedwork is too risky these days between my tendinitis and training exclusively for multiday events (all of which I'm going to work on in the coming year)

I tried to lose some weight this spring but only lost 3 pounds. I allowed myself to be a little more hypothyroid than I normally am so I'd avoid problems with the heat like when I unknowingly ran it hyperthyroid in 08, but I don't think it was enough to affect my weight. My body really likes it's 125+ pounds now, and I would love to drop about 10 pounds, but I sure as hell am not going to starve myself to do it. A little more intensity in my training will help with this, once I rehab my tendon.

2. Crew adjustments- As far as crew, I think the people we had were great. I would change how I approached their roles, though. I allowed one crew member to pace me quite a bit on the return trip, he was training for a 100 miler and I normally don't like to have a pacer.

It was nice to have the company the first day, on the second day I told him he could stay back far enough so I wasn't aware of his presence. I figured he probably wanted the training opportunity and I didn't care as long as I felt like I was alone. I kept asking him if he was okay and he said he was.

By the third day he got dehydrated and started blistering, and this resulted in some friction on the crew, so I insisted on going alone. The runner shouldn't be having to worry about a crew member, and the crew member should not put the runner in a position of having to think about the crew member's well-being, blisters, kidney function, etc.

3. Other- I wouldn't do anything else differently except maybe adjust the quantities of stuff we bought, since we had so much left over and unused at the end.

Am I glad it's over? No. Would I do it again? Yes. Will I do it again? I don't know, but I can't imagine doing Badwater again without doing a double, because the race is over with too quickly and there is too much to see and experience out there that you can't do in the rushed setting of a race. Death Valley has so much to offer in it's beauty, and the chance to see the colors and landscape at different times of the day, is something you really shouldn't miss in a lifetime.

photo credit: Felix Wong