[[File:2014Graveyard100Hypothermia can occur in surprisingly warm conditions.jpeg|right|thumb|500px|The Graveyard 100In fact, taken by [http://www.flickr.com/photos/triple_f/ Frank Lilley], used with permission.]]With the kinder weather hypothermia occurs as often in summer as it does in 2014, the graveyard 100 went well for me. I started at a gentle pace, winter and was in 10th place by the first aid station at mile 21. By this point I knew belief that two of the top hypothermia is related to cold weather can leave runners in the race were way ahead of me, so I continued on at a conservative pace. By the second aid station at mile 42, I was in fifth place unprepared and feeling strong, but the leader was now nearly an hour aheadvulnerable. What the half-way point my pace started to slow ==The first casualty==One thing that makes hypothermia particularly dangerous for a little and while I was feeling strong, I didn't have runner is captured in the ability to speed up. saying "The second half first casualty of the race hypothermia is generally made up of long, featureless, barren and inhospitable stretches of straight roadgood judgment. I generally love the solitude of ultrarunning" If you are hypothermic your decision making is likely to be impaired, but these sections will mentally corrosive and deeply lonelywhich leads to further dangers. In many ways this part 20-50% of deaths due to hypothermia involve the race was remarkably like treadmill runningvictim undressing, with no sense of progress or changea symptom related to severe hypothermia. I was still in fifth place at the fourth aid stationPoor decision making when running can be extremely dangerous, but I unknowingly passed such as when crossing the fourth-place male, Jan-Erick Olson, in the fifth aid station at Cape Hatteras lighthouse. I learned later that he was [[Hypothermia| hypothermic]], though I don't know if this was because he'd slowed up and become chilled, road or if he'd overdressed, becoming chilled when he sweated through the extra clothing. I passed the lead female, Connie Gardner, navigating in the last few milesback country. I finished in fourth place in 16:48:30, which was okay, though I was two hours behind the winner!=What Worked and What Failed=Risk Factors==As always, I like to document the successes and failures There are a number of each major race. This time around I am combining the successes and failures into a single list, as there were no major problems, just a few caveats to the successesrisk factors for hypothermia in runners.* '''PaceAir Temperature'''. Overall I think I paced This is the race reasonably wellobvious factor, and finished strong. The first third of the race was run at an effortless pace; almost of the same effort level but it is sitting on the couchmost deceiving. It Hypothermia is possible that a more aggressive start would have given me a better overall timelikely at 50f, but it's also possible that it would have cause a meltdown and a can occur at much poorer timewarmer conditions.* '''FuelWet'''. For this race I used [http://www.amazon.com/Ensure-Complete-Balanced-Nutrition-Chocolate/dp/B000ARTNJW Ensure Plus] as my primary source of calories rather than my usual [[Fellrnr's Go Juice| Go Juice]]. This was partly to experiment with a higher fat intake, and partly to reduce As the stress on my wife who was crewing. Mixing the drinks is a real pain for the crewwater evaporates, and it cools your body making the Ensure Plus seemed to work quite welleffective temperature much colder. I ended up drinking more than I expected, getting through 16 bottles, which gave me 5,600 Calories, 176g fat, 800g carbs, and 208g protein. The Ensure Plus remained palatable right to the end, and I might Wet clothes also have had more of them if I brought a sufficient supply. Other than the Ensure Plusfar less insulation value, I had a couple of soft, chewy cookies, but nothing else solid. I did fill a cup with Coke at aid station 3 (65 miles) though wool and found myself cradling the bottle like a mother with a newborn baby, repeated filling and emptying the cup until I'd consumed a good portion of the 2 literssynthetic fabrics are better than cotton. * '''Fluid'''. I drank nearly 2 gallons of my [[DIY Electrolyte Drink]]When running in cool conditions, it is important not to overdress and this kept the well hydrated. * '''Morton Stretch'''sweat through your clothing. The [[Morton Stretch]] worked amazingly well, and every time I did itInstead, I felt stronger and smoother afterwards.* '''Downhill Training'''. It may seem bizarre try to do [[Downhill Running| Downhill Training]] to prepare for a completely flat racecarry excess clothing, but I'm convinced or wear clothing that this is the reason why my quads remained stronger and pain-free throughout the race. In fact I had no quad pain or [[Delayed Onset Muscle Soreness]] after the race. [[Downhill Running| Downhill Training]] is so effective for a flat race because it builds up resistance to the eccentric stresses involved in the running, even running on the flat coursecan be adjusted by opening zippers.* '''Mental tricksWind'''. 100 mile race is always an immense mental challenge, and the longer barren stretches The movement of air will suck the graveyard exacerbate this. I found a number of mental tricks that I've used on other races became particularly valuable. ** To overcome the sense of not making progress, I would pick a landmark and run to it, then pick the next landmark. Sometimes these landmarks would be anything heat from a sign to a piece of trash by the road. This worked most of the time, but some stretches are so desolate that there is nothing to fix your eyes on other than the horizon. At these points in the racebody, all you can do is keep your head down and avoid looking at how far if you have to go.** Like any ultraare wet, I find it's important not to think about will increase the overall distance, but to run to the next aid station/crew access pointevaporative cooling.** I usually listen to music when I run, but on this ultra I found myself focusing more on the music and really listening to it.** Having read books on willpower, I was more aware on this race of conserving my mental energy. While I normally do most of my creative thinking while Remember that running, on this ultra I focused more on [[Stillness in Motion]], I'm letting my mind reststill conditions will create air movement over your body.* '''DigestionRain'''Rain will obviously make you wet, but heavy rain will directly chill you and torrential rain can rapidly trigger hypothermia. I 've had no digestive problems moderate hypothermia hiking on this race at alla 95f day when a summer storm occurred, which with my history of nausea was truly pleasantsoaking me cold rain.* '''Mood stateExhaustion'''. Early on in the race I was chatting If your body as low energy, you will struggle to another runner and joking about that point keep warm in an ultra conditions where you start longing for a broken leg so you'd have a good excuse to stopwould otherwise be comfortable. Although I did encounter some mild depression midway through the race, it was nowhere near as bad as I've had on other This means longer runs and races. To my surprise, I didn't even have increase the usual angst that occurs as it gets dark and deep instinct cuts in that tells you that you should be safely indoors instead of out runningrisk for hypothermia.* '''SunburnSlowing up'''. In last year's race I sunburned my arms rather badly, so this year I wore my long sleeved [[UnderArmour HeatGear Top]]. This thin white top protected me from the sun and helped keep my temperature stable. In addition to the well-known long-term health risks and short term pain of sunburn, there are more immediate consequences for Running generates a runner. The redness lot of sunburn prevent your body from conserving heat when it's cold, and generally makes the perceived temperature 20f warmer than the skin damage limits sweating when it's hotactual temperature. This means that sunburn makes it much harder slowing up or stopping can cause you to control your bodybecome chilled, especially if you's temperatureve been running at a faster pace. Sadly, I didn't think to put on my sun cap that would have shaded my neck been comfortable while running in cool rain, and facebecome mildly hypothermic within a couple of minutes of stopping, so these areas did get sunburnedthen moderately hypothermic within 10 minutes.* '''Heart Rate MonitoringSun down'''. I think I finally cracked The risk of hypothermia increases when the problem of my heart rate monitor strapped chafing during longer ultrassun goes down, so it was nice to be able to have that information available. Sadly mypartly because the heat from the sun is lost, and Garmin 310XT ran out of power about mile 95, probably because I've not been using it for but also this is the last few months as I've been testing other devices. This meant time that for the last hour of temperature drops the fastest. In a long race my subconscious was continually asking "are we nearly there yet", which was like running with an attention deficit three-year-old in your headthis is often a psychological and physiological low point, creating a perfect storm. ==Symptoms=Course Overview=For those of * If you who are thinking about running with someone in potentially hypothermic conditions, the graveyard 100 I thought I'd include my perspective on first symptoms may be the course"umbles" – stumbles, grumbles, mumbles, fumbles. Remember that you may be doing fine when your companion is suffering. Beware doing anything that puts you at risk from hypothermia when helping someone else; never create a second victim. You can’t help someone if you are also impaired.* '''Currituck to Southern Shores''' (0-21 miles). This is some of the most pleasant on the graveyard 100If you are shivering, running through the lovely town of Duckbut can stop if you make an effort, with low trees some sidewalks to get you away are suffering from traffic (most of the course is on the shoulder of the road).* '''Southern Shores to South Nags Head''' mild hypothermia (21core 96-42 miles98f). This section with runs through an unending sequence of beach houseswill reduce your coordination, which could be a problem on technical trails. The biggest problem is that mild hypothermia will make you mildly stupid, and seems interminable at the timeless lightly to make good decisions. However, you look back with fondness It is important at this section when you're going through stage to correct the later sectionsproblem as soon as possible.* '''South Nags Head''' '''to Hatteras Lighthouse''' If you are shivering and cannot stop even if you try, you have moderate hypothermia (42core 91 -87 miles95). Mostly this Coordination is empty likely to be obviously impaired and barrenyour skin is likely to be pale, possibly with long straight, featureless straightsblue lips, ears and more exposed to the wind than other sectionsfingers. There are This is a few small towns dangerous condition; you go throughneed to get warm and dry urgently.* If the shivering comes in waves, but mostly it's emptythis is probably severe hypothermia. There is also one long bridge where you run on a narrow shoulderOther symptoms include difficulty speaking, but the race has a police car warning drivers approaching the bridge very poor coordination and all inability to use the vehicles a saw were gracious, polite hands. Collapse is likely at this stage and gave me lots of room. For the last 6 miles before the lighthouse, you can see the flashing beacon, so it's easy victim may appear to feel like you're not making progressbe dead. This is made worse when (If you take pull the turn to go on the out victims arm away from their body and it curls back to the lighthouseup, which is much longer than you'd expect and feels like it's going the wrong waythey are still alive. )* '''Hatteras Lighthouse''' '''to Hatteras''' (87There is some evidence that hypothermia may increase the oxygen consumption for a given exercise load<ref name="Campbell-100 miles). After the wilderness1991"/>, this section seemed relatively friendlyas well as dramatically reduce muscular endurance<ref name="SustCold"/>, with only a few stretches of emptiness. Even in the darkmuscular force<ref name="Sargeant1987"/>, the sight of houses and trees seemed a welcoming sightmuscular power<ref name="Sargeant1987"/>. [[File:Graveyard 100 Route.jpg|none|thumb|500px| The route of the Graveyard 100, starting near Corolla in the north and finishing in Hatteras in the south.]]=The Graveyard Challenge=Prevention==As with many ultras the weather To avoid hypothermia it is a variable that important to be able to adjust your clothing to stay warm. * A hat can be tucked into your waist band and carried easily* A light waterproof jacket can make be wrapped around your waist and it will boost the race easier or tougherinsulation value of your other clothing dramatically. However, the Outer Banks This is notorious for changeable, violent weather, especially at this time of the year. I feel it's worth enumerating the issues you may face with the weather on this race, as they particularly valuable if heavy summer storms are more significant than other eventspossible. * '''Wind'''Zippers on tops allows for quick and easy adjustment. The wind is the most obvious factor==Dealing with Hypothermia==If in doubt, seek shelter, get warm and a mild tailwind can make the race far easierdry quickly. On the other handA delay is likely to result in impaired judgment, further increasing your risk. If you could easily face strong headwinds that could make running hard or even impossible. Wind speeds of 20-30 MPH are commonwith someone, and the difficulty of running into especially if you are pacing them on a headwind generally varies with the square long race, monitor them for symptoms of the wind speedhypothermia. It Medical help is possible that required for the headwinds could dramatically reduce the amount more significant levels of running that a participant could manage, requiring a lot more walking than anticipatedhypothermia. * '''Cold & Rain'Remember the saying "You're not dead until you're warm and dead". The day before the 2014 race had high winds and near freezing rain that felt viciously coldEven if someone appears to be dead, seek medical help as revival may be possible. ==See also==* [[Running in the full race under these conditions would create a high risk of [[HypothermiaCold]], especially for anyone who is running and has to slow to a walk, when their temperature could plummet. * '''Sand'''==References==<references><ref name="Campbell-1991">AP. The Outer Banks is sandyCampbell, and the high wind can create a sandstorm that would make the race tremendously unpleasantBD. Sykes, both for Effects of internal motions on the runner and development of the crewtwo-dimensional transferred nuclear Overhauser effect. Sand also becomes an , J Biomol NMR, volume 1, issue as an abrasive4, pages 391-402, Nov 1991, getting into shoes and clothingPMID [http://www.ncbi.nlm.nih. gov/pubmed/1841707 1841707]</ref>* '''Flooding'''. <ref name="SustCold">The rain and storms can create flooding, and duration of sustained contractions of the 2013 race had to be an out and back due to the resulting road closurehuman forearm at different muscle temperatures http://www. Even minor flooding can make progress harder, especially when the flooding involves deeper water over thick sandncbi. Trying to make progress over deep sand is tough, especially as you can't see what you're stepping onnlm. Also, small areas of flooding that cover part of the road will create a one way area for cars, and the runners have to contend for that narrow areanih. gov/pmc/articles/PMC1356726/ </ref>* '''Heat'''<ref name="Sargeant1987">Anthony J. You are unlikely to face hot temperatures at the GraveyardSargeant, but a mild tailwind Effect of muscle temperature on leg extension force and full sun means the perceived temperature is higher. In 2014 there were times when the tailwind was about the same as my running paceshort-term power output in humans, so I was travelling in a small pocket European Journal of stagnantApplied Physiology and Occupational Physiology, volume 56, warm airissue 6, 1987, pages 693–698, ISSN [http://www.worldcat.* '''Sun'''org/issn/0301-5548 0301-5548], doi [http://dx. Because the temperatures are generally cool it's easy to forget how strong the Carolina sun is this time of the yeardoi. Sunburn creates the immediate damage to the skin that limits sweating in the heat and reddening that can cause excessive heat loss in cold conditionsorg/10. There are also the longer term problems of the pain and possible cancer1007/BF00424812 10.1007/BF00424812]</ref></references>
