Hypothermia can occur [[File:2014Graveyard100.jpeg|right|thumb|500px|The Graveyard 100, taken by [http://www.flickr.com/photos/triple_f/ Frank Lilley], used with permission.]]With the kinder weather in surprisingly warm conditions2014, the graveyard 100 went well for me. In factI started at a gentle pace, hypothermia occurs as often and was in summer as it does in winter and 10th place by the belief first aid station at mile 21. By this point I knew that hypothermia is related to cold weather can leave two of the top runners unprepared 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 and vulnerablefeeling strong, but the leader was now nearly an hour ahead. ==The first casualty==One thing that makes hypothermia particularly dangerous for What the half-way point my pace started to slow a runner is captured in little and while I was feeling strong, I didn't have the saying "ability to speed up. The first casualty second half of hypothermia the race is good judgmentgenerally made up of long, featureless, barren and inhospitable stretches of straight road." If you are hypothermic your decision making is likely to be impairedI generally love the solitude of ultrarunning, which leads to further dangersbut these sections will mentally corrosive and deeply lonely. 20-50% In many ways this part of the race was remarkably like treadmill running, with no sense of deaths due to hypothermia involve progress or change. I was still in fifth place at the fourth aid station, but I unknowingly passed the victim undressingfourth-place male, Jan-Erick Olson, a symptom related to severe hypothermiain the fifth aid station at Cape Hatteras lighthouse. Poor decision making when running can be extremely dangerousI learned later that he was [[Hypothermia| hypothermic]], though I don't know if this was because he'd slowed up and become chilled, or if he'd overdressed, such as becoming chilled when crossing he sweated through the extra clothing. I passed the road or navigating lead female, Connie Gardner, in the back countrylast few miles. I finished in fourth place in 16:48:30, which was okay, though I was two hours behind the winner!==Risk Factors=What Worked and What Failed=There are As always, I like to document the successes and failures 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 number of risk factors for hypothermia in runnersfew caveats to the successes. * '''Air TemperaturePace''' This is . Overall I think I paced the obvious factorrace reasonably well, but it and finished strong. The first third of the race was run at an effortless pace; almost of the same effort level is sitting on the most deceivingcouch. Hypothermia It is likely at 50fpossible that a more aggressive start would have given me a better overall time, but it's also possible that it would have cause a meltdown and can occur at a much warmer conditionspoorer time. * '''WetFuel''' As . 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 the stress on my wife who was crewing. Mixing the drinks is a real pain for the water evaporatescrew, it cools your body making and the effective temperature much colderEnsure Plus seemed to work quite well. 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. Wet clothes also The Ensure Plus remained palatable right to the end, and I might have far less insulation valuehad more of them if I brought a sufficient supply. Other than the Ensure Plus, 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) and found myself cradling the bottle like a mother with a newborn baby, though wool repeated filling and emptying the cup until I'd consumed a good synthetic fabrics are better than cottonportion of the 2 liters. * '''Fluid'''. I drank nearly 2 gallons of my [[DIY Electrolyte Drink]], and this kept the well hydrated. * '''Morton Stretch'''. When running in cool conditionsThe [[Morton Stretch]] worked amazingly well, and every time I did it , I felt stronger and smoother afterwards.* '''Downhill Training'''. It may seem bizarre to do [[Downhill Running| Downhill Training]] to prepare for a completely flat race, but I'm convinced that this is important not to overdress the reason why my quads remained stronger and sweat through your clothingpain-free throughout the race. In fact I had no quad pain or [[Delayed Onset Muscle Soreness]] after the race. Instead, try [[Downhill Running| Downhill Training]] is so effective for a flat race because it builds up resistance to carry excess clothingthe eccentric stresses involved in the running, or wear clothing that can be adjusted by opening zipperseven running on the flat course. * '''WindMental tricks''' The movement . 100 mile race is always an immense mental challenge, and the longer barren stretches of 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 air will suck not making progress, I would pick a landmark and run to it, then pick the heat next landmark. Sometimes these landmarks would be anything 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 bodyeyes on other than the horizon. At these points in the race, all you can do is keep your head down and if avoid looking at how far you are wethave to go.** Like any ultra, I find it will increase 's important not to think about the overall distance, but to run to the next aid station/crew access point.** I usually listen to music when I run, but on this ultra I found myself focusing more on the evaporative coolingmusic and really listening to it.** Having read books on willpower, I was more aware on this race of conserving my mental energy. Remember that While I normally do most of my creative thinking while running , on this ultra I focused more on [[Stillness in still conditions will create air movement over your bodyMotion]], I'm letting my mind rest. * '''RainDigestion''' Rain will obviously make you wet, but heavy rain will directly chill you and torrential rain can rapidly trigger hypothermia. I've had moderate hypothermia hiking no digestive problems on a 95f day when a summer storm occurredthis race at all, soaking me cold rainwhich with my history of nausea was truly pleasant. * '''ExhaustionMood state''' If your body as low energy, you will struggle . Early on in the race I was chatting to keep warm another runner and joking about that point in conditions an ultra where you would otherwise be comfortablestart longing for a broken leg so you'd have a good excuse to stop. This means Although I did encounter some mild depression midway through the race, it was nowhere near as bad as I've had on other longer runs and races increase . To my surprise, I didn't even have the risk for hypothermiausual angst that occurs as it gets dark and deep instinct cuts in that tells you that you should be safely indoors instead of out running. * '''Slowing upSunburn''' Running generates . 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 a lot runner. The redness of sunburn prevent your body from conserving heatwhen it's cold, and generally makes the perceived temperature 20f warmer than the actual temperatureskin damage limits sweating when it's hot. This means that slowing up or stopping can cause you sunburn makes it much harder to become chilled, especially if youcontrol your body've been running at a faster paces temperature. Sadly, I didn't think to put on my sun cap that would have been comfortable while running in cool rain, shaded my neck and become mildly hypothermic within a couple of minutes of stoppingface, then moderately hypothermic within 10 minutesso these areas did get sunburned. * '''Sun downHeart Rate Monitoring''' The risk . I think I finally cracked the problem of my heart rate monitor strapped chafing during longer ultras, so it was nice to be able to have that information available. Sadly my, and Garmin 310XT ran out of hypothermia increases when the sun goes downpower about mile 95, partly probably because I've not been using it for the heat from the sun is lost, but also this is the time last few months as I've been testing other devices. This meant that for the temperature drops last hour of the fastest. In a long racemy subconscious was continually asking "are we nearly there yet", this is often a psychological and physiological low point, creating a perfect stormwhich was like running with an attention deficit three-year-old in your head. ==Symptoms=Course Overview=* If For those of you who are with someone in potentially hypothermic conditions, thinking about running the graveyard 100 I thought I'd include my perspective on the course.* '''Currituck to Southern Shores''' (0-21 miles). This is some of the first symptoms may be most pleasant on the "umbles" – stumblesgraveyard 100, grumblesrunning through the lovely town of Duck, mumbles, fumbles. Remember that with low trees some sidewalks to get you may be doing fine when your companion away from traffic (most of the course 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 impairedon the shoulder of the road). * If you are shivering, but can stop if you make an effort, you are suffering from mild hypothermia '''Southern Shores to South Nags Head''' (core 9621-98f42 miles). This will reduce your coordinationsection with runs through an unending sequence of beach houses, which could be a problem on technical trailsand seems interminable at the time. The biggest problem is that mild hypothermia will make However, you mildly stupid, and less lightly to make good decisions. It is important look back with fondness at this stage to correct section when you're going through the problem as soon as possiblelater sections.* If you are shivering and cannot stop even if you try, you have moderate hypothermia '''South Nags Head''' '''to Hatteras Lighthouse''' (core 91 42- 9587 miles). Coordination Mostly this is likely to be obviously impaired empty and your skin is likely to be palebarren, possibly with blue lipslong straight, featureless straights, ears and fingersmore exposed to the wind than other sections. This There are a few small towns you go through, but mostly it's empty. There is also one long bridge where you run on a narrow shoulder, but the race has a police car warning drivers approaching the bridge and all the vehicles a dangerous condition; you need to get warm saw were gracious, polite and dry urgentlygave me lots of room.* If For the last 6 miles before the shivering comes in waveslighthouse, this is probably severe hypothermia. Other symptoms include difficulty speakingyou can see the flashing beacon, very poor coordination and inability so it's easy to use the handsfeel like you're not making progress. Collapse This is likely at this stage and made worse when you take the victim may appear turn to be dead. (If you pull go on the victims arm away from their body out and it curls back upto the lighthouse, they are still alivewhich is much longer than you'd expect and feels like it's going the wrong way.)* There is some evidence that hypothermia may increase '''Hatteras Lighthouse''' '''to Hatteras''' (87-100 miles). After the oxygen consumption for wilderness, this section seemed relatively friendly, with only a given exercise load<ref name="Campbell-1991"/>few stretches of emptiness. Even in the dark, as well as dramatically reduce muscular endurance<ref name="SustCold"/>, muscular force<ref name="Sargeant1987"/>the sight of houses and trees seemed a welcoming sight. [[File:Graveyard 100 Route.jpg|none|thumb|500px| The route of the Graveyard 100, starting near Corolla in the north and muscular power<ref name="Sargeant1987"/>finishing in Hatteras in the south.]]==Prevention=The Graveyard Challenge=To avoid hypothermia it As with many ultras the weather is important to be able to adjust your clothing to stay warma variable that can make the race easier or tougher. * A hat can be tucked into your waist band and carried easily* A light waterproof jacket can be wrapped around your waist and it will boost However, the insulation value Outer Banks is notorious for changeable, violent weather, especially at this time of your other clothing dramaticallythe year. This is particularly valuable if heavy summer storms I feel it's worth enumerating the issues you may face with the weather on this race, as they are possiblemore significant than other events. * Zippers on tops allows for quick and easy adjustment'''Wind'''.==Dealing with Hypothermia==If in doubt, seek shelterThe wind is the most obvious factor, get warm and dry quicklya mild tailwind can make the race far easier. A delay is likely to result in impaired judgmentOn the other hand, further increasing your riskyou could easily face strong headwinds that could make running hard or even impossible. If you Wind speeds of 20-30 MPH are with someonecommon, especially if you are pacing them on and the difficulty of running into a long race, monitor them for symptoms headwind generally varies with the square of hypothermiathe wind speed. Medical help It is required for possible that the headwinds could dramatically reduce the amount of running that a participant could manage, requiring a lot more significant levels of hypothermiawalking than anticipated. Remember the saying "You* '''Cold & Rain''re not dead until you're warm . The day before the 2014 race had high winds and dead"near freezing rain that felt viciously cold. Even if someone appears Running the full race under these conditions would create a high risk of [[Hypothermia]], especially for anyone who is running and has to slow to be deada walk, seek medical help as revival may be possiblewhen their temperature could plummet. ==See also==* [[Running in the Cold]]==References==<references><ref name="Campbell-1991">AP'''Sand'''. CampbellThe Outer Banks is sandy, BD. Sykesand the high wind can create a sandstorm that would make the race tremendously unpleasant, Effects of internal motions on both for the development of runner and the two-dimensional transferred nuclear Overhauser effectcrew., J Biomol NMR, volume 1, Sand also becomes an issue 4as an abrasive, pages 391-402getting into shoes and clothing. * '''Flooding'''. The rain and storms can create flooding, Nov 1991and the 2013 race had to be an out and back due to the resulting road closure. Even minor flooding can make progress harder, PMID [http://wwwespecially when the flooding involves deeper water over thick sand.ncbiTrying to make progress over deep sand is tough, especially as you can't see what you're stepping on.nlm.nih.gov/pubmed/1841707 1841707]</ref><ref name="SustCold">The duration Also, small areas of sustained contractions flooding that cover part of the human forearm at different muscle temperatures http://www.ncbi.nlm.nihroad will create a one way area for cars, and the runners have to contend for that narrow area.gov/pmc/articles/PMC1356726/ </ref><ref name="Sargeant1987">Anthony J* '''Heat'''. SargeantYou are unlikely to face hot temperatures at the Graveyard, Effect of muscle but a mild tailwind and full sun means the perceived temperature on leg extension force and short-term power output is higher. In 2014 there were times when the tailwind was about the same as my running pace, so I was travelling in humans, European Journal a small pocket of Applied Physiology and Occupational Physiologystagnant, volume 56, issue 6, 1987, pages 693–698, ISSN [http://wwwwarm air.worldcat* '''Sun'''.org/issn/0301-5548 0301-5548], doi [http://dxBecause the temperatures are generally cool it's easy to forget how strong the Carolina sun is this time of the year.doiSunburn creates the immediate damage to the skin that limits sweating in the heat and reddening that can cause excessive heat loss in cold conditions.org/10There are also the longer term problems of the pain and possible cancer.1007/BF00424812 10.1007/BF00424812]</ref></references>
