Thursday, February 14, 2019

The Beginning: The Teacher Appears

“The world is full of obvious things which nobody by any chance ever observes.” ~ Arthur Conan Doyle

I stand waiting for my turn at check in, the imaging waiting room is packed on a Friday afternoon. The woman behind me, at least 10 years younger than me, is laboriously breathing in and out. In and out.  Out of the dozen siting in chairs, waiting for various scans, I'd estimate that about 90% of them look sick. Very sick. Some in wheelchairs. Some hooked up to oxygen canisters. Many with a glazed over, dazed look in their eyes. 

It is almost 3 p.m. and I have not been allowed to have any caffeine for the whole day. Now, I don't drink a lot of coffee. I have one not-so-large mug in the morning and that's it. But, take that away from me and I feel the withdrawal effects. Add to this not being able to eat for three hours (yes, I know that's not very long, but it is for me!), and I feel rather a mess. My head is throbbing and my blood sugar feels like it has bottomed out. 

A nurse approaches me asking me if I'm here for a TM stress test, and we make our way to the "nuclear medicine" side of things. She attaches a bunch of electrodes to my body, holding all the wires together with a belt fastened just a bit too tight around my belly (I hate things strapped to me when I run!) places the pesky O2 reader on my index finger - the doctor comes in, asks me a few questions and then informs the nurse, "This is going to take a while. We need to put her through the paces". He looks at me and says, "This could take 20 minutes. Are you okay with that?" "Sure" I respond. What are my choices? 

So we start at a fast walk, picking it up gradually. I am feeling just a bit out of sorts - lack of caffeine and low blood sugar is not a good combo for me. Add in the tail end of the flu and a still fairly compromised respiratory system, and things could get ugly fast. But things click along. Things speed up and the angle increases at distinct intervals. Every few minutes the nurse wraps my arm with the blood pressure sleeve as I try not to fall. God, this is tedious, I think to myself.  Due to all the straps attached, I have to run while holding into the front bar. The whole damn thing feels so awkward and unnatural. Meanwhile as I'm trying to keep my shit together the doctor is chit-chatting with me - talking about Leadville and the peaks he's bagged there, asking me questions that I can barely answer without completely falling flat on my face and becoming one of those pathetic YouTube TM fail videos...This is me, potentially!

So at some point I am gasping for air and the doc says "We'll be cutting things back in a minute" as I fight to keep it together for just one more minute. The TM slows, the angle drops, and I'm walking again. 

As the doctor enters data into the computer he comments, "This is what's called a "negative" test. You're in the top 1% for your sex and age, but given what you do, I'm surprised it's that low."

"Could that possibly be due to still recovering from the flu?" I ask.

"Absolutely. Make sure you tell the cardiologist that when you see him."

I leave, get more blood drawn and make my way home. Still with zero answers. Every test thus far, save the echo, has been negative or normal. Now I have to sit and wait another week for my appointment with the cardiologist. Waiting waiting waiting...

Over the past week I've continued to run. I'm keeping the pace easy. I'm wearing my heart rate monitor (something I rarely do). I'm keeping things at about 10 miles or less. Everything feels just fine. The juxtaposition of my echo results and my empirical experience is just so hard to reconcile.

“You can’t go back and change the beginning, but you can start where you are and change the ending.” ~C.S. Lewis

My date with the cardiologist is on Valentines Day. How appropriate. I get up early since I'm not sleeping well anyway and head out for an easy five miles with the dogs - just in case I'm told I can't run anymore, I want to get this run in. It is early and quiet. I hear a few meadowlarks bringing in a beautiful morning. It's a peaceful, wonderful, soul calming run. I try to take it all in. Just in case. 
“Anyone who has lost something they thought was theirs forever finally comes to realize that nothing really belongs to them.” ~ Paulo Coelho
Anxiously I wait in the small examination room. Dr. Drake knocks and walks in. I stand up, we shake hands and then sit back down. 

He asks, "So, where did this all start? What brought you here?"

"Do you mean, why did I have the echo?"


So I tell him the story: about the past year, possibly two, of coughing, which became more noticeable and bothersome over the past 10ish months. About the inhaler prescribed that seemed to do nothing...about the races and training runs where I had no issues...about the races and training runs where I was wheezing and hacking...the negative pulmonary function tests...the nasal steroids that seemed to help, until they didn't...about the symptoms when they happen...and that the echo was ordered just to "rule out" possible heart issues that might be the cause...I explained that I've never had heart pain or strange water retention...and on and on. I tell him that the issues feel like they originate in my sinuses. But then the echo results came back...

We talk more about my running, and I admit that I am not very good at taking recovery time between big races probably because I tend to feel pretty good shortly after - Yes, some general fatigue and soreness, which I always allow time for, but never experiencing weird swelling or other typical issues that many other runners often claim to experience. And, in fact, I have remained uninjured through all of this for many many years.

He then looks at my record: 

"So you quit smoking in 1985 after just a few years of smoking."

"Yeah. College. I still ran though." 

He chuckles.

"How about alcohol?"

"So." I begin. "I think this has been an issue. Once I started looking at what "moderate" means I realized that moderate means a very small amount compared to what I thought it meant. To be honest, I've been thinking about this for several years, and wondering if I might be overdoing it, self-medicating to deal with stress - though that's just a lame excuse - but, yeah. When I actually started thinking about it, I realized that it's not been healthy in any sense - even though everyone around me would call it very moderate."

So, we dig into this some more. For my size, 5'5'' and 110 lbs, going beyond moderate and healthy is surprisingly easy. 

"With women in particular," He notes, "I would say the majority of these cardiomyopathy cases, have an alcohol component. I've had patients who had two glasses of wine a night and had cirrhosis of the liver. The question is: How large are those glasses, or even one glass?"

I joke about all the lame drinking memes out there and how they all just feed into the general acceptance of excess, and most of us don't even question it, or if we do, we fight to dismiss the thought as quickly as it enters our consciousness.

"Well, I've had no alcohol in two weeks, almost 3 really, and I can say one thing: I feel a gazillion times better even though I thought I felt good before - I actually didn't. And it's not just physical, it's psychological I've been working on letting things go and I think not drinking has helps with that as well."

He looks at me hard and asks: "So you just stopped after the echo results?"

"Yes. If this is the wake up call I had to have, then so be it. But I just really hope I can turn it around."

Sometimes a teacher appears, ready to teach you a lesson you may not realize you need to learn, only to come to understand that it's the most important lesson you've learned thus far. You may not welcome the teacher at first, but if you listen closely you will feel the deepest gratitude. Sometimes what can kill you can also save you. At least that's my hope.

He explains that he thinks, but can not be certain as time will tell how things respond, that this can be repaired, fixed, reversed.  He agrees with me that the heart issue is a red herring concerning the cough, and that it does indeed sound like a sinus issue. He explains that addressing the heart damage will take months, not weeks. I will need to be on a medication that blunts the effects of adrenaline on my heart, since in these cases the body sometimes over responds by demanding more of the heart when the heart needs to rest and recover. I need to monitor my blood pressure (which is quite low). And I need to wear my HRM when running and keep things very easy, 70% or below. He suggested no long races or runs for now. After I get settled on the medication, I will be hooked up to HR harness for 24 hours to see how things go during a typical day. After three months I will have another echo to see where things are. Then we will proceed as needed.

He explains: "I do think that alcohol is a factor here, along with possible chronic over-training (meaning that I train a lot over time, not that I over-train at any given time). And the combination may be the issue."

Of course, I want things to happen faster. Three months. Three months is not a lot in grand scheme of things, but still. It means no Boston this year. I was trying to get 10 consecutive years. This pretty much shoots that goal to shit. But, this is my life I'm dealing with. It also means that Miwok 100k is out. Plans to run Behind the Rocks 50k again, also out. 

But, all of this really doesn't matter. What matters is seeing my daughter grow up. What matters is maybe returning to health and running with a new approach to it all. What matters is growing old, I hope, with my husband. What matters is being here for my friends. What matters is the future, the real future, not just the next 3 months or 12 months, or 18 months. I will do anything for that amount of time, or more, if it means being given another chance. 

Now, all of this could amount to nothing. It is still possible that the cause is not what we think and that this is not reversible, and that thought terrifies me. But for now I choose to be hopeful and do everything in my power to give myself the best possible chance at getting my life back.

This Saturday I may cry because I'm not running Black Canyon 100k. On Patriots Day I will most certainly cry, missing what should be my 7th Boston. In May I will have to miss a race I have wanted to run for years. This all really really sucks. But if this is the teacher I need to have appear at this moment and this is the lesson I must learn, I also welcome it. 

To be continued...

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