Dr. Ballard is an associate emergency physician at Kaiser-Permanente in San Rafael, CA, and the chair of the CREST ED Research Network. His writing credits include co-authorship with Angela Ballard of the award-winning travel narrative A Blistered Kind of Love: One Couple's Trial by Trail (Mountaineers Books, 2003) and authorship of The Bullet's Yaw (IUniverse, 2007). Dr. Ballard writes a biweekly-medical column for the Marin Independent Journal, which he posts on his blog: http://incisionanddrainage.blogspot.com/.
Here's an idea. Just for fun, may I suggest the following trifecta? Start with a “Boa Constrictor Crawl” through a series of pipes up and downhill into freezing mud. Follow this with an “Arctic Enema,” where you jump into and swim through frigid water, and then finish with an “Electroshock Therapy Run” through a field of live wires (10,000 V). Sound totally awesome? If your answer is yes, then I bet you're interested in participating in a Tough Mudder race.
Haven't heard of Tough Mudder? The Mudder is a 10- to 12-mile obstacle course through a series of MOB (mud, obstacles, and beer) runs. Billing itself as the premier obstacle course in the world, the event has exploded in popularity since its inception in 2010, with now more than one million participants worldwide. Intrigued? Before you jump up to join, I suggest you take a look at the recent case series published in Annals of Emergency Medicine. (2013 Nov 7 [Epub ahead of print].) Marna Rayl Greenberg, DO, and colleagues documented five severe medical complications (of 38 people requiring ED evaluation) sustained during a two-day Tough Mudder event in Pennsylvania this past summer. Among them:
* A previously-healthy 31-year-old man who had completed 20 of 22 obstacles before developing seizure activity along with right-sided weakness and confusion. Initially thought to have Todd's paralysis, he was ultimately found on MRI to have a left-sided middle cerebral artery stroke. He was hospitalized for four days and then sent to a rehabilitation facility. At six-weeks post-event, he had residual right-sided weakness.
* A 28-year-old man presenting with syncope, headache, and altered mental status after sustaining multiple electrical shocks to the head while running through water. He was hospitalized for two days and treated for pericarditis, electrolyte abnormalities, and elevated CK (peak 1,841 U/L).
* A 25-year-old woman who went down after taking a shock to the chest just before the finish line. She was incontinent of urine, dizzy, and tachycardic in the ED. Her CK was 10,152 U/L. She was hospitalized and discharged without sequelae.
Reading these cases, you may be asking, why did these people risk their health for recreation? It's a fair question, one that we emergency physicians tend to ask on a daily basis. Of course, we know that the Tough Mudders are not alone. Many other thrill seekers join them: the big wave surfers and avalanche skiers, the marathoners and CrossFitters, the free climbers and free divers. Their cohort also include the copycats of Jackass (if you look these up, check out the “Toro Totter” and “Alligator Tightrope”) and, overseas at least, devotees of zorbing, coasteering, and the Nevis Arc, the world's highest flying trapeze!
Why are people drawn to such “adrenaline” pursuits? The simple answer is that these activities fill a void for many left by the mundane nature of modern life, the mund-sanity, if you will. The good health for others may depend on challenging themselves with a healthy dose of risk-taking. Take CrossFit, an extremely intense workout ethos with a devoted following despite the fact that it can, according to its founder, “kill you.” But for most CrossFitters, the risk is more than worth it for the physical and emotional awards. Recreation for these and other extreme sport participants is inextricably linked to cardiovascular condition, muscle mass, flexibility, and adaptation, and it is a pretty good cure to the “smokadiabesity” that plagues much of sedentary America.
The Tough Mudder participant who conquers his fears along with the event may also garner confidence and optimism to face challenges elsewhere in life. It used to be that psychologists, especially those influenced by Freud, saw risk-taking as evidence of a diseased mind. Nowadays, though, the perception is changing. Sports psychologist Ken Way, quoted in an article in Intelligent Life magazine, said “Personality studies and psychological profiling support the idea that those who regularly take on calculated risks tend to be the least anxious, the least neurotic. They are resilient people who manage their fear and still perform.” Contrary to popular conception, it is not so much that thrill seekers are taking risks for risk's sake, but rather that there is another reward at the end of it all. Whether it is physical fitness, increased confidence, an emotional boost, or something else entirely, the risk is a means to a recognized end.
That's the key then: challenge yourself but do so with calculated risk. Know what you are getting into. Sometimes easier said than done, but good advice indeed. Wear a helmet when you cannonball down the single-track, take a buddy with you when you surf the big ones, and know when to say “when” to the CrossFit challenge. The smartest mudder is the one who pushes through obstacles until his body says stop.
That's all well and good. But what about the strain that extreme sporting events can place on our emergency medical services? Tough Mudder organizers and others must do their part to ensure that an adequate medical professional presence is arranged at their events to help manage the inevitable health hiccups. Participants also should do their own risk due diligence. Perhaps before signing up for the Arctic Enema and Electroshock Trifecta we should encourage everyone to make sure that he is signed up for health insurance. Now's the time.