Hauled away in an ambulance

[donheff]

I posted the following cautionary tale in a biking forum I frequent. Since many of you here are physically active you might take heed as well. Failure to keep up with your water intake can have sudden and severe adverse effects:

Well, I had an inauspicious start to the season. I went out for my first group ride today. It is described (probably accurately) as a casual, flatish route, with some hills thrown in for interest. From my wussy condition I would describe it as a rolling route with some moderate hills - just what I need to get in shape for the Bike Virginia hills. At any rate, the ride started out fine, the first leg was about 11 miles to a brief stop to regroup. The second leg went to about mile 24 with a stop at a rec center. As I rode this leg I realized the group was probably riding at about 2 mph over my average. We looked to be averaging maybe 15 MPH. That is pretty mild by standards hereabouts, but my wife and I take our time and enjoy the scenery so I was pushing things a bit. 50+'s Grampster (tcl20010) dropped back to motivate me and his cheerful company kept me moving along. As we topped the last hill and entered the rec center I felt a bit tired but not too bad. I figured I would drop back and take the last leg a little slow.

Unfortunately, I sort of passed out at the rec center

. So I sat down but the dizziness and spots in front of my eyes remained. I was going to rest for a while and then continue on by myself following the cue sheet in a half hour or so. But after about 10 minutes with no improvement the cooler heads around me prevailed and called an ambulance. The EMTs said my BP was in the dumpster and they measured my pulse at 190 (that is higher than my max and I had been sitting for 15 minutes - I suspect their device misread, but I was way out of sync). At the hospital they found me quite dehydrated. A bag of juice in the veins and I popped back to what feels like normal a little later.

The lesson for me is to build up slowly until I am in better shape and to watch the fluids. I will drink more, and learn about electrolytes -- even for short rides. The funny thing was one of the EMTs was back at the hospital a little later and dropped by to chat. Seeing my regular BP and remarking at the 24 miles we had ridden when he pulled me he said "you are in great shape for a 60 yo." I told him he should have checked out the bunch of folks he didn't have to pull - most of them were older than me and were barely breaking a sweat. Heck, Grampster rides out about 8 miles each way from DC just to join the group ride.

I plan to join this ride again in the future but I will do a little conditioning first. One episode like this adds a little interest to the day, a second would get old

 

[Rambler]

Sorry it took a little scare for you to learn this lesson. I think a lot of us are the same...I've had a lesson taught to me by a recent stay in the hospital (when the doc says stay down, it means STAY DOWN).

Anyway, thanks for sharing this. I'm in relative wuss shape myself, and wanting to get in better shape, but with a bad habit of trying to push myself too hard before I am physically capable of the task. Perhaps your experience will save one or the other of us a similar experience.

R

 

[bambambam]

Yeowch.

Sounds like you rode 35 miles at 15 mph, meaning a little over 2 hours. How much did you drink during that time? What was the temperature like?

 

[donheff]

Yeowch.

Sounds like you rode 35 miles at 15 mph, meaning a little over 2 hours. How much did you drink during that time? What was the temperature like?

I only got to 24 miles. I missed the last leg. I had knocked off about 2/3 of a bottle so it wasn't that I was not drinking at all. But I was pushing myself and didn't grab a drink until my mouth felt a little dry. I think it was just too little, too late. And the condition sneaks up on you. I didn't feel exhausted and was fully expecting to finish the last leg, if at a bit slower pace. But when I stopped and sat down I broke out in sweat, saw "snowflakes" in my vision, etc. Runners and bikers call it a "bonk." I thought it would go away in a minute or two but it didn't. When you get past a certain point it can take a while to get the blood volume back up - my pulse stayed way high and BP way low until after I was in the hospital.

By the way, the distance we were riding wasn't the problem. DW and I ride 20 or 30 miles frequently. We are building up for a tour that will average 40-50 miles a day. But we take more breaks and go at a slower pace. Trying to keep up with the Joneses I was riding with, coupled with the first really warm day of the year, coupled with my lack of knowledge about dehydration effects did me in.

 

[W2R]

Take care of yourself!

I am about your age (will turn 60 in June), and I have noticed that my mind and my body have different ideas about how much I can do. Often things that I used to do long ago, that seem like they ought to be easy for me, really knock me out unless I do less and build up to whatever-it-is.

Good idea to continue riding with your wife, at a slower speed and gradually build up speed before trying this again. Hopefully with this technique you will be riding for many years to come.

 

[dumpster56]

I only got to 24 miles. I missed the last leg. I had knocked off about 2/3 of a bottle so it wasn't that I was not drinking at all. But I was pushing myself and didn't grab a drink until my mouth felt a little dry. I think it was just too little, too late. And the condition sneaks up on you. I didn't feel exhausted and was fully expecting to finish the last leg, if at a bit slower pace. But when I stopped and sat down I broke out in sweat, saw "snowflakes" in my vision, etc. Runners and bikers call it a "bonk." I thought it would go away in a minute or two but it didn't. When you get past a certain point it can take a while to get the blood volume back up - my pulse stayed way high and BP way low until after I was in the hospital.

By the way, the distance we were riding wasn't the problem. DW and I ride 20 or 30 miles frequently. We are building up for a tour that will average 40-50 miles a day. But we take more breaks and go at a slower pace. Trying to keep up with the Joneses I was riding with, coupled with the first really warm day of the year, coupled with my lack of knowledge about dehydration effects did me in.

It was up near 80 yesterday in the SE. 24 miles 60 YO not been riding most of the winter. Drinking less, yep it can come a crashin down. Listen to your body. Glad they filled you up with liquids.

 

[TromboneAl]

What I get from this story, is that we can't trust our bodies to make us drink when we need to. The water was right there, and yet you're body wasn't screaming enough for water to make you simply reach down and get it.

Did you drink anything while resting at the rec center? Do you think that if you had drunk a liter of water, you would have perked up and avoided the ambulance?

 

[Rich_by_the_Bay]

Dehydration can be very difficult to identify by symptoms. In fact, many people lose their sense of thirst when they are dehydrated. The only reliable prevention is to drink exaggerated amounts before, during, and after. If it's extremely hot or humid or if you are working out for more than 45-60 minutes, dilute electrolyte replacement drinks may offer a slight benefit, but usually water is fine.

It's the real deal. Healthy people can die quickly from this.

When I lived in Tucson I continued to jog up to 99 degree temps. Here, I go up to 90, given the humidity. I use a camelback hydration system. It's not unusual for me to down 12 oz before, 30-40 ounces during, and 12 ounces after a 5-mile run. And I use a heart rate monitor to know when to break into a walk. If you rely on how you feel, you'll be wrong much of the time. Heat exhaustion can cause confusion and bad judgment - it's like drunk driving.

I'm on a bit of a soapbox here mostly because I've lost a few otherwise fit and healthy patients over the years because they underestimated the dangers of heat and dehydration during exercise.

 

[samclem]

donheff,

Glad to hear that everything turned out well. Thanks for sharing the cautionary tale.

In the military they were fanatical about having/making us drink water whenever we were exercising or subject to heat stress. It's true that your body does not have effective mechanisms for giving you warning that you are in trouble. It's such a big deal that occasionally a soldier will die from drinking too much water (not a risk for most of us, but it's possible to get your electrolytes out of whack by drinking a LOT of water--called "water intoxication." )
Those Camelback rigs Rich mentioned are now worn by most people doing tactical work in Afghanistan or Iraq. They've probably prevented a lot of casualties.
Thanks again.

 

[donheff]

What I get from this story, is that we can't trust our bodies to make us drink when we need to. The water was right there, and yet you're body wasn't screaming enough for water to make you simply reach down and get it.

Did you drink anything while resting at the rec center? Do you think that if you had drunk a liter of water, you would have perked up and avoided the ambulance?

I don't know whether I would have perked up on my own. I did drink some water at the rec center but, like Rich pointed out, I didn't feel overly thirsty. The thing that scares me is that if the rest stop was another 5 miles on I would have kept blithely on cranking. I might have really worked myself into a state at that point.

Once burned, twice learned. I plan to take Rich up on his suggestion and get in the habit of drinking more than I think I need. I will also look into GU20 or some such electrolyte supplement since I often ride for several hours. I will also work with my regular doctor on how best to approach things. I take Flomax which lowers BP and, according to the docs, likely exacerbated the problem. I was not aware of that side effect. I don't want to stop the Flomax but I may need to take extra precautions. Ah, the joys of hitting 60

 

[donheff]

And I use a heart rate monitor to know when to break into a walk. If you rely on how you feel, you'll be wrong much of the time.

I recently got a HR monitor, although I didn't have it on at the time. I want to learn how to properly interpret the numbers and will wear it routinely. I don't have a doctor tested max HR but using several different formulas and sub-max tests I estimate my max rate at ~175-178. So ~140 is 80%. So far I have only used the HR on the trainer and at the gym on ellipticals so I haven't gone for long times. 140 feels like a substantial pace but one I could hold for quite a while - more than an hour I think. A little lower and I could go for a long time. Should I set a limit (e.g. if the monitor is creeping up toward 85% or something) that I should use as a gauge on when to slack off a bit? I can tell you, 160 on sprints feels bad.

 

[lazygood4nothinbum]

people are like bamboo when it comes to water. if the leaves start to curl, the plant is already dehydrated. as you learned, you have to drink before you get thirsty. on road rides i have two bottles on the bike and i use them. on trail rides, often away from potable water sources, i keep a bottle on the bike and a camelbak on my back. if i trail ride in the florida summer heat i'll also keep a cold bottle in the car for my return.

the other thing i notice at this age is how quickly i get out of shape when i do not stay with an exercise routine. still fighting depression, i have periods where i might go a few weeks of being very lazy. when i finally pull myself out of it i'm really surprised at how much i've deteriorated and so i'm careful to work my way back into better shape, taking it just a little at a time at first.

 

[Notmuchlonger]

"the other thing i notice at this age is how quickly i get out of shape when i do not stay with an exercise routine. still fighting depression, i have periods where i might go a few weeks of being very lazy. when i finally pull myself out of it i'm really surprised at how much i've deteriorated and so i'm careful to work my way back into better shape, taking it just a little at a time at first."

I notice that too. Going on a long vacation and skipping exercise. Your 1st few days back at it kicks your butt.

 

[Alan]

thanks for posting the story - a good reminder for us all. We do similar amounts of biking and I have one of those Camel backpacks which is geat, although a couple of weeks back we cycled a mere 30 miles, it was not hot and we ran out of water right at the end of the ride - obviously not enough for 2 of us.

 

[Nords]

I don't know whether I would have perked up on my own. I did drink some water at the rec center but, like Rich pointed out, I didn't feel overly thirsty. The thing that scares me is that if the rest stop was another 5 miles on I would have kept blithely on cranking. I might have really worked myself into a state at that point.

My last military training command used Navy divers to teach submariners how to SCUBA dive. The students were almost all youngsters in their 20s and they had to be extraordinarily fit. I did a couple weeks of the class and in my late 30s found the physical part to be extremely challenging. It wasn't impossible but it was a bit harder than taekwondo. I managed to grow a six-pack and shed five pounds without trying.

PT was always in the (very) early morning or (very) late afternoon with plenty of tropical breezes. "Hydration" to a Navy diver means lots of swimming and, during land PT, garden hoses. The students also drank at least a liter an hour (of course they carried their supplies with them) and yet one's bladder rarely filled up more than once or twice a day.

Despite all of the screenings and precautions and plenty of experienced supervision, out of the 200+ students each year we'd always have at least two who lacked the physical ability to regulate their body temperature. It wasn't detectable and no one knew about it (including them) until it was almost too late. They'd go right from "warm but OK" to heat exhaustion/stroke with no warning. Some would just fall back during situps, one collapsed right after crossing a finish line. The corpsman would find a core temperature over 100 degrees and start pumping in IVs while the ambulance was on the way, and one student was even delivered to Tripler packed in ice bags (which saved his life). Their bodies would be overwhelmed with such speed that there was no time for anything but emergency lifesaving.

So you may feel betrayed by your own body, but it's quite possible that age is robbing your ability to stay hydrated. You may have to work a lot harder to keep up with the water and to stay on top of the heartrate. Shep Nuland, author of medical books like "How We Live", says that the "220-age" formula is one of the most widely-applicable thumbrules in medicine and its limits shouldn't be pushed even by Lance Armstrong. It's not a physical-conditioning issue, it's the age-related stiffening of the heart muscle and a weakening of the electrical controls.

But I'm glad to read that you plan to keep on going. I'm hoping that someday on one of your rides you'll encounter Chris "Younger Next Year" Crowley and can run him over for me...

 

[figner]

donheff,In the military they were fanatical about having/making us drink water whenever we were exercising or subject to heat stress. It's true that your body does not have effective mechanisms for giving you warning that you are in trouble. It's such a big deal that occasionally a soldier will die from drinking too much water (not a risk for most of us, but it's possible to get your electrolytes out of whack by drinking a LOT of water--called "water intoxication." )

donheff, glad it turned out ok!

I've gotten mild versions of "water intoxication" or hyponatremia while hiking in the desert. Probably my engineering mindset which makes it dangerous for me to try to take many things literally. I'd often heard that "you can't drink too much water while desert hiking - drink early, drink often." Trust me to drink too much water, and not realize that I should be replenishing electrolytes as well (I did eat some salty rice crackers and a normal lunch). By the end of a long hot day, I was quite nauseous and headachy. Stopped by a burger joint to grab dinner and as soon as I saw the french fries, my body started hollering SALT! Fries with extra salt were the best thing ever. 30 mins later and I felt fine.

I've also been hospitalized for hyponatremia once (related to surgery, not exertion), and it didn't feel all that similar - more of a lightheaded dazed sort of feeling.

 

[Buckeye]

I worked in a steel foundry one summer during college. I guess the foreman had seen folks drink too much water in the hot foundry because when I went to the him asking to go home because I felt tired and nauseated and spacey he handed me two salt tablets and I was better in no time at all. It was a Monday morning and I had been hiking that weekend and drunk way too much water.

 

[Moemg]

Glad to hear you are okay . Maybe you coud ask one of the trainers at your gym about your target heart rate and how long you should stay at it .

 

[mb]

Dehydration can be very difficult to identify by symptoms. In fact, many people lose their sense of thirst when they are dehydrated. The only reliable prevention is to drink exaggerated amounts before, during, and after. If it's extremely hot or humid or if you are working out for more than 45-60 minutes, dilute electrolyte replacement drinks may offer a slight benefit, but usually water is fine.

It's the real deal. Healthy people can die quickly from this.

When I lived in Tucson I continued to jog up to 99 degree temps. Here, I go up to 90, given the humidity. I use a camelback hydration system. It's not unusual for me to down 12 oz before, 30-40 ounces during, and 12 ounces after a 5-mile run. And I use a heart rate monitor to know when to break into a walk. If you rely on how you feel, you'll be wrong much of the time. Heat exhaustion can cause confusion and bad judgment - it's like drunk driving.

I'm on a bit of a soapbox here mostly because I've lost a few otherwise fit and healthy patients over the years because they underestimated the dangers of heat and dehydration during exercise.

Yes and thanks for bringing this up Rich but I think that the importance of electrolytes should not be under stated. I have read that it is critical to replace electrolytes for anything longer than about 1 1/2-2 hours. Several recent articles in Runner's World, Triathlete, etc. on the importance of also replacing electrolyte along with water. As you implied this usually isn't a problem for an hour or less.

According to what I have read, problems with excess electrolyte losses are increasing especially with the Team-in-Training types that are taught to drink a lot of water. There have been cases where people have literally "washed the salt out of there bodies" by drinking to much water without any electrolytes.

MB

 

[mb]

Glad you are OK donheff.

Hope you are able to get back in the saddle soon.

MB

 

[Rich_by_the_Bay]

I don't have a doctor tested max HR but using several different formulas and sub-max tests I estimate my max rate at ~175-178.

It's more like 220 - age, or 160 in your case. So, 80% is 128. 80 to 85% probably won't feel that strenuous but it's enough for aerobic conditioning and safe if you are conditioned and don't have other medical issues.

 

[RunningBum]

Sounded like a good wake up call, donheff. Glad you came out ok.

A lot of good info here. I especially agree with the comments about drinking before you get thirsty, and taking electrolytes in the form of sports drinks, and/or salt tablets or the electrolyte capsules (brand names like E-Caps or Endurolytes) that replace other chemicals as well as salt.

The way I read thirst is that it works as a sign if you don't continue exertion, but if you're still running/biking/whatever, you'll fall further behing as you continue on. You need to train yourself to drink early and often, and definitely not just water if you're out there a long time. You can only process so much water at once, so sip often rather than taking a few big drinks. Cramps are a first sign you are losing too much salt, but you may not always get that sign before you get into worse trouble.

Personally I go half-and-half water and gatorade if I'm out for more than 90 minutes, and add e-caps depending on how much longer and how hot it is. I also add honey or Gu for 3 or more hours out there, and solid food at 5 hours or more. That's a rough guide rather than hard and fast numbers.

 

[lazygood4nothinbum]

I've gotten mild versions of "water intoxication" or hyponatremia while hiking in the desert.

I worked in a steel foundry one summer during college. I guess the foreman had seen folks drink too much water in the hot foundry because when I went to the him asking to go home because I felt tired and nauseated and spacey he handed me two salt tablets and I was better in no time at all.

i though i remembered a story about florida (where else?) parents who were brought to court because they made their kid drink so much water that the child died. can't find an article about it but i found this:

BBC NEWS | UK | Magazine | Why is too much water dangerous?

Drinking too much water can eventually cause your brain to swell, stopping it regulating vital functions such as breathing, and causing death. So what happens?

Water enters the body when we drink and is removed primarily in the urine and sweat. The amount of water in the body is regulated to control the levels of certain compounds, such as salt, in the blood.
If you drink too much water, eventually the kidneys will not be able to work fast enough to remove sufficient amounts from the body, so the blood becomes more dilute with low salt concentrations.

water: dangerous stuff. handle with care.

 

[dumpster56]

I have not had water issues in my 40+ years of running. I remember my pericarditis event in 2001 july. Had run 5 or 6 miles that day heat was 95 and humid. Did not drink at all during the run, drank some water in the evening then my situation that sent me to the ER then the ICU for two days. I told the doctor and nurses that I was probably dehydrated when they did lab work.Guess what I was not. In fact I was not really thirsty either. Over the years I have been always aware of water intake not too much not too little all through the day.

crazy though. Heck last thursday drank a 6 oz cup of water before my 17 mile run in 60 degree dry temps. Not a problem. Then again I would not run 17 on a hot and humid day. Gotta know the weather!

Being really trained makes a difference and the degree of speed and distance will dictate fluid intake. too much always is a problem.Having to do a number UNO during a run tells me I have had too much to drink.

 

[Alan]

Personally I go half-and-half water and gatorade if I'm out for more than 90 minutes, and add e-caps depending on how much longer and how hot it is. I also add honey or Gu for 3 or more hours out there, and solid food at 5 hours or more. That's a rough guide rather than hard and fast numbers.

The guy that invented Gatorade died recently. He was the team Doc for the Florida Gators football team and realized the players would drink lots of water but needed to replace electrolytes. He made up a batch of what he thought was needed and gave it to the players to drink - they said it tasted like urine. Proving how dedicated he was to his beliefs he actually drank some of his own urine and decided they were right

His wife then helped him with his recipe to make his new drink more palitable.