THEIRS WERE NOT the usual DNF (did not finish) stories in sports, but in their quest to avoid that ignominious distinction, the finish line came too soon.

On a hot muggy Sunday morning two weeks ago, in the opening leg of the 34th Milo Marathon eliminations, 37-year-old Remus Fuentes collapsed barely a kilometer from the finish line and succumbed to heat stroke two days later. It was his third?and last?half marathon.

Last year, three runners in the 2009 Detroit Marathon died within minutes of one another. The 2007 Chicago Marathon sent 49 participants to the hospital and one runner died during the race. Top American distance runner Ryan Shay died while competing in the 2007 US Olympic marathon trials one day before the New York City Marathon. A 25-year-old who traveled from the United Kingdom to join a race in Kuala Lumpur died 2 kilometers before the finish line.

The first known long-distance runner who died of an apparent heat stroke was probably the Greek messenger Pheidippides, who in 490 BC ran from Marathon to Athens to announce the victory of the Athenian army?s victory over the invading Persians.

Running boom

Most definitely, Remus Fuentes will not be the last victim of the heat in long-distance running. His death has brought to the fore once more the perils of running in a tropical country like the Philippines, which is enjoying an unprecedented running boom.

(Milo Marathon organizers said more than 28,000 runners registered for the July 4 race over five distances?the full 42.195-km marathon, the 21K half marathon, the 10K, 5K and 3K?although its list of finishers had less than half that figure. The Run for the Pasig River is aiming for a record-breaking starting field of 120,000 for its race in October.) (See story on Page A1.)

Has long-distance running become a dangerous sport? Definitely, experts say. And they have said so since the running of the ?70s and ?80s.

Biggest hazard

Then and now, heat has been the single biggest hazard that runners must confront.

A 2009 study released by the American College of Cardiology found that ?1.5 sudden deaths occur for every 100,000 participants in triathlons (swimming, cycling, running),? compared to 0.8 out of every 100,000 marathon (42.195 km) participants. Heart diseases, hyponatremia (an electrolyte imbalance like low blood sodium levels) and heat-related illnesses such as heat stroke are the usual causes of death.

But local experts say serious injuries?and death?can be prevented.

?Listen to your body,? coach Manny Calipes of the University of Santo Tomas track team said. ?First and foremost, it is the runner who is responsible for his safety.?

Calipes, a UST athlete from 1976 to 1980, said a runner should know when to stop.

?The symptoms usually happen slowly, one at a time,? he said. ?If you feel your body can no longer go on, don?t push it.?

Hydration, Calipes said, is another important factor that some runners tend to overlook.

?Don?t wait until you?re thirsty because thirst is a sign of mild dehydration,? he said. In a tropical country, the reminder is ??drink before you get thirsty.? In temperate weather, it is, ??do not drink until you?re thirsty? or you?ll fall victim to hyponatremia.

?Risks are always there, especially for runners who do not declare their true health conditions, that?s why runners are made to sign waivers,? added Calipes. Waivers are also a way for organizers to escape responsibility for any injuries or deaths during a race.

Father?s story

But Rudy Fuentes, Remus? father, has accused organizers, sponsors and a hospital of incompetence and negligence. He said water ran out in the final stretches of the route along Roxas Boulevard, that medical help was not quick enough and that the Ospital ng Maynila mishandled his son when he was taken into the emergency room. He also accused the sponsors of insensitivity in treating his son?s death ??as a learning experience.?

The younger Fuentes, married and a father of two, was working for multinational information technology company Hewlett-Packard at the time of his death. He had been participating in several 10K races.

It was unusually warm that Sunday morning which is considered to be well into the rainy season. Previous Milo Marathons were sometimes held in the rain. According to the weather bureau, the temperature at the time of Fuentes? collapse was between 27.5 degrees to 31.5 degrees Celsius with humidity at 73 percent. The 31.5 was recorded at Pagasa?s Intramuros monitor at 8 a.m.

These parameters are considered normal for this time of the year. While conditions were not ideal to run a long-distance race, it was well within under the ??90-90? maximum (90 degrees Fahrenheit and 90 percent humidity) beyond which every runner is in danger of heat-related injuries and no race should be held for safety reasons.

Heat stroke

Heat cramps and heat exhaustion are the mildest forms of these heat-related injuries but they can progress into heat stroke unless the runner stops and seeks medical attention. Heat stroke is characterized by an abnormally elevated body temperature and, as in the case of Remus Fuentes, it can be fatal if not properly and promptly treated.

Heat stroke victims also suffer from absence of sweating, with hot red or flushed dry skin, rapid pulse, difficulty in breathing, strange behavior, hallucinations, confusion, agitation, disorientation, seizure and coma.

Based on the account of the victim?s father published in several blog accounts and reaching even the Nestle headquarters in Switzerland which produces Milo, Fuentes collapsed at the 19.9-km mark. A policeman and Fuentes? running buddy quickly took him by taxi to the Ospital ng Maynila.

National race organizer Rudy Biscocho, in a telephone interview with the Inquirer, said Fuentes fell a few minutes before 8 a.m. near the Aristocrat restaurant along Roxas Boulevard. Biscocho was at the final kilometer area on the corner of Pedro Gil, along with medical and communications staff at the time of the incident.

?We received a report that a runner needed an ambulance and immediately dispatched one,? said Biscocho, the country?s most experienced race director.

The ambulance, one of the event?s seven units, did not find Fuentes there.

Initial diagnosis

Initial diagnosis was heart attack. The elder Fuentes recalled seeing his comatose son having seizures and breathing heavily. At about 11:30 a.m., the family arranged for his transfer to Medical City in Pasig.

?The Medical City doctors said his status was unstable, contrary to the earlier advice by Ospital ng Maynila,? narrated Rudy.

Although doctors said Fuentes? heart was strong, his kidney and liver functions deteriorated after 36 hours. Intensive care unit doctors had to perform dialysis and blood transfusion.

Rudy said his son died early Tuesday, July 6, about 30 minutes after doctors got the family?s consent to stop administering cardiopulmonary resuscitation (CPR). He left behind his wife Takako and children Raphael, 8, and Therese, 4.

The elder Fuentes said his son had no history of any serious illness, had been running since high school and regularly played basketball with his brothers on weekends. Younger brother Roy, he said, is the faster runner and in fact had already finished the 21K Milo race when he learned that his brother collapsed.

Remus finished his first 21K race?the Nature Valley run at the Bonifacio Global City on May 30?in two hours, 44 minutes and 23 seconds (1,124th out of 1,547 finishers) and his second at the Freedom Run in Greenhills last June 13 in 2:27:12 (82nd out of 123).

Making the cut

Before he collapsed, Fuentes might have been trying to make the 2:30 cutoff time. His father blamed the cutoff as one of the factors that led to his son?s death. But there were 358 runners, including the last finisher who came in at 4:03:04, who were listed among the finishers.

Biscocho said they were not aware of Fuentes? case until the following day because it was not their medics who attended to him. Just the same, he immediately went to see Remus after learning of his collapse. Nestle Philippines, which paid for the hospital and funeral expenses, ordered the veteran race organizer to look into Fuentes? condition the next day.

Had his running buddy and the policeman waited for the race ambulance, Fuentes might have been alive today, reports said. The ambulance crew was trained and equipped to handle running emergencies like heat stroke.

Biscocho said every Milo marathon race is well-equipped to handle emergency situations. Apart from seven ambulance units, the Metro Manila race had five teams of roving medics on bicycles, nearly 500 marshalls and 14 medical aid stations. There was a hydration station (water or Gatorade) around every one kilometer of the 21K race path for a total of 13 water stations, 10 Gatorade stations, and 1 banana station located throughout the 13.5 km race loop.

?It?s a tragic incident that nobody wanted to happen,? said Biscocho.

Milo Marathon statement

The Milo Marathon statement on its Facebook page also reminded ??all runners who plan to participate in the forthcoming Milo Marathons to adequately prepare before the race, ensuring that they are properly conditioned mentally and physically. This includes undergoing the necessary training, getting enough rest, properly hydrating, and eating the right food.?

Fuentes was the third known Milo Marathon casualty. In 2007, 38-year-old electrical engineer Fidel Camson fainted near the 10K finish line at the Quirino Grandstand. His wife admitted that although Camson was a frequent runner, he was hypertensive and usually experienced heart palpitations.

A 21K runner also collapsed on the Buendia flyover of the July 4 Milo race, some 4 kilometers from the finish line. He was attended to by an ambulance, taken to the Ospital ng Maynila and was discharged the same day.

Regular runners would always say they are prepared and informed and look at races as safe activities.

Just the same, it won?t hurt to follow the oft-repeated reminders of fitness experts: Train intelligently and sufficiently, stay properly hydrated, have regular check-ups and, in case of illness, stop.

And the still grieving Rudy Fuentes is batting for a better marathon organization and quicker medical response in the hope that ??something good will come out of my son?s death.?