Doctor on the run for 135 alpine adventure racers

I felt like one of those doctors you see on period military dramas where the doctor is attending wounded soldiers and invariably sawing a leg off.

This was the inaugural Alps 2 Ocean Ultra multi-stage adventure race that was a 316km run/walk, taking runners from the foot of Mount Cook to the coastal township of Oamaru over seven days from 25 February to 3 March.

It was conceived by an ultramarathon runner Mike Sandri from Oamaru who competed in an ultra marathon in the USA and fellow runners asked him why there was not such an event in NZ. An idea was born. As a runner myself, with marathons including the Kepler Challenge, 60km, the Routeburn Classic and Christchurch marathons under my belt. I was asked if I would be interested in being the doctor for this event.

After being assured that all profits were for Oamaru and no one was being paid, I was happy to donate my time and experience to the event.

I later discovered this event could not be staged without a doctor due to the stress put on runners. About 135 runners were coming from all over the world and I must admit I was both exhilarated and anxious. Among these runners were going to be some of the best in the world. I was acutely aware I had a duty of care to these runners and, to a lesser extent, the support crew. 

Having no experience being a medic for such an event I had to let my imagination do the planning and looked forward to the challenge. I made preparations with the local hospital for supplies as I made plans for worst-case scenarios. 

My biggest concern was the weather, as it gets quite hot in Central Otago in the summer. My research told me heat-related illnesses can be very serious, ranging from simple cramps and sunburn through to exertion-related heat stroke that has a 10 per cent mortality rate rising to 33 per cent when combined with hypotension.

Other considerations included injuries from falls including fractures and lacerations and minor issues such as blisters and chafing. I thought hard whether to take the practices' resuscitation equipment especially when we had had a cardiac arrest in the practice three weeks before the race. The only other medic to be present was Janine Hayes, a nurse from Oamaru Hospital. 

The weeks before the race New Zealand experienced a heatwave followed by Cyclone Gita the week before. I was getting nervous.

Pre-race day the crew and runners gathered in the old part of Oamaru for a rousing haka from Waitaki Boys High School before the runners boarded the buses for a tour of various sights on the way to Aoraki/Mount Cook. Meanwhile the crew went to prepare a camp site at the southern end of Lake Pukaki and then Mount Cook before the arrival of the runners. The weather was crystal clear and Mount Cook looked outstanding. It could not have been a better showcase for New Zealand.

My work began shortly after when one runner approached me and said he thought he had giardia. My preparation had not taken this into account! Arrangements were made for appropriate antibiotics just in case.  

It has been a long time since I inserted a cannula in the middle of the night and I never expected to do it in a dark medical tent while using a head torch for lighting

Sunday saw the start of the marathon’s first stage where the runners ran 7km to a helicopter pad for a quick thrilling flight to the northern end of Lake Pukaki.

The high winds only added to the thrill as I understand they were at the top end for safe flying. This was fortunate as there was no plan B. Stage 2 was a 47km run down the eastern side of the lake where the next camp was situated at the southern end of Lake Pukaki and was the end of day one.

There were various checkpoints on each run and after the last runner had passed through my checkpoint I made my way to camp and got to work as soon as the runners started arriving. The problems presenting were mainly blisters and chafing but I was surprised by the sheer number.

In hindsight, I suppose, with 130 runners, this should not have been too much of a surprise but given the quality of the runners, I expected fewer. It turned out to be the first of many late nights. 

So, what were the medical problems? Blisters and chafing were by far the most common. But what is the correct management of blisters in a runner/walker with 316km to complete?

To open or not to open the blister. That is the question.

We felt that if the blister was small and not too painful then it was left but if it was larger and causing problems it was opened after cleaning, needling, covering with a non-adherent cover and dressed.

As the week progressed, headaches and nausea became prevalent and probably indicated increasing dehydration.

Paracetamol tablets became a frequent request as did metoclopramide, to a lesser extent. Other problems included fevers, a bee sting in a runner previously de-sensitised for anaphylaxis to bee stings and presenting with facial swelling, a corneal abrasion that had to be sent to the emergency department with a request to send him back so he could complete the run, an MS patient admitted after deteriorating for a few days due to dehydration, abdominal pains and faecal frequency that needed loperamide, and a runner with a chest infection requiring antibiotics.

I was also surprised by how many had pains in the foot pads over the metatarsals. This proved quite distressing and hard to treat. Another issue was haematuria. One had urinary symptoms but the others did not. The issue here is that the usual advice for exercise-induced haematuria is rest and reassurance it should resolve within 72 hours. But how do you tell an ultra-marathoner who has travelled here from overseas to rest in the middle of a seven-day event?

Among all these issues were the musculoskeletal issues of the legs, especially around the knees and anterior ankle. Just as well we had a physiotherapist who was kept just as busy as I was.

Surgical procedures conducted included the removal of a runner’s big toenail, deformed by past runs. Now this nail chose to become very painful and I was asked to remove it.

Performing minor surgery in a tent with poor light levels in a camp site was a new experience, as other runners came to have a look.

Another day, another runner asked for a toenail removal after it became painful and again this was conducted. A surprising problem noticed was the development of blisters lifting the entire nail which presumably was due to rocking of the nail on the nail bed causing soft tissue damage.

On the fifth day when I got back to camp late from a check point, I arrived to find that one of the runners had sustained a 6cm laceration to her lower leg from barbed wire and that the nurse had steri-stripped it.

It was too dark in the tent so I moved the examination couch outside and proceeded to clean, anaesthetize, explore and suture the laceration. I felt like one of those doctors you see on period military dramas where the doctor is attending wounded soldiers and invariably sawing a leg off.