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Need a Doctor in the LA/SD area who specializes in Endurance Athletes...
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Title says it all but I know some of y'all will want more details so...

About 6 weeks ago I started having a few symptoms and I didn't put them together at first. I was recovering very slowly from workouts and could no longer do back to back workouts like my schedule sometimes calls for. I'm a 5k runner so these would be things like 5x1M @5:30 w/ 60s rest on Wednesday followed by 6x1000m @ 3:10-12 w/ 400-600m recovery on Thursday.

I started noticing I was getting a few headaches and dizzy upon standing up kind of things eventually. Then the kicker came when I started to not be able to breathe very normally while running. Every now and then a breath would not feel full. In the middle of these symptoms though I did drop a 1:15:50 half during a tempo run but the breathing was becoming an issue during it.

Fast forward to like a week or two later I was racing a 5k and probably should've been around 15:40-15:50 and by 1.5m I was totally sucking for air. Big gasps that just felt empty. I decided to take a day off for the first time in a while and then on Monday I went for an 11 miler. I was doing like 6:50's when around 5 miles I had to stop and just wait a minute to catch my breath. Each subsequent mile I had to stop again and catch my breath. That was 3 weeks ago, since then I've kind of had nonstop pressure on my chest and shortness of breath. I finally decided to run again friday but even 5m at 6:45 immediately made me sore for two days.

I finally saw a GP and had bloodwork done. Iron and what not was all good, thyroid was all good. But my EKG showed some heart block. Saw an electrophysiologist and did a stress test and I didn't drop any beats though while running, only while very relaxed which he was okay with. My ECG also looked good.

So here I am no thyroid issues, no iron anemia, nothing crazy wrong with my heart yet i've shortness of breath, tight chest, I yawn incessantly, and my muscles get sore so damn easy. I mean, I can literally lay down and flex my muscles and it'll go into a charlie horse.

I'm young, fit, eat well, do not drink (soda or alcohol), do not smoke, and I opted to get back on a multivitamin a week ago just to be safe and added magnesium to that.

Thus I'm in the market for a doctor in the LA/SD area (very willing to drive a good ways) who has worked with very fit endurance athletes who can shed more insight than a GP.

I'd strongly prefer the doctor to have experience with high mileage/quick athletes. Given there are so many pro triathletes/runners and college triathletes/runners around LA/SD, I figure there has got to be a doctor or five who will be able to help me.

Thank you so much!

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Last edited by: justarunner: Jul 13, 15 16:38
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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While I can't say that he specializes in endurance athletes, my EP doc is Navinder Sawhney in San Diego. I REALLY like his calm demeanor, he is very thorough and attentive, unlike other cardio/EPs I've seen. He did my ablation for atrial fibrillation last year and is usually at his Palomar hospital office although he goes to Poway on Mondays. My wife would recommend Dr. Charles Athill with Sharp in San Diego - he is an EP specialist and did her pacemaker implant last year after Stephen Higgins at Scripps La Jolla botched her ablation resulting in complete heart block (so obviously, we'd recommend NOT going to him!). Dr. Athill is super conservative and also extremely thorough (his father died from complications from afib, so he takes it personally). He has also been in practice longer than Dr. Sawhney so has likely seen more cases and more variety.

John Rogers at Scripps Green Hospital is also a great guy (not EP specialty) that you'd probably like. Doug Gibson is the main EP guy at Scripps Green, and is not recommended by my cousin who operated with him on numerous occasions as a cardiac OR nurse.

Hope this helps.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Endurance athlete and unexplained SOB I think of a possible pulmonary embolism. I'm not nearly as fast as you but other than the muscle issues that was me 6 years ago. Could not get a full breath all the time. Felt like aomeone was squeezing the lungs. Went to 3 specialists over 6 weeks including a pulmonologist who all failed to dx it. Have them run a d dimer blood test as an initial screen. But I would not fuck around with SOB without a known cause.
Last edited by: ChrisM: Jul 13, 15 18:27
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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How is your heart rate during those episodes? I wonder if exercise induced asthma would explain it. LA is my home town I'll see if any of my old training buddies know anyone.

“Bloom wherever you are planted"
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ChrisM] [ In reply to ]
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ChrisM wrote:
Endurance athlete and unexplained SOB I think of a possible pulmonary embolism. I'm not nearly as fast as you but other than the muscle issues that was me 6 years ago. Could not get a full breath all the time. Felt like aomeone was squeezing the lungs. Went to 3 specialists over 6 weeks including a pulmonologist who all failed to dx it. Have them run a d dimer blood test as an initial screen. But I would not fuck around with SOB without a known cause.

good call. also to OP did they run a CPK on you to check muscle enzymes? that doesn't really fit with the PE picture but i didn't sleep in a Holiday Inn last night (i think that's how it goes?).

http://harvestmoon6.blogspot.com


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ChrisM] [ In reply to ]
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ChrisM wrote:
Endurance athlete and unexplained SOB I think of a possible pulmonary embolism. I'm not nearly as fast as you but other than the muscle issues that was me 6 years ago. Could not get a full breath all the time. Felt like aomeone was squeezing the lungs. Went to 3 specialists over 6 weeks including a pulmonologist who all failed to dx it. Have them run a d dimer blood test as an initial screen. But I would not fuck around with SOB without a known cause.

+1. Not sure you need to see an EP or a sports medicine MD specifically. I would consider returning to your primary care doctor and seeing whether he has additional investigations, especially if that would mean you would be seen sooner. SOB is a common complaint and it doesn't seem like it has been fully worked up. Are you tachycardic or wheezy during an episode? Leg swelling? Family history of clotting disorders? Did you have a chest x-ray? Has the SOB gotten worse? Is the pain reproducible by touching a part of your chest? etc etc. It would be reasonable to get more history, some more lab tests, a chest x-ray, and consider further testing or referrals. Sometimes a generalist is the best MD for a general complaint (and I say that as a specialist).
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Agree with the above; you should be checked for a pulmonary embolism. D-dimer would be a start, although further diagnostics are necessary. Be aware that doctors tend to blow off the possibility of blood clots in athletes, when in fact the risk seems to be raised. If you have any leg pain, especially calf, along with your shortness of breath, you need to really be insistent that you be checked for a DVT/PE ASAP. Unrelated to a potential clot (I think), did your blood work include sodium, potassium, and magnesium levels?

If you're looking for a cardiologist, David Cannom in Los Angeles is really good and is known for his work with athletes. He's been around a long time and really knows his stuff, and is on top of latest research and innovations. He would definitely know what to look for heart-wise; I suspect that he would also recognize the possibility of a PE, even though that's not his specialty area.
Last edited by: HeidiC: Jul 13, 15 21:26
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [HeidiC] [ In reply to ]
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If you're looking for a cardiologist, David Cannom in Los Angeles is really good and is known for his work with athletes. He's been around a long time and really knows his stuff, and is on top of latest research and innovations. He would definitely know what to look for heart-wise; I suspect that he would also recognize the possibility of a PE, even though that's not his specialty area. //

This is my doctor and he is very good with the heart stuff. And there are many possibilities, but you said you had some heart block, and that could be it. Most often when you go to get it checked, it will be fine, that was my experience. All your breathing difficulties could just be from going through the block during racing and training, that is what happens when your heart stops, you gasp for breath. Has nothing to do with your lungs, just the lack of oxygen getting to them. And it is not ;ike a heart attack or something you feel, in fact it is painless if electrical. that is what mine was, and i just thought i was getting sick or the flu. But luckily i used a HR monitor very regular, and i noticed very funny readings every time i felt funny, so went to the ER room. They could find nothing, then another night later rushed back in, and nothing again.


Not until i put on a 24 hour halter monitor did they find the long blocks i was having. Sometimes for 20 seconds. People usually pass out when it happens this long, but as endurance athletes, we walk around for a very long time before we actually pass out. Our brains are trained to go without oxygen a lot longer than the average person walking around, so we often take longer to get diagnosed with heart block. Once they read the monitor, it was emergency pacemaker surgery, they felt very stupid to have sent me home twice in my condition, 3rd degree heart block it was.


Try and get into see Dr Cannom, he is downtown LA at LA Cardiology. He is a very busy guy, as he travels and teaches a lot too. But there are some other very good docs there, some even very good runners and triathletes, so I trust them a lot more. Plus i have taught them a lot about this problem and its association with elite endurance athletes, so the have that knowledge from me being the guinea pig. I even put Greg Welch on to him during his problem time, but i think his insurance did not cover it with him, or some other problem. But he had a lot to say about the bad care he had gotten up til then from his other docs.


If it is indeed heart block, there are many ways you can proceed, and several will let you still race, even with a pacemaker(like i have). Get it sorted out and PM me if you have any other questions and concerns. It can be a scary time, but information can really make it go easier, wish I had someone to talk to when i went through all that crap. Could have saved me a few gray hairs, and many years of worry and inactivity.

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Was not expecting such well thought out answers (nothing against any of y'all!).

So let me expand upon a few of the questions.

My initial labs tested the following,

Iron and TIBC
Creatine Kinase,Total,Serum
Aldolase
Ferritin, Serum
CBC With Differential/Platelet
C-Reactive Protein, Quant
Comp. Metabolic Panel (14)
TSH reflex to T4F

Per my GP, the numbers for all of those came back good. Nothing in any of the tests were outside the normal ranges.

Starting from the first real episode of strong gasping during that 5k 23 days ago, the 11 miler two days later (21 days ago) was the worst thing to date workout wise. I felt like I just couldn't continue to breath while I ran. Beginning that night immediately following the run began the constant pressure on my chest and shortness of breath. It set in during the 11 miler and has not left since. It's been worse at times where I almost wanted to have panic attacks due to the SOB and then there have been days where it's been better and I will feel like I can breathe freely most of the day. When it does get bad I try hard to relax physically and mentally and assure myself I'm breathing fine (even if i'm not, telling myself i'm not would cause me to panic). I would like to add though that I do not recall swelling or pain in the lower extremities, symptoms i'm assuming would be linked to DVT. I just remember that I started the 11 mile run feeling good and fresh so I decided press the pace a bit given that it was supposed to be an easier day and I suddenly found myself awfully short of breath.

I have run twice during all of this and that was this past friday and Saturday. Friday's run was a 5.1 miler which I did around 6:45 pace. It left my calfs quite sore and I definitely felt tightness in the chest and SOB throughout the run.

Saturday I decided to run another 5 miler and this time fished out my HR monitor. I kept the run at an AHR of 160 and I was able to do 7:20 at that HR with 250' of total climbing. The run felt a bit better than the day before but to be fair, Saturday/Sunday were to of my best breathing days to date. They preceded today which was not my worst breathing day but not my best either.

The muscle soreness has just continued to be a problem and the fact that as I type this I can lock a handful of muscles in my legs into charlie horses is a huge problem. It's limiting my ability to really go hard.

My first EKG which was taken 18 days ago showed heart block while at rest. My EKG/Stress Test today showed no heart block while at elevated heart rates. But when I was resting and the doctor wasn't in the room I spotted two heart blocks within like 5 beats of one another on the machine (i'm not a doctor but I can definitely spot a heart block occur when there's a massive flat line from the time the upper chamber beats to the lower chamber beats or doesn't beat at all). I mentioned those to the EP and he wasn't overly concerned about them since I was very calm and resting. My resting heart rate at the time that occurred was 38. I assume it probably gets lower than that when I'm truly at rest and undisturbed and perhaps sleeping.

As I sit here and type this I have SOB and just yawned to increase the oxygen intake. It's one of the sure fire ways I can relax is to force a yawn. I've NEVER yawned this much in my entire life. Whether I sleep 4 hours or 10 hours, I will wake up and just begin to yawn.

As for family history, my father's ailments in life have only ever been the result of his athletic endeavours, my mother however has had numerous medical problems and has definitely had many blood clots although i'm unsure if they're byproducts of medicines she's been on for the numerous surgeries she's had. I can ask her tomorrow but I do believe a few of them have occurred on their own out of the blue.

For now...

I continue to eat like a normal human being and try to keep it well rounded, I take a multivitamin every day alongside a magnesium supplement and two iron pills which get me to about 130 mg of elemental iron per day in supplements. I sleep roughly 6.5-8 hours/night and work behind a desk mostly.

So as for what y'all have said, it seems like it might be good to press my GP to take another blood sample and to the D-Dimer test and possibly a few others?

Also, I will look into the Cardiologist in Downtown LA, seems like he's got a reputable clientele.

Thank you so much in advance, this has been extremely mentally tiring. We're all type A athletes and so to be sidelined for 3 weeks has crushed me. I had plans to travel to Oregon to break my 5000 PR in August and that's been nixed for now. Still have a half marathon planned in October but it's quickly becoming something I may just trot through and not race at this point.

Thanks again!

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Last edited by: justarunner: Jul 13, 15 23:44
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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I'm not a doc and am admittedly particularly sensitive to them having had two episodes, and know nothing of heart blocks, but reading this post makes me think even more of a PE given my experience. It came and went. The only way I could get a full lung breath was to yawn. I had the typical strains and pulls we all get but they never found d a DVT related to my PEs. My stress test and scans were fine. My pulmonary function tests were normal, 02 sat was 98%. No calf redness/soreness.

I'm not an alarmist, but i lived with these symptoms for 6 weeks until I began experiencing severe pain below the ribcage, enough to drive myself to the er where they assumed it was pleurisy or exercised induced asthma but they ran a "let's just run a d dimer before you leave" just to close thst loop. Rest is history. They admitted me for 3 or 4 days and the pain was nearly umbeaeable. Morphine did nothing. Because they took so long to diagnose i ended up with some lung damage which eventually healed. Not saying you should be going to the er tonight but you should be demanding an appt tomorrow to address this asap. The family history is another risk factor, as is ironically a low RHR, your heart simply does not beat with enough regularity to push blood pooling in extremities back to the heart

Hopefully it's nothing serious
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Thought y'all might like to see this. Snapped it while waiting for the doctor. You can see it fuzzily says "38" for my BPM and you can see Heart Block occur on the left and then a few beats later a pretty much Heart Block again. My EP apparently didn't find this concerning? I still think it's interesting regardless.


For those who don't know what you're looking at. Look at either the middle or bottom line (they're probably different to a trained professional but the same for me). You see two good heart beats and then a big gap. What should happen is you get a little bump for your upper chamber beating, then a big bump for the lower chamber, then a medium bump for the recovery. So where I should've had a third beat, there's a big delay between my upper chamber and my lower chamber firing. I then have two more good heart beats before my upper chamber fires and my lower chamber doesn't fire at all, you see a small bump then medium bump as the heart recovers. Shortly thereafter there's a small bump which is the upper chamber firing again and a long pause before the lower chamber fires off.

I'm surprised he didn't find this weird because to me, a laymen, it looks like 3 beats out of five were no good which seems incredibly high. Who knows though, my degree is in economics?



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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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I would really call and schedule with Dr. Cannom ASAP. If he thinks you need to be assessed for a PE, he'll do that. I have a friend who scheduled with Cannom late last week, also as a new patient, and is being seen today, so there's a chance you can get in relatively quickly. Keep in close contact with your GP until you can get in.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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to add to the voices, my son had a 100% collapsed lung and was not SOB and his O2 sats were mid 90s (above 95).

also you might see if you can contact Dr. Larry Creshwell (damn i can never remember his name) but he is on ST and runs a blog. let me see if i can find it. athlete's heart or something? http://www.athletesheart.org/

send him your ECG pic and see what he says. PE is not to be messed with. if your mom had some blood clot issues AND you have a PE you need to insist on a coagulable workup as you may have a hereditary condition (Iirc) like factor V or one of those. (course then you'll be on thinners life long but better than dying from a PE. because they are Not to be dismissed). good luck and keep us updated!

also were you definitively dx'd with hb? because that EKG doesn't look to me like HB (but what do I know).

also you're not taking any statins, right? those would cause muscle soreness.

http://harvestmoon6.blogspot.com


Last edited by: kathy_caribe: Jul 14, 15 10:44
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Ya, you should go see Cannom, you can use my name if you want, we are quite friendly, and he has enjoyed working on me. Some things you left out that are very important, magnesium, sodium, and potassium levels right now. Do you drink a lot of coffee, sodas, caffeine drinks? Do you drink alcohol at night, and if so, how much?

And what is your normal stress level? Of course now you are making it worse with all your worry, and that is normal. When i knew what was going on, my anxiety went through the roof, and my symptoms quadrupled just from that. I would get that 24 hour halter monitor, do your run in it, and write down what time of day you experience your symptoms so they can go back and see "exactly" what was going on with your heart at that particular time. Like i said, going into the ER or hospital for random checks really produces nothing, and even when it does like in your example, they sluff it off. It is normal for folks to have a couple hundred PVC's a day, more when you get anxious. So that is probably what they thought you were having. And in low levels of mag and sodium, you will have a lot more issues, that is what triggered mine into going haywire. that along with doing a race in that state. So get those checked, or go back and look where they were.

They will often say everything was normal, but they neglect to tell you if it was low normal. For instance, normal mag could be 2.7 to 3.8. If you are at 2.7 or so, it just spits out as normal, but really you are borderline low. And one good workout and you could be 2.3. Same goes with sodium and potassium, look to see where you are on the spectrum, because these minerals can have devastating affects on your heart rhythm.

Good luck, and stop working out and figure this thing out before going forward. It is ok to take time off, either a little now, or a lot later, usually how the choice goes.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Whatever happens, please check back in and let us know you're OK. It sort of freaks me out when people post symptoms and get advice re what might be at issue and then they don't post the resolution (usually I suspect because it turns out it's nothing).

Good luck with it
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ChrisM] [ In reply to ]
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So I went back and looked at all the lab test and the sodium, potassium, etc we're all mid range, not towards the lower end. I'll still continue to supplement with a multi and magnesium pills just to be sure.

I also called my PCP and have requested that they put in an order for a D-Dimer to hopefully rule out the PE or DVT if it comes back negative or perhaps gives a good heads up if it comes back positive.

If it comes back negative I will surely reach out to Dr Connam but it will have to hold until after the Special Olympics World Games as I am heavily involved in that event for 18 days.

I will definitely report back though on this thread to close the loop.

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Hey - I'm an Emergency Room resident physician - so I have some experience with heart stuff, but I've just finished med school and started residency training. (I also raced tri at a fairly high level a long time ago).

Looking at that short rhythm strip it looks like you have a AV block - I can't really tell from the strip but it looks like a AV type 1 - but it doesn't look classic to me (gradually prolonging P wave - and then a dropped QRS). Reading your story i'm concerned and I would be getting a fairly emergent consultation by a cardiologist to rule out both PE as well as AV type 2 / 3 block (those kind are really bad).. I know you said the EP? dr wasn't concerned, but given you're symptoms and that short ECG I'd again strongly recommend emergent follow up.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [dayvic] [ In reply to ]
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dayvic wrote:
Hey - I'm an Emergency Room resident physician - so I have some experience with heart stuff, but I've just finished med school and started residency training. (I also raced tri at a fairly high level a long time ago).

Looking at that short rhythm strip it looks like you have a AV block - I can't really tell from the strip but it looks like a AV type 1 - but it doesn't look classic to me (gradually prolonging P wave - and then a dropped QRS). Reading your story i'm concerned and I would be getting a fairly emergent consultation by a cardiologist to rule out both PE as well as AV type 2 / 3 block (those kind are really bad).. I know you said the EP? dr wasn't concerned, but given you're symptoms and that short ECG I'd again strongly recommend emergent follow up.



huh? It is hard to tell from his photo as it is too poor of resolution to make out the P waves. Also your terminology of the AV block types is confusing. If it's 1st degree AV block, there is long PR but all atrial impulses are conducted via AV node. 2nd degree type 1 is Wenckebach and benign. Both 1st degree and Wenckebach are both extremely common in athletes with high vagal tone. 2nd degree type 2 is an emergency because it can progress to 3rd degree which is also an emergency because it is complete heart block. However, I have heard at least one EP say that 2nd degree type 2 and possibly even complete heart block AT REST in a highly conditioned athlete who is asymptomatic is not an indication for a pacemaker. OP is not asymptomatic, obviously, so if he had 2nd degree type 2 or 3rd degree it would possibly be an indication. To OP, I am guessing that the reason your EP was not concerned about those dropped beats is that you have one of the two benign types of heart block as mentioned above. The idea for a Holter may be reasonable, to see if you can speed up adequately or if you are having bradycardia coincident with your episodes. I am assuming though that that was done at least for 10-15 minutes during your treadmill test and was normal.

I do agree, however, that you might consider pursuing a more expeditious workup for PE.
Last edited by: solitude: Jul 14, 15 17:44
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [solitude] [ In reply to ]
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Agree - I can't really tell which 2nd degree AV block it is due to the picture resolution - because I can't see the P waves. The QRS look in the middle rhythm stop to be gradually elongating (which suggests a type 1), but then he has that odd morphology where he misses the ventricular depolarization but still has what looks like a small T wave? (I really would love a full 12 lead).

As I said, if a cardiologist wasn't concerned then its unlikely a type 2, but if that pictures showed up, I wouldn't discharge him until a PE and type 2 block (or even a slow a fib) had been ruled out by cardiology.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [dayvic] [ In reply to ]
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dayvic wrote:
Agree - I can't really tell which 2nd degree AV block it is due to the picture resolution - because I can't see the P waves. The QRS look in the middle rhythm stop to be gradually elongating (which suggests a type 1), but then he has that odd morphology where he misses the ventricular depolarization but still has what looks like a small T wave? (I really would love a full 12 lead).

As I said, if a cardiologist wasn't concerned then its unlikely a type 2, but if that pictures showed up, I wouldn't discharge him until a PE and type 2 block (or even a slow a fib) had been ruled out by cardiology.

this, which is why i'm somewhat discounting the docs assessment. SOB and abnormal EKG along with (albeit athletic heart) brady and I'm going to probe a little more, no?

http://harvestmoon6.blogspot.com


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ChrisM] [ In reply to ]
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ChrisM wrote:
Whatever happens, please check back in and let us know you're OK. It sort of freaks me out when people post symptoms and get advice re what might be at issue and then they don't post the resolution (usually I suspect because it turns out it's nothing).

Good luck with it

THIS!! the ONLY reason I came to ST today was to check this thread. please keep us UTD, Justarnner.

http://harvestmoon6.blogspot.com


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [kathy_caribe] [ In reply to ]
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Hello! I'm still alive, still short of breath, ha!

I've called my doctor and requested they put in the D Dimer test but they are horridly dragging their feet. She said they'd call me back by the end of day. I just really need to get that blood drawn before I leave to work the World Games. Because once that starts saturday, i'm fully involved for 18 straight days. If it comes back negative then i'll see the cardio post world games, if it comes back positive, i'll take a break from the World Games and immediately take the next step in tracking down whether it is for sure a DVT or PE.

Also, once I have all the files, no matter what i will follow up with a second cardiologist and let him look at all the blood tests, symptoms, EKGs, ECGs, etc and get a holistic perspective from a doctor who will listen and be thorough.

I will deliver, I assure you, I'm intensely curious as to why I have to yawn and feel like i can't breath.

Thanks for the support though, it's warming and reassuring.

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Also, here's an image of the very first EKG I had done on June 26. My heart rate during this was 40 bpm.


And here's a slightly less blurry picture from part of the EKG while i was laying down waiting for the doctor this past Monday. You can just barely see the pixels that should be the upper chamber beating I think? Again, econ major, not a doctor!



Edit: Tomorrow my EP is going to install a Insertable Cardiac Monitor so that he can watch my heart beats should anything get funky.

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Last edited by: justarunner: Jul 16, 15 13:27
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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good to read. while he is doing that have him run a d-dimer. or if easier do a v/q scan. and take care!

http://harvestmoon6.blogspot.com


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [kathy_caribe] [ In reply to ]
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Heart monitor installed, did not like how it felt once the lidocaine wore off, haha.

D-Dimer was done also, should hopefully know early-mid next week if it comes back positive/negative. Will inform either way.

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Good luck, sincerely hope it's nothing
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ChrisM] [ In reply to ]
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I have not forgotten about you all and promised I would up date!!!

So the Special Olympics were pretty good to me, amazing to oversee the Ops of the first ever triathlon in the Special Olympics. Very proud of that. My breathing got better too while I was there and I was optimistic. However it shortly returned after the games and i've only ran like 4-5 times since and lifted weights about the same amount of times. Electrocardiologist believes my problem is more pulmonary or cardio based so I headed back to my GP and she was convinced I should get a bronchodillator (sp) inhaler and come back and take a breathing test. I've attached those results for you all.






So as you can see, when I hadn't used the inhaler, my breathing was far below what it should be for my age/sex. The inhaler bumped it up quite a fair amount, to the place it should actually be. While this was exciting news, the problem is, it doesn't alleviate my symptom of having a tight chest and feeling like I can't breathe. Thus yesterday my GP prescribed me a steroid inhaler which she hopes will alleviate that problem.

Problem is, apparently that inhaler is not under my insurance so my doctor is currently having to request an exemption based on need to get it covered. So I'm waiting on that. So it'll probably be about 4 weeks until I will know whether this inhaler is the solution to my problem. In the meantime I can take the albuterol inhaler which forces me to get air even if I continue to feel like i'm not getting it.

So there you have it. That's where I stand. I won't leave y'all hanging, I promise.

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Hey, thanks for the update, sounds like you are on the road to figuring it out.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Welcome (?) to the wheezer club.

There are lots of different steriod inhalers so if that one isn't covered another one probably is.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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thanks so much for responding! so the numbers you're looking for are vital capacity, FEV1 and FEV1/FVC ratio. all those numbers increased post albuterol? did they use albuterol? so really all that does is show response. it doesn't necessarily mean asthma. i'd go see a pulmo and/or allergist.

did you ever get a d-dimer and/or BNP or (even better V/Q scan)? another thing is to query all the asthmatics here and see if they don't have significant response from albuterol. I feel it within minutes. i'm a little concerned that you're not feeling significantly better and something is still being missed.

again, thanks for the update!

http://harvestmoon6.blogspot.com


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [kathy_caribe] [ In reply to ]
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kathy_caribe wrote:
thanks so much for responding! so the numbers you're looking for are vital capacity, FEV1 and FEV1/FVC ratio. all those numbers increased post albuterol? did they use albuterol? so really all that does is show response. it doesn't necessarily mean asthma. i'd go see a pulmo and/or allergist.

did you ever get a d-dimer and/or BNP or (even better V/Q scan)? another thing is to query all the asthmatics here and see if they don't have significant response from albuterol. I feel it within minutes. i'm a little concerned that you're not feeling significantly better and something is still being missed.

again, thanks for the update!

Well, for starters, they finally found a cheaper steroid inhaler but the CHEAPEST one on my plan is $141. How is that even a thing? How is a damn steroid inhaler $141 AFTER insurance. I feel robbed.

My followup is 5 Oct, that will give me one month on a steroid inhaler, if I don't feel 101% by then, I'm going to go see a Pulmo.

D-Dimer came back negative.

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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that looks like a 3rd degree heart block. you need to see the cardiologist right away. maybe you already did. avoid strenuous exercise and get in immediately.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ironhonu] [ In reply to ]
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Cardio said my heart is a go. On to the pulmo in October if a steroid inhaler doesn't help me.

Still f'n stunned that a steroid inhaler covered by insurance is $141! Absolutely criminal. How do people afford inhalers?

Currently the albuterol inhaler runs $50 for two weeks so you need two a month and the steroid inhaler is good for one month so you've got a grand total of...

$241/month to be on two inhalers. Or $2800/year for two little inhalers. Can anyone please tell me how that's a thing when I'm fully covered with insurance?

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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justarunner wrote:
Cardio said my heart is a go. On to the pulmo in October if a steroid inhaler doesn't help me.

Still f'n stunned that a steroid inhaler covered by insurance is $141! Absolutely criminal. How do people afford inhalers?

Currently the albuterol inhaler runs $50 for two weeks so you need two a month and the steroid inhaler is good for one month so you've got a grand total of...

$241/month to be on two inhalers. Or $2800/year for two little inhalers. Can anyone please tell me how that's a thing when I'm fully covered with insurance?

That's terrible. I pay $20/month for each of my inhalers (and I think it's less if I get them from my mail order pharmacy) from my employer sponsored healthcare. Unfortunately there aren't any generics anymore since they had to change the propellants to take out the CFCs.

My first job out of college had a $500/year cap on prescription meds, and my inhalers were a lot of money. My allergist took pity on my and gave me bags of sample inhalers.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Subclinical hypothyroidism is one condition that could connect your wide global symptoms. TSH and free T4 were in "normal" range, but your free T3 might still be low. Re: your pulmonary function: Try immersion to the neck in a pool to test whether that impairs your breathing.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [Pedalhead] [ In reply to ]
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I'm here to close this loop.

After we found my breathing was way below normal we started yours truly on a steroid inhaler. At first we went with 40mg 2x a day (morning/evening). We did this for 5 weeks. There was improvement for sure but I still struggled when trying faster efforts. For example, I tried a 200 hard, 200 easy, 200 hard, 200 easy, 400 hard, 400 easy workout. I made it through 3 sets and I just couldn't do it.

So I went back to the doctor and we upped it to 80mg 2x a day. Since then i've shown solid progress. I did 8x400 at 70.5s and didn't start to really gasp until 7 and 8. Then I turned it around last week and did 10x400 at 70.5s with no gasping and did a 5k tempo earlier in the week at 17:15 which was preceeded by 4x200.

Thus I think it's going away. I believe after all these months that one of the biggest correlations with my bad breathing was the air quality. On days where the air quality was bad per airnow.gov I struggled. When I visited other states like New Hampshire, Colorado, or even headed down to San Diego, I would suddenly find myself breathing quite a bit better.

From here i'm just going to keep taking my steroid inhaler for the foreseeable future. I could careless if I have to use an inhaler if I run well.

I'm going to jump into a Turkey Trot and hopefully run like a 16:15 which would put me just 10s behind where I was before this entire ordeal began. And then focus on doing the best training I can do leading up to the Carlsbad 5000. Then I'm going to turn my sights to the Air Force Marathon next September.

I really appreciate all who commented and took an interest in this. It was a very emotional roller coaster ride this summer. I'm glad the ride is almost over, I've been waiting to get off of it for a while now. :)

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Thus I think it's going away. I believe after all these months that one of the biggest correlations with my bad breathing was the air quality. On days where the air quality was bad per airnow.gov I struggled. When I visited other states like New Hampshire, Colorado, or even headed down to San Diego, I would suddenly find myself breathing quite a bit better. //

Dan and I had the exact same experience, so we moved. Desert climate or right on the coast where the wind blows everyday were the cures, and I mean total cures. After medicating for over a decade, and the issues just getting worse and worse, pretty amazing what a change in location can due for your health. My advice, don't stay somewhere where you "KNOW" aggravates your asthma. Not worth it in the long run.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [monty] [ In reply to ]
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Yea, I live 30 miles east of LA. It's right north of Chino, specifically the town of Claremont.

The problem is Mt Baldy lies 2 Miles to my north, San Gorgonio is 40 miles to the East, Saddle Back is 40 miles to the South, and the Chino Hills are just 5-10 miles to my South West. Thus I live in a bowl.

Here's a perfect example of it. I live right above Chino where the 210 label is. As you can see, I live in a perfect little bowl where the airquality is always worse than its neighbors. It's fun. :)



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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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I can sympathize, I lived between LAX and the Chevron oil refinery. To top it off, house was all carpet, and virtually every house older than 10 years had mold. Like you, I had the perfect storm of environmentals to set off my asthma. Took awhile to figure out, but like you every time i went out of town to race, things got better. Finally clubbed me over the head, but until i moved to the desert, I never knew it was 100% so. You always think that outside factors contribute to an underlying cause, but sometimes it can be the cause. Drug free for about 15 years now and breathing like a mountain climber..
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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Not meaning to sound whatever but is the "steroid inhaler" allowable under the anti-doping regulations??? I really do not know but it seems like anytime anyone uses anything involving steroids, testosterone, etc, someone raises the "you're a doper" accusation:)


"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ericmulk] [ In reply to ]
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Steroid inhalers are localized to the longs, they don't really operate outside of that realm. So performance enhancement isn't what the drug is about. It essentially reduces inflammation in the lungs to allow you to breath better if your airways are inflamed for whatever reason.

Having said that, I do believe USADA/WADA ban their use outright. However, if you need one for medical use, they will give you a TEU (Therapeutic Use Exemption) good for a certain duration. Galen Rupp has had like 1-2 TUEs for steroid inhalers in his career as has a variety of breathing afflictions.

And it's a shame they don't help performance, cause I stunk up the track tonight with my awful workout lol!

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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justarunner wrote:
Steroid inhalers are localized to the lungs, they don't really operate outside of that realm. So performance enhancement isn't what the drug is about. It essentially reduces inflammation in the lungs to allow you to breath better if your airways are inflamed for whatever reason.
Having said that, I do believe USADA/WADA ban their use outright. However, if you need one for medical use, they will give you a TUE (Therapeutic Use Exemption) good for a certain duration. Galen Rupp has had like 1-2 TUEs for steroid inhalers in his career as has a variety of breathing afflictions.
And it's a shame they don't help performance, cause I stunk up the track tonight with my awful workout lol!

Ah, i see, thanks for the explain. Asthma inhaler use is very high in the competitive swimming world, with something like 30% or so of all swimmers at national meets using an inhaler. I don't know if these are "steroid inhalers" or some other type but, apparently lots of top swimmers have asthma and get a TUE for an inhaler. In fact, it is so prevalent that some people have questioned whether the inhalers are giving these swimmers some sort of advantage. I haven't read much about it lately but it has been a hot topic off and on over at least the past 7-8 yrs or so.


"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ericmulk] [ In reply to ]
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Under the WADA code, the most common asthma inhalers (albuterol, formoteral, and salmeterol) are not prohibited and don't require a TUE provided they are used in "normal" amounts. They are prohibited only in very high doses (such as more than 10 to 16 puffs a day depending on the drug).
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [craigj532] [ In reply to ]
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Eric is correct here. The typical albuterol inhalers were approved for mass use quite a bit ago (mid 2000's iirc).

Studies have shown that even in people without asthma that an albuterol inhaler will open your airways a bit more (a couple percent I believe) but that they found no correlation between that extra dilation in your airways and performance enhancement. I think they believe that this is because oxygen is not the limiting factor in performance in the people they were testing.

I can't remember where I read all this, sorry about that!

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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justarunner wrote:
Eric is correct here. The typical albuterol inhalers were approved for mass use quite a bit ago (mid 2000's iirc).
Studies have shown that even in people without asthma that an albuterol inhaler will open your airways a bit more (a couple percent I believe) but that they found no correlation between that extra dilation in your airways and performance enhancement. I think they believe that this is because oxygen is not the limiting factor in performance in the people they were testing.
I can't remember where I read all this, sorry about that!

I wonder though if in swimming, where you can't just breath as often as you want but rather have to stay in your stroke rhythm, if the extra 2-3% of air might help. Don't know if you've followed the swim threads on breathing every arm stroke (rather than every arm cycle) on occasion when extra oxygen is needed. Apparently, Sun Yang and other top D swimmers take two breaths going into their turns most of the time, so it would appear that they are pretty low on O2. OTOH, the widespread use of inhalers could be due to a placebo effect. Actually, all of this discussion has got me thinking i should stop by my local Walgreen's and get one to try it out myself, just to see:)


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ericmulk] [ In reply to ]
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ericmulk wrote:
justarunner wrote:
Eric is correct here. The typical albuterol inhalers were approved for mass use quite a bit ago (mid 2000's iirc).
Studies have shown that even in people without asthma that an albuterol inhaler will open your airways a bit more (a couple percent I believe) but that they found no correlation between that extra dilation in your airways and performance enhancement. I think they believe that this is because oxygen is not the limiting factor in performance in the people they were testing.
I can't remember where I read all this, sorry about that!


I wonder though if in swimming, where you can't just breath as often as you want but rather have to stay in your stroke rhythm, if the extra 2-3% of air might help. Don't know if you've followed the swim threads on breathing every arm stroke (rather than every arm cycle) on occasion when extra oxygen is needed. Apparently, Sun Yang and other top D swimmers take two breaths going into their turns most of the time, so it would appear that they are pretty low on O2. OTOH, the widespread use of inhalers could be due to a placebo effect. Actually, all of this discussion has got me thinking i should stop by my local Walgreen's and get one to try it out myself, just to see:)

You can't get an albuterol inhaler without a prescription. There used to be OTC inhalers that weren't albuterol (can't remember what they were) but they're pretty ineffectual, even if they're still around.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [Erin C.] [ In reply to ]
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Good news that the heart is good but, why did the ECG show skipped or irregular beats? Problem with the test protocol maybe?
Last edited by: NealH: Oct 27, 15 12:08
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [Erin C.] [ In reply to ]
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Erin C. wrote:
ericmulk wrote:
justarunner wrote:
Eric is correct here. The typical albuterol inhalers were approved for mass use quite a bit ago (mid 2000's iirc).
Studies have shown that even in people without asthma that an albuterol inhaler will open your airways a bit more (a couple percent I believe) but that they found no correlation between that extra dilation in your airways and performance enhancement. I think they believe that this is because oxygen is not the limiting factor in performance in the people they were testing.
I can't remember where I read all this, sorry about that!


I wonder though if in swimming, where you can't just breath as often as you want but rather have to stay in your stroke rhythm, if the extra 2-3% of air might help. Don't know if you've followed the swim threads on breathing every arm stroke (rather than every arm cycle) on occasion when extra oxygen is needed. Apparently, Sun Yang and other top D swimmers take two breaths going into their turns most of the time, so it would appear that they are pretty low on O2. OTOH, the widespread use of inhalers could be due to a placebo effect. Actually, all of this discussion has got me thinking i should stop by my local Walgreen's and get one to try it out myself, just to see:)


You can't get an albuterol inhaler without a prescription. There used to be OTC inhalers that weren't albuterol (can't remember what they were) but they're pretty ineffectual, even if they're still around.

Ah, i see, thanks for that info. I was mostly just kidding but the thought had occurred to me:)


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ericmulk] [ In reply to ]
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ericmulk wrote:
justarunner wrote:
Steroid inhalers are localized to the lungs, they don't really operate outside of that realm. So performance enhancement isn't what the drug is about. It essentially reduces inflammation in the lungs to allow you to breath better if your airways are inflamed for whatever reason.
Having said that, I do believe USADA/WADA ban their use outright. However, if you need one for medical use, they will give you a TUE (Therapeutic Use Exemption) good for a certain duration. Galen Rupp has had like 1-2 TUEs for steroid inhalers in his career as has a variety of breathing afflictions.
And it's a shame they don't help performance, cause I stunk up the track tonight with my awful workout lol!


Ah, i see, thanks for the explain. Asthma inhaler use is very high in the competitive swimming world, with something like 30% or so of all swimmers at national meets using an inhaler. I don't know if these are "steroid inhalers" or some other type but, apparently lots of top swimmers have asthma and get a TUE for an inhaler. In fact, it is so prevalent that some people have questioned whether the inhalers are giving these swimmers some sort of advantage. I haven't read much about it lately but it has been a hot topic off and on over at least the past 7-8 yrs or so.

there is a study somewhere with a correlation between chlorine swimming and asthma. FWIW. as for steroid inhalers, they are not required for a TUE. systemic steroids are but not inhaled unless you're taking in nebs and i did the calculations once - i think it was 5-6 nebs a day. when i'm doing that much i'm not even able to get out of bed so no worries on needing to be drug tested.

http://harvestmoon6.blogspot.com


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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so are you on maintenance roids? sounds like you are (40 vs 80). if you're not on maintenance, you might find your "flares/attacks" will become much, much less about 1-2 weeks after starting the maintenance (LABA and others_) roids.

also, if you are still suffering with albuterol costs, i am pretty sure i pay WAY under $10USD for mine. i can pick some up for you and have them sent to you if you want. so glad you updated us! thanks so much!

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [kathy_caribe] [ In reply to ]
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kathy_caribe wrote:
ericmulk wrote:
justarunner wrote:
Steroid inhalers are localized to the lungs, they don't really operate outside of that realm. So performance enhancement isn't what the drug is about. It essentially reduces inflammation in the lungs to allow you to breath better if your airways are inflamed for whatever reason.
Having said that, I do believe USADA/WADA ban their use outright. However, if you need one for medical use, they will give you a TUE (Therapeutic Use Exemption) good for a certain duration. Galen Rupp has had like 1-2 TUEs for steroid inhalers in his career as has a variety of breathing afflictions.
And it's a shame they don't help performance, cause I stunk up the track tonight with my awful workout lol!


Ah, i see, thanks for the explain. Asthma inhaler use is very high in the competitive swimming world, with something like 30% or so of all swimmers at national meets using an inhaler. I don't know if these are "steroid inhalers" or some other type but, apparently lots of top swimmers have asthma and get a TUE for an inhaler. In fact, it is so prevalent that some people have questioned whether the inhalers are giving these swimmers some sort of advantage. I haven't read much about it lately but it has been a hot topic off and on over at least the past 7-8 yrs or so.


there is a study somewhere with a correlation between chlorine swimming and asthma. FWIW. as for steroid inhalers, they are not required for a TUE. systemic steroids are but not inhaled unless you're taking in nebs and i did the calculations once - i think it was 5-6 nebs a day. when i'm doing that much i'm not even able to get out of bed so no worries on needing to be drug tested.

Ummm, what exactly is a "neb"??? You've lost me here and even Google doesn't know:)


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ericmulk] [ In reply to ]
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nebs = nebulizer

Justarunner -> suggest you move outside the bowl so you can eventually/hopefully wean off the meds!
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [buddyblanke] [ In reply to ]
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buddyblanke wrote:
neb = nebulizer
Justarunner -> suggest you move outside the bowl so you can eventually/hopefully wean off the meds!

OK, thanks. Upon a further reading i see that a nebulizer is actually a "drug delivery device used to administer medication in the form of a mist inhaled into the lungs". Anyway, thanks for spelling out the word:)




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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ericmulk] [ In reply to ]
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fyi, when i'm coming up google empty i just add more context http://lmgtfy.com/?q=asthma+neb

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [kathy_caribe] [ In reply to ]
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kathy_caribe wrote:
fyi, when i'm coming up google empty i just add more context http://lmgtfy.com/?q=asthma+neb

Sure, i could've searched more and figured it out but the way you used "neb" made it sound like you were taking some sort of pill, as in "i'm taking 5-6 nebs a day". I just think your using "neb" in this manner is kinda sorta off base, at least for people with no background in this area:)


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ericmulk] [ In reply to ]
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ah. sorry about that.

for me neb is both noun and verb. "i need a neb" "are you going to neb yourself now or do you want to wait?" and there are nebs (plural noun form). :) consider yourself among the lucky that you aren't so well versed nebs. :)

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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [kathy_caribe] [ In reply to ]
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kathy_caribe wrote:
ah. sorry about that.
for me neb is both noun and verb. "i need a neb" "are you going to neb yourself now or do you want to wait?" and there are nebs (plural noun form). :) consider yourself among the lucky that you aren't so well versed nebs. :)

Well, thanks for understanding my point of view, and i do consider myself lucky in never needing to use the "nebulizer". Your use of "neb" reminds me of the F-bomb: can be used as noun, verb, adjective, adverb, gerund, etc:)


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ericmulk] [ In reply to ]
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i think fuck has to be one of the most versatile words in teh English language. unless you're in Oz. then it's cunt. :)

http://harvestmoon6.blogspot.com


Last edited by: kathy_caribe: Oct 28, 15 8:09
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [kathy_caribe] [ In reply to ]
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kathy_caribe wrote:
i think fuck has to be one of the most versatile words in teh English language. unless you're in Oz. then it's cunt. :)

Ya, the F-bomb is very versatile but can get a person in trouble at work, or even at the pool, if you are not very careful. As a result, i'm trying very hard to say "frig" instead:)


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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [mblocher] [ In reply to ]
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Hello mblocher, Monty, and All,

I just got a pacemaker. For those triathletes that have a pacemaker ..... what adaptations (if any) to your training and racing are required?

My EP doc is also Dr. Navinder Sawhney (who I highly recommend) with Arch Health Partners practicing at the new Palomar Hospital in Escondido.

Similar to Monty I had some symptoms but passed all the tests .... exercise EKG, nuclear perfusion, sonar, etc. and used a Zio Patch monitor for a couple of weeks with out any data detailing a cause for occasional light headed feeling when at rest with low heart rate. (heart worked fine at higher heart rates)

Early in December 2015 I got a Medtronic LINQ monitor inserted under the skin over my heart:

http://www.medtronic.com/...ors/reveal-linq-icm/

The LINQ saves heart rate data in memory and transmits each night from 2400 to 0600 via bluetooth to a handset unit bedside and then over the cell network to your doctor.

The LINQ has a lifespan of 3 years without charging (and would make a great replacement mode for a chest strap .... no muss, no fuss).

Last week while I was at rest ..... the LINQ recorded some 4 second dropouts at low 30's beat per minute heart rates and that indicated that I needed a pacemaker. I did not want to pass out under water, driving, or just fall over and crack my head ..... so now I am the Biotronik Man.

Yesterday Dr. Sawhney installed my new body part ......... (Biotronik Pacemaker) and removed the LINQ at Palomar Hospital.

My Biotronik Eluna 8 DR-T Pacemaker has 240 days of memory on board and at 0100 each day transmits the previous 24 hour (or longer if traveling) heart data to Dr. Sawhney. (would be nice if I could get the data too and import it into Golden Cheetah or the like.)


https://www.biotronik.com/...r&pw=974&pt=

https://www.biotronik.com/...n&pw=974&pt=

The CLS Closed Loop Stimulation feature that adapts to bodily functions appears to be useful if it functions as advertised.

The Biotronik Rep advised me that the unit adapts the voltage that triggers the heart contraction based on a feed back mechanism that also includes an accelerometer that provides a parameter along with the CLS that increases heart rate with sensed physical motion.

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mblocher wrote:
While I can't say that he specializes in endurance athletes, my EP doc is Navinder Sawhney in San Diego. I REALLY like his calm demeanor, he is very thorough and attentive, unlike other cardio/EPs I've seen. He did my ablation for atrial fibrillation last year and is usually at his Palomar hospital office although he goes to Poway on Mondays. My wife would recommend Dr. Charles Athill with Sharp in San Diego - he is an EP specialist and did her pacemaker implant last year after Stephen Higgins at Scripps La Jolla botched her ablation resulting in complete heart block (so obviously, we'd recommend NOT going to him!). Dr. Athill is super conservative and also extremely thorough (his father died from complications from afib, so he takes it personally). He has also been in practice longer than Dr. Sawhney so has likely seen more cases and more variety.


John Rogers at Scripps Green Hospital is also a great guy (not EP specialty) that you'd probably like. Doug Gibson is the main EP guy at Scripps Green, and is not recommended by my cousin who operated with him on numerous occasions as a cardiac OR nurse.

Hope this helps.



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Cheers, Neal

+1 mph Faster
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [nealhe] [ In reply to ]
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Neal- if you don;t mind my asking- how old are you? seems like afib and this sort of stuff becomes more of an issue once you hit 50
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [Allezdude] [ In reply to ]
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hi, that EKG from june does shows 3rd degree block in the bottom rhythm strip. ironhono called it as well.
http://lifeinthefastlane.com/...omplete-heart-block/
that ekg should be reviewed again, its not normal
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [Allezdude] [ In reply to ]
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Hello Allezdude and All,

I think you are partially correct ..... some published data agrees ..... arrhythmia prevalence increases 9 to 15% > age 80 .... http://www.ncbi.nlm.nih.gov/pubmed/12766527

I will be race age 83 in a couple of weeks.

http://www.ncbi.nlm.nih.gov/pubmed/1782647

Bradycardia (slow heart rate) is found in young student athletes.

The study below is more on point and affected athletes (in this study) with a mean age of 38 years.

My case was primarily bradycardia with occasional skips and it appears that athletes are more subject to the effects of bradycardia than the general population:

http://www.ncbi.nlm.nih.gov/pubmed/6508966

"One hundred and sixty consecutive patients less than 50 years of age (mean 38 years) referred for long term electrocardiographic recording were evaluated retrospectively. Significant cardiac arrhythmias were detected in 51 of 107 (48%) patients examined because of syncope [fainting] or dizzy spells or both."




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Cheers, Neal

+1 mph Faster
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [nealhe] [ In reply to ]
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Similar to Monty I had some symptoms but passed all the tests .... exercise EKG, nuclear perfusion, sonar, etc. and used a Zio Patch monitor for a couple of weeks with out any data detailing a cause for occasional light headed feeling when at rest with low heart rate. (heart worked fine at higher heart rates)
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My I as what symptoms you had?

Was it just light headed at rest?


Train safe & smart
Bob

Last edited by: Longboarder: Dec 19, 15 16:56
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [nealhe] [ In reply to ]
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Hey Neal - I do not have a pacemaker, but Dr. Sawhney did my ablation last October. I've got 0 training or racing limitations. A different doctor did my wife's pacemaker this past Feb. (3rd degree AV block) - she also has few limitations to her workouts (not a triathlete, but a personal trainer and fitness nut). Some overhead exercises are limited, but cardiac-wise she's got no limits. Low rate is set at 50, high at 180. Be sure to take it easy the first couple weeks and let your body adapt to your new parts.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [justarunner] [ In reply to ]
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This story sounds very familiar. In 2010 I was running a lot of miles, feeling run down, not recovering between workouts, etc. I also noticed my heart skipping beats during runs and while at rest. Really freaked me out. Turns out I have a heart block. I was also overtrained, which caused the block to act up more frequently. The overtraining also caused all the other issues. A couple weeks off with proper hydration and nutrition and I was able to resume normal training. As a 15:xx 5k runner, I'm guessing you probably considered this already, but thought I'd share my experience since it sounds so similar.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [ericmulk] [ In reply to ]
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ericmulk wrote:
kathy_caribe wrote:
i think fuck has to be one of the most versatile words in teh English language. unless you're in Oz. then it's cunt. :)


Ya, the F-bomb is very versatile but can get a person in trouble at work, or even at the pool, if you are not very careful. As a result, i'm trying very hard to say "frig" instead:)

I get SO excited when I here 'ffffffuuuu' from my Dad. He's so mild mannered and level headed, in language especially.

But it always ends in 'dddddggggeee. Oh Fudge? C'mon Dad. Excite me a little here.
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [JSully] [ In reply to ]
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JSully wrote:
ericmulk wrote:
kathy_caribe wrote:
i think fuck has to be one of the most versatile words in teh English language. unless you're in Oz. then it's cunt. :)


Ya, the F-bomb is very versatile but can get a person in trouble at work, or even at the pool, if you are not very careful. As a result, i'm trying very hard to say "frig" instead:)


I get SO excited when I here 'ffffffuuuu' from my Dad. He's so mild mannered and level headed, in language especially.

But it always ends in 'dddddggggeee. Oh Fudge? C'mon Dad. Excite me a little here.

I wish i had that problem. TBH, I've gotten into varying degrees of hot water for dropping the F-bomb about 4 or 5 times over the past 15 yrs or so. One time i offended a male coworker, one time a dentist, once a lifeguard, etc...:)


"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [mblocher] [ In reply to ]
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Hello mblocher, Longboarder, and All,

Longboarder, my symptoms were primarily being light headed at rest with very low heart rate …. Which I blew off as not a big deal ….. da Nile (a river in Africa).

However I had a wakeup call. After driving to Napa from Escondido for a family wedding …. and getting a bit dehydrated so I would only occasionally have to stop to pee …

...... while attending one of the pre wedding parties I met Bruce Doscher http://brucedoscher.com/cyclingposters/ (he had arrived from New Zealand - prize for longest distance?) who is also a triathlete, and we were standing outside on the patio swapping triathlon stories. (I gave him some View-Speed skewers and he comped me a couple of Tour posters)

I was telling him about the 2010 Kona race when I was at about mile 85 on the bike and tore my adductor muscle …. I said, “it hurt like a son of a bitch” and then said, “I feel dizzy” [for real] and passed out. Bruce was into my story and thought I was acting it out by falling. Fortunately for me, the prospective groom was also listening but not all that interested in the story (or triathlon) …. and caught me to break my fall so I did not crack my head on the concrete steps. I was only out for the time of the fall but was drinking red wine and spilled it on my face so it looked like I had blood on me ….. and after that my wife insisted that I get checked out.

I was fine for the next few days and when I got home I contacted Dr. Sawhney ….. and 3 months later I have a pacemaker.

mblocher, we are just swapped ….. my wife had an ablation (tachycardia), with Dr. Sawhney, and I had the pacemaker. I have to avoid lifting more than 5 lbs for 6 weeks with left arm but can use a bike or trainer at 2 weeks. No lifting left arm above shoulder for 6 weeks to avoid dislodging wires going into heart. After 6 weeks I am good to go for SBR or weight lifting etc. My pacemaker is set at 50 low …. so I think I feel it kick in occasionally when at rest .... like on computer or driving ..... but it may be my imagination. It is set high at 130 but since my heart works OK at higher rates that is not limiting and I can go to about 173 when last checked for a treadmill max.

I have great confidence in Dr. Sawhney and after reviewing the various manufacturers pacemakers I am pleased that he recommended and installed the Biotronik from Germany with its advanced features.

I am being lazy for the first couple of weeks as instructed and as you suggest to let stuff start healing ...... but I feel great and at loose ends ……..



.

Cheers, Neal

+1 mph Faster
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Re: Need a Doctor in the LA/SD area who specializes in Endurance Athletes... [nealhe] [ In reply to ]
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Neil
Thanks for the reply. My resting HR runs around 40 and has since I took up endurance sports in 2002 at 50. No real symptoms but I do get orthostadic hypotension sometimes. I'm do for a cardio work up its been a few years.

Sounds like you'll be a racing again next year, I hope to be racing at 83 too. Good luck.


Train safe & smart
Bob

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