Triathlon Magazine Canada - - GEAR - BY TANIA HAAS

IT WAS SUP­POSED to be the cul­mi­na­tion of a train­ing dream. As a sea­soned sprint triath­lete, I knew I was tak­ing things to the next level with the half dis­tance – 1.9-km swim, 90-km bike and 21.1-km run. I fol­lowed a 12-week train­ing plan, worked with a per­sonal trainer, posted pho­tos from my weekly swims and bike-a-thons to In­sta­gram, and found win­ter runs more tol­er­a­ble with cre­ative photography in the ice, snow and sleet. When race day ar­rived on Feb. 20, 2016, I felt I had pre­pared ac­cord­ingly.

But, in­stead of cross­ing the fin­ish line with a huge smile across my face, I lay un­con­scious as I was shut­tled be­tween hos­pi­tals in an air am­bu­lance. My life rested in the hands of ICU nurses and doc­tors in a for­eign coun­try.

Known as the world’s most scenic triathlon, Chal­lenge Wanaka is the race of a life­time. I wrote about it in the May/june 2016 is­sue of this mag­a­zine. Set in New Zealand’s pic­turesque South Is­land (imag­ine the charm of Muskoka with the grandiose of the Swiss alps), triath­letes travel from around the world to com­pete in this lush wonderland.

My race started off well. The months of train­ing pro­pelled me dur­ing the swim (44:53), which was es­pe­cially chal­leng­ing given the choppy glacial wa­ters. I was in high spir­its as I went through tran­si­tion and made it on my bike. As I climbed my first hill, I mar­velled at the spec­tac­u­lar route be­fore me.

But my awe grad­u­ally changed to con­cern over the next five hours. A per­sis­tent headache, which I had at­trib­uted to de­hy­dra­tion, seemed to grow in sever­ity de­spite my drink­ing wa­ter and elec­trolytes. At around the 80K mark on the bike, I asked to see medics.

For what seemed like an eter­nity, I sat un­der the rest tent, while well-mean­ing vol­un­teers en­cour­aged me to get back on my bike and wrap up the re­main­ing 10 km. Men­tally and emo­tion­ally I wanted to, but my body was slowly shut­ting down. When the doc­tors asked me to walk, I had to grab chairs to keep from fall­ing. When they asked me to sit in their car, I im­me­di­ately passed out. I was rushed to the near­est hospi­tal. I have no mem­ory of the next 17 hours.


What I was ex­pe­ri­enc­ing was an ex­treme case of hy­pona­tremia – also known as wa­ter in­tox­i­ca­tion. This is when the body takes on more wa­ter than it can re­lease, caus­ing blood sodium lev­els to drop to danger­ous lev­els.

“It is in­ter­est­ing to note that be­tween three to 27 per cent of ath­letes seek­ing med­i­cal care are di­ag­nosed with ex­er­cise-as­so­ci­ated hy­pona­tremia,” says Rachel Han­nah, an elite run­ner and reg­is­tered di­eti­tian at the Med­can Ex­ec­u­tive Health and Well­ness Clinic. “Most of those cases are gen­er­ally asymp­to­matic. Mild symp­toms such as loss of en­ergy, nau­sea or headache are eas­ily brushed aside as a con­se­quence of en­durance ac­tiv­ity.”

My sodium lev­els dipped to 123 meq/l (nor­mal lev­els are around 135 to 164 meq/l). I was later told that hy­pona­tremia is life threat­en­ing if the plasma sodium dips be­low 120 meq/l.

Hy­pona­tremia is com­mon among marathon run­ners, triath­letes and other types of ath­letes. In 2014, a 17-year-old foot­ball player died from over­hy­dra­tion dur­ing foot­ball prac­tice.

Lon­don marathon­ers may be fa­mil­iar to the 22-year-old man who died of hy­pona­tremia after run­ning in 2002. In 2005, a study showed that 13 per cent of Boston Marathon run­ners stud­ied had hy­pona­tremia, with 0.6 per cent hav­ing a crit­i­cal case.

New Zealand ICU

The headache and grog­gi­ness was a re­sult of my brain swelling. At the small hospi­tal where the race team took me, I was un­able to dis­tin­guish a clock from a pen. When my mother ar­rived at my bed­side, I wasn’t able to iden­tify her. I had gone blind. My case was se­vere. I’m lucky the New Zealand ICU team re­sponded ef­fec­tively by first drain­ing me of the wa­ter. The doc­tors rec­og­nized the sever­ity of my case, and de­cided to trans­fer me via air am­bu­lance to the South Is­land’s largest hospi­tal, a 45-minute flight away. I have no mem­ory of this surely re­mark­able he­li­copter flight over the Crown Range moun­tains il­lu­mi­nated by a bright moon. In the Dunedin emer­gency ward, I was given in­cre­men­tal amounts of sodium and my con­di­tion sta­bi­lized. Upon re­gain­ing con­scious­ness the next morn­ing, I was told though my sodium lev­els were back to nor­mal, there was a risk that the ex­treme fluc­tu­a­tion in my sodium lev­els may have per­ma­nently dam­aged my brain cells.

“The se­ri­ous­ness was in the ra­pid­ity of the change,” ex­plained Dr. James Maska­lyk, a friend and an emer­gency room physi­cian at St. Michael’s Hospi­tal, in Toronto. “Be­cause the body has no time to equi­li­brate by us­ing other pos­i­tively charged solutes/cations, it af­fects cel­lu­lar func­tion, in­clud­ing nerve con­duc­tion.”

Phys­i­cal re­cov­ery vs emo­tional im­pact

Back in Canada, three weeks later, I had trou­ble ac­cli­ma­tiz­ing to life after a near-death ex­pe­ri­ence. Over the next few months, I had trou­ble fo­cus­ing at work. Sleep wasn’t easy, I was emo­tional and I con­stantly ref­er­enced my near death ex­pe­ri­ence in ca­sual con­ver­sa­tion. I was scared to run or swim again in case it trig­gered a seizure. While the phys­i­cal symp­toms – headaches, nau­sea and fa­tigue – even­tu­ally sub­sided, my anx­i­ety es­ca­lated. A visit to a neu­rol­o­gist con­firmed that I showed no signs of per­ma­nent brain dam­age. He told me, “The only thing this in­ci­dent did was give you the hee­bie-jee­bies.”

Fear and doubt crip­pled me. The neu­rol­o­gist helped me re­al­ize I re­quired a dif­fer­ent

type of med­i­cal sup­port. Over the next few months, I met with a psy­chol­o­gist, talked to my fam­ily physi­cian, reached out to friends for sup­port and made an in­cre­men­tal re­turn to fit­ness.

Ther­apy comes in many forms

After the hy­pona­tremia and hos­pi­tal­iza­tion, I felt like I had a sec­ond chance at life. Such a pro­found ex­pe­ri­ence was surely go­ing to af­fect my psy­che. I learned that the strug­gle I was hav­ing was a com­mon re­sponse to trauma.

“I think the pa­tients who bounce back the most from trauma are those who can grow tremen­dously from the trau­matic ex­pe­ri­ence and learn a valu­able les­son be­neath what hap­pened,” said Markus Be­se­mann, a physi­a­trist and head of the Re­ha­bil­i­ta­tion Medicine with the De­part­ment of Na­tional De­fence. Be­se­mann is a re­ha­bil­i­ta­tion doc­tor who treats in­juries or ill­nesses that af­fect how you move. He works mostly with mem­bers of the mil­i­tary.

He in­tro­duced me to the term “post­trau­matic growth,” a psy­cho­log­i­cal phe­nom­e­non in which trauma deep­ens life’s mean­ing. Be­se­mann says that jour­ney usu­ally in­volves be­ing vul­ner­a­ble.

“Peo­ple need to feel vul­ner­a­ble in or­der to heal,” says Be­se­mann. “When you sup­press emo­tions, you are more likely to suf­fer a set­back or get sick.”

Stud­ies show that not every­one who ex­pe­ri­ences trauma may be open to growth dur­ing re­cov­ery. Around 35 to 75 per cent of trauma sur­vivors ex­pe­ri­ence some form of post-trau­matic growth. Psy­chol­o­gists have found that cer­tain traits like op­ti­mism, agree­able­ness and ex­tro­ver­sion in­crease the like­li­hood of growth. Seek­ing clin­i­cal help can also help.

With­out know­ing it I was prone to growth be­cause of my ex­tro­verted nature and open­ness. I asked for help and be­came more self-ex­pres­sive. A psy­chol­o­gist helped me to rec­og­nize that the way I was think­ing was hin­der­ing my re­cov­ery. She used Cog­ni­tive Be­havioural Ther­apy, a type of talk ther­apy where neg­a­tive thought pat­terns about the self and the world are chal­lenged to al­ter un­wanted be­hav­iour or ways of think­ing.

A lead­er­ship course re­in­forced what was in my con­trol and helped me let go of past ex­pe­ri­ences, which were no longer serv­ing me. I chose to so­cial­ize with pos­i­tive peo­ple. I avoided the com­plain­ers and gos­sips. I spent more time walk­ing in nature.


Un­der­stand­ing hy­dra­tion and rac­ing

I spoke to Han­nah, an elite dis­tance run­ner her­self (she won the bronze medal in the marathon at the Pan Am Games), about what I did wrong from a hy­dra­tion point of view. She shared with me how she pre­pares with pre­hy­dra­tion and re­places sodium loss dur­ing her races.

“The goal of pre­hy­drat­ing is to en­sure you start the run well hy­drated and with nor­mal plasma elec­trolyte lev­els,” says Han­nah, who drinks about one litre of flu­ids be­fore a morn­ing ses­sion and eats foods con­tain­ing sodium to help re­tain these flu­ids. Han­nah says that, when she is well hy­drated to start, she drinks ac­cord­ing to thirst and aims for 0.6 to 0.8 L/hour.

“I pre­fer to use an en­durance for­mula for my flu­ids since this pro­vides me with car­bo­hy­drates needed for en­ergy and sodium and potas­sium to help re­place sweat elec­trolyte losses,” says Han­nah. “I also try to take one to two en­ergy gels for my runs last­ing longer than two hours. In ex­treme tem­per­a­tures (over 30 C) I will also take in ad­di­tional wa­ter based on my thirst. I aim to con­sume the max­i­mal amount of flu­ids dur­ing my runs that do not in­ter­fere with my pace or ef­fort and do not cause gas­troin­testi­nal dis­com­fort.”

She also says that urine is a good in­di­ca­tor. Its fre­quency and colour is a tell-tale sign of your hy­dra­tion health.

What I would do dif­fer­ently

If I were ever to train for an­other 70.3 (some­thing I am re­luc­tant to even con­sider), I would most cer­tainly work with a coach, reg­is­tered di­eti­tian and also take a sweat test.

“Drink­ing habits need to be in­di­vid­u­al­ized to re­duce the risk of ex­er­cise-in­duced hy­pona­tremia,” says Han­nah. “Since peo­ple vary in body mass, run­ning speed, heat pro­duc­tion and the weather is also vari­able. It is es­sen­tial to prac­tice fluid strate­gies dur­ing prac­tice be­fore com­pe­ti­tion.”

A grad­ual re­turn to rac­ing

Soon my sleep im­proved, and I was able to bal­ance work and re­la­tion­ships with more grace and ease. I re­turned to yoga, specif­i­cally restora­tive prac­tices. The slower pace and deep breath­ing mit­i­gates the stress re­sponse that was en­com­pass­ing my days.

I also re­turned to run­ning. I com­mit­ted to a com­pany team 10K in May and eased into build­ing up my strength and en­durance again. On race day, anx­i­ety symp­toms re-emerged. I was the last of my group to com­plete the run as I ex­pe­ri­enced a se­vere stress re­ac­tion dur­ing the race.

I had se­vere per­spi­ra­tion, dry mouth and cool, pale skin. My body rec­og­nized the race en­vi­ron­ment as a threat, and adren­a­line re­leased into my blood­stream. While the 10K was hardly en­joy­able, it was a nec­es­sary step to re­turn to fit­ness.

“I see that all the time with mo­tor ve­hi­cle ac­ci­dents – when peo­ple who have had an ac­ci­dent don’t want to get back into the car. But the longer you go out, the harder it is to get back into the car. You must con­front your demons. The best thing you can do is ease into a re­turn to that ac­tiv­ity,” says Be­se­mann. “Grad­ual de­sen­si­ti­za­tion to that stim­u­lus with the help of your fam­ily, friends, or, if needed, pro­fes­sional help.”

Bik­ing and run­ning was a tough tran­si­tion

In July, I en­tered a mini triathlon in Graven­hurst, Ont. I wanted triathlon clo­sure, and a try-a-tri seemed like the ap­pro­pri­ate

dis­tance. While train­ing for the swim, I would ex­pe­ri­ence tight chest. The day be­fore the race, I went to drop off my bike. When I saw the orange py­lons, bike racks and sig­nage, I started to cry. This re­ac­tion was weird be­cause I was feel­ing emo­tion­ally neu­tral. A doc­tor later told me that my re­ac­tion was a flash­back.

“That’s your fight-or-flight re­sponse. The adren­a­line rush when you are con­fronted with some­thing that could be threat­en­ing again. Your mind may ra­tio­nal­ize that it’s a one-off, and it won’t hap­pen again, but phys­i­o­log­i­cally, when you step into a race set­ting or sit on your bike, the mem­ory is still there and this is still a threat­en­ing sit­u­a­tion or piece of equip­ment, that could have killed you,” says Dr. Be­se­mann. “But most re­peat scares are not life threat­en­ing. The longer you re­sist – whether it’s get­ting back on the bike, driv­ing a car or re­turn­ing to fit­ness, the harder it be­comes.”

De­spite the cry, I com­peted the next morn­ing. Once I had com­pleted the run I ex­pe­ri­enced a won­der­ful sense of re­lief and ac­com­plish­ment.

Five months after my hos­pi­tal­iza­tion, I had fi­nally crossed a triathlon fin­ish line. A few weeks later I did an­other triathlon – this time a team race – on Toronto Is­land. I ex­pe­ri­enced no flash­backs or phys­i­cal stress symp­toms. I felt back to my old self.

My train­ing was phys­i­cal and psy­cho­log­i­cal. Be­se­mann en­cour­ages all those in­jured to ease back into ac­tiv­ity and to wel­come the ob­sta­cles that arise as a part of your com­pre­hen­sive re­cov­ery.

“For those who have dif­fi­culty re-en­gag­ing when they are phys­i­cally ready, they may be blocked by un­re­solved trauma that this in­ci­dent has re-awak­ened in you,” says Besse­mann.

Post-trau­matic growth can hap­pen

My trau­matic ex­pe­ri­ence awak­ened the need for more bal­ance and self-care in my life. It con­trib­uted to per­sonal growth and a greater ap­pre­ci­a­tion of life. I learned that mov­ing for­ward (how­ever grad­ual it may be) de­fines re­silience – a com­mon char­ac­ter­is­tic among triath­letes. And, with the right ap­proach, we need not be lim­ited by the pro­found chal­lenges we en­dure.

Tania Haas is the in-house writer at Med­can. She also teaches post-trau­matic growth yoga at the Toronto Mil­i­tary Fam­ily Re­source Cen­tre.

OP­PO­SITE TOP Tania Haas re­flects in Wanaka after her emer­gency

OP­PO­SITE BOT­TOM Haas on the bike prior to pulling out of the race LEFT Start to Chal­lenge Wanaka

BE­LOW Tania Haas in the hospi­tal re­ceiv­ing treat­ment and rest­ing

BE­LOW LEFT The Sport­ing life 10K was Haas’s re­turn to rac­ing BE­LOW RIGHT After a full re­cov­ery Haas com­petes in the Graven­hurst try-a-tri and fin­ishes with a smile on her face

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