Doc’s Talk 04-21-2013

A teleological question:  Why do we have fingerprints?  For the police?  Probably for another function, …which Dr. Scaff may discuss next week.

If you cannot attend the Doc’s Talks on Sundays, all of the information Dr. Scaff covers is in his book, Your First Marathon – The Last Word In Long Distance Running, by Jack H. Scaff Jr., M.D., F.A.C.S.M., available for purchase at the Honolulu Marathon Clinic on Sundays and online at:  If you are traveling, Dr. Scaff would encourage you to get a copy, not because it helps the Honolulu Marathon Clinic, but because Dr. Scaff wrote it due to the fact that he cannot say everything that needs to be said in 10 minutes.  There is just a lot of good material in the book (and it is a fun read).

Post-Race Collapse
Last Sunday, Dr. Scaff talked about heat exchange, and how when a person’s core temperature starts reaching 104°F – 105°F heat stroke occurs, and untreated it can be 80 percent fatal.

There is also something else that occurs.  It was first reported by the Honolulu Marathon Clinic, but now the phenomenon is well understood throughout the running world, and it is called Post-Race Collapse.

What happens in Post-Race Collapse is when someone running a race crosses the finish line, looks great, arms triumphantly raised in the air, walks around for a period of time, and the next thing you know s/he’s unconscious in the First Aid tent, when a few minutes before s/he was a healthy relatively young runner.   

The first time Dr. Scaff and company saw Post-Race Collapse happen was at the Honolulu Marathon Clinic.  A gentleman showed up at the clinic after a run, sat around a little bit, and while driving his car home on Kalanianaole Highway he became unconscious, hit a rock wall, totaled his car, and they took him to the hospital with a “heart attack”.  At the hospital they found out there was nothing wrong with his heart, and he never had a heart attack.  Until he got the bill!  (humor!)

The bottom line is we blame everything on heart attacks.  Whenever you see a runner collapse along the course it is always attributed to a massive heart attack (Dr. Scaff says small ones are just as bad).  And yet a lot of times autopsies find the heart is normal.  Most of these are rhythm disturbance deaths.  When you have a heart attack you don’t feel good.  When you have a rhythm disturbance you just fall on the ground, and in most cases that is what is happening.

It’s All About the Heart
The way we humans evolved was to try and live as long as possible in all sorts of situations.  It doesn’t help to have a heart attack when you are running away from a saber tooth tiger.  You want to be able to run.

So everything is directed towards the heart, not the brain.  The heart is what is important because when the heart stops everything quits.    You can have a stroke and stay alive for a long time, but you cannot live a long time without a heart.  The heart actually performs several functions.  You know when you run you develop lactic acid, a muscle depressant.  The heart can take the lactic acid from running and change it to pyruvate and actually metabolize it.  In other words, it can metabolize the byproducts that are making us want to quit running and help us keep going, that’s how important the heart is.

As you are running you sweat.  When you come back from a training run you are 2 – 3 pounds lighter.  A gallon of water weighs 8 pounds; so if you are 3 pounds lighter that is roughly a little less than half a gallon, which is more blood than you have in your bloodstream.

If you measure blood volume for the things of concentration (red cells, etc.), it’s normal.  All the way through the race it changes a little, but if you just did a blood volume on a person running a race you could not tell that they had dehydrated and are 4 – 5 pounds lighter.  Where is that fluid coming from? It is coming from the muscles and everywhere else.  That is why at the end of the run you look wrinkled.  As a matter of fact, if you want to know what you are going to look like in 10 years, look at yourself in the mirror right after you finish the marathon and that will tell you because you are dehydrated.  But the blood volume is normal because the muscles are giving up everything to the heart, so you can keep going.  However, there is a payback time.

The payback time is the minute you stop running.  The muscles say, “Ok, I’m done working, give me my fluid back.”

At that point, the gradient towards maintaining blood volume disappears and fluids start going back into the muscles.  When you sit down fluid tends to pool in the legs, and heaven forbid you immediately have a beer which is a vasodilator.  Alcohol (e.g. beer),) is not bad overall, but immediately after a race alcohol could be a problem.  The next thing you know, you are passed out.

Why does Dr. Scaff mention Post-Race Collapse?
Because you are going to see it in marathon training.  It has happened every year in the Honolulu Marathon Clinic.  One instance of Post-Race Collapse was when woman came in after a run and fell on top of a big coffee urn, she spilled it all over herself, hit the ground and burned herself, and she didn’t know what was happening, and yet there was nothing wrong with her at all.

Post-Race Collapse will only occur with runs that are longer and a little bit harder, not a 1-hour run that everyone is used to.

Post-Race Collapse does not occur because of low blood sugar, blood sugar tends to be high at the end of a race, not low, because of gluconeogenisis, where your body is taking fat and converting it to carbohydrate, along with the pretzels, drinks, and everything you’ve consumed along the way.

How Do We Avoid Post-Race Collapse?

For yourself:
1.  As soon as you stop running start re-hydrating.  If you are trying to lose weight, of course, you do not want to eat anything right away.

2.  Keep moving around.  If you don’t feel good, lie downhave somebody get you water.

Actually cola is the best for 2 reasons:
1)  It gets you out of lactic acid metabolism, and
2)  The caffeine is a stimulant and causes mild vasoconstriction.

For someone else:
1.  Start them on some beverage, e.g. Gatorade, or cola with a straw that bends.
2.  Lie them down.
3.  If they have a pulse and they are talking they should be alright.
Dr. Scaff is not saying that you should not call 911, but you have to remember, when 911 arrives, by law they cannot legally treat a person on the scene, they have to take the person to the hospital, unless the person signs out against medical advice (AMA).

4.  If they have no pulse you may do CPR.
What happens if you start CPR and the person doesn’t need it?  They’ll tell you! …It hurts!

So you have to put all of this together.

Cardiopulmonary Resuscitation (CPR) Training
Dr. Scaff noted that the Honolulu Marathon Clinic used to do CPR training. The Honolulu Marathon Clinic can get an instructor down to Kapiolani Park some Sunday and do CPR training for anybody who wants it.  We can get it done for free, but if you want certification it costs about $30.  The money does not go to the Honolulu Marathon Clinic or the instructor; it goes to the American Heart Association to pay for the certification and the practice dummies.

So, tell your team leaders, if there are a lot of you interested, we can set up a training.  You may even hold the training in your home, so have a party somewhere and invite a lot of people.

Dr. Scaff personally believes everyone should be CPR certified.  People who have been with the Honolulu Marathon Clinic for a long time have seen Dr. Scaff and others perform CPR at Kapiolani Park and know how effective it is.  The Honolulu Marathon Clinic has not lost a person yet, …and some people really needed a lot of intervention.

Now You Know
So, now you know the physiology of heat, heat stroke, fluids, and Post-Race Collapse.  You are really experts.

Next Sunday: Dr. Scaff will talk about weight, how it affects running, …and maybe fingerprints.

The following Sunday, Dr. Scaff will talk about stretching, whether it’s beneficial or not.


For some good reading on nutrition, Dr. Scaff recommends everyone check out the daily postings on Dr. Alan Titchenal’s “Got Nutrients?” web site:

Here is a recent posting from the “Got Nutrients?” web site:

April 18, 2013
As shown by many studies of the placebo effect, brain function can be affected by many factors. A recent study found that just the taste of beer, without the alcohol, increased brain levels of dopamine much the same as beer with alcohol. Those with a family history of alcoholism were most sensitive to this effect.

Consumer Link
Taste of Beer, Without Effect from Alcohol, Triggers Dopamine Release in the Brain

Research Link
Neuropsychopharmacology. 15 April 2013. [Epub ahead of print]