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.”