How Drinking Water Almost Killed Me – Part 5 of 5 – Thanks and Conclusions

This is the last part of the series. The fourth described my loss of conscience, hospitalization and recovery.

During this long stay, which was actually my first hospitalization (well, following my first marathon), I was lucky to receive a lot of love. TheÂ hospitalÂ provided a great service and a good medical treatment.

Everybody was very kind and patient. My Spanish is far from perfect, to say the least, and I don’t speak Catalan. This never put the smile off the faces of the staff there.

My parents and Galia’s sister got on a plane to Barcelona as early as they could. When hospitalization was extended, my mother extended her stay for a few more days. Thanks again!

The people from the running group also showed a lot of love.

: Barcelona Casual Road Runners – Photo Credit: Ingmar

That’s my name spelled by the runners. Special thanks to Ingmar, the organizer of the group, who came many times to visit me. Special thanks to Laura and Eli that ran errands for us and for aforementioned Tim and Reli who dropped everything to support Galia in the hospital.

Also other people from the group, out of the group in Barcelona and in Israel helped me a lot with their help, love and support and offers for logistical help to me and to Galia.

And of course, special thanks to Galia. She saved my live. That’s practically what happened.

I only remember going to sleep and waking up in a hospital a day and a half later. She saw me, faint, vomit out of sleep, undergo convulsions and perhaps also lose my breath. Later, she saw me unable to speak and had to communicate my situation to everybody. Not a fortunate task that she did very well, to say the least.

Thank everybody!

Conclusions

Why did this happen?

Fear of dehydration due to the sunny weather.
Israeli mentality that increased the fear of dehydration / heat shock. In Israel, such cases of water intoxication are much more common than in Europe.
Pushing aside the importance of sodium despite the early knowledge. My pure stupidity.
Drinking too much water during the race.
Not consuming enough isotonics during the race.
Hardly having any food during the race. If I was able to easily speak during the race, I certainly could have eaten something.
Waiting too much before grabbing more food to eat after the race.
Not insisting on eating, despite the nausea.
Drinking more water while the situation was already deteriorating.

The easiest conclusion is to directly connect the long marathon race and water intoxication event and to avoid long runs. This is too simplistic. Here’s why I don’t subscribe to this point of view:

I certainly believe that my near death experience was caused due to an extreme imbalance of too much water and not enough salt. See above.
I was ready for the marathon: I made all the necessary training, and ran in a very calculated and balanced manner: when I began feeling tired, I slowed down. I finished the race feeling great.
I have no tendency for water intoxication. Actually, there’s no so such thing.
So far (touch wood), I have no long term damage that prevents me from running.
Running is an important part of my life. I enjoy running, I sleep better and my appetite is healthier thanks to running.
Are the best means of prevention prevention? I don’t think so. There certainly is a better way to do it.
I want to overcome this event. This isn’t only an egoistic thing, but also important for my well being.
I am convinced I can do it.

Here’s the group picture from the end of the race:

Barcelona Marathon 2012 - Photo credit: Ingmar Weber

What am I planning to do?Â

Rest as ordered at least until the next meeting with the doctor on April 23rd.
When allowed, I’ll get back to running, listening to my body in addition to the doctor.
I’ll gradually step up. After this event, it will take my muscles a lot of time to rebuild. This isn’t exclusive to my legs, but also to all my muscles that are recovering from the convulsions.
When the time comes for longer races, I’ll consult a doctor who is an expert in sports, describe my event and ask for specific advice about the required behavior before the race, during the race and afterwards.
Perhaps I will become a better person after this near-death experience 🙂

I am responsible for my wrong decisions and I hope I learned the lesson. (undoubtedly the hard way).

That’s it! This was a long project which helped me get better. I hope you didn’t get too bored. I usually write random, disconnected thoughts that don’t exceed 500 words…

As mentioned earlier, I plan on writing a Hebrew version and perhaps a short Spanish one. But this takes time…

All the chapters:

Barcelona Casual Road Runners Group

How Drinking Water Almost Killed Me – Part 4 of 5 – Losing it and Getting Back

This is the fourth part in the series. The third part described race day: from the successful run up to my last memory of that day.

Galia remembers hearing weird voices from the bedroom. She called me and I didn’t respond. She entered the room and saw foam coming out of my mouth, while my eyes were closed. She tried turning me aside, so I wouldn’t suffocate fromÂ vomiting while not beingÂ conscience.

Then came the scary part: I had convulsions, and all my body was shaking. I even fell from the bed, luckily on the thick blanket that fell on the floor.

At that point, she called the emergency services and demanded an ambulance to come at once. While the ambulance was on its way, I woke up and began screaming, not speaking any understandable language. This seems more scary than losing conscience. The doctor on the telephone line kept her busy and collected information.

The paramedics that arrived on the scene already guessed that I was a case of low sodium, orÂ water poisoning. They tried speaking to me in Spanish, but didn’t get a response. When Galia translated their basic instructions to Hebrew, I did partially cooperate. We traveled to the emergency room while I was awake but unresponsive.

The doctors at the emergency room at Hospital del Mar were already briefed about the “Marathon Man”. They described my situation as “grave”. Not very encouraging but still reversible. Healthy people have sodium levels of between 135 to 146. Mine was 117.

Recovery

The treatment is simple yet slow: the level of salt should carefully rise back to normal, using IV. Pumping it up too fast can cause irreversible damage to the brain. No medicine helps. They told her that I won’t get back to normal functioning until the sodium returns to normal. And that wasn’t guaranteed.

At this point she called two good friends who live in Barcelona and they came immediately to be with her in the ER. I am very thankful for that Reli and Tim. My parents, who were fearful before the race, hadn’t heard from me since the end of the run, and began trying to communicate me and then her.

During the night between Sunday and Monday, my sodium levels fell to 115, but my situation stabilized. A brain scan showed nothing unusual, but given my behavior, it was probably flooded with water. I was transferred to the Intensive Care Unit.

On Monday, Galia began communicating my fortunes to family and friends. My parents got flight tickets immediately. I thank them very much for their support. So did Galia’s sister. Thank you very much as well.

My eyes were open during Monday, but I wasn’t really there. They had to tie my hands and legs, in addition to the regular and intense monitoring. I tore off an oxygen mask and luckily I didn’t need really need it as I was breathing easily.

Back to Life

My first memories are from realizing I’m not at home. Each time I saw the hospital bed and lights, I refused to believe it, and I went back to sleep. I was so dizzy, that nothing seemed real.

Eventually I began realizing that these hospital sights are real and that they’re not going away. I began recalling the marathon, the sick feeling at home and the dots began connecting.

The medical staff asked me in Spanish: “Do you know where you are?”. I answered them in Spanish: “In a hospital?”, still uncertain. They confirmed. They told me it was around 4 AM, and before going back to sleep, I wanted to verify that it’s Monday, but they told me it’s already Tuesday. I was shocked to discover that a day and half were totally lost.

The first time that I saw Galia was with her sister. She was very relieved to see me communicating once again. I was surprised seeing her sister. Once again, I had doubts about being awake as her sister lives in Israel…

When my parents arrived, they were happy to see me in my normal behavior. At the end of that day, I was already transferred to a normal unit, for a few more days of recovery.

Muscle Destruction

The plan was to release me in a day or two. On Wednesday, my sodium was around normal levels and I felt much less dizzy. I was ordered to drink only a rationed amount of water, to keep on lowering the sodium levels. They already disconnected me from all the machinery, including the IV.

And then, a doctor rushed in saying that they are reconnecting me to the IV, in order to lower myÂ CKÂ (or CPK) levels. This is an enzyme that appears (also) during the destruction of the muscles. The convulsions took their toll. Normal levels are 20-200 and I had a level of more than 150,000!

So now, I had to wash out this toxic (by drinking water in addition to the IV) and they wouldn’t let me go until it stabilized. Such high levels could have caused damage to the kidneys.

Eventually I stayed in hospital until Tuesday, April 3rd, when blood tests showed that the CK level fell to 3K. The next test, on Thursday, already showed 726 – still over 3.5 times the maximum desired levels. I am ordered to return to physical activity very gradually, and I won’t be running at least until another appointment with a doctor on April 23rd.

The next chapter includes a few thank yous, my conclusion from the race and plans for the future.

All the chapters:

How Drinking Water Almost Killed Me – Part 3 of 5 – Race Day – From Euphoria to ER

This is the third part in the series. The previous one described the preparations for the marathon.

March 25th 2012 was a special day. The first cup of coffee after 4 days was great. I also ate a few cookies and a yogurt. Perhaps also an energy bar. I drank water of course.

It was a bit cold in the morning of the race, but not too bad. I put on sun screen and wore a cap. The plan was to run at an average pace of 5:34 per kilometer, finishing the race at 3 hours and 55 minutes. This made sense given my fitness and the fact that it was my first marathon race.Â The organizer of the running group, who is a veteran runner, designated himself as pacemaker for the first time runners.

A group picture before the race:

The Race

The first few Ks were packed with people but we stabilized at around 5:30 not too far off from the start. The atmosphere was superb: many people were cheering us along the way, the sun was shining and Barcelona’s natural beauty was at its best: the course passed through some of Gaudi’s buildings, La Sagrada Familia, Camp Nou, the sea and many other nice places.

There were 11 water stops along the way: each one consisted of a bottle of 330Â milliliters of water and a small open cup of Powerade, an isotonic drink. I assume there were about 100Â milliliters of Powerade in every cup.

I stopped in at least 9 out of those 11 stations, consuming both the full bottle of water and the cup of Powerade. There were two stations of sports’ gels. I stopped in only one of them and chewed on most of the gel. There were 6 stations of “solid foods” – I didn’t stop in ANY of them. They had bananas, oranges and nuts. This was the initial error.

After about 30-32K I enteredÂ uncharted territory and began slowing down. Ingmar, the organizer of the running group and another guy also slowed down together with me and also encouraged me. Their presence kept me motivated and the pace matched my abilities. We ran at around 6 minutes / kilometer – not such a big difference.

We slowed down towards the finish line, and crossed the line while hugging each hugging each other. The finish time was 3 hours, 58 minutes. This was a bit longer than planned, but this slowdown was a reaction to what the body told me, and still a nice time (under 4 hours).

My wife Galia cheered me up twice along the way. After eating half a banana, a bottle of Powerade and more water, I left the running zone and went to the meeting point.

After the Race

We took our time at the meeting point, waiting for everybody to appear, having a great time. We were many first-timers that were thrilled to finish the race.

Perhaps an hour passed by since the end of the race (around 13:00) until we began searching for some place to have a drink and eat something. When we found a place to sit, it was in the sun, though not too hot. I ordered water and a sandwich. I assumed water was important in order to prevent dehydration. That was another big mistake.

The Downfall

Upon putting the sandwich in my mouth, I felt a nausea and couldn’t eat it. I ordered more water and asked Galia to go home. She paid, got more water upon my request and we began going home.

I felt a bit shaky on the way, but managed to make the journey. At home, I drank more isotonic drinks and more water. Galia told me I should eat something and I eventually ate some plain toasts. She also convinced me to take a shower, even though I only wanted to rest.

Somewhere late in the afternoon, around 17:00 or 18:00, I felt bad, got out of bed and immediately threw up, before getting near the toilet. It was mostly fluids. I was quite surprised and shocked, although I felt more stable afterwards.

After some cleaning up and taking a shower, I got back to bed.

The next chapter describes what happened afterwards including a day and a half I don’t remember and the recovery that followed.

From here on, this is Galia’s account as I don’t remember anything from Sunday at around 19:00 – 20:00 until the early hours of Tuesday.

All the chapters:

How Drinking Water Almost Killed Me – Part 2 of 5 – Preparing for the Marathon

This is the second part of the series. The previous one described my running background up to the 30K run to Montserrat in November 2011.

After completing that 30K uphill run, completing theÂ famous marathonÂ run certainly seemed feasible. It required careful training. I also preferred doing it in one of my home towns such as Barcelona or Tel Aviv, rather than doing it on unfamiliar ground.

I had a break from running during the beginning of January 2012 due to a visit in Israel, and I began considering the Barcelona marathon upon returning towards the end of January.

The race was planned for March 25th. At first I didn’t register, as I wanted to be certain I’m up for it. This cost me more money when I eventually registered, but I could afford it. So, I began training in the city and around.

: Besos River – Barcelona city limits

Preparation

A friend helped me find a good plan, and I began running at least 3 times per week. This included several short and fast training sessions, medium length and medium speed runs and most importantly lengthy runs on weekends.

The long runs consisted of doing a half marathon, followed by a 32 kilometer (20 mile) training session on a gravel road in “Carretera de les Aigues” above the city. This run left my knees aching and a bit worried I’m not up for the big run.

During these long runs, I became aware of the power of Powerade (or Gatorade if you wish). The isotinc drinks presumably has the right balance of water, sugar and salt, and I felt that they gave me a big boost along the runs.

A week later saw another half marathon race in which I didn’t encounter any pain and in which I set a personal best of 1:44:42. It certainly motivated me.

The longest run of a bit more than 32K was a bit hard, but I completed it successfully. This was 3 weeks before the big run, and I felt comfortable enough to register for the marathon.

The plan was to run 24K a week later, but it turned into 30K, which was already in warmer weather and more tiring, but after having all this capacity behind me, adding a bit more seemed within reach. It was.

According to the plan, the last weekend before the big day was an easy 15K run in order to “taper down”. That’s exactly what happened.

: Montjuic as seen from the outskirts of Barceloneta

I had my last short training session 5 days before the race. Then I started a coffee and alcohol diet: abstaining from coffee was done in order to clean my body towards the race and then have a nice cup of coffee on the morning of the big race. This way, the fat burning that caffeine offers would be more effective.

Abstaining from alcohol just helps clean up from a tiring factor before a significant physical effort. I also woke up early and got up early, getting myself ready for waking up early for the race, especially as it was planned for the day that DST came into effect.

The next chapter will be published tomorrow and includes the race itself and the aftermath (what I remember).

All the chapters:

How Drinking Water Almost Killed Me – Part 1 of 5 – Running Background

Everything in life should be done within normal ranges. Apparently also the consumption of water has its limits.Â I lost myÂ conscience many hours after my first marathon run because ofÂ over-hydration and I live to tell the story.

Here is the full story divided into 5 chapters that will be published on a daily basis. They include my background in running, preparations for the marathon, race day, the collapse, a day and half that I don’t remember, the long hospitalization, the ongoing recovery and a few conclusions.

Small note: I’ve neglected this personal blog in the past year or more. This story certainly brings pumps life into the blog. Hopefully I’ll write more. Life in Barcelona supplies quite a few stories (though much less dramatic). I also plan on writing a full Hebrew version, and perhaps a short Spanish one.

Running Background

My love for running began way back in the 90s, when I was in high school. I used to go to the gym and/or run throughout my adult life. About 5 years ago, I participated for the first time in an official race, a 5K night run in Tel Aviv.

The excitement of racing got me to take things a bit more seriously and I began running more often, quickly moving to 10K runs. At some point I picked up a serious training program on the web, that involved running 6 times a week. The local gym in Tel Aviv was too close, and most of the runs were performed there – apart from the longest ~17K runs.

Barcelona

When I moved to Barcelona in March 2011, running on the promenade was a great way to discover the city and see the wide variety of people roaming the streets, but I stuck with short and sporadic runs.

The big change was in August, when I accidentally discovered Meetup, and the Barcelona and the Barcelona Casual Road Runners group. This great collection of people runs 10K twice a week, in a very casual and pleasant atmosphere. Everybody from the organizer to the latest newcomer are great and positive people.

Cursa de la Merce 2011 - Image Credit: Alex

My first official 10K run in the city was a popular race named Cursa de la MercÃ©. Given the race is so crowded, we took it with a very casual atmosphere indeed: with costumes of sheep. Great fun!

Montserrat on Foot

A bigger challenge came in the middle of November: a run called Pujada a Montserrat: a 30K run from theÂ suburbanÂ town ofÂ Terrassa to the historical and touristic site ofÂ Montserrat. It consisted of around 21 kilometers of a flat and downhill stride, and then around 9 kilometers of a running along the twisted road leading to the site.

This was the longest distance I ever ran until that point, and the last part was a tough uphill struggle. I combined running and walking in the final part, but I was very excited to reach the finish line.

I ate a few energy bars I brought from home and some water along the way. At the end, there was a nice table full of snacks and drinks. I remember the organizer of the running group encouraging me to grab some peanuts, mentioning it’s important for myÂ electrolytes. I ate the peanuts as well as anything I could put my hands on, as I was very hungry and thirsty.

I’m mentioned this seemingly subtle note just to show I had awareness to the importance of salt and electrolytes, though neglecting it at the critical moment.

I felt tired after the run, like every long run. Also my muscles ached, but that’s normal. All in all, I was feeling good, not suffering any knee or back pain and very happy to have competed this hard run along the beautiful landscape.

Pujada a Montserrat - Photo credit: Ingmar

The next chapter will be published tomorrow and details the preparations for the race.

All the chapters: