I've always used Swiss doctors and it's been no problem, so I'm sure a German doc is fine. MDS is the only race where they really scrutinized the paperwork. There they actually sit you in front of a panel of 3 docs and do a mini interview to check your paperwork, scan your EKG, and find out if you actually trained for the race. All the rest -- they just grab the paperwork, toss it in a file, and put a check by your name.

Agree with you about the heart stuff -- a redlined 5K seems to me much more of a burden on the heart than a 50-miler on trails!