Even for the best of us, running a marathon can be hellish. But for one 37-year-old man running his first 160-kilometre ultramarathon in California, the experience became a downright nightmare when he vomited so hard that he tore a hole in his esophagus.
According to the report, the man had been running in the Western States 100, his first ever ultramarathon. One hundred or so kilometres in, he and his pacing partner checked in with an aid station. But soon after they departed, the pacing partner returned alone to request help. No less than a “few hundred” meters ahead of the station, the man had tried to take an over-the-counter nonsteroidal anti-inflammatory (NSAID) pill but immediately felt the need to vomit and spit out the pill. Once he vomited, he felt chest pain so severe he worried he had broken a rib. During his trip to the emergency room via ambulance, he was treated as though he might have had a heart attack.
“This was top two, top three of the most serious things I’ve ever had to deal with while working at one of these events,” case study author Andrew Pasternak, a physician at the Silver Sage Centre for Family Medicine in Reno, Nevada who was working at the aid station that day, told Gizmodo by phone.
Twelve hours later, following a CAT scan, doctors had a better idea of what happened to the man. His esophagus had spontaneously torn open, a rare condition called Boerhaave’s syndrome.
Though most cases of Boerhaave’s happen in older people with pre-existing risks like smoking, the man’s vomiting apparently put enough pressure on his esophagus to do the trick. While the authors aren’t sure why taking the pain pill sparked the vomiting, it’s well known that long-distance running tends to wreak havoc on the gastrointestinal system. This is, however, the first case of Boerhaave’s ever linked to ultramarathon running, as far as they know.
“We do think it was a complete freak occurrence,” he said. “As to why the pill got stuck [in his esophagus] on that day during that moment of the race—could that have been related to some of the stresses of running? Maybe.”
When the condition was first described by Hermann Boerhaave in the early 18th century, it was universally fatal. But surgical and medical advances have made it much more survivable, especially if it’s diagnosed early. So while the man did require surgery and hospitalisation for over a month, the hole did heal. And according to Pasternak, the man has subsequently recovered enough to try running the Western States 100 in 2020.
“The whole experience gave me a new perspective on life and the importance of health, and I have learnt to appreciate the little things in life,” the man wrote in an accompanying patient perspective.
The man’s bizarre injury obviously isn’t a major health risk for runners to be worried about. But Pasternak—a runner himself—notes that taking NSAID painkillers before or during a race is a well established no-no for running long distances, since they can harm your kidney and gut. One study linking NSAID use to gut leakage and inflammation even involved runners in the Western States 100; it also found no effect from NSAIDs on reducing muscle soreness.
If you do have to take something for pain while running, Pasternak said, “make sure you drink some water with it. Take a big gulp and maybe, you know, slow down a little bit when you’re trying to swallow.”