Fat Dog, Fluid, and Renal Failure: My Experience with Rhabdomyolysis and Acute Kidney Failure

“Hi Run Like A Girl community! Leader and Street Team Ambassador Willa here to share with you about my experience with kidney failure two years ago during a 120-mile ultramarathon. Grab a snack and get comfortable, it is a bit of a long haul! Also I welcome anyone with questions to contact me. I will be happy to answer to the best of my abilities!”

“Fat Dog, Fluid, and Renal Failure: My Experience with Rhabdomyolysis and Acute Kidney Failure”

August 2016, Manning Park, BC

I had been training my butt off for months to get ready for Fat Dog 120 mile- back to back training weekends and consistent weekly (and monthly and yearly) mileage had me feeling extremely prepared and ready to improve upon my previous finish the year before. Then I got a cough. The week before the race I got a cough that wouldn’t go away, and I was experiencing lots of chest congestion. I was concerned but crossed my fingers and hoped for the best. The few days before the race I started to feel better and believed the worst had passed. I was optimistic heading in to the race, as I had a good training base and a great crew to support me. My plan was to take it easy and see how far I got.

I hopped in with friends Avery, Andy, and James for the drive out to Manning, dropped our bags at the Lodge and headed to the race briefing in Princeton. I connected with a friend Nikhil from my trail running group on Facebook who had contacted me after my Fat Dog finish last year, and who had been picking my brain ever since regarding Fat Dog training and gear, etc. It was great to finally connect with him face to face! The race briefing was great- my good friend Kat surprised me by sending a bag of Red Vines for me! Yay for sweet race fuel!

In the morning we got on the bus to head to Keremeos to the start line. It was already hot, and the bugs were out in full force! I knew this would be a very different race than it had been the previous year (which had been named “Wet Dog” and “Hypothermia Haven”)! I loaded up on sunscreen and bug spray and tried to hydrate as much as possible prior to the start.

The race began and we crossed the bridge and headed straight into our first climb up Red Mountain. It is about 5,000 feet up over 20 km, and pretty hot and exposed and dusty (and buggy). I wrestled with this climb, feeling like I was much slower than the last year, and I had trouble keeping my breath steady. I was drinking a lot of fluids which was good, as it was about 38 degrees C with very little wind.

I reached the summit and the views made it all worth it! This course is just stunningly epic! I can’t say enough about how much I love this terrain! After that first climb I finally started to hit my groove and I cruised the downhill into our first major aid station at km 29- Ashnola. The heat and humidity were really high but some aid station angels were there to take care of us! Solana you have no idea how awesome it was to see you and the cold sponge bath and freezies were so appreciated! You are the best! Thank you!

My plan for this race was to spend as little time in aid stations as possible, to allow for more time on the course. I think I was in and out of Ashnola in about 2 minutes. I started the climb up Flat Top Mountain. As I suffered my way up the start on the logging road, I looked back to see my friend Linda (aka “Super Mom”) power hiking and pumping (she was still breast feeding her almost one year old). What a champ! That definitely told me to suck it up lol.

The climb up Flat Top is a big one with a long ridge run along the top. This was the point of absolute freezing last year- while this year I was in shorts and a light tee shirt and still warm! What a change! Here is where I saw a wolf peering at me from the tree line. It was pretty amazing. We just looked at one another for about 5-10 minutes and then he turned and went into the woods. The descent from this summit is the most fun descent on the entire course! I felt like I was flying into Calcite aid station. I had made up time during this second climb, as last year I reached Calcite well after dark, and this time I was there in the light. My drop bag had a surprise in it! A kind note from Solana with words of encouragement! So awesome!

I was looking forward to the next portion of the race, as it would bring me down and across the river and into Manning Park where my crew and first pacer were waiting for me. Unfortunately, in my excitement, I missed a turn off the logging road and ran an extra 9 or 10 miles (oops). I blame all the toads on the road (it was toad crossing season) for distracting me- I was so busy trying not to step on them that I wasn’t noticing markers much! Anyway, I finally got back on track and made it to the river and past the hot tub party into Manning Park- where my crew was waiting! Nicole, Kyle, Chris, and Suzanne got me fed, changed, and ready to tackle the climb up Bonnevier- a 19 km ascent to the sub- alpine Heather Meadows. Kyle had agreed to be my pacer for the entire stretch from Bonnevier to Cascade aid station (about 60 km). What a gem! Thanks Kyle!

We were treated to a clear sky with views of the Perseid Meteor Shower as we climbed. It was gorgeous. We got to Heather Meadows ahead of schedule and made our way down to the new aid station location (it had been moved 2 miles further away making the course a 122-mile race). We passed Linda and Gary on our way down as they were coming back up. Linda looked strong and I knew she was going to finish!

Heather aid station was awesome- lots of hot broth and tequila, and vegan goodies! Mexican theme! It was great to see Brandi (who I ran some of the course last year with) and catch up a bit before heading back out into the cold night air. We ran across the meadows through the night and were rewarded with an amazing sunrise (see pic). This however is where my race began to go south. I started to feel pain in my hip flexors, like I had torn them. I figured it was just stiffness from the cold, however it just got worse and worse. I was not a happy camper coming in to Nicomen Lake (which is always my most difficult leg of the race mentally), and even though I was happy to see some friends (hi Matt, Erin) I was almost in tears from the pain in my hips. I filled up my pack and headed out quickly because I knew if I stopped too long I wouldn’t start again.

The downhill from Nicomen to Cayuse was awesome last year- I flew down that hill! This year however, I was crippled by pain. I could barely lift my feet off the ground, which made crawling over all the fallen trees extremely difficult. I was crying out loud with each step. We started to see all the 70 milers coming past us- they were fresh and flying, yelling out words of encouragement. I was not in a happy place and knew that something was wrong. I was stopping every few steps to stretch out my back which was aching really badly, and I was falling a lot due to tripping over everything I couldn’t lift my feet over. I knew this wasn’t just a “low” like everyone was trying to tell me. It was something more serious- but I couldn’t figure out what.

Kyle during this time had managed to get the worst blisters on his Achilles and they were bleeding. It was not a happy stretch for either of us. But we had to get down, so we pressed on (with lots of cursing and crying and hating life haha). We eventually made it to Cayuse Flats (well off my pace from last year) and pressed on to Cascade. The stretch from Cayuse to Cascade is only about 8 km but it has these steep little hills that just suck when you are this far into a race. We cursed our way through it and finally made it to Cascade aid station, where Chris, Suzanne, and Nicole were waiting for us. I took some time at Cascade aid station to rest and decide whether I wanted to continue. I began to feel better and since the next leg was fairly flat and runnable, I decided to press on. Nicole was my pacer for the next stretch and she put up with me extremely well as I cried (screamed, swore, sobbed) my way over every climb to Shawatum.

I know everyone meant well by telling me “it’s ok, it’s just a low- it will pass- you can do this” but man it made it worse! I knew it wasn’t a low, as I had been in it for over 12 hours and it had only gotten more painful. At this point I was stopping to scream to release some of the pain every few minutes. Sorry Nicole, I was not much fun to run with! I must have looked like a crazy lady during this stretch (sorry to anyone who I may have scared off with my erratic behavior)! We finally made it into Shawatum- in the dark (last year I made it in the light). Suzanne was waiting to pace me to Skyline, but I knew I would be hard pressed to make it over the hills in this much pain. I seriously considered my options. I figured I could tough it out over the next few legs but I was beginning to get concerned about the back pain I was experiencing.  I worried that if I made it up on to Skyline and got into serious trouble up there- it would be a search and rescue endeavour to get me down safely, and I did not want that on my conscience (don’t be THAT guy!).

So, I made the extremely difficult call to DNF after 105 miles (due to my bonus trek). We loaded up in the car and hit up a McDonalds for a McFlurry (HEAVENLY). I went in to the washroom and urinated what looked like coca cola with gel bubbles in it. I now know this is a very serious sign of a medically urgent matter, but honestly, I was sleep- deprived and brushed it off as maybe I had gotten my period and that’s why the toilet paper was dark. I think I would have been more worried had I continued to have dark urine, however after this incident it returned to more of a light amber so I figured I was doing better hydration- wise. In my head this made sense because I had been drinking water and electrolytes like mad the whole race so did not expect dehydration to really be a factor at this point.

We headed back to the hotel for a shower and then went and slept at the finish line and cheered on the other runners as they crossed. I got to watch Linda and Nikhil finish and that was awesome. We watched the awards and then got into the car to drive home.

I had my first week of the new semester of my nursing program the next day and I was out of breath and coughing and full of fluid in my chest. I struggled to stay awake through my classes and was starting to get really puffy in my face and legs. After 4 days of this, my husband took me into the Chilliwack Emergency. I was pretty sure I had pneumonia, but I was concerned about my kidneys because of the back pain.

 

At the hospital they got me through quite quickly, took my blood and sent me for a chest x ray. I came back from x ray and it was confirmed I had bilateral pneumonia, however they were more concerned with my blood work. My EGFR (measure of kidney function- should be between 80-100) was at 5. I was in acute kidney failure. They suspected rhabdomyolysis- a condition where your body breaks down striated muscle tissue and causes kidney tissue death. I was in shock. The ER nurses were skilled and reassuring. They started an IV in each arm and began a bolus of 1000 ml of normal saline in each arm over 30 minutes. Sometimes pushing fluids is all it takes to kick-start the kidneys again. Unfortunately, this didn’t work for me. All the fluid went out of the vessels and I turned into a huge swollen puffball with no improvement in kidney function.

An internal medicine specialist came to see me and said I would be staying the night. I called my mom (who happens to be a physician) and she sounded calm but worried. I was admitted to the ICU and hooked up to cardiac monitors, had a catheter inserted, and was put on oxygen, as my O2 levels were hovering around 70 on room air (not good). I was in excruciating pain (mostly to my back) and was not given any pain killers, as they were so worried about my kidney function the doctor had refused to order any. The nurses were amazing- bringing in hot blankets to stuff under my back and reposition me (as I could not move myself). They gave me sponge baths, and brushed my teeth and fed me ice chips, as I was too weak to do anything myself.

By the following morning I was positive 8 L of fluid in my body tissues, with nothing having gone through my catheter (NOT good- kidneys were completely at a halt). I finally was allowed to get some morphine for pain, thanks to the nurses who demanded the doctor help me. The pain was so severe it was causing me to vomit and wretch. There was no improvement in my EGFR and I was so full of fluid my eyes were swollen shut. I truly believed that I was about to die. It was terrifying. I said goodnight to my husband and 3-year-old son and honestly thought I was saying goodbye. My mother confided in me months later that she believed I was going to die, so yeah, I guess it didn’t look good.

I made it through the second night in the ICU and they transferred me to Abbotsford Hospital in the morning where I was to see the nephrologist and begin dialysis. I was taken up to the dialysis unit right away and they inserted a femoral port and hooked me up to the dialysis machine for my first short round of two hours. Following dialysis I was hit with a really bad headache and was drained for the rest of the day. Over the next 3.5 weeks I went to dialysis every other day for 4-hour rounds, but it took almost 3 weeks for my kidney function to start to improve. Biopsies of my kidneys were inconclusive as to why they were taking so long for my kidneys to perk back up. After discharge I was told that the nephrologist had been very close to putting me on the transplant list, as he had never seen someone come back from that degree of damage with dialysis alone. He had told my mother he thought I might die without a transplant if things didn’t improve soon.

The hardest part of being hospitalized for an extended period of time was seeing my friends and family visit me and then not being able to go home with them. Being a mom to my son for an hour at a time, every other day or so- was gut- wrenching. Being so exhausted when he visited that I could barely hold him or keep my eyes open was heartbreaking. When I was finally released home I had difficulty climbing stairs, as I was really weak. I camped out on the living room couch for the week. Digger and Kona (my dogs) were happy to have me home too and slept on the couch with me.

I got the all- clear to walk/ run again a few weeks later. I cried. I had been worried I might not have been allowed to run again after all of this. However, I have to say I have had to change a great deal about how I run and adjust my expectations a lot. I am predisposed to kidney issues now, and every hard training run or race puts me at a greater risk for injury than those of my peers who have not been in renal failure. I especially have to be cautious around heat and hydration, and I now have to think about extended pre-race hydration, managing electrolyte imbalances, and ensuring I do not have any medications in my system when I am racing (so I have to discontinue them a few days prior to race day), as they would put my kidneys at risk. I have to make sure I am not wearing out my muscles when I exercise, as this causes release of a compound called myoglobin which is toxic to the kidneys and causes tissue death and renal failure. I have to constantly think and evaluate whether pain is regular training discomfort, or something more serious (which is not easy given I have a high pain tolerance and I tend to zone out when I run).

My takeaways from this life- altering experience:

  • I had no idea about rhabdomyolysis (“rhabdo”) until I got it. The more you know, the better equipped you are to prevent it from happening or reduce likelihood of suffering severe and possibly long- term effects from it.
  • Your kidneys are super important! They kind of run the show (along with the brain) and if they don’t work you get really sick really fast. If the kidneys are compromised, your other organs are at risk. I had some pretty scary heart and lung stuff happening in hospital due to the kidney failure (sky- high blood pressure, high and erratic heart rate, breathing difficulties, even had to be given Nitroglycerin for pain to my chest which felt like a heart attack).
  • Signs of rhabdomyolysis: flank pain, coca- cola colored urine (may be frothy or bubbly), muscle pain (my legs felt shredded), fluid accumulation in your tissues- swollen face, hands, legs etc., difficulty urinating (once the kidneys shut down they aren’t producing urine), soreness, fatigue, bruising, generally feeling yucky, itchy skin (if the kidneys are in bad shape you build up uric acid in your blood), fever, nausea, vomiting, confusion. You may only have a few of these or a lot of them (depends on your degree of injury).
  • Go to hospital early rather than later (i.e.- don’t do what I did and go to school and wait a week before seeking medical help). IV fluids are key and if done early enough can be all you may need to get those kidneys back working! Which is much easier and more comfortable than having a femoral dialysis catheter hooked up to a big beeping machine that looks like a reel 2 reel player for hours and hours on end!
  • Prevention Tips: build up your endurance properly and allow your body time to heal in between hard or long training sessions and do not train through injuries. Ensure your kidneys are adequately perfused (i.e.- hydrate to replenish fluids and electrolytes). WATCH YOUR PEE! Seriously, keep tabs on the frequency, amount, color and concentration of your urine- aim for clear to light yellow (dark or frothy or painful is bad). Whenever I run with friends now I am like the urine police “Have you been drinking? When did you last pee? What color was it?” Yeah, I am THAT person! Because I care about your kidneys!
  • Don’t pop medications while you are racing. Ibuprofen and acetaminophen are filtered by the liver and kidneys and they can cause rhabdomyolysis and organ failure. Also good to keep in mind creams such as Voltaren are medications that get filtered by the kidneys as well so they are best to avoid as well while running.
  • If you have an infection or inflammation in your body- don’t race with it! I had what I believed was a cough, but was actually pneumonia, and this is one of the main factors that put me at risk for kidney failure.
  • Learn the difference between training/ racing discomfort, and pain that is problematic. As athletes, we tend to put our bodies through a lot to achieve the desired results, which can make it difficult to distinguish “good” pain from “bad” pain. When something does not feel right, or is nagging you more than usual, listen to your body. I knew something was off during this race, but I listened to others saying, “it’s just a low, you will bounce back” and so I ignored the warning signs for another 12 hours of agony before I finally pulled myself out. I do not advise learning your good/ bad pain levels by reaching your maximum pain threshold over 60 km of remote single track! (“Do as I say, not as I did!”)
  • Lastly, recognize how fortunate you are to be able to do what you do. I had the scare of my life facing my own mortality, and then I had to face the idea that I may not be able to run again. That was terrifying. I was extremely fortunate to be able to continue running and racing, albeit slower and with a lot more obstacles in my path, but I can still do it. I am extremely thankful for this. I have so much respect for my body and how it operates. I am still here, and I can use my story to help others remain safe and healthy while chasing their adventures!

Comments

  1. I always knew that you were superwoman, that article confirmed it.
    You are strong and wise and noble for Sharing to spare others from the nightmare that became your life.

    Well done on every accomplishment Willa. You are one of life’s high achievers. Here’s to many many more miles doing what you love to do most.

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