Wednesday, May 18, 2016

What Did I Do to Myself?

Two days after completing the "World's Toughest Half" the headache I developed on the run finally started to subside. My quads still ache when I stand up, but I can deal with that kind of pain.

Hard to see, but my fingers were terribly swollen
Tuesday morning, as I was getting ready for work, HS noted that the bloating in my belly was going down. I could tell the difference too and thought "What did I do to myself?" I told him I thought I looked bloated in some of my race photos and he agreed. The definition was gone in my arms and my belly looked a little distended. I actually believe I managed to gain weight during the race!

My bloating was bad enough that during the run, my fingers became so swollen that they hurt to bend. They looked like fat little sausages sticking out of my hands. Now, swollen fingers are not something new for me, but it usually happens on a long run in 90+ degree heat.

The last few days at work have been torture. I have been tired, sore, and my head throbbed. It was all I could do at lunch to Google my symptoms. One thing that kept showing up in my various searches...hyponatremia.  Could I have been over-hydrated and/or had too low of sodium levels?

The Basis of My Diagnosis 

Risk Factors (from University of Connecticut Korey Stringer Institute website)
  • Exercise duration greater than 4 hours or slow pace (Yes on both)
  • Female sex (Check)
  • Low body weight
  • Excessive drinking during the event (I didn't think I did, but maybe)
  • Pre-exercise overhydration (I drink a LOT of water everyday, HS says too much)
  • Abundant availability of drinking fluids at event (Water, Gatorade and/or Coke at every stop)
  • Nonsteroidal anti-inflammatory drugs
  • Extreme hot or cold environment
At the Ultra Matathon Cycling Assocation website I found some very interesting information about bloating hyponatremia and urination shutdown.
Recognizing Bloating Hyponatremia
"The only way to definitively diagnose hyponatremia is to take a blood sample and analyze it for plasma sodium. Fortunately bloating hyponatremia has its own set of symptoms, first of which is the bloating itself:
  • Bloating: puffiness around the sock line and shorts band, at the wrists and hands around a watch and ring. The rider begins to feel and/or resemble the Michelin Man. The rider may experience a forehead headache which is accentuated by riding on a bumpy road.
  • Weight increase: a bathroom scale is essential for crewed events. The 2003 Boston Marathon placed scales along the course and advised anyone who gained weight during the run to stop drinking[34].
  • Nausea and vomiting: common in bloating hyponatremia, possibly more so than in other "exertional maladies"[31].
  • Altered mental status in a bloated athlete: indicates brain swelling and represents a dire medical emergency as do convulsions (or seizures) and coma.

I won't claim to look like the Michelin Man, but I do know that HS and James were laughing at the size of my arms in a picture of me on the bike. I don't think it was muscle so much as bloating.

The Urination Shutdown Mystery
"It is possible to grossly overdrink and overwhelm even the best of kidneys. Maximal urination rates are in the neighborhood of one quart/hour. If you're taking in fluid at a rate that exceeds what you're putting out via sweat plus urine, they you will bloat. Overdrinking has been the cause of many cases of hyponatremia.
It is also possible for unrination to shut down in the presence of a moderate fluid overload, one that the kidneys at rest will excrete. Why the urinary overflow jams shut for some people during exercise is not understood, but the result is bloating.
Urination shutdown can be dangerously misleading. If an athlete is not urinating, we think dehydration - but here is the exact opposite, an overhydrated athlete who has stopped urinating. To avoid making a mistake, consider the context: is the non-urinating athlete bloated? Has his/her weight increased? What has been his/her fluid intake over the last few hours? 

Without going into too much detail, let me just say that after I warmed up my wetsuit in Folsom Lake, I didn't go to the bathroom again until I was back home in Stockton...over 9 hours later! And that was after drinking  3-1/2 bottles of sports drink on the bike, fluids at every aid station on the run, and a large ice filled diet coke when we stopped to gas up the truck.

One More Thing
"Athletes aren't the only people susceptible to this condition. The elderly can also be affected because of the physiological changes that come with aging. Renal function, for example, can dramatically change the metabolization of water in the body and upset the sodium balance [Source: Merck]. According to the American Academy of Family Physicians, as many as 18 percent of elderly people living in long-term care facilities are hyponatremic [source: Kugler]. Women entering menopause are also at risk of hyponatremia because of hormone fluctuation and its effect on the body's ability to regulate sodium levels." ~ How Stuff Works
Great! Just freakin' great!!!!

Plan Going Forward 

I'm not sure if this was my problem or not, but I'm going to take a little precautionary measures to see if I notice a difference in how I feel...especially now that the weather is heating up and my race season has officially started. Here are some of the things I am going to try:
  • Weigh myself before and after long training sessions
  • Start taking electrolyte tablets during hot and/or long training sessions
  • Reduce the amount of water I drink during the day
  • Salt my food a little bit more