Monday, March 25, 2013

Diagnosis, decisions, discoveries

For those of you who follow with any interest the running aspects of this blog, you may have noticed that the last few long runs (Boulder Marathon in October, first 42 of JFK in November and NOLA marathon in February) all mentioned that my lungs didn't seem to want to play and that I went (even more) slowly to finish each of them.  Then I had the cold from hell in January and when I was totally out of breath going xc at Rocking Horse (both the E time and the successful, but slow, time), I chalked it up to that.  When I saw my physician for my annual exam a couple days after the NOLA marathon, I mentioned to her that I should probably get a pulmonary consult as my lungs seemed to be getting worse.  She agreed and also scheduled me for a stress echo.  The pre-stress echo got finished up with not a lot of waiting, but then the cardiologist came into the room.  Turned out that things didn't look so good.  Apparently, the radiation for Hodgkins impacted more than my lungs (and my shoulders, but that is a different story) and the echo had detected "moderate" aortic stenosis - maybe:

Classification: Aortic Stenosis Severity
  1. Aortic jet velocity
    1. Normal: <2 li="" m="" sec="">
    2. Mild: 2.5-2.9 m/sec
    3. Moderate: 3-4 m/sec
    4. Severe: >4 m/sec
  2. Mean gradient
    1. Mild: <25 li="" mmhg="" nbsp="">
    2. Moderate: 25-40 mmHg
    3. Severe: >40 mmHg
    4. Critical: >50 mmHg
  3. Aortic valve area
    1. Normal: 3 to 4 cm2
    2. Mild: 1.5 to 2 cm2
    3. Moderate: 1 to 1.5 cm2
    4. Severe: <1 cm2="" li="">
    5. Critical: <0 cm2="<!--0--">
While the area appeared to be around 1.1, the gradient looked much more on the mild side and they were having trouble figuring out the velocity.  Apparently, when you go around running marathons with your heart in this condition, it screws up the standard diagnostic procedure, but there is definitely a diagnosis and an issue (and, of course, the symptoms). Next on the medical front is a discussion with a cardiologist, probably catheterization as it will provide a more accurate picture and is especially recommended when the echo findings aren't consistent or conclusive (true in my case). Then, they will likely still do some sort of functional test to see what the heart does under a workload.

Aside from the medical side of getting figured out exactly where the diagnosis falls, they have said that in the meantime, physical exertion is not a great idea.  After talking with several physician friends (both internists and cardiologists), I decided to continue with the plan to do the 50 miles at the Inagural Prairie Spirit Trail Ultra, but to walk it rather than making any attempt to run.  Looking at a forecast with a low of 30, a high of 40 and a 70% chance of rain/sleet/snow, I had more than a passing thought that I had the perfect excuse to bag it.  But, I'm pretty well trained right now, there is no time limit, I own vast amounts of warm and waterproof clothing and who knows what might happen over the next few weeks/months, so decision made - and remade several times in the days leading up the event.  I had the perfect excuse to not go out in the cold and rain/sleet/snow, but I knew that if I didn't, it wasn't for the good reason of not wanting to harm my heart, but for the feeble reason of being a weather weenie, so the decision didn't change.

I flew into Kansas City on Friday afternoon and the weather was promising.  The drive down to the bed and breakfast was easy, as was check-in, packet pick-up and a pasta dinner.  This time, there were no Friday night nerves, they waited to make an appearance until around 5:00 a.m. Saturday morning.  I didn't need to be awake that early, but I was, so I sorted through gear, prepared my drop bags, had a cup of tea and then headed off to the start.  We hung out in the gym at the Don Woodward Community Center for a bit.  I chatted with some other participants, especially a woman named Amber, who ended up with a great finish in her first 50 miler and started gearing up.  Runners are great.  Ultra Runners (in my limited experience) are even more into supporting each other and offering help and tips.  Then it was time.  At 8:00 a.m., it was full light and in the upper 30s, not bad at all.  I set off at a walk.  My goal pace was 16:00/mile.  I was very near the end of the group and alone most of the time.  I met up with a trio from Oklahoma (Caroline, Roman and Bobby) several times during the run. The first time, when we chatted a bit at the first unmanned aid station at mile 5.25.  I also made a point to eat my Almond trail bar before then and my first packet of Clif Shot blocks before the first manned station (Princeton) at 9.75, knowing my chewing interest wanes as events proceed (one of these days, I'm going to need to embrace gel - maybe - see I forget (or am in total denial) that I may not be able to continue to do this).  Spent about 5 minutes at the aid station, turned down the offer of a taco. Sonny (son of organizer and part of the Brigade) was having a potato taco, which was interesting, but not at all appetizing sounding to me.  On then to Richmond at mile 16.  The trail was lovely in many places.  Woods (which you don't necessarily expect on the prairie), lots of birds, bridges over lovely creeks and rivers, cows in the field, something very, very green (maybe the last of the winter wheat?), and a smooth trail.  Richmond to Garnett went well and I pulled into Garnett at 6:26, 15 minutes ahead of goal.  I used that time and more warming up, changing hand warmers, resting a bit and chatting with Roman and Bobby.  Then, off for the second half.  By this time, it was snowing.  It had started lightly in the last couple of miles to Garnett and was coming down in earnest as I left.  Big soft, but very wet flakes of snow.  It wasn't sticking on the paved part of the path in Garnett yet, but was once back on the trail.  Around mile 27, a stunning big fox crossed the path right in front of me.  That smile lasted at least a couple of miles.  Had it been warmer and drier, I would have taken some pictures (would have missed the fox - he was very fast), particularly of the beautiful blue of the juniper berries on the ground, some of the birds, and more amusingly a "can you identify this scat" series as there was sign of any number of animals all along the trail. Got back to Richmond (mile 34) feeling good, but a little soggy (much thanks to Rob for advice on the Patagonia Houdini - it was working its magic, hence only a little soggy).  I had ramen and hot chocolate, switched out my gloves and added a second pair of handwarmers and put my Arc'teryx jacket in a ziploc and added it to my pack (much thanks to Barry Lewis for suggesting the Ultra Aspire pack - I didn't use the water bladder, but it was amazingly comfortable for carrying stuff and I was able to hook my hand held water bottle super comfortably into the front straps, so I didn't have to carry it), and then headed off to Princeton.  At Princeton, I discovered that my one packing failure was not having a third pair of gloves, but Andrea (another Brigade member) was good enough to work hard at getting the ones I had a bit drier.  I pulled my Arc'teryx on over my pack and added my headlamp (thanks to Andy Glick for the Petzl Myo RXP headlamp for my birthday present), and headed out for the final (not quite) 10 miles.  I think I did cover 10 miles because by now there was pretty significant slow on the ground.  At the road crossings, it was quite deep and slushy in places and so I walked around a bit to avoid the deepest parts, same as I passed into the final three miles and the snow was deep and slushy on the paved path, so I wove around a little.  I still felt quite strong and passed a few people in this final stretch.  I was also passed with somewhere between 2 and 3 miles left by the first finisher of the 100 mile race.  He looked amazingly strong.  I just continued along.  Getting to the finish was a bit of a comedy.  I didn't really understand the cones that were set up and so went to the front door of the center and went in, then was told to go back out and around to the back.  When I did that, I ended up at a locked door.  I pounded on it and waited a little and was about to head back around to the front when someone came to open it (apparently the door stop had failed - oops).  I was able to head in, where they had set up a really neat finish line and had a photographer (I will try to add the photo once they are posted).  I walked in the front door at 10:16 p.m.  Attempting to correct for the longer aid stations stops, I mainted my 16 minute walking pace.  I was not the final finisher and not everyone at the start line crossed the finish line, but everyone of them had a story, all of them in one way or another EPIC.  Thanks for reading mine.  

I'm not sure that a pretty epic March snow was what Eric Steele (the race organizer) had in mind when he was thinking that the event would be epic, but I'm really glad I did it.  It is a nice bucket list item to have participated in an inagural 50 mile event 2 months after my 50th birthday.  I fairly quickly got back to the bed and breakfast, almost cried when I wasn't sure I could manage to turn the key in the lock with my frozen hands, but succeeded and had a short soak in very hot water in the lovely big tub in my room at the Three Sisters Inn. I got up in the morning, got packed up and headed out - into about 10 inches of snow and an unshoveled driveway.  With the incredibly generous help of another guest, I got the car out (after about an hour of shoveling and rocking and pushing and shoveling) and headed to the airport.  Driving was a little slow, but easy enough.  Apparently, despite being in the midwest, MCI airport hasn't quite figured out the logistics of plowing the runways, so it took our plane over an hour to get to the gate, meaning I missed my connection from Cleveland to Philadelphia.  The good news was that missing a flight in the middle of March Madness isn't that sad, because sitting in some sports bar watching basketball would be on my list of preferred activities for a Sunday afternoon anyway.  It was fine that it was at an airport.  Finally got home around 10:00 p.m. and neither yesterday nor today was I particularly sore (the benefit of walking or of being cold acting like icing during the endeavor?).
So, what are the discoveries alluded to in the title?  I don't really remember, I wrote the title on Friday, but I can say I've learned: That the ultra community is a great one and I hope I can stay involved as the diagnosis progresses; that the praririe is lovelier than I expected; that I can overcome being a cold weenie for a good enough reason; that I have amazing people in my life and that life is good (the latter which I knew).
I also need to add some shout outs, to Caitlin Silliman winning the Intermediate at Southern Pines on Remi this weekend, Jenna for texting me those results as they happened, the Blue Hill Crew and Sally Cousins for successful weekends at Poplar, Rob Colenso for his blazing fast Terrapin 50k time, Kaiti and Jen for their messages leading up to and through the weekend, Natalie Hollis for successfully completing the Jungle Cup in weather almost as bad as in Kansas (and more water obstacles involved), and always Henry for setting his worry aside and supporting my crazy endeavors.


Suzanne said...

Wow... you are now my hero! Good luck to you and thanks for sharing!

Annika Kramer, PA-C said...

Indeed! As usual, Seema, you press on in the best of ways, with the best of both intentions, as well as attitude, Good Luck with the continued process....