Date:         Sunday, Oct 4th 1997
Subject:     One More test ... Bring In The Electrician

Executive version:

I had to bail out before the end, lots of whining followed by a more objective assessment of what it means.

Detailed version:

A week ago Thursday I had my post-OHS stress test. It confirmed, once again, my hatred of running on a treadmill! It's not natural, it's harder than running the roads or on a track. It was made worse by the all the electrodes, wires and gauges dangling from my torso. In short, my best intentions were reduced to a question of willpower ... "how much longer can I take this?". My own expectations as to how well I could tolerate physical stress six months after OHS were dashed by a machine. This, after 5 months of running ... the last 4 of which I would categorize as training!

Here's what happened. The same personnel was on hand for this test as were for the pre-OHS test I had in February. With the exception that my cardiologist and friend, John Jayne, was not present and a different cardiologist was running this test. This guy was hilarious, I might add - must have made money as a comic during medical school. I should have been extremely relaxed given the setting this time. But I wasn't at all, I was actually nervous. In fact I was nervous AND dehydrated - my favorite combination for inducing Vaso Vagal Syncope! Anyway, this set up was far less complicated than last time. They weren't trying to capture echocardiogram images as I exercised this time, only before and after images. Only the EKG was ongoing throughout the test. This, in fact, was where it got exciting early on (sobered that new Cardio Guy right up).

First off, we get started with a very mild pace for the first 60 seconds. I could do nothing more than walk. John (the comic) explained, "I rigged the machine up to be as challenging as possible, seeing how you're a sprinter and all ... but it's gonna have to get there gradually." He goes on to remind me of the plan - that as soon as I feel like it's time to quit I need to allow him 10 more seconds to make the transition to the ECG station. In essence, I have to try and predict 10 seconds ahead of need. The thought of this puts a dent in my confidence ... I wasn't actually thinking about needing to quit at all until he mentioned it. When stage 2 commences I start to lift my knees a bit as if to jog. John quickly advises me to keep walking, that we weren't ready for running yet. After 3 minutes we enter stage 3 where the speed had increased a bit and the grade rose to 12%. Now I'm feeling the need to jog. But certainly not challenged. Meanwhile, John's assistant is reaching for my arm to take my blood pressure each time we enter a new stage. Shortly after she finishes, a sudden flutter rushes through my chest. "Oops", I think to myself, "I wonder if anybody will notice that?". Well, the EKG plotter is going frantic! John himself is in a slight panic as he calls out to his staff, "There's a two-beat ... and there's a three-beat! I'd better call Jayne right now!". And now the once very cool comic is punching numbers on the phone faster than my heart's beating. In the meantime, I am under no stress from this - it's all very familiar to me, have 'em a couple times a day ... what's the big deal? He has no luck reaching Dr. Jayne with the first number, but before he could finish dialing the second number the EKG settles down instantly, like someone has thrown a switch or something. John looks over to me and says, "Could you feel that?". I say, "Yah, sure!", with a cocky tone, "Get 'em all the time!" "Well I guess you've resolved it now anyway", he mutters. I'm thinking to myself, "I didn't do anything ... they're totally random."

Okay, now the end of stage 3 is approaching after almost 5 minutes. I'm starting to breathe a little heavier now and also realizing that the grade is beginning to tax me. At stage 4 the speed is increased to 5 mph at a grade of 18%. Now this is still only a 12:00 per mile pace, but the grade makes it feel like 8:00 or less! A minute of this brings my heart rate up, makes my breathing hard and my arms are starting to fatigue. The fatigue gets bad enough that when the assistant goes to take my blood pressure I hesitate to take my hand off the rail. By the end of the seventh minute I'm contemplating whether I can stand much more. I'm also getting upset by the thought of quitting before the end! The last time I did this test I was on my back peddling a bicycle - it was a breeze, my HR barely rose to 160 bpm. My HR is already close to 180 bpm at this point and I know this level all too well from the settings on my HRM when I run ... CHIRP, CHIRP, CHIRP, CHIRP!

We enter stage 4 - 7 mph at a grade of 24%. I immediately feel it in my legs! I'm breathing very hard and I think I'm feeling dizziness! But I wonder if it's really the exercise or just the anxiety of quitting. A few moments later I remember I've got to give John 10 seconds in advance. I think to myself, "Ten seconds ... this is like the last 70 meters in my 400m sprints ... I can't hold on much more!" At 7:20 I surrender to the machine and let John know it's time. The surprise is that they move me over to the ECG station and hook me up in far less than 10 seconds. "Jeez, I quit too soon!", I'm thinking as the technician presses the scope against my rib cage. I hear John say that my HR reached 191 bpm. Yeah, that's about right these days.

Okay, so it wasn't a race. It wasn't an experiment. It wasn't a performance test ... it was a diagnostic test! Nothing more. But why do I feel defeated? I admit that I've taken this recovery from OHS too personally, maybe. Since mid-April I've done no less than my level best to accelerate my recovery, to run sooner than anyone expected I could, to train sooner and to train hard sooner and to compete sooner. Within the obvious limitations, I've done everything possible to turn this year into a normal year in terms of running. But it just won't happen! I claim sole responsibility for all this expectation - I was the ONLY one putting pressure on myself, though I used DRS for my stage. I don't want to wait, but it seems I MUST wait! My body simply isn't ready. What used to seem like base-level stress associated with routine training is NOW major stress by comparison! My body ... no more specifically, my heart and lungs still work inefficiently. It's seems like a simple function of time where after so many minutes of physical stress the task of re-oxygenating the blood is too great, my heart reaches maximum effort and I head for oxygen debt.

In reality things haven't gone all that badly, either. When I think about what I've been able to accomplish this year despite the layoff that came with two back to back surgeries, there's a lot to be grateful for! My sprinting has gone quite well since late June - I was way ahead of schedule in bringing my 400m time down. And my successful reacquaintence with the shorter sprints with which my personal history of running actually began was a very pleasant surprise. Apparently the intense bursts associated with the 50m, 100m and 200m distances have not been hampered at all by this tachycardia I'm experiencing. Running at the anaerobic threshold is an entirely different game ... one that I'm still faring well. So what am I whining about?

This past Friday I saw John Jayne for his analysis of the test. We got reacquainted for a few minutes (I hadn't seen him since May) and then it was right down to business. He started quizzing me about my history of dizziness and passing out. I thought this was strange, first, because we covered all that way back in February and second, because I expected that I was through with this stuff having had a successful structural correction done with OHS. John paused and after a slight sigh all he could say is "I'm not sure what to do with you." With the tone of his voice I immediately flashed back to my grammar school days. Sitting nervously in front of the principal's huge desk, drowning in Catholic guilt and dreading the next words to come out of his mouth. "You've really disappointed me this time, Peter!", he lectured. I quickly snapped out of it as John opened up the folder containing my EKG and other data.

We went over the EKG graph together. I began to understand the connection between the electrical side of cardiology and the structural side, finally. John picked one of the spikes on the graph and we calculated the equivalent HR in beats per minute ... 1 beat over 260 ms, that translates to 231 bpm!!! I told him that my HRM was registering spikes like that and that I was going into data and changing the values to smooth out the curve. He responded, "That's one way to eliminate the problem!". That made me chuckle. We somehow got on to my obsession over breaking 60 in the 400m. I told him that I'll probably die on the track at the finish ... keeled over in my lane, my right hand clasping my left wrist, my index finger pointing to the 59.9 on my watch. We laughed a lot over that. Then he explained that cardiologists take a very cautious view about arrhythmias like this. Aerobic sports in particular are discouraged with these conditions. What a blow! Not me ... this is impossible, I'm not hindered in any way by my palpitations. But then the last time I thought I knew better than John he proved to be totally correct. I know better than to argue cardiology with any of these guys by now. We talked some more about the dangers of an abnormal rhythm and medications to control it. We also discussed the proof in the ECG images that my heart muscle is totally normal for the first time in my life. He made me realize that, even though my HR is high and I fatigue easily, given enough time my cardiovascular system will improve. I simply need to be MORE PATIENT! But his concern over the arrhythmia is real. And he'll be arranging for me to meet with an electro physiologist to lend some expertise to the problem.

So, although this stress test was slated to be the one last test, I may yet have one more test for the arrhythmia now. In conclusion, the plumbing job was a complete success. Now on to the electrician. What I did learn from this meeting with John was that the danger of my ALCAPA condition was truly an event waiting to happen. That is to say, in combination with the arrhythmia it was purely a matter of time before the ischemia I suffered during exercise would send my heart into fibrillation. That in itself was worth having the bypass done. It hardly matters whether I ever regain/improve my running endurance again! I'm alive ... I'M ALIVE!!!

Obligatory Running Note:
Had a very pleasant 3 mile run today on the dirt roads and trails surrounding my home. Once I finally made it to the top of South Hill, that is. With that nasty chore behind me (though I do remember it being much nastier not so long ago) I was able to enter my comfort zone. Nope, no damned noisy HRM's chirpin' at me today because I left it at home! Ran easily along the summit, enjoying the colorful foliage in the dampness of the day. Half way into the run I came upon the elderly Mrs. Hendricks, a few of her grand kids and her huge German Shepherd. They were walking down their road heading back to their home ... the same as I was. The Hendricks' own a large part of South Hill. It's just before their house where the road forks to a rocky trail down the hillside. It makes me glad to see how much they enjoy the land and it's value as it exists in it's natural state. No logging, no maple taps, no improvements whatsoever! I got by the their dog without too much commotion. A minute later I was greeted by their huge Boxer ... much quieter than the other dog, but snorting heavily. This guy insisted on making contact so I slowed down just enough for him to slime my hand. As I started on to the trail I saw Mr. Hendricks turn the corner. It seemed as though his Boxer now liked me enough to want to join me on my run, so I stopped and waited while Mr. Hendricks called him back. No watch, no HRM, no hurry! A minute later I followed the soggy trail through the dense brush. Shoes sunk into the mud ... got that out of the way! For the rest of this half mile I had to lift my feet high and place my steps carefully - the rock and perpetually wet earth always provides a challenge here. Finally, I made it down to the connecting dirt road. My legs felt really strong once I left that tortuous path. Even my breathing was more subdued than usual. Turning on to West Hill Road now, which follows the stream all the way to my house, I made it past the old Community Hall ... then past another barking dog restricted by a picked fence ...then past the town cemetery ... then past the wooden bridge and ultimately up one more incline to my own driveway. It felt great to take it easy for a change - no time, no heart rate and, best of all, no expectations!