Cardiac/ Pulmonary Trouble with No Luck (Read 66 times)

Hello.

I am a collegiate runner in my Junior year and I have been running competitively since middle school, but also I ran a lot in my childhood because my dad was also a big runner. Basically, it's not like I am new to running.

But I have run into a health problem that has stumped me. Towards the end of February, during Spring Break and before Covid, I was gearing up for outdoor track and running some of my highest mileage yet, around 64 miles a week and rising. I had also run my first 20 mile run and was feeling good. I usually ran six days a week with one off day. But, around March, I started running into chronic calf-tightness, which I had experienced before, and which made me calm down my running a lot. I'm pretty sure I was just over-exercising without enough rest. So I ramped down my running and had to take time off. Gradually, the calf tightness went away. But something else reared its head then, something I hadn't experienced before. Gradually I began to run into breathing and heart rate issues. Before I had been able to run 10 miles or however much easily and without much strain. Now, I was barely able to run 3 miles without my heart rate getting up into the 160's-170's, which was crazy. For example, on my 20 mile run, which was at 7:44 pace average, my heart rate averaged 149 bpm. Now, I can't barely run at 8:00 pace without getting extremely worn out, with my heart rate averaging in the 160's even on slow runs. It's like I go anaerobic, except way too quickly. I also have trouble breathing.

So I went to the doctor to get it checked out. I took a spirometer, a blood test, a heart echo, as well as having doctor's listen to my heart,and they found no issues. Nothing came back abnormally. My diet hasn't changed, an inhaler didn't help, and neither does time off. I am still going to see a pulmonologist, but at this point I am at a loss. I am running around 5 miles a day, with a day off, but it is still incredibly difficult to run at all. So, while I was logging my runs (my xc team does that through this), I thought I would throw this out there. Sorry if it is too long, but I might as well shout however long I want into the void, since that is the point I am at now.

Ditto on the second opinion.

If you were a new runner, I might also attribute to heat/humidity.  But....it sounds like you are experienced enough to know how to adjust for the summer, and I'm assuming (possibly wrongly) that you haven't moved recently.

I would ditto a second opinion.  Even though the inhaler is not making a difference, I'd still see the pulmonologist.   When my asthma is bad, I can suck on an inhaler all day and it doesn't accomplish anything.

When you do, make sure to get the full bronchodilator test.

There are three steps to that test - a) They have you breathe into a machine and record your values; b) they give you a big dose of albuterol; c) they have you breath into a machine again and record your values.  A big improvement in the values between a) and c) indicates asthma.

Problem is, if your values meet or exceed certain value (determined by the population norm) on the first test, they often stop it there, and don't complete the challenge - reasoning that if your values are that good, you must be fine.  However, as runners our lung capacities are well above the population norm, and we can be quite restricted and still hit the population norm.  Without asthma meds I test just ever so slightly below the population norm for women my age and height (keep in mind that most women my age are sedentary).  But give me a big dose of albuterol to open stuff up, and I show an improvement of 35% in lung capacity (and I feel a heck of a lot better).

So....ask for the full test, even if they tell you you're fine after the initial part.

Also....in my experience, it's better to work with an allergist who specializes in asthma issues than a pulmonologist.  The reason is, pulmonologists see patients all day who are REALLY sick - COPD patients on portable oxygen, etc.  Tell a pulmonologist that you can only run 5 miles every other day, and they'll tell you that's wonderful and you're doing great.   Allergists tend to see more relatively healthy people, and so are more likely to respect your concerns.  So....if you feel like the pulmonologist blew you off, go see an allergist with a specialty in asthma.

Other avenues besides asthma to pursue -  what is your ferritin?  What is "normal" for ferritin can actually be way too low for runners.  Here's some reading.

If after looking into those points you still have no answers, it might be worth a consultation with a rheumatologist - they can be very good at figuring out weird and unusual stuff.

Also...a question one has to consider in these times...have you been tested for Covid 19?  If not, I would definitely get that done as well, in case this is an example of a case with mild symptoms.

I second the suggestion that you look at ferritin as well. Runners frequently have issues with low iron stores and it makes a huge difference in your ability to run. Breathing becomes more difficult and speed goes down.

1)  Get a second opinion.

2)  Are you absolutely sure you weren't pushing too much and over-training?  Over-training syndrome is a very real thing.  It causes your body to react to training stresses in exactly the opposite way it should.  It can indeed lead to abnormally high heart rate on runs, decreased stamina, much of what you are experiencing.  And time off doesn't help.  You need like a 6-month stoppage in training to reset your endocrine system.  Been there, done that.

3)  Take a harder look at all numbers related to iron and red blood cells.  Back in grad school I had similar issues.  I'd had a really good training cycle but over-did it at the end and fizzled out.  For the next 2 years I'd have moments of brilliance, but for the most part, I was frustrated and could not perform consistently at the level I should have been.  I went to several doctors who all said nothing was wrong.  But after several blood tests and demanding more detailed ones I finally realized that all of my RBC and iron related numbers were on the low end of normal.  I questioned a doc if I was possibly anemic and his exact words were "if you were anemic you would barely be able to walk in the door."  To this I replied, "I'm not an average patient, I'm a competitive runner.  Do you not consider that these tests may mean different things in these two types of people?"  He seemed like he hadn't considered this.  Which wouldn't have necessarily been a surprise, except he was the team doctor for a Division I track team.  I went on liquid iron supplements and it might has well have been EPO, in 6 months I was demolishing my PRs as several years of unrealized training gains bore fruit.

Take a hard look at your iron numbers.  If your ferretin numbers are anywhere on the low end of normal you should consult a doctor about supplementing.  That could be a sign of long-term pressure on your iron supplies and inability to keep up.

I don't think I was pushing myself any more than normal. I was running higher mileage, but that was with no workouts and only a little bit higher than what I'd normally be doing in track season. I'll definitely look at the numbers myself, thanks for the advice.

1)  Get a second opinion.

2)  Are you absolutely sure you weren't pushing too much and over-training?  Over-training syndrome is a very real thing.  It causes your body to react to training stresses in exactly the opposite way it should.  It can indeed lead to abnormally high heart rate on runs, decreased stamina, much of what you are experiencing.  And time off doesn't help.  You need like a 6-month stoppage in training to reset your endocrine system.  Been there, done that.

3)  Take a harder look at all numbers related to iron and red blood cells.  Back in grad school I had similar issues.  I'd had a really good training cycle but over-did it at the end and fizzled out.  For the next 2 years I'd have moments of brilliance, but for the most part, I was frustrated and could not perform consistently at the level I should have been.  I went to several doctors who all said nothing was wrong.  But after several blood tests and demanding more detailed ones I finally realized that all of my RBC and iron related numbers were on the low end of normal.  I questioned a doc if I was possibly anemic and his exact words were "if you were anemic you would barely be able to walk in the door."  To this I replied, "I'm not an average patient, I'm a competitive runner.  Do you not consider that these tests may mean different things in these two types of people?"  He seemed like he hadn't considered this.  Which wouldn't have necessarily been a surprise, except he was the team doctor for a Division I track team.  I went on liquid iron supplements and it might has well have been EPO, in 6 months I was demolishing my PRs as several years of unrealized training gains bore fruit.

 

Take a hard look at your iron numbers.  If your ferretin numbers are anywhere on the low end of normal you should consult a doctor about supplementing.  That could be a sign of long-term pressure on your iron supplies and inability to keep up.

I usually suffer in the summer and definitely prefer the winter, but I have never experienced anything like this, so I am not so sure.

I would get a second opinion.

 

It could also be the usual beat down we all get from the summer heat and humidity.