Monday, December 03, 2012

Blood pressure

Amongst the many vexations I suffered as a result of the chaotic administration of the ultra-marathon event I took part in three weeks back (a longer post is brewing!) was the fact that the organisers sprung on us at the last minute (which is to say, it had not been mentioned at all in what little advance information about the event had been made available) that there was to be a compulsory blood pressure check before each of the races, and that failure to pass this would result in exclusion from participation.

Now, I only found out about this because I had some other urgent questions I wanted to raise at the 'technical briefing' (which had itself scarcely been publicized) on the eve of the race. There were no notices put up about these health checks, and only a couple of fleeting, unexplained references in the runner's information packs. Many competitors might have remained completely unaware of them. And it would have been quite easy to inadvertently bypass - or deliberately avoid - the doctors and nurses conducting the checks, since this was happening in the lobbies of the various hotels where we were being lodged - and it wasn't absolutely necessary to go through the lobbies (certainly not in the third and final hotel, where my room was in a separate annexe, a couple of hundred yards away from the main lobby; and even in single building hotels, I tend to use the stairs rather than the lifts, for exercise, and to leave via the fire exit to avoid possible crowds in the reception area). Moreover, the few references in the information pack actually gave incorrect times/locations for the checks - so, I think we might be entirely forgiven for having skipped them. And, as I discovered, there seemed to be no effective enforcement in place. There were no checks as to whether someone had taken the BP test or not, no system for excluding people who hadn't from starting, not even any subsequent follow-up if they realised later that people had run without having been given the all-clear to do so (I took part without completing the check on all three days, and not a word was said about it).

I might possibly have been denied an official finishing classification for having failed to complete the check (big deal!). And it would have been entirely reasonable to exclude me from the organisers' health insurance coverage if I'd become ill during a race. But I really don't think anybody was keeping any effective record of the test results at all.

One of the other runners at the technical briefing, a super-keen amateur from Hong Kong who'd evidently run lots of ultras before, and taken part in this event two or three times previously, objected that in past years the doctors had tried to exclude some runners for having a blood pressure that was supposedly too low, and he asked for reassurance that this wouldn't happen this time. The organisers' spokesman (the only member of the entire organising committee, it seemed, who spoke any English; but he didn't introduce himself by name, and was never seen again after this meeting) didn't give a very clear response, but he seemed to indicate that the health checks would be "more of a guideline", and that nobody would actually be excluded from taking part if they were confident they were healthy.

It was such a woolly answer that I didn't take much comfort from this. And I was anxious that I was likely to fail the test. Heck, the anxiety about possibly failing the test - the anxiety about having to take a test - was raising my blood pressure considerably. And I'm not super-healthy, not at all a natural athlete. I felt quite intimidated by the rest of the field: even the other amateurs taking part in this event - at least, on the first two days; a bunch of fun runners showed up for the final much shorter race on Sunday morning - seemed to be very serious runners who'd done heaps of marathons and ultra-marathons before. I was one of only four or five who were over forty; and the only one who wasn't whippet-thin.

What's more, I'd come down two days ahead of the first race, and... the concussed bee stupidity of the organisers had just got a bit too much for me. I'd arrived in quite a happy and relaxed mood, but after 48 hours of confrontation with this relentless incompetence, my blood was boiling. I knew there was no danger that my blood pressure was going to be too low. Oh no, it was going to be TOO HIGH. There was no doubt about it.

But still, my innate respect for following the rules bade me try to pass the test, on the first two days of the competition.

The first time I attempted it, I was recorded at 150/100 - which is, admittedly, quite bothersomely high; but not quite in instant heart attack territory. Given the amount of hassles I'd gone through in the previous few minutes, I was quite pleasantly surprised that it was that low. I'm quite sure it must have been at least 10 points higher just a few moments before, and that I'd managed to bring it down quite substantially by a sheer effort of will. So, the doctors told me I'd failed - but I could come back and try again in 10 minutes. Since I was now anxious and angry about the prospect of being excluded from the race on medical grounds (after having travelled 1,000 miles and shelled out a lot of money to get there), and since there was less than 40 minutes to go before the start of the race, and I still hadn't found anyone to take care of my computer (long story), nor had I been able to discover where the dropoff point for race-day bags or the assembly point for the race itself were (despite having asked everyone in sight at least 10 times: NOBODY knew!).... the chances of my blood pressure going down seemed pretty slim. I did try one more time, about 5 mins later; and this time I was apparently 140/100 (which leads me to suspect that the medical staff just weren't very good at using the equipment; I'm quite sure my pressure at this point must have been the same or higher). I didn't think this would be over any reasonable 'danger threshold', but they seemed to think it was, and were still trying to stop me taking part. Eventually they proffered a piece of paper, which I assumed was some kind of waiver of responsibilty if I died, but they weren't able to explain it to me, and..... well, just as I was about to sign it to get them off my back, another little crisis started unfolding, and I went away to deal with that and entirely forgot about signing their damn waiver (if that's what it was).

The following morning, I was in a similar zone - 140/95. Although it was damned hard to get them to tell you what your reading was; and even harder to find out what the 'pass' threshold was. I eventually divined that it was 140/90 - although I might have been misled about that. I suspect it might have been 130/90, which is typically given as the threshold definition of 'pre-hypertension' in medical books.

Now, to me, excluding someone for having a blood pressure which is not ideally healthy, but well within the normal parameters of the general population, seems unduly harsh. Oh sure, we'd all like to be down around 120/80, but how many of us ever are? I doubt if very many people would register that level after an even averagely stressful week at work. Certainly not many middle-aged men.

I doubt if my blood pressure is ever much better than 130/90, not when I'm up and active. I don't recall ever recording a reading lower than that, anyway (but the mere fact of being tested probably bumps it up a few notches; I do not like doctors). And a big race unleashes a huge jolt of adrenalin into your system: half an hour or an hour before the race, I'm pumped. My blood pressure is going to be elevated by at least 10%, if not 15-20%, I should think.

In summary, it is INSANE to seek to exclude runners from an event like this because their blood pressure is slightly higher than normal. It is INSANE to conduct such tests less than an hour before the start of the race. It is INSANE not to the tell people what the parameters of the test are. And it is deeply ANNOYING and STUPID not to let people know about something like this well in advance. It is also completely bloody POINTLESS if no record of the checks is being kept, and half the competitors are ignoring them anyway. This is the kind of thing, I'm afraid, that only seems to happen in China. And it is apt to RAISE YOUR BLOOD PRESSURE.

A few days later, I had the chance to get my blood pressure measured again by a young nurse who was offering free health checks on the street. Removed from the stress of the incompetent event management, I was back down to my 'normal' 130/90.

By the by, Blood Pressure is the title of one of Damon Runyon's classic humorous accounts of New York's gangster low life during the Roaring Twenties, one of the first of these that I read. I discover it's now available online - here.

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