Your Health

You've done the training. You know what to expect from your body. But things can go wrong.

People who climb 20 mountains in perfect health can develop altitude sickness on their 21st climb.

Over the years you runners have become much better trained and much better prepared, but you also push yourselves harder. Just staying awake for 24+ hours isn't an every-day activity, much less running the entire time.

Although exceedingly rare, we have had serious medical incidents at the race. The last ten years of the race equates to about 2,700 runners, and out of those we've had 4 medical events that have required an ambulance. (That's way less than 1%.)

We understand that you want to finish -- the lure of the buckle is strong -- but there are times when you need to keep your future wellness in mind.

When and How to Get Help

Listen to your body.
Know your normal.

Each entrant is responsible for knowing his or her own physical limitations.

Please report anything outside of what you've experienced during training or in other races. Especially notable are issues with your:

On the back of the bibs are emergency phone numbers (including Race HQ). We've had great success with runners and pacers looking out for one another and summoning help when needed.

If we don't notice that you're having a problem, get our attention.

Do not try to hide a condition from your crew, your pacer, or our staff. It's kind of a reverse Catch-22: if we catch you hiding something, we're more likely to assume that you're mentally compromised, and we might be more inclined to pull you from the race.


The Race Captain, Race Directors, Assistant Race Captains, and Aid Station Captains can help you decide whether to continue running or not.

They can also make the decision for you if they think your physical or mental condition has deteriorated to the point of endangering your safety. We want everyone to achieve their goals, but we also need to protect you from what could be a clouded mind.

We will not withdraw a runner lightly, and without very good reason, so don't think that if you have a sniffle or a bit of swelling that we'll yank you from the race.

Available Aid

We have personnel at Race HQ and Aid Station #2 (on the opposite side of the park) to help you with medical issues. As you might expect, Race HQ has more medical aid and resources.

Red Cross members trained in first aid are available at the Headquarters Aid Station. Some Red Cross members are EMTs and even Paramedics (though they won't have access to the same equipment or procedures during the race). Their job is to administer basic first aid and recognize when something is critically wrong (in which case we arrange transport or call an ambulance).

We have more advanced aid near Umstead park:

The Big Disclaimer

The information below is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. You're an adult, you're a runner, and you're responsible for your own health and well-being.

Table of Injuries and Ailments

Cuts and Scrapes

We can bandage and bandaid you and get you on your way. We won't do suturing/stitches -- we leave that for emergency rooms.


We'll do everything we can to help alleviate pain from a blister and try and keep it from getting worse. We can clean you up, put on bandaids, tape you, apply pads or talc, and help you put on dry socks.

One thing that Red Cross first aid volunteers are NOT allowed to do is 'pop' a blister (they can't do anything that breaks the skin). You, however, can do anything you want to your blister.

Because blisters can be very difficult to effectively treat in the field, we'll probably ask you what YOU want done. Consider bringing your own supplies in a 'foot bag'.

Also see Blister Prevention by Jonathan Savage (who's usually very kindly fixing feet at race HQ).

Foot Pain Without Blisters

Foot pain is probably normal for the abnormal thing that you're doing.

This might be why your feet hurt:

You strike the ground with between 2 and 3 times your body weight.

A 24hr pace equates to roughly 14 minute miles.
A 14 minute mile = 4.3mph, which is about 150 steps/minute.

150 steps/minute * 60 minutes = 9,000 steps per hour
9,000 steps/hr * 24 hours = 216,000 steps

A 120 pound runner at 2.5 times that weight = 300 pounds per strike
300 pounds * 216,000 strikes = over 64 million pounds absorbed!

There's also the chance that you might be battling plantar fasciitis (a sharp, tight, pain usually near the base of the heel).


There's a lot of dust and pollen on the trail. Know what triggers you, and how serious it is on long runs. Have your medications (like an inhaled corticosteroid), and know your administration procedure, and the effective duration of the treatment.

It doesn't do you any good to take a puff and then have the effect wear off in the middle of the next lap where you don't have your inhaler.

Maybe take your (full) inhaler with you and leave an extra in your bag or car?

We DO NOT have any kind of epinephrine auto-injector (aka EpiPen) on site. If you know that you are at risk of anaphylaxis, a potentially life-threatening allergic reaction, have your epinephrine injector with you at all times, and wear your medical alert if you have one.


Drink before you are thirsty!
Lesser-known corollary: pee before you get near a crowd.

A runner can easily sweat .5 liters/hour, and that really adds up over the span of 24 hours (to 12 liters, actually). That's 6 2-liter bottles!

Just to give you an idea of how much fluid that is, unless you're truly a giant, you don't have more than 6 liters of blood in your whole body. You must replace fluid if you want to finish!

Signs of dehydration include headache, nausea, dizziness, and decreased (or non-existent) urine output.

If you're dehydrated, you need to rest and drink fluids, preferably water AND something that contains electrolytes (sodium/salt and potassium).

Dark Urine

This is a really common symptom of dehydration and decreased liver function. It's also difficult to notice when it's dark outside. Don't be surprised if we ask you about this.

The dark color is just a sign, so we don't get worried about it unless you have some other complaint.

Avoid this by hydrating with electrolytes.


Kind of the opposite of dehydration. Hyponatremia is a condition where there's very little sodium in the blood. In runners this is typically caused by drinking A LOT of water, and nothing that has electrolytes (sodium/salt and potassium). You have too much fluid in proportion to the sodium in your blood, so things go bad.

Sodium is vital for regulating blood pressure and a well-functioning nervous system. Once you reach hyponatremia, it's a serious thing.

Symptons include nausea, vomiting, headache, fatigue, sluggishness, and swelling of the hands and feet. A person may not react to their surroundings and their reflexes may be compromised (you might mistake them for being a little drunk).

Note that swelling of the hands and certainly the feet is not abnormal for ultra-running, so we won't take those on their own as signs of hyponatremia.

Vomiting Dark, Coffee-grinds Looking Stuff

You're vomiting blood that's in your stomach. The blood is there as a response to the incredible stress you're putting on your body.

This is rather common, and isn't particularly serious. You probably can't hold ANY food down, even sips of just broth or water.

You need to rest. We've seen people come in, throwing up blood, absolutely depleted of energy, convinced that they can't finish. After a 3 (or 6) hour nap they get up, eat a barrel of food, and then head out for their last 2 or 3 laps. It's pretty amazing to see the change.

Anti-inflammatory Drugs

We really don't want you to take any type of anti-inflammatory drug during the race.

The stress of an endurance event significantly reduces your body's ability to metabolize and eliminate these drugs, and the amount that you can safely take in a given time is not the same as under normal circumstances. Therefore, we do not advocate their use and we will not dispense them.

Obviously, we can't prevent you from taking anti-inflammatory drugs on your own, but please do not experiment during the race. Do what has worked for you in the past.

Bring all medications in marked containers.


DO NOT sleep on the trail. Come to HQ for that.
We even have a cabin dedicated to sleepers!

If you do sleep on the side of the trail, we'll invariably get a report that a runner is "down". Then we'll have to race out of HQ and try to find you on the course, blinding and disturbing other runners.

Cold / Hypothermia

After you're depleted of energy, even a nice 65°F day can chill you to the bone; it's less than your core temperature, so you're slowly losing heat over a very long time.

Symptoms from moderate to severe:

If you get too cold: get dry, add layers, stay in HQ by the fire and drink soup.

Hot / Hyperthermia

You're too hot. We've seen it happen even in cold weather to people who were wearing too many layers.

Symptoms from moderate to severe:

If you get too hot: rest, hydrate, get into a cooler environment, and give your body time to cool. Ice can help, but you have to be careful with that too because you don't want to freeze your skin.

GI Issues (upset stomach, diarrhea, etc)

Ultra-runners run so long they typically need real food (fat and protein) not just liquids and sugars like those "short-distance" runners. Unfortunately, this varied diet can lead to more gastrointestinal problems.

Diarrhea can lead to dehydration and then other bad things.

If your gut isn't behaving, rest and hydrate. Everyone responds differently, but salty crackers, ginger-ale, ginger packets, or Pepto-Bismol can help.

Muscle Cramps

A result of use and dehydration.

If you're cramping, hydrate (with electrolytes), massage, stretch, rest. Yelling can help too.

Breaks and Stress Fractures

These do happen.

Unfortunately, we don't have an X-ray machine -- can you imagine the liability!? We can only look at you and identify an obvious deformity, swelling, or immobility. Then we'll say something like "Wow, that's a lot of swelling -- might be broken."

When the swelling is so great that it immobilizes the joint, that's the body protecting the joint. When the swelling decreases, the break or fracture could become more evident, and probably more painful.

We probably won't want you running on anything that looks truly busted. You probably won't either.

Insect Bites and Stings

In 2017 we had a runner come in to HQ complaining of foot pain.
Turns out there was a bumble bee in his shoe!

We have topical sting relief medicine to help.

If you know that you are at risk of anaphylaxis, a potentially life-threatening allergic reaction commonly associated with stings, have your epinephrine injector with you at all times, and wear your medical alert if you have one.


Extreme fatigue, darkness, dehydration, and shadows can all play havoc with your mind. Sleep usually fixes you... if the wolves don't get you first. (Just kidding -- it's the land sharks you have to watch out for.)

Recognize that seeing something and knowing that it is not really there is different from seeing something that is not there and believing it really is. We treat the second thing much more seriously.


Pretty common sign of fatigue and dehydration.

Fix your headache with whatever usually works for you.

Neck Pain

Common. You're tired and probably looking down a lot. Your head weighs a lot, and your poor neck is trying to keep a big, bobbing weight from crashing into the ground.


Chafing is when skin rubs on something. Try to reduce the friction: change into dry clothes, move clothing (but don't necessarily REMOVE clothing), or apply a cream or powder designed to make you slippery.

Heat rash is caused by sweat and dirt clogging skin pores. Commonly looks like little red bumps that are itchy or painful.

Rashes from allergies can look just like heat rash, but also like hives (larger red blotches). Antihistamines can help.

Let us know what ails you and we'll try to help. If you're prone to these types of things, there are anti-friction/anti-prickley-heat powders and creams, and hydrocortisone creams.

Blurred Vision

We haven't seen this, but it does apparently happen.

This is blurriness that's beyond tired, stinging eyes from fatigue, dust, or allergies.

The blurriness is due to corneal swelling caused by changes in blood pressure (usually a drop caused by dehydration). It's temporary, but please report it because your blood pressure should not be dropping that much.

We'll want you to hydrate with electrolytes and rest while we monitor you.

Other Ailments to Watch Out For