Well, I updated my blog a couple weeks ago with a lengthy report on my visit to Mayo, only to lose everything on my last key-strike. I was unable to recover about an hour's worth of work, so my frustration got the best of me and I stayed away from blogging for a couple weeks! Anyway, I'm going to give a brief update on Mayo for those that may be interested.
As many of you know, I was diagnosed with Wolff-Parkinson's White syndrome (WPW) several years ago. This is basically a heart condition where the ventricles of the heart are pre-excited via an accessory pathway in the heart known as the Kent bundle. It showed up on my EKG, and was suspect of causing some arrythmia and shortness of breath that I was experiencing. However, I never had the very rapid tachycardia that is often associated with WPW. My heart never raced to 200 bpm or anything. I would just experience "missed" heart beats and irregular rhythms.
In July 2007, I had a bad bike crash, and never seemed to fully recover. While I felt physically recovered from the injuries (minor concussion, bruises, scrapes, etc), I noticed fatigue setting in more quickly while training, and my resting HR and blood pressure was elevated. This was concerning to me, and I always wondered if WPW or anything in my heart/nervous system had gone awry causing some of these symptoms. So, after having some tests done at my local doctor, they referred me to Mayo for additional testing.
I was pleased to go to the best doctors in the world, and was looking forward to learning something. Unfortunately, the first couple days of testing were a disappointment. They started me off with a electrocardiogram, some blood work, an echocardiogram, and then set me up with a holter monitor for the night. During the night, I had a kidney stone attack (see the Kidney Stone blog entry). I was curious as to how this would show up on the holter monitor! I also ran 8 miles at a 6:40 marathon pace to see how that registered on the holter.
The next week I returned to Mayo to visit the cardiologist and discuss the test results. This was where the disappointment started. First off, I found out I wasn't pregnant! (that's right - they took a pregnancy test on me while in the ER for my kidney stone - I thought these were supposed to be the best doctors in the world!). Secondly, they got my EKG mixed up with someone else. I had to point this out, because the cardiologist noted on my EKG that my HR never got over 115 bpm. I told him that I ran 8 miles on the treadmill and my Polar HRM said 160 bpm. I asked to look at the chart and noticed someone else's name on it. They had my EKG mixed up with another! Again, I wasn't too impressed. Well, Dr. Lim was very apologetic about this (he was a very good Fellow working under Dr. Bradley, the primary cardiologist). Dr. Bradley then came in and saw me. He had no answers. In fact, it was rather discouraging, because I asked him why my resting HR would be so elevated (it now is around 70 bpm and always had been around 45 bpm), and his response was "Well, that's a good question. There hasn't been very much research on resting heart rates and why it would increase, so we really don't have any answers for that." What? This coming from one of the best hospitals in the world?! He basically couldn't address any of my symptoms.
About that time, Dr. Lim, the Fellow, returned with my holter monitor results. He noted a couple incidences of AV block (AV Block) and was concerned, so he ordered me back for a stress test to see if the incidences occur while training or racing. We scheduled this stress test for December 15, the day after the White Rock Marathon! I knew I'd have tired legs for the test.
Well, we returned to the Mayo for the stress test on the 15th. Looking back, it is clear to see the hand of God working in this process. At this point, I was frustrated with not having any further insight to the increased resting heart rate that I was experiencing. My stress test was scheduled for 10:15 a.m., but I had it rescheduled to 9:30 so I could get home sooner. A few minutes before the stress test, my mom called and suggested I see if they have any good exercise cardiologists on staff. We had talked about this before, after my frustrations with Dr. Bradley's lack of help or understanding of my issue, and I was glad she reminded me. I proceeded to the stress test (quite difficult on post-marathon legs!). At the conclusion of the stress test, I asked the technicians if Mayo had any good exercise cardiologists or physiologists on staff. She said they had three, and asked if I'd like an appointment. I jumped at the opportunity, and she immediately got on the phone. This responsiveness was impressive and surprising! Well, it turns out that they had an appointment at 10:00 with Dr. Allison that just opened up! I couldn't believe I got in this quickly, and started to have some hope. It was 9:55 a.m., so I had to hurry (keep in mind that my original stress test was scheduled for 10:15, so I would have missed this appointment and opportunity if we stuck with the original plans.
So, at 10:00, I head to Dr. Allison's office. In walks this older gentleman. I was a bit disappointed at first, because I was hoping for some young, athletic hot shot who would be able to understand ironman training and what I was going through. However, my disappointment was short-lived when Dr. Allison started looking at my ECG and stress test results. Immediately, he noticed the issue. He stated that I had an abnormal p-wave and it was clear that I had an ectopic heart rhythm during rest. An ectopic hearth rhythm as I understand it is a rhythm that arises from a center or node other than the normal pacemaker, the sinus node. He noted on my ECG that, during rest, my heart was not operating via the sinus node, but that it switched to the sinus node when exercising. Now, this made perfect sense to me, as I could see it on the graph and relate it to my symptoms! When resting, my heart was using an accessory pathway or other node and was not beating in its normal sinus rhythm, thus raising my resting heart rate. However, when exercising, it went back to the sinus rhythm. Dr. Allison speculated that my heart was so conditioned that it was beating so slowly when resting and found an accessory pathway that it fell into in this rest state. He also noted that he did not see any pre-excitation, and therefore felt that WPW was a misdiagnosis. He encouraged me to keep training and not to worry about it. He noted that I have an accessory pathway that others do not have, but I probably wouldn't notice it if my heart wasn't so conditioned.
He then called in his colleague for a second opinion, and his colleague agreed. I had an abnormal p-wave and an ectopic rhythm at rest, but it switches to sinus rhythm when exercising. He said it was similar to Frank Shorter's heart!
I then found out that Dr. Allison was an elite runner (2:20 marathoner and olympic qualifier)and friend of the legendary marathoner Frank Shorter (Frank Shorter)! Indeed, God is good! He knew that I needed to see with my own eyes what was going on (the ECG showed it), and comprehend from my engineering mind the cause of the problem. He also knew that I am not a real trusting person, and threw in an elite marathoner for my doctor, just to give me the confidence that I needed! Praise the Lord!
I finished the Mayo trip with a final visit with Dr. Lim, who confirmed everything that Dr. Allison, the exercise cardiologist, had reported. Dr. Lim stated that Dr. Allison was one of the best in the world, and had full confidence in his diagnosis. Dr. Lim also noted that I had no further incidences of AV block when doing the stress test, and he cleared me for training and competing.
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