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 ultrarunning.com: “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.”

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Insanity Defined

Dan the insane ultra runner

Dan completed all 101 miles of his run and he finished 8th out of 540 people!! Crazy! Crazier still, the average age of the runners and walkers was probably around 55! Dan can provide you with the juicy details, but he considers that 25.5 hrs of running one of the best days of his life. Dee & Pietro, Matt & Pete, and Elizabeth & I all crewed him during the day & then our amazing housemates crewed him throughout the night. It was a gorgeous sunny day and we travelled in style in D&P’s new camper van, Rondine. After the race we all had a delicious BBQ together. Personally, I really needed to eat a nice meal and relax after such a strenuous day of riding in the camper. And I think Dan may have been a bit worn out as well for some reason…

THE RACE!!!!!

JUNE 8th

June 8th: After having stuffed my small high endurance pack with the essentials for the ultra I cycled to the 15 miles to Gtown as my last training before the race. After 5 minutes on campus rummaging through the first aid kits for blister prevention supplies we headed for Pennsylvania! We went straight to the finish line to scout the terrain and envisage the last few strides of the race- v exciting stuff. At 5:30pm we went to the pre-race dinner- pasta, bread, cake, salad- every ones plates were stacked high! Listening to the race director go on about all the tricky spots on the course and giving sound advice about the initial 8 mile climb had us all ears. The atmosphere was pretty thick with anxious excitement, after a brief chat with some other ultra runners we headed to the hotel for a beer before bed (it was very stormy on the way back- but we were assured that the front was just moving through making for a sunny but dry race day!). Over a beer at the hotel two older looking men joined us- they were in their 60ies and fellow competitors. We sat and talked ultras for a half hour- one of these guys had no cartilage in his knees, was missing a few bones among other injuries “but just loves the atmosphere at ultras” and so was going to run the full 70 the next day, crazy. The other guy had run 10 100 milers in a year and 35 100 milers in total- but was totally chill- he was planning to just make every cut off and just have fun. When he left Rick informed us that he ha written a book too (I guess he didn’t want to boost his ego!)!! Bed at 8pm -sleep much- I don’t think so (that’s the problem with trying to stay super hydrated all day- you spend all night getting up to go potty!! The beer did not help in that department by the way!)

JUNE 9th RACE DAY

June 9th: Woke up at 2:45am- went to finish and caught a school bus to the start (over 1:30hr ride). The bus drivers Claire coming through the clouds!remarks as he dropped us off were: “I’m going to drive back now- you guys can run!”- and we did. After the last preparations and lubrications 5:30am came and …. OFF we went. race-1.jpg 100 nutters climbing up this hill with big smiles on our faces! The advice was to not go fast up the first 8 miles or we would be paying for it 4-5 hours later… and slowly but surely we went. Rick assured us that we would see all the sprinters again later on (and we did!). The first 2 hours were in a cloud of fog with occasional drizzle (not what the weather had forecast but e were hopeful all the same). At mile 12 I got a bit of a funny pain above my left foot which was quite worrying as it was a very acute ache that I had never had before. Trying to stay positive I focused on all the prayers and thoughts of many for me and begged Big G for some ole healin touch- and surely enough at mile 20 it completely disappeared, as did we from Ricks sight. Rick was doing a great job of pacing and I was determined to stay with him, but I was so eager to burst on ahead that when he encouraged Claire and I to go on for the third or fourth time we did. He said “you know all the important stuff now so go at your pace and just don’t go fast up the hills (mind you if I pass you later on- I will laugh!!)”. Claire and I spent the next 2 hours CRUISING with fantastic conversation before we joined on to another duo with Marathon?… easy!!!whom we chatted for 10-15miles. Miss Richmond and Mr Blue (I’m not good with names). And so we raced past the marathon 26 Beautiful Fernsmile and the 50k mark slowly progressing in to un-chartered territory! The scenery, as you can see from the photos, was absolutely stunning, ferns that were glowing, fluorescent green and sometimes as tall as us; thick forests that only let shimmers of light through and sparse fields surrounding lakes brilliant in the sunshine. I also need to mention the uplifting aid station crews who were so encouraging and helpful: greeting you with huge claps as you emerged out of the trees, taking our packs and getting us all the supplies our bodies craved! When the trail got kind a rocky we lost Mr. Blue and Miss Richmond and sped up ahead to mile 46 where we were re-united with a drop bag of goodies (a bag we had prepared and asked to be left at this marker to give us something to look forward to!) Our goal until now was to finish STRONG before 22hrs- no injuries, safe and sound with the thought “I could have done this faster”. Well something was happening as we were going by more and more markers, my Happy at 50 miles!competitive side was kicking and screaming to come out! I started to dream about finishing before 18 hrs which was the old skool cut off time that challenged many…. then looking at my watch and pace I cut it to 16hrs- according to our speed that was well within our grasp!! After a proud moment with the 50 mile post we hurried on… only 20miles left!! We were well on target to finish strong!! But something happened- a little demon called fatigue started to catch Claire and the next 10 Mr Blue and Miss Richmondmiles were spent trying to out run him. Our goal for a 16hr finish diminished in to a 17hr- but that was ok. We tried everything- words of encouragement- pep talks that I think made Claire want to shoot me at times, but then at mile sixty whoooop! Claire got a second wind!! I think what did it was making very loud animal noises that did it, or it could have been singing “I’m a lumberjack” or maybe “the hills are alive”!! The second wind lasted until the dreaded grilled cheese sandwich aid station. At mile 62 there stood the last aid station- the last calorie kick until the finish, the last smile and bit of support before the descent of the mountain. Emotions can be a bit warped after nearly 16 hours of running so it shouldn’t have been a surprise that Claire fell in love at this point. She fell in love with her wheat breaded grilled sandwich, and was now down to a mesmerized walk. It was dark, and somewhat selfishly I still had high hopes of breaking 17hrs. I had told my dear friend that I wouldn’t leave her in the dark, but we had now come across a fellow competitor who was going at her pace…. and I still regret this a bit but I said: “do you mind if I go…”. Claire said: “sure”- and with that I booked it! So much for camaraderie (I had just let go of my word in favor of pride- quite shameful really- Flying High!SORRY CLAIRE). I looked down at my watch and I had to average 10minute miles for the last 8… on rolling hills, in the dark, in the woods- hhmmmm. I took a few pain meds and thought- whatever- you only live this race once. Peggin it down the path I made the first 6 Going strong beyond the 50miles at an average of 11 minute- but I knew that the last 2.5 where steep technical down hill. That could mean careful safe steps down or RISK IT ALL AND JUMP! Guess which one I chose. I made the last 2 at a 7 minute and last one a 6 (this is notoriously a short mile though!). Sprinting past the finish I ran and hugged the first person I saw- which ended up being my bro in Law! Quickly kissed Anna and asked- “what was my time? what was my time? did i break 17hrs????”………….. 16:59 baby- oh yeah!! 10:29pm. Its funny how things turn out just right innit. I would re-live that whole 17 hours in a second- it is up there with the greatest days of my life so far…. could it be due to so much prayer…. I think so. Thank you to every one who supported me!