The Lewa Downs Safaricom Marathon

Last weekend I was lucky enough to be part of the team giving medical support to the Lewa Downs Safaricom Marathon. This marathon has been placed among the 10 ‘must-do marathons’ in the world. It has a cap of 1000 runners and it is an extremely popular yet formidable challenge. A marathon distance is difficult enough for most people but this particular jog through the bush also involves the dry heat, high altitude, tough terrain and a host of local beasts trying their best to interfere with the curious long line of humans running through their home.

I have been involved in medical support for a few endurance events and I would like to start by congratulating the organisers on a slick and effective job. I would urge anyone reading this blog – if you are looking for a unique endurance event with stunning scenery and a great party atmosphere, not to mention the opportunity to see some of the fastest long distance runners in the world disappear into the distance, this is the race for you.

The medical support came from multiple different groups, local ambulance providers, local hospitals and even a couple of medics from the British Army (I never got a chance to say thanks to those guys, but they were brilliant the whole day) coming together to provide excellent care for anything from muscle sprains to head injuries.

I had the opportunity to fly around the race course in a helicopter looking for collapsed runners. As you

probably imagine from the description of the race above, there are generally quite a few to scoop up. The same problems keep cropping up but there are a few unique hazards on this race. We had to spend the first hour of the race scaring off elephants, buffalo and rhinos from the course. Some of these runners are fast but I guarantee none can outrun an angry bull elephant. I’ve learned that they can be horrible creatures when they want to be. Apparently they will smash your body against a tree or the ground, then grind you into the dust with their back legs. There is often little left that is recognizable human anatomy after a fatal encounter with an elephant. So Pooh was right to be scared of heffalumps. He wouldn't have been quite as anxious if he and Piglet had been shooing them off in an awesome helicopter.

It was not long before we were called to one runner after the next. One poor chap had collapsed unconscious into some bushes with his neck flexed partially obstructing his airway. We got to him in minutes and he looked terrible. He had that horrible see-saw breathing showing not a lot was getting past his pharynx. It’s a shame to think that bystanders hadn’t cottoned to the fact that all he needed was a minor shift in the position of his head and he would probably have come round. His blood oxygen saturations were only 65% (they should be 95%) and he was deeply unconscious. We sorted his

airway quickly and put him on oxygen fully expecting him to need further resuscitation back at the finish tent. Wonderfully he gradually regained consciousness as we landed and I left him trying to work out where on earth he was. He genuinely had no idea he hadn’t crossed the finish line. 

The next patient was a classic heat-stroke, staggering about, confused with skin as dry as parchment and a temperature of about 40. Just like in extreme cold you will lose the ability to shiver, in extreme heat you can lose the ability to sweat. Just when you need to the most! He did well after we liberally coated him with water and then blasted along the bush with him in the helicopter. One of the best

ways to prepare for such a race is to acclimatise for a couple of weeks and build up your tolerance to exercising in the heat. But people rarely do this. I can see why. I’m not going off running in the bush when I might get mashed by an elephant, gored by wildebeest, torn to bits by hyenas, bitten by snakes or robbed by bandits. No thanks.

When we arrived at the resuscitation tent I was greeted to find a patient who had been brought by land ambulance in a collapsed state. He had regained consciousness only to go completely ballistic, screaming the place down. It had taken a large dose of sedative to control him. My best guess diagnosis on this chap, was of brain swelling secondary to low sodium, however that is yet to be

confirmed. The safest thing for this chap was to sedate, paralyse and transfer him back to Nairobi in the Caravan air plane. The team worked brilliantly together including our exceptional pilot Emmanuel for whom nothing was too much trouble. 

It difficult to confirm if low sodium was his particular problem. Low sodium or hyponatraemia in marathon runners is caused by them drinking too much water. Check out Dr Tim Noakes book ‘Waterlogged’ if you are a runner and want to know more about this, but the dogma that sports drink manufacturers would love you to believe about fluid replacement is pretty much garbage. Imagine our ancestors, cultural endurance athletes, I very much doubt they drank 3 litres of fluid when covering the same distances. Dehydration maybe a matter of performance but rarely a matter of life and death. Your sensation of thirst is a pretty good driver of behaviour to top yourself up just like your drive to get warm when it is cold. Unfortunately the strange sensations associated with water excess, make people believe they must be dehydrated and so they drink even more! In a study of Boston marathon runners in the NEJM (http://www.ed.bmc.org/library/core-curriculum/NEJMhyponatremia.pdf) 13% had moderate hyponatremia, with 0.6 percent had critical hyponatraemia which could easily cause seizures, coma and death. Nearly every year I hear about a London marathon runner dying from this entirely preventable cause. The anti-ecstasy drug campaigners would also love you to believe that these high profile tragic deaths of teenagers in night clubs was down to the drugs when it was actually due to harmless old H20. Occasionally I even see someone, who in the midst of a bizarre psychosis, has taken it upon themselves to drink gallons of water with the same dire consequences. Who would have thought water could be so dangerous.

So if you want to give this marathon a try, and I thoroughly recommend it, take my advice: - train hard, acclimatise somehow, keep your airway patent, drink when you are thirsty and bring a camera!

(and for those who enjoyed the last little film, I have put together another 5 min long one, purely about the marathon)

http://www.youtube.com/watch?v=N-ompKAWivc