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Running shoes Marathon diary Follow our medical director as he prepares for the London race

Dr Sneh Khemka, Bupa International's medical director, completed the London Marathon on 25 April. In this diary you can follow his training leading up to the race and get advice on running.

 

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The end of the road

Dr Sneh Khemka finishes the marathon

Well well, it’s all over. Finished. And I’ve got the medal to prove it.

It was when I approached the ‘40km’ marker post that I began to realise what an awfully long way I’d run. I started to feel a sense that I had, after all the effort, actually achieved something.

Things started well. Despite the weather predictions of the hottest day of the year so far, and fear of desperate dehydration and sunstroke, the early light showers of the day and the overcast sky were a welcome relief. It was even vaguely cold.

I started in the red section, pen 9, and the first 15 to 20 minutes of the race were spent shuffling with the jogging hordes until we actually reached the starting line, when we could find space enough to start the race in earnest.

I knew it was going to be fun – the atmosphere and chatter among my fellow runners, the Tannoy announcing the charities represented, the TV cameras swinging overhead taking the crowds into view. I set off, and immediately felt buoyant with the supporters urging us on along the route. People were overtaking me, but I was comfortable with my pace and was not feeling any discomfort.

Mile five came and went without event, and it was not until mile 11 that I felt the first real twinges of fatigue. A brief stop to apply more cream to exposed areas refreshed me, and I completed the first half of the marathon in less than two hours, strong and confident.

I came over Tower Bridge, and spotted a bunch of friends on the other side of the road. I waved at them, and ran on with a smile on my face. With headphones in my ears and a downhill segment ahead of me, mile 16 represented a brilliant moment of euphoria – I could do this, and do it well. Maybe I was, after all, designed to be a runner.

I don’t know if you’ve heard of ‘the wall’. I hit it, hard, at mile 18. Beset in both thighs by crippling cramp, I had to be helped first by a policeman and then by St John’s ambulance service, who whisked me off for 20 minutes of massage and rehydration, before I resumed the run.

Medical science hasn’t fully explained why cramp happens. Some attribute it to a build-up of lactic acid in the muscles, others to a lack of salt and essential electrolytes in the muscle fibres. I’d never really experienced it to this severity before, but suffice it to say that I honestly thought it was the end of my race.

But it wasn’t, and although the next eight miles were in no way a demonstration of graceful running, they were a show of fortitude and strength, and I crossed the finish line just about five hours after setting off.

I ate five packs of carbogel – high calorie preparations that give your body a temporary relief from relying on reserves of glycogen in the muscle, and let the metabolism revert to using glucose to give a more immediate energy.

I drank seven litres of fluid – alternating between plain water and isotonic drinks, to ensure that both fluid and electrolytes were replaced. A long run like this releases vast amounts of a protein called creatinine kinase, and this can clog up the filtering tubes of the kidney. Fluid helps to flush it out and keep you healthy in the long term.

I took 1.2 grams of brufen – a non-steroidal anti-inflammatory preparation, which helped to reduce concurrent and sequential inflammation, and keep the pain my hips and knees were shouting about out of mind.

So I’m left with asking myself the longer-term medical question of whether doing a marathon is good for you or not. I’ve decided it’s not.

As I said in the first part of this diary, a human being is not designed to run this far in one go, and I think the adverse health implications may just outweigh the positives. Ligament, lower back and joint damage, coupled with the real possibility of lasting impairment to a muscle or tendon are very real risks. But weight loss, cardiovascular fitness, and better core muscle strength are very beneficial side effects, which I’m enjoying.

So my resolution is not to do another marathon, but to keep running. I’ve already spotted my next challenge - a half marathon in a couple of months. But I haven’t climbed Mount Kilimanjaro for a few years, so I’ve now got that pencilled in for October. Watch this space…

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