http://www.metrowestdailynews.com/marathon2003/more_coverage/spo_marathonwater04162003.htm

Officials warn: Don't drink too much water

By Michelle Hillman
Wednesday, April 16, 2003

BOSTON -- Race officials this year are doing more to warn runners about the dangers of drinking too much fluid on the course -- a deadly condition that killed a 28-year-old runner last year.

Dr. Marvin Adner, medical director of the Boston Marathon, said a bulletin was sent to every registered runner this year about hyponatremia, or "water intoxication," and how to avoid over-drinking on race day.

"It's a preventable disease," he said. "It doesn't have to happen. The problem that wasn't recognized before is -- you can drink too much water."

Hyponatremia killed Waltham resident Cynthia Lucero last year making her the second fatality in the race's history. She was the first to die of hyponatremia.

Runners have been told to weigh themselves before and after a two-hour training run to determine how much fluid they need to drink. If they gain weight, they're drinking too much; if they lose weight, too little. Adner said one pound is equivalent to one pint.

"Everybody's different but people can determine their own fluid needs," he said. "A perfect race is you don't gain anything and you don't lose anything."

Marathon officials had been concerned about hyponatremia since 1999 when several runners developed the condition after the race and were brought to emergency rooms because of seizures.

Lucero's case has raised awareness about the dangers of drinking too much.

"Everyone was shocked by it," Adner said.

The condition is common in smaller people like young women and inexperienced runners who are running for five or six hours and drinking continuously throughout the race.

Adner, chief of medicine at MetroWest Medical Center in Framingham, said this year a talk was held for charity runners to inform them of dangers of drinking too much.

For the last 20 years, he said, the emphasis has been on drinking to avoid dehydration and making sure runners often stop at water stations.

This year, runners are advised to know their limits and be aware of how much fluid their bodies require during the course of the race.

Lucero -- a charity runner for the Leukemia and Lymphoma Society -- collapsed at mile 22 and later died at Brigham & Women's Hospital. She was the first Boston runner to die of the condition caused by diluted blood sodium levels.

Hyponatremia can be hard to diagnose because symptoms are similar to dehydration. Drinking too much causes dizziness, fatigue, vomiting, headaches, disorientation, seizures and in severe cases coma and death.

For the last three years, Adner said a blood test has been available in the medical tent to test sodium levels. Runners with low sodium levels are sent to local emergency rooms for treatment.

The amount of fluids a runner needs is not dependent on the weather, said Adner. Also, runners should avoid taking pain medications like Motrin because it can cause water retention.

"We really have to educate runners to take care of themselves," Abner said.

Also this year, new technology is being piloted to track every runner who enters medical tents along the course. About 12 to 15 hand-held scanners will be used to download information from runners' chips and number identification bibs.

Chris Troyanos, medical services coordinator for the Marathon, said this year is the first scanners are being tested. If successful, they could be helpful in a mass casualty incident.

Troyanos said he focused on creating better communication between town emergency services involved in caring for runners. He met with ambulance, fire and hospital officials in each town to stress the importance of notifying race officials when a runner is transported to the hospital or being treated on the course.

Ultimately, race officials, not community providers, have to account for runners' whereabouts and be able to tell families where their relative is when they do not cross the finish line.

Two years ago, a heart transplant patient running the Marathon "disappeared" after mile five. Race officials began calling area hospitals to find out where the runner was. A short time later, it was determined the runner was still on the course, but not before relatives were alarmed.

Troyanos, director of sports medicine at Babson College, said this year he will receive "real time" information from emergency service providers so every runner is accounted for as soon as he or she is transported to area hospitals or when treated on the course.

"It's a very difficult animal to manage," said Troyanos about the race. "Every year you learn something new and make adjustments to technology."

At the finish line and the start of the race this year Massachusetts General Hospital physicians will be using ultrasound CT scans, or computer enhanced X-rays, that take cross sections or slices of the heart. This allows physicians to study the effect of stress on the hearts of 20 runners.

Dr. Malissa Wood, a cardiologist at MGH, said the study will look at whether heart muscle function declines depending on how long it is stressed.

Equipment is being provided by General Electric Medical Systems and volunteers sponsored by MGH for the study. Data collected from runners will be compared with information collected from 20 sedentary people. A follow-up exam will be done on runners a month after the race.

Wood said she believes the study will help physicians better understand how people's hearts respond to stress -- physical and emotional.