My Last Mountain Bike Ride....

for the next 32 days and who knows how many hours and minutes.

Some of you know and some of you do not, tomorrow I am getting the hole in my heart patched up.  If you remember last May we discovered I have a PFO, well it turns out this is not the case, and luckily we found out before anything serious happened.

I haven't said much about how I have been feeling, the past few months, because it's not something I have wanted to talk about.  But since my last race in October I have not been myself.  I have been able to ride 2 times a week and that was it, and most of the time I was extremly fatigued.  I was so happy in December when we found out finally what was causing the low blood pressure, fatigue and everything else.  What I didn't let you know was when I had the seizure and my heart stopped during my table tilt test, I didn't fully recover for a good week--things were not great.  By the time I started to feel better I had my nose surgery.

As most of you know the nose surgery went well, but it took 2 weeks to get out of bed, and another week of half days before I felt really good.  What I didn't write about was what happened 2 weeks after my surgery.  It was the final day of recovery, and I was feeling pretty good.  I was cleaning the house and preparing to go back to work the next day.  As I was doing all of this I all of the sudden got a thunder clap headache.  The headache was so bad I could not think--all I wanted to do was lay down and hope the pain would go away.  I did this, and fell asleep, but do not recall the falling asleep part.  When I woke up a few hours later I was numb on the left side of my face down to my arm.

At first I thought I had slept funny, but after time passed by it remained numb--like novacane from the dentist.  Royce and I decided I probably should go to the hospital and have it checked out.  I went reluctantly, because I did not want to bother the hospital.  I figured I would be fine, but was not 100% positive.  I think I wanted to be fine, and did not want to acknowledge something was wrong.

At the hospital, they did some tests.  I had a CT scan, and xray and eventually an MRI.  All of which was to see if I had, had a stroke.  You see the symptoms I had were classic symptoms of a stroke.  Lucky for me I did not.  I did have an infection in my nasal cavity, and a lesion on my brain.  These 2 things got me sent to my ent the next day, and then a referral and appointment to the neurologist.  The ent gave me a special antibotic spray, and got me in to the neurologist within 2 days.

At the neurologist we discussed my past medical history.  I also was able to show her my MRI from last May to make a comparison.  What was noticed was the lesion was there before, but a little bit bigger, and there was more white matter.  Not a lot, but a little.  She knew I had a PFO, so she recommended I see Dr. Sherman Sorenson a cardiologist in Salt Lake.  He has worked on many PFO's (thousands) and knew he would be able to help me.  I was able to see Dr. Sorenson in about a week.

At my appointment with Dr. Sorenson I underwent another test, called a Trans Cranial Doppler test.  The test is a new test which measures brain artery blood flow by using safe ultrasound echo probes placed on the surface of both sides of the head.  If microscopic bubbles injected through an IV shunt past the lungs to the left heart, TCD detects and counts each bubble as it appears in the brain arteries.   When the test is over you are then given a rating from 1 to 5, with 1 being no bubbles get through, and 5-300+ bubbles getting through.  I was a 5 plus.

What this means is I am at high risk for a stroke, and I do not have a PFO.  Instead I have a fossa/fassa (I can't remember the spelling even though Dot told me).  A fossa is a hole without the shunt.  Which means even when my body is at rest I can have blood pass through to my left atrium, and skip going the right direction.  Which as I said means I could have a stroke.  The technical term is Atrial Septal Defects (ASD).So what needs to be done?

I am currently taking Plavix.  This is a blood thinner, which causes bruising and a few other side affects, but is worth it so you reduce the risk of a stroke.  The other thing I need to do is get the hole plugged up.  That is what I am doing tomorrow.

Tomorrow morning the doctor is going to go up my femeral artery and measure the hole with a balloon.  From there he will get the right size of patch, go back up and put the patch in place.  And I will not be fully sedated for the whole thing!

Once it's done I have to stay in the hospital overnight, and then will be released the next day to do normal activities as long as there is no physical exertion involved.  I am not allowed to ride my bike for one week.  After one week I can ride, but must take it easy, and I cannot lift anything over 50 pounds.  Also, there is no riding my mountain bike for a month!  I am somewhat bummed about no trail riding, but at least I will get to ride something after a week.

So what does this mean?  It means hopefully my low blood pressure and stuff will partially resolve.  It means I can start riding regularly and start losing all the weight I gained from lack of being able to ride.  It means I should have more energy and not feel so fatigued--my circulation should be better as well as my breathing.  The best part it means I have greatly reduced any chance of a stroke, and by doing so I will have many more mountain bike rides to come and longer to be with my family.
Pictures from my last ride on the BST...at least for 32 days.

Results

I received the results from my holter monitor. The good news is my heart is very healthy. I had a maximum heart rate of 180 during the race--for 40 minutes. My doctor thought this was crazy, but I explained Sundance is up hill--he still thought I was crazy. There were a few other things, but basically my PFO has nothing to do with my low blood pressure, dizziness, fatigue and the need to pass out.

The next step is completely hypothetical, but the doctor wants to try this next. Because I had significant weight loss over the past year (45 pounds) he thinks this may have to do with my veins. He tested my blood pressure laying down, sitting up and then standing up. When I stood up my blood pressure dropped 15 points. This is a symptom of the vein problem. To see if this is the problem he has started me on a medication for 30 days to raise my blood pressure. I have to take my blood pressure daily in the 3 different positions. If the blood pressure levels out, the dizziness subsides, fatigue and passing out then I will see a vascular surgeon and have some veins closed off.

I am a little discouraged because with the PFO we hard a solution. Now we are back to trying to figure out what is the cause. I guess the good news is at least my doctor is trying to figure it out, and right now I need to look at the good news so I won't get too discouraged.

I'm Hooked Up

I got my holter monitor today for a 24 hour read of my heart. There is a lot more involved with a holter monitor than I thought. I thought they would put it on me and then I would bring it back 24 hours later. Not the case.

First of all you have to write down almost everything you do and when you do it, and I mean everything! If I go to the bathroom I have to write it down. Eat write it down. Have a strong emotion write it down. When I sleep and when I wake, write it down. Anyway, you get the picture.

There also is the magic button. Should I feel dizzy, lightheaded, pass out, heart palpitations or short of breath I should push the button. I am not quite sure how to press the button if I pass out, but I will make sure to write it down.

Tomorrow is a race. I am climbing up to the top of the chair lift at Sundance. I am pretty sure I will feel short of breath as I climb to the top, and when this happens I need to press the button. I suspect during the race I will be pressing it a lot. So as you ride by and see me grab my side don't worry. I am just trying to ride fast and find the button to push.

I will keep the monitor on for a few hours after the race. Then take it back to be input and read. I think the results will be interesting, and I can't wait to see how they turn out.

The Diagnosis

As a few of you know I have not been up to par lately. I have been recovering from being sick, fatigue and very low blood pressure. These symptoms actually showed up last year at the Snowbird race, at the time since it was not affecting my every day life so my family doctor was not too concerned, although it was affecting my riding and racing, but it was manageable. Recently though it is affecting my every day life, my riding and most definitely my racing, so off to the doctor I went. As I wrote previously the doctor did a lot of tests, and when I left off we had just finished with me having an MRI.

As predicted my MRI came back normal, except according to the doctor it did show I was a bit of a blonde. My doctor has a great sense of humor. However, the MRI gave a small indicator that I needed an echo-cardiogram. The appointment was set for me to go to cardiology on Monday and have an echo-cardiogram with a bubble test, so on Monday I went.

For those who have never had an echo-cardiogram it is a painless procedure. They put 3 patches on you with electrodes coming out of the patches that attach to a machine. Then they put a gel on an ultra sound wand and place it over the heart area. It is cool to see the heart and what it looks like. I got to the the valves and the left and right side of the heart. After about 45 minutes we then did the bubble part. This is also painless except for putting the IV in you. That usually is not so bad, but the technician missed my vein, and it took everything I had to keep from yelling out as she moved the needle around trying to find the vein. Please just quit when you don't get it, don't keep sticking the needle around trying to see if it is there. Luckily she got someone to come in for the second attempt, and he made it on the first try--I did not want to go through that again.

So back to the bubble part. It takes 2 technicians do the bubble part, one to administer the saline solution and one to continue doing the ultra sound. What they do is shoot a saline mix into the IV, as soon as it goes in you can see it the mixture immediately go to your heart it looks like a whole bunch of little bubbles. Imagine then how quickly drugs get to your heart. I thought it was really cool to see the bubbles go through the 3 different holes in my heart. You could see the valve open and close. It is really cool watching the heart at work. The technician ended up having to shoot the solution in a second time. The second time as he was prepping it he ended up showering me with some of it. I guess I needed a mini shower. After the bubble part we were done. The technician told me it would be about 5 business days before my doctor would get the results. I had an appointment with my doctor the next day, but oh well, maybe he would have something new to tell me.

The next day it was back to the doctor's office for a 2 hour wait and then a visit with the doctor. Well, guess what....the results from by echo-cardiogram were back! The doctor had the report and wondered if the tech told me what she saw. Of course she didn't, but in this case I think the doctor would have been fine with it. He and I read the report, which by the way is not written very well. The results showed I had a Patent Forma Ovale (PFO).

The foramen ovale is a small hole located in the atrial septum that is used during fetal circulation to speed up the travel of blood through the heart. When in the womb a baby does not use it's own lungs for oxygen-rich blood, it relies on the other to provide oxygen rich blood from the placenta through the umbilical cord to the fetus. Therefore, blood can travel from the veins to the right side of the baby's heart and cross to the left side of the heart through the foramen ovale and skip the trip to the baby's lungs.

Normally the foramne ovale closes at birth when increased blood pressure on the left side of the heart forces the opening to close. If the atrila septum does not close properly, it is called a patent forament ovale. This type of defect generally works like a flap valve, only opening during certain conditions when there is more pressure inside the chest. (reference)

Basically what this means is I have a hole in my heart. Which accounts for the 3 holes I saw on the echo-cardiogram. At the time I didn't know what I was looking at, but once I read the report it all made sense. I am so happy to know what I have. I have told friends, family and others very excitedly, because it is a solution. My husband thought it was funny I was so excited over a heart defect, but actually it is nice to know what it is and there is a solution. Now for the solution.

The next step is going to be to wear a halter monitor for 24 hours moitoring what my heart is doing. The doctor wants it on me for a race to ensure a good mixed reading--guess I won't need a heart monitor that week. We decided the Sundance race would be the best. One because it is coming up soon, it is a good uphill climb and higher altitude. Hopefully it will show what goes on before I race, during a race and after.

After the race I don't see the doctor for awhile as it takes at least a week to read the results. Once I see him we'll decide what direction to go. But the good news is although I have a hole in my heart it is very fixable!!!!