Eighteen Again

Through a twisted series of events, I was told that I’ve got the heart of a healthy eighteen-year-old. After duly professing my love to Tina the technician for her assessment (and wishing that other parts of my body imitated that condition), I’ve had some fun with this convoluted story.

Revert to my review of Joey Keillor’s book Run Great When it Counts; High School. In that review mentioned that I took some of his advice. His book addresses a topic I’d never really considered: the unique blood-iron-levels required in endurance athletes, entirely aside from standard anemia, and how this metric is generally overlooked yet often implicated in poor performances. His recommendation was simple: It’s a quick test, just get it done. Uncover the problem or rule it out.

Not only did this seem potentially plausible, but I knew I had a few additional unique characteristics (I’ll spare you the gory details) that could up the likelihood of this being a factor in the now-you’re-bored-of-hearing-about-it slump. And a few days later I heard about this same issue from a club companion, unprompted and independently. My racing buddy specifically brought up the problem of foot-strike hemolysis, or micro-bleeding through the feet that can occur with high mileage on asphalt – gee, sound like me? Stars aligning, time ticking toward that fall marathon, I needed to find a way out of this slump, so let’s just do this, do it fast, and find out.

But I’m what one might call an activist when it comes to trying to contain medical costs. I take the intent of the high-deductible insurance plan to heart, which tries to make us smarter consumers of health care services. Call it economic patriotism, call it core frugality, whatever, but I boil when I see pharmaceutical companies doing their best to convince the public that everyone needs treatment for toenail fungus. I cringe in the face of so-called defensive medicine, where tests and procedures are run in the interest of avoiding future lawsuits. So my first step was to call my insurance company and verify that this was not an extravagant test. Based on their assurance that it was indeed inexpensive, (which turned out to be a total lie, but that’s another story), I rang up Lady Doc’s office in early August and explained my wishes with no economic guilt.

With this background you can appreciate my dismay when the response was both a great delay – please come in for a visit first, and we can schedule you in four weeks – and the recommendation to pile on a bunch more tests – cha-Ching! I had neither time to waste nor desire to soak the my wallet or the medical insurance system. What followed was a somewhat comical series of negotiations, during which I came to recognize that she was clearly right in that it made little sense to address my complaint of a performance slump with simply one simple test, and her office came to recognize my sense of urgency and agreed to move forward in advance of our planned visit. And heck, that high deductible was about to tumble anyway, so go ahead, pile it on! I changed my stance from medical frugality to damn the torpedoes, full speed ahead, and obligingly gave up several trillion red cells in the interest of science, the end result of which was to prove that there was utterly nothing wrong with me, at least not that a blood test could determine. I had plenty of iron and all kinds of other stuff floating around in me, and no discernable lack of anything. OK, so now at least we knew.

Time flies when you’re documenting adventures, and by then it was time for that office visit anyway. Lady Doc and I had all kinds of great chit-chat, bringing a few grins to the young resident accompanying her on her rounds. I learned a new word, bradycardia, the name given to an abnormally low pulse so typical of runners, like mine which dips into the high thirties and beats when it feels like it, sometimes at mildly odd intervals. But importantly, Lady Doc took a sincere interest in trying to uncover what, if anything beyond my head, was ballooning my training times. The best we came up with was those pesky cholesterol meds, which we decided I’d knock off of for a while just to see (so far with potentially promising results, we’ll check back in on that in a while).

Meanwhile, back in the White and Chrome exam room, Lady Doc decided that a baseline EKG wouldn’t be a bad idea, slump or not, for a nearly fifty-year-old guy. (Fifty! Yes, it’s coming.) Now, Lady Doc, like any other doc, deals with a daily stream of non-athletic (read: normal) people, sick, aged, unhealthy, out-of-shape, and it is easy to chalk up this EKG decision to sticking to the medical norm. After all, as a marathoner, pretty much the last thing I worry about is my heart. But I had to agree that no matter how fit, there’s always that chance that there’s something going on, and besides, we’re all going to die of something, right? So wire me up, bring it on!

Two EKG machines later (apparently we killed one, they all have to die of something, right?), we’d produced a single sheet with a bunch of squiggly lines that looked to me exactly like, well, an EKG. A perfectly normal EKG, because unless they are filled with flat lines, they all look pretty much perfectly normal to me. But I’m not a doctor, she is, and there was one eeny-weenie little bump that indeed did not look perfectly normal to her.

I do like my doctor, and I have a feeling that in a convoluted sort of way, she appreciates my quirky involvement in medical topics where she is clearly the expert. And I appreciate that she finds herself in a predicament in cases like mine: balance the fact that this guy is highly fit and conditioned against the fact that he’s basically fifty and has a funny bump on his chart. I could stand there all day long and promise I would never sue her, and she could even believe me, removing this from the realm of defensive medicine, but as a doctor, she really can’t ignore this. “Look,” she says, “this is probably nothing, but we should be sure, and I’m not the expert here.” And so off goes my collection of squiggly lines to the cardiologist.

Just saying the word cardiologist, when you’re a marathoner, evokes funny emotions. Aren’t those the people who get involved only when things are really ugly?

She reports the next day that the cardiologist said, “Look, this is probably nothing, but we should be sure.” She explains that said chart bump hints at thick heart walls, also known as cardiac hypertrophy, a possible sign of, say WHAT? Heart disease?

We’re all going to die of something, right?

But a little medical web sleuthing – usually dangerous for anyone remotely prone to hypochondria – turns up yet another new phrase for my vocabulary, Athletic Heart Syndrome, which, as its name implies, is what happens to your heart when you train a lot. It’s all good, but on paper, specifically EKG paper, it looks a bit like, well, heart disease. And it’s exactly what you’d expect: bradycardia – that low pulse, arrhythmia – irregular heartbeat, and, wonder of wonder, an enlarged heart, a.k.a. cardiomegaly, including that enlarged heart wall, a.k.a. cardiac hypertrophy. Got all that? There will be a quiz later. In short, your heart’s a muscle. You work it and it gets bigger and stronger and just doesn’t have to work very hard when you’re not working it. Go ahead, be proud.

But we’ve got to be sure, and so I am booked for a cardiac ultrasound. I’m ever so mildly apprehensive – hey, you never know – but pretty confident this will be an academic experience. And at this point I am really happy that my deductible has been met.

Long story preserved from becoming painfully even longer, it was a blast! It was so just plain ultimately wicked cool, wicked pissah cool as we say in New England, that I’d do it again just for fun, if it weren’t so darn pricey. There’s little that can compare to watching your own heart, the pump of your life, chug away happily on the screen. Tina the technician was more than happy to oblige my child-like curiosity and explain every angle, every image, every valve and movement, and while she couldn’t pronounce a verdict, she was happy to point out the lack of all the typical woes she sees daily. Further, while she promised that the medical imaging department would supply my hoped-for souvenir CD (which they did, and several images of heart valves and so on are scattered herein), she invited me to snap stills and videos of the screen with my phone as we went along. Oh my golly this was just plain fabulous!

It almost goes without saying that the report came back the next day with a verdict of, “Not going to die, doesn’t have heart disease,” which I translated into, “Athletic Heart Syndrome, yeah baby!” But I pretty much knew that before I left, having asked Tina, “If you didn’t know I ran or anything about me, would you be able to tell from looking at these images?”

“Well, no,” she started, much to my dismay, but then continued, “I’d assume I was looking at a very healthy 18-year-old.”

Ponder if you will, how this came about. I’d really had no plans to see my doctor. But a simple bit of advice in a coaching book – one aimed at teens for that matter – led to, via this twisted path, a pleasing confirmation that all the energies we put into running really do produce benefits. Seriously, I don't really believe my heart is eighteen, but I know it's not typical nearly-fifty, either. Sweet.

Run on, my friends, run on.