Thursday, 9 August 2012

Ultrarace 100 2012 & the aftermath

Sitting in a hospital bed contemplating the real possibility of permanent dialysis, was certainly not on the agenda when I set out on my latest 100mile race. Not in my wildest dreams had I seen what was coming.

Ok the Ultrarace 100 experience started for me the night before as I had the pleasure of entertaining Rory & Jen plus Fluff Ball (dog). They did not arrive until late, having spent most of the day driving the course ensuring that all the markings were in place as they should be. No small feat, and to be fair they looked like it had been a long day when they arrived.

Still suitably fed and watered (thanks mum for your input, well actually for producing all the food, it went down a storm), after a quick catch up it was to bed for an earlish start to the day.

I came down the next morning to be greeted with the sight of Jen asleep on the sofa with ball of fluff practically lying on her face, it did make me chuckle. Well within half an hour my kitchen had become a production line, as the well-oiled Ultrarace team went into action producing the quantities of food required for the check points.

Suddenly it was approaching 10am and I had arranged to meet Tom at the local train station.  When I arrived he was already making plans on how he could move to this part of the world and still commute, impulsive as ever. It was good to catch up as I had not seen him for a while, having missed the chance to run a leg of the Jogle with him by 1 day.

Once back at mine people were arriving to go to the start, my parents who were following for a bit and then manning CP8, and my girlfriend Sarah who was to be my crew for the first day, then Gerry my brother was taking over for the night section while Sarah slept before resuming her duties for the next day.

Well with all the planning done it was just a question of getting to the start line on time, which was fun as we only had 10mins to spare. So much changing in the car was required, much to the amusement of Sarah.

Stratford was reached, and some quick hellos & introductions were said to various people, and bang we were off.  Having had to curtail my training due to my on-going abdominal issues, I was going into this race having probably done the least amount of training ever, before entering a long ultra race. That said I had still been averaging 40miles a week with a couple of 40milers thrown in 8-10 weeks before, just not my usual 50-70mile per week training schedule.

I settled down into a nice rhythm looking at averaging 5miles an hour which was comfortable and manageable on this course, which to be fair had some nice hills to contend with throughout the course.

Tom seemed happy with the pace and we bumbled along nicely chatting utter rubbish as is the norm. Oh and looking for the inevitable push into the hedge photo moment which seems to have become the norm now….

We were joined on our jolly outing by Chris Whistler who I had met briefly in various events last year. I had the dubious privilege of sharing accommodation with him earlier this year before running a very cold snowy marathon. This turned out to be great fun and he was great company. So our duo became a trio and to be fair we worked really well as a team, when one of us was down the others pulled him through. Chris had to endure various shorty jokes being 5ft nothing (or around that); it was amusing when we walked the hills seeing Chris having to trot now and then to keep up with our fast walking pace.

Well 5 miles was reached and there to greet us was Sarah with a car full of goodies.  It quickly became apparent that my crew was going to be shared with the other two, which is what the ultra-running community is all about.

Well we pushed on happy in our task running through sections that to were very familiar to both Tom and I, as it was the third time of running this event for both of us - yes I did have to endure the banter of my DNF last year. However I did have to point out to Tom that I was the one with a sub 24hr in the bag on this event…..

Check point 1 soon came into sight and somehow Tom and I without any communication both broke into a sprint for the line.  We were told that it was a dead heat but I still maintain I just took him…..

A brief stop to replenish and trade banter so to speak, and we were off running.  At this point I was feeling very good, and although my inevitable ab pain was there, it was just rumbling away in the backgrounb  - nothing serious as yet.

Once we were through Mickleton, then it was onto the start of the bigger hills.  This was when we started to see some runners start to come back to us as inevitably the flatness of the first 10miles or so can lure some runners into starting too quickly. Soon we were through Chipping Camden and as we were half way up the hill, we saw Sarah drive slowly past us - she had got lost in Chipping Camden, but she did very well to get back on track.  She stopped about 200 yards further on, where we once again raided the supplies.

The weather upto at this point had been fairly kind to us just a couple of showers with a mixture of sunny spells. Once we had climbed into the hills though it certainly seemed to turn noticeably colder and the rain showers became heavier, nothing we could not handle though and it did not dampen our spirits, we had the mentality - well it certainly could not get as bad as last year could it….

The second check point was reached in good time I forgot the exact time!  We carried on our way knowing the next 20+ miles were more undulating than other parts on the course. We soon hit what we thought was the biggest hill of this 10mile section, only to turn the corner and see a monster!  It gets you like that when running a course you have run before.   You think you have remembered the course correctly only to find something your mind has conveniently blocked out, due to it being nasty.

Well having safely negotiated the large hill we started running again, and soon found ourselves at the 25mile point, with Sarah waiting in a very windswept and fairly cold spot, which was a good incentive to keep moving.

The next 5 miles to the 3rd check point seemed to give me fairly painful flash backs to last year’s race. It was during this section that I came to the decision to pull out. So I was glad when CP3 came into sight and I could put that section behind me.

The next 10miles were a bit of a blur, things happened which I can remember, but not necessarily in the right order.

Chris informed us quite specifically where he had got to last year when the rain started to fall heavily. Tom continued with his vain attempts at communicating with the various animals we passed on the way. For me this section was when the niggling AB pain I had been suffering from about 5miles decided to make its presence known in a stronger manner. The pain level notched itself up fairly dramatically in this 10mile stretch, but I decided to ignore it, as it seemed to be worse in the transition from walking to running. Once I was running again the level of pain plateaued, and was manageable.  I remember the supply stop, Sarah sent me on my way with a kiss and a hug as she had been doing throughout, so Tom decided that he had earned the right for the same treatment, share the love so to speak…

We finally saw the 4th check point come into view over the hedge line, and Tom and I broke into another sprint for the line, much to the amusement of Ian Berry who was manning the check point. It was great to see him as I had not seen Ian since our Capital Ring adventure.  However, suddenly remembering we were in a race, we soon raced off into the distance (well actually I think it was more of a walk because we were demolishing the goodies we had picked up).

Ok I have to admit I have no idea on the next 10miles apart from the race was on to try and get to the half-way point without needing head torches!  (We failed with around half a mile to go so not bad). It was during this section that Sarah handed over to my brother Gerry at the 50mile point so she could get some sleep before the Saturday stint started.

So when we reached Farmington I was greeted by the ever encouraging words “What took you so long”!   A quick change into warmer clothes as it had got noticeably colder with the onset of the dark and we were off. I had decided to plug myself into some music for a bit to try and take my mind off the pain I was in which to be fair seemed to work very well.

We were bumbling along quite nicely when we suddenly noticed Gerry’s van on the side of the road which was always nice when you weren’t expecting it. So 55miles reached, I went to see what food I wanted and it was at this point that I realised I was feeling very nauseous, so I decided to not have any food.   I just grabbed some extra water and carried on hoping that the feeling would go.

Well the next 5 miles was a battle of pain and sickness and trying to hold it together so I did not let the other 2 down, but it was all I could do to keep up with them. When we reached the 60mile point I did let on that I was feeling sick to Gerry and to the guys. I got some extra fluid on board, and took a chocolate bar with me to munch on.

I battled on, but I was falling off the back of the other two, although to be fair to them they did keep me in sight. I noticed  someone coming up fairly quickly, and when he drew alongside it was Dave Fawkner. He seemed to give me a boost as we chatted away, and we quickly caught the others up. For me though it was short lived, as within a mile or so I was finding myself further and further back.  It was at this point that I realised that something was clearly not right. I got to the point where I could not run or even walk in a straight line.   I was meandering from one side of the road to the other, and was struggling to even process decisions on when to run, walk and drink.  I battled like this for around 2 miles, until I saw my brother walking towards me. I said to him this was race end for me.

He replied “Let’s get to the van and get some food in, you might feel different. We got there and I knew it was over for me so I said I wanted to get in the van. Gerry knew though if I did that, it was race over, as it is very difficult to get going once you sit down.   To his credit he wanted to make sure that I was not making the decision lightly.

I knew that for me I would not be able to continue, so for me it was an easy decision to make. My brother took me down the road to the other guys so I could let them know I was pulling out. Then we went to the 80mile point to let my parents know and to drop the guys drop bags off.

Gerry soon got me home (around 3am) where Sarah was waiting, to be fair I don’t really remember much.  I know I was cold I guess the last few miles I was slowing down so the cold affected me. I also remember going to the toilet and realising that I was peeing a rusty red colour, which was worrying.  I have been told I had a bath and got into bed (well collapsed probably).

The next morning I awoke and I was still peeing a rusty colour, I was hydrating well but it did not seem to make any difference. I really wanted to get to Stratford to see the guys finish.  As it happened we missed their finish by about half an hour or so, but they were still there. We had a good chat before they made their way wearily off for a much deserved sleep I guess. They had all managed to get the sub 24hrs they were after, which was cracking..

I was still feeling pretty rubbish but I just put it down to normal post-race fatigue etc.  On the plus side I was hydrated and the colour was normal again.

On Saturday evening Sarah had cooked a lovely meal, but I simply could not eat any of it. I knew that something was wrong then, as normally I would be ravenous after a long ultra and be devouring anything and everything in sight. Not long after I started vomiting (which although I did not know it at the time was going to last for 10days), then it was a fight to ensure that I hydrated well in order to compensate for the vomiting.

I still did not think there was anything seriously wrong just a bug or a viral infection maybe. Throughout Sunday I spent a lot of time in and out of sleep, I don’t really remember much. I know Sarah and my Mum were concerned.  Apparently I sounded confused and incoherent on the phone.

Well Monday came and I went to the doctors in the morning to be told I had a urine infection, and they took some blood samples  (incidentally the first time I had ever had bloods taken). That evening I had a call from the doctor to say I needed to go to Worcester Hospital to be checked out. At the time I am not sure how,  but Sarah appeared at the door.  She was supposed to be working ( I found out later she was so concerned that she told them she had to come over).

Dutifully we arrived at the hospital; I was feeling very much a fraud thinking I was not that bad to warrant a hospital visit. However after having various instruments and devices strapped to me for monitoring purposes, I was shown to a bed where they started pumping me with Saline solution.

Well for me the next 7 days was a very confusing time, I remember parts of it and I have been told afterwards of events that happened. I saw many doctors and consultants while they tried to diagnose and treat me. Family and friends were fantastic throughout this period, with their support and concern and I wish to thank them all.  It really helped me get through it.

So what was the diagnosis well I had a condition called Rhabdomyolsis…..

Here is a brief meaning of the condition and causes.

Approximately 40 percent of our total body mass consists of skeletal muscle. Unaccustomed and especially eccentric (muscle lengthening while contracting) exercise can damage muscle cells, causing them to disrupt and release potentially toxic substances into the bloodstream. The term “rhabdomyolysis” literally means the dissolution of skeletal muscle and is a common and well-known consequence of strenuous physical activity. Since ultra-marathon running - and racing in particular - requires heavy skeletal muscle recruitment and places demands on the body that are well above and beyond what is typically encountered during daily training, rhabdomyolysis is a common post-race biochemical finding.

A diagnosis of rhabdomyolysis is generally made when creatine phosphokinase (CPK) levels rise above 10,000 U/L, well above the upper limit (200 U/L) of the normal range. CPK is an enzyme found inside muscle cells, so when muscle cells are damaged, this enzyme is released into the bloodstream in relative proportion to the degree of muscle breakdown. The CPK enzyme itself is not particularly harmful, but is commonly used as a surrogate marker of myoglobin release. Myoglobin is a big, red, protein that can potentially block and/or crystallize within the kidney tubules. Thus, rhabdomyolysis can lead to acute kidney injury – and renal failure in severe cases – when these massive myoglobin proteins get stuck within the filtering system of the kidney as the body is trying to excrete these substances into the urine. So, dark-colored urine (looks like coca cola) is a unmistakable sign that there is a large amount of myoglobin being released into the bloodstream and, therefore, kidney function must be monitored carefully.

Unlike non-exercise-induced rhabdomyolysis (crush injuries, infections, drugs and toxins, for example) where the progression from rhabdomyolysis to acute renal failure is between 17 – 40 percent of cases, exercise-induced rhabdomyolysis only very rarely progresses to acute renal failure. The reason for this curious but clear difference in the progression to renal failure is not known. However, in those very rare instances where rhabdomyolysis leads to renal failure in ultramarathon runners, it appears that a “perfect storm” of factors seems to be present (extremes of hydration, non-steroidal anti-inflammatory drug (NSAID) and analgesic use, heat stress, recent viral/bacterial infection, low fitness).

Ok to clear up a few pointers, I was not dehydrated during the race this was carefully monitiored, and I was consuming around half a litre an hour which was the normal intake for me. I was not taking anti inflammatory drugs on a regular basis (although I had done in the past); on this occasion during the 15hrs I was racing I consumed 4 neurofen.

I did have a viral infection leading up to the race and maybe my fitness was a tad low but that’s debatable.

My CPK level when admitted to hospital was 76000.

Once I was through the first 7 days in hospital I was taken off the saline solution after having 31litres pumped into me. My urine output was still low so all that fluid was just sitting in my body where ever it could; I had put on 3stone in 7 days. Gradually my urine output went up culminating in an output of around 10litres a day; consequently my weight loss over the next 5 days was just as dramatic.

I came out of hospital after 2 weeks, I know it’s a cliché to use the phrase it was a life changing experience, but I firmly believe it was very much up there as a major event in my life. To be told that you might have to face permanent dialysis is a very sobering thought, coupled with that fact seeing the effect of what  my actions was having on my family and loved ones, was very thought provoking.

I had a follow up appointment with my GP later that week and he informed me that my kidney function had gone down to less than 8% output, 15% is survivable anything less is not.

So what now -  Well having had much time to reflect and recover, well the recovery is on-going just walking long distances is still beyond my reach at the moment let alone running. For me I am hanging up my Ultra running shoes, it has been an easy decision to make. For me I see this as a second chance, as I was so very close to requiring permanent dialysis which would have been a massive life change. Thankfully I don’t require that so for me this is a second chance, so why would I jeopardise that by pursuing the sport that caused my condition in the first place.

Having said that I won’t give up running I will just curtail the distance I run, I will certainly be looking at other sports to fill the void though, who knows maybe the dark side will beckon and I will venture into Triathlon.