My appointment was scheduled for 8 am in the morning. It was raining for the walk down to the Hospital, but that is better than snowing at least! It was about 15-20 minutes, and we grabbed a few snacks on the way to tide us over until after the appointment.
I didn't quite know what to expect when we arrived. There were still significant COVID protocols, so we each had to go through a screening and get guest passes to go in. We made our way up to Cardiovascular Performance Program offices and after a brief check in, we were moved back into an office to wait to meet our doctor: Dr. Timothy Churchill. A quick knock on the door and Dr. Churchill came in with two other doctors that worked within the practice. After some brief introductions, we proceeded to spend the next hour and a half detailing out my history of how this all started, the tests performed over the past few months, the medicines I had been placed on, and the diagnoses that I had been given. We also covered what their practice does/specializes in and even Dr. Churchill's personal experience as a distance runner. They were excellent listeners, took copious notes, and occasionally interrupted to ask clarifying questions. Toward the end of this initial discussion, he simply asked: What are you looking for out of this appointment/trip? I think it all boiled down to the following things: 1) Am I going to die walking down the street next week? 2) Are all of these diet changes and meds necessary? and 3) Will I ever be able to compete/race again?
They assured me that they would be able to answer all of these questions for me, but first we needed to repeat my 12-lead EKG stress test, only this time it would be run by their technicians (this was pre-planned) so that they could see first-hand what was happening with my heart. We went a few doors down to get ready for the test. The room was covered in jerseys and pictures of professional and Olympic athletes that had been seen there previously. I had the choice between doing the test on a treadmill or a bike...and I obviously chose the bike. I also got to all these nifty leads stuck all over my chest and then it was finally time to get the party started. One fear I had in pushing this again, was that I was still under advisement not to push my heart over Z2 (easy pace) from the previous doctor but obviously these guys were monitoring me.
This is the picture Tara took during the test which only lasted about 10-15 minutes total. Overall, I thought it went well but I wouldn't know for sure until we met with the doctor again. After a quick change, we went back to the other room to wait for the doctors again. After they joined us again, it was time to get some answers and we spent the next hour or more going through everything.
To start from the top and paraphrase a bit, Dr. Churchill said that I was dealing with a relatively long-term heart issue that can be managed. Outside of an unforeseen issue arising, there was no immediate significant risk that I was under. He explained that for reasons unknown to doctors, endurance athletes build up calcium within their hearts at a higher rate than the normal population. He even remarked that if my whole team had undergone the same Calcium test, many of them would have likely had some sort of similar condition. There is some inherent risk in racing half Ironman distance races as I get older, but that is more of a general heightened risk than anything specific to me. This was the first big sigh of relief from the day for me and immediately made me feel like so much fear and weight were lifted off my shoulders.
In looking at some of the prior interpretations of test results and medications, he confirmed that the Calcium build up that I did have was not obstructing the artery in my heart. The best long-term strategy to mitigate the risk is to continue with the Atorvastatin (to reduce cholesterol) and the daily Aspirin (blood thinner). My bad cholesterol was sitting at something like 80, but he would like to see it down below 40. Any other medications (related to blood pressure issues) were unnecessary and he didn't see any reason to continue with those. This all made good sense to me, so no objections outside of seeing how my body continued to tolerate the Statins. He also immediately dismissed the low-sodium diet as something that would provide very little benefit, as my blood pressure (anxiety attacks aside) was quite normal. He also dismissed the 3rd degree diastolic disfunction diagnosis, saying that what I have is very typical thickening of the walls of the heart that is seen in endurance athletes. There was no reason to worry about this area which also put down another area I was worried about.
Here is where things started to get interesting, though. In performing a second stress test, my first results from Colorado were confirmed in that my heart was still continuing to show significant duress (>2 mm ST segment depression) under exercise. Technically, this is a test fail. At the time, his only explanation was that for a very small segment of the population their hearts show this electrical duress, but it doesn't actually mean that the heart is in trouble. This was a bit harder to fully comprehend, but a few weeks later he said that my case was reviewed by the larger practice (in a group session of interesting cases) and there was one study that had been completed that showed clinical evidence of this theory. This made him feel better, as well, as he had some solid research behind his explanation.
The last major questions were regarding if I could train and race again. Dr. Churchill said that there I could resume training, but also cautioned that prolonged high-intensity training did carry an inertly higher level of risk than what is recommended. Taken with some cautioned words, this was the general alignment that I could start to train again and see how it went. The end goal would be to race again, but I have had so many issues over the last few months that I knew it wouldn't be easy to face my anxiety and fears and toe the line again. A realization that was both exciting and frightening at the same time.
To wrap this up, I think we were at the hospital for almost five hours working with a team of three impressive doctors. This was the single best experience at a hospital that I have ever had. I just really felt understood and heard. I also was able to answer every question that I had come in with and for the first time I felt like I knew what I was dealing with. So thankful for all of their time!
After spending so much time there, we were starving so we changed back at the hotel room and then ventured out to find some food and explore more of the city. We ended up at this place in Little Italy on the north side of the city. It only sat like five or six tables, but we were able to sneak in and the food was amazing! This was my Bolognese dish that was out of this world. I think I might have a problem if we were around places to eat like this all the time.
