Meh..

I always say a little prayer before i head out the door for my runs, because I know it may be my last.


Runner collapses, dies at marathon
Man, 27, had just finished race in LR

By Chris Givens

Monday, March 3, 2008

LITTLE ROCK — Little Rock Marathon organizers were prepared to proclaim the city’s sixth annual 26.2-mile race as the most successful yet.

Instead it turned into the most tragic.

Adam Nickel of Madison, Wis., died moments after crossing the finish line of the Little Rock Marathon Sunday morning. He was 27.

“A loss of one of your race participants is just a terrible, terrible tragedy,” co-executive director Gina Pharis said.

Nickel’s death was the first in the six years the race has been held. In 2006, a runner collapsed after suffering a heart attack, but he was resuscitated.

Nickel never regained consciousness or a pulse after collapsing, said Dr. Kent Davidson, the race’s medical director and a doctor at Arkansas Specialty Orthopedics.

Davidson said the cause of death is not yet known, and it is unknown if there will be an autopsy. Nickel was pronounced dead at 11:59 a.m. at UAMS Medical Center.

“At this point, we really have more questions than we have answers,” Davidson said.

The situation surrounding Nickel’s death is puzzling, to both race organizers and medical personnel.

Photos of Nickel passing the 6-mile mark showed him looking strong. There were no reports ofhim being in any distress on the course, officials said.

Nickel was running his sixth marathon, and his official Little Rock time of 3:02:26 is considered an elite time. He finished 18th out of 1,600 entrants, which was the most ever for this race.

Nickel ran the 2007 Boston Marathon, one of the most prestigious races in the country, in 2:57:20, which was in the top 3 percent.

“He looked strong coming into the finish,” Pharis said. “He had a big smile on his face.”

The smile quickly faded as the color drained from his face and Nickel immediately put an arm up to request medical attention.

Two members of the race’s medical support team, assembled by Davidson, rushed up on either side of Nickel and put arms around him, but Nickel went to the pavement 20 feet past the finish line in Little Rock’s River Market.

His eyes remained open but rolled up with only the whites showing.

“We started immediate CPR,” Davidson said. “We had a [Metropolitan Emergency Medical Services] defibrillator on the scene. We never really had any sort of heart rhythm at all - the whole time we were resuscitating.”

Nickel’s collapsed at 11:03 a.m., and within seconds mouthto-mouth and cardiopulmonary resuscitation began. A breathing tube was inserted at 11:08.

At 11:09 a MEMS defibrillator was brought to the scene, and Nickel was shocked several times.

There was no response.

Runners continued to finish all around Nickel’s prone body as resuscitation efforts continued. Music blared from the loudspeakers and the announcer shouted out finishers’ names as officials tried to keep a sense of normalcy and volunteers formed a line to direct runners away from Nickel.

Few runners or spectators knew the severity of the situation when contacted by reporters.

Nickel was moved to a waiting ambulance at 11:18. Inside, Davidson said, drugs were administered intravenously and CPR continued. At 11:28 the ambulance departed for UAMS, and Nickel was pronounced dead 21 minutes later.

Davidson said it was too soon to determine the exact cause of death, and an autopsy will be done only at the request of the family.

Shirley Thiel, who described herself as a friend of Nickel, accompanied him from Madison to Little Rock. She told the Post-Crescent of Appleton, Wis., thatNickel had no health problems.

“He crossed the finish line, smiled and dropped,” Thiel said. “There was no indication anything like this would ever happen.”

Thiel described Nickel as “quiet, with a great sense of humor.”

“Everybody who knew him loved him,” she said.

According to the Post-Crescent, Nickel, a native of Kaukauna, Wis., was attending graduate pharmacy school at the University of Wisconsin-Madison. He was running the Little Rock Marathon to prepare for a spring event inSan Diego as part of the Leukemia & Lymphoma Society’s Team In Training, as a tribute to his grandmother.

Davidson said the death of Nickel, who was a high school and college wrestler, was likely cardiac-related.

“Odds are when something that catastrophic occurs - and I’m really speculating - it indicates that there was a congenital heart condition or something out of the ordinary,” Davidson said. “He was a young guy, a healthy guy and it was a very sudden, catastrophic event.”

Davidson said it is not unusual for runners to collapse after crossing a marathon finish line, a condition known as “exercise-associated collapse.” However, he said, this was not what happened to Nickel.

“[Exercise-associated collapse] is due to cooling of the blood in the lower extremities,” Davidson said. “It’s a benign condition. It’s not a heart-related thing. This [Nickel’s collapse] was not a faint. Typically with these cardiac-related conditions, people die on the course. They don’t die at the end.”

Ryan Shay, a 28-year-old elite runner from Michigan, died on the course Nov. 3 at the U.S. Olympictrials in New York. Unlike Nickel, Ryan collapsed at the 5 1/2-mile mark. His death has been linked to an enlarged heart and a condition known as “sudden cardiac death.”

Doctors have defined sudden cardiac death as a condition in which the heart starts beating so rapidly that it cannot pump the blood necessary to meet the demand the body is placing on it, although there is little research on the condition.

Another condition known to cause deaths of elite marathon runners is hyponatremia, also known as water intoxication, which occurs when athletes consume too many fluids, which dilute the body’s sodium levels.

A recent study showed that as many as 13 percent of runners at each Boston Marathon may have suffered some form of hyponatremia.

It is unknown how much water Nickel drank. Davidson would not rule out either hyponatremia or sudden cardiac death, but said a pre-existing cardiac condition was more likely.

If there was a pre-existing condition, the heat on Sunday may have played a factor, Davidson said.

According to the National Weather Service, the temperature was 59 degrees at the start of the race and 65 degrees at 11:03 a.m.

By contrast, the race-day high was 55 degrees last year, with a race-start temperature of 28 degrees.

Davidson said his medical team treated 52 people, including Nickel, at the finish line Sunday. The reasons varied from heat-related problems to cramping and blisters. He said the number of people treated was a little more than average.

The Chicago Marathon was cut short for the first time last October when 88-degree heat caused hundreds to require medical attention. One person, 35-year-old Chad Schieber of Midland, Mich., died in the middle of the race.

The Little Rock Marathon did not have such wide-spread problems, although some complained of heat.

“It was a warm day, but it wasn’t so hot that we had any water issues,” Pharis said.

Pharis said the race committee was prepared for the heat, as well as any other medical issues that might arise. Medical personnel on bicycles rode the course route, and there were 18 aid stations along the route.

Race director Bill Torrey said the marathon was going exactly as planned on a beautiful day until the tragedy unfolded, marring what was an otherwise pictureperfect event.

“You stand there and you make a plan for 12 months and you hope that your plan is going to be successful,” Torrey said. “And 90 percent of it was. But ... this puts a damper on it. People cheer you and tell you what a great job you did. In the back of your mind you feel good about it, but on second hand you don’t feel good because you know that it didn’t go perfect. There’s a participant who isn’t here that enjoys the sport that we love.

“It’s an unfortunate situation, and we’re real sad about it.” Information for this article was contributed by Nick Walker of the Arkansas Democrat-Gazette.