Happy Thanksgiving y’all. There’s not a day which goes by since 10/15/2013 that I’m not actively grateful to just freaking be here.
That said, as a heart patient, there are times when you realize that normal is for other people.
This morning I sat down to work on my race reports from the New Roads Triathlon Festival, which is very late, and Ironman Florida, only a little late, and I started thinking about yesterday.
Yesterday I had an Echo Stress Test. It’s a redo of the one I had a year ago.
On some level, I guess I blame Elton John – or rather the NYTimes article about his 1970 show for starting me down a sad path.
I’ll get those race reports finished, but first I want to talk about my stress test. Just thinking about it makes me sad, frustrated, and angry
As I said, I did the same test at about the same time last year. Like last year, I exercised in the morning before. Unlike last year, I understood that how long you stay on the treadmill matters to the test.
Wait, let me back up a little. For those who don’t know, an Echo Stress Test consists of an Echocardiogram (i.e. an ultrasound of your heart in action from multiple angles) and a treadmill test with an EKG and BP taken at escalating levels of effort.
You start with the Echo, for a baseline, then you get a baseline standing blood pressure and EKG (think squiggly heart rate lines you often see on TV).
Then, you get on a treadmill which increases in speed and incline until you reach 85% of your assumed max heart rate (85% of 220 – your age), which puts my target at 142 BPM.
Last year I stopped after I got to the heart rate target thinking that was the whole test. I learned only when reading the report that quitting early is a sign of “lower than average exercise tolerance”. As an Ironman athlete I was like “screw that” — “lower than average”!? So this year I was committed to staying on until at least 10 minutes.
I let the nurse know we were going to call it at 10 minutes around 8:20 which is just a little after I hit the HR target. The messed up part is they make you give an excuse when you bail: pain, breathing, or fatigue. I was none of the above so I cited “boredom” — the nurse still put fatigue, but added boredom, too, so my pride was somewhat intact. I was definitely breathing heavy but I could have probably held on a few more minutes.
In all I felt good about the test. It took me much longer to get to the target HR, indicating a higher level of overall cardiovascular fitness. I feel like this is probably true based on all the work I’ve done this year.
I got home and Angie asked how the test went. I told her, what I thought at the time, that I’d “aced” it.
Then, I got notification that my results were on the Ochsner portal. Their portal, and communication through it are one of the better reasons to do your healthcare with them.
I opened the portal, read the narrative and looked at the numeric results which all looked good to me.
My blood pressure is higher than the American College of Cardiology would like but otherwise all the numeric values look like they’re in order.
My blood pressure is a point of frustration for me. I eat almost NO meat, NO dairy and very little salt compared to the standard american diet. The vast majority of my nutrition is whole-foods, plant-based. So, the fact that my BP remains high really pisses me off – and, I take drugs, too. It’s part of the reason I’m trying to reduce my body fat, as that is a contributing factor.
So here’s the thing. I try not to look at anything serious on my phone before bed. I prefer Kindle to books for logistical reasons, so I’m not phone-free at bedtime. And right before switching to airplane mode I got a notification from the Ochnser app that I had a message from my provider.
It turns out that my doctor didn’t agree with my reading of the results.
First, the message from his nurse indicates he wants to add another BP medicine and then, and this is the one which really set me off, he indicates he wants to do a “cath”.
For those not in the know, that’s shorthand for Cardiac Catheterization. His actual statement is:
“Stress echo is modestly abnormal but at very high level. Normally, this would not be enough to merit cath and revascularization and I would just repeat this test in 10 months, but since he does super hard training and races/triathlons, we probably should do a cath – if he is not training this hard now or in near future and not racing, we could be more conservative.”
In other words, he’s worried that at higher loads, my heart muscle isn’t getting enough blood and he may want to “fix” that. When doctors “fix” things, it usually includes drugs, knives or devices. And frankly I want none of the above.
We’ve got an appointment next Wednesday and I replied to the note indicating I’d like to talk about it in person.
It’s hard to put a name on my feelings. I think frustration, anger and sadness are a good starting point.
I’m trying. This happened. These are my feelings. I know I can’t change the things that have already happened. I can only control the actions I take from here forward.
But god damn it! I feel like I’m not getting rewarded for my hard work.
So, as I often do, I look for inspiration to Ryan Holiday’s interpretation of Stoicism. Quoting Marcus Aurelius, Holiday writes:
“It’s unfortunate that this has happened,” he wrote. “No. It’s fortunate that this has happened and I’ve remained unharmed by it—not shattered by the present or frightened of the future. It could have happened to anyone. But not everyone could have remained unharmed by it.”
Which is exactly what we have to say today, no matter how minor or major the difficulties that befall us. Why not me? I’m about due. No, I won’t let someone else take my place. I got it.
Today I’ll say it and maybe tomorrow I’ll believe it. I’ll wallow a little and then I’ll move forward, ultimately unharmed by it.
Today I’m thankful for life, family and the ability to feel all the feelings. And I’m thankful for you who choose to read this.
- Electrocardiography image: See page for author, Public domain, via Wikimedia
- Turkey Image: by John James Audubon, Public domain, via Wikimedia Commons