As athletes we prepare ourselves physically and mentally for the huge challenge that is an endurance event such as Ironman. However, there is also a lot of work going on behind the scenes of the event to ensure that you are well cared for and as safe as possible on the day. At the forefront of this is the medical team, who are highly specialised at identifying and treating some of the specific and potentially life-threatening conditions that may see you end up in medical on race day. We had the chance to talk to Dr Tony Best, who has been the Medical Director of Ironman WA for the past 15 years and asked him, how can athletes avoid the medical tent; what doctors wish you knew about race day…
What is the number one reason that athletes end up in medical on race day?
The most common reason athletes end up in the medical tent is dehydration and exhaustion, often related to gastric upset during the race. Often athletes will exceed their ability to absorb the food and fluid intake resulting in vomiting resulting in even less absorption.
How often do you see life threatening conditions occur?
The most common life-threatening condition we see (apart from bike accidents) would be hyponatremia, which is low sodium levels in the blood, usually caused by electrolyte losses through sweating. Usually there would be between 1-5 cases per year with symptoms of nausea, headaches and poor balance. Severe cases can present with confusion, seizures and even result in coma. Hyponatraemia was far more common in the earlier years of the event, as better athlete education and training has helped athletes avoid this preventable condition.
Can you explain the risk of dehydration compared to hyponatraemia?
Hyponatremia (low sodium) is far less common than dehydration but also far more serious and much harder to treat. It is easy to rehydrate an athlete by topping up IV fluids but difficult to manage too much fluid. Hyponatremia is caused by the body releasing ADH (a hormone that retains fluid) in response to the physical stress of competing. Athletes sweat out fluids and salts but often replace the fluids without adequately replace the salts. Sometimes the amount of fluid ingested is in excess of fluid losses complicated by fluid retention causing a positive fluid balance ultimately resulting in hyponatremia. That can cause altered conscious state, vomiting and on some rare cases seizures and death.
Physical stress + sweating + replacing with water only = potential hyponatraemia.
Do you ever pull athletes from the course, and what sort of symptoms are you looking for?
Very rarely we pull athletes from the course. Mostly we would remove athletes that have no chance of finishing and are failing to make any meaningful forward progress! If someone is confused or had a significant injury we would pull them from the course but again that is not very often.
What are your recommendations for carbs and fluid consumption on course?
Have a plan and stick to it. Remember to adjust to the conditions on the day and adjust for heat and cold and remember that just because there are fluids at an aid station it doesn’t mean you have to take it, only drink when thirsty or to your plan.
What are your three best tips on how to avoid the medical tent?
- Don’t race when sick. It’s a big day where you need everything in your favour. Being unwell before the gun even fires is asking for trouble.
- Just because you are at an aid station that does not mean you have to drink, especially if you have slowed right down or are walking. Pace your fluid and electrolyte intake, have a plan and stick to it.
- In the leadup to the race make sure you train and familiarise yourself with the on-course fluids – this means practicing with what will be provided on course so you know your tummy can handle it. Alternatively – carry your own!
A final word from the Medical Director…
“It always amazes me the power of the human body’s recovery. Athletes often cross the line looking like they are having a “near death experience” which often spooks the catchers and others at the finish line. They can be heard muttering how they will “never do this to themselves again”. Lo and behold, that same athlete will be seen five minutes later sitting with their mates looking great and discussing PBs, how awesome their rave was and they’re already planning for next year’s Ironman.
Sensible training, pre-event nutrition planning and realistic goals are the keys to a safer race. It’s great to race your mates and try and crack PB’s but at the end of the day it is a form of recreation and the main aim is to have an enjoyable memorable day finishing in a healthy state if possible.” – Tony Best , IMWA Medical Director
Thanks Tony – a great perspective on keeping safe as we enjoy our sport!