NSAID Useage

This was previously a page on our website but we feel this is a more appropriate place to share.

I’ve been following several threads in an Ultra-marathon Medical Director’s email group and felt it was prudent to create a page here to post the summaries of the various discussions. I know as ultra-runners we’re a wildly independent bunch and don’t respond well to mandates from “think-tanks”, but I’m keeping this page tuned to information generated from physicians and others who are in the middle of the ultra-running world and trying to keep us all aware of the most recent medical findings surrounding our sport.

One recent thread regarding NSAID use can be summarized in the following bullets:

  • The theoretical risks from NSAID use in this environment are clear, and so NSAIDs should not be made available by the race. 
  • Regardless of the grouping, if a drug inhibits prostaglandin it would be just as dangerous to kidney function.
  • Runner education about the concerns of NSAID use should continue. This should not be limited to education about use during a race, but also should include education about the risks from chronic use during times of injury.
  • Runners can easily carry their own drugs if they continue to desire to use them.  
  • Most race’s medical directors in the thread don’t believe there is any solid evidence that NSAIDs actually reduce pain. One of the physicians in the thread was only aware of one paper that looked at this (from a study at WSER), and they found no benefit in terms of pain relief of reduced delayed-onset muscle soreness.  
  • In a recent study (the paper is currently in review, and is expected to be presented at ACSM in 2012) at the 2011 WSER, post-race blood work was done on approximately half the finishers. Based on “injury” and “risk” criteria for acute kidney injury of blood creatinine 2.0 and 1.5 times estimated baseline, respectively, 4% met the criteria for injury and an additional 29-30% met the criteria for risk of injury. There was no statistical difference in the use of NSAIDs among the three groups (those with injury, those at risk, and those not meeting either criteria). The posting physician suspects that this finding just points out that factors in addition to NSAID use are often more important in the potential development of renal injury in ultra-marathon running – the so called “perfect storm.” The overall NSAID use was 34%. Interestingly, the use of NSAIDs was at 57% in 2009, so hopefully this represents some progress with educational efforts.
  • It was generally agreed that limited use (a few hundred milligrams per 24 hr period) of NSAIDs or Tylenol was not likely to cause health effects, but other factors endemic to ultra-running combined with increased use of either of these could compound to create health effects.
  • There is a small trend being discovered by some race medical directors indicating that narcotic use during events may also be occurring, which is completely contra-indicated and dangerous.

A Word From Sarah

Sarah here. I wanted to say hi to all our runners out there. Jesse & I are SO excited to be the new RD's for Salt Flats Endurance Runs. We joined Salt Flats in 2014...you know, the year of the 100 year storm. The year of the missing runner who I spotted using Morse code from my cell phone flashlight. The runner who was life-flighted out of the course during the break in the storm. The year we ratchet strapped the canopy to our vehicle so it wouldn't fly away & woke up to snow the second day. 

A little back info...In 2014 we were in introduced to the Ultra Running community thanks to Ray Smith (the previous Assistant RD). Ray & my husband work together & Ray mentioned needing some volunteers for an upcoming event. Jesse asked me if I was interested. We have a sense of community about us & our family. Since we were both athletes growing up & avid adult "runners" (5k, 10k, 1/2 marathoners) we thought SURE! Our introduction was a cold, windy, wet, snowy one. BUT what was really amazing was the Ultra spirit we experienced. Everyone was SO thankful & polite. Despite 2014 being insane we went home & I contacted ALL the Ultras in the Northern Utah area to volunteer too. 

So in 2014 we were the AS Captains at AS #9. (We also started aiding for 3 other ultra runs starting that summer & fall.) 

In 2015 we were the AS Captains at AS #10 & brought one of our daughters. We've also continued aiding at 2 other ultras in Utah. 

In 2016 we were back at AS #9 as AS Captains again as well as serving as the turn around point for the 50K earlier in the day. Jesse also went out several days for set-up during the weekend before the race. In 2016 we brought our entire family plus another teenage friend for my daughter to hang with. Victoria (our oldest) & Jesse also spent several hours tearing down the course after the race. We also continued aiding at other ultras in Utah, 3 more this year. 

In 2016 Vince also announced at the pre-race meeting that Jesse & I would be taking over the race in 2017. 

In 2017 we plan to be there with the whole family again serving in multiple locations but most importantly at the Start/Finish. Hopefully you'll get to know our BIG family well this coming year & for years to come. 

I wouldn't consider us Ultra newbies at this point but we always welcome comments & suggestions. Also look for a few changes along the way. 

2015... Classic Salt Flats

This was it..a classic Salt Flats year.  Great running temperatures, spotty rain, a few hours of wind, and a great success ratio for both distances.  We saw several "first timers" succeed at their chosen distance, and some veterans have to dig deep just to finish.  The terrain lived up to its subtle reputation, and the last climb from 82 miles to 90 miles had many 100 milers using a wide variety of colorful language to describe their feelings.  50 milers also had some fun on the descent from  the mountain pass at mile 42.  Ray Smith, our Logistics RD along with his kids, and my two sons-in-law, did a masterful job ensuring the trail markings, "Honey Buckets" and Water were placed and then retrieved in record time.  Chriss had everything organized for the volunteers, and they all received great compliments as they were enthusiastically engaged with each runner, with Aid Station 13 edging out a "win" with their Pizza Oven, party lights, and music rocking the 90 mile mark!  Our support teams from Elko SAR, South Jordan Police, and Salt Lake Ham Operators were brilliant and we were able to keep runner progress posted to the web (once we fixed a URL issue).

We learn more each year, and this year was no exception.  It's always fun to realize how much we can improve, and we start planning for next year even before we've packed up and left the salt.  We'll continue to refine and improve, so every year we can make the experience better for everyone.

As always, the most enjoyable part of the entire experience is seeing runners finish.  The crossing of the finish line is just a single step, but it represents the triumph over the mental and physical battles that rage during an ultra-distance run.  I was able to stand at the finish and welcome each runner across the line, and that makes the effort of putting the run on worth it.  A big thanks to everyone; runners, volunteers, SAR, Comm, friends, and family who come together to make this happen.  It's a monster effort, but it's all worth it when the medals and buckles are handed out to very tired, but very happy runners!

Community

In 2008 I was introduced to the concept of the Ultramarathon when I was asked to provide the timing for Karl Meltzer's Speedgoat 50K at Snowbird UT. At the time, I was a runner for two reasons: First - I had my annual fitness assessment in the National Guard each year so I needed to maintain a reasonable level of fitness for that, and Second - I was running daily to de-stress from a very difficult business collapse.  Meeting Karl was an eye-opener to be sure.  The idea of running beyond 15 miles or so never even occurred to me, and here was this guy telling me that 31 miles through the mountains in a day is "normal".  I'd never even entered a 5K in my entire life, and yet I signed up to run the Speedgoat the next year, and it became my first-ever "race".

Obviously, I was absorbed into the culture and have adopted running at ultra distances as a major part of my life. I've gone on adventure runs across the Highline Trail in the Uinta Mountains, and run solo through the West Desert in Utah.  I've met 100s of amazing people who I call my friends.  I enjoy the general lack of "competitiveness" and the supportive nature of most participants in these events.  I've stopped to help others many times during an event I in which I was "competing" in, and had others offer their help when I was struggling. My competition has always been with myself, and for me the process of the ultramarathon has more importance than the result.  I realize there are many to whom that concept is unappealing, but that's the magic of this sport; it is capable of supporting many different perspectives within it's ranks while not alienating any one of them.

Recently however, I've observed situations that indicate the culture of our sport is in danger.  Some within this community are willing to deride and degrade others because of any number of things that aren't in-line with their own perspectives.  I see exclusionary statements are being directed at people just looking into our sport via online forums because they've "only" done a 10K or 1/2. I've now heard of ridicule and derision being relentlessly laid upon a runner who became lost in the dark and epic storm of last years Salt Flats 100 event. I find it inconceivable that someone would find it acceptable to be anything but fully supportive and concerned for someone who experienced such a traumatic event. 

I believe we are better than that. I believe that the ultramarathon itself allows us to become introspective, resilient, accommodating and generally better people as a result of our participation. I think we're a special community simply because we run in places where we often need volunteers, and each other to succeed. I hope that we as a community will work hard to continue to make our sport as welcoming and inclusive as when I was first introduced to it by Karl. 

Keep running!

The 2014 epic run

Hello Runners, Crew, Observers, and Passers-by!

I decided to add a blog to the site, and post thoughts about the race throughout the year (as it is pretty much a year-round activity in my world now).  The 2014 Event was epic on so many levels, that I thought it would be good to start to voice my feelings about it in this first post.  

The NOAA radar picture Friday morning looked a little concerning with a number of storm cells in the area but the temperatures were good, and the forecast was wildly variable from hour to hour, so we started the race on time and sent the runners out onto the beautiful salt flats.  All was looking good until just before dusk, when both the weather, and the NOAA radar picture turned very ugly.  80 mile per hour winds hit various parts of the course, and by night-fall the rain was in full force.  

It turns out, the rainstorm was a "100 year storm"... average April rainfall is 0.40 inches, and this one storm alone was 1.1 inches.  Temperature fell to below freezing by 0400.  The entire Salt Flats flooded with 6" of water by 0600.  Runners were dropping at every aid station, and the volunteers were shifting to Hypothermia triage rather than aid station workers.  The racers that came through the finish in the dark were at various stages of hypothermia, and we quickly shuttled them into the trailer and fed them hot soup.

The 50 milers who were supposed to start at 0500 and run out on the Salt Flats ended up being re-routed twice... once off the salt (as it was under water), and again off the dirt roads (as aid vehicles were sliding off the road and unable to get out to the aid stations).  It was chaotic, stressful, and insane.  By 1000 on Saturday, the sun was poking through the clouds, the rain had stopped, and it was perfect running weather again.  I thought back to the previous 3 years and how each had it's own "character", but all had been pretty friendly compared to this.  It is truly amazing how much can change during the course of a 100 mile event.

When all was said and done, everyone was safe (one rescue did occur, proving our SAR and Comm team are truly world-class).  All vehicles were accounted for, although one was stuck for several more days until Ray Smith (Assistant RD) and I could get out and extract it after the mud had dried a bit.  One of the portable toilets was blown 2 1/2 miles away from it's original position on the Salt Flats.  I found course flagging alongside the freeway near Wendover, many miles from its closest possible origin.

The Salt Flats is always a harsh environment.  On the website I state that runners and volunteers alike should be prepared for any weather, but I must admit that mother nature hit with all she had this time, and it challenged every facet of the event.  Good emergency plans, excellent personnel, and great teamwork paid off, and the event was a success despite all of it. 

Epic.  No other word for it.