Dehydration Can Be A Real Problem (or: Blood in Urine! Not Again!)

Last summer I posted a 100 mile PR by over an hour with a solid 15:27, but then spent the next 30+ hours in the ER. What was said to be rhabdomylosis probably was at least part of that, but it was also compounded with dehydration. That day in upstate NY was quite warm, and while I thought I was drinking enough liquid, I only urinated twice, the first being orange, the second being red. Blood red. We shall ignore (for now) the fact that I should have stopped, blah, blah, blah. What we should note was that I was a few pints low on liquid and the IV bags were plentiful and fast-draining for me afterwards.

So you would expect me to be better about drinking more liquids. Well, I thought I was doing better. Fall came and temperatures dropped, so I did not have to keep my liquid intake as high as in the summer and I seemed to have no problems.

In the spring of this year, I became a ketogenic athlete getting the majority of my energy from fats instead of carbs. When you are on a ketogenic diet, turns out you need to be drinking more water than normal, because of the way your body uses the fat for fuel. So I needed to up my water intake just because of my diet.

When I ran the Indiana Trail 100, it was cold (30-40 degrees) but I made sure to drink lots of water, and I urinated many (read: enough) times so I was ok. I drank roughly a quart of liquid (with electrolytes) every 16 mile loop. That means I I drank 3 gal of liquid during the race. at the temp never went above 45 degrees. (read: it was cold) Summer finally arrives in Michigan and my training runs were being done in 70+ degree heat, so I had to start drinking even more.

Now, I have never been good about drinking enough water, even before I went ketogenic. I just don't like the taste of water. I use Mio (and generic equivalent) flavoring to make it taste better, and when running add Hammer Electrolyte Fizz to also help, but it is the physical act of drinking lots of liquid that I still struggle with.

Then last week happened.

Memorial day weekend I spent in CA with brothers and friends and I did have more alcohol than I should have and less water than I should have, so I was a little dehydrated but thought little of it. I got back and then had a 34 mile training day on Wednesday and everything was fine, or so I thought. For my long day of the week, I was planning on doing 50ish miles on Friday. My body was totally ok (not sore from Wednesdays workout) so I took off for the first marathon of the day at 7am, knowing I had plenty of time to hit 50. At mile ~9, I picked up my friend Joel (who coincidentally told me a few days previous that he wants me to help him train for a 12 hour ultra) and we did 8 more. I had drank what I thought was enough water for the run up until that point, and sure enough, I had to go pee. It looked like Coca-Cola. Yup, blood in my urine.

I did not pass go, I did not collect $200. I stopped my run for the day, even though just like in August I felt just fine otherwise. Within two hours I was in my doctors office getting checked out. Sure enough, I had blood in my urine, but no infection (good news). We suspected rhabdomylosis again, but 2 things indicated that was not it. One was the fact that in those two hours I drank a good amount of liquids and my urine went back to clear (rhabdomylosis doesn't clear that fast) and subsequent blood test confirmed no rhabomylosis.

It looks like it was dehydration. We waited 3 days (and about 5 gal of liquid later) and did another battery of tests (blood and urine) as well as getting an ultrasound on my kidneys. The good news was that the urine sample came back negative (no more blood) and the blood test came back all cool. Again, it was negative for rhabdomylosis and other stuff (blood sugar, electrolytes, etc.) were all good as well.

The ultrasound was different. They found a cyst, but the good news is that it was not of size/location to cause concern or need for more tests.

Crisis, averted. What is funny is my doctor's official record says 'Patient may resume running and should drink water before, during, and after all workouts'. Ummm. yeah. :)

So I am supposed to drink 2.5L a day just because of my diet in addition to whatever I should be drinking for my running, which in the summer is A LOT. How the heck do I down that much liquid? I need to come up with some solution. At least now I have some more motivation because I know what will happen if I do not get enough.