Case Study: Buckle Fever

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by Ken Neely

Buckle fever, or chronic ego driven exhaustion (CEDE), has been known to cause premature DNF and extreme remorse. This case study is taken from the 2015 Western States Endurance Run.

Patient is a 43 year old white male with signs of over-exertion, gastric distress, severely blistered feet and piss-poor attitude admitted to the Michigan Bluff Aid Station one and a half hours before the cutoff.

Patient’s chief complaints include bloated stomach, sharp joint pain, lack of enthusiasm, lack of confidence, lack of focus, lack of energy, general malaise and frustration. Additionally, patient claims his body is “shutting down” and “only has one gear”. Patient claims he “does not want to continue and does not want to do this anymore.”

Present illness began at race start in Squaw Valley early that morning. In an effort to secure a silver buckle, the patient exerted an unacceptably high effort at altitude in warm temperatures. Over approximately 40-50 kilometers the patient sustained heart rates at or above 80% of maximum. Additional complications arose from in-race nutritional supplements containing beets, which darkened his urine to the point of alarm. This resulted in over-hydration until the source of the problem was correctly identified and normal hydration was resumed.

Patient’s medical history includes similar instances of over-exertion, most recently at Marin Ultra Challenge 50k.

Patient’s family history includes parental marathoning, sibling middle distance running and overall health improvement through regular exercise.

Patient’s social history shows numerous examples of epic challenges, including but not limited to: Alaskan commercial fisherman, previous WS100 finisher, long distance sailor, avid ultra runner. Patient also appreciates fine craft beers often.

Physical exam reveals some chafing, lack of color, salt-caked skin, thousand-yard stare and a curious odor.

Assessment: Patient requires tough love and the confidence that finishing is still possible. While reasoning with the patient is unlikely, shaming and guilt can be used with moderate success. Thought exercises illustrating the remorse of dropping have shown high rates of success.

Patient treatment course: Patient was given ten minutes to get his shit together, after which he was given two baggies containing sandwiches and fruit, along with the necessary lighting and water to make it to the next aid station, Foresthill. Patient continued on through the night, utilizing his “one gear” to stay ahead of cutoffs and eventually finish the race. This was the sought after outcome, and treatment was deemed to be successful.

You can find Ken at wander-place.blogspot.com

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3 Comments

  1. Mark Smidt on

    Hilarious. Best line: “While reasoning with the patient is unlikely, shaming and guilt can be used with moderate success.”

  2. Andy Meisler on

    As a healthcare provider who spends hours reading (and writing) medical records, this is a hoot! I, personally, have endured many episodes of this dreaded condition and have been treated successfully but, for some reason, I keep relapsing!

  3. Melissa Lipari on

    When I dropped from a race this year, I told my friend I was “choosing comfort over extreme and aggressive measures”. The quality of my miles more important than the quantity. I had signed my DNR/DNF. He told me , “Next time, I’m making sure I have your durable power of attorney so I can override this asanine decision.”