Medical Advice – The Marathon

BEATEN BY A WAR AND A PANDEMIC

Posted on May 15, 2020September 28, 2022 by DAVE JACK

Only two things have beaten Comrades since it started in 1921. A war and a pandemic.

World War ll saw Comrades stop from 1941 to 1945 and the global pandemic we came to know as Covid – 19 brought Comrades to a halt in 2020 and 2021 and with it the hopes and dreams of over 27,000 runners.

The last Comrades before World War ll in 1940 went down in the record books because most runners didn’t think it was going to take place and as a result very few continued training and because a lot of the men who were expected to enter had withdrawn and left to join their units at training camps at various centres around the country the field was left to just 23 who set off on the Up Run that year.

Those who did run are said to have eased back on their Comrades training as they were not sure whether Comrades would take place or not and it was only Allen Boyce already with three gold medals and two of them for second place in both 1938 and 1939 in his collection who took the decision that he was going to give his training his full attention in case Comrades did in fact happen.

Allen Boyce won in 1940 by a staggering 1 hour and 50 minutes a gap unlikely to ever be beaten in the future but that was the end of Comrades until 1946 because of World War ll and since then there has not been much that has threatened to disrupt the race.

We had already had the launch of the 95^th Comrades scheduled for the 14^th of June 2020, the slogan of which was to be “Iphupho Lami – Dare to Dream” and the field had been increased to allow a massive 27,500 runners to take part, the biggest number ever and the excitement was there both locally and from runners overseas.

Entries had sold out in two and a half days which was something unheard of and the organisers got themselves ready to start preparing for everything and then at the beginning of 2020 a city in China called Wuhan, hardly known to the average South African shot to prominence and we started to hear more and more about it on the news. There was clearly nothing much to worry about because the Americans weren’t too worried it seemed and then we started to hear alarming stories coming out of Italy and then Spain and then the rest of Europe about something that was being called Covid-19 or corona virus and it didn’t take long and it was being called a “global pandemic”.

South Africa is part of the “globe” surely but still nothing was happening here or anywhere else in Africa it seemed – then it started.

By March the Americans and the Brits were taking very real notice of what this “pandemic” seemed to be doing but still nothing too much in the southern tip of Africa but we started to hear things and then towards the end of March, we were all glued to our television sets as our president told us just how serious this pandemic was and what had to be done to slow it down even though it wasn’t doing too much damage at that stage and South Africa found itself in “lockdown” so that we could prepare for what was coming, a new experience for us all.

The regulations were stringent. Restaurants had to close as did theatres and other places of entertainment but we then heard that sports events were being affected by the “lockdown” and our national cricket and rugby teams had to cancel overseas tours and we couldn’t leave our homes or exercise in groups and running was affected so what about Comrades we all asked?

The Comrades organisers put out a media release saying that they were going ahead with the planning but unfortunately the media release was incorrectly read by many of the important people and in a flash we had cabinet ministers and suchlike people coming on TV saying Comrades would not be happening without the permission of the controlling body of athletics in South Africa.

The problem was that at no stage did Comrades say that THE RACE would go ahead as planned but rather that the ORGANISING would go ahead. When one considers that it takes virtually a full year to organise this event it then all makes sense but for a short while a lot of unhappiness all round until the confusion was resolved.

Eventually in mid-April a further media release, this time from the controlling body of athletics came out saying that Comrades would be postponed to a future date still to be announced and that – other than announcing a complete cancellation – was all that could be done at that stage. That made sense because we had no idea what this virus was going to do.

It was beyond the control of the Comrades organisers but not all runners saw it that way and many took to social media saying that the Comrades Marathon Association owed it to runners to tell them what was going to be happening. The fact that they couldn’t do this didn’t matter, some people thought that Comrades organisers were duty bound to tell runners something that was impossible for them to do.

The other thing that happened was that the organisers said that if it did take place the latest it could take place was the end of September but that was also not acceptable to all and runners then started deciding on dates for the race and some were quoted in the media giving the “perfect date” with reasons when it should be held, the dates which didn’t agree with those thought by the organisers.

The country however remained in lockdown and slowly – ever so slowly – restrictions started to be eased but we all remained very frustrated, not so much because we had no answer about Comrades but because some of us fall into the so-called “high risk category” of over 70 years of age and “experts” in the field of viruses started to suggest that those of us in that category should perhaps remain in lockdown until the end of September!

Then eventually on the 14^th of May the joint media release came from Comrades and ASA telling us that Comrades 2020 was cancelled and was definitely not taking place that year so all the confusion, all the uncertainty and all the anger could finally be laid to rest.

So for the second time in the very long history of this incredible event, it is being cancelled for a reason beyond the control of the organisers but it is still the organisers who will take the anger and abuse levelled at them by many runners and by many members of the public.

Those of us who love this race – and I am certainly one of them – are very disappointed about the cancellation but we need to understand that this is not the fault of the organisers nor of the athletics body nor the government and that it’s been said over and over that just as it was a World War that stopped Comrades once before, so has a war, this time against an invisible enemy, done exactly the same thing again and just as the race came through the last war that stopped it and it survived, so it will do so again this time.

May 2020

COMRADES – MODEST TO MEGA

Posted on February 13, 2019October 1, 2022 by DAVE JACK

One dictionary definition of the word modest states “Moderate or limited in size” and whilst Comrades had started in 1921 and was very modest, it had many exciting tussles by those runners winning in those early days and we had the first three of the five time winners in Arthur Newton, Hardy Ballington and Wally Hayward all by the early fifties as well as the slowest winning time set by Bill Rowan in 8:59 when he won the first Comrades in 1921.

We’ve seen a couple of very close finishes. Phil Masterton-Smith beat Noel Burree by 2 seconds in 1931 and Manie Kuhn beat Tommy Malone (who had won in 1966), by just one second in 1967. The biggest winning margin was set by Allen Boyce by almost 2 hours in 1940 but it was really only in 1959 that the transformation to what we have today slowly started.

It was in 1959 that entries went to 100 for the first time and spectators at the finish to around 200. It was also around that time that we started to see spectator interest from parts of South Africa other than the Durban and Pietermaritzburg areas of this “thing” held annually.

Runners had been travelling to Natal to take part in Comrades from the early days and there had been non Natal winners (Bill Rowan was the first one) but interest was fairly low. The same spectators in small numbers came out every year to watch what was simply called “The Marathon” by locals.

It was the sixties when the changes really started to happen and by the end of that decade entries were up to 1000 although it was fairly lonely running at times.

I don’t remember exactly where this photograph was taken but it was during my first Comrades in 1968 and not too many other runners around me.

It was also in the sixties that we saw the first foreign runners in the form of a team of four Englishmen running for the Road Runners Club in England up against a South African team. The fairly small band of Comrades supporters had always regarded Comrades as a South African owned event so it was a major dent to the ego when Englishman John Smith won the race.

He led the rest of his English team to four of them in the top five with Jackie Mekler, the sole South African in the top five. Jackie himself told me years later that he misjudged that race very badly and ran like a novice and by that time he already had a couple of wins to his credit!

It wasn’t until the early seventies that interest from the UK was seen again when a team from Tipton Harriers arrived and against all odds, Mick Orton won the race beating Savages favourite Dave Bagshaw who had won the previous three races.

Bagshaw was a superb runner and his wins in 1969, 1970 and 1971 during which he set a course “record” twice showed just how good a runner he was.

Orton was back again in 1973 to defend his title but failed dismally in his attempt to repeat his win, so Comrades became the property of South Africa again when Dave Levick was first home. Levick, from UCT, was also the first university student to win Comrades.

Orton, incidentally had something like an 11 minute lead going through Pinetown with about 20km left to run. He was caught and passed by Gordon Baker and with just a few Kms left it looked as though Baker was going to get that elusive win. He was in the lead and could virtually “smell” home but it was Levick who came through to win, leaving Gordon Baker with yet another gold medal to his collection. In 9 Comrades, Baker had 8 gold medals but was never able to achieve his dream of a winner’s medal.

Orton, after his 11 minute lead with about 20km to go, finished in 5^th place.

The 50^th Comrades in 1975 was certainly the year that changed everything.

The first thing that troubled the organisers was whether the “old road” could handle more than 1500 runners. It was (and still is) narrow and with seconds’ vehicles on the road, it was a major problem. Organisers limited the field to 1500 with the requirement that novices had to qualify with a marathon time of 3:30 or better. Interesting that we all thought we would have to qualify in under three and a half hours so most of us ran our best marathons at that time. I ran my three best times when I thought I would have to qualify in under 3:30.

That wasn’t the only thing that happened in 1975. Organisers approached the SAAAU, the controlling body of athletics in South Africa at the time and after numerous discussions, the powers that be allowed Comrades to be open to all races instead of only white males between 18 and 65 as had been the case previously and also to women.

The one thing very few of us could understand and it still remains a mystery to me, is why black runners were required to wear ethnic tags denoting “Zulu” or “Xhosa”, etc. An embarrassment to everybody.

Comrades survived the seventies and the second half of the decade saw the race dominated by Alan Robb who was the first person to finish the Down Run in under 5:30.

All the while the entries grew and at the end of the seventies the roads really were too busy, but there were no further limit on the number of runners, so only one other thing could be done.

Get rid of vehicles from the road and so we saw the introduction of refreshment stations and after a few years a total ban on motor vehicles except those with special permission to be there such as the media.

By this time TV was becoming firmly entrenched in South Africa and in the second half of the seventies, the SABC staged a race in central Johannesburg that was screened live and the numbers of runners started to explode as the sport sparked the imagination of “ordinary people” who took to the roads.

Then came the eighties and the Fordyce era and Bruce’s persona did a huge amount to swell the fields even more but as we were still in isolation the runners were all South African.

The early nineties saw the start of the political change in the country and in 1993, the German runner, Charly Doll took advantage, came to Comrades and won it. 1994 and American, Alberto Salazar did the same thing.

After that for a few years South Africans claimed the race back with wins by Shaun Mieklejohn in 1995 and Charl Matteus in 1997 but then came the late nineties and the wave of runners from Eastern Europe and particularly Russia dominated.

By the time 2000 arrived, Comrades had moved another step forward with the appointment of a woman, the late Alison West as Chairperson and marketing got under way for the 2000 Comrades. The finish was moved to Scottsville racecourse in Pietermaritzburg to accommodate the numbers expected and numbers there were.

24,000 people entered “The Millennium Run” and at the same time the time limit for the race was increased to 12 hours to allow as many people as possible to finish and earn that precious medal. Russia’s Vladimir Kotov won the 2000 event and the Russian dominance continued for years.

The race has continued to grow and for the 2019 race there have been 25,000 entrants. The entries sold out in 6 days, such is the popularity of Comrades now. The 12 hour time limit has given the “ordinary” runner who could never have dreamt of running and finishing Comrades in the 11 hour time limit as it was previously, the opportunity to be part of it.

I’ve seen all but three Comrades Marathons since 1956 and I have watched the race grow and the changes taking place as we moved into the modern era of online entries, the Expo and highly professional refreshment stations providing virtually anything and everything a runner might want. That’s a far cry from the early days when runners had their own seconds and when those seconds were stuck in traffic jams which has always been the case on Comrades day.

I remember in my first Comrades in 1968, my second arranging to meet me in Westville for my first drink – if he could get there, but if not it would have to be in Pinetown. 20Kms to my first drink but I didn’t think anything of it. That’s the way things were then.

So Comrades has gone from a very modest race in 1921 with just 16 finishers of the 34 who started to what we have today where we expect around 19,000 or even 20,000 to start this year.

We have seen the time for the first Comrades which was a Down Run, won in 8 hours 59 minutes to the fastest time for the Down Run set in 2016 by David Gatebe in 5:18:19 and that’s going to take some beating.

That’s an indication of the way the race has changed and grown.

The medical facilities at Comrades have gone from none in the early days to the biggest temporary medical facility in the world outside of a war, disaster or conflict zone and with radio contact between ambulances on the road and the finish medical facility. The medical facility at the finish has around 45 Interns, 20 or more medical doctors, over 10 specialists and over 20 nurses working in the tent and that’s apart from the medical staff on the road.

Comrades has certainly gone from “Modest to Mega” but was it better back then when things were a lot more “personal” because of the size of the fields or is it better now? The answer to that is easy.

Yes it is – and the reason I answer that way is because each Comrades is unique. Each with its own stories of the heroes and heroines who win and the “gladiators” who finish a lot further back.

We look forward eagerly to the 2021 race which will celebrate the 100^th anniversary of the first Comrades in 1921, but that’s not the only thing we have to look forward to. 2025 will be the 100^th running of this amazing “happening” (the race wasn’t run during the Second World War) that we call the Comrades Marathon.

A “happening” because for the vast majority of the runners it isn’t a race against anyone else. They race against themselves and the clock and it matters not where anyone else finishes. The average runner leaves the racing to the fantastic runners up at the front. Those who re-write the history books every year.

For the rest of the field, it is an event that is much more than just another road race. In many instances it’s a life changing experience that can’t be explained to anyone who has never run it.

For the last 5 years Comrades has been in the hands of its Race Director Rowyn James who has done a fine job with this very special event.

The advantage that Rowyn has is that he is a 15 time finisher of the race himself and he knows what the runners want from every facet of Comrades.

They train for months and complete hundreds of kilometres in training and in races just so that they can go home with that precious medal.

That’s the “happening” that’s gone from “Modest to Mega in the last 100 years.

February 2019

COMRADES DOCTOR GIVES MEDICAL ADVICE

Posted on February 17, 2017February 19, 2022 by DAVE JACK

Dr Jeremy Boulter has been responsible for the medical facilities at Comrades for many years and has been involved with the facilities for the last 38 years – 2017 will be his 39^th consecutive year. I asked him how he had got involved with the Comrades medical facilities and that was the subject of my previous blog but in addition to that he gave me the article he wrote for the Pre-Race brochure for the 2014 Comrades which he tells me is as applicable today as it was three years ago and it’s certainly worth publishing on its own and given the importance of the subject here it is.

My thanks to Dr Jeremy Boulter and to Comrades Marathon Association for the use of this article.

Comrades Marathon has focused attention on the health, fitness and responsibility of runners. The following is aimed at providing advice as to what runners can do to prevent themselves from ending up in a situation where they are in need of medical attention. It is important to remember that medical attention is retro-active, ie. we only respond when a runner is in trouble. Prevention is better than cure, and the prevention of problems is in the hands of you, the runner.

WHAT CAN RUNNERS DO TO PREVENT SERIOUS HEALTH PROBLEMS?

Firstly, it is important to appreciate that runners who collapse after they have finished a race, even if they require urgent medical attention, will almost certainly recover fully. However, those who collapse during a race are most probably suffering from a serious and potentially life threatening condition. So, what can be done to prevent this latter situation from arising?

The first thing that runners can do is to make sure that they are adequately prepared. This means that they should have done enough training. They should also do their best to ensure that they have no underlying medical problems, of which they may or may not be aware. The following is a list of questions that runners should ask themselves. If you have answered “yes” to any of these questions, it is strongly recommended that you see your doctor or a Cardiologist for a full check-up before starting the Comrades.

Has your doctor ever warned you that you have “heart issues” or that you should only be physically active or do sports under medical supervision?

Are you overweight or underweight?

Is your girth over 88 cm (for women) or 102 cm (for men)?

Are you over 35 and have not been physically active for a long period of time?

During blood pressure monitoring, have you ever recorded high blood pressure?

Have you ever been diagnosed with high cholesterol?

Do you smoke or have you smoked extensively in the past?

Has anyone in your direct family ever suffered from high blood pressure, calcification of the coronary blood vessels/heart attack, blood sugar disease, or stroke?

Do you have diabetes?

In the past few months, have you had the sensation of a ‘racing heart’, problems breathing, or chest pains, whether while at rest or during athletic activity?

Are you taking any medications for high blood pressure, heart or breathing conditions?

Do you ever feel dizzy or pass out, whether at rest or during physical activity?

Do you have any problems with your musculoskeletal system, which worsen during physical activity?

Remember, any of these symptoms could be indicative of a serious underlying medical problem.

Another important point is to prepare yourself to get used to the fluids etc. available on race day. Don’t drink a fluid during training that will not be available on race day. You may well not be able to tolerate these fluids if you are not used to them. The same applies to food.

Don’t try anything new on race day. This also includes running shoes.

Do not run if you have been sick in the 3 weeks prior to the race.

A cold is different ie the symptoms are “above the neck” with a runny nose, possibly a mild sinus type headache, and a feeling of not being 100%. BUT you don’t feel really sick.

If you do run, then be extra careful and be aware of any untoward feelings and pull out. However, if you have had a temperature, generalised aching body, chest symptoms and you feel pretty miserable then that is Flu and you should not be running. Similarly, if you have needed anti-biotics then don’t run.

Do not return to training, or run the race, after illness or injury without first being cleared to do so by your doctor.

During the race be aware of any unusual symptoms that may develop eg chest pain, dizziness, severe nausea, unusual shortness of breath, change in your running style, confusion and disorientation. If this happens, stop running and seek medical attention. It has become apparent over many years that people feel it is more important to finish the race than be concerned about their health. [Or is it a matter of pride?]

DO NOT TAKE ANY MEDICATION AT ALL, either before or during the race, especially anti – inflammatories [eg. Voltaren, cataflam etc].These are commonly called N.S.A.I.D’s. They are a class of drug which reduce pain and inflammation after an injury. However they can have serious side effects. One of these is irritation of the lining of the stomach, causing an ulcer. This will cause pain, but can result in [sometimes catastrophic] bleeding. Another serious problem is the effect on the kidneys. It has been shown that NSAID’s constrict the artery to the kidney, reducing the flow of blood through the kidney and thus reducing its ability to filter waste products. Combine this with dehydration, and Acute Renal Failure [ARF] can result. This can be fatal. There are increasing numbers of runners developing ARF after Comrades, and one of the major contributing factors to this trend is the taking of anti-inflams during the race. Renal Failure is a serious condition and can be fatal.

Not only NSAID’s are dangerous. It is known that Paracetamol [commonly known as Panado] can cause Liver and Kidney damage in very high doses. Evidence now shows that it can also damage Heart muscle, causing ECG changes similar to that of a heart attack. Although these effects are usually only apparent with high doses, when dehydration is present kidney function is reduced and metabolites can build up in the body, sometimes to toxic levels. This could cause heart problems as well as affect the kidney. Anti-cramp medication can also be a potential problem. It clearly states in the packaging that they should not be taken in the presence of dehydration. When this is present problems can arise. If one considers that about 45% of the runners who come into the Medical Tent after the race are dehydrated, then one can see that taking products like these could put runners at serious risk!

PAIN!

Pain is a sign that all is not well with the body. In my opinion, any runner who needs pain killers before the race should not be running. They are not fit enough!

Pain that develops during the race indicates that some damage has occurred. It may be of a minor nature, but could be something more serious. If the pain reaches a degree where a runner cannot continue, then he/she should stop running and climb into one of the rescue busses. DO NOT TAKE PAIN KILLERS.

FLUIDS.

Ensure that you take in adequate fluids. During training you will have reached an idea of how much and how often you need to drink. Approximately 500ml per hour should be adequate. However, this is just a guide. Each runner is different. Do not simply start filling up right from the start, rather drink when you are thirsty.

FOOD.

Make sure you take in enough food to keep up with your energy requirements. Don’t try new products on race day. If you are going to take things like Goo’s, then make sure you have used them before.

My appeal to runners is that they demonstrate a great degree of self-responsibility. Take care of your health. Make sure that you are adequately prepared to run Comrades. The following is a list of the basic principles every runner should adhere to.

DO drink enough.

DO eat if necessary.

DO listen to your body.

DON’T run if you are not fit enough or not properly prepared.

DON’T run if you have been sick or on anti-biotics in the three weeks prior to the race.

DON’T take ANY medication during the race.

DON’T be afraid to bale.

Remember, the aim is to enjoy the race and finish in a reasonably healthy state. It is your body, and your responsibility to care for it! Be sensible, take note of what is happening to yourself, and make responsible decisions.

If you start running into trouble, pull out before it’s too late.

After the race it is important to make sure that you take in adequate fluid, to correct any minor level of dehydration which may be present, as well as to monitor your urine output. If you have not been passing much urine during the race it may be due to the presence of a hormone called ADH, which can be released by physical stress. If so, you will start passing large amounts of urine very soon after finishing. However, if you continue to pass very little, or none at all, late that day or night, it may be indicative of a kidney problem such as renal failure. One should then seek medical attention.

Rest is also important. Get over the initial stiffness and then start with some gentle jogging. Don’t get into any serious running too soon. Let your muscles and joints recover from Comrades!

Dr Jeremy Boulter

First Written in 2014