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THE OFFICIAL BLOG OF BEXAR ATHLETIC TRAINING

A WORD WITH
DOCTOR SPRAGGINS

Injury treatment and prevention guidance with Bexar Athletic Training owner, Dr. Spraggins.

Heat Observed

Field Notes: Observations of an Athletic Trainer at an overnight ultra-marathon in the Texas heat


For starters, you probably want to know why anyone would want to read my field notes. As a runner I am based out of San Antonio Texas. I live behind O.P. Schnabel Park, it has been my own 202-acre playground with trail systems that allow me to cover ground on the northwest side of town from Six Flags to 151 highway without using much of that hot concrete. Don’t believe it, see Adams article in here about trail running in San Antonio. I used much of this trail system to train for running 30 miles for my 30th birthday while training to run Grand Canyon Rim to rim to rim with some dusty trail friends. Meaning I am no stranger to the hazards of trail running in the Texas Heat.

As a professional I am an Athletic Trainer well versed in conditions that may plague runners and endurance athletes. I received my undergrad in Athletic Training at University of the Incarnate word here in San Antonio Texas and my post grad work at Indiana State University. As a Doctor of Athletic Training, I have seen many of the conditions that runners develop and have seen the Texas heat try to ruin many an outdoor outing. I have also went back and taught Emergency conditions for Athletic Trainers at UIW.


This leads me to want to talk about a trend I witnessed at the last race that we took the Recovery Den to. We were at Muleshoe Bend Recreational Area in Spicewood Texas. The race was the Captain Karls overnight Trail Series in Muleshoe. This was the second race in a series of 4 races by Tejas Trails. This was a fantastic production by PJ and his band of merry volunteers. I watched too many volunteers to count as they sliced, diced and peeled various fruits by the steam table panful. They set out various snacks that ultra-runners have been known to love such as pringles, pickles, Oreos and more. They marked the course in such a manner that even the lowest blood sugar having runner could avoid being lost.


However, it was incredibly hot. How hot you ask. My truck recorded 115 that day, and the canned soft drinks the volunteers were setting out, begun to explode in the sun around 2pm. They sounded like remnant fireworks of the 4th as the tops severed their seems exiting through the shrink-wrapped plastic at a fascinating speed.




A few hours before the race began, and shortly before packet pick-up started, I noticed a volunteer that I thought has lost that excitement she had a few moments ago. Her face was absent of a smile, in its place was a look of incoherence. Also missing from her face was the steady drip of sweat every other volunteer, and even myself had at the time. If you are unaware, not sweating in the heat isn’t a good strategy. Upon going over to visit with her she let me know she had been slightly dizzy and nauseous even. She also mentioned that it felt as if all her strength had left her. She was however aware and cognitively not-impaired. I asked her to move over to the recovery den and sit in the AC while I moved her last few cases of water. Once in the AC she started to perk up a little. I was still getting the cold tubs chilling down and had one at just barely 60 deg. I asked her to simply stand in it for a few min, getting water to just above her knees. Upon standing in the cool water for less than one min, the color returned to her face, she began to chat and feel more comfortable and mentioned “I guess I just got over heated.” We were able to eat some fruit from the cooler and restore her strength and function.




My intention with this posting is to bring awareness to heat illness and give everyone some more strategies to cope with the heat. I would love to change the concept of just getting “overheated” to seeing heat illness for the danger it is. The heat can kill you, absolutely.


“When you overheat your body, you can basically cook your cells, essentially, and that will cause cell death and cell dysfunction,” said Rebecca Stearns, the chief operating officer of the Korey Stringer Institute, a nonprofit housed at the University of Connecticut dedicated to studying and preventing heatstroke in athletes.


There are 4 main heat illness to be aware of. Let’s break these down and look at how to best avoid these heat illnesses. I want to increase awareness so we can avoid these issues and continue training and performing at our best. Plus, If I can provide you with the knowledge and tools to perhaps help another athlete, then, that’s a win too.

The Korey Stringer Institute (KSI) is a nonprofit institute housed at the University of Connecticut, named after the Minnesota Vikings linebacker that passed away from exertional heat stroke in 2001. KSI is dedicated to studying the recognition of, effects of, treatments, prevention and finding solutions to athletic related heat illness. I will reference them often as they are a great subject matter expert on all things heat related. KSI is a fantastic resource too, feel free to check them out, I get nothing from it, but WE (globally) are all better if we all know better.


Heat Syncope

According to KSI Heat Syncope, also known as orthostatic dizziness, is a fainting episode experienced in higher environmental temperatures usually by someone not acclimated or in their initial days of heat exposure. Being that we live in military city USA, I am willing to bet many of you have seen someone unfortunately fall out of a military formation, marching band or just standing too long in line for the newest iPhone. This is something to be aware of, but isn’t directly related to what we are talking about, so I wont spend loads of time here.


This situation occurs when an individual in the hot /humid climate looses adequate blood flow to the brain causing them to lose consciousness. This is unfortunately more common in situations where prolonged standing occurs for long periods or sudden standing from seated or lying in the heat. The common factor that causes someone to lose consciousness is that temporary loss of blood flow to the brain. Standing for prolonged time does this by promoting a lack of muscle contraction of what we call smooth muscles aiding in flow of blood through our system. Other times this situation occurs is when we have individuals wearing heavy gear they are not used too, often looked at as firefighters bunker gear, or police and military load outs. How does this apply endurance runner? Have you ever taken a vacation run? Have you ever run in a new shirt or with new gear? Running in a new place with a hotter or elevated humidity than your home trail system can really change things. Acclimatization can be a real issue and can take up to 14 days to really get back to your original level of output in the new environment depending on the level of change.


Heat syncope has been related directly to dehydration, by way of its limiting effect on total blood volume. Avoiding things considered to be diuretics would also serve the traveling athlete to acclimatize faster. That can mean regulating caffeine intake and holding those cold brews until after the race is over. I bring up syncope so we can understand what it looks like, early recognition is the key to solving these issues once they occur.


Heat Syncope signs and symptoms

Dizziness or lightheadedness

Weakness

Decreased or weak pulse

Pale or sweaty skin

Tunnel Vision

Loss of consciousness

Heat Exhaustion is probably what most in our active populations will experience. Also, its definition is debated in some circles, but KSI has it fairly clear. The inability to continue exercise in the heat due to cardiovascular insufficiency is heat exhaustion. It is important to also define cardiovascular insufficiency; the point when the heart has difficulty providing enough oxygenated blood to muscles and organs. This is exacerbated by dehydration from the excessive sweat the body produces in effort to cool itself.


Again, the biggest tool to prevent this issue is early recognition, so familiarize yourself with these signs and symptoms below. Learn how to listen to your body and adapt your activity to help you get through it safely. Live to train another day. Being adequately hydrated sounds like a no brainer with ultramarathons, yet, in this heat you need to be looking at the percentage of water loss. Most humans can be ok with a 1-3% loss day to day if you replenish. However, 10% can be fatal. A trick for this is monitoring your weight as you get into the long run. Many runners go out an celebrate the act of running an event by having drinks the night before, thus starting you off dehydrated on race day. Work/ Rest ratios are also important, I will dive further on that later.


Heat Exhaustion signs and symptoms


Dizziness or lightheadedness

Weakness

Decreased or weak pulse

Tunnel Vision

Pale or sweaty skin

Loss of consciousness

Fatigue

Nausea

Vomiting

Chills

Diarrhea

Heavy sweating

Irritability

Headache

Decreased Blood Pressure

Decreased Coordination

Hyperventilation

Elevated core temp


For me as an Athletic Trainer, Heat Stroke is probably one of my top 5 most feared events. Some reading this may not think it that serious. I want you to know that there are very few emergency events that ATs drill and practice. Yet as an AT in Texas, in high school and military settings, you better bet we drill our response to heat stroke frequently. As most things medical and science go, I disagree slightly with KSI on a small point. I agree that heat illness is not a spectrum, you don’t get syncope, then cramps, then exhaustion, then stroke….that’s not how it plays out. Simply if you passed out in the parking lot, you probably didn’t compete in the activity after that. However, where I differ, is Heat Stroke. Heat Stroke will present a lot like Heat Exhaustion to a degree, until its too late. Heat Stroke really presents itself when someone has the signs of heat exhaustion and pushes past it. This is why many ATs get fired up when an athlete ends up in the hospital or dies from heat stroke, it's preventable. When you get your core temp elevated over 105 for extended period of time you begin literally cooking cells. Kidney, liver and brain tissue can easily become irreversibly damaged.

Heat Exhaustion signs and symptoms. As I have mentioned before the best key is to be familiar with the above and below signs and symptoms, and stop activity at the first onset of heat illness. It really is that plain, if you stop and go in the AC when you get dizzy and lightheaded perhaps start getting tunnel vision, then you don't have to experience throwing up and passing out. I agree that these illness are not on a spectrum, yet the symptoms are kind of progressive.


Heat Stroke Signs and symptoms

Dizziness or lightheadedness

Weakness

Decreased or weak pulse

Tunnel Vision

Pale or sweaty skin

Loss of consciousness

Decreased Coordination

Nausea

Vomiting

Chills

Diarrhea

Heavy sweating

Irritability

Headache

Decreased Blood Pressure

Irrational behavior

Hyperventilation

Elevated core temp (105)

Emotional instability

Disorientation

“Out of it” appearance

Dry mouth

Insatiable thirst

Staggering


I hope you noticed that I kept all the symptoms of the previous illness and added the remainder, that’s on purpose. Truthfully, do I need everyone that reads this to know how to diagnose the difference between heat exhaustion and heat stroke. Eh…not really. If your running buddy is overheated to the point of any of these symptoms, especially the last set, you need to get them cooled off in a hurry.


Let’s talk about what getting some one cooled off can look like.

Now I am spoiled, I have the recovery den and cold tubs at my disposal. If you are at an event with me, I will move all things to get someone overheated into that tub, rapid cooling is going to be key. Let’s pretend you don’t have a Plunge Tub in a trailer outside with you.



  • STOP ACTIVITY (if your running, Walk)

  • Move the individual to a cool/shaded area

  • remove “excess” clothing (be smart here, the point is to get cooler, not arrested)

  • Elevate legs to promote venous return.

  • Cool the individual with fans, rotating ice towels, or ice bags.

  • Best places are base of neck, armpits, chest and groin.

  • Provide oral fluids for rehydration.

    • Avoid super sugary “aids”

    • Cold Fruits are great to get nutrients up.

    • Take it slow, no chugging, you can start vomiting again making things worse


HEAT STROKE PLAN

If your running buddy exhibits ANY of the signs of cognitive decline, such as irrational behavior, emotional instability or heaven forbid a complete collapse. Then you have high probability of heat stroke. At this point you have two goals, rapid cooling and getting higher level of care.


  • Get cold (See above cooling plan.)

  • Get Emergency medical


Heat Stroke is very serious, your running buddy cold at a minimum loose kidney function or suffer brain damage, at the most, they could cross the final finish line.


Training Suggestions

When it gets hot, pace becomes a really poor indicator of your efforts and output. Heart Rate (HR) is a far better indicator of exertion. For example, if you’re used to run a 10k at 8min/mile, averaging 140 bpm. Then on that 108 degree race, stick to the 140bpm, even if it means that pace drops to 10 or 11min/mile. Heart rate training is great way to both easy into the summer heat and prepare yourself to be more heat tolerant. If you haven’t looked into this yet, it will transform your running, but be very patient with it. You will need to run slow to earn the right to run fast again. When I first started heart rate training my pace dropped to a shuffle. This is also where we will mention work/rest ratios again. when training in the heat, and watching your Heart Rate, you can use a walk/ run method to keep your HR in check. Setting an alarm a few bpm below the threshold and walking until you get it lower is a great strategy.


Give this method a shot, its well proven and worth a shot


Another method to keep track of summer training is the weigh in and out method. Many runners in the Texas heat will sweat out 10lbs on a long run, this sounds like a lot, and it kind of is, but if you put it back before the next run, then you are ok. Doing a 20 miler, loosing 12lbs of water and then getting up in the morning to run another 15miles while still down 10lbs is a bad start. You wouldn’t run a half-marathon hungover would you (don’t nod your head). That essential what it would be like, that’s a good formula for a heat illness. You can treat water loss by weight. If you sweat out 8.6lbs, you need to put a gallon of water back in. My recommendation is to put some electrolytes back in. Drinks like nuun, liquid IV, and Drip Drop are some I enjoy and they make it easy. In the Marines they would just give us a packet of salt….the aforementioned items are much better tasting. Keeping your electrolyte balance in check will aid in proper absorption of water. Lack of the electrolytes can lead to another heat related issue called hyponatremia, I’ll make another post on that soon.


For more information on heat related issues, look at KSI

Sunrise at Mule-shoe Bend Capt'n Karls

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