Tuesday, August 2, 2011

And the Doctor Said, "Deal with it."

The hay is in the barn. All training is done. Now we get organized and wait. There is a lot more organizing than waiting, however. We will have a team teleconference tonight, the last before we meet on Saturday in Furnace Creek. Deborah has developed a plan for crew rotation that is based on my projected progress. As we have learned, planning is necessary, but plans are useless. Something will happen to change everything. But, with a plan there might be a smooth transition into the unknown. Deborah has worked hard. She gives a lot to my efforts. I would not know how to do it without her.

We are going into this with a small, but nagging uncertainty. My heel problem that I mentioned elsewhere has resolved. But, during training in Death Valley I found I was not processing fluids correctly. I also was getting light headed and sick. I was well hydrated, so something else was going on. At the time, this seemed like a major problem. We consulted my most capable and supportive MD. We quickly realized I likely was going hypotensive – very low blood pressure. I have controlled extreme hypertension – very high blood pressure. Over the past year, my doctor has worked to get that under control with a new combination of medications. I was on those meds during the training in Death Valley. Under normal environmental conditions, I did not notice a problem. In Death Valley, I took it to the extreme with high heat and dryness, hard effort, and long hours. With my BP normal, it was entirely likely I was going well subnormal.

We ran a test this past weekend. For those of you looking at the tracking page, you would have noticed I went to the Salton Sea. That was the closest place I could find some heat. It was not that hot, but the heat index was 117 F, so it would be good enough. It smelled bad out there and the flies were just horrible, but it had to be done.  I was off the BP meds for about 18 hours and that made the difference. Starting with predictably high blood pressure, I went into the normal blood pressure range in just three miles. I felt good and I processed fluids well. While this was a successful test, it was not Death Valley. I have to start with caution. While there is little that will stop me, the risk of killing my kidneys is not something I particularly want to take to high levels. The first twelve hours will tell the tale.

In some ways I have the cardiovascular system of an obese couch potato, or worse. Doctors and nutritionists will tell you that exercise and diet will lower your cholesterol and maintain a good blood pressure. Absolutely that is the case. Please, please do that for your health. But, it does not always work, and in some cases heredity fights whatever you do to prevent such issues. I am one of those cases.

The highest blood pressure reading I remember having taken was at the start of the Angeles Crest 100 Mile Endurance Run. Here I am in 100 mile shape getting a blood pressure measurement of 240/150. The guy doing the measurement said if I am not careful, I will pop. It was during that race that my back failed me badly, and I was out at 26 miles. I went to my (previous) doctor for my back. Here begins a story of bad doctoring that leaves me cold to think this man is still out there “helping” people. I respect doctors. My grandfather was a great doctor, the last of the house call docs. He died of a stroke on his way to his last house call. I might have been a doctor, if I did not fear blood so much.

This doctor took an X-ray of my back. I already knew this almost certainly would not show anything. X-ray’s do not show soft tissue – the most likely case given the type of compression injury I had. I do not remember why, but he also ran blood work on me. Well, the X-ray came back negative. Instead of ordering an MRI, he just told me to take naproxen and “deal with it.” He actually used those words – “Deal with it.” I told him I run 100 mile races, and that I know pain when I feel it. No help.

When it came to my blood work, my total cholesterol was around 320, triglycerides off the chart at 1600, and my BP was around 200/100. Instead of being concerned, this doctor told me all I needed was to get more exercise. Really? I had just told him I ran 100 mile races, ran 60 miles a week, trained 6 or 7 days a week. Ugh. He stuck to his guns, for whatever use they provided him.

At this point, knowing I knew more about diagnostics than my own MD, I changed insurance and found another. The recommendation I received was one of true brilliance. I also was lucky. His practice was full. I got in because of knowing the right person.

He listened to my tale of woe. When I finally got to him, I was in a lot of pain – a real lot. I was scared for my running. The previous blood work was not on my mind, only the pain and if I would run again. I got the MRI that I needed, and that clearly showed I had a badly herniated disk. I got treatment and I am where I am now, not fixed, but doing a lot better. He did not question my diet or my activity level. He worked to fix the problem. Simple, good doctoring of the kind my grandfather did. To be sure the bad blood chemistry had not done any damage, he ordered a new scan of my heart that would directly image any build up. This is where the lifetime of running did show its benefit. I have zero build up in my heart and critical vessels. None. The usual chart for such things shows me at lower than a 25 year old’s level. Nice.

What I am now working on is my weight. In photos of me, you might notice a rather large gut, especially for someone who does what I do. It is the “Latter Gut,” the place my family puts its extra pounds. Not very attractive, I must say. Most of that weight went on while I was down with my back issue. I am getting older and something changed during that time. I used to be able to exercise a little and lose a lot of weight. Now I train and train and nothing happens. Yes, cutting calories works. But, when I am training I find it hurts the work too much. I am currently much heavier than I want to be. It is a compromise for my goals this summer. After I am done, I will work to solve the weight problem in a serious way. Life is a compromise. We must choose our battles and prioritize them.

It took a few attempts to get the blood pressure to acceptable levels with the right combination of drugs. I am there now. But, as one might expect, such medications are not tested on people trying to do crossings of Death Valley in the summer. I will go off those meds a couple days before the start and hope for the best. Not wanting to “pop,” I will start them again right away afterwards.

Doctors are people – flawed individuals for sure. Just like all of us. Some should really be doing something else. But, there are many good and very good doctors. Don’t accept one you do not like or do not trust. Find a good one. Ask around. They are out there and you can find one.

Also, do not accept your status as a very active person as a reason to never worry about your heart and blood chemistry. Get them checked. If you are like most people, you will be fine. If you are like me, get the medication you need and then you are sure you will be fine. If you decide to explore physical boundaries, be careful, but do not stop trying. 


"Badwater" Bill
Tujunga, CA

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