Runner Down

George Spears had run almost all of his life. He had run as a boy on the Red Lake Ojibwe reservation in northern Minnesota and on his high school cross-country team in New Mexico. “He was always running as a kid,” says his widow, Melanie. He ran, she says, because of the spiritual and physical benefits (he was also a black belt in karate) and because he simply loved to run. As a father, social worker, and activist in the Native American community, he used running to set an example and help teach kids that a healthy life was a good life.

“He lost his father in a car accident when he was two,” Melanie says, “and his mother when he was sixteen. One of his grandfathers died of a heart attack, though not especially young, and beyond that, he just didn’t know much about his family’s medical background.” He was, in any case, well aware of the increased incidence of heart disease in Native people, correlating with serious levels of obesity, diabetes, and other contributing conditions. He ate healthy foods, avoided junk, and neither smoked nor drank. George and Melanie, who met as freshmen at Macalester College, had been married for thirty years.

George competed in twelve marathons, including his first TCM in 1987, and countless other events over the years. He told his four sons, all of whom are runners, that he had once run a spectacular two-forty-five in high school—his personal best. More recently, according to his twenty-six-year-old son, George Jr., he had been running in the high threes and low fours. “He’d gotten slower as he’d gotten older,” George Jr. says. George Sr. had developed problems as he’d moved into middle age—for instance, what his wife calls “sports asthma,” for which he used an inhaler when necessary—and he’d had surgery on a knee and biceps in recent years. Nothing, though, really slowed him down, his family insists. He had prepared for the 2006 TCM by running with another son, Chester, along the Mississippi River Road, a couple of times a week. “He kept to his routine and never complained of anything,” Chester recalls. “I didn’t notice any shortness of breath. He was just getting older, so he was running a little slower.”

Melanie says her husband visited his doctor for a routine physical a couple of weeks before the TCM and said he was told that everything looked good. He had complained about his hip when he came home after a karate workout on Saturday, but otherwise seemed ready for the marathon. George Jr. had seen him at a dinner on Friday, and his dad, when asked, said he felt fine.

Brad Huckle ran his first Twin Cities Marathon right out of college, then several Grandma’s Marathons in Duluth. He ran his first triathlon in the late 1980s. The son of a Marine Corps pilot, he ran cross-country at Appleton High School and was a varsity wrestler at the University of Minnesota. “I’ve always enjoyed running,” he says. “I love the competition, the socializing, and the healthy lifestyle that go with it.” After watching a friend run in the Boston Marathon, he was inspired to get serious again about marathons. He qualified for and ran in his first Boston in 2005. Last September, he and a friend competed in the Ironman Wisconsin triathlon. The Twin Cities Marathon was three weeks later. “I decided I would run hard enough—my personal record is three-fourteen—to qualify for Boston in the spring,” he says. “That was the plan.”

Huckle had no known medical concerns. Neither his parents nor his siblings have had any serious health problems; he had never smoked, had safe cholesterol readings, and maintained a trim, well-muscled 140 pounds on his five-foot, six-inch frame. As a nod to middle age, he saw a doctor once a year and, last spring, had passed a stress test that he’d taken to gauge his aerobic capacity and  training efficiency. “I felt great after the [Wisconsin] Ironman—actually better than I feel after a typical marathon,” he says. “I jogged a couple of days afterward, then had a decent-sized run—ten miles or so—maybe a week before the Twin Cities. The idea was to maintain my fitness level without aggravating the muscles from the ironman."

Sunday morning, the first of October, dawned clear and crisp, with a race-time temperature in the forties and a comfortable dewpoint. The temperature would rise to a warm but not oppressive sixty degrees by ten o’clock. Of George Spears’s four sons, only George Jr. was running that day and, arriving at the course from his own home, he had hooked up with a college friend and didn’t connect with his dad. Melanie Spears, Chester, and other family members had positioned themselves where they usually did for the TCM—on Minnehaha Creek near Portland Avenue in south Minneapolis, near the course’s ten-mile mark. Huckle was running with a pal with whom he’d run in the recent Ironman. The friend says Brad, wearing his cap and dark glasses, looked and sounded up to the challenge.

There were no reports of Spears having visible difficulty before he went down shortly after Mile Six. While other runners, including a registered nurse named Robert Schepers, and emergency personnel tended to him on the ground before he was rushed to HCMC, George Jr., who had been moving at a swifter pace but had problems of his own, was looking over his shoulder. “I had rolled my ankle at about Mile Sixteen and was running really, really slow, and I kept watching for him,” the younger man says. “When we were kids, my dad used to slap us on the back when he’d catch up to us, and that’s what I was waiting for. I kept thinking, ‘OK, Dad, where are you?’ ”

Melanie and Chester waited, meanwhile, at Mile Ten. Finally, Chester jogged back a way up the course. Returning, he reported, “There are no other runners, Mom.” The puzzled but not particularly worried family returned home shortly before noon to find a phone message instructing them  to come downtown to the hospital. When George Jr. reached the finish line in St. Paul, he was met by grim-faced marathon officials. “They were waiting for me with the news,” he says. “But my dad was the last person I thought they were going to tell me about. It never crossed my mind that something like that had happened to him.”

Huckle, meanwhile, passed members of Minnesota Red, his running club, along the second half of the course. Later, they told him he’d “looked great”—strong and focused and striding along at a low-seven-minute-per-mile pace, which would allow him to qualify for Boston. Coming down the hill from the cathedral less than a quarter-mile from the finish, however, runner Mike Fecht saw Huckle down on one knee off to the side of the course. Fecht, an experienced marathoner himself, happens to be a captain with the Metropolitan Airports Commission fire department so also has experience with distressed persons. At first glance, Fecht thought Huckle was suffering a muscle cramp. Up close, Huckle’s expression told him it was something more serious.

Someone asked Huckle if he was all right; Huckle said no. And that, apparently, was the last thing he said until he woke up in the hospital the next day.

Bill Roberts, TCM medical director, has more data than explanations for what happened last year, both nationwide and here at home. In 2006, he says, “there were about 440,000 finishers across the country and seven deaths, so the death rate was about 1 in 65,000, which corresponds pretty closely to the papers Dr. Maron and I have published. On the other hand, between the Twin Cities and the Marine Corps races, we had four heart attacks and two deaths.” He mentions something statisticians call a “Poisson distribution,” when rare events that are usually spread thinly over a long period cluster at some point. “That’s what happened here and in Washington—rare events clustered, which makes it look as though these events are more common than they really are. A coincidence? A blip? A fluke? I don’t know. We’ll just have to see if it’s more than that.”

The numbers Roberts and Maron have collected comprise some interesting details. “Historically, [heart attacks] seemed to happen more often along the latter part of the course—Mile Nineteen or Twenty and on,” he says. (The only previous heart fatality at the Twin Cities Marathon was forty-year-old Thomas Becker of Bloomington, who collapsed and died after he finished the race, in 1989.) “But more recently they’ve occurred about a hundred yards from the start and at or after the finish and places in between. The fastest runners get out ahead of the pack, and, for the most part, they’re younger people and not the ones who usually have problems. Nationwide, there have been a few deaths in people under thirty who have congenital heart problems. But atherosclerotic heart disease—the most common cause of heart attack—usually becomes evident in people around the age of thirty-five or forty, and that’s the group we’ve been most concerned about.”

Ironically, a serious marathoner’s focus and experience may actually work against his or her awareness of a cardiac threat. “Marathon runners, as a rule, are pretty fit and in tune with their bodies,” Roberts explains. “If things are going pretty well, they don’t think about their hearts as a problem. Most folks who arrest during a run probably haven’t had much of anything in the way of symptoms. Some may have had mild symptoms, which they’ve ignored, which is always a mistake. But a lot of the surviving runners I’ve talked to say they haven’t had any real symptoms at all. It turns out that they’ve had changes in their coronary circulation, but those changes haven’t been enough to show with normal activity. Maybe there’s a 50 or 60 percent obstruction, but the blood flow to the heart has been adequate. Then for some reason during the race a clot blocks off the blood flow and initiates the cascade of problems that lead to cardiac arrest.”

Jay Cohn, founder of the Rasmussen Center for Cardiovascular Disease Prevention at the University of Minnesota, says that the “dynamics” differ from heart attack to heart attack. He also notes, “Most heart attacks do not occur during exertion—I think more occur in bed than at any other time.” In most cases, no matter what the victim is doing, a clot is involved. “We’ve learned that it’s the clot forming on atheriosclerotic plaque that builds up in a coronary artery,” Cohn says. “We call them unstable plaques because they release a substance that causes the blood to clot as it passes, and the clot forms suddenly and you have a heart attack.” In some cases, Cohn adds, blood flow restricted by a plaque-narrowed artery causes such notorious symptoms as angina; in other cases, however, the individual doesn’t experience chest pain until he actually suffers the heart attack.

“There’s also the possibility that during intense exertion a plaque will rupture,” Cohn says. “And there are such things as blood-pressure changes during exercise that may aggravate the plaque and make it rupture, and then it becomes the site for a clot.”

Roberts says he knows of no major marathons that require medical screening for their participants. But he and other medical professionals say screening would be impractical and ineffective. “We have almost 10,000 entrants in the Twin Cities, and trying to screen and keep track of that screening would be difficult, to say the least,” he says. “Besides, I don’t know if it would make any difference. At least two of the people in our data base who suffered cardiac arrest had normal stress tests within a month of the marathon, and one that died had a normal stress test within the past year. There are some screening tests that hold some promise—the rapid CT scan, for instance—but it would also be an expensive proposition to screen everybody with that kind of technology. I say if you’re feeling pressure in the chest or you’re short of breath, you should see your doctor. But I’d say that whether you were planning to run a marathon or not.”

As technology advances, the discussion of cardiac screening will grow more intense, Roberts acknowledges. “But for the average person in generally good health, who’s never smoked, who eats well and maintains a lean body mass, who has no family history of heart problems—I’m not sure we’d gain much from screening,” he says. “The greatest risk is ignoring symptoms. If you’re having symptoms, see your doctor. If you’re having symptoms during a race, stop. Don’t keep going.” Which, he concedes, may be the most difficult decision for any marathoner to make.