S-T-R-E-S-S Test

[Alaiyo]

Apologies that this is only partly about running. In particular, why I was afraid to run and what I did about it.

Just yesterday, I found out that I am at considerable risk for heart disease due to a previously-unknown heritable heart defect in my family. Turns out one of my biological parents had a heart attack at 36 caused by this problem (I had no idea). My 36th birthday is in a few days.

I am pretty understandably concerned. I am scheduled for an ECG, ordered by my doctor *prior* to getting this news, because of an irregular heartbeat coupled with mild difficulty breathing (presumed to be "exercise-induced asthma"). I've had both symptoms for ages. In the case of the arrhythmia, I had been told it was nothing to worry about. In the case of the "asthma", it was prudent to use an inhaler during exercise if I needed it, but also totally safe. (Turns out the two could be connected and indicative of something else altogether.) So I guess I am doing what I am supposed to, getting checked out early next week. I will definitely be letting my doctor know about my new family history information, and will probably press for a more comprehensive set of tests, which is rrecommended as appropriate screening for first-degree family members (kids, parents, siblings) of those with this disorder.

I have been truly glad to be starting C25K again, and enjoying my return to the trails. So I was really conflicted about running today. Is it safe? Am I just being silly, paranoid or avoidant? Is it just an excuse to skip, saying I am worried a short run could cause a heart attack?

Then I remembered that running is one of the ways doctors diagnose various disorders under a condition called a "stress test". They hook you up to a bunch of machines and get you on the treadmill, seeing how you respond to the exercise. Knowing this, and buoyed by the information I read about how very critical exercise is for those who *definitely* have heart disease, not to mention all the rest of us, I decided it was probably ok to go out again.

I am glad that I did. Of course I was just fine. All the "risk factors" have been there all along, even if I didn't know about them, and exercise is super-important for continued health regardless. I felt generally good, and in fact, the running itself helped me manage my anxiety about this whole heart-health business.

Allow me to go on record and say this: no one should ever, ever ignore their concerns about heart disease, or make light of any symptoms of a heart attack. Nor should any of us put off appropriate screening or treatment.

I chose to go out because I *am* getting doctor's oversight and care, because I generally felt ok, and because I realized the things that got me worried had always been there without causing a problem so far. AND because I have my testing scheduled, but can't get it done any sooner than next week, and my doctor knows about the running and the schedule and is ok with it. I will continue to be modest with my exertions, go slowly on my runs and follow up with my doctor to be sure I am healthy (or at least get appropriate treatment if I am not.)

Here's to hoping I am totally fine after all, and the worst thing I will experience is the worry until I hear back!

***Update: later that same day (night, actually)

My (extremely mild) chest pain returned, and I began to be very nervous about not having already told my doctor about the new information about my family history - I hadn't known it at the time I went a few days ago. I ended up calling a 24-hour hotline run by the medical establishment to find out if I should see my doctor right away again, or if I could wait a few more days and just have my planned tests.

The nurse on the hotline told me to get into my doctor ASAP and in case be seen by a doctor today, even if I can't get into my family doctor's clinic. Which was pretty worrying.

So I saw my family doctor, who was also not super reassuring. He ordered a bunch of additional tests and sent out an urgent cardiologist referral. To be clear, it is still possible that my heart is fine, perhaps more than 50-50 chance I am fine. But there is still a pretty big chance I will need some treatment, depending on my new tests and new cardiologist's assessment.

(Somewhat ironically, one of the extra tests he ordered was a stress test. A proper one. At least I am trained up in preparation!)

And - no running, doctor's orders. No exercise of any kind actually, for the time being. Hopefully it will only be a very short diagnostic break while we discover that I am totally healthy and fine!

So my return to running is going to be very short-lived this time, not quite two weeks! But if things go well, I will be back again, for a third attempt.

[Rockette]

What a worrying time for you . Hope everything turns out well when you have your tests & in the meantime enjoy your running

[Alaiyo Graduate in reply to Rockette]

Thanks Rockette! It looks like I have to take a break from the running for now, and I do appreciate your good wishes.

[Hidden]

Thank you for your post. It must be a very worrying time for you. Well done for going out running. You make a very valid point that exercise is important for good health. Also, I know that the advice to check with your doctor before starting any excercise program is often repeated so much as to lead to it being ignored. However it is vital. In some cases, exercises may need to be adapted or the doctor may reccommend that extra rest days are taken depending on the condition. also with some conditions, for example, with asthma, a different type of medication may be needed to help manage it while exercise is taken up. Alternatively extra support may be required: for example, I have thalassemia trait and am also vegan/vegetarian. So in this case I need to take extra nutritional supplements to help support my body. Everyone's situation is unique, but if there is an issue, a good doctor will help find a solution. And even if there is no underlying problem, it's always useful to get a baseline check with a doctor. It can be useful as a way to check the progress you are making in your health, but also, if you do have any problems along the way, the doctor may come up with alternative answers to keep you moving.

[Alaiyo Graduate in reply to Hidden]

Hi Tanyag. It is so very true that it is important to get the go-ahead on exercise, and also to make sure any issues are being properly managed. I have been exercising quite a long time, and added running under the support of one of my (several) doctors, but I guess I needed another one to be monitoring too.

I am really glad that you are getting the care you need also!

Since I have to take a running break, I may not chat for a little while, but when (positive thinking here) I return, I look forward to more conversations with you.

[Hidden in reply to Alaiyo]

keeping my fingers crossed and looking forward to welcoming you back.

[aliboo70]

sorry to hear that you are going through a hard time, hopefully those tests will be done asap and you can set your mind at rest. i've been lucky so far in that i don't really have any pyhsical health issues except for a dodgy elbow,so i can't fully appreciate how it feels- but over the last few years have had some mental health problems which it has been a long road to recovery, sure the running is doing that some good and perking me up. all the best for the next few weeks, hope you can get back to your running soon......

[Alaiyo Graduate in reply to aliboo70]

Thanks aliboo! I am keeping my fingers crossed.

[Realfoodieclub Graduate]

Thank you for your post. As you say it is a very important point, one which all forms of exercise use as there rule. IF IN ANY DOUBT, CHECK IT OUT. I hope that your tests go well and they get you sorted. You might be like me, but with a different health issue. learning to run highlighted a very serious overactive thyroid issue that was stressing my heart. I had no idea until I started to run and found it very difficult. With the help of my doctors I have learnt to run In The correct way and and the correct time for me. I have found that talking to every health professional who is looking after you about your desire to run helps them to provide you with a program to getting to where you want to be. Unfortunately too many doctors don't push exercise because they think that is the last thing a patient wants to hear about. Good luck and hope you are back out there soon.

[Alaiyo Graduate in reply to Realfoodieclub]

Thank you Real - I am definitely going to push my doctors to let me return to exercise as soon as it is deemed "safe". Given that among people with high risk for heart disease, exercise reduces mortality rates over the course of 8 years by 45%, I have a pretty strong motivation to return to my program as soon as I can.

[Hidden]

I know how frightened you must feel waiting for tests and then the results (I recently went through tests etc for another situation). I sometimes think the waiting time is the worst. I hope the tests show that you are okay. In the meantime I echo KittyKat in saying that I also believe you should continue to post here whilst you are advised not to run. Quite apart from the lovely poetic posts you put up for us, it will probably do you good to receive the support you need from the site. Good luck with your tests and my very best wishes to you.

[Alaiyo Graduate in reply to Hidden]

Bless you, Fitmo. I am really touched (as always) with all the encouragement and true welcome I receive here. I will continue to "pop in" occasionally, while I wait for my chance to get back running.

[no-excuse Graduate]

How worrying for you, I sincerely hope you get your tests and good results asap. Please keep posting and replying if you are able, your words are good for all of us to read. Best of luck to you. x

[Alaiyo Graduate in reply to no-excuse]

Thank you no-excuse. I think I will take you up on that offer!

[AnnieF Graduate]

Hey, well done for keeping behind this. I hope it all turns out well for you. I'm always impressed when people hang on in there and don't allow doctors to tell them 'it's all in your mind' or similar. Like others here, I've got stuff going on and parents who died young and it's very discouraging when you go to see your GP and they just think you're anxious or their response to you trying to run is to tell you that you shouldn't do it. When I started running again and got cysts on my plantar tendons, the GP rolled his eyes and shrugged and because they are all 'on the blocks' about cancer that's immediately what they think if you have a problem like breathlessness. It's hard to get them to look at more subtle symptoms and at symptoms that are diverse and not just located in one small area but are body-wide and connected. I'm trying to get investigations relating to my thyroid at the moment, it's a long road! If anyone has any especial tips about getting a GP to pay attention, then do let us know.

Meanwhile, just to repeat where I began, take good care of yourself and I hope things get sorted out so that you can begin to run and enjoy exercise in the near future. All the best.

[Alaiyo Graduate in reply to AnnieF]

Annie, I am glad to be in good company (although I wish all of us were healthy instead!). It can definitely be hard to get effective treatment, and I am not sure I am exactly the expert on making that happen. But I have learned a few things over the years that seem to help:

(I am not saying that any of this is a judgement of the validity of your concerns. You may well be completely right about what is wrong in your body, and I certainly can't tell by a post on this forum. In which case, some of this may not be applicable, and please don't be offended. They are just things I learned from my own experiences, about dealing with vague, undiagnosed issues, coupled with my own history of issues for which tests come back "normal".)

1. If your GP isn't taking you seriously or getting you results, look for another one. (There is a *dire* shortage of family doctors in my city, but there are also people who are silly xenophobes, sexists, and people who over-value many years of experience in practice. I found a few quite good doctors accepting patients because they were: women, recent immigrants who weren't Caucasian, or reasonably young. They can all be terrific doctors. As for youth, experience is definitely valuable, but good young doctors may make up for it by being especially keen, by being trained in the most recent best practices, and by relying on more experienced mentors when they encounter something new. Not all new doctors are good, but I would prefer a good doctor in their first few years of practice than a complacent, uncaring one counting the days to retirement.)

My current doctor is quite experienced, but moved here from South Africa in the past several years, and was therefore setting up a new practice when I needed a new doctor. I have to listen carefully to ensure I understand through his accent, but I *love* how he doesn't rush his visits, readily gives referrals to specialists as needed, and seems to genuinely like treating his patients. He is really great that way.

2. Inform yourself reasonably, relying on legitimate sources. (Major health organizations, serious scientific and medical journals are good sources. Yahoo! answers, patient forums based primarily on personal experience, any site trying to sell your something (medicine, their book, special consultations) or people whose medical work is more celebrity than patient treatment/research should be viewed with skepticism. It is possible they are correct, but look for confirmation from somewhere more legit.)

Informing yourself reasonably can be a hard balance, as it can be easy to assume that every cough is actually your lungs collapsing, every headache a brain tumor. So you have to be aware of the tendency (of everyone) to find symptoms when they look for them, and take it with a grain of salt. That said, if you are able to identify likely underlying causes yourself, you can then inform your doctor of your true symptoms in a way that could be helpful; you can get the necessary tests to rule them out or secure a diagnosis. Similarly, remember it is human nature to give more credit to people with a good record of accuracy, and doctors are people too. So if you are able to limit any "brain tumor" type scares to only ones that are really, truly likely, they will probably pay closer attention.

Also remember that you can do your research and even be quite well-informed about your suspicions, but it is very likely you will not have that kind of depth for the "whole picture". 10+ years of dedicated training that doctor's get before they are practicing on their own is often required for that amount of knowledge. Doctor's can certainly be wrong, but we as patients also can be wrong too, and should make some attempts to heed their advice if it seems plausible. The more balanced you are with your own research, the more likely both you and your doctor can get to the root of the problem.

3. Understand that there are two types of "all in your head" and they are very different. One type, which is more or less hypochondria, is the tendency to be very sensitive to "symptoms" experienced by healthy people, and the tendency to be certain it is really dangerous and/or the tendency to need lots of attention to feel important. This is the "all in your head" we tend to think of the most - "complainers". In some cases, this is truly the problem, and doctors should be providing useful "treatments" like orders to exercise, treat anxiety, desensitization to whatever is bothering them, developing connections in their communities, etc. (Some doctors do a poor job of this and just tell them to "go away" which isn't too helpful.)

The other type of "all in your head" is called "psychosomatic". This means that the symptoms are actually totally real. The pain is genuine, or the vomiting, or stiffness or whatever. The challenge is that psychosomatic issues originate in the head, so treating the symptoms "normally" won't really work very well, and tests showing physical causes will come back normal. It is a legitimate, well-known, but poorly-understood phenomenon. The treatments that actually work in this case tend to be the same ones as above: managing anxiety, any underlying mental health concerns, desensitization, etc. So it can be easy to think that if the doctor looks at blood work, says "it's normal" and tells you to try more exercise or meditation, that they are saying "you're a complainer - go away". It isn't the same thing, and that isn't what they are saying (if they are a good doctor). They are actually prescribing legitimate treatment for verifiable bodily dysfunction. Unfortunately, it is often misconstrued by the patient as their issue being ignored, and can cause frustration and resistance to treatment.

4. Be persistent. In the case where you are really sure you need more investigation, keep asking. In my case, I had to dig to find a really good doctor to take me on. But even he isn't perfect - his front desk staff seem woefully unable to manage good follow up. So, after having consulted casually with another doctor friend and a couple of nurses, I am calling every single day to get an update on my "urgent" cardiology referral that still isn't scheduled. I will keep pestering them until I am certain the wheels are turning, because it is so terribly critical and urgent. I definitely don't do this for every small thing - but this one is different.

And it's a totally worthwhile use of my time in the case of a serious and urgent issue.

Best of luck to you!

[Ullyrunner Graduate]

Sorry you are having such a worrying time of it. No matter how logical we try to be, there is always some fear lurking in the back of our minds when something like this is going on. Hopefully you will have a better idea what you are dealing with next week after your tests. All good wishes.

[Alaiyo Graduate in reply to Ullyrunner]

Thanks Ully. I am definitely fighting the fear with facts, and with only moderate success sometimes. But hopefully it will be cleared up soon. I appreciate the good wishes.

[Alaiyo Graduate]

Thanks so much, Kitty. I think you are very right about the benefits of having a confirmed diagnosis and also keeping connected to the things I find helpful in the meantime. I will probably be much more erratic about posting, but you are absolutely correct that writing is a great way to process, even when I cannot run.