asthma

asthma sucks. i went out for another run today, and it sucked too. because of my asthma. it was about 11 degrees colder and about 4 hours earlier than friday's run, so i'm not sure what i was really expecting. but lemme tell ya, it was damn cold out there. cold and very windy. so much so, in fact, that my 'run' wasn't. it was a walk. and not even a fast one at that. so see - asthma sucks.

since i was diagnosed at the age of 2, i've been able to fine tune things when i'm having an asthma attack. when i was little, as is the common reaction, i'd panic. this doesn't help. actually, it's the worst reaction possible. now that i'm older, i liken it to scuba diving. when you have your very first scuba lesson, they will take you into very shallow water first. they'll tell you what to do, how to breathe, and even warn you that you might panic. you bite down on the plastic and go under. and for the first 5 minutes or so, you fight your body's natural fight-or-flight response. you have to talk yourself down and concentrate on breathing through your mouth. those first five minutes are similar to an asthma attack. you know your triggers, you find yourself in the midst of one or two or all of them, you feel your lungs shutting down, and you have to fight to remain calm. in my younger days with ignorant coaches, my mom used to scream at them to go run a mile with a paper bag over their head to see what it feels like. this is a pretty good analogy as well, especially if you have the intelligence to realize the oxygen within said bag is quite limited.

the annoying part about today was that my body itself was cold, but my lungs were completely shut down. it feels like you're in a girdle, and you can't expand your chest cavity enough to get a deep breath. one of my triggers obviously is cold weather. it takes my lungs about 20 minutes to become acclimated in such cold weather. and maybe 'acclimated' is a misnomer, seeing as how my lungs never become fully functional again while still in that environment. for example, today, even after my 20 min, i wasn't able to run. i tried. knocking my HR up in the midst of an asthma attack never goes well.

asthma is one of the 'air-trapping' 'reactive airway' diseases, under the same umbrella as emphysema and COPD. it's counterintuitive. the alveoli (the end of the road as far as the lungs are concerned, the place where gas exchange occurs) fill up with oxygen, to the point of becoming bloated and can't take on anymore. the airways inflame and constrict. what you feel is that you can't get a deep breath, you can't breathe period. this is bad, because you end up breathing faster as compensation, which causes you to even further air-trap in hyperventilation. what i tell my pediatric patients is that they should try to blow up a balloon, or try to blow out a candle a few feet in front of them. the goal being to express all that trapped air. my dad, who used to be an avid marathoner, told me when i was little that while running, and especially for me and my asthma issues, i should try to make my breaths out last more steps than the breaths in. the reason this particular trick didn't work today was because cold is one of my triggers. so regardless of how much control i had over my breathing, i was still breathing in very cold air. cold is a vaso/bronchoconstrictor. i was screwed the minute i stepped out the door. evidently my time in alaska taught me nothing about cold air.

so the lesson we learned today, boys and girls, is that charrissa's lungs have a very definite temperature restriction (pun intended), and it lies somewhere between 45 and 34 degrees. good to know.

CUIDADO from colorado springs

title explanation: i'm down in colorado springs with dave, and on my run today along Fountain Creek there were a bunch of signs posted everywhere about the dangers of falling into this creek, which was only about 2 feet deep. granted, yes, with runoff i'm sure it can get a little more dicey, but i still found the plethora of signage comical. more on my run later. first:

update on medical issues: the great Dr. Mandelbaum and his minions at SMOG have come up with a plan for my knee. for the time being. he says/thinks/knows i will have to have surgery. i have new calcification now, and there’s a definite mess inside the joint. however, to buy me some time, the current plan is to inject my knee with my own Platelet Rich Plasma and synthetic synovial fluid. i’ve already tried the synthetic fluid once before, but it didn’t make much of a difference. since my fitness is much more refined now, i’m hoping it works. as a nurse i was very interested in the PRP injections, hadn't heard about it and i think it's absolute genius. they literally take blood out of your arm, spin it down in a centrifuge, and inject the concentrated plasma back into the joint. very cheap procedure, and supposedly somewhat effective. as for my heart, my labs came back normal (anemia notwithstanding). my Echo also came back normal, so far as i know. with docs, no news is good news. so, we’re pressing on. may get a 24 hour round or 2 of halter monitor wear, but that’ll be decided next week.

i’ve found it very difficult lately to get myself started with training. i’ve had a total lack of motivation. it feels like life is yet again a roller coaster, and there’s no one around to tell me when the hell to get off. it’s getting very frustrating. and i know at some point i’m just going to have to take charge and get started. today, the minute i landed in denver, i wanted to go for a run. and i was excited. so, an hour after making it to colorado springs i was out on the road. had an awesome 1:30 run along a creek here by the hotel. the path was mostly dirt, which was awesome, and it was a constantly changing terrain, up and down and up and down. i’m back to crap running again, my HR is through the roof regardless of speed. and i still only have one speed. i’m alternating run/walk so as to maintain a decent HR average overall, and for once i found myself losing track of time. and this was during the run portions, that’s never happened. i’m usually watching my watch like a hawk. my goal this weekend is to completely relax. i’m on vacation. i want to workout and have a good time at it. hence my 1:30 run. my other goal of the weekend is to ensure my workout load this weekend carries over into this next week. i need to get the ball rolling. and dammit, i’m going to make it happen. i still can’t believe at the end of this year, i hopefully will be an ironman. the swim and run aren’t anything that bother me, it’s all that damn marathon at the end. so, mentally, i’m avoiding it, still. denial is quite powerful, ask any mental health professional. vineman is coming, all to quickly for my liking. i have to run a half marathon. dave recently did the LA half marathon, and stuck to his goals. i’m still so envious of people who can run. especially those who make it look so easy, and are obviously having a good time. i'm sooo tired of saying stuff like that too. i want to be one of those people i'm so jealous of! so, i'm going to make it happen. this is going to be the season i become a 'runner'. i've decided. it's official. so there.

the heart of the matter

last tuesday dave went north for work. that evening, after work, when i was about to go to sleep, i felt some palpitations. for the layperson that's when you feel your heart skip a beat, or that flutter in your chest. this isn't exactly an abnormality. i have them every once in awhile, but i don't think much of it, and it's always before i drift off to sleep so it's easily forgotten. wednesday came, and throughout the day i felt them again. thursday, more of the same. so much so, in fact, that at work it was so pronounced that i hooked myself up to our unit's crash cart and printed out strips. i sat in a dark room, amongst resuscitation drugs and rocking chairs, quietly for 25 min. in that 25 min, i had 14 PVC's (premature ventricular contractions - the bottom chambers/ventricles of your heart contracting on their own, without coordination from the top/atria = incomplete filling/emptying of the heart). at that point i freaked out. i know they're harmless. but after days of them, and after 14 in 25 min that were right there in front of my eyes, i thought it time to see a doc. so i spent 2+ hours down in the ER, which, if i may say so, was the most tremendous waste of all time. i go down there, in my scrubs, name tag on, stethoscope around my neck, couldn't possibly look more like one of 'them' in the ER, yet i still waited. and waited. throwing PVC's the whole time of course. dave did his best to talk me down from 1000s of miles away, but not a lot was helping at that point. when i did finally get to a doc, he was purely infuriating. he stated that PVC's are harmless (knew that), he stated that in 90% of the time labs aren't indicative of anything and therefore would be a waste (WTF?), and that he recommended i wear a halter monitor for at least 24 hours to monitor everything, but that i wasn't a Kaiser member so getting me one ordered through all the red tape would be really difficult. so what the hell DID he do for me, you might ask? well, he did jack shit. nothing more than anger me.

wednesday's strip:

luckily i found a doc through my insurance's website that afternoon and made an appointment for friday. it was time for my yearly physical anyway, and i was SURE that the PVC's would be gone by the time i went to that appointment anyway. friday rolls around and they're still there. by this point i was just purely depressed. even though i knew i was having them still, all i wanted was to blow off my appointment and take Izzy out and ride on PCH. but i didn't, i knew i had to go to my appointment.

the appointment went well, the doc was awesome. he drew 3 vials of blood with at least 10-12 different tests, did xrays and even a urinalysis. he also ordered an Echo (ultrasound of the heart) and made an appointment for a week later to discuss my lab results. so, thursday i have my follow-up appointment with Mandelbaum about my knee MRI, followed by my lab discussion with this new doc. the following day i have my Echo.

i have no idea what this all means for my training. i have never had issues beyond my control. mine have always been injury related, such as my knee and last season's plantar fascititis. i was driving home this past week one night, and i started thinking about the safety of going on a run. PVC's themselves aren't harmful. no, the nurse in me knows that. however, the nurse in me also knows that PVC's can occur at any given point in the electric/filling cycle of the heart. there's one place in particular that if a PVC hits, the results are very bad. and without knowing the cause of said PVC's, it's hard to figure out what's safe and what's not as far as daily activities. while at work saturday, i hooked myself up again to the crash cart and documented another 11 PVC's in 25 min.

saturday's strip:

i decided that night to compare the look of both sets of printouts. without going into too much medical jargon, the thing i'm worried about is that saturday's PVC's are all very uniform. with heart function, there's a regular rhythm and a regular rate. you can have irregular rhythms and rates as well, of course. saturday's strip is exhibiting a regular irregularity, meaning that the PVC's themselves are irregular, but their timing and their conduction/wave shapes are uniform. this freaks me out beyond belief because they're becoming normal.

i've told dave, i'm sure i'm just freaking out over nothing. a family friend of mine has lived with full-on atrial fibrillation for the last 30+ years of his life. translation - his heart beat is NEVER coordinated, his heart literally just quivers, the top and the bottom chambers just firing sporadically. granted, this man is NOT an athlete, nor has he been for years, but still. there are numerous 'thought to be causes' of PVC's, including stress and caffeine consumption. obviously i've switched to decaf, something i did about hour 15 of this PVC marathon. for once in my life i don't really find myself under that much stress.

today i just finally said fuck it and went for a run. the sun has been shining, the temp as i was driving home from lunch was 77 degrees and the sun hitting my skin felt amazing. the run went relatively well, aside from some asthma issues, as usual. it felt good to get out there. life goes on.