Tuesday, July 30, 2019

When calls the heart

When the heart calls, listen.

I should not have been surprised. And to be honest. I was not. But there I was in the doctor's office being shown the results of a Cardiac CT, a totally non-invasive screening test that looks for calcium deposits in the coronary arteries and aorta. My numbers indicated a high likelihood of coronary artery disease. Shoot.

Within days, I sat in another office, this time cardiology. I specifically picked Dr. Pete O'Brien
because as an outstanding runner himself, he understood runners. He listened carefully to my conundrum: Was my inability to get fit a result of a natural aging process or was there a cardiac issue? Let's pause so I can fill in the back story.

The last year and a half have been rough. Between a knee injury post the 2017 Mountain Masochist 50 Miler, caring for my father-in-law in our home during the final nine months of his life, and an unfortunate incident in February of 2019 that left me with a distal clavicle fracture and two scapular fractures, training has been difficult to say the least. Try as I might, it was just so hard. Yes, I know getting fit is supposed to be hard, but THIS hard?!?!? I kept having conversations with myself. Was I just playing out the age card that tells me I am supposed to be getting slower and wimpier? Or, was there something else, something more medically sinister in nature?

That something else was cardiac disease. Several years after a massive heart attack suffered while playing a championship tennis match, my father died post cardiac surgery and on an LVAD (left ventricular assist device) at the age of 62. I am currently that same age. My mother also has cardiac disease, earning herself a stent some years ago and now suffering with significant valvular disease at age 91. Many of the grandparents, aunts and uncles on both sides have died as a result of cardiac-related issues. My chances of escaping this ominous heritage is slim.

There have been a few runs in the last year or so when I felt somewhat normal. Not fast. But OK. Reasonable. However, on too many occasions to count, it just felt harder than it should have been despite my snail-like pace. I ran mostly by myself, avoided roads with traffic, and embraced night runs. I was embarrassed, quite frankly, with how pedestrian I had become and wished no one to see me slogging along. I know what it takes to get in shape but this seemed a bit ridiculous. I tried to be patient. "Just be glad you are moving," I would tell myself, even if it meant A LOT of walking. It was immensely frustrating.

The day before I saw Dr. O'Brien, I went for a short run through the woods. "Smooth and efficient. Just be present. Don't rush. Enjoy the cooler temps and lower humidity." But even on an extended downhill, it didn't feel right. When I began the trek back up the mountain to the car, my legs and arms felt very heavy. I had no chest pain per se, but did feel a tightening in my throat and up into my jaw. When I slowed down to a walk (which wasn't far from my "run" pace), things felt better. This pattern, that had become typical over the last 18 months, was repeated all the way back to the car.

"How do you feel about invasive procedures?" Dr. O'Brien quarried.

"YES!" Let's do the cath!" I was sick and tired of wondering if there was a cardiac issue. A cardiac cath would leave no doubt. If I was cardiac disease-free, I would chalk up my pitiful attempts at training to being older, but commit to do the best I could under the circumstances. If it was cardiac in nature, then there would either be an intervention in the cath lab or a trip down the hall to see my favorite cardiac surgeon. Either way, I was so happy that answers were forthcoming. Without hesitation, Dr. O'Brien scheduled me for his first case Monday morning. This was Friday. I couldn't help but think there was a degree of expediency to get this done.

In the aftermath of the visit, I glanced at my instruction papers. It was strange to see CAD listed as a new finding. I began to mull over contingency plans work-wise should I end up on a surgical table. That would really booger up plans for the scheduled August and September team retreats I was tasked to implement. And should I run in the meantime or not? Running is a way to clear my head. So, yes. I ran. Don't worry. I ran comfortably in the cooler darkness, only about 4 miles, and it was fine. Still, questions and possibilities swirled. Potential plans slowly evolved.

Arriving at the hospital at 6 a.m., I was quickly admitted to the unit, changed into a hospital gown, and prepped for the procedure. Having been a cardiovascular perfusionist for so many years, I spent a good amount of time in cath labs. They didn't scare me. In fact, I was looking forward to experiencing the whole process from a patient's perspective. In fact, for the first ten minutes in the cath lab, I had a grand time chatting it up with the nurses and techs. I noticed the circulating nurse loading a syringe into my IV line, immediately feeling a slight swoon. "What was that?" One CC of Versed had left it's mark. But I was still able to tell him that I wanted to be alert and watch everything. Well,
that didn't work out too well. Other than a few moments when I saw the guidewire across the lesion on the monitor, I remember nothing. Nada. Not the doctor coming in. Not any discussions I may have had or heard. Not any dye coursing it's way down the arteries. Nothing. That makes me sad.

I do not remember the procedure being over. I have no recollection of arriving back in my room. To me, it seemed like only 15 minutes had passed. I was shocked to know I was in the lab for over an hour and a half. Gary tells me I asked him the same questions a million times, suggesting a foreshadowing of my senility as an old woman. Supposedly, the doctor told Gary I was talking appropriately after the procedure when he explained all that he did in the lab. Dr. O'Brien also told Gary I may not remember that conversation. He was absolutely, unequivocally correct. I recall NOTHING. NONE. NADA.

Dr. O'Brien, the good doctor, later come to my room armed with his computer. This I do remember. For me, this was the first time I actually heard him explain that I had a long lesion in the mid-LAD. (The Left Anterior Descending is a major artery supplying a significant portion of the left ventricle. When blood flow is insufficient, that part of the heart dies.) Tests he did evaluating blood flow (IVUS and FFR, both state of the art technologies) led him to place a drug-eluting stent across the 60% stenosis, therefore increasing the diameter of the lumen and theoretically allowing sufficient blood flow to all left ventricular tissue feed by the LAD. A blood-fed heart is a happy heart. "Do you think this explains the way I felt when running?"

"Yes," came the confident reply. I felt relieved that my slogging was not imagined nor was it self-imposed. I was happy and hopeful that I would be able to get back to normal training without having to second-guess myself. He left the room, and I returned to asking Gary the same questions over and over.

And now in the aftermath, reality sets in. I am now a card-caring cardiac stentee. I am to carry this card at all times since having the stent may impact future treatments or procedures. I have a mesh tunnel inside a coronary artery. It's my personal tiny alien who has taken up residence. It's my forever buddy. Perhaps I should name it. Hum...Stanley Stent?
There is a treadmill stress test in my near future, followed by three months of cardiac rehab. I have a plethora of drugs that I must take. The stent is a foreign object in my body. Means need to be taken to prevent a clot from forming on the metal mesh. "Whatever you do, don't forget to daily take the Prasugrel! You will take this for at least a year, maybe a lifetime," explained my discharge nurse. My new normal has turned my kitchen counter into a satellite pharmacy. Maybe I should get those little multi-day pill boxes to keep myself straight.

But I am grateful. Grateful that I never had an actual heart attack or inflicted damage to my heart. Grateful that I had the screening cardiac CT. Grateful that I did not ignore that inner voice telling me that something was not right. Grateful for a cardiologist who took me seriously and refrained from-- and will never tell me--not to run. I am grateful there was an actual explanation--the blockage--for my inability to get race-fit. And, I am hopeful.

Hopeful to be able to train. Hopeful to be fit. Hopeful to embrace challenges rather than fear them. Hopeful to develop a third generation of "Shindigglers," young women who grow to love the mountain trails as much as I do. Hopeful to push the limits of what is possible. Hopeful to dream--and complete--great new adventures. Hopeful to run long, run strong...one day at a time.

Tuesday, April 23, 2019

I remember when

It had been awhile. Life - including a busted up shoulder - had gotten in the way of regular trips to the mountains. But with near perfect weather, the mountains called my name and I had to go.

It's not that today's ramblings were of epic proportions. It was probably no more than 11.5 miles, though fairly technical and rocky. But with sun shining, birds chirping, and pleasant temps, my solo venture was a welcome escape from normal day to day schedules. I was free to climb, free to go faster or slow down, free to lollygag to snap photos, free to scramble, free to think, free to figure, free to remember. But most of all, free to be me.

With my car parked at the end of a gravel road, I began the steady climb. How many times had I been there, done that? Too many to count. I remembered many January 1 "Kingdom runs" that had their beginnings and end at the same trail head. I recalled how I shared these beginning steps with neophyte trail runners, some of which were kids I was coaching. Usually, a half mile up we took the trail to the left to begin the loop. With gentle ups and down, ins and outs, and multiple stream crossings, it was a good way to ease into the run.

Circa 2014
Instead of making that turn to the left, today I forged straight ahead. "Straight ahead" meant three miles of steep, hard climbing, interrupted only by two short descents to be positioned for the next extended ascent.

I remember in former days doing repeats of this climb in an attempt to beat my body into submission; to become accustomed to climbing harder and then descending faster without regard to fear or failure.

I remember the rock garden, steep and difficult to climb, but even more challenging to descend. So many memories of snowy, icy, and wet and leaf-strewn conditions which rendered the downhill direction treacherous at best. Today I was glad for the slower, more controlled uphill direction.

Place where runner was on the ground
Ascending further, I remembered when the earliest version of the Terrapin Mountain race was run in the clockwise direction one year; the next in counter-clockwise direction. I remember running this section with Jonathan Basham, pushing hard to stay in front of the crowd, but managing to talk about time spent on the AT. I remember passing a runner who collapsed out of exhaustion halfway up the mountain. He was a road runner who apparently had little respect for what it took to conquer a couple thousand feet of ascent.

Some of my runners, 2014
Arriving at the rocks with a view, I pondered how many times I had stopped to take in the scenery. Across the way wound the Blue Ridge Parkway and the Appalachian Trail. Down below, the road through the valley had been my chosen path in many a training run or race. But the rocks themselves? It was a photo op for all the people I brought along with me in years past. The rocks were a place that encouraged a welcome break from the downhill quad pounding. And to be honest, those rocks were one of the first places I learned the art of peeing standing up, carefully noting wind direction to avoid a warm stream hitting my shoes. These were the best of times and the worst of times.

Entering Fat Man's Misery

Higher up the mountain I came across Fat Man's Misery, a narrow sliver between rocks that runners in the Terrapin Mountain races must pass through. But besides the passage during races, this place was a highlight of the time I took my high school distance runners on this loop. It was December. We had encountered thigh-deep snow higher on the mountain, with icicles dominating this hollowed out rock alcove. Those who failed to wear tights and ankle-covering socks, sported bloody ankles at this point, a result of breaking through the ice-covered snow. Still, I remember nothing but smiles; sweet, sweet smiles.

Rhodo tunnel
"One more knoll"
 I remember passing through the rhododendron tunnel many times when it was in full bloom, the white showy flowers marking a magical pathway. Unfortunately, today's journey preceded the flowery spectacle. But shortly after the traversing the tunnel, I glanced up to see the summit and the knoll that came before. Immediately, I could hear faint echos of David Horton quipping, "Just one more knoll until
the top," as if he thought his humor could ease the reality of far more climbing.

Circa 2010
I maneuvered out on the rocky ledge on the summit, something I had done countless times before. On this run, four buzzards startled me by rising gracefully from the treetops below to soar effortlessly overhead. I could not recall this ever happening. Still, as I gazed over at the valley and then to the "golfball" perched atop a neighboring mountain, I clearly remembered so many races and training runs through those hallowed grounds. Blazing hot, freezing cold, or somewhere in between. Some runs were with friends. Many I chose to venture solo. So much time spent. So many miles covered. So many memories made.

Today's overlook

This journey was in a counter-clockwise direction. I breathed a sigh of relief once I reached Camping Gap, glad that the technical and rocky trail off of the summit was behind me. I remember thinking about how happy I was during the counter-clockwise races to feel free to pick up speed on the next three downhill miles. And then as I ran further down this section of trail today, I clearly did NOT remember how rocky and crappy those miles actually were. Perhaps years of washouts have turned up more loose rock, or perhaps I merely suppressed the memory of the ankle-wrenching
Circa 2014
terrain. Nevertheless, I picked my way off the mountain, amazed at how fast the streams ran, overflowing normal boundaries and flooding the rough forest road. Though I plunged right through the water on this run, I remember so clearly times when my running partners and I tempted fate and the risk associated with crossing mid-stream rocks in an attempt to own dry feet.

Circa 2010; Successfully crossing Reeds Creek
Reed Creek was stampeding today, cascading over rocks and creating small whirlpools between the boulders. How many times had we posed for pictures at this same spot? Too many times to count. How many times did I rush across the stream in the other direction, anxious to complete the last mile and a half of the race? Lots. But today I did not rush. I put those impulses aside and carefully picked my way through the stream laced with algae-covered rock, bracing myself against the swiftly running water.

I clearly remember the four or five miles that wind along the front of the mountain. Up and down. In and out. Countless sweeping turns and shallow streams to cross. "Surely, I'm getting close." But alas, another up, another down, another twist, another turn. My memory served me well. But rather than feeling my

impatience in the past, today's travel along these miles made me smile. The temperature was perfect, the late afternoon
sun filtering through the newly budded trees. I owned the trail, sharing it only with an occasional squirrel taking advantage of his own outdoor playground. Ground flowers in a variety of colors and shapes seemed to nod as I passed by. I gleefully stomped through streams and admired the waterfalls. I was happy to run, happy to hike, happy to remember.

Arriving back at my car, I recognized that same satisfaction of finishing a journey as I experienced so many times over the last 25 years. I realized that despite what might come in the future, being able to remember what happened in the past is enough. I am grateful.

Thursday, February 28, 2019

When life comes crashing down

I glanced up just in time to contemplate what was about to happen. In the next nanosecond, my body felt like it had exploded when the 500 pounds of hardened steel crashed down on me. The pain was searing. I could not breath. I heard myself let out a guttural scream from within while I thought to myself, "Give it a second. You'll be alright."

But I wasn't alright. In a freak accident, the spotting rig of a trampoline used by the divers
unexpectedly crashed in the process of taking it down. I don't have clear recall about the ensuing moments, but the pain in my shoulder and back will be forever unforgettable. My vision was cloudy and voices seemed very far away. I was in a haze but curiously fascinated by the ever-expanding pool of bright red blood a foot away from me. Though my forearm was bleeding from a three-inch gash (a fact I was unaware of at the moment), I was confused by the steady red drip. Someone said it was coming from the head of the assistant dive coach. I remember wondering if he was still alive. (John did survive the glancing blow to his head, requiring but three stitches to seal the wound.)

Slouched on the floor with back now against the wall, I continued to come and go from reality. Someone was trying to butterfly together the wound on my arm. When I heard another say that EMS was on their way, my mind protested because I had planned to get in a lengthy trail run in the rare and warm sunshine. But alas, that was not going to happen. The pain in my left shoulder, forearm, and right rear flank gave my mind permission to concede defeat. My immediate future necessarily required transport to the hospital in the back of an ambulance.

Wheeled from the natatorium on a gurney and loaded through the back doors of the emergency vehicle, I began to spontaneously shiver, perhaps from the pain, perhaps from the shock of it all. Assessment of my status continued and IVs were started. For the most part, I squeezed my eyes shut tight, trying to get to that place deep inside where I could get a handle on the course of events. I began to settle in, although the substantial hit of morphine likely helped in that process.

There was something about being rolled through the hospital hallways that was disconcerting. I could only see the ceiling tiles wiz by, my head being held in position by a cervical collar. I didn't particularly like the whole scenario. It bordered on embarrassing. But soon enough, I was settled into an emergency department bay, hooked up to monitors and awaited the next steps.

Waiting with me was Chelsea, one of the swim coaches. I appreciated her willingness to take that ambulance ride with me and chat while we awaited the arrival of Gary, my husband. X-rays, CT scans and other assessments followed, along with more morphine. My laceration was closed, and news of a fractured shoulder delivered. I was released hours later to go home. Despite nausea and dizziness thwarting my effort to get out of the wheelchair and into the car, the journey home and into this new normal began.

A visit to orthopedics two days after the fact revealed not one, but three fractures; the distal clavicle and two fractures in the scapula. Complete healing will be, I learned, a lengthy process. Therefore, the immediate challenge was to figure out how to complete the simplest of tasks, such as securing my ponytail or tying my shoes.

It's been a week since the accident. Each day gets a little better and I am finding I can walk fast without much pain. In fact, it's possible I may occasionally break into a slow run test while holding my slinged arm tight. It's actually not too bad, and that is encouraging. Of course, lifting my arm is difficult and getting out of the deep claw-footed bathtub using just one arm is a problem yet to be solved. Dressing and undressing is also a challenge. Still, I can't be too upset. I am fully alive.

Had my head been two inches to the left, there is little doubt that February 19 would have been my last day on earth. I am not trying to be melodramatic or overstate the case. But it's the truth. A direct blow of 500 pounds to the head would not have been survivable.

Sometimes as I lay in bed, I see that rigging descend upon me. I cringe at the memory of the horrendous impact and the narrow margin between life and death. And then I think about the "what if's." What if the outcome would have been different? Would my last day have cemented a legacy of a life well-lived, or would it be left wanting?

I will heal, I have no doubt. But if this unfortunate accident has any value (and it clearly does), then I will be thankful for the reminder that each sunrise should be greeted with gratitude. Each day should be lived intentionally, righteously, and with purpose. It's pretty simple, really. "What does the Lord require of you? To act justly and to love mercy, and to walk humbly with your God." (Micah 6:8)

Oh help me, God, to live this way every day!

When calls the heart

When the heart calls, listen. I should not have been surprised. And to be honest. I was not. But there I was in the doctor's office be...