This was the start of one of the most difficult periods I have ever gone through in my life. It all started with just coming off of the Ironman 70.3 World Championships where I had just had an epic race and a mountaintop experience. Within the triathlon world, an older well-known pro (Tim O'Donnell) had recently had a heart attack during a race. He finished the race but went to the hospital shortly after finishing, where he underwent some emergency procedures to address his issues. This started conversations within he Triathlon forums about how could this have happened and what do we need to do as aging athletes to make sure we aren't next to have a heart attack? We all think we are all healthy because we compete and race at high levels, but how do we know that's true? The consensus approach, from several people in the medical field that also race, was that the best thing you can do is to go get a CT heart scan (CAC test) to give you a Calcium Scoring. This gives you like a quick and dirty assessment of your heart health.
Given it was the offseason, I spoke to my Primary Care doctor about getting this done just as a preventative measure and she was a bit skeptical given my health but agreed to prescribe it. So, at the end of October, I had the scan and it came back with a Calcium score of 54 which put me in the 90th percentile for calcium burden for my age/sex! I received the follow up call from my doctor and she was shocked. She referred me to meet with a local heart specialist the next week to better address the issues. At the heart appointment, we reviewed the back story and then I completed a Treadmill Stress Test which shows how my heart performs under stress. I completed the test, and because I was just coming off peak fitness with Ironman races, I did quite well. However, my heart showed that under stress (i.e. exercise) my heart shows significant signs of distress. More specifically, at higher exercise levels and measuring with a 12-lead EKG, my ST segment shows > 2mm depression which is indicative of myocardial ischemia. The doctor came back in the room and shared the results of the test and things started to get a bit more serious. She recommended that I stop all exercise, she put me on several medications: 81 mg Aspirin - which acts as a blood thinner and Atorvastatin - which lowers cholesterol (though my cholesterol as always been fairly low) and we scheduled several more diagnostic tests including a CT Angiogram with Contrast and a Cardiac Ultrasound. She also had me start on a super strict ultra-low sodium diet. Both of the diagnostic tests were three to four weeks out based on hospital scheduling and the ultra-low sodium diet was almost immediately an eye-opening experience. Needless to say, I was freaked out! Was I going to walk down the street next week and die of a heart attack or what? I haven't dealt with heart issues before and I went into this whole expedition just thinking it was going to show that I was just fine. While waiting to figure out more, I started the medicines and waited for the next set of tests. I also bought a blood pressure cuff and pulse ox monitor just to continue to better understand what may or may not be going on with my body.
Fast forward about a week or two and the above happens. I was driving home from work and sitting at a stop light, and someone crashed into the back of my car at a light near Pecos and 58th. To make matters worse, I stumble out of the car to check what happened and the person slams it in reverse to back away from my car and peels out around me and the car and takes off! I tried to grab my phone but was a bit disoriented and all I could do was yell at them to stop and then I just broke down in tears. The fact that it was my new car of about six months was disturbing enough, but I couldn't understand why someone would hit someone and take off without understanding if the people they hit are alright or not. I phoned the police, who responded fairly quickly, and they took down all of the details but there wasn't that much they could do as I noticed while they were speeding away that the car didn't have a license plate. In the end, the car was mostly fine but had to get repaired and no immediate damage, outside of some general soreness to my body, was apparent.
However, that led to the next big part of the story. A day or two later, I was alone at our house and my heart was just pounding. I took my blood pressure a few times and my blood pressure just kept rising and rising. Normally, I have fairly standard/low pressures (e.g. ~118/76) but I was watching it climb up to 160-170/135. I couldn't explain why it was happening, but I was starting to feel like I was having chest pain and having these measurable stats that were super abnormal. So, after a few hours of trying to talk myself in and out of what to do, I drove myself to the ER to get it checked out. What is nice is that when you show up with a heart complaint you get triaged/seen right away, which is great, but after that I had to wait in the waiting room for another 30 minutes or so. In hindsight, that was probably because they didn't see anything that concerning. Ultimately, they took me back and validated the high BP but other markers (e.g. Troponin I) of cardiac distress were not present which meant that I wasn't having a heart attack. They kept me or several hours while giving me some aspirin and rehydrating me and finally released me when my vitals were more within standard ranges for me.
My heart doctor and I spoke after the ER trip, and she prescribed two additional medicines: a beta-blocker and some other drug to address the high blood pressure. I started taking these but almost immediately they just wrecked my world. I felt like I was out of my mind and started having all sorts of other symptoms like vertigo, nausea, and just a general brain fog. I stopped taking the beta-blocker but kept on the blood pressure medicine. This seemed to help overall, but I spent the next two weeks trying to convince my doctor I didn't have high blood pressure and should stop the blood pressure medicine too. This was a discussion that continued for several more months and eventually I started taking my blood pressure four to five times a day and plotted it out on a graph to try to demonstrate that I was fine.
The next two weeks would prove to be very challenging as I started to also develop insomnia and have panic attacks and had a very real fear of just being left alone at any time. I was scared that I might die and that nobody would be around to call for help. In retrospect, again, one redemptive part of this story was that it brought Tara and I closer than we had been in quite a long time. I was in such a place in need, that I had no choice but to lean into her support and comfort as we walked through things. She was absolutely fantastic and prayed and cared for me around the clock. She also had to help the kids understand what was going on with me when we didn't even know ourselves. Two weeks later I went through the next set of diagnostic tests which had some mixed results. The CT scan with Contrast showed that the calcium build-up that I had was non-obstructive and was less than 25% stenosis of the main artery in my heart and showed the Calcium Score was more accurately 42 (down from 54). This was good news! The Ultrasound showed that I had Stage 3 Diastolic Dysfunction which was something related to the hardening of tissues within the heart. This was not good news!
Once again, I met with my heart doctor to discuss the results of these tests and continued to feel like I was being treated as some sort of 80 year-old obese patient and not a 40 year-old competitive triathlete. I just wasn't getting the answers I needed, and things didn't make sense with how it all fit together. I realized I needed to get better answers and change things up, so I reached out to the original person in the story that started this whole saga, Tim O'Donnell, and found out who was providing his treatment. It turns out he was using a small group of Sports Cardiologists out of Massachusetts General Hospital (MGH) that work with professional athletes with heart issues. This was Dr. Baggish's practice. I immediately reached out to the group and was able to schedule a consultation (in Boston) with the group in the beginning of February. As expected, it would turn out to be a long hard two months until the appointment there, but the story will continue in a future post...
