Injury Reserve: Break Hearts? (Round II)

For the new reader; we left off on this random adventure of nonsense with a trip to the emergency room, Troponin, and chest pains. After four and half hours of entertaining nurses with unstoppable word vomit (I am so sorry to the University of Kansas Emergency Room), I was informed that I would be seeing a cardiologist and have a stress test done in mid-July.

Reminder from the rules of the previous post:

Rule 2: Yes, you do have to go get a stress test in July. That will cover anything else that may have been missed.

Oh, if only life was that easy. Granted, I had been restricted on my activities up until my followup on July 9th. This meant that I only had to survive the Night Hawk 50K, not actually run in it for 2018. It also meant going a little stir crazy, really embracing the ADHD, making a ton of origami cranes*, and making random trips to Colorado.

No big deal.

I had two objectives in relation to my health:

• Meet the doctor, laugh about what a crazy experience this all was, promise to behave, and move on
• Go to the stress test event. Knock it out of the park and hop back into the world of ultras.

Objective 1:
In an early morning, fighting the traffic of Johnson County, Kansas (bring on “the 405” world), I stumbled into the Mid-America Cardiology Office at Overland Park, Kansas. I was the youngest in the room by 50 years, and I wore all my running gear because I was told I was going to get a treadmill.

Being nervous I walked into the room, and started the process…

Go ahead and step on the scale.

*Reads 260.5 pounds*
*Steps off scale*
*Makes joke*
*Cries on the inside*

The nurse and I stepped into the cold medical room of a flat table, one-ply paper on the bed that would be a God-sent if you needed as toilet paper after 40 miles…but only then, and she started with the standard routine.

Checking blood pressure.

So she checked the blood pressure.
So she got quiet.
So I stared off into space.
So this was the most awkward date I had, had in years.

155/105. Is your blood pressure usually this high?

Wrong response:

Ha! If you think that’s high, you should have seen it in the emergency room when it was 163/137!

*Nurse walks away*

I sat in the room alone, fidgeting, trying to understand why these rooms always feel so cold, listening to my heart, and trying to figure out if I could get in the miles I wanted during the week.

That’s when the doctor came in.

I thought that the doctor was a cardiologist (ignorance is bliss people), but later I would learn it was a PA (physicians assistant). She gave me a quick look, looked at my chart, and said…possibly…one of the most awkward things I’ve heard in quite some time…

Shawn. Do you understand with this kind of blood pressure you are on the cusp of being at high risk for a stroke?

We’re going to get you started on some blood pressure medication today.**

So I got quiet.
So she left.
So I felt sick.
So, in my running singlet, this was the second most awkward date I’ve had in years.

After I stepped out of the office with my prescription and schedule for the real stress test (because somehow that wasn’t it), I did what any normal person would do after being diagnosed with high blood pressure as an ultramarathon runner at the age of 30…

I went and got a shake, two cookies, and nearly lost it at the gym that I train at because I was emotionally devastated.

Yes, even as a sub-par, daydreaming athlete, I felt broken. Also, because of the time between the medication and the stress test, every day felt like a ticking time bomb. However, there were so many people that found themselves frequently calming me down, showing me articles of ultramarathon runners who are on high blood pressure medication, and I even started to get random, vegan cookbooks in the mail from friends elsewhere in the United States.

The world was telling me to eat broccoli, and hope that I would survive.

I kept running with the new medication in me. There were no to very little side effects, but the toll it took on my brain was extensive. Medication is new to me, something that doesn’t happen too often, and after a stellar month of running in June, July was slowing down and quickly turning into the summer from hell (no pun intended in relation to the heat in Kansas City during this time). I made some adjustments to my diet (DASH, yay!), and counted down the days until my stress test.

Results: Objective 1 ended like a dumpster fire you find with MLB baseball teams (or at least their trash cans in their parking lot).

Objective 2:

I had dialed down the miles, focused on yoga and strength, and enjoyed frequent meals of hay. Sure, it was only two weeks since the blood pressure medication started, but after a round of panic attacks, I was feeling solid. Heat running scared me, but like any good runner…I wasn’t dead…yet.

The stress test comprised of three specific tests: echocardiogram, treadmill stress test, and a nuclear heart scan. The catch was no caffeine for a day before the test, no food from midnight on to the test…allow me to repeat that…a runner was not permitted to eat between midnight and the test at 9:15 AM. People! I almost died of starvation (and they almost died of me being hangry).

For this stress test I waltzed into the office ready to slay anything before me. I was rocking my Run 816 singlet, BOCO hat, and my 6″ compression Ruhn Co. shorts (shout out to the 93 year old that couldn’t take their eyes off of me! Again…I am so sorry).

I can say, looking back, that I would never wish a stress test on anyone. It’s, well, stressful. They started by making me feel like I was expecting and was in my final trimester by smothering me with the gel that you see with ultrasounds, and running through an echocardiogram.

The technicians were silent. The only time they spoke to me was when the needed me to breathe, hold my breath, breathe normal, let some air at, get some air in, etc…

It wasn’t the Simon Says that made my hyperventilate, it was seeing my heart beat on a screen, and watch people do their jobs…silently.

I was convinced something was up.

After an hour of that out-of-body experience I finally got my treadmill. Now, a friend of mine that runs ultras (like, actually runs them) had been on the treadmill test before. Meaning one simple thought…

…I have to beat her on the treadmill.

After the kind folks hooked up all the cables on me (while shaving a smiley face into my

Race day on the treadmill.

chest hair), they allowed the newest version of Doc Ock to step onto the treadmill.

The rule was simple: I had to keep track of where I was on the pain chart. They started me moving slow and at an incline. Every three minutes the treadmill will automatically speed up and increase in elevation.

Basically, I was running hill repeats and I was rather giddy. I started pounding the rubber while they kept looking at my vitals, and checking my blood pressure. It was crazy hard (remember, no food since midnight), but I lasted a solid 15 minutes on the device. I maxed out at a 204 HR (104% of my max HR), and a blood pressure of 200/100 (the only time that is normal is while conducting strenuous activity, as the poor lady had to remind me…frequently). I also set a course record on the treadmill for the amount of sweat left on the device after finishing. No regrets.

Directly after the test they shot a nuclear isotope into my body, giving me the strength of The Hulk (missing the intellect of Bruce Banner though), and set me up in the machine to watch that particle move through my body. I fell asleep.

I started this whole process at 8:00 AM. I was completely finished with everything by 3:00 PM. That gives you an idea of the duration of the full order of an echocardiogram, stress test, nuclear heart scan, and blood panel. Afterwards, a scheduler set me up with my next appointment to go over the results with a cardiologist.

Results: Something was fishy with the echocardiogram, and the salad shop just down the road was a disappointing lunch.

I so wish the story ended right there, but trust me…things are about to get even stranger…

I was first scheduled for the next Wednesday to go over the results. On Tuesday I was told that I need to see an actual cardiologist (because I wasn’t going to this time either?), so they moved me to the next Wednesday. On Wednesday, while at my parents house, I received a call again from the department. I was informed that they were needing to change my appointment again. Becoming a little more confident in my patient rights I asked what was going on for all of this to happen.

The. Next. Statement.

Shawn. Looking at your information, we need you to see a cardiologist because your tests had some questions in them.

Your coronary arteries are hardening, so you’ll need to get in to see what options…including heart surgery…may exist to get this addressed.

Go ahead. Reread that quote again.

Processing…

What you’re telling me is that even though I ran a 50 mile race last September, even though I ran a 50K mountain race in June, even though I climbed a mountain a month prior to this…my arteries are hardening?

You can only imagine what my search history on Google looked like for hours after that. Like any decent human I panicked, and spent the day problem solving, learning about stents, reading articles about ultrarunners and blocked arteries, and trying to get a grasp on what was going on. I went from training, running like crazy, to sitting in my car thinking about heart surgery. It was that fast.

The race director of The Hawk 100 suggested that I call the cardiologist for more information (shoutout to her for being an awesome mother over the past month). I called and left a message, directly after telling my administration of my school I may have heart surgery during the school year.

At 4:30 PM, while trying to process all of this with my wife, the phone rang. I answered it because I thought it was a friend that I had just spoken with about heart attacks, and overall cardiovascular health.

It was a nurse from the cardiologist office. Her name was Mary, and she asked what was going on that had me worried about my meeting with the doctor.

I gave her the story.

Shawn, I am so sorry. We do not even have your test results back. It would be impossible to give you that kind of information. I am so, so sorry. I have some of your information here from the blood work and the stress test. I’ve been doing this for 30 years, so let me take a look at a few things because that does not make sense.

*reading*

Shawn, you there? Great. Listen, your blood panels are perfect. What information I have from your echocardiogram shows a very healthy heart. I can’t imagine your fear, but know that what we’re looking at shows that you are very healthy.

The conversation lasted a few more minutes, lowering my blood pressure (HA!) in the process. I was able to sleep that night, soundly, for the first time in three weeks…after I had to go back and tell everyone that had been tracking me that it was all a clerical error.

I woke up the next morning, Friday, to another phone call from the cardiologist. They felt horrible about the mistake made, so instead of me waiting a week to see him, they were wondering if I would like to come in within the next hour.

I was out the door.

I met with Dr. Dak Burnett from the University of Kansas Cardiovascular Health. He’s in his late 50’s, early 60’s I’d guess? When he walked in he wanted to know what went on with the scheduler and the ‘hardening of the arteries’, so I repeated the story. They had long since launched an investigation into the phone call and discovered that someone had read me the results of another patient.

After getting that out of the way; Dr. Burnett hopped right into the facts:

Your echocardiogram was abnormal during your tests. If you were a 70 year old woman who didn’t move, we’d be prepping you for surgery because of your heart. However, because of your background, you are on the opposite end of the bell curve in relation to heart health.

Your heart is enlarged, but not just the muscle tissue that gets many people in trouble. Everything is enlarged, including your coronary arteries. What this means is you ‘idle’ lower than the average person. It requires less strokes from your heart to move the same blood through your body. We would compare you to an elite soccer player because of this, and if the department existed, we would be tempted to move you to sports cardiology. It’s a fascinating heart, and it has evidently adapted for what you do with the miles you log.

I kind of felt proud.

Overall, if someone did not know my background as a runner, the tests would have been off substantially, raising flags in the process. However, because of the amount of running that I do, my heart has adapted to that environment, and displays on tests that it happens to be extremely efficient.

I have zero heart issues. My sodium levels, cholesterol levels, self esteem levels were all right where they should be.

That was the first area of discussion.

The next piece was the blood pressure. I had been on Norvasc for three weeks at this point, and it had not put a dent in my blood pressure (still 150/96). Obviously, this is still a massive problem because a 31 year old should not be walking around with that kind of blood pressure. The doctor put me on Losartan along with Norvasc. It’s also a very friendly “runner drug”, but staying hydrated is super important because of what it can do to your kidneys.

I brought up the weight with him also because no one made a comment of…well…I weigh a lot!

Could you lose weight? I guess? If you want to? No one talked to you about it because you can run 40 miles at 260 pounds. Also, you could change your diet, weight, sodium intake, etc…your blood pressure is not going to be affected by those changes.

This one is 100% genetics, and you’ll be on these drugs for the rest of your life.

Fun fact about this doctor; he’s a hiker. He hikes things like the Andes Mountains, and backpacks across entire countries. It was such a relief to hear that about him, because he’s active enough in an extreme sense that he understands my own stupidity interests.

Before stepping out I asked if there were any restrictions to activity. His words made my day:

Go run your ultras.

Missed.

I left his office and drove straight to the gym to share the information.

 

I ran just under 6 miles that night.

I ran 4 more two days later.

That’s the most miles I put together in three days in over a month.

Training for my next 50K starts next Monday.

Moral to the story: Sounds cliche, but seriously, if you are doing something considered an ‘extreme sport’ by the rest of the world (be honest people), get yourself checked out by a doctor just to make sure everything is functioning as it should.

*I made zero cranes.

**This is the first time in my life that I have ever been given a prescription.