I am writing to so many people for a few reasons -
first, I have received many inquires about how I am
doing after the Vermont 100 miler. Also, many
people heard about what happened (which I'll explain
below) but only got parts of the story. So you'll get
the story here - as best I know it, from me, Michele
Burr - the person who got a severe case of
hyponatremia at VT100. The people who do know about my
getting hyponatremia have urged me to post something so
that people are aware of this very serious problem.
I must admit, I don't remember much because I had a
seizure and went into a coma but I have pieced together
many things from people who saw me at the end of the
race and from talking with my husband, who thank God,
was there at the finish line and with me during my 5
day stay at two hospitals in Vermont and then New
Hampshire.
WHAT IS HYPONATREMIA? This is a condition in which
there is a very low concentration of sodium in your
blood. It is also seen in conjunction with WEIGHT GAIN
(not weight loss) and most often occurs during
endurance exercise lasting more than 5 to 7 hours. More specifically, hyponatremia develops as sodium and free
water are lost and replaced by fluids, such as
plain tap water, half-normal saline, or dextrose in
water. Basically, this condition occurs when a person
takes in too much water and not enough salt. So you are
probably wondering...was I taking Succeed! caps? Was I
drinking electrolyte fluids? Yes to both of these
questions but obviously I was not taking enough of
either one of these things and yes, I was also eating
potato chips, peanut butter and jelly sandwiches, fig
newtons, and potatoes-but again, it wasn't enough salt
and I was taking in too much water. My weight was up 5
pounds at the last weigh-in. To give you an
understanding of where my sodium level was compared to a normal
person....most people have about 140-145 mEq/L - this
is some sort of measure of the amount of salt in your
blood. I had 113 mEq/L. This is extremely low.
So, why is this a problem? Because you need sodium in
your blood for your brain to function.
WHAT ARE THE SYMPTOMS? The answer to this question is
the scary part and why this is such a medical emergency
when it occurs.
****Many of the symptoms are NEUROLOGICAL in
origin.**** Level of alertness can range from agitation
to a coma state. Variable degrees of cognitive
impairment (eg, difficulty with short-term recall; loss
of orientation to person, place, or time; frank
confusion or depression).
Other symptoms include seizure activity and irrational
behavior. In patients with acute severe hyponatremia,
signs of brainstem herniation, including coma; fixed,
unilateral, dilated pupil; decorticate or decerebrate
posturing; and respiratory arrest. Coma and seizures
usually occur only with acute reduction of the serum
sodium concentration to less than 120 mEq/L.
(Remember my sodium level was at 113 mEq/L.)
I didn't recognize where I was or who my friends were
or who my husband was at the end of the race. I walked
the last 5 to 10 miles which is very unusual for me and
people said I didn't know who they were and it appeared
as though I didn't even know I was in a race. Shortly
after I crossed the finish line on Saturday night I
started to vomit uncontrollably then I had a seizure
then I went into a coma. I remained in a coma
for 3 days. At some point before I woke up out of the
coma I began the "irrational behavior" mentioned above.
I pulled out all my IVs and ripped off my EKG patches
and tried to kick and hit the nursing and neurosurgeon
staff. I was very combative whenever someone tried to
touch me and was eventually given antipsychotic
medication. When I woke up I didn't know where I was,
what had happened, what month, or year it was. Upon
being forced to give a guess for the month I told the
neurosurgeons, "I think it's Vermont" for the
month. I couldn't read and I couldn't add numbers. On
Tuesday after the race I started to feel much, much,
better. I could read again and I had watched a car
commercial to figure out what year it was. I also got
a lot of the story about what happened from my husband.
It was on this day (or maybe Monday?) I learned I had
been in another hospital earlier. Why was I first in a
small local hospital (Ascutney in Windsor, VT) and then
transferred by ambulance to Dartmouth-Hitchcock? That
has to do with the scariness about how to treat this
medical emergency.
It you don't do it right, it will lead to further and
permanent brain damage.
HOW IS HYPONATREMIA TREATED? From
http://www.rice.edu/~jenky/heat.html:
It
says that the condition is frequently mis-diagnosed as
dehydration and that the consumption of water makes
matters worse because it dilutes the blood sodium
concentration even further than it already is.
From
http://www.emedicine.com/EMERG/topic275.htm
:
"The principal causes of morbidity and death are when
chronic hyponatremia reaches levels of 110 mEq/L or
less and cerebral pontine myelinolysis (an unusual
demyelination syndrome that occurs when
HYPONATREMIA IS CORRECTED TOO QUICKLY).
Much has been written about treatment of hyponatremia
and the potential adverse outcome of central pontine
myelinolysis. This condition is demyelination of the
pons, which can lead to mutism, dysphasia, spastic
quadriparesis, pseudobulbar palsy, delirium, coma, and
even death."
Upon being admitted at the first hospital in Vermont my
sodium level was 113mEq/L but then quickly went to 116
and the next reading was at 126. The hospital felt
uncomfortable and kept telling my husband it was
possible I'd get "PONDS" - which is central pontine myelinolysis
(permanent brain damage). They also told him to think
about long term care for me and that "things could turn
out a number of ways". They also asked him if I
remained in a vegetative state, would I want my organs donated
and did I have a living will prepared. At this point,
an ambulance took me to New Hampshire to
Dartmouth-Hitchcock. Needless to say, I think I
aged my husband about 10 years during these 5 days.
WHAT ARE THE LONG TERM EFFECTS? Well, so far I feel I
am about 95% back to where I was neurologically before
the race. (Physically, I lost 10 pounds.)
I couldn't remember my password when I got to my office
so I couldn't log into my computer and I forgot a
combination lock number I often used. I also forgot a
few people's names. I had a little bit of trouble
typing and signing my name but that seems to be gone now. The
last clear things I remember from the race are at the
mile 18 aid station.
I am also a bit spacey (it's a bit difficult for me to
concentrate) but I can drive. I am a research
scientist so it's important that I be able to generate and
interpret statistics. I haven't tried that yet but I'm
optimistic.
Here are a few more links (in case you
just can't get enough about hyponatremia):
Finally, the way to avoid this in the future (for me)
is to drink less water and eat more salt. I will also
push for a blood test from my doctor before I run
another 100 (this was my 5th one) to make sure I am not
starting out at a deficit - which is what the doctors were
suggesting at Dartmouth-Hitchcock Hospital. They said
that my low sodium diet, combined with a high volume of
running (sometimes as much as 100 miles/week) and
sweating in the heat and humidity here in the
Washington DC area were the problem combined with the
low volume of electrolyte fluids (relative to the
amount of water I was taking in).
This was scary. I hope some people will be educated by
reading this and for the many people who emailed and
asked me what happened, I hope this answered their
questions.
Thank you so very much again everyone for your concern.
My friends, co-workers, relatives, and the ultrarunning
community have been great!