Logan Johnson’s Story – August 13, 2010
By: Logan Johnson, Jonesboro, Arkansas
It was Friday, August 13, 2010, as I walked in to the hot, unairconditioned gym that was well over 100 degrees, all I could think about is what others had told me about the conditioning of Jr. high basketball…how hard it was and that I would throw up. NO ONE could have told me how hard it was really going to be.
After shooting around for a few minutes we were all told to get on the baseline. We ran about four wind sprints and then ran four sets of bleachers. We did the same thing over again and on the last set of bleachers I missed the last one and fell and hit my left knee and bruised it pretty bad. After that, the rest of practice is almost a blur. I remember falling down the bleachers again and remember running sprints and stumbling. I got back up and as a went to run I fell again. After doing wall jumps we did wall sits for our “breather.” While sitting on the wall, I looked across the court, barely able to make out the shape of the goal that I was staring at.
We all finally got a water break and when I got to the fountain, I noticed that the water didn’t quench my thirst. Now almost at the end of practice, we were told to run around the gym. On the first lap, my legs felt like iron and my feet felt like bricks. I could barely walk around the court. After the first lap, I went to where my coach was standing and told him that I was very dizzy. I remember the expression on his face, even though I could barely see him. He gave me a look like come on just finish. He then told me to keep on going. During the next lap, I was literally taking one step at a time.
I remember some of my teammates actually pushing me with their hands to help me get along. After that lap I told my coach that I thought I might be having heatstroke, not knowing that I was actually having a heatstroke. He again told me to keep on going with that same look which was actually getting more blurry.
After the third lap, I thought that I can’t do this anymore and I told the coach that I would just go to P.E. which is where the boys who didn’t want to play or just couldn’t handle the conditioning went. As I walked to the other gym where the P.E. class was, I actually stepped on one of the boys sitting in the floor because I couldn’t see or control my legs. I headed straight for the water fountain in the other gym and drank and splashed my face. Then, I headed for the cafeteria, which is where my grandmother works, and as I entered through the side door I hollered, “Gramma, Gramma, help me!”
Just then my legs buckled and I collapsed, but one of the lunch ladies caught me before I could hit the floor. Four of the lunch ladies picked me up and laid me on the floor, or so I’m told. They iced me down with trash bags full of ice and wet towels. Never a day goes by without me thinking how lucky I was that I collapsed in a cool place instead of the gym. The ladies continued to ice me down as Gramma called my mom. The rest of the time before the ambulance gets there is a blur.
The ambulance took me to the hospital and they let me go home about an hour later without EVER giving me an IV. It seemed like everything kept going downhill from here on out.
At home, all I did was lay on the couch and try to sleep but I couldn’t sleep from being in a lot of pain. Every time I tried a bite of food, I just threw it up. I stayed miserable until my mom came home around four o’clock. She said that they were going to take me to the NEA Hospital in Jonesboro. So, we go to the emergency room at the hospital and the nurses try to put an IV in four to five times before they finally find a vein and put the IV in.
After spending several hours at the hospital, the nurse says that I can go home and he gives me some stomach medicine. That night, I again tried to eat a bite of food and I actually hold some of it down until the morning.
By Saturday, things hadn’t gotten better but worse and I couldn’t stop throwing up. I have had the stomach virus, but this was ten times worse than any stomach virus. The whole day was terrible and by the afternoon my parents yet again, decided to take me back to the hospital. In the ER, they put another IV in and they admitted me later that night. They determined by blood tests that I had rhabdomyolysis (rhabdo). Rhabdo is the rapid breakdown of skeletal muscle due to injury to muscle tissue. During heat stroke, the body begins shutting down things that are not necessary to survive…skeletal muscle is one of the first things to break open. In this process, creatinine is released into the bloodstream and blocks kidney function, sometimes causing renal failure. Flushing out the system with a large amount of fluids is one treatment for rhabdo. Over the course of the next 12 hours or so, I was flooded with 5 bags of fluid. However, My kidneys were shutting down and wouldn’t work, so the fluid began getting into my lungs causing pulmonary edema and enlarged heart. I was very swollen and was having a very difficult time breathing. After a pulse-oxygen reading of 72, I was immediately put on oxygen and taken to ICU. Soon the doctors made the call for me to be airlifted by Arkansas Children’s Hospital’s Angel One helicopter. At first I thought it would be cool to ride in a helicopter, but actually it was miserable and uncomfortable. I remember thinking, as we came into the hospital, “Why am I here, only sick kids come here.” As I saw the other kids in the PICU, I realized that I must be very sick.
At the hospital, immediately the doctors and nurses there began prepping me for dialysis and also inserted a catheter. After the dialysis and catheter, over 4 liters of fluid from my body had been removed. I continued to progress throughout Monday and on Tuesday, they moved me from the PICU to an Intermediate Floor where I stayed two more days as I was being weaned from the oxygen. After this, we stayed in a regular room for one night and were allowed to go home on Friday, one week after the heatstroke.
I am in the eighth grade now and I play on the Jr. high basketball team. Through this experience I hope to educate many people about the seriousness of heatstroke and how it can happen to anyone. Now, I’m just your average teen with a story that can hopefully save a life.
Andrea Johnson – August 13, 2010
A Mother’s Perspective
By: Andrea Johnson, Jonesboro, Arkansas
Arkansas Summers are often unbearable, but August of 2010 proved to be a record-setting summer of heat with a common heat index of 110 + for several continuous days. Our then 12 year old son, Logan, goes to a small, private school in Paragould, Arkansas (located in the northeast part of the state). Friday, August 13, was his second day of school, but the first day of basketball practice in an un-air-conditioned gym. As a seventh grader, Logan was very anxious about “tryouts” which consisted of seeing how many players could make it through the hard first practice. If they couldn’t handle it, they would have to go to the other gym and join the P.E. Class.
I was very aware of the heat, and had heard a doctor on the local radio station just a couple of days before explaining heat related illness symptoms…dizziness, nausea, etc. So, I made sure Logan had a healthy breakfast and made sure he was drinking water on his way to school. As, he got out of the van, I said, “Logan, if you get dizzy, you tell someone.”
His practice was the first class of the day at 8:15 am, so he immediately went to the gym. It was already very hot and humid; I would estimate that the gym temperature had to be well over 100 degrees already that morning. They divided into two groups and ran 4 to 5 sprints and approximately 4 sets of bleachers. Then they alternated back to sprints and bleachers again, this time Logan fell twice down the bleachers. His bruising on his left knee and elbows and shins showed he fell very hard. (Logan says he was having trouble seeing during this 2nd set of bleachers). He also fell twice just running on the floor. He continued to have trouble and kept telling the coach he was dizzy, but was never told to stop. After several more minutes of dizziness, blurry vision, and his legs not working very well, he left the gym knowing that he wouldn’t make the team since he couldn’t do this conditioning. Instead of stopping in the P.E. gym, he decided to go to the cafeteria (his grandmother works there), stopping at the water fountain and splashing water on his face and drinking some, which didn’t help. His body was very hot, sweating, he could barely see, and his legs were numb. He managed to open the door to the cafeteria and hollered out, “Gramma, Gramma, help me!” Some of the lunchroom ladies saw Logan and yelled for her. Logan leaned against the wall and his knees buckled and one of the cafeteria ladies caught him as he was collapsing and laid him on a bench of one of the tables.
According to my cell phone records, at 8:50 am, I got the worst call of my life. My mother with a trembling voice said, “Logan’s gotten too hot, you’d better get here.” The cafeteria ladies proceeded to move him to the floor from the bench, lifted up his shirt, and wiped him down with cool towels, and put ice in trash bags and laid them on his legs and torso.(We later learned that these efforts saved Logan’s life) They removed his shoes and gave him tepid water to drink. He came to, but was confused and disoriented, his heart rate was incredibly fast and his face was extremely red – all symptoms of heat stroke. When I reached the cafeteria at 8:55 am, I was very alarmed at Logan’s very rapid heart rate and how his eyes had a glassy look to them. I kept saying, “Logan, are you okay?” And, he would answer, “I don’t know, Mom.”
After some discussion with some of the school’s administrators, we decided to call an ambulance to take him to the local hospital. My husband, Richard, arrived quickly after I had called the ambulance and we were both very concerned with Logan’s rapid heart rate. When the ambulance arrived, about 45 minutes after the initial collapse, his heart rate still registered 160. The EMT’s asked us, “Do you want us to take him to the hospital?” We thought this was an unusual question, since we had called them. Not wanting to over-react, we said, “Do you think he needs to go to the hospital?” They answered that they couldn’t make that decision. To this day, we don’t really understand this, but we do understand that even medical professionals sometimes do not recognize the seriousness of heat related illnesses. Logan says they tried to start an IV in the ambulance a couple of times, but because of the dehydration, were unable to. The EMT’s told him that he would get an IV at the hospital. However, at the hospital, they just gave him a large cup of water (probably 16 oz or so). His axillary temperature was normal and he drank the water and he seemed to perk up, so after running some blood tests and a chest x-ray, they released him.
Thinking this scary Friday the 13th was over, Logan went home and stayed with Bethanie (his older sister) and Richard and I returned to work. However, he continued to feel bad and had a lot of stomach pain and vomiting, so after calling a doctor, we decided that evening to take him to the ER of a Jonesboro hospital. They determined that Logan was still dehydrated and gave him 2 bags of IV fluid. After getting the fluid and some pain medication by IV, he seemed to feel better, so we again were released and went home. He was able to eat something and keep it down that evening and slept well, but woke up on Saturday morning being nauseous and having stomach pain again. Around 4:30 pm on Saturday, we decided to go back to the ER of the Jonesboro hospital where it was determined by blood tests that Logan had Rhabdomyolysis (rhabdo). Rhabdo is the rapid breakdown of skeletal muscle due to injury to muscle tissue. During his heat stroke, his skeletal muscle started breaking open. In this process, creatinine was released into his bloodstream and started blocking his kidney function. Flushing out the system with a large amount of fluids is one treatment for rhabdo. Over the course of the next 12 hours or so, Logan was flooded with 5 bags of fluid. However, his kidneys were shutting down and wouldn’t work, so the fluid began getting into his lungs causing pulmonary edema and enlarged heart. He was very swollen and was having a very difficult time breathing. After a pulse-oxygen reading of 72, he was immediately put on oxygen and taken to ICU. The doctors soon decided to have him airlifted to Arkansas Children’s Hospital in Little Rock. I was allowed to be in the helicopter with Logan. How did things get to this extreme so fast? Why did I ever let him practice in that hot gym?
Logan and I arrived at ACH around 9:00 pm on Sunday evening. My husband and my parents followed in our van to Little Rock (a 2 hour trip from Jonesboro). Logan was taken to the PICU and immediately the doctors and nurses there began prepping him for dialysis and also inserted a catheter. He was struggling so much to breathe, it was an unbearable sight for us. Around 3:00 am on Monday morning, they started the dialysis and told us it would take about 3 hours. After the first two hours of dialysis, we began to see some improvement in his breathing. After the dialysis and catheter, over 4 liters of fluid from Logan’s body had been removed. He continued to progress throughout Monday and on Tuesday, they moved him from the PICU to an Intermediate Floor where he stayed two more days as he was being weaned from the oxygen. After this, we stayed in a regular room for one night and were allowed to go home on Friday, one week after the heat stroke.
After this, I immersed myself in research of exertional heat stroke and rhabdomyolysis. It is obviously something that can be prevented and through much education can also be treated with quick actions. We are so fortunate that the cafeteria ladies immediately starting cooling Logan’s body when he made it to the cafeteria. We shudder to think about what could have happened had he collapsed in the hot gymnasium.
It took around six months for Logan to begin to exercise again at a normal pace. And, of course, this past summer, I was very hesitant to let him do much in the extreme heat. We and his coaches monitored him closely and made sure he was very well hydrated and that he stopped whenever he needed to. He has done well and has no lasting effects of the kidney failure or other problems.
Our family has been fortunate to meet Dr. Douglas Casa of the Korey Stringer Institute and we hope that through Logan’s story, others will be educated about exertional heat stroke and help spread the word to save many lives.