Saturday, May 7, 2011

Sweet Sweat! My Thoughts on Running and Hydration

"You did not sweat much, your training is not enough..." I was told by my coach after doing the drills on our training session one Thursday evening. Surprisingly, my other groupmates who ran the same distance as I did were sweating like a wet sponge and me, none! I'm as dry as though I haven't started running and to think I was so dead tired already.

Why is that so? My coach told me "You're dehydrated".

After that session I assessed myself. Am I really dehydrated? I know I am drinking water on a regular basis and my skin is not dry. But why am I not sweating much even after a tedious exercise?

Then I started to research about running and dehydration. While researching, a name Remus Fuentes appeared on my top results.
Who is Remus Fuentes? According to the my readings, he is the 21K runner who died of severe dehydration in the recent 34th Milo Marathon last July 4, 2010.

I remembered when I was new to the running community I heard about this news, and some of my runner friends even know Remus personally. Some even saw him and some even witnessed what happened to him on the race. A lot of speculations arises and I've heard a lot of insights from them. But what really happened that fateful day of July 4, 2010? Here is the statement from his father. 

REMUS FUENTES died of multiple organ failures as result of heatstroke secondary to severe dehydration two days after he ran the 21K in the recent 34th Milo Marathon last Sunday, July 4, 2010.
His death was the result of fatal mistakes, incompetence and negligence in the event organized by Organizing Team.
Photo courtesy of his father
My son, 37-year-old Remus ran the 21K together with a running buddy when he collapsed at 19.9 kilometer mark. There was none of organizer’s ambulance nor marshals to respond in the incident. Policemen hailed for a taxi and they, together with his buddy, assisted in bringing him to the nearest hospital, Ospital ng Maynila. At the ER, the diagnose was suspected heart attack. My wife and me, upon being informed by his younger brother, Roy Fuentes, who also ran the 21K, rushed to the hospital and saw that Remus in coma, had seizures and struggled breathing in spite of hand-pumped oxygen and dextrose attached. His body temperature was 40 degrees C and when asked, the medical attendant told us he had fever. She introduced paracetamol intravenously twice at interval of about 15 minutes. Remus continued having seizures even until the arrival of Medical City doctor & ambulance attendants that we have arranged for his transfer. The Medical City doctor attending said his status was unstable, contrary to the earlier advice to her by the Ospital ng Maynila ER doctor. They rushed him  with the ambulance to Medical City at about 11:30 AM. There, a  series of tests were done, including blood chemistry, CT scan, etc. Cardiologist told us his heart was strong and no intervening medicine was necessary. Blood Chemistry results showed positive findings on creatinin level, an indication of  kidney failure. They suspected liver failure too. To stop his seizures, Remus was put on full sedation for 12 hours. Kidney functions further deteriorated after 36 hours. Blood pressure and heart rate went erratic. Doctors attending him in the ICU asked our permission to do dialysis and blood transfusion to stabilize his blood pressure.  Seven hours later, ICU nurse woke us up and asked us to rush to the ICU. We saw 18 medical people around him, several taking turn doing the CPR. Failing to revive him, the doctor asked our consent to stop the CPR after 15 minutes. We begged them to continue hoping for a miracle. 30 minutes further, doctor told us again that all numbers in the monitoring board “were bad” and asked again the consent to stop the CPR. Finally, we relented. Few minutes later, his heart rate monitor went flat. All these happened in front of his mother and me. We lost Remus 48 hours after he collapsed into coma which he has never recovered. His young wife and his eight-year old son took the news very badly.
About Heatstroke:
It usually happen in extreme sports like basketball, football, boxing and marathon.
Heat stroke is a life-threatening medical condition. The person’s cooling system, which is controlled by the brain, stops working and the internal body temperature rises to the point where brain damage or damage to other internal organs may result. The body temperature, usually at normal 37 C, goes up during the exertion of effort as result of the increased heart rate. When it reaches 40 C, the person is in danger of getting heatstroke. Above 40 C and mostly at about 42 C, the person can collapse into unconsciousness.  If nothing is done within few minutes, he can slip into coma and brain damage may occur. The proven first aid response for heatstroke is cooling the body rapidly in whatever means to the level of below 40 C before bringing him to a hospital.  Ice and water is the best way to do this, the same way it is done for a child having high fever who has convulsion.
Another way of understanding heatstroke is comparing it to the performance of car engine. At idling, the engine temp is low and safe. At sustained high speed, engine temperature increases rapidly but because of the cooling system, the heat is continuously dissipated in the radiator and safe temperature level is maintained. But when the water in the radiator is gone, Undissipated heat will rack up the engine temperature and ultimately exceeds the safe limits. At this condition, engine breakdown will occur in minutes starting with broken piston rings, rods, pistons, etc.
With the human body, perspiration cools down the body so hydration by drinking water is essential. Without water, perspiration stops and body temperature goes to critical level and into heatstroke and then organs and brain begin to fail.
Big obvious difference between human body and car engine is that you can always overhaul the engine but you cannot do that on the human body.
Why Heatstroke is More Dangerous in Marathon than in other Extreme Sports?
In basketball, the player exerts extreme effort only in bursts, stopping or slowing down intermittently which slows down heart rate and cools down the body. At timeout, they drink to replenish lost body water hence you always have the waterboy. Heart stroke is rare but ask any PBA player what they do when a player collapse. They don’t move the body but cool them off with water or ice before bringing him to the hospital.
The same is true in football and in many similar sports.
In boxing, in between rounds of three minutes, boxer rests and drinks water. We can only wonder what will happen if the rule of the sport is drastically changed and will only end when one is down and out.
In Marathon, the risk of heatstroke is much higher for the following reasons:
  1. The long distance runner aims for shorter time as a goal and therefore motivated to keep a sustained effort, not unlike cars at high speed in the highway.
  2. Furthermore, the target minimum time set by the organizer adds more to the motivation to run faster. The cut-off time added more pressure to the marginal marathon runner, meaning if you are used to run above the target time, the tendency is to do better time, probably at pace unproven by your body in practice. (Milo Marathon set the target for 21K medal at 2 ½ hours or less. Remus collapsed at near 20th km. with time of 2 hours 10 minutes when his previous record was 2 hours and 27 minutes. ).
  3. The more critical factor is that the hydration management is not in the control of the runner. He has to rely on water availability at the water stations provided and planned by the organizer along the route. ( In this 34th Milo Marathon, several runners including Remus brother, Roy and Remus running buddy asserted that practically there was no water to drink in the last 2~3 kilometers before the finish line, a fatal failure for Remus by the organizer when they changed the route resulting in merging and over-traffic near the finish line. There were record 28,000 runners on that day and the organizers failed to anticipate the complexity of hydration management. Milo’s last year marathon participants were well below 10,000 runners.)
  4. The correct life-saving response for heatstroke depends on few knowledgable people who may happen to be around the person. To mitigate this, the organizer deploys ambulances with water & ice for cooling heatstroke victims and is expected to respond within minutes. In addition, marshalls are provided along the route to assess runner situations continuously. (Obviously, the organizer failed again on this aspect because Remus was helped by policemen and his buddy instead. By this time, Remus is probably already brain damaged as evident by his seizure at the hospital. No Milo people knew of Remus case on that day until Roy, his brother, sent an email informing the organizer of the incident in the next morning)
  5. The Sun Factor adds to the danger in Marathon. Running under the heat of the sun in tropical country like ours cannot be underestimated. To minimize the effect of the sunheat, Marathon run is planned to finish in the early morning avoiding the heat at later time. Organizers usually take this into consideration. (Milo organized the 21K to start at 5:30 AM , a departure of common practice of  other marathons which started at 5:00 AM.  Remus collapsed at about 7:57 AM. Roy, who is a better runner than his brother Remus, complained that it was unusually hot that morning even if he was able to finish it earlier in 1 hours 45 minutes )
Clearly, Marathon is an extreme and dangerous sport even to the young, healthy and trained runners. This is not the “fun run” many people confused of.
The organizer has clear life-and-death responsibility to make sure that the conditions the runners will run under item 3, 4 and 5 above are done properly. Obviously they did not do their job properly in the 34th Milo Marathon. In my opinion, being the father of Remus, Milo Marathon Organizer have failed my son. It is their incompetence and negligence of their duty that results in the death of Remus …an unneccesary death.
About Remus:
At the time of his death, he was an IT project manager of Hewlett-Packard (HP) responsible in computerizing big companies like Unilab, Coke,  etc. including installation of hardwares (servers, etc.) and software system. He used to work for Intel for 10 years before he moved to HP 3 years ago. He graduated in Computer Engineering. He left a housewife, Takako and two children, Raphael, 8 years old and Therese, 4 years old. Raphael is enrolled at La Salle Greenhills. He played basketball with his brothers regularly on weekends. He has been running since his high school days in Lourdes School of Mandaluyong. He has run many 10Ks and two 21Ks before these, the “Freedom Run” in June 13 and “Nature Valley” in May 20 only this year. He has no history nor complaint of illness and he lived clean.
My Questions for the Marathon Organizer:
  1. How many died in the 34th Milo Marathon last July 4? Is it true that there was another runner at 42K who collapsed at 33 km and later died?
  2. How many runners collapsed in that marathon due to heatstroke who later survived but now are no longer the same person as before due to partial brain injury? At Ospital ng Maynila, we saw a 2nd runner brought in unconscious and woke up later but he can no longer recognize his family. Do the Organizers knew this? What happened to him. Are there more?
  3. Is it true that another 36 year-old runner, Fidel Camson, who ran the 42K 31st Milo Marathon in November 2007 collapsed near the finish line, brought to the Ospital ng Maynila and died later of undetermined cause? If true, what did they do to avoid a repeat which apparently did not happen in this 34th Milo Marathon? If true, why do they still keep the same Marathon organizer for 10 years until now?
  4. Do they keep tally of deaths in the 34 years of Milo Marathon? Do they study the statistics and establish how many died of heatstroke, the preventable one?
  5. What is the corporate culture of the Organizers regarding its respect of the value of life? Upon knowing the death of my son Remus, A Senior Vice President of the organizing team, who head its Beverages Business Unit went to see me and among other things, he told me that the Marathon is continuously improved and but sometimes “lapses occur and they will learn from these lapses”. Lapse is defined as  a ‘mistake’. People learn from ‘error’, a deviation from being correct but a ‘mistake’ is caused by a fault: the fault could be misjudgment or carelessness.  We learn from ‘error’ but we take action on ‘mistake’ and more drastic action when people die of this ‘mistake’. So death in my son’s case is a mere  learning process for this person? Is this the culture that pervades in their Organization? or only in him?
  6. Is the measly “humanitarian” offer to help the family shoulder medical & funeral expense to the family had become an SOP too often? Was it their expectation that as appreciation of this help, the family will keep quiet about the whole thing? Do they really think that the waiver signed by the runners protect them from being liable? Do they know that this waiver won’t apply if negligence of their duty as organizer can be established? 
  7. What did the Organizers do, if any, to keep the news of Remus death from appearing in the media even after one week? Not one news item of his death appeared in the newspaper, TV or radio. Could  the news  of “ HP Manager Died of HeatStroke during the Milo Marathon” not interesting to the public? Were they afraid that the bigger news is when the subline “Father charged Milo Marathon Organizer of Incompetence and Negligence” which may damage the public image of the company?
The answers to these questions will help enlighten the public whether Milo Marathon is safe or not for the runners. To the runners, their parents, wives and relatives…they all better ask these questions before the runners decide to run in Milo Marathon.
Last Words from Remus Father:
I am not condemning the sport but the organizer who failed to make sure runners will not die of heatstroke, when the risks can be greatly minimized with proper route planning, hydration management and quick medical response. I am condemning the contribution of the apparent culture of the sponsor of diminished value of human life as indicative of its senior executive’s attitude that my son’s death is a result of lapses. My hope is something good will come out of Remus death and as result of improved organizing of the marathon run,  few lives will be saved from heatstroke. My other hope is to get justice and for the Organizing Team to  answer for his untimely death. I am working on it.
Rudy Fuentes, Father of Remus
One main cause of his death - dehydration! After reading this article I said to myself "dehydration really is no joke and I need to do something about it". Now I realize it's importance. Some of us, including me don't even consider it as fatal. So, I did my own research on hydration and running, and then I started to follow a hydration therapy plan I created on my own based on those readings.

How to find out if you are dehydrated? Here are some of the symptoms...
  • You don't sweat much during runs
  • You have dry skin
  • You don't urinate often
  • You experience cramps during exercise
  • You experience snowy vision
  • Your blood pressure decreases (hypotension)
  • You have cracking lips
  • You experience constipation

What I did about my dehydration?

I planned my water consumption - I made sure I am taking as much water as I can all throughout the day. I am always keeping a 1-Liter bottle containing water on my desk at work and I finish it in 1 or 2 hours. At home, I also do the same thing on my bedroom side table so I can just grab and take a sip if I feel like it. I am not a fan of carbonated drinks and juices. I really prefer water over them. I stopped drinking coffee, tea, alcohol and carbonated drinks for a while since they are diuretics, they'll make you urinate more and they can dehydrate you.

Keeping a water bottle on sight will encourage you to drink more, even if you're not thirsty
Before I start doing my LSD runs on Sundays (Long Slow Distance, 16K or more in 3 hours time), I drink a glass of cold water. I make sure my hydration flasks are filled with fresh water. During the run, ever so often I took sips even if I'm not thirsty. That way I absorb more fluid that drinking the whole flask. Human body is like a sponge. How much we should drink during runs depends on the weather (heat and humidity), and how far are we running. The maximum amount  we should drink is the amount that can empty from our stomachs. Research shown that most runners' stomachs can only empty about 6-7 ounces of fluid every 15 minutes during running. If we drink more than that, the extra fluid will just slosh around in your stomach and not provide any additional benefit. We may be able to handle more or less than the average, however, it depends on the individual so experimenting with how much liquid your stomach will tolerate will be a good option.

I do this on a regular basis now even if I don't have upcoming races. By doing so I am maintaining myself hydrated all the time.

It's wise to strap around a Hydration Belt for instant access to drink plus a good storage of essentials like mobile phones, car keys and extra cash for emergency needs.
When I do my LSD's, I stop at convenience stores to grab an electrolyte drink What is an Electrolyte drink? We commonly know it as Sports Drink. The famous brands are Gatorade, Powerade and my favorite, Pocari Sweat. Yes, water is good for hydration, but we cannot set aside the fact that there are some vital nutrients that water can never provide. One of those are electrolytes. 

When water is not enough, opt for a cold sports drink at a convenience store
What are Electrolytes? "Electrolytes are important because they are what your cells (especially nerve, heart, muscle) use to maintain voltages across their cell membranes and to carry electrical impulses (nerve impulses, muscle contractions) across themselves and to other cells. Your kidneys work to keep the electrolyte concentrations in your blood constant despite changes in your body. For example, when you exercise heavily, you lose electrolytes in your sweat, particularly sodium and potassium. These electrolytes must be replaced to keep the electrolyte concentrations of your body fluids constant. So, many sports drinks have sodium chloride or potassium chloride added." (Source:  U.S. Dept. of Agricultural Database).

If I'm monitoring my sugar intake, especially on days where my spikes are very high (blood sugar suddenly goes up with no apparent reason), I opt to drink Lightwater. It's just water but with electrolytes in it. Ofcoure you won't be enjoying the fruity taste that Sports Drink has but it gives you the same benefits. It's also good option to consider if you are watching your calories.
Water plus electrolytes. A healthy option for sugar and calorie watchers!
If you feel that sports drinks are expensive, I found an alternative solution. Remember OreSol? Also known as the Oral Rehydration Solution. They come in three forms, liquid, powder and tablet. These are the ones we take in when we were little when we have Diarrhea to replace lost liquids in the body. I love seeing it sizzle when I drop it in a glass of water! Cool huh? I bet you did that too! The OreSol tablet has all the sugar, salt and electrolyte content of that of a sports drink, I think even better. You can put that into your flask instead of  buying a sports drink from a convenience store, but you wont enjoy the cool drink from their freezers though, and it does not taste better as well.
Oresol tablets costs P13.25 at Watson's

I watch my salt intake - Salt is important. It puts flavor into food and most of all, it retains water in the body for longer periods of time. But too much of it can make you bloated, and you don't want that. Before a race, I put an extra sprinkle of salt over my dinner and for my breakfast, I eat energy bars which has considerable amount of salt in it.
Salt is composed of sodium, a water retaining chemical
I give in to my thirst after a run - I drink to my hearts desire after a long and tedious run. I drink almost anything! may it be flavored or sweet. I need to give myself a break sometimes. Besides, I ran far. I need to reward myself for being such a sweet obedient girl! ^_^ 
Nai Cha Jelly from North Park is a sweet treat after a long and hard run! ^_^
After a month of sticking to my self-made hydration therapy, What I have noticed is that my acne breakouts were lessened, my skin is more radiant, my urine color is now lighter and I now sweat when I do physical activities. I know now how it feels when sweat drips down my face whenever I run. I never felt any better!

Picture taken by a Greentennial Run Photographer at Run with Doctors Race in MOA. Grabbed a cold bottle of water a few meters from the finish line. Who cares about PR's now? It was scorching hot!
Now that the climate is getting hotter, we need to make sure that we stay hydrated at all times. It is important, not only for optimum performance but for overall well-being too. A lot of health concerns starts to arise when a person is dehydrated, and worst, it can lead to death. So start hydrating and get the feel of sweltering out this summer! Have a Sweet Sweat! Enjoy!

Good Vibes everyone and Sweet Running! ^_^

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