kidney krisis III

WEDNESDAY June 8th  – Dan was feeling a bit better Weds due to the dialysis and was even up for some visitors. This was especially good news because I had to leave my post by his bedside and return to work. On the one hand it was very hard returning to work, but it was also helpful to see the sights outside of the hospital and to not be 100% focused on the kidney craziness.

I spent a good chunk of time communicating w/Dan’s family in England and also my family here (both were supportive and superb), as well as sending out texts & Facebook updates to let people know what was going on.  It was beautiful to see so many people express their love and  prayers for Dan, but despite the “virtual friends” it was very isolating.  After 3 days of just me, Dan and a ever-changing stream of nurses and doctors, it was amazing to have flesh-and-blood visitors from Weds on.

After Dan started to receive dialysis he began to (finally!) show signs of improvement. He began producing more urine but his blood levels were still a disaster. All in all, Dan was more alert and awake and able to eat a little too (practically the first food he’d held down since last Friday). He still felt some nausea and a pain that he described as having a huge weight literally on his chest, but was less bloated since they removed excess fluids when they did dialysis.

THURSDAY JUNE 9 though WEDS JUNE 15 – Dan was improving and they moved him to another room, where he didn’t need a heart monitor. We even entertained hopes of still attending our dear friend Russ’ wedding in the Adirondacks that weekend…. but it was not to be.

When Dan improved after disalysis, it was hard to tell if his kidneys were beginning to function, or if the dialysis had just done the job his kidneys weren’t doing.  The main way to know if one’s kidneys are working is if his urine output matches his fluid intake, so we kept a constant tally of every milliliter Dan took in and put out.  Peeing was also important because if Dan started retaining fluids, the fluids could fill his lungs, causing pulmonary edema or congestive heart failure.

Thankfully, the doctor was optimistic enough to postpone the operation to have Dan receive an permanent-catheter that would be necessary if he needed to have continued dialysis treatment after being released from the hospital. The catheter currently in his neck couldn’t be used outside of the hospital due to high risk of infection.

And so the rollercoaster continued. Every day we asked the nurses, what the prognosis was:

“Will I need more dialysis?”

“When can I get out of  hospital?”

“How are my blood test results?”

And they would reply, “You have to ask the doctor.”

But the doctor was usually only available for 10 minutes a day – which 10 minutes was hard to say!  And you don’t even want to know how much money they charge for that 10 minutes! But, actually, despite the limited contact, our nephrologist was great.

Not knowing is the hardest part.

And the better Dan felt, the more restless he was to GET OUT OF THE HOSPITAL! And after “camping out” at the hospital with him for 10 days, I felt the exact same way.

kidney krisis II

MONDAY JUNE 6th –  The first few days and nights at the hospital were horrible. Dan was termendous pain and didn’t even have the energy to watch TV. When the doctor spoke of Dan’s situation he said, “He has severe severe dehydration and very very very acute renal failure.”  And despite all the IVs and meds and nurses and doctors, he was getting MUCH worse.  Dan was constantly receiving IVs that kept pumping him with liquids in hopes that eventually the fluid would break down the myoglobins blocking his kidneys… but it wasn’t working. Dan’s creatine levels continue to worsen, and he was becoming a human water balloon since for 3 days he didn’t urinate at ALL. Monday evening he peed for the first time and it looked like black coffee.

The nurses were monitoring Dan’s heart and Monday night Dan had to wear an oxygen mask but that made him feel claustrophobic and panicky.

I spent about 72 hours straight at the hospital.  My neck ached from sleeping on the hospital bed-cum-chair and it was hard to sleep with all the machines beeping and the nurses coming in every hour (but never when you needed them right away)!

TUESDAY JUNE 7th – Dan’s kidneys still were at 0 function. His body was filling up with toxins since his kidneys weren’t filtering them out and he still was barely urinating.  His body was literally poisoning itself. So, Tuesday morning, Dan went into surgery to have a tube inserted into his neck – a catheter that they would use to give him dialysis.  Hemodialysis dialysis is basically an artificial kidney. They connected Dan to this huge machine that looked like something from Back to the Future. Blood comes out of a tube from Dan’s neck and is then “cleaned” in this machine. The toxins (which would normally in one’s urine) are filtered out and discarded down the drain from a tube that comes out of the dialysis machine. And then “clean” blood is returned to his body through another tube.  However, like most mechanical substitutes for human organs, there’s risks involved with dialysis… such as hypertension and cardiac problems.
The scarriest part, however, was that the doctor said there was a 50/50 chance of Dan having to continue dialysis for weeks, months or even years.  I think we both tried to not even think about the possibility of Dan being on permanent dialysis, as this would mean a dramatic change to our lifestyle… trying to thru-hike based on dialysis centers? Never being away from civilization for more than 3 days?  No, our brains could not go there.
Thankfully, Dan felt better after his dialysis and they also removed 1 litre of fluids from him.

kidney krisis I

EXCUSES – Well, I’m guessing most of you know by now I have a pretty good excuse for not blogging for the past month. In short, Dan ended up in the hospital for 11 days with acute renal failure after a 50 mile run. It was terrifying and lonely and even after his release from the hospital, new ailments seemed to pop up daily. I kept thinking “I’ll blog about this when it’s all over,” but it seems to be never-ending… So I’ve decided I can abandon the blog no longer.

Here’s the nitty gritty:

BACKGROUND – Dan hadn’t been feeling the best, but we thought it was probably just nerves about his upcoming 50 mile race. Even though Dan’s done over 30 of ultra runs, including a 100 miler, he hadn’t raced competitively in a few years.

RACE DAY – SATURDAY JUNE 4 – Dan woke up feeling a bit nauseous, but he hadn’t been sleeping well and was now waking up at 3 in the morning  to run 50 miles in blazing hot sun. In the darkness, Dan and his running buddy, Bill, headed off to Algonquian Park, along the Potomac River, which was both the start & finish of the North Face Endurance Challenge Gore Tex 50 mile race.  They went out FAST…. their marathon time was under 3.30, but soon afterwards Dan started to lose energy, feel week and start vomiting. started vomiting (which isn’t unusual in ultras… imagine eating and drinking while also running almost 2 marathons back-to-back).  Dan’s memory’s of the race are a bit hazy but he does recall starting to lose balance if he slowed to a walk, so he kept running.

“Did you ever consider dropping out of the race?” I ask.

“No,” he responds simply.

So sure enough, he finished the full 50 miles.

And then he promptly collapsed in the grass, saying he didn’t feel well. But, heck, how many people feel great after running for a solid 9 hours? He still felt good enough to hang around the event for the rest of the afternoon – chilling in an ice bath, enjoying a free massage, having a few bites of his free lunch (I devoured the rest). Dan vomited once more and then we headed home. Since he’d vomited a fair bit, we made sure he drank lots of fluids and took plenty of electrolytes in to replenish.  Ultra runners’ thrive on the stories of the extremes they put their body through – bloody urine, inability to walk for days later, loosing 15 lbs in a day… With all the hype we’d heard, Dan’s situation didn’t seem abnormal or anything we should be concerned about. He drank even more water and then was off to sleep.

SUNDAY JUNE 5 – Around 3 am Dan vomited again and a LOT. This was not good.  “Ok,” I thought, “he’s not holding down fluids and is going to be seriously dehydrated unless we get him on an IV drip, we’ve got to go to the emergency room.” But Dan insisted he felt much better now that he’d thrown up and he didn’t want to go to the emergency room, he just needed to sleep more. I tried to fight him on it but he was stubborn so we compromised by having him rehydrate. But a few hours later that came back up too. We were able to schedule an urgent car appointment at Kaiser in Reston and went in at 1o am.

Dan hadn’t even showered after his race and was still wearing his nasty running clothes. He could barely walk but stubbornly insisted on walking to the car on his own.  Thankfully we had a car in the first place… normally our only mode of transportation is our bikes, but we were borrowing a car from some friends who were road tripping. We got to Kaiser and they put Dan on an IV drip. We were planning on going to the pool w/our friend that morning and then later going to the Textile Museum, so I figured our morning plans would have to be canceled but Dan would be up and running (ok, not literally) by the afternoon.

However, after Dan’d received 2 IV bags, the doctor came over to us and said, “Dan had acute renal failure, we’re transferring him to Reston Hospital.”

Acute renal failure? Rhabdomyolysis?

I’m thinking, “What?! I have no idea what that is but it doesn’t sound good.”  Dan was very out of it, mostly sleeping, and just moaning and saying one or two words when I spoke to him.  My mom came over to Urgent Care and we got the run down from the doctor.

THE SEMI-MEDICAL EXPLANATION – So basically when you exercise, you first drawn energy from carbohydrates in your body, then fats, and then… if there’s nothing left and you’re still exercising… your muscles. And when there’s a lot of muscle breakdown it’s called rhabdomyolysis.  Creatine phosphokinase (CPK) – a muscle enzyme – levels are normally around 200 U/L, you have rhabdomyolsis if your CPK levels are above 10,000 U/L. I don’t know Dan’s exact numbers, but the doctor said he had the highest CPK levels he’d seen in his 30 years as a kidney doctor.

Rhabdomyloyis is very common among ultra runners and even marathon runners (they call it Rhabdo), but generally the main symptom is weakness and the treatment is just hydration.  However, if enough big globs of muscle protein (myoglobin) are released into ones bloodstream, it can block the kidneys, leading to acute renal failure – or a sudden and complete shut down of the kidneys.

The kidneys basically function to filter toxins from our bloodstream, which we release as urine. If you have Rhabdo your pee will look dark like coca cola. If you have acute kidney failure, you can’t even pee. According to “Exercise-induced rhabdomyolysis only very rarely progresses to acute renal failure. The reason for this curious but clear difference in the progression to renal failure is not known. However, in those very rare instances where rhabdomyolysis leads to renal failure in ultramarathon runners, it appears that a ‘perfect storm’ of factors seems to be present (extremes of hydration, non-steroidal anti-inflammatory drug (NSAID) and analgesic use, heat stress, recent viral/bacterial infection, low fitness).”

AMBULANCE – So Dan got a ride in the ambulance to the hospital and I ran home to grab some items and drop off our dog at my parents.

And so for the next 11 days, we called the hospital our “home.”