IMLou race report: aka hyponatremia sucks

This was my first IM, and even though I was just doing it to finish after repeatedly hearing the recommendation to not race your first one, I had a conservative estimate of 13:30. I have done a few Oly’s and one half-IM; however, I trained in the heat all summer and felt ready for the race.

The abridged version:
My run special needs bag was empty, so my wife insisted that I at least include one pack of Sport Beans and some Band Aids.
For the second night in a row, I got almost no sleep.

Swim:
I was in the back of the line, and did not start until after 7:30. While snaking my way down to the river, I notice a poor guy in the water who is definitely not going to make the cutoff.
I thought that the time trial start was done wonderfully. I jumped in, was able to stay behind a few feet on my way to the top of the island and hit the turn feeling OK. A few minutes later, after nearly swimming in to a kayaker, I rolled on my back and heard “you need to swim to the left, you are too far out.” OK. I’ll turn some to the left. About 10 minutes later. A second kayaker said “you need to swim to the left.” No kidding. Apparently I still swim to the right in open water, which has plagued me at other races. After consciously turning left after every few strokes on the way back, I exited in 1:19. This was about 4 minutes short of my expected time, but I felt good. I ran into the changing sauna, and threw on my gear. As I was leaving the tent, I almost ran into a female racer who was running into the guy’s exit. Needless to say, she quickly realized her mistake.

Bike:
I settled in on the first few miles of the bike and ate some food before hitting the first hill. Dead deer, dead skunk, another dead skunk. Wow…a toe on my left foot feels really weird (I have no idea what was going on, but by the end of the day my #2 toe was a huge, sausage-like blood blister encompassing the entire toe). I almost got pinned between two cars on the one lane bridge out River Road as I was passing a stopped car in my lane and the oncoming car decided not to stop. I progressed out to the spur at an easy 16-17 mph while putting down some more food. I had a great time on the spur and a good first loop around LaGrange.

On the second loop is when my day started to go downhill. I just began to feel funny—cloudy. I slowly started having trouble eating anything and even had difficulty drinking my mix. I decided to take a break at the first water stop outside of LaGrange for about 10 minutes to let my HR drop and try to get some fluids down. I felt a little better and made it around to the water stop on 42, but felt really out of it at that point and stopped again. My leg seized up while trying to get off the bike, and the volunteers had to help me get my leg over the seat. I used the bathroom (the port-o-potties with ample toilet paper were worth the entry fee at that point), had a gatorade, and ate a banana. After about 15-20 minutes, I felt much better. I left the water stop and enjoyed most of the downhills on the way back into Louisville. I did encounter a tractor hauling a trailer and backing up a line of cars on 42, which forced me to ride occasionally on the rumble strip, pinned over by the line of cars. After the tractor turned off, the traffic opened up, but the cars were still frustrating. My bike time ended up being about 7:30. By the time I hit the dismount, however, I started feeling funny again. My toe was also really bothering me while hobbling down to the tent in my bike shoes. I think that I ate a banana at the transition water stop, but I don’t really remember. I then checked out for the run.

Run:
I did not feel that the heat was overwhelming as I had done my long runs starting at 3:00 pm, but after the second mile I started to get dizzy and had to walk. I stopped at the next water stop and drank some more Gatorade, but the cloudy, light-headedness would almost come on in waves. I walked to the third stop and felt really “off” at this point. I was never tired, I just did not feel normal. After going to the bathroom again, which left me dizzy sitting on the seat in the sweltering port-o-john, I decided to sit down on the curb with some chicken broth, fig newtons, Gatorade, and water. I sat there for at least 10 minutes, and finally decided to give it a try to the next water stop. I walked there, took another fig newton and some Gatorade, and then started a gentle stride, which ended up being a big mistake and resulted in projectile vomit. At this point I was trying to calculate if I had enough time to finish the race walking and beat the cutoff.

I walked the next few miles, picking up a pretzel with water and a gatorade at each stop. I would take tiny bites and soak the pretzel in water and Gatorade in my mouth to get it down. After hitting the turn, I again tried to run, but started feeling light-headed after 1 mile. At this point, I had come to the conclusion that if I ran, I was going to push whatever was wrong with me over the edge and not be able to finish. I struggled down to the special needs bag and almost decided to pass it by, but I thankfully got the Sport Beans that my wife had insisted I put in the bag. Our anniversary was Sunday, and this ended up being a great present. I was able to get these down one at a time, and I felt fabulous all of a sudden. I was able to walk 13-14 min miles…until the beans ran out. It was like I had been hit in the head about 5 minutes after I ate the last one. I started getting light-headed again. The blood blisters that had populated the back of my heels then decided to pop almost in unison, soaking the back of my shoes with blood. I started on the pretzels, Gatorade, and water again, and was determined to finish.

After watching the sun set, I was issued a fancy glowing necklace…ahhh, another perk along with the port-o-potty on the bike. As I trudged along, trying to closely monitor my situation and not push myself too hard, I came to realize that this race takes on a whole new tone after the streets clear and it gets dark. I saw a few athletes in small groups, but mainly it consisted of people by themselves. I finally made it to 26, and I just sprinted around the corner to finish in 16:20. I don’t even remember the chute as I was more running to the med tent than across the line. My wife met me there as two race volunteers, who were wonderful, were escorting me to the med tent. She had volunteered as a lead runner escort and had closely followed me the whole time with a good friend.

I had some blood drawn and a few finger sticks. My glucose actually came back high: 264, 153, and 171 on three tests about 5 minutes apart, while my sodium was 130, which was labeled as fairly low by their range. I was sent home with some broth, and they had my wife check on me every 2 hours.
I had a few dizzy spells on Monday and a few on Tuesday, but I seem to be back to normal today.

I am disappointed that I had to walk almost the whole marathon. I felt well prepared and paced myself accordingly on the first half of the bike, and at the time I did not know what I could have done differently nutrition-wise. For a little while, I also felt somewhat undeserving of the label Ironman. In the end, however, I think that I ended up finishing a different competition than the race I began in the morning. I now see this race as almost two separate competitions: a majority physical endeavor during the day and a predominantly mental challenge once the sun sets (especially when they decide to put the turn for the second loop 5 feet from the finishing shoot and people are yelling that you are almost done when, alas, you have to turn right instead of left). I believe that physical/mental split is what makes this distance great and lets this race challenge many different types of people.

Maybe one day I will take another stab at the physical Ironman.

To the lady I saw heading out on her second loop as I was nearing the overpass coming home, you rock whether you finished on time or not.

good job buddy! Similar report as mine. Looking back it was obvious I was drinking too much but during the race I really couldn’t think of that possibility!

Happy Anniversary and You are an Ironman!
Dan
www.aiatriathlon.com

I’m not sure I understand why you think you had hyponatremia. I see that your sodium was low, but isn’t it possible that you sweated a lot of it out in the heat and had heat sickness/heat stroke?

low sodium is low sodium. It does not matter how it became low. The typical range is 135-145. Way to go. I was right behind you at 16:32. I think I consumed only 7-800 calories for the day. Crazy bad stomach!

Oh man. That is good stuff. Glad to hear you finished after all that.

“I felt well prepared …”

I’m laughing so hard it hurts right now. That is one hell of a day start to finish. I can’t believe you pushed through.

Awesome job gutting it out to the finish. Any idea why you got the blood blisters? Had that ever happened before? Seems like kind of an odd thing to happen at random.

-C

Wow, so many of the race reports sound alike. Let’s see what a lot of us had in common…

Felt great until the second la Grange loop.

Dizzyness

Nausea

Walking the run

Blisters

Hating being so close to the finish and having to do another lap

Fighting a huge mental battle

Trip to Med tent.

Glad you made it and congratulations.

Awesome job to finish - the first goal for every racer. We prepare as much as we can but in the end we don’t know what we’ll be dealt. Not sure you had hyponatremia. Vomiting is almost always a sign of too many calories. Most of us can’t handle the 400 cal/hr that Mark Allen recommends. Listen to the nutritionists - 280 cal/hr or so is the max. Also, try avoiding solid food during a race (options are Perpetuem, Sustained Energy, Infinit) and avoid fiber (fruit is high in fiber). Stay away from dairy. Fueling strategies are very personal and must be tweeked over time. These are just some things to try in training. Good luck for your next race!

Congratulations on your finish. You’re one tough dude!

It’s not just here and it’s not just Louisville. You can head over to the race reports of trainewbies and read dozens of the same type of reports.

“Everything was fine until Lap 2 of the bike / mile X of the run.”

Usually it’s someone doing the first or second. My opinion is that we vastly overestimate how hard we can ride and still deal with heat, absorb food, drink appropriately.

Only after a bit of experience do we finally understand how easy you really have to go to keep from falling apart at the end.

Nice report…congrats on finishing and glad you’re okay.

I had similar experiences…not as severe, but stomach issues. I too felt that I was better prepared physically and I still feel that way because of how quickly my body has recovered after the race. It really shows you how much nutrition is extremely important.

Thanks for the feedback.
I don’t think heatstroke was the problem because I never felt that I stopped sweating or became flushed and my HR was never racing. But you are right, the heat definitely was not helping me. I still think that my electrolytes were well out of whack mid-way through the bike, which caused my leg to lock up when dismounting at the water stop. I had been leisurely cruising at that point in the ride.

The turn at the finish almost strikes me as cruel. They could have done the turn down 3rd street.

I believe that the blister were the result of me walking and almost overstriding. I normally strike on my midfoot when I run and not much farther back when I walk at a normal pace. The back part of my shoes were particularly cruel to my ankles as I hit with the rear of my heel.

Thanks for the recomendations, CarlyBoy. I was shooting for 280 - 300 per hour, but I exceeded that intake in the first few hours of the bike. I definitely need to figure out what is going on with my blood glucose when I exercise for extended periods and do some more nutrition experimentation.

Congratulations to everyone that finished before or after the buzzer, and thanks to the people who hung around toward the end to cheer the last racers in to the finish.

Hyponatremia is a serious issue. The biggest problem sometime is the overabundance of aid stations. In your example, you were drinking WATER and gatorade with some pretzels (thankfully), but nevertheless becoming continuously hypervolemic at each aid station.

Read these threads really carefully:

http://forum.slowtwitch.com/gforum.cgi?post=1369748;search_string=hyponatremia%20devashish;#1369748

http://forum.slowtwitch.com/gforum.cgi?post=504341;search_string=philbert%20hyponatremia;#504341

http://forum.slowtwitch.com/gforum.cgi?post=39377;search_string=taku%20hyponatremia;#39377

Bottom line is that you want to avoid more liquid than your actual sweat rate. You need to know how much weight you lose in sweat under a variety of heat and humidity conditions and intensities and essentially only consume liquid based on your known sweat rate. As Noakes points out, thirst is realistically the best indicator. The whole notion of, “if you wait till you are thirsty its too late” is a bit of bullshit. Yes, you don’t need to wait till you are parched, but waiting till you are mildly thirsty is fine.

Let’s put it in the most simplistic terms.

NO ONE IS GETTING HYPONATREMIA IN TRAINING.

If we all just drink in racing like we drink in racing, the problem goes away.

Like I said, part of the problem is the stupid unneccessary 140.6 mile buffet that NAS sport serves up. If Graham Fraser cuts out 50% of aid station then the problem goes away (and it also becomes cheaper to put on the races). That puts things at 1 aid station every 2 miles…even at walking pace, 2 miles is covered in 40 minutes…no one needs aid more often than 40 minutes apart…it takes almost 30 minutes to digest!

Dev

Really disagree with your thinking that it’s NAS’ fault for over-providing on the aid stations - isn’t that a little like complaining about the route your buddy put together on the weekend because it went past too many convenience stores? If you don’t need food or drink, don’t take it - but for my part, I take something at every aid station on the run and would suffer if I had to wait 15 mins between drinks.

but isn’t the point of aid staitions being every mile that they’re there when you need them? if i’m racing, i’ve got the option to partake or not … if you’ve practiced your nutrition the way you practice your SBR you’d know what you need and then make on-course choices appropriately. of course, nobody suffers from this in training, but then nobody’s doing the full monty in training … leading to the belief that “it worked when i rode for 100 miles, but now i have to run a marathon so i should eat/drink more” …

… but i could be wrong.

In hot weather conditions, I want aid stations every mile, not necessarily for food or drink, but for ice and iced sponges.

OK, I am being a bit extreme here. It is not North America Sport’s fault that people get hyponatremic. It clearly is the fault of those pouring all the liquid down their throat. Seriously, you say you need liquid every 15 minutes? Do you actually drink every 15 minutes in training?

To back things up about eliminating 50% of the aid stations, this is what they did under the guidance of Noakes at Ironman New Zealand and the Comrades ultramarathon in South Africa and since then they have pretty well had zero incidences of severe hypervolemic hyponatremia.

The problem is that most athletes do not know their sweat rate, and they think they need more liquid. They get hypervolemic and dizzy and thing they are dehydrated and think they drink more liquid.

I understand that we are all responsible for our actions, however, with the number of newbies in Ironmans who are ill informed about the effects of over hydration, and the inability of athletes with impaired brain function due to hypervolemic hyponatremia to make effective decisions, sometimes, providing ‘safer’ support infrastructure is not such a bad thing.

  1. If you remove half of the McDonald’s restaurants, you will not change obesity.

  2. Underhydration is MUCH more frequent than overhydration.

  3. We really don’t know if the OP was truly overhydrated without knowing his weight pre and post race. A low sodium on blood draw could even be spurious.

Tom, trust me, you can survive with an aid station every 2 miles. You might find that using every second or every third aid station actually makes your final time faster.

Anyway, some of you guys might just want to get out of your North America Ironman view of the world and compete elsewhere in the world, or compete in sports like XC skiing, where aid stations are there, but not around every corner. As an example, I am yet to hear of a single case of hypervolemic hyponatremia in a long XC ski race, where over 50K, you might only get 3-4 aid stations. The typical athlete takes around the same time for a 50K XC ski race as a marathon, yet the marathon world constantly has deaths from hyponatremia from the “aid station per mile” effect.

2*. Underhydration is MUCH more frequent than overhydration.***

Just show me the number of deaths from underhydration vs overhydration in any typical year in endurance sports events in North America. Underhydration will not cause you to die. Overhydration can and does yearly. Please read the thread that I posted above. Some of the foremost experts in the field from around the world have contributed to them.

With respect to performance, most of the poor races in Ironmans are from, “Man I was dizzy and my stomach was bloated and it shut down”…not from “oh man, I was so thirsty and dehydrated that I could barely move”…even in Kona

Dev