Mark Didham’s Story - July 25, 2014

Story of My Run

Background

I started running in April 2011 to lose weight. I was 27, and had packed on pounds during my days in University. I was sitting at around 270-280 pounds when I started. I began with short distances, building up capability using a 3.8KM loop of a lake near my workplace. Over the next year and a half, I would drop to just under 200 pounds. Developing a faster pace and handling longer distances.

In Newfoundland and Labrador, Canada, the most significant race is The Tely 10. It’s the third oldest road race in Canada, and one of the oldest in North America, having first been run in 1922. It’s a 10 mile race, now run in the last Saturday of July every summer. It’s a fast course, it’s largely downhill/flat.

This race is pushed heavily in the media and by local running clubs/fitness groups as motivation to get out and get active as the snow clears off, with numerous 8-12 week training programs available. It’s jumped in registration significantly in recent years.

I first ran it in 2012, it was my first time participating in an organized road race. I recorded a time of 81:35, far surpassing my goal. After that I became a regular in local road races, really motivating myself to push hard in a race and obtain new PBs. I ran the 2013 Tely 10 in 73:56.

2014 Tely 10

When 2014 came around, I started thinking about a sub-70 minute time as my goal. I can’t say I adjusted anything in my training for this goal, I just did what I always did, run a lot and push hard, especially in the races. I did not set out specifically to do tempo training or hill training, never really had recovery periods. I had not really changed my diet since initially losing weight, so despite running more, I was still at I’d gained a little, floating between 205-210 pounds.

A 5 mile road race 2 weeks prior had me confident that 70 minutes would be hard, but attainable. I’ve always had a stronger second half, not settling into a race until a couple kilometers into it. Based on my time, I figured I could improve enough in a second 5 miles to hit under 70.

The week of the race was warm, and it was looking like race day would be quite warm. Newfoundland is not particularly known for nice weather. We typically have a handful of days in the year that approach 30 degrees Celsius (86 F). Typically, if you are warm here it’s because of humidity and it’s stuffy. 2014 was above average in terms of quality whether for June/July. I am not the biggest fan of heat, and I like to run with my dog, so these days where the sun was shining strong, I typically waited until late in the evening/night to run.

The day before, it was looking like the temperature would be above 25 C (77 F). This temp made me nervous, I was worrying about how it would impact my goal. I was aware I’d need to hydrate more. I was cracking jokes about either hitting my goal or needing IV and an oxygen mask. It was the first time I ever completed the medical contact information on the race bib, just had a weird feeling.

On race day, as we arrived by bus to the start line at 7:20am, it was already around 25 C (77 F). It was definitely warmer than most local runners were accustomed to. Here you train yourself to be able to run in wind and rain, not heat. The biggest investment is in cold weather gear.

The Race

At 8am the gun went off. I started strong. Trying to avoid getting caught up in the start of race adrenaline rush. Remembering to run my own race. I was keeping a pretty solid pace around 4:25/km, right where I wanted to be. I recall thinking a mile and a half in that my feet were absolutely burning. My heart rate was already up around 170bpm. This was not unusual for me, I’ve always participated in sports, but I’ve never been athletic. I always just aimed to play the hardest to make up for not being skilled.

I remember having a cup of water and possibly Gatorade the first two water stations. The sun was getting higher in the sky and it was getting warmer. I took chilled sponges from spectators along the route, and additional water. I hit the 5 mile mark at about 35:49, a 4:27/km (7:09/mile), with my heart rate averaging around 175bpm. I had been hoping for 35:30 at the low end of the halfway point, but still thought it was possible to make up the time.

At around 6.3 miles, there was another water stop. Here I decided I could not keep up the pace for my sub-70 goal, my HR was bouncing above 180bpm. I took a walk break and took in water and Gatorade. After about a minute and a half of walking/light jogging, I decided I could still get a PB. I took off in a full run again, taking my pace down to about 4:32-35/km (7:18-23 per mile).

The Breaking Point

At this time, I recall just feeling exhausted and drained, but determined to slug through. Focusing on keeping one leg in front of the other and staying on pace. I remember completing one of the steeper inclines on the route. I remember getting a drink from either a water station or spectators. Shortly after this my memory is blank. Looking at my Garmin reports, this was around 7.6 miles. It was a flat part of the course, but my pace took a took a dip for about 45 seconds. My heart rate was at 184 bpm.

From this point on my Garmin stats are much more inconsistent. My pace is all over the place, ranging from 4:15/km (6:50/mile) to 6:00/km (9:39/mile), my heart rate is steadily in the 180s.

People who know me, recall yelling out and cheering me on, but I failed to acknowledge them. Around the 8.3 mile mark, a friend always watches. She always takes a picture of me to send to my wife at the finish line, to give her a heads up that I’m getting close. I always wave and smile, I just ran on this time. A video exist from a checkpoint along the route. It shows me up right and running, passing other racers, and seemingly looking okay. At 9.13 miles, my pace suddenly drops to 19:04/mile for a few moments and recovers. Very shortly after it drops again.

At 9.3 miles there is fire station. This is where my race ended. It was at 9:10am.

Fire stations along the route typically set up hoses on race day to allow runners to cool themselves if they wish. The firemen also provide first aid support. I spoke with one of the firefighters to try to learn what he remembered as I reached the station.

He recalled seeing me zigzagging across the road. Instantly becoming aware that I was in distress. As I approached the fire station, I headed straight towards the water hose. According to his account, I sat myself down under the stream of water. They came over to check on me. He recalls placing his hand on my shoulder and feeling my heart beating rapidly, it was still over 180 bpm.

They lifted me off the ground, I was dead weight, and sat me on a chair. I sat up on the chair, my eyes were open, but I was completely unresponsive. They started cooling me with more water. Attempts to get a response via trapezius pinches and sternum rubs received no reaction. My eyes were open, I was breathing on my own, sitting up on my own, but otherwise zombielike.

An ambulance was dispatched, I have not been able to obtain a report of treatment I received in the ambulance.

I arrived at the St. Claire’s Hospital; it was along the race route, just over ½ mile back. I was admitted to the ER at 9:49am. My body temperature was 40.3 C (104.54 F), I was unresponsive. Immediately I was placed in ice and a cold mist was applied.

I remained highly agitated and aggressive into the afternoon, I was rapidly breathing and shivering. Tests to that point showed signs of kidney trouble, and significant liver issues. They were surprised to see little impact on my kidneys. This caused them to make the decision to intubate me in the late afternoon, I was placed in ICU.

In a diary she kept, my wife notes that in the evening my temperature was still at 39.8 C (103.64 F). They wanted to take me for a CT Scan, but needed my temp to be below 38 C (100.4 F).

I was able to get a CT Scan. It revealed no obvious sign of brain injury which was relief.

By midnight my temp was finally at 34.2 C (93.56 F).

Race Day + 1

The next morning my temperature was back up to 38.8 C (101.84 F). There was a struggle all day to keep my temperature down. I was under sedation, but kept getting agitated and the shivering kept driving my temperature up near 40.0 C (104 F) again. They further sedated me to combat this.

Blood work was not significantly changed from the prior day. At night my temperature was at 37.5 C (99.50 F).

Race Day + 2

The doctors attempt to wake me from sedation for the first time. My wife recalls me trying to move my legs.

I had an ultrasound that revealed the presence of blood clots. I had of bilateral posterior tibial vein thrombosis.

A Helical CT of my head was performed. It revealed no intracranial damage.

All seemed steady throughout the evening until the Doctors tell my wife that I’m in critical condition. I went into liver failure. Blood work showed my AST levels were 1,754 units/litre, well above a normal range of 40 units/litre. However, Doctors remained confident due to my age that I would bounce back.

Race Day + 3

In the morning I seemed stable. There are attempts to wake me, but I do not respond. Signs of pneumonia are spotted on a chest x-ray.

My AST level hit a peak of 3,123 units/litre.

Another concern remained my unresponsiveness.

Race Day + 4

In the morning I still don’t wake up, however, I’m agitated. They fully sedate me again. However, my wife says I did respond to the sound of her voice.

My AST levels were down slightly to 2,833 units/litre.

The pneumonia was not worsening, so that was good.

Race Day + 5

When my wife arrived the next morning, she was called into the ICU on her own. The nurse told her to speak to me, when she did, I responded, but with difficulty. Eventually I responded to questions by nodding and squeezing.

My temp did climb again, floating around 38 C (100.4 F). That evening I was put under light sedation again to conserve energy.

My AST levels were down to 839 units/litre. Doctors were happy the numbers were down.

Race Day + 6

Once again, when my wife arrived, I was awake. I still was running a fever. They restricted visitors and kept me resting.

Later that day, when my wife was allowed to visit again, I was sat up, without a tube in. She recalls being so happy, that she couldn’t cry. I asked questions apparently, but I don’t recall this.

At night, the fatigue of the day caused a slight fever once again. According to my wife I was confused.

Race Day + 7

On this morning, my wife is awoken by a phone call. It’s me. I’m conscious and asked a nurse to call my wife. From this point on I’m not longer sedated. I recall parts of the questions and conversation we had on this night. I became aware of what had happened.

Race Day + 8

I’m finally moved out of ICU and into a private room. Seems like I’m on my way to recovery, I remember thinking that I’d be discharged in a day or two.

Race Day + 10

While the Doctor is examining me, I indicate that I feel stiff and sore. I assume this is from lying down for so long. He is instantly concerned. In no time there is blood work completed and I’m hooked up to a potassium chloride IV. I was diagnosed with rhabdomyolysis. My CK levels had spiked to 19,187.

The Doctor explains the risks, how high levels of fluid are needed to help prevent kidney damage. I would remain on this IV until the day I was discharged. I learned later that in the first couple of days my CK and other levels all returned to a more acceptable range, so they were not monitored so closely. The sudden increase in CK levels was a surprise. At 5pm on Race Day it went to 983.

The status of the blood clots was evaluated. It was determined that progression of the thrombus from the calf veins into the popliteal veins in both legs.

Race Day + 12

CK levels hit their peak, 31,330.

I had an abdominal ultrasound performed. The examination revealed no abnormalities; my internal organs appeared to be functioning properly.

I began very light physio therapy. Just learning how to stand again, and getting the used to balancing.

Race Day + 18

I was examined by a Rheumatologist. He was following up on the elevated CK levels. He checked to ensure there was no underlying conditions, particularly autoimmune diseases.

The physio progressed to the point where I was able to walk a lap around the floor with the assistance of a walker and my wife. It was incredibly exhausting and slow, but a great accomplishment to be able to leave the hospital room.

Race Day + 24

Finally my blood work was improving to the point that the Doctors determined it was safe to discharge me. My CK was at 1,651, they debated keeping me, but I was insistent on getting out.

This may have been one of the greatest feelings in my life. I was thrilled, overwhelmed with emotion. Don’t know if I ever enjoyed a car ride so much in my life. Just seeing the world up close again, not from a hospital. Knowing I was going home.

The doctors told me it would be 2-3 months before I would probably go back to work. I was going to be starting outpatient physio services immediately, as I still could not walk without the aid of a walker. My strength had been greatly diminished by the muscle damage in my legs. My medication was down to just blood thinners for treating the blood clots in my legs.

Within a week I shed the walker, and pushed through on my own two feet.

Race Day + 50

After 3 a week physio sessions, pool training on my own a couple days a week, and a lot of convincing people I could handle it, I got permission to return to work on an easeback capacity. I worked mornings for 5 days a week at in my accounting job.

By this time, my blood work had finally returned to normal levels across the board. I continued to attend physio therapy, but was at the point where I was pretty independent. Speech and fatigue were still an issue.

Race Day + 52

I ran for the first time since the Tely 10. It was more walk than run. I was escorted by my physiotherapist, and under strict rules, 1 minute running, 2 minutes walking. When my heart rate hit 160, I was to immediately walk again. It was 4.5 km, and it took me 47:30, but it may have been the greatest feeling I ever had while running.

Race Day + 71 to 75

I returned to work full time during this week. I was also discharged from physio therapy. I passed my balance test, losing only 1 point throughout all the exercises.

In my head I was determined to complete a race on Remembrance Day (November 11) about a month from this date. It was an 11K event, and I just wanted to feel the accomplishment of crossing a finish line. It didn’t matter if I could run the whole thing or not, I would walk it, I just wanted to finish a race.

I was running with my running group again, but still on restrictions with heart rate and pace. I was getting out very sporadically though. In the end, judgment prevailed and I sat out the race. I recognized that I was not ready for that exertion.

Race Day + 93

I had a followup with the Rheumatologist. He confirmed that the rhabdomyolysis was caused only due to the heat stroke, no underlying conditions. Strength testing of my muscles revealed negligible weaknesses.

Race Day + 158 to 249

We had bought a new house in the mid-Fall. January 1, I decided it was time to get back on the road regularly. I was going to take it easy, just run comfortably, not worry about paces or PBs, just get back to enjoying running. I joined a different running club, this one was much larger, and set out to finalize my recovery.

It started pretty slow. My lungs were fine, but my legs were still building strength. Luckily there were many varying packs of running paces in this group, so I always found someone to keep me going. Through the snowy winter months I kept at it regularly, building up the distances again, and dictating pace by how I felt. I was no longer going to be a slave to driving myself for the PB, especially on a training run.

Race Day + 250

On Good Friday every year, it is a tradition here for runners to run the Tely 10 route, we call it the Tely Teaser. It may have started as a way for the runners who’d gone into winter hibernation to get motivated to get back on the road/trails, or just to measure where they were at compared to peak conditioning.

It’s not a formal event, roads are not closed, water stations are not set up (officially), and there are no set start times. But I saw this as a chance to gain some mental closure.

I went with a group from my running club, keeping pace with them. Not pushing past a comfortable zone during the run. I hoped I might regain some lost memories as I went by landmarks along the route, but I did not.

The start and finish of the race are permanently marked. The feeling of crossing that finish line was indescribable. I know the conditions weren’t the same, but just making it to end, crossing that line closed out my recovery process for me. I finished in 92:29, but included regular rest periods and stops of traffic lights. My moving time was 84:32. My heart rate averaged 157 bpm.

The Aftermath

I am now closing in on one year since Race Day. In 2014 about 4,200 people registered for a road race, 3,774 people finished, I was not one of them. I’d never imaged crossing a start line and not crossing the finish line. Luckily most of the near 400+ people who did not finish, had the judgement not to start in the heat, or to withdraw before it was too late.

My exertional heat stroke, the support I received from friends and family through my recovery, and the feeling of getting back out there, is something that will stay with me forever.

I have completed road races since, I’d love to run the Tely 10 again this year, but due to commitments made prior to last years, I am unable to. Instead I’ve turned my attention to a local fall marathon. I have been waiting to try a marathon since I started running, but kept putting it off, time to knock it off the bucket list.

I think right now, I could push my pace beyond the levels I was hitting last year, but I have limited myself to certain exertion levels based on my heart rate. Recently I have been seeing the effects of an improved fitness level. I’m getting more out of my body without pushing to the brink when I’m running. It’s more important to be here for family and friends the next day then hit a PB.

I love running again. I’m not doing it because I feel I need to anymore, I am going out because it’s relaxing and enjoying. No more judging a run by how much I’m hurting the next day or two. I’ve done 10+ mile runs since, where the next day, I hop out of bed like I’d done nothing the day before.

The only lingering effect to this day is still some speech difficulties. When I’m fatigued or cold, it’s harder to form certain sounds. All things considered, I know I am very lucky.

I was excited to come across Dr. Casas’ story and learn about the Korey Stringer Institute. It caused me to ask the questions about why did I suffer from EHS? What treatment did receive? Is it safe to return to activity? How can I prevent this from happening again?

I think I succumbed to EHS due to two key reasons. 1) Lack of Heat Acclimation. I always avoided running in the heat; waiting for cooler periods. I was not prepared for 70+ minutes of burning sunshine while I ran hard. 2) Fitness level did not match exertion level. As I said earlier, I had mindset to reach my goal, but not the body to get me there. I burned out. The encouraging thing is that I can recognize these issues and fix them for the future.

I run with a motto, “It Never Always Gets Worse.” I know now that it’s clearly not NEVER gets worse; just never always. Sometimes it does. However, even still, in the hospital as bad as things were, it still could have gotten worse. I hope I have learned enough in the last year, to help ensure really does not get worse.