Today was always going to be an important day for me. I'd been hanging out for it for out about three weeks: my appointment with the cardiologist. In some respects it felt like an appointment with destiny. But deep inside me I felt the old ticker was fine - there were no real signs or symptoms that anything was wrong, and I after all I put it through it would seem weird that it would go postal on me all of a sudden.
So let me backtrack. My last post outlines the position I am in. So since this last update there have been a few (non-)developments. My GP continued to be stumped (his words).
First I was sent for a contrasted dye CT scan. I suppose this was to fully check out my lungs and put to bed the nagging possibility that the blood tests had failed to pick up any clots, and look for anything the normal X-ray did not pick up. I went through the X-ray tube four times, once with my blood pumped full of whatever it was (probably iodine) that would make it show up. As soon as the chemicals entered my blood I could feel a rather hot surge through the upper body, and left me with a metallic taste in my mouth. This all showed that my lungs and arteries were in good shape: no sign of any collapse, clots, or anything else that could be causing the problem.
Next I was sent for some Spirometry tests to test lung functions. I got through these with flying colours, with my initial breath expiration at 122% of normal for my age, weight and height. The other readings were just above or below the normal line. On the basis of this, and the CT scan the doctor ruled out asthma. I am not persuaded this is an accurate diagnostic method. These can be good for ruling asthma "in", but the high chances of false negatives means asthma should not be ruled out. I believe I need to tested again with methacholine and excerise challenges. And if the symptoms show, as I expect under exercise at least, then I need to see if a bronchodilator results in a reversal. Of course it's difficult to tell the doctor what he should do, but I feel that in the absence of any other diagnosis I can push for it.
Anyway, back to today. First I had a normal at-rest ECG. As it was my third one in the last few weeks I expected it to be normal, as it was. Then I underwent an echo cardiogram, which is basically an ultrasound of the heart, not too different from the ultrasound that pregnant woman have. I know many of you might want to know if I have a male or female heart, but honestly, I wasn't going to ask, and the cardiolist didn't offer an opinion. Dr R. has a great manner. She comes across as very precise, and kept me well informed throughout the process. This gave me a lot of confidence in her. And besides she is a ceroc dancer of old. She told me she met her husband at ceroc, and once they were married they stopped going. I digress, but that was an important fact!
My heart showed no scarring or any other signs of damage. One little problem was obvious however, and even I could see that once she explained to me what to look for. The valve pumping into the main upper chamber (this is the one that does most of the work for athletes) was a bit leaky. In otherwords not all the blood in the lower chamber was making it through the valve - a small percentage was squirting back. Now from what I understand this is nothing to worry about. It is quite common, and at that level of malfunctioning it is not worth worrying about it. I need to get it checked every five years, just to be safe. I imagine this would be slightly inefficient from an athletic performance perspective - well I have to blame something for being such a slow coach!
Once Dr R. was happy the heart was in good shape she had no issues with stress testing me on the treadmill. She ordered her technician to wire me up again, and put me on the Accelerator programme. I had just told her my whole story, and once she heard about full distance triathlon and what was involved she told him to crank it up. No point in putting me on the granny programme she said.
So I started out at walking pace on a slight incline. The ECG and heart rate ran continously and I eyed out the resus kit next the the treadmill. My blood pressure was taken every two minutes, but I had to keep going. My maximum heart rate was determined using the arbitary age method as being 170. I knew though I could go a bit higher than that as I can normally race for about 20 minutes at 170. They eventually had me running at 10kph on a 22% incline, and that was enough to take my heart rate to 175 at which point I didn't have the stomach for it anymore and asked to stop. I could have pushed through to 180, but I felt that was far enough - if something was going to show it would have shown by then. She had wanted me to go as hard as I could so that I would have confidence to race again.
So through it all my ECGs were absolutely normal. At 175 beats per minute I did throw a few uneven heartbeats. But that is quite normal under that level of stress, and I am used feeling it, so nothing to worry about there.
But this is where the second issue showed up. My blood pressure at rest is pretty much in the middle of the normal range. However once I started to exercise it is supposed to increase. At Stage 3 for example (stage 7 is maxed out), my blood pressure was still quite low at 157/83 although my heart rate was already at 117. And at stage 7 with the heart rate at 170 plus, the BP was 173/75. And this could very much explain why I am not getting the air that I need - there is simply not enough pressure to get the blood flowing through fast enough to oxygenate themselves.
Now once I stopped my blood pressure was supposed to decline back to normal. The first reading was down, but 2 minutes later it rocketed up to 215/84 - what it should have been when I was at maximum heart rate.
But Dr R. could not say for certain that this was abnormal for me. She did say the low BP could well be a result of my fitness. And the delayed effect did fit well with what I knew from my interval training. If I am planning say 10 intervals I will pace myself accordingly, but after the second or third one I feel exhausted and am only just making my target times, but by the fourth and fifth one I seem to hit my straps and suddenly my times drop. So despite a well structed warm up, I need to get to peak heart rate several times before the efficiencies kick in. And maybe that is all that happened today.
The other possibility is that the low BP is an autonomic response from a viral infection. Autonomic is basically an involuntary nervous system response, but as to how this could be influenced by a viral infection is beyond my ken. Nevertheless this gives me something to monitor. I can "wire" myself to my electronic BP monitor (I've had one for years, I'm a health geek) while I am on the windtrainer and measure what is happening. The breathing symptoms are most obvious under low stress, so this makes it easy to measure. I need to see if the phenomenon is reproducable, and if it changes over time. If it is a viral response it should be improving with rest.
I do think things are not as bad now as they were 4 weeks ago, but that may be because I have got used to the symptoms, and I know how to manage them. Added to this is the fact that I am not nearly as worried that I might die soon. I know this sounds a bit melodramatic, but it is how I was feeling some of the time.
Dr R. is keen that I have the extended asthma tests I mentioned earlier, and is happy that I can start training after a break provided I take it really easy to begin with.
So all in all it's a good result so far. I may not be much closer to a diagnosis, but I certainly have ruled out a lot of really bad things. And that has to be good. Obviously I still have to take things easy, avoid stress and build a good recovery for myself until I have a clearer picture of the situation.
