Well here we are a week after the Cleveland Marathon. I should be resting easy and recovering from my 6th full marathon, but instead, I've been training all week long. Why? Well, if you follow my Instagram, you know that my race ended with a DNF at mile 11.8. It wasn't due to fitness, doubts, or an injury. My DNF was caused by my legs giving out from under me due to hyponatremia. You might be asking, what is that? Believe me, I've gotten this question a lot in the past week. I'll go into more detail later, but the short answer is that it's overhydration. Yes, that can happen. And it's much more dangerous than dehydration.
I was crushed that my race ended early, especially because it was going really well. Honestly I think I was more angry than scared or stressed about what was happening to my body. But after I had time to reflect on how bad of a state I was in, I realized how lucky I was that my body shut me down when it did and how fortunate I was to recovery quickly. So while this post will recap the race and race weekend, the focus is going to be on hyponatremia, what I did wrong, and what I learned.
Race weekend kicked off Friday with a trip to the expo and the VIP dinner with all of the other Cleveland Marathon Ambassadors. It was a great night full of good food and fun in downtown CLE.
Then on Saturday I got in a morning shakeout run and headed downtown to my hotel. I had a lazy afternoon and evening and just tried to stay off of my feet. I went to bed early and set my 8 alarms to make sure I could wake up at 4:30 to get my breakfast in.
In the morning I got dressed and headed to bag drop to meet my running partner. It was lightly raining and humid, but the temps weren't too high. He calmed my nerves and we got in a quick warmup before heading in to the corrals. Before I knew it, it was time to take off.
Miles 1-5 - 8:04, 7:51, 7:57, 7:49, 7:56 - Felt great, tried to keep the pace controlled, and was in the zone
Mile 6 - 7:51 - Felt great, climbed the small mountain at mile 6.5 at about an 8:50 and felt ok while doing it. When I got to the top, my legs felt heavy and I couldn't shake that feeling.
Miles 7-9 - 7:59, 8:06, 8:07 - Still had heavy feeling legs from the hill and tried to shake it off. I was still on pace but it was feeling more difficult. Overall, I just felt kind of odd. Once I hit 9.5 I was at about an 8:25 and it felt way too hard. That's my go forever pace and I knew something was wrong.
Mile 10 - 8:24 - Something was off. I felt slightly uneasy and felt kinda like I was gonna puke. I seriously considered turning with the half.
Mile 11 - 8:31 - I felt my legs wobble. I shook it off, thinking it was a weird step or pot hole or something. Then it proceeded to get worse. I was pretty sure I was gonna puke. I seriously struggled to keep the pace even at 8:30. I knew something was really wrong and I was just trying to stay upright. I told myself just to get to my mom at 12.5.
Last .8 - 9:20 - I was just trying to stay upright until I could get to my mom. I looked at my watch and it said 9:20. I was like woah, what?! C'mon lets push a little faster, and my mind was screaming go but my legs would not move. As I approached the 11.8 mile water stop I saw the medical tent and told myself to just get to them. I motioned to them and yelled I'm going down and collapsed into their arms.
In the medical tent, I sat in a chair while they did some testing for strength. I had no pain, no numbness, no tingling and I was pretty coherent. They said my strength was good everywhere but my quads had very little strength. I sat about 10 minutes and then stood up to try to push to see my mom. As soon as I stood up my legs gave out and I sank back into the chair. At that point they told me I was going to main medical.
They made me take an ambulance back to the main medical tent and gave me oxygen. When I got back to the main medical tent, they laid me in a bed and wrapped me in a space blanket. My vitals were all good. They did a bunch of "can you feel this" tests and I also had more strength testing and everything was good until they asked me to lift each leg. The left moved about 3 inches up and that was it. The right wouldn't move. At that point they decided I needed an IV. About a minute into that, I started violently shaking because the IV was 58 degrees (air temp) so they cocooned me in space blankets and it stopped. After I drained the IV, when they made me try again to lift my legs I raised each about two feet with no problem. At that point they said I was clear although I was still rather pale at that point.
So what is hyponatremia? How do you get it?
Hyponatremia occurs when the concentration of sodium in your blood is abnormally low. Sodium is an electrolyte, and it helps regulate the amount of water that's in and around your cells.
In hyponatremia, one or more factors — ranging from an underlying medical condition to drinking too much water — cause the sodium in your body to become diluted. When this happens, your body's water levels rise, and your cells begin to swell. This swelling can cause many health problems, from mild to life-threatening. In acute hyponatremia, sodium levels drop rapidly — resulting in potentially dangerous effects, such as rapid brain swelling, which can result in a coma and death (why they gave me the oxygen).
Hyponatremia signs and symptoms may include:
So what did I do wrong? Well, a lot. But first let's talk about why I did it. I completely over thought everything about this race. I was an emotional wreck in the weeks leading up to the race. I was so nervous and was having race nightmares. Everytime I had to make a decision about something I always do, I came up with something that could go wrong, and I broke my pre-race routine to avoid that what if. Additionally, I was so nervous that I didn't pay as close attention to other things I was doing (or wasn't doing) and so I broke my routine. Calming these nerves will be critical next time around.
What I did:
Week Leading Up - Starting Monday I increased my water intake each day. I was probably drinking over a gallon and a half each day. I was drinking straight water except probably 1, 8 oz glass of Nuun each day M-F (1 tablet). Usually, I eat pretzels throughout race week but for some reason I didn't.
I had probably over a gallon and a half and I actually may not have had any Nuun.
I drank 5 of my Hydroflasks full of water (32oz) and was alternating Nuun performance with water (3 were water, 2 were Nuun). I also had 1 16oz bottle of water, 1 32oz gatorade, 1 8oz glass of water, and 1 cup of coffee.
I had a 16 oz bottle of diluted Nuun before the start. On course I took water from 4-5 water stops. I took my first gel at 8 (over an hour into the race).
Usually I write this all out as I'm hydrating to keep track, but I didn't this time. I also don't eat a ton of processed food or really eat out at all. Which means the salt I take in, is the salt I actually add to my food. And all I really added to was the chicken I cooked for dinner a few times in race week.
You don't have to be a doctor or an expert in this area to see that I drank way too much water and hardly any electrolytes. Hyponatremia is rare for Americans, given the average American usually eats 3-4 times the amount of salt they need. However, if you are like me, and your salt intake is pretty much right on point, even slightly too much water can put you into the hyponatremic state. Case in point: I've finished at least two other races in this state. Likely due to too much water the day prior or even just on course. In those cases it didn't hit me until the end, probably because I wasn't so overhydrated like I was this time. While its less likely for other runners to get hyponatremia to the extent that I did on Sunday, it is very possible for others to get it in mild forms like I have in the past.
My current action plan per my coach:
1. Less fluid intake over the duration of race week. It's unnecessary. I do long runs of 20+ miles on a more more fatigued body with less fluid in me and without drinking this crazy amount all week long. It doesn't serve a purpose to drink that much for the whole week.
2. Increased fluid intake makes sense in the 2 days leading up to the race. Before then I do what is normal, about half my body weight in oz each day plus whatever else to compensate for workout sweat as needed.
3. I will be substantially increasing my electrolyte intake for the 2-3 days before the race, the morning of the race AND during the race.
4. I will be eating more frequently while on course (i.e. gels).
5. I will be revisiting my diet in the week and days prior to the race as well as the morning of the race.
Of all of the ways I pictured my Cleveland Marathon race experience ended, I never could have imagined that I would collapse before even reaching the half way point on the course. Sunday was a learning experience for me and I think the main takeaway is the dangers of overthinking. My coach and I (among others) are confident that everything goes back to me being a nervous wreck and overanalyzing every little detail. Staying calm and relaxed as a key race approaches will be a big focus for me going forward. The other thing I learned is that I probably don't hydrate properly prior to a marathon and possibly in life in general (I was drinking a gallon a day regularly. That's too much water.) So I'm taking the opportunity to change my practices to become better fueled and stay safe going forward.
I'm still heartbroken about Sunday and I'm still pretty emotional. I find myself thinking maybe it was another race nightmare I'll wake up from at some point. But mostly I'm chosing to look forward to the future.
It's finally here! Cleveland Marathon Race Week! Four and a half months of training in the bank leading up to this coming Sunday. It's just about time to put the training to the test.
Race weather is looking ok-ish (rain but not too high temps) but it's Ohio so who knows how much more it will change in the mean time. So I'm trying not to obsess over that...too much. My coach has had me practicing heat acclimation techniques these past few weeks, including running in long sleeves in warm temps, and taking very hot baths right after most of my runs. It seems to be working too because I'm pretty comfortable in my long sleeves now and I'm noticing that even the slightest bit of cold feels frigid to me.
Now that it's race week, the mileage is dwindling and there are no real workouts left on the schedule, except a few minutes here and there just below goal pace. But the taper crazies are in full swing. Last week was fine because I was so busy at work that I didn't have time to think about the approaching race. Now that work has calmed down, my mind is 100% focused on the race which is creating a lot of stress as I overanalyze the past four and a half months. I definitely feel very jittery and tonight's run was a true race week run, completely with phantom aches and pains, doubts, and inability to run anywhere near race pace, until I took my mind off of what I was doing. Luckily my coach has been quite the asset in talking me through my stress this week and I'm working on some techniques of my own to calm down and destress this week.
I'm also trying to do some targeted focusing on the parts of the race that I'm excited about and those that don't stress me out. I'm visualizing parts of the race and I'm getting my race music and outfit picked out. I also have my Cleveland Marathon Ambassador dinner on Friday night to look forward to and the expo that afternoon. Plus I'm staying in a hotel in downtown Cleveland the night before the race which should be fun as well.
Most importantly, all the hard work is done, the miles logged, and the time put in. It's time to enjoy the taper and get pumped for my favorite race of the year, Cleveland Marathon race weekend number 6 and my 6th full marathon! No matter what happens on Sunday, it'll be a great time and I don't regret any time spent training for this race.
Cleveland, let's do this!
There's still time to register, by the way and HKCLE10 will still get you 10% off your registration!