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.”



JUNE 2nd: Blessed indeed. I ran with JT (a friend from church) at the retreat… and while running hinted that I wanted to do a long training run in the night this weekend, but was anxious about doing it on my own. Without hesitating he said he would join me. I thought he was being polite, but alas he phoned me in the week and we organized a 50 k run for tonight! The cross county trail runs for 38 miles through the whole of Fairfax county (you run in the woods crossing a hand full of roads- its hard to believe that you are running through suburbia). I scoped out a thirty two mile run and spent the afternoon making peanut butter sandwiches , cliff shot electrolyte mix, gathering salty treats and hiding them in a safe place at the mid point on the trail. I also went to the pharmacy to stock up on pain killers, muscle cream and lube. After a big bowl of pasta and chicken John and I set out for an epic run (8pm). Once the sun goes down the challenge of running becomes quite different. The mind has to stay well alert for rocks and logs on the trail, bends and stream crossings, tracts where other trails cross and trail signs seem to disappear, movements of deer and other animals and after a few hours of running when you start getting tired shadows definitely start playing tricks!! During a night trail run you can expect to spend a fair amount of time retracing your steps and running ahead a bit on unknown trails to make sure they are correct before you commit to sticking to them- but either by luck or skill John and I only lost a few miles doing that the whole night (I think it would have been quite a few more had i been on my own!). Another point to note was that my estimate of the distances we were running definitely seemed a little off (some of the maps i researched hadn’t quite taken in to consideration the many little bends in the trail!)- one of the miles seemed to go on for about 4… we just made that in to a bit of a joke, and adapted our route accordingly. Great conversation, 2 peanut butter and jelly sandwiches, some muscle rub, gallons of water and gator aid, some pain killers, wheat thins and 7 hours and a half later (3:30am) and quite frankly who knows exactly how many miles later (definitely over the 50k planned) John and I were stretching and smiling by the car! It should be noted that John had never run a 50k (although he has done marathon running) – and he breezed through this run – awesome!
The plan for me is now not to run until Tuesday to let everything recover slowly and not risk any injury!


MAY 30th: Claire and I met with Rick (a ultra running pro- with many 100 milers under his belt) to discuss plans for the race. Rick actually gave up running a 100 miles on June 2nd to run with us and keep us motivated! He gave us plenty of sound advice- among my favorites was the kidney advice: never pee out everything in your bladder (especially before a long down hill)- its pretty scary when you go to the toilet after having emptied completely and finding out that you are peeing pure blood due to the empty kidneys having rubbed together for a while…. I am glad that rick has gathered so many useful tips along the way to prevent many mistakes like that- or explain what is going on if they happen.
After meeting with Rick, Claire and i went hill running to practice for the mountains in now less that a week and a half!!!
June 1st: My legs aren’t aching too badly, but i definitely feel like I haven’t given them much of a break recently, so today I shuffled for an hour to give them some rest before my last long training run tomorrow.


MAY 29th: 15 miles in the morning before work went v. well. I managed to slow my pace by a half hour, stretched well and the fact that it was early enough that the sun wasn’t too hot helped a lot. Mind you the thing I find hardest is when someone on a slow 3mile run over takes me- my pride gets broken a little (which is a good thing)- I think running in a small group keeping a pace will be key to slowing down more (essential in the 70).
The way back was only slightly harder due to the sun. I actually increased the run by 2 miles making the day in to a 50k. I definately felt my legs cry out on the last 5 miles but with home nearly in sight I kept up till the front door.
The key elements to the run were- 2 GUs (gulped down when I felt like stopping), long stretching at the end of the run, a quick stop in to 7 11 to get some gatoraid to replenish the salt that was visible on my face, backpack, shorts and shirt (they all looked like they had been sprinkled with talc!), massaging my legs to get rid of the lactic acid build up. I had one beer when I got home- but it definitely made me feel a little oozy- so maybe it doesn’t do it for me!


MAY 28th: OK- I am back home for good until the race!! Wohoo- serious training can finally begin. Today I added a few ultra-running sites to my favourites that had a ton of reading and check list advice–keeping hydrated, well fed, replenishing electrolytes/salts, techniques to stop chaffing, even why drinking beer or wine as you run might help!! In the afternoon Anna got her rolling blades on and we went for a 10 miler together. Tomorrow I am planning my first long run (of 2 before the race). I will run 15 miles to work and then 15 back- that’s about 46 kilometers. The biggest challenge will be keeping a slow pace ( I usually run to work in 1 hour 50 minutes but i want to make the 30 miles draw out in to at least 6 hours to get my body used to being on the go for a long time. I will also try a few different foods on the way to see what my body craves when it is under strain. Here are a few things i might try:
Pb and J sandwiches, tuna pasta, salt tablets, double latte Gu, banana Gu, coffee, Gatorade, muscle relaxants and maybe a beer! (i’m not sure what the law says about that on the cycling path however!!)



MAY 27th: Less than 2 weeks until the race!! I got back from the Georgetown trip to Sicily and England three days ago. On the trip I was ready not to train at all so it was a pleasant surprise to have three keen runners as participants. We managed an hour to an hour and a half run every other day. The runs seemed like no effort at all with great conversations and awesome scenery (beaches, rolling hills, quaint towns). Even so, a little anxiety set in as I landed back in the states knowing that the race was coming soon and serious training had not yet began. With that in mind the day after I landed Anna and I went off for two days for our spring church retreat (with Georgetown Community church). I managed to squeeze 1 two hour training run along the Potomac near Leesburg just before setting off… the run went well- although it definitely felt like I hadn’t run for over 1.5 hours in a while (maybe it was the humidity and hot sun)- running for ten times that amount does make me a little nervous. On the retreat I was once again blessed to find two friends who came running with me.


MAY 2ND: I am leading a trip in Sicily from 7-24 May, so the real training will start after that! That only gives me 2 weeks of hardcore prep which will include a few 50k runs to get my body used to being on the go for many hours. The training right now is shorter and faster runs (8-15miles), cycling (15-30miles). About 1-2 hours of exercise about twice a day. That will be cut down to hardly anything in Sicily. The biggest challenge is not going to be one of speed, but one of mental and physical endurance. Upping the running for periods of 7 + hours in the 2 weeks before will be crucial. The actual race will have me goiing for 15+ hours!