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.
