BHL
08-28-2007, 10:09 PM
On the D2R2 ride a few days ago, I learned the hard way what most ultra-endurance athletes already know about sodium balance.
I ride a lot (commute to work, some brevets, 5-10 centuries/year), but I'm not a racer and have never considered myself an endurance athlete. I've heard of marathon runners 'drinking themselves to death', but haven't thought that I fit into the ultra-endurance category. That all changed last Sat on the D2R2 ride when the combination of high temps, high humidity, a brutally challenging ride and some ignorance on my part made for a perfect storm of circumstances that ended up sending me to the hospital for the night.
I had been looking forward to the D2R2 ride for almost the whole year. After doing the shorter ride last year, I was really excited to try the longer ride this year. At the beginning of the ride, I was talking with some other riders about how it would be hard to stay hydrated during the ride 'cause it was going to be so hot. I've done plenty of rides during hot and humid weather, but rarely a ride this hot and long.
I was having a great ride for the first 90 miles, feeling strong up the hills, enjoying the company of Randy from Vt and Tom from Kansas. We were all working well together, cranking up the hills and flying down the sometimes sketchy descents. I was drinking a lot, but the thought of sodium balance didn't enter my head, partly because I just didn't know that it could be a problem for me and partly because I was also drinking Gatorade (about 1:1 with water bottles) and eating what I thought was enough (PB+Js, many bananas, and 'energy' bars). I also tried a few of the Hammer supplements that the organizers had included in the 'goody' bag.
At the extra water stop near the Green River after talking with Ginger (and getting my picture taken as a forum lurker-she was on a mission), I sat down for a bit in the shade and thought about the rest of the ride. I was starting to feel tingly, which I associated with dehydration, so I drank some extra water, and told Tom and Randy to go on without me. I was just starting to feel wiped and had been having trouble keeping up in the last few miles. I sat for a while and started to feel crappy about abandoning so I thought I'd go down the Green River a ways and see how I felt when I got to the turn-off to go up the hill. I didn't feel any better and knowing how steep the hills were, I gave up and headed back towards Greenfield. I was still feeling ok, tired, but nothing unusual.
Back at the start, I talked briefly with Ginger and Jtferraro about going out for beers (that would have been 'exciting'), took a shower, drank some coke (water didn't seem appealing) and tried to eat some enchiladas. Unfortunately, I didn't feel like eating much so I just sort of sat there and listened to the music. I was kind of worried about the guy sitting across from me who was putting his head down a lot and eventually got up and lay down on the grass. I realized eventually that I was sitting next to Kevan, but I was starting to kind of fold in on myself and wasn't feeling very social. I was waiting for Tom and Randy to see how the rest of the ride was and when they didn't show up I decided to head home at around 6 and see my family.
I was still feeling ok for the drive home, a little tired and out of it, but still nothing unusual.
It's good I left when I did, because I only remember snapshots of the next 10 hours.
When I got home I was feeling lethargic, my wife said I didn't look too good and maybe I should take a bath because she thought I had heat stroke. After the bath (which I don't really remember), my wife asked if I was ok because I apparently seemed kind of dazed. She said (later) that she was getting worried especially when I didn't respond when she asked if I needed to see a doctor (she knows I'll do anything to avoid the attention, unless absolutely necessary). Then I guess I started shaking and she called the ambulance (btw, she was absolutely wonderful and non-judgmental about the whole [terrifying to her] experience-I'm very lucky).
The short story of the hospital stay is that my sodium level was at 121 units 3 hours after I got the IV in the ambulance-so it had probably been even lower. Apparently 130-140 is normal and 115 is very dangerous. I was shaking uncontrollably for I guess 4 hours and didn't know where I was and could not easily form thoughts or answer questions (brain edema from sodium imbalance). My wife tells me I had IV's in both arms for several hours and the medical staff was very concerned about seizures (they even threw in a CT scan).
After continuous IV, I could sleep calmly by 3 am and by 8 am I felt perfectly fine. The strange thing is that for the rest of the day I hardly felt like I did a hard ride - no soreness, good flexibility and very little fatigue (my doctor neighbor said this is because my whole system was essentially flushed with all the IV fluid).
I hate that I put my wife through this, and I'm mad at myself that I was ignorant enough about sodium balance on super hard rides that I didn't take care of it.
I'm writing this (it's not my proudest moment :) ) because I think there are a lot of other hard-riding 'recreational' riders out there, who like I did, think that hyponatremia (lots of good info on the web if you search 'hyponatremia ultra-endurance athlete) doesn't apply to them, simply because we don't place ourselves in the 'endurance' category (even though we clearly should-100 mile rides seem normal to us, but they are standard deviations away from the average). The other problem is the 'gatorade myth'. I now know that there are some good studies that have shown that gatorade cannot replace salt lost during hard rides because it its hypotonic (and mostly sugar anyways). I thought that I would be fine as long as I downed some gatorade. As many forum members know (TT, Skrawny et al.), but some may not, some kind of true electrolyte supplement or salty food source is needed to balance out salt lost during sweating and to prevent the diluting of blood from drinking water. My doctor actually suggested simple salt tablets-any thoughts on this?
I think it's worth stressing that hydration is important, but equally important, especially on rides longer that 3 or 4 hrs, is maintaining sodium balance (again, I realize that many people know this, but I hope my ignorance/denial will help someone avoid this very dangerous condition). I'll leave it to others more knowledgeable to comment on specific strategies or you can search 'hyponatremia' on the forum for some good discussion.
I feel very humbled by this experience. It's scary that I could have gotten so close to actually dying just by doing what I love to do. Yes, I realize the conditions were extreme and that this probably wouldn't have happened last year, but I should have known. If you ride long distances, please read up on hyponatremia and acknowledge that what we are doing are ultra-endurance events.
I ride a lot (commute to work, some brevets, 5-10 centuries/year), but I'm not a racer and have never considered myself an endurance athlete. I've heard of marathon runners 'drinking themselves to death', but haven't thought that I fit into the ultra-endurance category. That all changed last Sat on the D2R2 ride when the combination of high temps, high humidity, a brutally challenging ride and some ignorance on my part made for a perfect storm of circumstances that ended up sending me to the hospital for the night.
I had been looking forward to the D2R2 ride for almost the whole year. After doing the shorter ride last year, I was really excited to try the longer ride this year. At the beginning of the ride, I was talking with some other riders about how it would be hard to stay hydrated during the ride 'cause it was going to be so hot. I've done plenty of rides during hot and humid weather, but rarely a ride this hot and long.
I was having a great ride for the first 90 miles, feeling strong up the hills, enjoying the company of Randy from Vt and Tom from Kansas. We were all working well together, cranking up the hills and flying down the sometimes sketchy descents. I was drinking a lot, but the thought of sodium balance didn't enter my head, partly because I just didn't know that it could be a problem for me and partly because I was also drinking Gatorade (about 1:1 with water bottles) and eating what I thought was enough (PB+Js, many bananas, and 'energy' bars). I also tried a few of the Hammer supplements that the organizers had included in the 'goody' bag.
At the extra water stop near the Green River after talking with Ginger (and getting my picture taken as a forum lurker-she was on a mission), I sat down for a bit in the shade and thought about the rest of the ride. I was starting to feel tingly, which I associated with dehydration, so I drank some extra water, and told Tom and Randy to go on without me. I was just starting to feel wiped and had been having trouble keeping up in the last few miles. I sat for a while and started to feel crappy about abandoning so I thought I'd go down the Green River a ways and see how I felt when I got to the turn-off to go up the hill. I didn't feel any better and knowing how steep the hills were, I gave up and headed back towards Greenfield. I was still feeling ok, tired, but nothing unusual.
Back at the start, I talked briefly with Ginger and Jtferraro about going out for beers (that would have been 'exciting'), took a shower, drank some coke (water didn't seem appealing) and tried to eat some enchiladas. Unfortunately, I didn't feel like eating much so I just sort of sat there and listened to the music. I was kind of worried about the guy sitting across from me who was putting his head down a lot and eventually got up and lay down on the grass. I realized eventually that I was sitting next to Kevan, but I was starting to kind of fold in on myself and wasn't feeling very social. I was waiting for Tom and Randy to see how the rest of the ride was and when they didn't show up I decided to head home at around 6 and see my family.
I was still feeling ok for the drive home, a little tired and out of it, but still nothing unusual.
It's good I left when I did, because I only remember snapshots of the next 10 hours.
When I got home I was feeling lethargic, my wife said I didn't look too good and maybe I should take a bath because she thought I had heat stroke. After the bath (which I don't really remember), my wife asked if I was ok because I apparently seemed kind of dazed. She said (later) that she was getting worried especially when I didn't respond when she asked if I needed to see a doctor (she knows I'll do anything to avoid the attention, unless absolutely necessary). Then I guess I started shaking and she called the ambulance (btw, she was absolutely wonderful and non-judgmental about the whole [terrifying to her] experience-I'm very lucky).
The short story of the hospital stay is that my sodium level was at 121 units 3 hours after I got the IV in the ambulance-so it had probably been even lower. Apparently 130-140 is normal and 115 is very dangerous. I was shaking uncontrollably for I guess 4 hours and didn't know where I was and could not easily form thoughts or answer questions (brain edema from sodium imbalance). My wife tells me I had IV's in both arms for several hours and the medical staff was very concerned about seizures (they even threw in a CT scan).
After continuous IV, I could sleep calmly by 3 am and by 8 am I felt perfectly fine. The strange thing is that for the rest of the day I hardly felt like I did a hard ride - no soreness, good flexibility and very little fatigue (my doctor neighbor said this is because my whole system was essentially flushed with all the IV fluid).
I hate that I put my wife through this, and I'm mad at myself that I was ignorant enough about sodium balance on super hard rides that I didn't take care of it.
I'm writing this (it's not my proudest moment :) ) because I think there are a lot of other hard-riding 'recreational' riders out there, who like I did, think that hyponatremia (lots of good info on the web if you search 'hyponatremia ultra-endurance athlete) doesn't apply to them, simply because we don't place ourselves in the 'endurance' category (even though we clearly should-100 mile rides seem normal to us, but they are standard deviations away from the average). The other problem is the 'gatorade myth'. I now know that there are some good studies that have shown that gatorade cannot replace salt lost during hard rides because it its hypotonic (and mostly sugar anyways). I thought that I would be fine as long as I downed some gatorade. As many forum members know (TT, Skrawny et al.), but some may not, some kind of true electrolyte supplement or salty food source is needed to balance out salt lost during sweating and to prevent the diluting of blood from drinking water. My doctor actually suggested simple salt tablets-any thoughts on this?
I think it's worth stressing that hydration is important, but equally important, especially on rides longer that 3 or 4 hrs, is maintaining sodium balance (again, I realize that many people know this, but I hope my ignorance/denial will help someone avoid this very dangerous condition). I'll leave it to others more knowledgeable to comment on specific strategies or you can search 'hyponatremia' on the forum for some good discussion.
I feel very humbled by this experience. It's scary that I could have gotten so close to actually dying just by doing what I love to do. Yes, I realize the conditions were extreme and that this probably wouldn't have happened last year, but I should have known. If you ride long distances, please read up on hyponatremia and acknowledge that what we are doing are ultra-endurance events.