Beware! Lest any of the following maladies may befall you!
NOTE: They may be offensive to some, but the truth often is not a pretty thing.

Bounced Prostate
From rough riding; not to be mixed up with “bounced off and then prostrate”

Split infinitive
A severe form of Bounced Prostate with rupturing; infinitive nearly refers, but not always, to the pain. (This as an intellectual joke rather than a malady and I am not sure whether even I understand it myself…)

Wobble eye
Generally occurs after the steep downhill ride on corrugations, with jammed shocks, when the rider is frozen in terror and grips the handle bars with rigid extended arms. The resulting vibration causes the eyeballs to rattle long after the ride, making map reading and fine motor co-ordination impossible. A rest in the dope fields of the Umkomaas valley tends to cure it.

Bonking
Low blood sugar level resulting in collapse and sporadic twitching on the ground. Most victims fall on their backs. But if you roll them over on their faces, whilst they are in full spasm, you get to see where the term “bonking” comes from. Try slipping a cheap inflatable doll underneath them to get the full humour effect. A good thing about this is that if the victim recovers they generally can’t remember a thing.

Sand Piles
Like haemorrhoids, this can be extremely painful but luckily it is temporary. You get it by hopping on your bike straight after crawling/swimming from a huge shore break after an early exit on the sea paddle leg.

Calloused Chommie
Very embarrassing. You go to the doctor thinking you’ve got Sand Piles. He then looks puzzled after examining you. These hard bumps and protuberances are cured by using good cycling pants and milking cream or Fissan paste.

Gunge Toe
Not pretty, but if you say that you haven’t smelled the black stuff from between your little toe and second toe after a five day race, then you are a liar.

Straddle Walk
The cowboy-walk you develop on the second day of racing because you a) are not wearing underwear; b) are not using lube and/or; c) did not have the right pants/shorts. Vaseline helps. If all else fails the old standby of duct tape will see you through.

Salty Cracks
Related to the above. Develops when in close proximity to the sea, (like K—-n).

Winky Walk
When you race without underpants you’re likely to get chafed on the end of your thingy (like S—–n).

Sea Cucumber Syndrome (SCS)
Background: a sea cucumber, when attacked, will eviscerate (vomit up) their entire stomach in the hope that their attacker will eat the stomach, allowing time for the sea cucumber to escape.
Foreground: A combination of exhaustion, dehydration and inadequate nutrition can make an adventure racer go into uncontrollable heaving spasms. Much self control and a slight slacking of the pace may pull them through it, but it is scary waiting to see if your team mate’s stomach will pop out and even scarier to think about what it is attacking their guts (like R—–d).

Myximitosis (a man-induced disease to control rabbits)
Bouncing like a blind rabbit in the wrong direction and then dying of despair and embarrassment when realising that you are hopelessly lost (like me).

Although most of the ailments listed above are physical many AR maladies occur in the head. Some of the simpler ones are easy to deal with and are not really maladies but rather temporary problems.

Red Indian syndrome
This is a problem from which I too suffer. It involves dreaming of Wigwams and Tepees during the two hour sleep on the second day. You are two tents – (say it aloud) – learn to chill.

Around the next bend
As seen in others, often the team leader/navigator or the strongest person in the team. This fabrication is often used by the team leader or navigator to motivate and inspire lagging team members. It refers to checkpoints, water, transitions, downhills and such. These 4-words are nearly always preceded by “It’s” as in “It’s around the next bend”.
Unfortunately, this is nearly always a lie and often the perpetrator is the only one around the bend.

Some head problems are far more interesting. These are the ones that often keep potential racers away from AR; like the fear of the unknown. These ‘issues’ are hard to pin down, name and define. They should be befriended and used as an ally.

The Sleep Monster
Strange really, not nearly so monstrous as many make out. He/She/It can really be quite a pleasant fellow unless you get together whilst on a bike or near steep cliffs. It generally isn’t the monster that’s the problem, but the resulting accidents, abrasions and ridicule.

My best experience with ‘The Monster’, was on the last ride of the Nguni. I wasn’t even really tired. It was 02h00 – the graveyard shift – when I became aware of a figure in a flapping black cape riding next to me on the jeep track. I turned to look at him but he dropped back and when I looked ahead he came up next to me again. His face remained hidden and I tried to talk to him, but he stayed silent and we rode in companionable silence for some time, his steady cadence and flowing cloak breaking the monotony of the night. I was riding quite a way ahead of my team and it was dark and quiet. We approached a bumpy section and I couldn’t cross over into the smoother track because my new friend was in it. So I hit the rocks and fell off. When I got up he had gone, but I swear I heard a soft chuckle in the still air before the rest of the team arrived.

Oh well…
until the replacement shrink comes,
I remain,
Vaguely Disturbed (aka George)

Author: George Forder

Leptospirosis is a bacterial disease resulting from contact with contaminated water, food or soil. Severe infection causes a systemic illness that often leads to renal and hepatic dysfunction.

The infectious agents, Leptospira bacteria, are carried by a variety of wild and domestic (cattle, pigs, horses, dogs, rodents) animals. They are most commonly transmitted indirectly to humans; through food, soil and water contaminated by urine excreted by the infected animals. Infection occurs when contaminated food or water is consumed or when contaminated water and soil comes into contact with cut or abraded skin, mucous membranes (nose) and conjunctivae (eyes).

Although leptospirosis occurs worldwide, it is common in temperate and tropical climates where the bacteria proliferate in fresh water, damp soil and vegetation.

Also known as swamp fever, mud fever and swineherd’s disease, leptospirosis is predominantly an occupational disease (sewer workers, plumbers, veterinarians, rice-field workers). But, it is increasingly recognised as a recreational disease contracted by those travelling to tropical and equatorial regions. Risky activities include swimming, caving (soil contaminated by infected bat guano), hiking, wading through rivers, white-water rafting, mountain biking through mud and puddles, and other outdoor sports played in contaminated water. The risk of infection is increased during heavy rainfall and periods of flooding when water saturates the environment spreading Leptospira present in contaminated soil directly into surface waters.

The incubation period (time from exposure to the presentation of symptoms) varies from 2-days to 4-weeks. In the first phase of the illness, the infected person will preset with fever, chills, headache, muscle aches, vomiting and/or diarrhoea – symptoms also associated with other infections like malaria and Dengue fever. In this first phase the patient may recover, feeling well for 2-3 days before becoming ill again. During this more severe Phase Two (Weil’s Disease) meningitis, renal (kidney) dysfunction, hepatic (liver) necrosis and pulmonary (lung) dysfunction are characteristic. Patients are only likely to develop full-blown Weil’s Disease if contamination is high and treatment is delayed.

The illness usually lasts from a few days to 3 weeks but may last up to 3-months if the infection progresses to Phase Two. Recovery takes several months and may take up to 2-years if you’re trying to get back into racing condition. A blood test will confirm infection (be sure to notify your doctor of your exposure risk).

Antibiotic, usually doxycycline, treatment should be started immediately.

PREVENTION
In the case of leptospirosis, behavioural actions like not walking around barefoot, keeping wounds clean and covered, and regularly cleaning your hydration mouthpiece – especially after it has been lying on the ground – will limit exposure and risk.

Although no preventative vaccine exists, chemoprophylaxis is available. Outdoor Quest’s medical team provided each competitor at the 2003 and 2004 events with the antibiotic doxycycline, which is most commonly taken as an anti-malarial drug. Effective in preventing leptospirosis, doxycycline also offers protection from regular stomach upsets caused by bacterial infections.

APPROPRIATE TREATMENT
Where bacterial and viral infections are to blame for illnesses, appropriate treatment is all-important. One of the big problems when returning from an exotic location, host to a tropical disease, is that doctors back home don’t recognise the symptoms for what they represent. Give your home-town doctor the necessary information (countries visited, duration of stay) to make an accurate diagnosis and provide appropriate and immediate treatment.

Visiting and competing in foreign countries exposes competitors to health risks, which through increased awareness and preventative protocols are greatly reduced

At the 1995 Raid Gauloises (held in Sarawak, Borneo), the 1998 Eco Challenge Borneo (held in Sabah) and Borneo-based Outdoor Quest races, competitors contracted leptospirosis. As with malaria, the degree of infection and the severity of symptoms do vary from person to person. Fortunately, as proven at last year’s Outdoor Quest, preventative medication is effective.

Leptospirosis is a bacterial disease resulting from contact with contaminated water, food or soil. Severe infection causes a systemic illness that often leads to renal and hepatic dysfunction.

The infectious agents, Leptospira bacteria, are carried by a variety of wild and domestic (cattle, pigs, horses, dogs, rodents) animals. They are most commonly transmitted indirectly to humans; through food, soil and water contaminated by urine excreted by the infected animals. Infection occurs when contaminated food or water is consumed or when contaminated water and soil comes into contact with cut or abraded skin, mucous membranes (nose) and conjunctivae (eyes).

Although leptospirosis occurs worldwide, it is common in temperate and tropical climates where the bacteria proliferate in fresh water, damp soil and vegetation.

Also known as swamp fever, mud fever and swineherd’s disease, leptospirosis is predominantly an occupational disease (sewer workers, plumbers, veterinarians, rice-field workers). But, it is increasingly recognised as a recreational disease contracted by those travelling to tropical and equatorial regions. Risky activities include swimming, caving (soil contaminated by infected bat guano), hiking, wading through rivers, white-water rafting, mountain biking through mud and puddles, and other outdoor sports played in contaminated water. The risk of infection is increased during heavy rainfall and periods of flooding when water saturates the environment spreading Leptospira present in contaminated soil directly into surface waters.

The incubation period (time from exposure to the presentation of symptoms) varies from 2-days to 4-weeks. In the first phase of the illness, the infected person will preset with fever, chills, headache, muscle aches, vomiting and/or diarrhoea – symptoms also associated with other infections like malaria and Dengue fever. In this first phase the patient may recover, feeling well for 2-3 days before becoming ill again. During this more severe Phase Two (Weil’s Disease) meningitis, renal (kidney) dysfunction, hepatic (liver) necrosis and pulmonary (lung) dysfunction are characteristic. Patients are only likely to develop full-blown Weil’s Disease if contamination is high and treatment is delayed.

The illness usually lasts from a few days to 3 weeks but may last up to 3-months if the infection progresses to Phase Two. Recovery takes several months and may take up to 2-years if you’re trying to get back into racing condition. A blood test will confirm infection (be sure to notify your doctor of your exposure risk).

Antibiotic, usually doxycycline, treatment should be started immediately.

PREVENTION
In the case of leptospirosis, behavioural actions like not walking around barefoot, keeping wounds clean and covered, and regularly cleaning your hydration mouthpiece – especially after it has been lying on the ground – will limit exposure and risk.

Although no preventative vaccine exists, chemoprophylaxis is available. Outdoor Quest’s medical team provided each competitor at the 2003 and 2004 events with the antibiotic doxycycline, which is most commonly taken as an anti-malarial drug. Effective in preventing leptospirosis, doxycycline also offers protection from regular stomach upsets caused by bacterial infections.

APPROPRIATE TREATMENT
Where bacterial and viral infections are to blame for illnesses, appropriate treatment is all-important. One of the big problems when returning from an exotic location, host to a tropical disease, is that doctors back home don’t recognise the symptoms for what they represent. Give your home-town doctor the necessary information (countries visited, duration of stay) to make an accurate diagnosis and provide appropriate and immediate treatment.

Visiting and competing in foreign countries exposes competitors to health risks, which through increased awareness and preventative protocols are greatly reduced.

Author: Lisa de Speville

Tick bite fever occurs in many parts of the world and is often given regional or local names (see table). 

Tick bites most often occur when hiking or camping in wilderness areas, particularly where there is long grass. Hardticks, which have lifecycles that involve dogs, rodents or other animals, are the hosts of the bacteria. Amblyomma ticks will actively seek out humans on which to feed, while Rhipicephalus ticks tend to lie in wait on grass, picked up when you brush past.

The incubation period (time from the infected bite to the appearance of symptoms) is 5-7 days. Symptoms vary depending on the bacterial species, your age and current health status. Typical features include the presence of a black mark at the site of the bite, a fever, severe headache, swollen lymph nodes near the bite site and sometimes a rash. The blackened bite mark is called an eschar. It looks like a small ulcer (2-5mm in diameter) with a black center, similar to a spider bite. The bite site may be difficult to find with the eschar appearing once the other symptoms begin.

A rash is not always present but when it does occur, it consists of small red marks on the skin, raised slightly above the skin’s surface. It will typically start on the arms and legs, spreading to the abdomen and if severe, even to the palms and soles.

African tick bite fever is usually mild, thus serious complications and death are rare. Rocky Mountain Spotted Fever is more severe with a death rate of up to 25% if left untreated.

Should you experience a severe headache, fever, swollen lymph nodes and feel really ill a week or so after a trip away where you hiked or camped (or raced) in a rural or wilderness area, suspect tick bite fever, especially if the area is a known tick bite fever area.

The presence of the eschar or rash is a strong diagnostic sign. Blood tests will confirm the presence of antibodies produced by your immune response cells in reaction to the infection. But, the antibodies may only show up after a few weeks.

In most cases you will get better in about two weeks without treatment. Treatment with the antibiotic doxycycline can shorten the duration of symptoms and reduce the chance of developing a serious complication. Chloramphenicol may be used. There is no vaccine against tick bite fever.

As with most things, prevention is better than cure and early diagnosis speeds recovery.

1. AVOID TICK BITES Wear long sleeved shirts, long pants and shoes. Apply insect repellant to exposed skin.
2. EARLY DIAGNOSIS If you’ve been in a known tick bite fever area and are suffering from a fever, headache, swollen lymph nodes and have located the eschar, seek medical attention. The eschar is not always visible so don’t rely on its presence as a diagnostic sign.

Of the four Plasmodium species, Plasmodium falciparum is the only one capable of causing cerebral malaria, which if not treated promptly, will cause death. In most parts of the world P.falciparum has developed varying degrees of resistance to the drugs used for malaria prevention and treatment.

The mosquito is intrinsic to the life-cycle of the parasite, thus factors such as altitude, climate, mosquito-breeding sites and human behaviour are responsible for the successful transmission of the disease.

These THREE RULES will aid in preventing infection, illness and death from the malaria disease. 

AVOID MOSQUITO BITES The Anopheles mosquito feeds between dusk and dawn. In high-risk areas, especially during or immediately after the rainy season, avoid mosquitoes. Wear long sleeves shirts, long pants and shoes. Apply mosquito repellant to exposed skin every 4 hours. If you are not staying in a well-screened and air-conditioned environment, sleep under a repellent-impregnated bednet.  

DIAGNOSE AND TREAT MALARIA PROMPTLY Any fevers and flu-like illness (chills, headache, muscle aches and fatigue, sometimes with diarrhoea and vomiting) beginning 7-10 days after entering a malaria area should be presumed to be malaria. Onset of symptoms could occur up to 6 months after leaving an infected area. If not immediately treated, Plasmodium falciparum infections may cause kidney failure, coma and death. If you experience any of these symptoms, a doctor must be consulted urgently whether you have or have not taken malaria-preventative drugs. Remember to tell your doctor your travel history. 

USE PREVENTATIVE ANTI-MALARIAL DRUGS Anti-malarial drugs work by killing the Plasmodium parasite before the traveller becomes ill. Medication is started before entering the malaria area, to ensure that protective levels are reached and that the drugs are tolerated. Drugs administration should be continued for up to 4 weeks after leaving the area to ensure that parasites still emerging from the liver are elminiated. The drugs are ineffective against the parasites when they are in the liver.

Malaria Prevention Drugs
While no drug is 100% effective, they do confer 90% protection over and above mosquito avoidance measures.

Anti-malarial drugs do not mask the symptoms of the disease. They do reduce the numbers of infecting parasites, minimising symptoms and the severity of the disease. When the drug is stopped, symptoms may appear, but by this stage the traveller should be in an environment where they are able to receive adequate medical attention.

The decision whether to use preventative drugs or not should be based on the relative risk in the area to be visited as well as the potential side effects of the anti-malarial drugs.

MEFLOQUINE (brand name: Lariam^TM and generic)
The adult dosage is one 250mg tablet weekly, on the same day each week, after a meal with plenty of fluid. Dosage starts 1 week before entering a malaria area and ends 4 weeks after leaving the area. Heavy alcohol consumption should be avoided for 24hrs before and after the weekly dose.

The most common side effects include headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances. If minor side effects occur, the dose can be split i.e. half a tablet on Sunday and the other half on Thursday. If major symptoms such as dizziness, agitation, depression or racing pulse result, stop medication and seek advice.

People with epilepsy, psychological illness, abrnomal heart beats or heart conditions, pilots, scuba divers and high altitude hikers should avoid mefloquine.

DOXYCYCLINE (many brand names and generics are available)
The adult dosage is one 100mg tablet daily, taken after a heavy meal. Medication starts 2 days before entering a malaria area and ends 4 weeks after leaving. Doxycycline is related to the antibiotic tetracycline and must be taken with plenty of food and liquid, otherwise is may cause nausea and heartburn.

Sun sensitivity (you get sunburnt more easily) is a common side effect. More care must be taken when out in the sun i.e. sunblock and protective clothing. Women who use doxycycline may develop a vaginal yeast infection.

Children, pregnant women and people allergic to the tetracycline group of antibiotics should not take this drug.

ATOVAQUONE/PROGUANIL (brand name: Malarone^TM)
Atovaquone/proguanil is a fixed combination of two drugs, 250mg atovaquone and 100mg proguanil. It is a section 21 medication and is available under special circumstances. The adult dosage is one tablet daily, taken at the same time each day, with food. Dosage starts 2 days before entering the malaria-risk area and ends 7 days after leaving the area.

The most common side effects reported are abdominal pain, nausea, vomiting, and headache.

Children weighing less than 11 kilograms, pregnant women, women breast-feeding infants weighing less than 11 kilograms (25 pounds), patients with severe renal impairment and people allergic to atovaquone or proguanil should not take this drug.

CHLOROQUININE & PROGUANIL
These drugs are no longer recommended.

DIAGNOSIS
If you suspect that you have malaria, do not delay. Go immediately for blood tests to confirm infection. Once infection has been confirmed appropriate treatment can be initiated.

For travel risk-area information, visit the Centre for Disease Control website at www.cdc.gov and your local travel clinic.

Author: Lisa de Speville

Cholera results from infection by a bacterium, Vibrio cholerae, often found in coastal saltwater, brackish water and estuaries.

The bacteria multiply rapidly producing an enterotoxin, choleragen. The toxin is one that is absorbed by and acts primarily on the intestinal tract. The toxin acts by attaching and entering the cells of the small intestine, activating an enzyme, adenyl cyclase. In response, the cell secretes large volumes of water and electrolytes (dissolves salts) into the intestine – as much as 20-liters of fluid per day. This causes diarrhoea.

Humans become infected after drinking contaminated water or eating contaminated food. Common sources of foodborne infection include raw or poorly cooked seafood and unwashed fruit and vegetables. Other foods can be contaminated during preparation or storage.

The bacteria present in the faeces of an infected person are the main source of contamination. V.cholerae can remain in the intestinal tract long after recover, being shed by the carrier for up to a year after infection. Consequently, the disease can spread rapidly in areas where sewage and drinking water supplies are inadequately treated.

On average the time from infection to the onset of diarrhoea is 1-3 days. But, it can be less than 1 day and as much as 5 days. The speed on onset and serverity of the disease is dependant on the amount of bacteria ingested and the strength of the person’s immune system.

Due to the massive secretion of fluid into the intestine, diarrhoea results and onset is rapid. One minute you’re fine, next you’re violently ill.

More than 90% of cases are of mild or moderate severity and are difficult to distinguish clinically from other types of diarrhoea. These individuals will present with diarrhoea for 3-5 days. Less than 10% of infected persons develop typical cholera. In these severe cases, patients develop very watery diarrhoea. Stool is without odour and appears cloudy and watery with flecks of mucous, resembling water in which rice has been washed. It is described as “rice water” stool. Vomiting can occur from 6 hours to 5 days after exposure to the bacterium.

It takes the body a few days to produce antibodies to neutralise the toxin.
While the diarrhoea serves to flush the parasites from the intestine, it also causes dehydration. This is the main problem. Also, as essential electrolytes are flushed from the tissues patients may experience muscle cramps.

Diarrhoea and other symptoms should clear within a week.

Besides clinical suspicion, the only diagnostic confirmation is the identification of bacteria in stool.

Rehydration is the most important treatment. This can be done orally (drinking fluids containing glucose and electrolytes) or intravenously. In severe cases, if fluids are not replaced, dehydration increases resulting in hypovolemic shock and renal failure.

For most cases, rehydration is sufficient. The diarrhoea will flush the bacteria from the intestine. Antidiarrhoeal medicines (Imodium) should never be given as they only prolong the illness.

Antibiotics, administered once vomiting has stopped, do shorten the period of diarrhoea and thus the amount of fluid lost, but are secondary to rehydration therapy.

Outbreaks are likely wherever water supplies, sanitation, food safety, and hygiene are inadequate. If you’re swimming in coastal seawater or a river near the coast, downstream from an underdeveloped, overpopulated settlement where sewage flows into the sea or river, you’re at risk. You’re also at risk if you drink water or eat food from high risk sources.

Yes, through proper sewage treatment and water purification; and through the rapid detection, isolation and treatment of infected people.

In high-risk areas wash your hands frequently, especially before food preparation and eating. Eat food while hot and boil or treat all drinking water. Avoid swimming in contaminated rivers. Regarding food and drinks, remember:

Boil it, cook it, peel it, or leave it

The injectable cholera vaccine, previously used, conveyed incomplete, unreliable protection of short duration and is no longer recommended. Two new oral cholera vaccines, which provide good protection for up to 3 years, are now available for use by travellers. However, as these vaccines do not provide 100% protection, basic hygienic precautions should always be followed.

Did you know…?
That you’re more likely to get cholera if you

Author: Lisa de Speville

As a tourist, it isn’t much of a problem. After a few days you get used to being sweaty, sticky and lethargic, symptoms alleviated by spending hours at the pool-side bar drinking iced tea. But when you’re a competitor at hot, humid and sticky event like Outdoor Quest, held in Sabah, Malaysian Borneo, the situation is considerably different; competitors must deal with high-intensity exercise over a prolonged period without the benefit of acclimatisation.

Following weather updates online from your home country, where it may be 36°C, you can be forgiven for thinking that 30°C is not that bad. But,have you ever noticed how 30°C feels hotter when it is humid than when the air is dry? This is where the humidex formula comes in.

The humidex value is derived by combining ambient temperature and the relative humidity of the air (how much moisture the air contains relative to how much it can contain at a certain temperature) to describe what the temperature feels like and how it is perceived in reality.

For example: the humidex value of 28°C/82F ambient temperature at 10% relative humidity is 28C/82F, at 40% it is 31°C/88F, at 60% it is 35°C/95F and at 85% it is 40°C/104F! These values have been applied to a scale that describes what the temperature really feels like outdoors in terms of the degree of comfort/discomfort experienced.

Humidex values: Degree of comfort or discomfort

< 29°C: Little or no discomfort
30°C to 34°C: Noticeable discomfort
35°C to 39°C: Evident discomfort
40°C to 45°C: Intense discomfort; avoid exertion
Above 45°C: Dangerous discomfort
Above 54°C: Heat stroke probable

So, how does this relate to an equatorial-based race?

Heat, which is produced by working muscles, must be eliminated from the body to maintain a relatively constant body temperature around 37°C/98.6F. Most of the heat generated is conducted in the blood stream to the skin where it is released into the environment. Although conduction and convection (transfer of heat from the warmer body to the cooler environment) are involved in heat elimination, evaporation of sweat is the most important and effective means of cooling.

This is where the crunch comes in as humidity is the greatest barrier to evaporation.

The rate of sweating is high in a humid environment but because the air is already substantially saturated, sweat cannot evaporate and thus cooling is substantially limited. The situation becomes more serious when the volume of sweat produced exceeds fluid intake and the person dehydrates. Cooling then becomes even more difficult, performance drops dramatically and heat injuries (heat cramps, heat exhaustion and heat stroke) are certain.

Heat cramps will often occur in the arms, legs or abdomen. They are thought to be caused by the depletion of salts and electrolytes from excessive fluid loss. Heat exhaustion is a little more severe. The competitor will likely have a headache and will feel weak and dizzy. Their blood pressure will be low, their pulse will be elevated and their body temperature will be higher than normal. Some time in the shade, a bottle of electrolyte fluid, plenty of water and salty food will see them back out on course.

Heatstroke is a life threatening. It results when the person is severely dehydrated, their body temperature is high and the body’s cooling mechanisms are shut-down. Most patients stop sweating, their pulse is rapid and weak, blood pressure drops and body temperature is greatly elevated. This is when damage to the brain, heart, lungs, kidneys and other organs may occur. Medical intervention must be immediate and effective or the person will die.

Hyponatraemia, overhydration with insufficient replacement of sodium, is probably not as much of a risk as the above heat injuries provided that electrolytes are adequately replaced.

Heat acclimatisation takes over a week, a luxury which most – if not all – competitors have not had. Thus, wearing light-coloured, moisture-wicking, loose-fitting, light-weight clothing and carefully monitoring their fluid and food intake will be crucial. But, while the competitors may be drinking a large volume of fluid, the problem in this environment is that the rate of sweat loss can easily exceed the rate of absorption of ingested fluids.

Compulsory 15-30-minute cool-down sessions, as implemented by Outdoor Quest, force the competitors to rest and re-hydrate before continuing and enable medical officers to keep an eye on the racers.

Finally, sunburn is a temporarily painful condition that, if severe, could see a competitor withdrawing from the race. Overexposure is also a serious long-term health risk; skin cancer (melanoma), premature aging of the skin and other skin problems, cataracts and other eye damage and immune suppression.

The ozone layer – more specifically, depletion of the ozone layer – is a critical environmental concern as it shields the Earth from the sun’s harmful ultraviolet (UV) rays, light of 290-400nm in wavelength. Ozone depletion, as well as seasonal and weather variations, cause different amounts of UV radiation to reach the Earth at any given time.

The UV Index considers the ozone layer thickness, UV incidence (incoming radiation level) on the ground, cloud cover (clouds reduce UV levels) and altitude (UV levels increase by 6% for every 1km of elevation gain). It does not include the effects of variable surface reflection (e.g., sand, water, or snow), atmospheric pollutants or haze, which may nearly double UV exposure strength. Thus, the UV Index, which ranks UV radiation levels on a 1-11+ scale, is a useful tool in assessing exposure risk.

UV Index Scale

• <2: danger is low. Wear sunglasses and if you burn easily, cover-up and use sunscreen
• 3-5: harm is moderate. Stay in the shade at midday and if outside, cover-up, use sunscreen and wear sunglasses.
• 6-7: high risk of harm from unprotected sun exposure. Avoid outside exposure from noon till early afternoon. Use a sunscreen with a Sun Protection Factor (SPF) of at least 15 and wear a wide-brim hat and sunglasses to protect your eyes.
• 8-10: Risk of harm is very high. Use a sunscreen of >SPF15, wear protective clothing (hat, long sleeves, sunglasses) and avoid sun exposure from noon to late afternoon. Unprotected skin will be damaged and can burn easily.
• 11+: risk of harm is extreme. Minimise exposure during midday hours (10h00 – 16h00), apply sunscreen of >SPF15 every 2hrs and wear protective clothing. Unprotected skin will burn in minutes.

The risks associated with racing in an equatorial country in summer are high. Fortunately these can be managed. But even so, many competitors will suffer under such extreme conditions.

Author: Lisa de Speville

As the basal metabolic rate is the smallest amount of energy required by the body purely to keep you alive at rest, an additional quota will enable your body to react to environmental stressors like heat and cold by sweating and shivering to regulate body temperature and to perform work. In order to be active, we have to provide the body with fuel. Food is the body’s fuel. Carbohydrates, fats and, to a lesser extent, proteins¹ provide the body’s metabolic systems with the means to generate energy, measured in kilocalories (kCal) and kilojoules (kJ)², via numerous metabolic pathways. High intensity exercise, like marathon running, lasting longer than two minutes and up to three hours is predominantly powered by the aerobic glycolytic system. Here glucose is broken down in the presence of oxygen to generate power for muscle contraction.

For longer, less-intense ultra-endurance events, fats (lipids) – in the presence of oxygen – provide most of the energy for muscle metabolism. An efficient system, this aerobic lipolytic system delivers 9 kCal per gram of lipid³. During prolonged activity the use of fats relative to carbohydrates varies according to the fitness of the individual, the intensity and duration of activity and their diet.

Using and losing energy
As distance covered increases, an athlete’s running speed will decrease due to the mismatch between the demand for energy by the working muscles and the supply of energy from the metabolic breakdown of carbohydrates and fats.

In events over five hours fatigue results when muscle glycogen stores are depleted the body switches to using fats. But, as the supply of fats from the adipose tissue is slower than that of glycogen the athlete is forced to run slower, reducing his intensity and thus matching his energy expenditure with the rate at which fats can be metabolised.

Now consider a 130km adventure race where activity intensity is generally low to medium but the racers are active for the entire time. Using a sport wristwatch, which is able to accurately calculate the energy expended during activity from the heart rate, we can assess energy expenditure. At this particular event, the racer used 13 000kCal of energy to complete the 130km race in 20hr15min.

13 000kCal equates to 38 peanut butter sandwiches (or 112 bananas) – an impossible amount to eat in a 20hr period.

This would also mean that where a team is unable to replenish food stores from their race crates (unsupported event), or from their support crews, each individual would need to carry 3kg of food (at a 65:15:20 carbohydrate, protein and fat ratio) to fulfill their energy requirements in a 20hr period.

In reality, even with hi-tech food supplements, the racers don’t consume the necessary volume of food to obtain sufficient calories and yet they still manage to maintain performance for days on end. Thus, by using stored lipids, particularly where glycogen stores have been depleted and carbohydrate intake is insufficient, the body is able to fulfill its energy requirements for a reasonable period of time. Post-race munchies are common, serving to correct the accumulated nutritional deficit.

¹ Protein building blocks, amino acids, are primarily used to build, repair and maintain the body’s protein-based substances (muscles, cellular structures, hormones, enzymes etc). But, if a sufficient amount of carbohydrates and lipids are unavailable, then this amino acid pool is used for energy – compromising the primary function of repair and maintenance. Endurance athletes do use a small amount of protein for fuel in their normal endurance activities. ² Most commonly mentioned in books and on food labels in kCal. If you read something as Cal, it is likely to mean kCal. There are approximately 4.2kJ in 1kCal. ³ The aerobic glycolytic and proteolytic (protein) systems produce 4 kCal per gram of carbohydrate and protein respectively.

That some competitors will experience mild symptoms of acute mountain sickness (AMS) is likely. It’s a condition related to altitude and the speed of ascent. Onset is rapid and those susceptible to the condition are not confined to age, gender or fitness categories. Symptoms increase in severity with continued ascent and time spent at altitude. The most effective treatment is immediate descent.

In a race environment repercussions are huge. Consider this scenario. A member of the leading team succumbs to the symptoms of AMS and is unable to continue upwards…

Altitude is defined on the following scale:

High: 2438m – 3658m (8000ft – 12000ft)
Very High: 3658m – 5487m (12 000ft – 18 000ft)
Extremely High: >5500m (>18 000ft)

Basic Physics
Barometric pressure is the amount of force exerted on a surface by the weight of the air molecules above it. As your altitude increases, there is less air above you and consequently the force exerted decreases. Therefore, barometric pressure decreases with increasing altitude.

Air is made up of many different gases. Oxygen molecules comprise about 20.95% (we’ll use 21% for convenience) of the mix, nitrogen accounts for around 79.02% with carbon dioxide clocking in at around 0.03%. There are also miniscule quantities of rare gases – argon, neon, helium, krypton, hydrogen, xenon, and radon, which bear no consideration here.

Dalton’s Law of Partial Pressures explains that we can consider the weight exerted by each gas independently. Added together they would produce the total barometric pressure.

So, now consider a large syringe containing 21 marbles (oxygen molecules). When you squeeze the plunger down, you’re exerting a force (weight of the air above them) on the marbles, squeezing them to the bottom. The 21 marbles are close together and in a smaller, more compressed volume. This is the sea-level image. Now raise the plunger. The same number of marbles are free to roll around in a larger volume. This is the altitude image.

At sea-level the oxygen molecules are concentrated and thus with every breath you inhale a lot of them. As you ascend higher, the weight exerted by the air above decreases and although the same number of oxygen molecules are available, they’re more ‘dispersed’ and not as easy to access. With each breath you inhale less oxygen molecules. Subsequently the amount of oxygen available to the blood and tissues is reduced.

We need oxygen to fuel our cells for various processes, the most important of which is the generation of energy, which keeps every essential biological process ticking over. Oxygen deprivation is comparable to suffocation.

Acclimatisation
The body is able to adjust to being at higher altitudes where there is less oxygen. Physiological adaptations like increased breathing rate (higher breath rate means more oxygen will be inhaled overall) and increased heart rate (pumping blood around faster to increase the oxygen turnover) are important initial adjustments. An increase in the amount of red blood cells (oxygen carrying cells) in your blood is more gradual, taking place over about 10-days. These mechanisms ensure that oxygen carrying potential of the cells is maximised and that oxygen delivery to cells is efficient.

In most races, exposure to high altitude is brief as competitors ascend rapidly and will probably punch a check point before descending even more quickly. As their stay at altitude is brief physiological adaptations are immediate and restricted to an increased heart and respiratory rate.

Altitude induced-illnesses
Going too high, too fast is the major cause of altitude induced-illnesses.

Rapid accent to high altitude often results in a syndrome known as acute mountain sickness (AMS). AMS is common; at elevations over 3048m, 75% of people will have mild symptoms. Onset is dependant on altitude, the rate of ascent and individual susceptibility (not limited to age, gender or fitness) and a headache is the most common symptom. Dehydration does increase the probability of experiencing AMS. Fortunately treatment and symptomatic relief is simple – Go Down!

If the person susceptible to AMS remains at altitude and/or continues to ascend their headache will be accompanied by fatigue, nausea, vomiting, dizziness and irritability. The severity of these symptoms increases with altitude and time spent at altitude.

While severe altitude-induced illnesses are unlikely in adventure races, mild symptoms are possible. And, should a team in the upper ranks be affected, the race outcome could be drastically affected.

Author: Lisa de Speville

The adage holds true – adventure races are won on foot. As Gerard Fusil, the father of adventure racing says, “Fast cars need good tires”.

Finding what works for your feet is a trial and error process. People will give you suggestions, but what works for them may not work for you.

Blisters form when the ‘glue’ (basement membrane) connecting your outer skin layer (epidermis) and the underlying layer (dermis) becomes unstuck and the space between these layers becomes filled with fluid. The following are four ‘glue-dissolving’ elements we regularly encounter:

• Heat causes a thermal reaction which breaks down the ‘glue’. Heat buildup is caused by ineffective sock materials, hot ground surfaces, non-vented shoes and friction.
• Cold temperatures initiate a physiological response that reduces blood flow to the extremities (yes, your feet), making the skin more fragile.
• Moisture is absorbed by the skin making it soft and tender. The skin will be more likely to stick to your socks, rubbing inside your shoes. Sweat can build up as a result of non-wicking socks and non-vented shoes and obviously walking through streams, snow and dew-covered grass will wet your socks and shoes.
• Friction is caused when two surfaces rub against each other – between feet and socks or socks and shoes. It is also caused when your shoes are too tight, your socks bunch up or when dirt gets into your shoes.

A precursor to a blister is a hot spot, an area that has become red and sore as a result of rubbing. With continued rubbing the glue connecting the outer (epidermis) and inner (dermis) layers of skin is broken down and the sac inbetween fills with lymph fluid. And, as the outer layer is cut off from oxygen and nutrients it becomes dead skin. If the blister bursts, the sensitive dermal layer will be exposed.

BASIC FOOT CARE KIT (carried in your backpack)

• Small container of foot powder
• Alcohol swabs
• 2.5ml syringe and a few needles
• Tube or sachet of lubricant
• Friar’s Balsam & gauze
• Tape, plasters and blister patches

Treating and protecting a hot spot is your first line of defense and if caught early it will not develop into a blister. As lubricants will only provide only temporary relief the hot spot must be covered with tape to protect it against further rubbing. It is important to determine the cause of the rubbing and eliminate it. Then clean your feet, change your socks, powder your feet and continue racing.

But, if you do develop a blister, treat it as soon as possible, draining the fluid-filled sac. The easiest method is to use a small syringe and needle. If you can’t do it yourself, ask a teammate to do it for you – it really doesn’t hurt. If you’ve only got a needle, prick a few holes in the blister-roof and use finger pressure to drain the fluid. Even if you’ve only got a small developing blister, drain it as soon as possible and keep up the maintenance thoughout the race.

When you’ve drained it, patch it. There are a number of tapes and plasters available. Green Cross and Scholl make special blister patches – even those donut-shaped corn plasters will work well. If you apply a little Friar’s Balsam to the skin around the blister the plaster will adhere better. Avoid getting it into the blister, or any open cuts, as it will sting like hell. Don’t get the sticky part of the plaster on the blister as it will create friction and will rip the roof off your blister when removed later.

In extreme cases Friar’s Balsam or methyolate can be injected into the blister. This is INCREDIBLY painful. Forget about a red-hot poker, it’s like having a white-hot poker held against your foot. The method is to use a syringe (without needle or you’ll end up with the needle in your heel) to inject the chosen solution into a drained blister, immediately applying pressure to make the blister’s roof adhere to the base skin. Ask one teammate to do the injecting while another holds your leg still. A brave few are able to do this themselves.

I tried this once, on day 2 at the Augrabies Extreme last year – and howled in pain. I only put up with it for one blister and retreated to drain the others myself. This proved to be the best and most successful treatment. I kept my feet clean, FB’d and powdered my feet and drained the troublesome blisters regularly. By the end of the 3rd day there was a vast improvement and by day 5 my feet were in better condition that anyone else’s and the blisters had healed giving me no trouble.

Super glue and many other creative methods have been used by racers to get them through races… But, by this stage if your pre-race preparations and during-race maintenance have failed you, then go for it.

You and your team have to understand the benefit of taking a few minutes early on to deal with hot spots and minor blisters before they develop into a serious problem. If you push on not wanting to hold up your team, remember that within a few hours you, or a teammate, will be in pain, will travel even slower and ultimately may not be able to complete the race.

OLD WIVES TALE?
Apply a mixture of teatree oil and vitamin-e oil (3/4 teatree + 1/4 Vitamin E) everytime before you run to the places where you are prone to getting blisters…

Handy Foot Care Tips…

• If the SHOE fits, wear it. You need a good outer sole for traction, enough room in the front/toe box so that toes arn’t crammed close together, a strong heel counter that grips your heel securely and quality insoles. Remember that in hot weather, over long hikes and in multi-day races that your feet will swell. You can use socks of different thickness to accommodate an initially looser fit. 
• SOCKS, socks, socks… you can never have enough. Try different types of socks of various thicknesses and fabrics (remember that thicker socks = hotter feet = sweaty feet = moist skin = blisters). Choose moisture-wicking fabrics with seamless toes over an all-cotton sock. Try a two-layer system – a thin sock under a thicker sock will offer an inner layer that moves against the outer layer, reducing the rubbing against your skin. Some people swear by pantihose socks under their regular socks as the pantihose almost acts as an outer layer of skin over which the sock can easily slide without friction.While racing, change your socks regularly always keeping an extra pair in your pack. 
• Spending TIME on your feet will condition them to the stresses and distances of adventure racing. Another way to toughen the skin is to walk around barefoot as much as possible on rough surfaces. 
• My favourite, GAITORS. They go over your socks and the top of you shoe preventing grass seeds, sand, stones, sticks and grit from getting into your socks and shoes. These irritants cause friction, which causes blisters – so the cleaner you can keep your socks and the inside of your shoes the better. Make sure that they fit correctly i.e. not too tight on your skin and that they stay around the top of your shoe. Make your own adjustments if necessary (velcro, safety pins). I always remove the strap that is meant to go under the shoe arch. They’re available as anklets or knee length gaitors. The knee length are handy when bashing through scratchy vegetation that is likely to shred your shins. 
• Like a well-oiled machine, LUBRICATE your feet. Reapply lubricants (look for silicone based lubes; nappy cream, Sportslube, KY Jelly) frequently making certain that you clean off the old layer before applying. And, make certain that your feet are clean and dry. Dirt will irritate the skin, making a hot spot and later a painful blister. Remember that lubricants have a softening effect and could make your skin tender and more prone to blistering. 
• If lubricants don’t work for you, then POWDERS may be the answer. They help to reduce friction between your feet and socks by absorbing moisture. Dry skin is more resistant to blister formation than soft, moist skin. Powers can cake in the presence of moisture (this includes sweat), causing blisters so dust your feet in the powder and don’t go overboard. (Johnson’s Baby Powder or even cornflour) 
• SKIN TOUGHENERS work by coating the feet for protection and drying the skin. The most commonly used is a tincture of benzoin, known as FRIAR’S BALSAM in SA (see box opposite). METHOLATED SPIRITS also works well by really drying out your skin. 
• TAPING your feet is also an option. But, your skin could react to the tape/ plaster, blistering within hours. Even before the race starts, place small pieces of moleskin over ‘hot-spot’ zones where you would normally blister. It’s thin and smooth, providing a little cushioning and more importantly it will not irritate neighbouring skin. 
• The GOLDEN RULE when taping your toes is that if you tape one, you must tape them all. The plaster/tape is certain to irritate and create friction on the neighbouring digits creating blisters on all your little piggies. 
• Trim your TOE NAILS to avoid toe blisters. Cut them straight across and file them so the front edges are smooth and will not catch on your socks. 
• Keep well HYDRATED to reduce swelling of the feet. When you are fluid and electrolyte deficient your skin will more easily rub and fold over itself causing blisters. 
• Take off your shoes and socks to AIR your feet whenever you rest so that they dry out and ELEVATE them above the level of your heart to reduce swelling. 
• TRAIN with the socks and shoes you are going to use on race day and run with your pack at an approximate weight to what you will be carrying in an event so that you are not subjecting your feet to new stresses at the race.

LISA’S SKIN TOUGHENING RECIPE
Friar’s Balsam (FB) is my favourite and over the past year I’ve perfected my foot preparation with great success. FB is readily available from pharmacies. Make yourself a ‘Foot Care’ box. In it you will need:

Author: Lisa de Speville

Adventure racing could be this crippling potion if you go into a race with your feet inadequately prepared and through inadequate maintenance during the race. Avoid “Little Mermaid Syndrome” with good pre-, during and post-race foot care.

Pre-race foot conditioning
Skanky toenails will jeopardise your comfort – and your race. Keep them short, trimmed straight across. Long toenails get slammed over-and-over against your shoe’s toebox, especially on downhills. This results in injury to the toenail bed, blackening, swelling and excruciating pain. Are your toenails crumbly, yellow or brownish in colour and/or thickened? This may indicate nail fungus; pay your podiatrist a visit.

Now that you’ve assessed your toenails, check between your toes for cracks and scales; these irregularities may indicate Athlete’s Foot. Next, visit your heels, checking for thickened skin, cracks (fissures) and calluses. Sandals and flip-flops are guilty of encouraging the formation of dry, thickened skin and fissures. Use a foot file and softening balms after showering to reduce and soften hard skin. Files and balms can also be used to treat calluses on the sides of your forefoot and balls of your feet.

If you suffer from blistering, try a skin toughening regime (read “Foot care for adventure racing”) and test out different types of socks (cushioning vs thin). Also learn how to treat your blisters efficiently with draining and patching techniques; and pack your repair tools (needles, plasters, tape, ointments) in your first aid kit.

Finally, in preparation for an event, spend time on your feet; walking, running and hiking. Mix up the activities and ensure, on a number of occasions, you spend four continuous hours (or more) on your feet on a number of occasions.

During the race
If your toenails are trimmed and you’ve dealt with hard skin and irregularities pre-race, then the most likely foot injury that you’ll encounter during a race is blistering. Blisters are a powerful force that sends grown men to their knees; crawling is only becoming to infants and leopards.

Blisters can occur on different parts of the foot at different times under different conditions. But there’s always a reason: shoes (old and new), socks (dirty, ill-fitting), lotions (lubricants and powders); a change in humidity, inadequate hydration and temperature (hot and cold); trail debris (sticks, sand, dust, grass seeds) and terrain (flat, uneven); mud and water; or even stiff mucles and tendonitis, which can alter your heel strike to toe off pattern.

With all of this variability, there is one similarity; hotspots, the precursor to blisters, are only a problem if you fail to respond immediately to the warning signs (pain, discomfort, irritation). Do not wait for the next checkpoint or transition. Deal with the hotspot immediately; your team mates should understand the urgency and the long-term benefit to the team’s success from early treatment.

After your race
While massaging your feet analyse what worked and what didn’t. What were the conditions? What did you do differently to other races? What was the outcome? What should you have done? What will you do next time to prepare your feet better?

Your feet are crucial to your enjoyment of a race; don’t be like Little Mermaid. Identifying techniques and products that work for different conditions takes a bit of trial and error and will be specific to you. Aim to prevent of foot injuries through sound pre-race foot care and practised maintenance techniques.

Seven foot basics

1. Learn how to look after your feet
2. Treat yourself to a pedicure at least every few months
3. Buy quality sports socks and discard threadbare socks
4. Wear shoes that fit properly; from the shoe bed (called the last) to the toe box, arch, ankle collar, heel cup to the thickness of the tongue. Don’t hope that wearing-in will make them fit better. Shoes today do not need to be worn in.
5. Wear gaiters to prevent trail debris getting into your socks and shoes
6. Massage your own feet after long training sessions and during races
7. Subscribe to John “The Foot Guy” Vonhof’s FixingYourFeet e-Zine at vonhof.typepad.com/fixingyourfeet to keep in the loop about foot care techniques and products; and order his book “Fixing Your Feet” through Kalahari.net (R302.00)

Author: Lisa de Speville | Published in Go Multi Magazine, Oct/Nov 2008