Medical professionals prepare to provide care at the Marine Corps Marathon.

The 2003 AMAA Sports Medicine Symposium at the Marine Corps Marathon[R]; Medical Management of Endurance Events was held October 25 and 26 at the Virginia Hospital Center in Arlington, Virginia. As in years past, the symposium exceeded all expectations and contributed significantly to the growing body of knowledge in reference to both marathon and running medicine.

The formula we use to develop the annual agenda remained the same: kick off the meeting with a keynote address by a noted leader in sports medicine, follow this with an afternoon devoted to race day concerns, and then hold an evening session tackling a "hot topic" in running medicine. On Saturday, we typically focus on topics relevant to the runner (i.e., nutrition, training, common injuries). Once again, this proved to be a formula not only for a successful CME program, but also for success in the medical tent on race day.

Jim Puffer, M.D., current executive director of the American Board of Family Medicine and former chief of the Division of Sports Medicine at UCLA, kicked off the conference with an outstanding keynote/Grand Rounds presentation on "The Athletic Heart: Current Concepts and Controversies." The cutting-edge material presented was fascinating and I was particularly interested with his work in the area of PET scanning, which is evolving as a modality that may elucidate the "gray zone" of athletic heart versus hypertrophic cardiomyopathy.

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Following Dr. Puffer's lecture, we "entered the medical tent" with lectures designed to train the medical and health professional to provide care to runners on race day. John Cianca, M.D., delivered an excellent review of his approach to care for the Houston Marathon. It was particularly interesting to learn of the strategies he and his medical team are using to combat hyponatremia. These include providing scales along the course for monitoring weight and obtaining ISTAT serum sodium levels from anyone who requires intravenous rehydration.

Penny Clark, Esq., legal counsel for the Marine Corps and a returning faculty member for the course, detailed medico legal concerns for the race and common problems. Her review of current guidelines was welcomed by all those scheduled to work in the tent. Of note, volunteers who work the Marine Corps Marathon are covered by the Federal Volunteer Protection Act. This, of course, makes it a "worry-free" experience for individuals providing care to the runners.

Another returning faculty member, Cathy Fieseler, M.D., gave a thorough review on the care and prevention of blisters for endurance runners and Fred Brennan, D.O., traveled all the way from Baghdad to deliver a state-of-the-art lecture on muscle cramps.

Concluding the afternoon session were lectures on exercise-associated collapse by myself, meeting chairperson and tent senior medical officer; heat illness by Scott Pyne, M.D., former Marine Corps Marathon medical director; and exertional rhabdomyolysis by Bruce Adams, M.D., current marathon medical director. These lectures were then followed by case presentations led by sports medicine fellows. The comic line of the meeting came in response to an excellent question of how to keep defib pads on a sweaty athlete. The answer, of course, was "to use the fellow."

After enjoying a dinner filled with good conversation and excellent food, everyone returned to the conference area for an evening panel discussion on hyponatremia--which was clearly a highlight of the meeting. The outstanding panel included Drs. John Cianca and Art Siegel from Harvard Medical School, and Drs. Steve Clement and Joseph Verbalis, endocrinologists from Georgetown who cared for the 35-year-old female runner who died following a collapse from hyponatremia at the 2002 Marine Corps Marathon. Dr. Verbalis is a noted expert in Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

The panel elucidated that the pathophysiology of dilutional hyponatremia in long distance runners is multifactorial, combining intrinsic and extrinsic risk factors. Specifically, running with heavy eccentric overload is thought to activate the cytokine system (interleukin 6), which leads to the systemic presence of vasopressin (AVP antidiuretic hormone). Runners who experience this condition while excessively hydrating, are unable to "pee-off' the excessive volume due to the unexpected presence of AVP. The result is SIADH and dilutional hyponatremia and its consequences.

Saturday's meeting featured a combination of well-articulated speakers sharing their knowledge. Al Morris, Ph.D., spoke about "Nutrition for Optimal Performance and Good Health" and Jim Ziccardi, D.O., gave a timely lecture on the impact of cardiovascular medications and exercise (see p. 11 of this Journal for an overview of Dr. Ziccardi's lecture). Dr. Rochelle Nolte then enlightened us with current controversies surrounding the "Female Athlete." Orthopedics were the focus of the late morning discussions, with an excellent introduction of the "Biomechanical Evaluation of the Runner" by Dr. Cianca. This was followed by detailed and state-of-the-art lectures by Brian Shiple, D.O. (Exertional Leg Pain), Robert Nirschl, M.D. (Patellofemoral Syndrome), and Ben Pearl, D.P.M. (Conservative Treatment for Plantar Fasciitis).

The marathon medical tent was crazy on Sunday--lots of action! The heat contributed to numerous injuries including collapse, heat stroke, cramps, blisters, hypoglycemia, chest pain, asthma and hyponatremia. The symposium, however, not only prepared us for the plethora of injuries, it again fulfilled its primary goal of ensuring quality care at the Marine Corps Marathon.

We hope to see you in attendance next year!

Dr. Francis O'Connor, who has been involved with the AMAA Sports Medicine Symposium at the Marine Corps Marathon since 1991, was profiled in the spring/summer 2003 issue of the AMAA Journal.

By Francis G. O'Connor, M.D., FACSM