Sunday, June 10, 2012

Dehydration - how it looks on me

They say that doctors make the worst patients, apparently the same is true for EMT's.  I suffered mild dehydration two weeks in a row - and I thought I'd blog a bit about it, in hopes that someone out there will learn something from it (because it sure as hell seems that I didn't).

The first episode happened last Sunday - I spent some time open water swimming at Coney Island while Samantha hung out with the family, then hopped back in the car, and continued on with my day.  It was really hot, and apparently I didn't have enough to drink.  Later that day, I went out for a run.  I had my Fuel Belt, my gels and everything I thought I needed, and I set off.  Knowing that this was supposed to be a long slow day, I kept my pace much slower than my goal marathon pace, and off I went.  A few miles into the run, I remember thinking to myself that it seemed to be SO hard to keep my pace, and I attributed it to the heat, and being tired, as I hadn't slept well the night before.  Next thing I noticed was that my heart was POUNDING rapidly.  I took a quick look at my heart rate monitor and was shocked when I saw a number > 200 BPM.  I stopped and took my pulse, which confirmed what my watch had told me.  I was a bit scared, so I wound up calling one of my paramedic colleagues who came down to get me.  He told me that I looked pale as a ghost, I was cold and clammy with sweat, and my capillary refill was really poor (that's a measurement of how quickly color returns to your fingernails when you press on them. Should happen within 1-2 seconds).  Even after I stopped running, my heart rate remained elevated.  After consuming 32 oz of water and sitting in an air conditioned car for a while, my heart rate finally started to drop.  After a quick EKG (I have a history of heart problems) confirmed that everything looked good, I thanked my friend and went on my way.

Sure enough, this Sunday, more of the same.  This time it was a long ride up Rt 9W.  Again, it seemed SO difficult to keep a pace that should have been easy, I was clammy and pale, and my heart rate was racing.  Here's my heart rate data from today's ride:

Compare that to the almost identical ride up Rt 9W from Friday, where apparently I was adequately hydrated (and weather was cooler / less humid).

What did I learn from this? Several things:

  • I know all about dehydration - I treat patients with it all the time.  It's very obvious when it is  happening to a patient when I assess them as a rescuer. When it is happening to me - not so obvious.
  • I always associated dehydration with cramps, nausea, vomiting, dizziness, loss of consciousness.  I didn't have any of that.  Apparently, when I dehydrate, I get tachycardic (rapid heart rate).
  • Pale, clammy skin is normal in the initial phases of heat exhaustion, but is very difficult to detect when you are running or riding, and are expecting to sweat buckets in the heat and humidity.
So, what am I going to do differently?
  1. Ensure that I am adequately hydrated EVERY DAY - not just when preparing to run or ride
  2. Be very conscious of my hydration and nutrition DURING the ride/run, and not wait until I FEEL something is wrong
  3. Be cognizant of my heart rate during training.  If I feel like I'm dragging, it's worth stopping to assess what my be going wrong.  I'm not going to just chalk it up to being tired, nervous, distracted, whatever.
Hope this was helpful - remember to stay cool, and stay hydrated out there.  The long hot days of summer are only beginning!