Top Doctor to the IRONMAN
Former Olympic sprinter Dr. Thomas Best served as the charge doctor for the IRONMAN® World Championship in Kailua-Kona, Hawaii.
A former Olympic sprinter, the University of Miami Miller School of Medicine’s Thomas Best M.D., Ph.D, recently served as the charge doctor for the IRONMAN® World Championship in Kailua-Kona, Hawaii. His rise to the top of the medical tent comes after three decades of volunteering his time and expertise to these elite athletes and dovetails with research he conducts into the risks of extreme exercise habits.
“To be the lead charge doctor at a world championship is a true honor,” said Dr. Best, professor and vice chair of research in the Department of Orthopaedics at the Miller School, as well as team physician for the the University of Miami football and track and field teams and the Miami Marlins. “It has been a privilege and has grown into something very special caring for these unique, world-class athletes. Any of us privileged to care for athletes will tell you that it’s the personal relationships and trust you develop over time that matter most.”
The legendary IRONMAN triathlon is not for the faint of heart. At any given time, there are about 100 medical professionals working in the medical tent, fortified by cold pizza and diet sodas. Though the competition begins at sunrise, the mountainous terrain renders the water pitch black when the athletes begin the 2.4-mile open water swim.
“The bottom of the sea is dark so we routinely pull a few people out due to panic attacks,” Dr. Best said. Those who complete the swim hop on a bike for 112 miles, then finish with a full 26.2-mile marathon. “It’s truly incredible!” he said.
As charge doctor, Dr. Best conducts initial assessments of the roughly 300 of 2,500 athletes who wind up being triaged in the medical tent. Some athletes are brought off the course, but most don’t come to the tent until they cross the finish line. Those who are simply exhausted head to the sick and dizzy section. Those who require IV hydration or other interventions go to the medically sick section. And those who are hyperthermic head to the so-called dump tank.
“It sometimes looks like the show ‘M*A*S*H*’,” Dr. Best said. “It’s like a mini-hospital. We do stat labs onsite. We start IVs and, this year, we had to be particularly strategic because of the national IV fluid shortage. It’s the real deal.”
Launching Pad for Sports Medicine Research
A firm believer in the benefits of exercise, Dr. Best is working with colleagues on a paper for the Journal of the American Medical Association outlining 30 years of observational data and lessons learned in caring for elite IRONMAN athletes. The paper addresses best practices for treating hyperthermia and electrolyte disorders, as well as exploring the potential long-term, negative effects of too much exercise.
This idea stems from the experiences of several IRONMAN participants whose cardiovascular health was compromised absent other well-known risk factors for heart disease.
During a conference held onsite for 200 physicians, physical therapists and athletic trainers interested in ultra-exercise medicine the week leading up to the race, Dr. Best delivered a keynote address on the topic.
“There is a growing concern that ultra-elite athletes, independent of other risk factors, are at risk for heart disease,” Dr. Best said. “We know that no physical activity is bad, but it may be that too much physical activity is potentially detrimental. We are going back now and getting data, and there’s clearly a dose response. The challenge is we don’t know what that dose is placing the athlete at risk.”
Dr. Best heads to Harvard University and the International Olympic Committee early in the new year to raise awareness about the potential health risks of sustained, long-term ultra-endurance exercise and possible best practices to avoid these problems.
It’s a very special thing, to do something that has a positive, life-changing influence on people.
Dr. Thomas Best
Meantime, the work of Dr. Best and others in the IRONMAN medical tent has influenced not only ultra-exercise medicine but protocols for the general public.
“We’ve done a lot of good by learning a lot and passing it on,” Dr. Best said. “A lot of the policies we’ve adopted in Kona, like onsite staffing and service requirements, have become worldwide policies, changing the course of how we stage mass-participation events. We have also contributed a lot to the management of hyperthermia and the importance of rapid cooling.”
Climb to the Top of the Tent
Dr. Best started working the tent in 1990 when he was a biomedical engineering Ph.D. candidate at Duke University. A colleague aware of his background in exercise physiology encouraged him to join a trip to Kona. Since that first trip, he has returned every three to five years to speak at the conference and volunteer at the race.
His research interest began early on. When the competition first got underway, competitors Dave Scott and Mark Allen battled for the top spot. Dr. Best and his colleague wondered if they could replicate the atmosphere in Kona back home in North Carolina to determine why Allen wasn’t winning.
“We set up an environmental chamber and drew blood from him every hour,” Dr. Best recalled. “We found out he had electrolyte problems going on, and he beat Scott the next year after consultation with a dietician and his coach to reorganize his fuel replacement on the course.”
Dr. Best, who today counts both athletes as close friends, cherishes all the relationships he has developed over the years. As a former Olympian who ran the 400-meter event, he laughs at the idea of competing in an IRONMAN competition himself.
“I’m definitely not an IRONMAN!” he said.
Dr. Best recalls an athlete who came to the tent with a temperature of 108 degrees. Two hours later, after quick recognition of the problem and rapid cooling in an ice bath, he walked out of the medical tent. Another young athlete came in during a heart attack. He was treated on the spot, transferred to a local hospital and recovered uneventfully.
From a disabled man with ALS who competed two decades ago to the many competing in honor of cancer survivors, the inspirational stories behind the desire to compete keep Dr. Best volunteering his time and expertise again and again.
“It’s a very special thing, to do something that has a positive, life-changing influence on people,” he said. “These people come from all walks of life and are spending their time and money, and many have heartfelt stories. It gets pretty emotional and helps to keep life in perspective.”
Tags: athletic injuries, Department of Orthopaedics, Dr. Thomas Best, sports medicine