Paving the Way
Once the Labman team started describing and treating new medical conditions, more studies were done in Kona every year. The team’s main cardiologist, Pam Douglas, was most interested in studying cardiac performance before and after prolonged exercise at Ironman, since at the time they started in the ’80s, “prolonged exercise” meant “greater than 30 minutes.” Labman was among the first to fully describe “athlete’s heart,” the syndrome in which the heart becomes enlarged due to excessive exercise. “The heart is muscle, like our arms and legs. If it is exercised, it gets a bit bigger,” Douglas said. “The problem is that heart disease and high blood pressure can also make the heart bigger. Our work provided a road map for differentiating between changes in cardiac size and shape due to healthy activities like exercise and changes due to disease.”
Douglas and team also discovered the phenomenon of cardiac fatigue, which changed the thinking about how the heart responds to stress. It was thought that a healthy heart would never show a reduction in function or leak muscle proteins into the blood stream, but both happen during Ironman and don’t seem to have any long-term negative effects. She was able to use her findings of cardiac fatigue in healthy athletes to help scientists understand more about sick non-athletes with heart disease. Another discovery occurred in 1993 when a group of researchers performed a double-blind study on muscle cramping. They became the first to use magnesium sulfate, dripped in slowly with fluid through an IV, as an efficient treatment for severe muscle cramping, a method still used today.
“Once we started doing research, we came up with anything we could think of that would possibly be interesting in exercise,” Hiller said. “It wasn’t science in the sense of ‘Let’s get together and get the same answer.’ It was the kind where no one knows the answer and you all try to go figure out what it is and go defend it. We looked at cramping, hemoglobin in stool, breakdown products in the blood, muscle and cardiac enzymes, psychological issues. We were the first or one of the first to describe a large number of things.”
The research has been vital to the sport, but equally as important are the med tent protocols Laird established for caring for athletes. He developed standards that were passed on to other races around the world, recommending the amount of equipment, supplies and personnel needed to handle the volume of athletes flooding the tent every year.
“[Ironman Hawaii] was the first large triathlon event in the world,” said Dr. P.Z. Pearce, the current assistant medical director for Kona and medical director at other Ironman races. “We’ve pioneered things as simple as what time you’ll see people in the medical tent to how many people come in per hour.”
Laird also introduced mobile medical vans on the course as an alternative to just stationary tents. At the 2011 Hawaii Ironman, there were seven vehicles on course carrying small medical teams, complete with GPS tracking devices that sent information back to a central communication system.
Racing in the Heat
The Ironman Hawaii doctors have seen athlete after athlete collapse right after crossing the finish line, and by now they know it’s usually a result of dehydration, the primary reason for a medical tent visit.
Anyone involved in the sport of triathlon will remember the 1982 video of Julie Moss falling, staggering, then stumbling across the Ironman finish line. To the average onlooker, what Moss’ body was going through looked serious. But as Laird remembers, “She didn’t look that good when she crossed the finish line, but within a couple of hours she was showered and dressed and talking to the press. Her primary problem was dehydration.” With a quick IV, she recovered pretty quickly.
When the legendary Paula Newby-Fraser collapsed before the line, Laird says she just ran out of gas.
“I remember talking with her a long time and she really felt terrible, but I could tell just by talking with her that she was probably going to be OK,” he said.
Kona’s infamous heat takes a toll on athletes, yet the finishing rates are extremely high—likely due to the quality of the field—hovering around 90 to 95 percent. Dr. Robert Sallis, Ironman Sports Conference co-chairman, has been involved with the medical tent and conference since 1996. Sallis has done multiple studies on topics such as athlete weight changes, pre-existing medical conditions common in Ironman athletes and bone density.
While heat stroke may seem probable in Hawaii’s steamy temps, the likelihood is actually very low.
“We don’t see it much at Kona at all,” Sallis said. “This race is so long and the athletes are a select group who are in good shape. To get heat stroke you really have to generate a lot of internal heat by pushing hard, so we’re more likely to see it in shorter races.”
One factor Sallis sees as a massive threat is wind. He says it causes sweat to evaporate very quickly and it makes the athletes work harder, putting them at a higher risk for dehydration.