Triathlete Ron Gordon learned about the dangers of hyponatremia and the importance of rehydration the hard way, and he's shared his remarkable story with us in the hope that fellow athletes can learn from his experiences...
My first collapse
When I awoke in the ambulance, I felt great, euphoric, warm and comfortable. The ambulance crew was less than amused and scolded me, "you have to drink something after a race, man, your blood sugar was below 2 ml/mol!”
I didn’t really know what that meant, but did start to realise that being in the back of an ambulance with no idea how you got there, should raise some eyebrows.
“You had a seizure,” the crew explained. Really? Well, I hope I was entertaining. “Was it a grand mal?”, I asked. “Yes, full loss of consciousness, body twitching, the whole show.”
Last thing I remembered was going into the transition zone to pick up my bike to transport home. I had just produced one of my best performances ever.
It was also my first relay, and the first time I'd ever reached the podium in a non-age group category. I was thrilled with my bronze in the Olympic relay distance.
My cousin was the swimmer, I cycled, and my sister ran. Out of the water, my cousin had us in the top-five and cycled our way into second. I was in top form having completed an IRONMAN the weekend earlier.
My bike, with full aero equipment, wasn't conducive to fluid intake – I never took one sip from my aero bottle. And since I wasn’t running, no reason to conserve energy.
The excitement of seeing my sister run for the podium had me following her around the course. I didn't even think about post-race hydration. My sister, pushing the 5th decade of her age-group, held off those youngsters for the bronze in an exciting final sprint.
It was almost exactly an hour after I'd finished my cycling portion that I collapsed.
I learned my lesson. Re-hydrate.
Preparing for another IRONMAN
Fast forward four years later, after many more races and training workouts, it was time to tackle another IRONMAN. The usual demands of time and training and diet were adhered to.
Although I was self-coached, I figured I had enough experience to know what I was doing (insert eye-roll here). This would be my third IRONMAN.
On a particularly nice, but cold, spring day, I headed out to ride trails with a buddy who is mostly 'roadie'. His idea of mountain biking is to hammer the flat gravel trails at top speed for an hour – exactly like my 40km time trial at that fateful relay tri.
My full suspension Kona has a rather poor feature for this sort of activity. The water bottle cage is underneath the down tube making the reach for the bottle awkward, if not impossible, at full speed.
We rode for just over an over before stopping for coffee, and then rode for home when the weather had risen to 7 degrees.
I woke up in an ambulance. Again, feeling darn good, and again, told I had a grand mal seizure.
Later, I discovered, I had been riding the trails for about 10 minutes but had no clue as to how I ended up where I was picked up by the medical crew – it was if I was riding unconsciously.
The usual tests revealed nothing but I was told I should go on anti-epileptic medicine.
Why? Well, after two unprovoked seizures, you're deemed to have epilepsy and a number of constraints occur, such as not being able to drive.
I didn't think I would participate in competitions again.
Nevertheless, a few small events went by without incident and after 2 years without any spells or episodes, I thought I would ramp up training once again.
Ramping up training again
Same as before, after a winter spent skiing, swimming, and increasing running mileage in preparation for a late spring marathon, it was time to get out the road bike for a spring ride.
Once again, a cold morning was met with several layers of my favourite wicking winter thermal wear. After our coffee stop, as 2 years earlier, time for the recovery ride home. The temperature had risen another 7 degrees. The last thing I remember is telling my friend I was too hot.
At this point, one is always worried of criticism from those who see the obvious in this story, “why didn’t you drink?”.
Two reasons, 1) I wasn’t thirsty, 2) I forgot.
How could you forget? My riding group is my entertainment and social support. Our eclectic mix of personalities generates vigorous discussions on every topic. Coffee debates can be just as intense as the sprint for the bridge!
Now armed with a GPS HR monitor details of what was to be my third seizure emerged. As before, I had ridden about 10 minutes with no conscious awareness.
My GPS suggested I was descending a hill, suddenly stopped, turned around and headed back up to the top where I collapsed and lost consciousness.
I can take some solace from knowing that I'm not the only one who has screwed up hydration in cold weather. Check out the story of Henry Worsley.
Things were pretty dire with a third seizure under my belt and it was back to testing. Again, the neuro-imaging tests were all negative. My driver’s license was suspended indefinitely until the cause of my seizures could be determined.
During this last episode, my HR monitor showed something interesting, my HR had gone from 120 bpm at the top of hill almost instantly down to 42 bpm. It was impossible to tell from the data if my seizure had started before the HR drop or after.
From my HR monitor data, it was impossible to establish if the sudden drop in HR was the cause of the seizure, or if the seizure onset itself was responsible.
Whatever the case, extensive investigations into my heart condition were undertaken. After a year of tests, they all came back normal. Blood tests revealed nothing unusual.
Finding a solution - Sweat Testing
That only leaves electrolytes but it’s unethical to try and provoke a seizure by dehydrating someone. This hypothesis would remain only speculative.
I had heard about PH's Sweat Tests and was tested by Sean, who asked if I thought I was a salty sweater. “Not at all,” I responded, "I would say average".
Wrong! I actually came out as a very salty sweater (1,433 mg of sodium per litre!).
I didn't think my actual sweat rate was all that high, but I’m always a stickler for the best high performance clothing.
Wicking away moisture in clothing layers is something I can say I have mastered. In the spring season, when temperatures can warm many degrees during a ride, this is critical for comfort, but is possibly confusing to my fluid intake perception.
You're sweating, but you don’t feel hot as the cold air on your face makes you feel cool and you feel no need to drink. [Why hydration still matters in cold climates and how to nail your hydration strategy].
Believing loss of electrolytes could be a source of my seizures, I immediately began using PH products and gradually picked up my training. It didn't take long before I started putting in longer miles and feeling great.
Soon, IM distance was in my grasp and I never felt better. Still, I hadn't cleared all the medical tests. I was waiting for the final report from a sports cardiologist.
Finally, it came, heart arrhythmia was not the cause of the seizures. Metabolic conditions due to dehydration, resulting in hypotension or exercise-induced hyponatremia was the differential diagnosis. The doctor recommended that I take additional sodium and stay on top of my hydration during exercise.
Buoyed by that information, I took my trusty PH tablets on a cycling trip in Japan, covering over 1000 km in 2 weeks.
Not huge mileage but with a loaded touring bike, those were long days (try climbing Mount Fuji with 80lbs of bike and gear).
Never did I feel at any time woozy or fatigued or in danger of collapse (I promised my wife I wouldn't push it - like we all do).
With the report from the cardiologist, I was finally cleared to drive and the whole episode taught me an invaluable lesson: post-race re-hydration with sufficient replacement of sodium is crucial.