Month: October 2018

Experts question why previous heatstrokes at Maryland colleges weren’t a wake-up call before McNair’s death (The Baltimore Sun)

The two football practices unfolded roughly four years and 40 miles apart.

At each one, a teenage football player ran drills outside, the temperature hovering in the 80s. When each started showing signs of exertional heatstroke, training staff applied cooling packs to the player’s armpits and groins. But the trainers stopped short of best practices: taking the athlete’s rectal temperature and immersing him in cold water.

About two weeks later, both student-athletes were dead.

Jordan McNair, a 19-year-old offensive lineman at the University of Maryland, College Park, died of heatstroke in June.

Marquese Meadow, an 18-year-old defensive lineman at Morgan State University, died of heatstroke in August 2014.

A year before that, a third football player in the state suffered heatstroke during practice. After a long hospitalization, Towson University’s Gavin Class survived, which he attributes to the trainers’ quick action in treating him with cold-water immersion.

Experts question why other major heatstroke incidents in Maryland college football didn’t serve as a wake-up call before McNair’s death — and they wonder what could be different now.

After Minnesota Vikings offensive tackle Korey Stringer died of heatstroke following a 2001 training camp practice, the NFL took a hard look at its protocols. No professional football player has died of heatstroke since. Meanwhile, according to the research institute named for Stringer, more than a dozen college football players have died of heatstroke since 2000.

“Reactive change is a problem. We need people to be proactive,” said Robert Huggins, president of research and athlete performance and safety at the Korey Stringer Institute, a University of Connecticut-based nonprofit that studies sudden deaths in sports. “We’ve had enough heatstroke cases, enough deaths, enough near-deaths to learn from and to serve as examples.

“Heatstroke is 100 percent preventable. We scream that from the mountaintops.”

McNair was attempting 10 repetitions of a 110-yard run during a May 29 practice when he started showing signs of exhaustion. Trainers eventually moved him to the football field house for treatment, about 30 minutes after the onset of symptoms. Another half-hour would pass before anyone called 911, records show. The trainers did not take his rectal temperature or use cold-water immersion treatment, which experts say are the two steps that could have saved his life. He died June 13.

After McNair’s death, media reports labeling the flagship’s football culture “toxic” brought more national scrutiny to campus, leading to a second investigation into allegations of bullying and abuse.

“I do feel the public eye is on the McNair case quite closely,” Huggins said. “I hope people really start to pay attention.”

The University System of Maryland’s governing body has been actively involved in overseeing the two investigations into the Terps’ football program. Board of Regents Chair James Brady spoke at a news conference last month, during which sports medicine consultant Dr. Rod Walters presented the findings from his review of the athletic department’s safety protocols.

Brady said the university system was “anxious” to learn from McNair’s death. He said Walters’ recommendations would be implemented not just in College Park, but at all other system institutions with football programs.

“We can and must learn from what happened,” he said, “and make any appropriate and necessary changes to make sure it never happens again.”

A University System of Maryland spokesman provided an emailed statement Wednesday, but it did not directly address questions about whether the heatstroke incidents involving Class and Meadow sounded alarms at universities across the state. Towson is part of the university system. Morgan State, though a Baltimore-based public institution, is not.

The system has already shared the Walters report with every campus, asking them to review the recommendations and implement any necessary changes to their procedures and protocols,” the statement read.

A University of Maryland spokeswoman was not immediately available to comment for this article.

Towson athletic director Tim Leonard said Walters was also hired to review Towson’s protocols after Class’ hospitalization in 2013. While the Board of Regents was provided with those findings, Leonard said, the system never assumed control of the investigation, nor were there attempts to broaden the scope beyond his school.

Class said he was disappointed other state institutions didn’t double down on heatstroke prevention and treatment awareness after his harrowing medical saga. He collapsed during an Aug. 12, 2013, football practice, and his body temperature reached an estimated 111 degrees. He arrived at the hospital in a coma, with significant organ failure. He was later transferred to the Maryland Shock Trauma Center, where his heart stopped and doctors resuscitated him. After he was stabilized, he required a liver transplant.

“It didn’t shake anybody until Jordan,” said Class, now an assistant strength and conditioning coach at Johns Hopkins University. “You’d think after Marquese dying, too, that things would’ve been shaken up, but nope.”

The law firm representing McNair’s parents wrote a letter to Brady last month demanding to know what the university system had gleaned from what happened to Class and Meadow.

“The facts that need to be disclosed now involve the systemic failures throughout the University System that preceded Jordan’s death, despite having actual knowledge that an incident like this had occurred before,” lawyer Billy Murphy wrote.

Much of the Board of Regents has turned over since 2014.

Dr. David Chao, who served as the head team physician for the San Diego Chargers for 17 years, said college football programs should’ve learned their lessons after Stringer died — and even more so when a heatstroke incident hit closer to home.

“One death of a child or adult from heatstroke playing football is one too many,” he said.

Since McNair’s death, a number of changes have been made within the Maryland football program.

The Terps added more on-site cooling stations and boosted the amount of medical staff on hand during practices and games. Student-athletes use a new tool that helps them monitor hydration levels and they have expanded access to cold-water immersion therapy. Walters led in-service training for athletic department staff on implementing emergency plans.

Walters’ review found the flagship’s athletics protocols on exertional heat illness meet standards, but proper steps were not followed May 29 in McNair’s case. The football team’s practice site was moved at the last minute, so the cold-water immersion tanks that are usually part of the field setup were not there on the day McNair fell ill. The university also didn’t monitor weather statistics in the recommended manner.

Walters said the failure of trainers to recognize McNair’s signs of heat illness was “a concern.”

Universities not only have to put the right protocols in place, Huggins said, but understand how to execute them properly.

In January 2012 — more than a year before Class was hospitalized — a group of leading athlete safety experts drafted a series of 10 recommendations for preventing sudden deaths in college sports.

They recommended conditioning periods be phased in gradually “to encourage proper exercise acclimatization and to minimize the risk of adverse effects on health.” McNair’s final workout was his first team activity in more than a month.

And they recommended that exercise and conditioning activities should not be used as punishment. Meadow fell ill while running during a “punishment practice,” according to a lawsuit filed by his mother.

The lawsuit, which ended in a settlement, states that Meadow attended a practice on Aug. 10, 2014, that was “scheduled to punish certain individuals on the team for team rule violations.” About an hour in, Meadow began stumbling and became disoriented — his temperature eventually reaching 106 degrees. At the hospital, he went into liver and kidney failure and suffered a brain injury because of the loss of oxygen. He remained in the intensive care unit on a ventilator for two weeks, before he died surrounded by family.

His mother, Benita Meadow, said when she saw McNair’s death reported in the news, it took her right back to the day her son fell ill.

“I couldn’t believe it was happening again,” she said in an interview. “The University of Maryland and Morgan State are like sister schools. It scared me and it made me angry — how is this still happening, so close and in the same way?

“This can’t be swept under the rug. … There has to be a change now.”

The Morgan State football team has since implemented new protocols, The Sun reported in August. Before practice, each athlete receives a 1-gallon jug of water. The players take two mandatory water breaks, without their helmets on. At the end of each workout, the players pile into ice tubs on the sidelines for a required 20-minute cool-down. Morgan State officials did not respond to requests for comment for this article.

After Class’ heatstroke, Towson also re-emphasized preventative measures, Leonard said. Mandatory breaks are written into the practice schedule. Coaches and trainers preach the importance of hydration. Officials are always monitoring for new evidence-based recommendations on avoiding heatstroke.

It remains to be seen what impact McNair’s death will have on other athletics department practices across the state.

But his grieving parents are hoping for change.

They’ve launched a foundation in their son’s honor, aimed at promoting awareness of heat-related illnesses, improving player safety and reducing heatstroke incidents among student-athletes. They say they don’t want any other parents going through what they are.

“While Jordan is not with us to build his legacy, as a family we are doing it for him,” his father, Marty, wrote in an open letter on the foundation’s website. “This is his legacy.”

Benita Meadow befriended McNair’s parents after their twin tragedies. She never imagined a friendship could stem from her grief, but she said their connection gives her renewed strength to talk about her son, whom she remembers for his drive, his big personality and his desire to be a humanitarian.

For years, it was too hard to tell her story. Now that heatstroke has struck another Maryland college athlete, it’s different.

“Marquese is telling me to help,” she said.

Source: The Baltimore Sun

The First-Time Marathoner’s Guide to Fuel and Hydration for Your Marathon Training (SELF)

First-time marathoners, if your training program is overwhelming you (and, if you’re anything like I was during training for my first 26.2, it is), I’m here to make one particular part of your marathon journey significantly less complicated and confusing: fuel. Specifically how to go about it when your runs get long.

When training for a marathon, people tend to focus on (and stress about) the obvious: running long and often. However, an overlooked—yet super important—component of crossing the finish line and staying healthy throughout your entire training cycle is midrun nutrition.

For some, it might seem simple: Can’t I just chomp down on half a banana during a long run? For others, it might be confusing: Is eating lots of sugar OK? What about GI issues, cramping, or bloating?

Use this as your guide to eating and drinking on the run, which is necessary for anyone training for a marathon. From gels to chews, hydration tabs to caffeine, here’s the deal, not only with what to consume while running, but why it’s one of the most important things to think about when it comes to crossing the finish line.

Note: This is specifically for athletes tackling a road marathon. Trail running—which typically equates to slower running with more elevation variation—usually means stomachs can handle different types of food and therefore follows a different race-day nutrition plan.

Midrun fueling—Why bother?

Before we dive into the what, let’s look at the why. Why the heck is it important to eat during a run? What’s going on inside our bodies?

“We only have so much glycogen stored, which is what the body uses for energy while running,” explains Kelly Hogan, M.S., R.D., who works with athletes and has run 11 marathons herself. “We can use up all of those stores in about two hours. That’s when people start feeling like they’re going to bonk.” (The bonk, by the way, is the point at which your body, brain, or both feel like they can’t take another step and it typically happens to endurance athletes especially when they’re not properly fueled.)

It’s important to start fueling well before our bodies are close to using up all our glycogen stores. For most runners, that’s 30 to 45 minutes into a long run. Still, every body is different, and it’s essential to practice fueling during your training runs so you don’t introduce something your stomach can’t handle on race day.

“The biggest mistake I see—by far—is people doing something different in their race versus training,” says Douglas Casa, Ph.D., professor of kinesiology at the University of Connecticut. He, too, has worked with athletes for years and is an avid trail runner. He continues: “Regardless of exact amounts—those are nitpicky things—a lot of ranges [for food and drink consumption] can be successful. Instead, it’s a matter of asking: Is your body ready for it? The crux of it is you have to rehearse.”

OK, I’m ready for rehearsal! Can I grab a Snickers?

Actually, yes! (Well, OK, maybe a mini Snickers.) The main rule of thumb for midrun food is to find something that will give you energy and is easy to digest, and kid-sized candy is actually something that many runners stick in their pockets before heading out the door. As a rule, the body needs fast-absorbing carbohydrates that will boost blood glucose levels and send sugars through the bloodstream and into the muscles.

It doesn’t have to be a candy bar, though. Most runners get their quick-digesting carbs from gel packets or sports chews (GU, Hammer, and Clif are great options), which are easy to slurp down while running. Other examples of easy-to-eat simple sugars include sports beans, fruit drops, and even thin, cookielike waffles. (In my opinion the Honey Stinger honey waffle will get anyone out the door for a long run.) You can also get sugars from a sports drink, like Gatorade or Maurten, a drink mix that’s an alternative to mainstream sports drinks and that’s used by many elite runners.

“I think GU and gels are getting knocked since they are processed sugar,” explains Hogan. “But it’s only sugar for a reason—we need it for running.”

That said, not everyone can tolerate the same types of foods. “It’s important to test different foods to see what your body can handle,” Hogan reiterates. If highly processed foods aren’t your thing, she recommends trying a less processed option, like dried fruit or pretzels. My personal go-to is Spring Energy gels, which use whole ingredients like rice, banana, and peanut butter, blended into a gel-like substance. As long as you can get over the fact is has the consistency of baby food, you’ll be set.

For coffee lovers, there are caffeinated fuel options! Certain energy gels also include caffeine; the amount typically ranges from 20 to 40 milligrams, though some are packed with up to 150 mg. (In comparison, a grande Starbucks coffee has 100 to 120 mg of caffeine.) While caffeine can give runners a nice jolt of energy, it isn’t a necessary additive to your fueling regimen. “Caffeine intake during the run is meant to give a bit of an energy boost, but is different in how it affects various individuals,” Hogan explains. “Starting out at the lower end of caffeine—that’s 20 to 30 mg—is a good idea to see how the body reacts, as opposed to going for a gel with 75 to 100 mg of caffeine right at the start.” Hogan also suggests alternating between noncaffeinated and caffeinated gels just to stay on the safe side. Unlike sugar in gels, caffeine stays in our system longer. “We don’t want to be up all night after a long run or race, or having lingering feelings of the jitters, nerves, or anxiety.”

So, what should I avoid?

As far as what should be on the “do not eat” list, foods that are too heavy on protein and fat might do more harm than help.

“Save the protein for after the race,” advises Hogan. “Calories from protein and fat won’t do much for your body. Fat especially can be the culprit of GI issues since we digest it the slowest.” Fiber could cause tummy trouble, too, since it also takes a toll on our digestive system.

For this reason, avoid foods like leafy greens, cruciferous vegetables (like broccoli and cabbage), and beans, along with red meats, fish, and cheese 12 hours before a long run or your race. Aim to have your prerace meal be about 75 percent carbohydrates, and stick to mainly carb consumption when you’re out on the course.

When should I eat? And also, how much should I eat?

Now that you know what to eat, when should you eat it? And how much is enough?

“The general idea is to start with consuming 30 to 60 grams of carbohydrates per hour,” says Hogan, which is the range our bodies can absorb glucose and varies slightly depending on how big you are, how fast you’re running, and how quickly you’re burning through your calories. This amount of carbs per hour could include two 1-ounce bags of sport beans or two energy gels. “For most people, start to fuel 30 to 45 minutes into the run to get a head start on your glycogen storage.”

If two gels seem too hard to stomach, go for a combo: a mixture of chews, beans, or a gel will also do the trick. Keep in mind that sports drinks, though they’re liquid, provide carbs, so you should factor that in when calculating your carb intake.

What’s the deal with water?

Hydration is another critical component of your fueling strategy. Casa recommends carrying water with you—whether in a hydration pack, fuel belt, or handheld water bottle—so you can sip water throughout your run versus relying on aid stations, where people tend to gather to chug down fluids.

“This allows you to drink whenever you want and you avoid the rush of people at the aid stations,” he explains. (I will vouch for him here; while aid stations volunteers are super helpful, and the tables are always stocked with food and drink, they sometimes can get overwhelmingly crowded.)

Just like calorie consumption, there isn’t a one-size-fits-all amount when it comes to hydration. In general, your fluid intake should depend on your sweat rate, which is the amount of fluid you’re losing through sweat while exerting energy. Sweat rates vary depending on body size, activity intensity, and environmental conditions. For example, a larger person who is running 7-minute miles in 80-degree heat might need 2 liters of water an hour, versus a smaller person running 10-minute miles in mild conditions might suffice with a half liter.

Luckily, there’s a foolproof method for figuring out your sweat rate at home. Simply urinate, get naked, and weigh yourself in kilograms. Then head out on an hour-long run without consuming any water or food. Once you return, weigh yourself again. The difference will show you how many liters you sweat per hour. For example, if you weighed 60 kg before your run and 59 kg after, you sweated 1 liter per hour. This is the amount of water you should drink every 60 minutes. That said, you definitely don’t have to use this strategy. The trial-and-error method is just fine, too.

Calculating this sweat rate not only ensures you’re drinking enough but protects you from drinking too much.

“Pay attention if your body feels super full and you have a sloshy feeling in your stomach,” Hogan says. “This is one of the first warning signs of hyponatremia.”

Hyponatremia is a rare and dangerous medical condition that occurs when the concentration of sodium in your blood is abnormally low, which can happen if you drink too much water. While Hogan notes that hyponatremia is rare, it’s important to understand the warning signs. When you’re drinking, make sure your body feels satisfied but not overly full. If you feel extra bloated and start to become dizzy and disoriented, it’s critical you pump the breaks and get medical attention. Casa echoes this sentiment; if you’re aiming for a five-hour finish time and the race conditions are mild, it’s easy to overcompensate and think you need to be drinking a ton. Figuring out your sweat rate will give you peace of mind and more confidence when you toe the line, because of course, you still do need to hydrate adequately throughout the race to avoid dehydration, another dangerous (and more common) condition.

A guideline I like to follow is taking in 3 or 4 long sips of water every 15 or so minutes. On long runs, I’ll often fill my hydration pack with water that has a hydration tab mixed in it, called Nuun, which has added electrolytes, like sodium. Electrolytes are minerals that keep our systems functioning and, in the case of extensive sweat loss, will need to be replenished. It’s easy to add electrolytes—especially sodium—into your running diet; sipping on Gatorade, using Nuun tablets, or even munching on some pretzels will help restore the electrolytes that become depleted in the body.

“Sodium is extremely helpful in a beverage,” notes Casa. “It keeps the thirst mechanism on longer so you replace the fluids you need, conserve urine, and replenish the sodium you’re losing in sweat.” Everyone loses different levels of sodium in their sweat. Casa says a gram of sodium per liter is generally a good amount, which is the serving size found in products like Nuun and Gatorade Endurance Formula.

Now that you know the why, what, and when of eating on the run, here are some handy tips to keep in your (running shorts) back pocket.

1. Practice your fueling and hydration strategy until you perfect it

Let’s be real. No matter what the guidelines say, it’s nearly impossible for anyone besides you to know exactly what your body needs. That’s why practicing your fueling techniques on long runs prior to your race is so, so important. Figure out what your stomach can handle, what you personally like to eat and drink, and how it makes you feel. Use your long runs as trial workouts before your marathon. You don’t want to introduce anything new to your body when you toe the line, so get it used to the exact things you’ll consume.

2. Find out what will be provided on the course and after you finish.

Check the race website or contact the race host to see what food and drink will be available on the course. Many races supply water, Gatorade, and gels at different aid stations, but it really depends on the race. See if there’s a course map that tells you what’s available and where, so you can figure out what you need to carry with you versus what you can snag at the aid table.

3. Figure out how to carry your fuel.

Speaking of carrying fuel, it’s important to decide how you’re going to do that. Embarrassingly, for my first marathon I stuffed a few Gu gels in my sports bra, and after the race, I had cuts on my breasts from the hard plastic poking into my skin. Nowadays, there is running apparel with plenty of pocket options for small snacks, or you can choose to run with a hydration belt, handheld water bottle, or even a hydration pack. As Casa reminded me, carrying water and sipping it throughout has its benefits, and most packs are designed so you don’t even feel like you’re carrying extra weight.

4. Get comfortable with the idea that you really do need more carbs (usually in the form of sugar), to keep running long and hard.

The most important takeaway is simply that your body needs calories while you’re running long, especially if you’re a new marathoner, which means it’s your first time putting your body through a 26.2-mile race. Trying to run long with too few calories will likely make it tough (if not miserable) to finish the race without bonking. Plus, it will make it much harder to recover from the race, says Hogan.

For your first marathon, remember what Hogan told me: “Carbohydrates are your friend, sugar is your friend.” Don’t be afraid to consume sugar on the course, drink moderate amounts of fluids throughout, and pay attention to how your body reacts to it. Although staying fueled while running can get complex, it really comes down to tuning into your energy levels, checking in on your stomach, and getting used to the types of foods your body really craves while hitting the pavement. Whether that’s an energy gel, handful of raisins, or Snickers bar is up to you and your gut.

Source: SELF