Sunday, December 4, 2016

Too Fit?

Outdoor folks tend to be a healthy lot. Their passion for outdoor activities drives them to eat well, stay lean and stay fit using a variety of methods. A few take it to another whole level with focused training, whether it be for the Boston Marathon, NECX Series, the American Berkie, or a now defunct bicycle hillclimb series. Fitness to excel in any of these disciplines pushes one out onto the very thin end of the distribution.

Regular doctors aren't accustomed to caring for athletic people at the highly-fit end of the scale. Sadly, the distribution of American fitness continues to shift toward obesity, pre-diabetes, heart disease and myriad other ailments that beset a sedentary, lousy diet lifestyle. These are the people doctors treat on a daily basis.

So what happens when a one-percenter, or even a 0.1%-er shows up? Something must be wrong! This has happened to me three different ways now.

I used to go years without getting routine physicals.  But the way health insurance is set up now, not getting "wellness" exams comes with a hefty financial penalty. Don't get me started on how this is an invasion of privacy with employer and big pharma meddling with your personal affairs.

Anyway, several years ago one of these wellness exams showed abnormally high liver function enzymes, like really high. My doc was sure I was lying about alcohol consumption, as he asked me 10 different ways about alcohol use. I've consumed zero alcohol for 32 years now. Then Tylenol. Again, don't use it, Aleve is much better for inflammation. So more blood work was ordered. Looking at meaning of elevated liver function values online, I got scared. Liver cancer, hepatitis and other scary things could cause this. Yet I was in the best shape of my life. The follow-up tests came back normal. I breathed a sigh of relief.

But wouldn't you know it, the next wellness exam, my liver function was high again! What was going on? I poked around more on the web. I stumbled across something interesting. I found elevated liver function enzymes was pretty common among body builders and ultra-endurance athletes. In one study, enzyme levels were checked before and after a marathon. A significant number of  runners came back with elevated levels after the race.I found many forums where endurance athletes discuss the problem of testing high and having to explain to their doctors. I mentioned it to my doctor, he looked into it, then said no exercise for two weeks, then well retest. What?!?! Like that is going to happen. I did back off a bit on my usual regimen of VOmax intervals and such, and the follow-up test came in just barely normal. That pretty much settled that anomaly. I have since tested high several times over the years since, but I know now it is best to not have blood drawn after a grueling weekend of riding or skiing.

A couple years later, I had another case of "that's not normal, lets check it out."  I mentioned to my doc that sometimes when I stand up quickly after being seated a while, I feel like I'm going to black out. This was after my HR was measured. I think it was low 40's in the doctor's office, but I mentioned I sometimes see it as low as 34bpm in meetings at work. This was also around the time I had a little trouble with acid reflux. Sometimes heart disease can be described as a burning sensation. So doc put all this together and said we first have to rule out anything going on with your ticker. You need a stress EKG. Really? So I got wired up, started on a protocol for the average American (remember, obese, sedentary?), which the lab tech quickly realized was not going to work for me. She switched to athlete protocol, which started faster and went really fast. That got my HR up, and the EKG showed perfect performance. Many people experience light-headedness upon standing. I think it is more common in athletic people with low HR and low BP. I just won't say anything about it to my doctor again.

Most recently, I had another scare from a routine wellness exam. While the doctor was palpating my abs, he spent more time than usual and was kind of like hmmm... When doc goes hmmm, that can't be good. My aorta was pulsitile, which means he could feel my aorta pulsing with each heartbeat. The doc did qualify that it is probably just because I'm very lean, but an ultrasound was needed to rule out an aneurysm. Oh great, another thing to worry about, study up online, until results are in. Most people die very quickly when an aortic aneurysm bursts. Do I even dare exercise? That evening when I laid on the floor to do some situps, I palpated my own ab. Sure enough, just above the navel, I could find a strong pulse. I could almost feel the woosh, woosh, woosh of blood with each beat. They were able to get me in the next day for an ultrasound, and I had results two days after that. Negative.

So three times now, being "too" fit has triggered additional screening. I think if I was still fat Doug (and still alive), none of these would have happened. Of course, I'd probably have a host of other real ailments by now. Better safe than sorry I suppose. Does make me wonder if there is value in finding another doctor that's more in tune with the needs of a master athlete. My body doesn't repair itself like it used to...


Jason said...

Thanks for sharing your experiences. I also have had the symptoms of feeling like I’m going to black out when I stand up. I had a hard ride yesterday afternoon and sure enough, last evening, I had a particularly strong sensation of almost fainting when I stood up quickly. I haven’t mentioned this to my doctor but I’ve been debating it. I didn’t have this happen when I was less fit. I’m probably the fittest for cycling I’ve ever been in my life, so I feel it’s likely a similar case to yours.

When I routinely have my heart rate measured on doctor’s visits, quite often the technician will remark about how low it is but they know I’m an avid cyclist. I have less worry knowing that I'm not unique in this phenomena.

Just curious, was there one particular reason BUMPS disappeared? Lack of participation in hill climbing events?

Hill Junkie said...

Some of the near fainting I think is dehydration too. It can take a couple days to reach hydration equilibrium after a hard effort or long weekend of activity. The reduced blood volume leaves even less for your brain when you stand suddenly.

I think it was mostly participation. Individual races were disappearing, like Ascutney, Burke, Equinox. Reg numbers were down. Takes a lot of volunteer support to tally series results too. It was a good run while it lasted. I think gran fondos and gravel grinders is what everybody is chasing these days. These are lower key non-sanctioned events for the most part, which was part of the appeal of hillclimbs. Don't need an expensive license and the cut-throat racing aspect is down played at these kinds of events.

Anonymous said...

I think it is worth looking for a new doctor. I got tired that they were taking my HR or blood pressure twice because it looked low (normal). The person was always surprise and was thinking that the machine was wrong or they made a mistake. I am only 34 years old...And if you had a real issue while you are healthy, they are going to send you home and asked you to rest.

You could look at the people waiting to see the doctor and all of them were very overweight.

the bully said...

Yep, standing up. No black outs, but I have to gather myself before taking that first step. EKG. I get one every year because of my Pericarditis back in 11. Doc said, lots of people get it, but never know they have it since they never get their heart rate up to aggravate the inflammation. It's aggravating that there aren't many docs that are fitness friendly.

gretta ava said...

Hi Doug,
I hope all is well., I have read a lot of your information posted on northeast cycling, and wanted to thank you for all the input!, I am thinking about attempting the autoroad hillclimb this year.