Holding Steady
On Monday, I had my stress test at Cincinnati Children’s Hospital. I last took one in 2021. With my congenital heart defect, my doctor likes to assess my cardiopulmonary functioning under intense exercise conditions every other year. In 2021, my results were…fine. Not amazing, not terrible. I lasted a bit short of seven minutes on the bike. As I described in October, I trained up for this one.
From October to early December, I performed high-intensity interval training (HIIT) with my strength trainer on Mondays and my yoga instructor on Wednesdays. I also trained by myself, usually another one to two days per week, rucking on a treadmill or using an exercise bike. For all of them, I trained with a nose clamp on, just like the actual stress test. With my strength trainer, I usually ran sprints. We built up the distance over the weeks. With my yoga instructor, I did a circuit of three exercises (hop jump, mountain climbers, jumping jacks), with rest in between each of three sets. Again, over the weeks, I performed each exercise for more time, with less rest in between each exercise and set.
If I am evaluating myself in the cold light of day, my nutrition behaviors did not match my exercise intensity. I am still not drinking alcohol (today is day 244), which remains a significant positive. But alas, I drank a fair amount of soda and ate an embarrassing quantity of fast food too. (I blame Ale-8 for its delicious Orange Cream and Roxa sodas for my weakness. Not my fault! Right? Right?)
December 11th came. The test proceeded a bit differently than I remembered and related in my October essay.
Unlike in 2021, the doctor wanted to measure my venous pressures, as a rough proxy for pressures in the heart. Fontan patients often have high pressures within the heart and between organs, which in the long-term affects functioning. To take these measurements, I needed an IV. I have tiny veins, which tend to move around quite a bit, making IV access a challenge. The hospital already knew to call in its Vascular Access Team (VAT), which utilizes an ultrasound machine to precisely identify vein location as the needle enters my body. So if the vein rolls, the technician or nurse can follow the roll and still successfully insert the needle.
With the IV in, I headed to the exercise test room. A technician took my height, weight, body mass, and other measurements. Then we walked over near the bike to begin the hookups. He placed a bunch of stickers with wires connecting them to monitors on my chest and side, and a sensor on my forehead. He wrapped all the wires against my body, encircling me with a brown fabric type of gauze, so the wires and stickers wouldn’t move much during the test.
Then I alternately laid down and stood up for a series of resting and breathing measurements. I moved to the far side of the bike for more breathing measurements. Soft inhale, soft exhale. Soft inhale, soft exhale. Biiiiiiggggg inhale, then blow it all out as hard and fast as possible! Push, push, puuuuuusssssshhhh!
Now to the bike. Before pedaling begins, the (now four? five?) technicians and nurses take…wait for it….wait…wait…more measurements. The nose clamp goes on. Breath into this mouthpiece. Now breathe into a different mouthpiece. Now back to the first mouthpiece.
I begin pedaling. Nose clamp on, breathing through one of the mouthpieces. Easy peasy, lemon squeezy. Every minute or so, a tech takes my blood pressure and calls it out. She begins asking me to rate my discomfort on a 6 to 20 scale. Right now, I point to the 6 – Extremely Easy.
The actual test begins! Boom! Go time!
In my October article, I said the incline increased every minute or so. That’s not correct. Every few seconds, the intensity increased by one watt. So it’s a slow, inexorable increase.
Every minute, the tech takes my blood pressure and asks me to point to the number corresponding to the discomfort I feel. My finger points to a 6 then an 11 then a 16, out of 20.
I hear music in my head. Songs, lyrics, beats from my “All-Kick-Ass, All the Time” playlist.
My legs burn. I don’t even notice my breath or the pain in my lungs. I only feel my legs.
The beat builds me up. I tell myself, “Crank the pedals ten more times!” “Five more!” “Five more!”
One of the nurses asks, “Do you have 15 seconds more?” “Yes, I have 15 seconds left.” Pedal, pedal, pedal. Five…four…three…two…one.
I slow down quickly. My legs cry out. Test over.
They tell me to keep pedaling for a little while longer – less intensity, fewer RPMs. They test my breathing through one mouthpiece, then the other.
Then I stop and slowly get off the bike. I sit down. More measurements. I lay down. More measurements.
Two years ago, I felt terrible afterwards. I felt so run down; my lungs burned deep inside. I could feel my heart racing.
On Monday, I got off the bike and felt pretty decent a few minutes later. My legs still ached, but I didn’t feel a burn inside my lungs. I didn’t feel my heart racing. By the time I left the exercise test room, I felt…well, not completely normal, but close.
Maybe I left a little bit of effort in the tank? Maybe the training I did helped with recovery?
An hour later, I met with my heart doctor. The results: almost exactly the same as two years ago.
Two years ago, I felt crushed by the result. Today – I felt fine. As I’ve noted before, even preventing deterioration counts as a win. So, same results but me being two years older? I’ll take it.
Maybe all my effort leading up didn’t show up on the test, but appeared through quicker recovery. Maybe I wouldn’t have done this well but for my training.
I’ll never know the answer. Holding steady: not the victory I imagined, but still a worthy achievement.
Friend, during this holiday season, can I make a request? Would you share Solvitur Ambulando with a friend, colleague, family member, or two? Or three? Or seven? I would appreciate it very much. Happy Happy Holidays!
Thanks to Anthony Pica, Jude Klinger and Simoun Redoblado for editing this essay.
Image by Midjourney.