Medical Aspects Of Endurance Training For An Ironman Triathlon

In the fantasy world, Ironman movies portray a superhero protected by metal armor eager to destroy evil around the world while in a romantic relationship with his boss played by Gwyneth Paltrow, billed in Hollywood as the most beautiful woman in the world. The real ironman is an athlete who swims 2.2 miles in open water, bicycles 112 miles, followed by running a marathon distance of 26.2 miles all in one day. On the weekend of July 27 this year my wife and I traveled to Lake Placid to observe the Lake Placid Ironman Triathlon competition and to hike Mt. Marcy.

While I can understand an athlete wanting to test their endurance, I am impressed that the human body can accomplish this extreme exercise, that one will spend long hours training and risking injury and that the Ironman event is popular around the world.

Even though athletes spend months preparing for this physically punishing event, serious medical conditions can develop. My interest in the Ironman, as a retired physician, centered around the medical tent where more than 400 athletes of the 2,507 participants were expected to visit with conditions ranging from blisters and road rash from falls off their bicycle to potentially serious problems like dehydration, over hydration, heat exhaustion, hypothermia (low body temperature) and exercise associated collapse.

I gained access to the medical tent most likely, since I told the director in charge, I was going to write an article about medical conditions treated by her staff for my hometown newspaper and not because of my medical background. The director, Cora Clark, an intensive care unit and school nurse, informed me that each athlete completed a medical history, was weighed the day before the event and had a chart filed in the tent. This weight was important because if athletes enter the tent confused and weak, as I observed, a new weight will facilitate a diagnosis to be made. Weight lower than their normal implies dehydration which is treated with fluids orally or intravenously. Higher weight implies over hydration from too much water intake during the race therefore treated with fluid restriction.

I was introduced to William Smith, M.D., a practicing orthopedic surgeon who has served as medical director for the 15 years the event has been in existence.

He acknowledged that the understanding of endurance athletic physiology has been an evolving process. The life-threatening condition, exercise associated collapse, was once thought to be due to heat exhaustion or dehydration.

Theories today, point to ischemia or lack of blood to carry oxygen to the intestines brought on when blood circulation is directed to the muscles for swimming, bicycling and running at the expense of the intestines (gut). Lack of blood and oxygen causes inflammation of the gut lining, resulting in leaky intestine walls which release toxins into the blood. Toxins cause the blood pressure to drop resulting in shock requiring immediate treatment.

The medical tent facility has 26 stations each with three beds (Chaise lounges), one nurse, one emergency medical technician, a runner for supplies and one physician. Close to 4,000 volunteers serve for the event, while 250 serve in the medical tent. Surprisingly, competitors come in all sizes, overweight and slender, tall and short. At times all beds are filled while potential patients wait in line for treatment.

Athletes came from 43 countries and 45 states. Women comprised 25 percent of the total. More than half of the competitors finished in 13 or more hours. Ironman entrants paid $700 to compete. Next year’s race registration fills up the day after this year’s race.

On Aug. 20, The Post-Journal reported that Southwestern High School graduate, Dan Moore finished his second Lake Placid Ironman. Also reported was “area native” Amanda Caruso’s intention of competing in the Louisville Ironman on Aug. 25; she finished and is now an Ironman! My wife and I followed the Lake Placid Ironman progress of “area native” and friend who was greeted at the finish by the announcer, as is the custom, with his name, proclaiming, “Lyle Hajdu, you are an Ironman!”