The Friday before the ride, I drove out to Bettendorf, Iowa, with several friends. We had dinner at a barbecue place, and I didn’t eat much because I didn’t have much of an appetite. I was getting over a cold and still taking a decongestant. I remember thinking I should be hydrating more, but we were going to be sleeping in tents that night and I didn’t want to have to get up in the middle of the night to use the bathroom, so I didn’t drink much water. (duh, sounds really ridiculous now to not hydrate for this reason!)
In the morning, again, I wasn’t feeling much of an appetite, but I did enjoy a huge cup of coffee. No, not the breakfast of champions....
Saturday morning was sunny, warm, and glorious. It was great to finally be riding and shorts and short sleeves and leave the gloves, jackets, and tights at home. I’d been riding quite a bit that spring in training for the AIDS Ride, so I had a lot of miles on my bike. But most of my riding that spring had been done in cold weather, so I was not acclimated to warm-weather cycling yet. Issue number one on my route to hyponatremia was that I was not realizing how much I was sweating. On the bike, when you sweat it evaporates rather quickly—I find that it seems like I sweat more when I go for a run….. actually, though, I think I sweat just as much on the bike, but because I’m moving faster on the bike, the sweat dries quicker.
As a dietitian, I know that I need to drink both water and sports drinks to replace both fluild and electrolytes, but KNOWING and actually DOING are different. I wear a camelback, which I use for water, and keep a bottle filled with a sports drink on my bike. When riding, it is much easier to drink from the camelback. It sounds crazy now, but I tend to avoid drinking from that bottle on my bike because of the additional coordination to reach for it, and the fact that it’s harder to keep my eyes on the road while drinking from the water bottle. Generally, I prefer to drink from that bottle only when I am at a stop sign or a pit stop. On TOMRV, there are not many stop signs between pit stops, which is great for riding, but not so great for someone like me who doesn’t like to grab a bottle while moving. Of course, I COULD put a sports drink in my camelback, but I have avoided doing that because it’s a lot harder to clean sports-drink residue from the camelback than from the water bottle. (again, this sounds crazy now, but that was my thinking at the time.)
So, the Saturday morning of TOMRV, I’m having a great ride, enjoying the sun and drinking like crazy from the camelback. The first pitstop was a local firehouse that makes a pancake and eggs breakfast for the riders. Did I eat? No (I know, duh!) Instead I downed a couple of ibuprofen because my knee was acting up. (I know now that ibuprofen and other nonsteroidal anti-inflammatory drugs can predispose some people to hyponatremia.) For reasons I can’t explain, I was not drinking from that Gatorade in my bottle even at the pit stops. Over the course of the morning I emptied that 50-ounce camelback 3 times, yet still did not need to make a bathroom pitstop. My body was holding on to all of that fluid.
At the next pitstop a friend mentioned that my forehead looked “salty” where I had been sweating, but I still didn’t get the hint. Clearly, I was sweating out sodium, but did I drink any Gatorade? I’m embarrassed to say I did not.
At the next pitstop I was feeling a little light-headed and woozy, and at this point I did drink a good 16 ounces of Gatorade, and when I got back moving on the bike I felt fine, so I kept going. The next pit stop was lunch and I still hadn’t needed to use the bathroom after all that fluid, and I was feeling even more light-headed, so I stopped at the medical tent. They advised me to stay there and not get back on my bike until I’d used the bathroom. An hour passed. I tried to eat some pretzels (finally, actually eating some food that day), and not too long later I was vomiting a whole lot of water, water that had just been sitting in my stomach with no where to go.
No more riding for me that day….at least no more bike riding. Instead I got an ambulance ride to Galena Hospital. There they discovered that my blood sodium was 119 (normal is about 135), and rather than hanging out with cyclists that Saturday night, I spent it in the hospital. Ultimately, with some IV electrolyte replacement I was fine and discharged in the morning, but hyponatremia can be serious, so I want to encourage everyone to not make the silly mistakes I made.
So, in summary, here’s what you can learn from my story:
- Be aware of the climate and what you’re accustomed to. Pay attention to your sweat and replace what you’re sweating.
- EAT! Don’t skip meals and snacks on long rides.
- Be liberal with salt during meals and snack on long-ride days (unless you have medical reasons that necessitate a low-sodium diet).
- Don’t let the annoyance of cleaning a camelback prevent you from putting a sports drink in there. :o)
- Practice reaching for that water bottle on your bike so you are comfortable drinking from it while the bike is moving. Or, be sure to drink some sports drinks at the pit stops.
- Be aware that some medications can increase the risk of hyponatremia—I am NOT saying to not take those medications, but just be aware so you can be extra-vigilant about keeping your electrolytes normal.
- Two other risk factors for hyponatremia are age (the older you get the bigger the risk) and gender (women seem more at risk than men). Of course, these are risk factors that we have no control over, but again, it’s just good to keep these in mind so you maintain an awareness of the need for fluids and electrolytes.
Shelley
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