“Breathe. Slow down. Cool off.” Audible commands verbalized at mile 80. As my stomach churned, I couldn’t help but imagine blood shunting from my gut to my skin. Gastrointestinal distress is one of the most common reasons why ultramarathoners fail to reach the finish line, and a process called splanchnic vasoconstriction contributes greatly to the nausea described anecdotally by athletes. Essentially moving more blood to the skin helps with evaporative and convection cooling – these mechanisms decrease body temperature through sweating (evaporation) as well as air blowing across the skin (convection). When I was at struggling with GI distress at the Western States Endurance Run (WSER), my mind was trying to solve how to get blood back to my gut. I was suffering, but still moving forward.
My passions of medicine and running are constantly intertwined. Moments of introspection take me deep into the physiology of my own body, which I promote through mindfulness and meditation practices while running. These medical puzzles are captivating and keep me enthusiastic about both my profession and my hobby. However, the question doesn’t always arise during active crisis; thankfully, I also enjoy the opportunity to prepare and ponder prior to getting myself into trouble. For instance, I previously trained for high altitude races at sea level, another of the big conundrums that face mountain ultra trail athletes. Pure fitness helps but doesn’t show a correlation with prevention of acute mountain sickness, nor does it negate the effects of lower oxygen. There aren’t great solutions beyond an early arrival to allow the body to adapt naturally – tents and masks and pills all offer very subpar methods and aren’t often practical. However, heat acclimatization demonstrates many comparable changes in the blood and musculature, the science of which is captivating to me as both a runner and a doctor. These kinds of discoveries are fascinating! Not only do I get to read and learn about them, but I have the opportunity to be my own experiment and benefit first-hand from this knowledge.
An amassed knowledge of the human body has contributed to success in trail racing, but it also propagates relationships through helping others – the root of why I love running. Whether this means chatting on a group run, formally treating a patient in my clinic, or offering advice over social media, medicine has drawn me closer to my running community. Most people can identify with this through crewing or pacing. These acts of service often require some critical thinking or emotional counseling to help a runner achieve their goal of crossing the finish line. As much as I gain from running like a doctor, sometimes the most meaningful interventions come from friends and family who provide less science and more love, ultimately infusing success with value.
There is an intermixing of these emotional and logical motivations that bring runners deep into trail races because at mile 80, something always comes up. For me, at Western States, its nausea. My friend places me in the river, a full-body immersion helping to more efficiently regulate my rising core temperature. My dad feeds me slush and chilled fluids, helping to cool internally and provide hydration. My brother fills the back of my running vest with ice, exploiting surface area with large capillary beds to cool on the move. However, even after doctoring with the best thermoregulatory mechanisms, my stomach never recovers. Instead, I suffer through twenty miles of horrible nausea and fatigue. At this stage, medicine is not what propels me forward. I have no protocols, no manipulations, no studies. Instead, I am feeling everything. I am willed onward by my brother who now runs and walks at my side as we move toward my dad who is waiting in Auburn. No science here, just love. I am certainly thankful for all I learn in medicine, but I experience unique growth as a runner when medicine has no answers and human connection is all that is left. As true as this is in running, I find it applies well to most of life.
Teddy Bross, MD
Family Medicine Resident
Runners Plus Athlete