Since 1982 I've written a newsletter, Running Commentary. A new issue appears here each week, and material is archived.

Thu, 8 May 2003 08:47:42 -0400

Getting to the Heart

RUNNING COMMENTARY 465

(Rerun from May 1996 RW)

The first medical words this doctor spoke to me were the last ones any runner ever wants to hear. His sentence ended chillingly with "heart problem."

I had gone to see this doctor last fall for a seemingly unrelated reason. I'd only wanted relief from dizzy spells that had come with a case of the flu.

"With dizziness," he said, "we always have to suspect a heart problem. Have you ever had an EKG?" Not for a long time.

"So we'd better take one today." His nurse ran the resting EKG, and the doctor came back later to interpret it.

"You have very dynamic heart action, which is typical for a runner," he said. "But I also see some irregularities."

He mentioned something about an "S-T segment" and "a possible problem with the left ventricle." I asked what that meant, and he dismissed the question with, "It's quite technical."

So what next? "At the least I recommend a treadmill stress test and an echocardiogram. I saw nothing alarming here, so there's no rush. Just don't wait too long."

Six weeks later seemed soon enough when we scheduled these tests. But the weight of waiting to identify an unknown enemy quickly turned frightening and depressing.

These symptoms didn't alarm the doctor, who sees a half-dozen worse cases before lunch each day. But I'd never dealt with anything like this before, and my imagination poked actively through the possibilities. They seemed to point to the end of life as I'd known it.

How could I cope with losing my life's one great constant -- the runs I'd taken almost daily since my early teens? How could I keep writing about running if my heart wasn't in it?

And how would I answer acquaintances who don't run and could now say, "See how much good all that running did you?" As if heart protection were the only reason I ran. As if I still believed that running granted immortality. As if family history and diet didn't have at least as much to do with these problems as exercise habits.

High blood pressure runs in both sides of my family. I'd always hoped it would skip me, but I couldn't outrun heredity.

More depressing news: "Your blood pressure is getting up there," said Doctor I. "We might want to put you on medication after the testing is complete."

He sent me to Doctor II, who took blood and urine tests. Finally some good news: All fell into the normal range, including the cholesterol that once had been borderline high.

My last and most dreaded doctor's visit remained. This was with the cardiologist, who would look into my heart at work and tell if it was working as it should.

I met Doctor III on December 21st, the darkest day of the year. At check-in, my blood pressure and pulse read as if I were starting my biggest race.

A nurse led me into the "echo room," where ultrasound and EKG machines shared space the size of a walk-in closet with a treadmill and an exam table. A doctor and two technicians squeezed into this room with me.

"Nice picture!" said the doctor as my beating heart appeared on the echo screen. I don't know whether he was complimenting me on a good heart or his assistant on her good work. Probably the latter.

Resting readings taken, I jumped on the treadmill. The doctor fired questions at me and orders to his technicians as the belt rolled faster and steeper.

"Let us know if you're having any problem," said the woman operating the treadmill.

"I'm having one now," I said. "I'm not used to walking this fast. Can I run?"

The doctor answered. "Go right ahead." Then he asked the operator, "What is his predicted max?" The operator gave the number.

"Push it up to that," said the doctor. I couldn't spot the pulse count, but he must have seen all he needed and announced, "There's no point in going further."

He now was ready to pass judgment. His first words were the most beautiful that any runner could hear: "Your heart is fine."

He quickly added, "You do have a slight thickening of the left ventricle. This is almost certainly a reaction to your high blood pressure, and the thickness should go back to normal when your BP drops."

Through my wide smile of relief from six weeks of worry, I asked his advice on the mildest way to bring down the BP without shaking up my body chemistry too much. He named a drug and handed over a sample supply.

"Will I always have to take this drug?" I asked. The doctor said, "You will as long as your untreated blood pressure remains high."

Then he added a note of hope: "It's up to you. If you're willing to modify your diet and control your stress better, you might lower the BP enough naturally to get off the medication."

The cardiologist didn't tell me to give up life as I'd known it, but asked that I open my heart to better ways of living.


UPDATE. In the seven years since this column appeared, my heart hasn't caused any problems. My cholesterol and other test scores are better than they were in 1995.

My weight is lower. My diet is better (though far from ideal).

But none of this brought down my blood pressure, which I'd left untreated after the fright described here wore off. Two years ago I finally went on a low-dose of a mild medication prescribed by a doctor who runs. This drug does its intended job without adversely affecting how I feel while running or otherwise.

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