Michele Burr, Ph.D., is a senior study director at a research company in Rockville, and is an associate adjunct professor at Gallaudet University where she teaches graduate research methods and data analysis classes in sign language. Michele began running ultras in 2000 and in 2001, placed either 1st or 2nd at every race she ran, with distances ranging from a half marathon to a 100-miler. In 2002, she ran a 100-mile PR of 17:23. Despite this incident, Michele is planning to run more ultras but has promised her husband she will not bring up the topic of 100-milers until next year.

Photo: Michele Burr, a frequent award winner at ultramarathons

The day of the Vermont 100 miler, Saturday, July 20th, started out a delight and ended in horror. At the finish line I was so disoriented I did not recognize my husband. I started vomiting uncontrollably, had a seizure, and went into a coma. I had a severe case of hyponatremia (low blood sodium level) and remained in the hospital for five days.

Hyponatremia is a condition in which there is a very low concentration of sodium in your blood. Usually seen in conjunction with weight gain (not weight loss), it most often occurs during endurance exercise lasting more than five to seven hours. The early warning signs of hyponatremia include cramps, swelling, weight gain, and nausea. As hyponatremia becomes more severe, a person will exhibit drunk-like behavior such as staggering, slurred speech, confusion, disorientation, and vomiting. In extreme cases, brainstem herniation, seizures, coma, and death can occur.

The medical literature points to three main reasons why endurance athletes get hyponatremia: 1) over-hydration, 2) low sodium intake, 3) over-hydration combined with low sodium intake. Taking ibuprofen, acetaminophen, aspirin, etc. can also contribute to hyponatremia (although I do not do this during 100 milers). I now believe I over-hydrated. I drank almost a full bottle of water mixed with Cytomax or Succeed in between each of the 34 aid stations and one or more cups of water, Coke, or sports drink while at the aid stations due to fear of dehydration. I thought there was no such thing as drinking too much, especially since the temperatures were expected to reach 90 degrees that day. I took Succeed! capsules every hour and, by all reports, was eating at the aid stations. Of course it is possible that I also didn't take in enough salt but I am more certain that I took in too much water and other liquids which ultimately diluted the sodium levels in my blood.

This race report will be different from most since the only way I know what happened during the race is through the observations of others. The last thing I clearly remember is going into the mile 18-aid station. I can't remember anything at all between miles 18 and 68. However, I was told that I got sick soon after mile 68, but I know I would probably not think much of that since people get sick during 100s all the time. Other runners and several crew people also told me that at the mile 83 aid station, I could not run a straight line and was staggering. I was told my weight was up 5 pounds and that I just needed to pee more. At the mile 90 aid station, I was still staggering but had also begun slurring my speech. After this point, other runners who passed me (that I knew) told me I did not recognize them.

At the mile 96 aid station, one of the other runner's crew people asked about me and the aid station worker said I could "barely talk". In fact, Sue Johnston passed me to take second place woman at about mile 97 and said I had problems putting together a sentence. She mentioned that the four words I did manage to say were very slow and slurred. After this point, when my pacer and other runners passing me asked questions, I could no longer respond. As reported by many people, when I got to the finish I looked extremely confused. I did not appear to understand where I was or what was going on and I did not recognize any of my friends or my husband. I stopped a few feet before the finish and stared at the banner with my mouth open, seemingly unaware of the fact that I was in a race. I eventually walked across the finish line in nineteen hours, twenty-six minutes (3rd place women).

A spectator has told me that my weight was up by 10 pounds at the finish. Besides the obvious cognitive problems I was experiencing, a weight gain of this much would have been an eight and one-half percent increase in my overall weight - another warning sign that something was wrong. While I sat down, my husband immediately went to find medical help. Although there were many veterinarians (because of the 100 mile horse race), he had a hard time finding a medical person. Once he found one, the medical person told my husband I would have to wait since he was busy. When the medical person did come over to me, he called an ambulance right away. It was at this time that I began to throw up repeatedly, had a seizure, then went into a coma.

An ambulance brought me to the emergency room of a local hospital in Windsor, VT where my blood sodium level was measured at 113 mEq/L compared to a normal person's level of 140 mEq/L. Without adequate amounts of sodium, the brain is unable to function. I remained in a vegetative state at the local hospital until some point on Sunday when my sodium levels began to rise too quickly, which can result in permanent brain damage. The local hospital called an ambulance and I was transferred to the ICU at Dartmouth-Hitchcock Hospital in New Hampshire. At Dartmouth, they warned my husband about the effects of my blood sodium rising too quickly. They told him to think about long term care for me and assigned him a social worker. Then they asked him if I would donate my organs should I remain in a vegetative state and asked whether I had a living will prepared. While still in a coma in the ICU, I began to act irrationally (which is typical of someone with hyponatremia). I was swearing, screaming, pulling out my IVs, ripping off my EKG patches, and trying to fight off the physicians and nurses. Eventually I was given anti-psychotic medication.

The first thing I remember when I came out of the coma on Monday night was a group of people standing around me with a man asking questions. With each question asked, I struggled to find the answer but I just could not pull it from my partially functioning brain. I didn't know where I was, or what month or year it was. When asked to take a guess at the month I replied, "I think it's Vermont." I also couldn't read and I couldn't add. The doctors asked me how I got the scars on my feet. (My feet are badly scared from electrical burns I received when I was caught in power lines during a skydiving jump - not something I would likely forget.) I looked at my feet but simply could not remember and eventually told the doctors I thought I was hit by lightening. I noticed four IVs coming out of my arms with tight wraps around them (due to trying to pull them out). I also saw that I was hooked up to a machine but couldn't understand what this machine was or the things in my arms.

On Tuesday morning I was less confused and, although unsteady, I began to walk with the help of my husband. I was released on Wednesday but still felt in a fog. When I went back to work the next week I still had a few problems such as forgetting people's names and passwords, and problems with typing and signing my name. Now, three weeks later, I am functioning at 100% again. I hope my experience can be used to help educate runners and race management about hyponatremia.