Interview: Doctor Serafim Borges
Flamengo's cardiologist explains the team's preparation and care for the game in Oruro
By Lucas Dantas - in
When the draw for the 2019 CONMEBOL Libertadores Cup was announced, we all knew that Flamengo would be "climbing the hill" twice in the first round. In their opening match, Flamengo would face Oruro, at 3735 meters above sea level, as well as San José, a team from the Bolivian city. If once wasn't enough, on April 24th, Abel Braga's team will climb again, this time to the "more pleasant" Quito, the capital of Ecuador, at 2850 meters, to face the Liga Deportiva Universitária.
Playing at the top is nothing new for the team. Flamengo has played above 3000 meters five times, all in the Libertadores, and their record isn't the best, with three losses, one draw, and only one win, a 3-0 victory over Cienciano in Cusco. Above Oruro, Flamengo has played twice in Potosí against Real, with one draw (2-2, in 2007) and one loss (2-1, in 2012).
For this new adventure, Flamengo has drawn on previous experiences and set up its logistics to face the scenario in the Bolivian city. The club's cardiologist, Dr. Serafim Borges, explained to the official website how the planning will work, what could happen, and what recommendations the team has been given to minimize the effects, allowing the players to focus solely on playing—and beating—San José.
During the Libertadores draw, Flamengo learned they would face two high altitude challenges. What was the medical team's reaction, and how did you begin planning to face the inhospitable Oruro?
The words were very well put. It's an inhospitable environment for physical activity and exercise. Up to 2.500 meters, we can rest assured that nothing happens. We have this data. What we've been doing for many years is arriving at game time, an hour and forty minutes early, warming up, and going into the game. We have data showing that things get very complicated after the sixth hour. And the seventh hour, for someone exposed to altitudes above 2.500 meters, is very complicated. Oruro is almost 4.000 meters. We've played in Potosí, at 4.000 meters, which was the worst. Quito is at 2.800 meters, and there they feel a little less.
The athletes did special training to strengthen their respiratory muscles. They also took vitamin C and ferrous sulfate supplements to increase hemoglobin. The more hemoglobin in your blood, the more oxygen you can carry.
Is there a lack of oxygen at altitude? No. The percentage is the same as 21% at sea level, but the pressure there is lower. If I throw a pea seed up there, they'll disperse. There's no pressure to put into the airways of the individual up there. Some precautions are taken; the speed of the ball increases significantly, and the athlete must be prepared. They shouldn't sprint for long periods at altitude, so as not to further increase their heart rate, which is already increasing significantly. Respiratory rate also increases. And when respiratory rate increases, you begin to lose the ability to obtain oxygen.
Flamengo is prepared for Oruro. The goal is to arrive on time for the game. And, obviously, the idea is to continue for Quito. It's less severe there, but there are problems. Players lose coordination. We have special training for the coaching staff as well, with medication, except for the players, who can't use medication.
There's much debate about the right time to arrive at the game venue. There's talk of days in advance, right on the spot, weeks in advance. So, what's the best recommendation?
The best thing is to arrive on time for the game. We've been doing this for many years. We have extensive experience with it. All our colleagues throughout Brazil have been doing this kind of adaptation process, which we've been doing for a long time. Arriving two days before the game won't result in adaptation; it will worsen. After all, we know that after the seventh hour of exposure to altitude, the situation starts to worsen. What worsens? Your heart and respiratory rate increase significantly and you lose performance. You would have needed to be there four weeks ago, but the schedule makes it impossible. When we developed the plan and took it to FIFA, we were defeated. All the doctors in South America signed the documentation, except the one from Venezuela. We requested that there be no games above 2.500 meters without the four-week adaptation period. It's an advantage that isn't fashionable in sports.
In 2007, the image of players using oxygen tanks in the match against Real Potosí became famous. Is this planned for this match? Is it really necessary?
Yes, they are necessary, and they must be done. We have the data. We have a device you put on your finger called a digital oximeter, which measures blood oxygen levels. Those with levels below 90 require oxygen supplementation. There's no way around it. It's not reinventing the wheel. It's about understanding the physiology of the matter to help the individual avoid exposure. Some are more sensitive, others more resistant. Everyone is measured. And for those who need it, we will have seven oxygen cartridges available.
Some players run more than others, like Berrío and Bruno Henrique. You said athletes should avoid sprinting. What about the team's runners?
Sprint athletes are studied. And they, like Berrío, perform better. Endurance athletes, who run more but at a lower intensity, are also studied. And they have a lot of ballast, so they don't feel it as much. It's a fact that if you start sprinting for more than two minutes at high intensity, regardless of whether you're at altitude or sea level, you start to produce acidosis in your body, which obviously harms performance. It's very difficult for an individual to maintain that sprint for more than two minutes. Fast players have a characteristic of having fast fibers. Fast fibers work with less oxygen. But what they need to understand is the weight of the ball. The weight and speed of the ball can deceive them. Goalkeepers, especially.
Will training in Santa Cruz de la Sierra involve any preparation for the altitude, or will it follow the schedule?
There, the schedule remains the same. It's sea level and doesn't need to be changed.
Do you know of any case of a player who had a specific problem at altitude?
During my visit, I didn't meet with players. I met with reporters and coaching staff. Not with players. Some have poor sensitivity, with a very severe drop in oxygen uptake. So we don't recommend them to go up. We've worked with this type of player at altitude and seen that they don't behave well. But I haven't had any serious cases.
What happens is called Mountain Sickness. The most severe symptom is acute pulmonary edema. High-altitude edema is different from sea-level edema. It significantly increases pressure in the pulmonary artery. Therefore, the person needs to be removed from the altitude immediately to improve. There's no point in trying medication.
After the preparation, what are your projections for the team in the game? Are there any surprises possible?
The team is ready. Surprises can always happen. We don't have data on who has the most sensitivity. Yes, from past teams, but not from this current one. We've had more time and know the players well. But this current team is prepared. The response physiology has given us suggests we shouldn't be surprised.
And after the game, what is the first step that should be taken?
Get off on time. But there's a problem. The drug test. If a player taking a drug test takes too long to urinate, it can be complicated. I had a problem with the Brazilian national team. The team gets stuck, and people start getting sick on the bus, players with high blood pressure, vomiting. If the player urinates quickly, it's fine, but when someone takes a long time, it's complicated. So you need to get off quickly; that's the first thing you have to do.