It's been one of those months...

I'm working on becoming a more interesting story. I've actually gotten some training done this month, but I've also had my share of ridiculous interruptions:

First, I had a root canal. You know when you say something is as bad as a root canal? It's not. Then, I had two teeth extracted (with bone grafts), and some gum surgery in the same area. That's as bad as a root canal, and then some. I had an ugly looking reaction to the antibiotic for that one, which really put a damper on things for a while.

Now, I've managed to fail a stress test, and the above looks pretty simple and silly compared to that. I have cardiac catheterization on Thursday here in Atlanta, and I'll know more then. Here's the whole story, in Q and A format:

Q: Why the stress test in the first place? Are you holding out on us?
A: The log from my July 21st 5K AT test run included "a breakfast repeat, and several minutes on the side of the road trying to decide whether I was dying (I wasn't)." I wasn't too worried, because it was a ridiculously hard run for me. My AT is 157 beats per minute or so, and I averaged over 170 for the first two miles before having the episode. However, Jen didn't like my symptoms there - chest constriction, dizziness, whiteout, near LOC, and more. She convinced me to go to a doc. He thought that I had enough risk factors besides the episode - my mom's shiny new pacemaker from April, my dad's addiction to Lipitor, the fact that all the men on my dad's side have been murdered 'Clue style' by their wives (Mrs. Berman. In the Kitchen. With the chopped liver.), and my own unkown cholesterol levels. He got me the stress test and ordered the lipids.

Q: How did you 'fail' the stress test?
A: I actually felt fine, and thought I had aced it. I got a thalium injection, and they took 'before' pictures. I did the Bruce protocol, and lasted 13 minutes, when 6 minutes is the pass/fail line. I had zero symptoms, and they stopped the test because they hit the target heart rate (also 157). The experience was much easier athletically than getting my AT testing done. The doc administering the test wouldn't tell me much, but the only EKG finding was increased T amplitude post-exercise, which is pretty normal. They took the second set of gamma pics of my heart, and I went about my day. I got a call from my doc a few hours later, who had gotten a call from radiology. I failed the second set of pictures.

Q: So what's wrong with you?
A: Dunno exactly. We know that, in the after pics, the bottom of my heart wasn't getting all the blood it needed. So, there's some ischemia (inadequate blood supply) in the area served by my right coronary artery. The fact that it only showed up in the after pictures means that there's no damage to my heart muscle itself from it, so it's called reversible ischemia (that also means that what happened on the 21st wasn't a heart attack, just a transient event). The most common cause is plaque build up in one or more of the branches of the artery. My lipid panel came back the same day, and my cholesterol is not so hot. My HDL is an athlete-worthy 61, but my LDL is out of control, despite the wee bit of exercise I do. That also leads the doc to think that plaque is the likely culprit, and he got me some lipitor to start last night. Other options would be vasospasm, a dissection of the artery itself, electrical problems leading to inadequate efficiency, and a few other options less likely. Tomorrow's catheterization will answer most of the questions.

Q: What are they going to do?
A: Cardiac catheterization is a really routine procedure, where they'll stick a long catheter from my femoral artery (thigh) up to the back side of my heart, where the arteries feed it. They'll fill the left side of my heart with more dye, so they can find their way around and measure flow. They'll check each branch for constricted flow or other fun. If there's constriction from plaque, but the arteries are less than 50% occluded, they'll likely just pull the thing back out of my thigh and tell me to keep my nitroglycerin handy and stay on aspirin and lipitor. If there are more occluded arteries, they'll inflate a balloon at the end of the cath to open the blocked artery (angioplasty), and leave a stent there to prop the artery open. If it's really occluded, or affects multiple arteries, they'll stop and I'll get a bypass ('cabbage' to docs, because it's a Coronary Artery Bypass Graft). Everyone thinks this is really unlikely in my case. If there's something else going on, they have a good chance of seeing it because the cath is first and foremost an imaging exercise to see all the arteries themselves, and the heart pumping. If they need to, they can dilate or constrict the arteries chemically to test my body's reaction. I'll be given amnesiac conscious sedation (yum, versed) so I'll be calm, and won't remember anything afterwards.

Q: Really, what are the IM chances?
A: Dunno, but I'm going to say very good. If they just pull out the cath because there's only minor plaque constriction, then I'm out of the hospital Thursday night, and I have a good shot at going back to training in a week. Can I finish missing a week in peak? I don't know, but I can try. If another scenario happens, like angio, or something more invasive to solve another problem, then there are just too many variables to know now. One day at a time.

Q: Silver lining?
A: Lots. My cardiologist and my beautiful wife agree that triathlon generally, and iroman specifically, probably kept me from having a heart attack. Without the training, I never would have stressed my heart out enough for symptoms before things had gotten much worse. Heck, I was even wearing my fancy new garmin heart rate monitor on the 21st, and I went over it line by line with my cardiologist yesterday (there are a couple 'holes' in the recording, which may be fibrillation, weak beats, or something else - very, very interesting with hindsight). Also, my overall good fitness will make the procedure much, much easier in the cardiologists' view. Finally, I probably wouldn't have even gotten my cholesterol checked. I'm a non-overweight non-smoker who exercises more than ten hours a week. In the 200+ hours I've worked out since March, I only had the five minutes or so of symptoms in that one 5K.

I'm doing okay, scared but not terrified. Jen's going to be there all day with me tomorrow, and that helps a lot. I love my wife. She continues to be my hero, holding my hand and answering my million questions. I'm still scared and a little blown away that, given my exercise, diet and general studliness, I have ischemia at all. However, with her by my side, I know that this isn't that big a deal, that a million people in America have been cathed, and that it's something we are likely not even to be thinking any more about in a month. She's not scared, so I'm sucking onto her strength for a few days.