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Saturday, May 12, 2018

When legs simply don't show up 3 - Looking for answers


I walked into a GPs room early in March 2017 knowing that I was there only to get a referral to a medical specialist – but at the time I thought I would probably be referred to an endocrinologist. I had over a few weeks, already ruled out many possibilities…. Mostly I believed very strongly that I was not injured, had no fatigue (nothing in my training history pointed to excessive training) and I was still reasonably fit. What I suspected was that my body had lost its ability to produce hormones that should prepare it for rigorous efforts. The fact that I developed symptoms only during training was a vital clue. After listening to my story (one that I would relate many times over), the doctor referred me to a Sports Medic.

The length of time between my perception of “the symptoms” and the Cape Town tipping point was more than sufficient for me to be very articulate about what I felt was wrong. I was able to clearly explain to the doctors that:
I have problems maintaining a heart rate of about 150bpm for up to 3 minutes
- After about 3 minutes above 150 bpm, I am forced to stop as I develop extreme fatigue that leads to pain on the calves;
- The fatigue later gets to the quads and hamstrings;
- In some instances, I reach a point where my feet get numb – especially when I am on the treadmill and on the stepper when I spent about 1,5 hours training;
- The symptoms are greater at the start when I have not warmed up and get better after about 30 min of exercise. The pace gets slightly higher and I can manage the climbs a little better but after about an hour and a half, my performance declines again;
- On the bike, I can barely keep up on climbs with the most under-trained people I know. On flats it is much better when I have not fatigued. On the bike, the quads take the most strain;
- I have gone from an FTP greater that 200W to below 100W. In recent times my best power output is 85W average over 1 hour,  at an average heart rate of about 125 BPM;
- I find cycling easier; Running presents the most struggle and I feel the effects (fatigue) many hours after the run – even under conditions where I was taking periodic rests.

Painful needling for my tight calves - 5 needles on each leg

After going through my sporting and medical history with my Sports Medic, the first tests I was prescribed were “bloods”. While I waited for the blood test results, I was also referred to a physiotherapist to assist with the tight calves and to rule out any possibility that they could be the cause. He was shocked at how hard they had become and so a very painful course of dry-needling followed.

The blood tests were all “negative” except one test which was of concern - CK-MB (Creatine Kinase MB) that was high. I was asked to take aspirin and immediately I noticed the next day that I was able to complete a 1 hour indoor cycling session without stopping. I did not perceive any improvement in the running though. Because of the high CKMB dosage, I went for an ECG Scan. I could not complete the scan and the highest heart rate I was able to reach was around 155bpm. We had to abandon the test as my calves were too painful.

I was then referred to a Cardiologist who conducted another ECG (even though I had one already), additional bloods and an Echo (Echocardiograph) – once again I could not reach heart rates higher than 155bpm on the ECG.  He also checked pulses from my arms down to the legs – but at rest, they turned out identical.
Next I did a Doppler Ultrasound, at rest, and after many attempts, unfortunately the doctor could not pick up restricted blood flow. The doctor also spent a lot more time trying to see whether she could pick up Popliteal Artery Entrapment Syndrome (she had a patient that had the syndrome) and again the results were negative.

I was then referred to a Vascular Surgeon and after considering all my history, prescribed a CT Scan, and again this did not provide any leads. The investigation then proceeded to an MRI scan and this time around I persuaded the radiologist to allow me to run up and down the stairs until I induce the symptoms. Again the scans did not reveal anything actionable.
We had sort of reached a dead-end and the advice I got from the Surgeon was that I continue with my training regime and wait for the problem to get worse, hopefully in another 6 months, we could start with another series of tests, starting with the Doppler.

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