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My dabblings with sports medicine in my first marathon
Blogs are not edited by PJ staff*. The opinions expressed in this blog do not necessarily reflect those of The Pharmaceutical Journal.
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By Laura Burley
This weekend I did something a bit different. I flew to Paris with a fellow pharmacist to complete our first marathon. Now in two different hospitals it was a nice reunion and another hurdle, perhaps comparable to that of the pre-registration year. Pharmacy may have been far from our minds, but medicine in general definitely had its role.
After a tough night’s sleep, the alarm clock sounded with dread. A bowl of porridge (for carbohydrates), with nutella (for protein) fuelled us up for the race. My urine output was up to scratch, evident from multiple visits to the ladies. This was a consequence of water-loading the day before. We then generously applied Vaseline, a runner’s saviour, to prevent from painful chafing (especially useful for men around the nipple region). Standing waiting for the race, some off – licence use of loperamide helped to prevent any runner’s diarrhoea. As each wave took off it was evident runners used everything from this to gaviscon to help settle a nervous stomach. Also littering the streets were tubes of magnesium, which is known to deplete in endurance sports and helps aid muscle contraction.
As I crossed the start line I focused on getting to every 5km where I could rehydrate. Too much hydration however is bad leading to potentially fatal hyponatremia. At each hour I refuelled with a gel, these replace electrolytes and carbohydrates and some contained caffeine. Caffeine as well as providing a mental boost is said to enhance recovery and speed. Regardless of this, the placebo effect worked miracles and they became my “magic” gels. Other aids included jelly beans and sugar lumps to help wave off hypoglycaemia. At mile 20 I begged my friend for some ibuprofen as my feet began to cramp. I was however only allowed this if I caught up with her. Sadly at mile 24 I turned down the offer of wine , unsure if it would hinder my finish.
Crossing the finish line was phenomenal. Post- recovery is not. Blister plasters, analgesia and the applications of “RICE” are some of the few pharmaceutical measures I will be using. However if you are thinking of doing a marathon, I say do it. I am yet to wipe the smile off my face.
16 Apr 2012
After a tough night’s sleep, the alarm clock sounded with dread. A bowl of porridge (for carbohydrates), with nutella (for protein) fuelled us up for the race. My urine output was up to scratch, evident from multiple visits to the ladies. This was a consequence of water-loading the day before. We then generously applied Vaseline, a runner’s saviour, to prevent from painful chafing (especially useful for men around the nipple region). Standing waiting for the race, some off – licence use of loperamide helped to prevent any runner’s diarrhoea. As each wave took off it was evident runners used everything from this to gaviscon to help settle a nervous stomach. Also littering the streets were tubes of magnesium, which is known to deplete in endurance sports and helps aid muscle contraction.
As I crossed the start line I focused on getting to every 5km where I could rehydrate. Too much hydration however is bad leading to potentially fatal hyponatremia. At each hour I refuelled with a gel, these replace electrolytes and carbohydrates and some contained caffeine. Caffeine as well as providing a mental boost is said to enhance recovery and speed. Regardless of this, the placebo effect worked miracles and they became my “magic” gels. Other aids included jelly beans and sugar lumps to help wave off hypoglycaemia. At mile 20 I begged my friend for some ibuprofen as my feet began to cramp. I was however only allowed this if I caught up with her. Sadly at mile 24 I turned down the offer of wine , unsure if it would hinder my finish.
Crossing the finish line was phenomenal. Post- recovery is not. Blister plasters, analgesia and the applications of “RICE” are some of the few pharmaceutical measures I will be using. However if you are thinking of doing a marathon, I say do it. I am yet to wipe the smile off my face.
Congratulations!
Congratulations and some caution
Congratulations on finishing the marathon. The Paris marathon is an extremely beautiful course.
With regard to hydration it is now recognised that people should be "drinking to thirst", rather than to defined hydration protocol. Planning to drink large volumes on a race can lead, as you say, to fatal hyponatraemia. Hyponatraemia is more common in slower runners, who are on their feet longer and therefore drink more, and in women (because it is suspected they follow hydration instructions more carefully than men). Finishing a marathon dehydrated to some extent is not a problem, drinking to thirst is going to provide adaquate intake of fiulds.
Some caution might be used with the use of NSAIDs during a marathon. There is conflicting data on NSAIDs for the development of hyponatraemia, but it has been cited as risk factor in some studies. Aside from the usual concerns about NSAIDs, this should be a consideration.
Regards
-- Anthony Cox
Marathon runners
Should marathon runners use oral rehydrating drinks, some found in sport drinks which will restore any loss of body's electrolytes and produce some energy? This might avoid hyponatremia.
And cooling themselves with water also help.
If you train well enough, you can run a marathon without any medications. However there is hardly any cases of runners get serious harm from taking pain killers.
Drink drink the hype
Oral rehydrating drinks can contribute to hyponatraemia, they do not "restore any loss of body's electrolytes". The amount of electrolytes they contain is offset by the volume of fluid that has to be consumed to obtain the electrolytes. The widepread view that such products have benefits is more due to advertising and promotion of their dubious benefits, rather than any sound science.
There was a rather good piece in the The Guardian which covers the issues well.
http://www.guardian.co.uk/lifeandstyle/2012/apr/18/how-much-water-drink-marathon
Cooling with water will not prevent hyponatraemia, regardless of its other possible benefits.
-- Anthony Cox