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Experts debate dehydration finding in Chicago Marathon death

William Caviness showed no signs distress this picture his family took about halfway through last year’s Chicago Marathon. He collapsed

William Caviness showed no signs of distress in this picture his family took about halfway through last year’s Chicago Marathon. He collapsed about 500 yards from the finish and later died.

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Staying
hydrated

Sunday’s Chicago Marathon will have 20 aid stations with water and Gatorade. Each is about two blocks long, so runners are advised to keep going if the first tables seem too crowded to easily grab a drink.

Though an autopsy report concluded runner William L. Caviness died of dehydration after he collapsed during last year’s race, experts recommend that runners should drink when they’re thirsty — not on any set schedule. For more information, go online to:

♦ American Road Race Medical Society: bit.ly/Vp8QF6

♦ American College of Sports Medicine: bit.ly/JzOOoy

♦ International Marathon Medical Directors Assocition: bit.ly/SwqJRD

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Updated: November 4, 2012 6:12AM



Doctors have been warning runners a lot in the past few years about the potentially life-threatening danger of drinking too much water and other fluids during marathons.

But a 35-year-old runner who collapsed about 500 yards from the finish line in last year’s Chicago Marathon might not have had enough to drink, according to an autopsy report obtained by the Chicago Sun-Times.

William L. Caviness, a North Carolina firefighter, had been on pace to finish the 26.2-mile race in under 3 hours and 10 minutes — good enough to meet his goal of qualifying for the prestigious Boston Marathon.

Caviness “died as a result of dehydration,” according to the autopsy report filed by Dr. Danielo Perez, an assistant Cook County medical examiner.

“Electrolytes . . . were markedly elevated, signifying dehydration,” according to Perez, who found that this put Caviness at “risk for the onset of fatal [heart] arrhythmias.”

As organizers prepare for this year’s race on Sunday, the autopsy finding suggests that Caviness might have survived had he consumed more water as he maintained the sub-7:15-per-mile pace required for a man his age to qualify for Boston.

Drinking more during the race “absolutely could have made the difference” between life and death, said exercise researcher Jonathan Myers, a Stanford University School of Medicine professor and consultant to the Stanford Sports Medicine Program who reviewed the autopsy results at the Sun-Times’ request.

Caviness’ widow rejects that possibility, saying her husband was an experienced runner who would not have skipped water stations and risked dehydration to avoid slowing his pace.

“I have had additional analysis [of the autopsy report] done; it will always be inconclusive,” Jenny Caviness said, declining to go into detail. “There’s no way on this planet my husband would have risked his life.”

Two additional experts who reviewed the autopsy findings for the Sun-Times also disagreed with the medical examiner’s conclusion.

“Ninety-nine percent of runners who pass the spot where he was are dehydrated,” said Dr. James M. Winger, a sports-medicine specialist with the Loyola University Health System in Maywood. “I find the [possibility] that he ignored thirst enough to send himself into [an arrhythmia] very unlikely.”

Dr. Aaron L. Baggish, associate director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center, said that even though Caviness’ heart looked normal when Perez examined it the morning after the race, it’s still possible the runner had a pre-existing heart condition the autopsy couldn’t detect. “Autopsies don’t hold all the answers,” said Baggish, who serves as the cardiologist for the Boston Marathon.

He and 10 other researchers did a study, published last January in the New England Journal of Medicine, that looked at nearly 11 million marathon and half-marathon race participants nationwide over a 10-year period and didn’t find a single dehydration death.

“When someone has a cardiac arrest and nothing jumps out as the cause, it’s probably an underlying heart problem,” Baggish said.

Chad Schieber, a 35-year-old Michigan runner who collapsed during the 2007 Chicago Marathon, died as a result of a heart condition called mitral-valve prolapse.

There has been flurry of research regarding just how much water or other fluids long-distance runners should drink. Still, a study published last year by Winger and two other researchers found confusion among runners on how much to drink.

The International Marathon Medical Directors Association recommends drinking only when thirsty, saying “scientific evidence says that thirst will actually protect athletes from the hazards of both over- and underdrinking.”

Winger and his colleagues, though, found that nearly one in 10 runners drink as much as possible, and nearly four in 10 take fluids according to pre-set schedules, putting them at increased risk for a condition called exercise-associated hyponatremia, in which sodium in the bloodstream gets diluted to abnormally low levels. In extreme cases, that can lead to cardiac arrest.

According to the autopsy report, Caviness had the opposite condition: hypernatremia. The sodium level in his vitreous fluid — taken from his eyes — was significantly higher than normal, the autopsy found. Pathologists analyze vitreous fluid because the eye fluid stays well-preserved for hours, even days, after death, so it can be analyzed during an autopsy.

Other electrolytes in Caviness were elevated, too.

“Based on autopsy, toxicological and laboratory findings and all currently available investigative information, it is this examiner’s opinion that William Caviness . . . died as a result of dehydration,” wrote Perez, who has since moved to Texas and couldn’t be reached for comment.

Caviness, a father of two, signed up for last year’s Chicago Marathon with two goals: to raise money for charity and to qualify for Boston. By the time he took to the starting line last Oct. 9, he had raised about $2,500 for burn victims and logged hundreds of miles around his Greensboro, N.C., home.

He had run 3:17:26 in a marathon just 11 months earlier, and he wrote on Facebook that his training for Chicago included two 20-mile runs — one in which he pounded out the last three miles at a 6:50 pace.

His previous marathon time had qualified him to start near the front of the pack in Chicago. For nearly 26 miles, the 6-foot, 177-pound Caviness cruised through the city’s streets on pace to qualify for Boston. At the time of his collapse, shortly after 10:30 a.m., it was 70 degrees out.

Jenny Caviness said her husband did his long runs with a fluid-storing CamelBak pack and had trained for months in 90-degree heat.

Caviness’ death could be a sign that too great an emphasis has been placed on the dangers of overdrinking, said Myers, the Stanford expert, who reviewed the autopsy report with a colleague who’s a cardiologist. “There’s been all the talk in recent years about hyponatremia,” he said. “And maybe there’s been too much.”

Winger disagrees. He points to Baggish’s study, which looked at 10.9 million marathon and half-marathon participants between 2000 and 2010. It found that 59 experienced cardiac arrest during or within one hour of a race, and 42 of them died. The researchers obtained medical information on 31 of the 59 runners and found the overwhelming majority had a pre-existing heart problem.

Two of the runners died from overdrinking, they found, and none as a result of dehydration.

“The dangers associated with overhydration far outweigh the purported dangers of underhydration,” Winger said. “What I would be concerned about is people take the data in this [autopsy] report and think they should be drinking more.”

Contributing: Mark Konkol



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