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.
Showing posts with label health. Show all posts
Showing posts with label health. Show all posts
Monday, September 10, 2012
Tuesday, August 14, 2012
The air that I breathe
This post is somewhat personal - more than I would normally talk about publicly. But I don't have the energy to explain my situation to those who need, or want, to know. And it describes a new journey for me. A journey not planned. A journey not wanted. And this blog is about my journeys.
On my flight back from Japan, after Challenge Roth in Germany, I had difficulty breathing. Not so bad that I was struggling for breath, but enough to keep me from sleeping or even relaxing. It was a bit worrying at the time, but no sooner had I landed, the problem went away. There were no issues on the short domestic flight home, and I put it down to bad air in the plane, even if no one else seemed to be battling.
Only on reflection did I recall that after I "hit the wall" on the run at Roth, that I was having a slight breathing difficulty on the long walk in. But anything can, and usually does, happen in a full distance triathlon - so something like that was hardly worth writing home about. It was the same kind of feeling I later had on the plane.
In the following two weeks I was fine, and managed a couple of short swims and runs as I eased back into training. I felt fine. I had had a bad cold just prior to flying out, and was loaded with antibiotics in the week before race day. I had been in a slightly weakened state when I raced but definitely not sick anymore. I finished, although somewhat slower than I hoped, and appeared to recover at my usual pace.
Then two weeks after my return I ventured out on the bike for what I expected to be an easy 90 minute ride. As I was idling along the flats by the river, some 5 minutes from home, I realised I was breathing hard, a bit like I had been on the plane. I checked my pulse and it was pretty low, and there were no other signs of exertion. Somewhat mystified I continued my ride for a while, but then concerned that something more serious than simple fatigue was going on, I cut it short and headed for home. And since then, now about two weeks, I have continually had this same difficulty in breathing. It usually gets worse with any mild exertion or mild stress, even say dealing with traffic at a roundabout, and seems to improve when I rest.
It is hard to describe what happens. In some respects it's like when I am lying in bed my breathing is like I am walking briskly, and when I am walking it feels the same as when I am jogging. But that is not a completely accurate description. Normally exercise makes me breath harder, but then I do not have the sensation that I am not getting enough air - my breathing just increases naturally and I do get enough air. Now, it's like I keep finding myself out of breath and I have to work to gain the oxygen I need. The closest I can come to it is for those who have tried altitude simulation training, where you breath through a tube attached to air filters and scrubbers. You have to suck on the tube and work quite hard to get enough air at the simulated altitudes. What I have feels similar, although perhaps not quite as difficult as breathing a 10,000 feet simulation.
The upshot is that it leaves me a little tired, and quite worried. The fatigue, and the worry come and go, pretty much in line with the breathing.
So after a few days I booked an appointment for the following week with my GP. However when I awoke on the Saturday morning, I was not a happy camper, and was at this stage feeling somewhat afraid of my circumstances. Put simply my mortality was much more obvious than it usually is. So despite my disinclination to sit in the weekend queue with dozens of sick people I headed for the clinic.
Not wanting to announce my shortness of breath which I knew would push me to the front of the queue, I patiently (OK, bad pun, I know) waited an hour and a half to be seen. However when they did see me, they began to mobilise reasonably quickly - and this scared me even more. Before long they had taken blood and rushed it under urgency to the lab, done an ECG, listened, prodded and poked at various places around my body. I was then allowed home until the blood test results came back a few hours later. Fortunately it seemed, I was not exhibiting any signs of the normal dangerous things associated with shortness of breath, in particular a recent or pending heart attack, or pulmonary embolism (a blot clot in an artery near the lung). The latter can follow DVT (deep vein thrombosis), which as an aging endurance athlete who had just been on a long haul flight was an obvious concern. Because long distance athletes have lower pulse rates the blood tends to pool in the legs on long flights more easily, making them more vulnerable than average.
I was back at the doctors on the Monday, and again on Thursday. Another ECG, a chest X-ray and more listening, and prodding has revealed nothing. The problem however, has not abated. For sure, it improves or worsens over time, but it is with me all the time now. My GP's advice is to go home and report back if there are any changes, and I have a list of things that I have to particularly watch out for. He understands that I am pretty much in tune with my body and am well aware of changes in things like blood pressure, oxygen saturation, pulse rate, temperature and so on. These things I tend to monitor fairly regularly as it is.
So this leaves me with the possibility that I am under some sort of stress which is causing this. While I am very much open to this possibility I find it hard to understand. For starters I live a good and happy life. To be sure it is not stress free, but things pretty much work for me. I don't work too hard, and I spend a lot of time following, and fulfilling my dreams. And then, I have no other signs that this is a stress response; my heart rate throughout has been rock solid at its relatively slow resting pace in the fifties or low sixties, and my blood pressure is on the low side but within the normal range. There is no sweating, and no feeling of any kind of fear, apart from the fact that I am finding the whole thing somewhat disconcerting. And the first "attack" after the airplane episode was when I was idling my bike on the track alongside the river doing what I like doing best - definitely not seeming like a stress situation.
Small mental or physical stressors can set me off. But sometimes they do not. And on other occasions it seems to get worse without cause. We had a real downpour at midday yesterday and water was pouring into the house. OK, it was only a few litres, but that is quite a bit water getting splashed over your bed, carpets and more significantly into the structure of the house. Normally I would find this quite stressful given my distaste for wooden houses that can rot, but this event had no effect on my breathing at all. Then later in the day I had to go to the Postshop to exchange some left over Euros I had lying around. And this little non-event left me quite breathless. I know I find dealing with people hard - I am the consumate introvert, I don't do that people interaction thing much - but this was a ridiculous response.
So in short, I don't know what this is all about. I have a growing strategy in my head on how to approach this. I am a computer programmer. I can write code quickly and easily, but I spend most of my working life debugging situations: either programming code, or end user descriptions. Defining problems is what I do. Now I will just have to do it in a different situation. I have a lot of confidence in my GP, but his "go home" answer to me is inadequate, so I think he is going to get to know me rather better in the next few weeks.
My training, and racing is therefore on hold, perhaps indefinitely pending further developments or solutions to this problem. With a little luck this bogey will vanish as mysteriously as it arrived. So my shot at the World Triathlon Champs in Auckland in October is looking rather unlikely. Despite my big efforts to get there, I am not too concerned about that. More significant for me is my January date in Wanaka. It's the one race in the year I don't want to miss, for if I do, I will lose one of the memberships I am most proud of - belonging to the small club comprising the original survivors of Challenge Wanaka. And the fact that I am one of only two people to own the entire set of southern hemisphere Challenge Medals is a big incentive too. But that is still nearly six months away. I figure things will have changed substantially by then, one way or another.
However, if I have to quit racing now, I will be philosophical. I have had a great 25 years of racing, spread over more than 30 years, with 19 ironman distance finishes and a dozen other similarly long events under my belt. And I've raced on foreign shores in the black singlet at age group level. I did my first triathlon in 1982, and was doing other endurance events long before that. I've always known the time will come when I will stop, but I rather suspected it would be a decision based around simply having had enough. I've kind of dreamed of "downing tools" mid race and saying "That's it, I'm done now".
But as for the rest of my life, I have much living to do, and damn it, I need the air that I breathe!
On my flight back from Japan, after Challenge Roth in Germany, I had difficulty breathing. Not so bad that I was struggling for breath, but enough to keep me from sleeping or even relaxing. It was a bit worrying at the time, but no sooner had I landed, the problem went away. There were no issues on the short domestic flight home, and I put it down to bad air in the plane, even if no one else seemed to be battling.
Only on reflection did I recall that after I "hit the wall" on the run at Roth, that I was having a slight breathing difficulty on the long walk in. But anything can, and usually does, happen in a full distance triathlon - so something like that was hardly worth writing home about. It was the same kind of feeling I later had on the plane.
In the following two weeks I was fine, and managed a couple of short swims and runs as I eased back into training. I felt fine. I had had a bad cold just prior to flying out, and was loaded with antibiotics in the week before race day. I had been in a slightly weakened state when I raced but definitely not sick anymore. I finished, although somewhat slower than I hoped, and appeared to recover at my usual pace.
Then two weeks after my return I ventured out on the bike for what I expected to be an easy 90 minute ride. As I was idling along the flats by the river, some 5 minutes from home, I realised I was breathing hard, a bit like I had been on the plane. I checked my pulse and it was pretty low, and there were no other signs of exertion. Somewhat mystified I continued my ride for a while, but then concerned that something more serious than simple fatigue was going on, I cut it short and headed for home. And since then, now about two weeks, I have continually had this same difficulty in breathing. It usually gets worse with any mild exertion or mild stress, even say dealing with traffic at a roundabout, and seems to improve when I rest.
It is hard to describe what happens. In some respects it's like when I am lying in bed my breathing is like I am walking briskly, and when I am walking it feels the same as when I am jogging. But that is not a completely accurate description. Normally exercise makes me breath harder, but then I do not have the sensation that I am not getting enough air - my breathing just increases naturally and I do get enough air. Now, it's like I keep finding myself out of breath and I have to work to gain the oxygen I need. The closest I can come to it is for those who have tried altitude simulation training, where you breath through a tube attached to air filters and scrubbers. You have to suck on the tube and work quite hard to get enough air at the simulated altitudes. What I have feels similar, although perhaps not quite as difficult as breathing a 10,000 feet simulation.
The upshot is that it leaves me a little tired, and quite worried. The fatigue, and the worry come and go, pretty much in line with the breathing.
So after a few days I booked an appointment for the following week with my GP. However when I awoke on the Saturday morning, I was not a happy camper, and was at this stage feeling somewhat afraid of my circumstances. Put simply my mortality was much more obvious than it usually is. So despite my disinclination to sit in the weekend queue with dozens of sick people I headed for the clinic.
Not wanting to announce my shortness of breath which I knew would push me to the front of the queue, I patiently (OK, bad pun, I know) waited an hour and a half to be seen. However when they did see me, they began to mobilise reasonably quickly - and this scared me even more. Before long they had taken blood and rushed it under urgency to the lab, done an ECG, listened, prodded and poked at various places around my body. I was then allowed home until the blood test results came back a few hours later. Fortunately it seemed, I was not exhibiting any signs of the normal dangerous things associated with shortness of breath, in particular a recent or pending heart attack, or pulmonary embolism (a blot clot in an artery near the lung). The latter can follow DVT (deep vein thrombosis), which as an aging endurance athlete who had just been on a long haul flight was an obvious concern. Because long distance athletes have lower pulse rates the blood tends to pool in the legs on long flights more easily, making them more vulnerable than average.
I was back at the doctors on the Monday, and again on Thursday. Another ECG, a chest X-ray and more listening, and prodding has revealed nothing. The problem however, has not abated. For sure, it improves or worsens over time, but it is with me all the time now. My GP's advice is to go home and report back if there are any changes, and I have a list of things that I have to particularly watch out for. He understands that I am pretty much in tune with my body and am well aware of changes in things like blood pressure, oxygen saturation, pulse rate, temperature and so on. These things I tend to monitor fairly regularly as it is.
So this leaves me with the possibility that I am under some sort of stress which is causing this. While I am very much open to this possibility I find it hard to understand. For starters I live a good and happy life. To be sure it is not stress free, but things pretty much work for me. I don't work too hard, and I spend a lot of time following, and fulfilling my dreams. And then, I have no other signs that this is a stress response; my heart rate throughout has been rock solid at its relatively slow resting pace in the fifties or low sixties, and my blood pressure is on the low side but within the normal range. There is no sweating, and no feeling of any kind of fear, apart from the fact that I am finding the whole thing somewhat disconcerting. And the first "attack" after the airplane episode was when I was idling my bike on the track alongside the river doing what I like doing best - definitely not seeming like a stress situation.
Small mental or physical stressors can set me off. But sometimes they do not. And on other occasions it seems to get worse without cause. We had a real downpour at midday yesterday and water was pouring into the house. OK, it was only a few litres, but that is quite a bit water getting splashed over your bed, carpets and more significantly into the structure of the house. Normally I would find this quite stressful given my distaste for wooden houses that can rot, but this event had no effect on my breathing at all. Then later in the day I had to go to the Postshop to exchange some left over Euros I had lying around. And this little non-event left me quite breathless. I know I find dealing with people hard - I am the consumate introvert, I don't do that people interaction thing much - but this was a ridiculous response.
So in short, I don't know what this is all about. I have a growing strategy in my head on how to approach this. I am a computer programmer. I can write code quickly and easily, but I spend most of my working life debugging situations: either programming code, or end user descriptions. Defining problems is what I do. Now I will just have to do it in a different situation. I have a lot of confidence in my GP, but his "go home" answer to me is inadequate, so I think he is going to get to know me rather better in the next few weeks.
My training, and racing is therefore on hold, perhaps indefinitely pending further developments or solutions to this problem. With a little luck this bogey will vanish as mysteriously as it arrived. So my shot at the World Triathlon Champs in Auckland in October is looking rather unlikely. Despite my big efforts to get there, I am not too concerned about that. More significant for me is my January date in Wanaka. It's the one race in the year I don't want to miss, for if I do, I will lose one of the memberships I am most proud of - belonging to the small club comprising the original survivors of Challenge Wanaka. And the fact that I am one of only two people to own the entire set of southern hemisphere Challenge Medals is a big incentive too. But that is still nearly six months away. I figure things will have changed substantially by then, one way or another.
However, if I have to quit racing now, I will be philosophical. I have had a great 25 years of racing, spread over more than 30 years, with 19 ironman distance finishes and a dozen other similarly long events under my belt. And I've raced on foreign shores in the black singlet at age group level. I did my first triathlon in 1982, and was doing other endurance events long before that. I've always known the time will come when I will stop, but I rather suspected it would be a decision based around simply having had enough. I've kind of dreamed of "downing tools" mid race and saying "That's it, I'm done now".
But as for the rest of my life, I have much living to do, and damn it, I need the air that I breathe!
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