This was to be the week of a few easy runs and lot of carbs. It was time to enjoy my hard work and get psychologically ready for the race--the California International Marathon (a point to point race from Folsom to Saramento). I had been battling sciatica in my left leg and buttock for several months but I was hoping that it would be in check when race day came that Sunday and I could relax during my "taper" week.

On Monday, I flew up to Vancouver to speak at the Vancouver Technology User Group on LINQ. Turned out to be a great meeting with about 50 people attending the talk. I flew back to Seattle, grabbed my car from ShuttlePark2, and got back to work around 11 AM on Tuesday. I met with my boss, Scott, and a co-worker, Brad, at 1 PM and we decided to respond to an RFP (request for proposal) that we had been considering going for at the meeting. It was not going to be terribly complex proposal, however, the big issue was that it was due the next day (Wednesday) at 1PM and we hadn't started it. Furthermore, I had to write the guts of the document--the technical proposal. This meant dropping several other pressing projects and pushing real hard to get the work done. I ended up working until around 4:45 and then drove to a play my daughter Anna was in. The play was great and after helping get the kids to bed I continued to work on the proposal at home until about 10:30 that evening.

Work can be a Real Pain in the Neck
On Wednesday, I got into work early, getting there just before 7 AM and managed to get the technical proposal done about noon. I was pretty stressed about the proposal and the work I was ignoring to finish the proposal, still I rose to the occasion and I was proof-reading my work at about 12:15 when all of a sudden I started experiencing pain--actually pressure in my upper chest and neck. I stood up and walked around a little but the pain continued. I completed my part of the proposal and was going to assemble the final document from the other pieces that Scott and Brad were preparing. But I was beginning to get quite concerned a bout the chest pain so I asked Brad if he'd assemble it and send it off and walked into Eileen's office, shut the door, and asked her if she could drive me to the Emergency Room. Eileen was great; she immediately dropped whatever she was working on. I got my jacket and we headed for the door. On the way out, I asked Scott if everything was okay with the proposal and he thanked me for my work. I didn't mention the pain (other than I was feeling ill) to anyone else at work.

I called Suzanne on the way to Swedish. She was of course quite concerned and I told her I'd call her back as soon as I knew something. Eileen dropped me off and I told the clerk at the ER desk I was experiencing chest pain. I graded the pain as a 4 on a scale from 0 to 10. Fairly quickly they whisked me off to a cubicle and attached 12 electrode leads to various parts of my body and performed an ECG. The ECG looked good, which relieved me but it wasn't over that quickly. I used to work in cardiology research and I know that chest pain demands a very rigorous protocol, especially if the patient is a 50 year old male or in some other high risk group.

Chest Pain Protocol 101
So I was moved to a ER room where I stayed for about 4 or 5 hours. A continuously monitored ECG was attached as well as blood pressure cuff, a device that clamped onto a finger which measured pulse and blood oxygen, and an oxygen tube was inserted into my nostrils. Next an IV was started in my right arm and four vials of blood were taken. From the blood, a number of tests were run including several enzyme tests which check for heart muscle necrosis. One of the tests was actually done in the room by a tech using this device that measured about 12 by 3 inches. Like all the other tests, it was negative. Soon after a doctor visited to ask me a number of questions and schedule me for a chest x-ray. When I returned to my bed from the X-ray, they asked me where my pain was on the scale. When I got to the hospital, I noted it as 4 on a scale of 1 to 10. But it had mostly subsided by now--I now scored it a 1. The doctor had the nurse give me an aspirin and some nitroglycerine. The nitro has a dual purpose: to relieve the chest pain, but it is also diagnostic since if it does relieve the chest pain, that tells the doctor it was likely cardiac in nature. The nitro did not affect the pain, which as far as I was concerned was a good thing.

Since the pain was still there, the doctor ordered morphine to be given to me through my IV. I tried to decline, arguing the pain was so small at this point that it was unneeded. The nurse didn't take no for an answer and the morphine was given along with an anti-nausea med. I noticed my pulse, usually in the 50s went into the 40s after the morphine and I felt queasy.

Soon after this the pain was gone; all told I experienced chest pain for about 2-2.5 hours. I remained in the ER bed for several additional hours. I have to say that I was quite uncomfortable; all the various attachments reduced my mobility and it was pretty much impossible to get comfortable.

A Joy Ride
Around 5 PM, they decided to admit me to the hospital. Unfortunately, this meant being transferred by ambulance to the Cherry Hill Campus of Swedish (the old Providence Hospital). So my dignity was lowered a bit more while the ambulance crew transferred me to an ambulance bed, strapped me in and hooked me up to a different set of instruments. The ride took about 15 minutes whereupon I was wheeled to the Cardiac Telemetry unit on the third floor of the hospital.

Not Exactly Carbo Loading
So even though everything was normal, I had to spend the night at the hospital. Fortunately, the accommodations were much nicer at the Swedish Cherry Hill hospital room (private, by the way) than the cramped ER room. And I was detached from the oxygen, bp, and finger doohickey, plus the ECG hookup was considerably less intrusive. And I could order dinner! But I was put on a cardiac diet. So here I was in the hospital on Wednesday night, 4 days prior to my marathon, plotting how to carbo load on a cardiac diet in a hospital. Anyway, dinner wasn't half bad but it was a little lower in carbs (and no caffeine) than I wanted.

The cardiologist, Dr. Paul Huang, came by before dinner and told me everything was okay and that they would do two more sets of enzymes (read that two more blood draws) and then if everything was still normal in the morning, he would release me. After releasing me, he wanted to schedule me for an outpatient stress test and echocardiogram at his clinic on Friday. I told him that I was leaving town on Friday to fly to Sacramento for the marathon. Was there any way we could do the test on Thursday instead? He said he would see if he could fit me in on Thursday.

Suzanne came for a visit after dinner and asked me if I needed anything. I asked her to get me a latte from the Starbucks in the lobby. She first checked with the nurse and initially he said no until she explained it would be decaf. The latte was great and so was the little bag of nuts and stuff that she bought me too. Suzanne stayed for another hour or so and then headed home.

Sleep that night was less than optimal. I pretty much had to sleep on my back because the lead patches made it difficult to sleep on my side. Plus, they woke me up at 2:30 to weigh me, take vitals, and draw two vials of blood from a fresh poke in my left arm. Why the heck they weighed me at 2:30 in the morning is beyond me. I think it has something to do with how my GI system was working.

At 8 AM or so, I ordered breakfast. Shortly, thereafter, Dr. Huang, filled out my discharge paperwork and told me I was scheduled for a 10:30 stress test. The nurse informed me that I couldn't eat before the test so breakfast was cancelled. By the time they unhooked me, removed my IV, and I took a shower, it was more like 9:15, so headed to the Starbucks in the lobby where I did some reading (but no eating or drinking) until it was time to check in for my test which was in the James Tower next to the hospital.

The Stress Test
I checked in at the clinic a little early and after the usual paperwork was escorted into the stress test room at about 10:25. The two young techs asked me lots of questions and explained to me how things would work. They wondered why I didn't bring sneakers and more comfortable clothes since I would be walking and maybe running on the treadmill. I explained that I was just discharged from the hospital and hadn't had a chance to go home. I removed my shirt and they proceeded to hook up lots of leads. I was flattered when the two twenty-something techs double-checked that they had the right chart since I looked much younger than 50. At this point, I think this was the fifth set of ECG leads that I had been hooked up to. There was lead glue all over my body. Anyway, I then lay down on a table where they took ultrasound pictures of my heart -- the so called resting echocardiogram.

The echocardiogram went on for about 30 minutes. The techs remarked that my right heart chamber was enlarged but that that was normal for an athlete. A nurse then came into the room to give me the treadmill stress test. I was worried about having to run in my shoes, so I took off my shoes and socks for the test.

Based on my age, my goal was to walk or run on the treadmill until I hit my target heart rate of 145. The rate is calculated based on your age. By now, they knew I was a runner and that I was planning on running a marathon on Sunday so they were sure the test was going to take a long time since athletes' hearts start at a lower resting heart rate and take much more exertion than the average person to elevate the rate. So I hopped on the treadmill in my blue jeans, no shirt, no shoes, and no socks but a whole mess of leads coming off my chest and a blood pressure cuff attached to my arm for good measure.

The standard cardiac stress test is made up of seven stages of three-minutes in duration. With every change in stage, the belt goes faster and the incline gets steeper, thus stressing your heart more. Most people are done by stage 3 or 4. In fact, the tech who had been there the longest mentioned that no one had ever completed stage 7 or even started stage 7 in the three years she had been administering tests. She had heard of another tech witnessing a completed test but it was a very rare event. They explained that once I had gotten to my target heart rate, they needed to stop the treadmill and I needed to hightail it over to the echo table so they could take more pictures of my heart at the target rate. But once again, since I was an athlete, my heart rate was expected to recover very quickly so it might be smart if I went over my target rate. How far over, they never really said.

Stage one barely nudged my heart rate into the 60s. In fact, I think it wasn't until stage 3 that my heart rate exceeded 100. I'm not sure when, but between the discussions with the nurse and the techs, I decided I wasn't going to stop until the test was complete, that is, until I got through all seven stages of the stress test. I got to my target heart rate during stage 4, whereupon I was told I could quit but I said let's keep going. With each new stage, the nurse would ask me if I wanted to continue, and I said yes. The techs were excited because, it looked like I might go all the way, and that for them was quite interesting. At this point, I knew I couldn't stop until I had gone all he way, unless, of course, I had some cardiac event or was just too exhausted to go on.

At the start of stage 7, my heart rate was about 170. (About a year ago, I had done a VO2 test at Real Rehab. This is a running treadmill test that I used to help plan my training and set the zones on my Garmin heart rate monitor watch. Based on that test, we had calculated my max heart rate at about 185.) At this point, I blurted out that I would stop when I got to a heart rate of 175, worried that I perhaps could not make it to the end of stage 7 but when I got to 175 with about two minutes left, I changed my mind--let's go all the way. The techs were quite excited. My heart rate got up to 182 as the full 21 minute test was completed. Now the trick was to get off the fully inclined treadmill and over to the echo table without falling. Not only was it hard to get off the table, but I was reminded that I might feel dizzy. In reality, I wasn't dizzy at all and quickly made it to the table whereupon they started the stress echocardiogram.

The stress echo was done in about 10 minutes and then I got to sit up and watch them review the results while I tried to towel off some of the sweat that was pouring off my body. Amazingly, they were able to get the first pictures while my heart hate was still at 182. And the results looked good. Nothing from my ECG, blood pressure, or echocardiograms looked abnormal. In fact, according to the techs and the nurse, I had the heart of a sixteen year old! I think that might have been a bit of an exaggeration but hey I wasn't about to argue. On my way out another tech blurted out congratulations. Apparently, word had gotten around that I had completed the test.

I got dressed and called Suzanne and asked her to bring me a fresh set of clothes because I was a sweaty mess. I then walked over to Starbucks and got my requisite split-shot venti non-fat latte along with a bagel and cream cheese. No latte ever tasted so good! Suzanne picked me up and dropped me off at work with my change of clothes at around noon on Thursday. I went to the locker room in the basement of our building and showered and changed and then went back to work.

At about 2PM, the stress test nurse called me to tell me that Dr. Huang had had a chance to review my stress test and echocardiograms. Everything looked great and I should run my marathon on Sunday! I worked until 7 PM that night, drove went home to pack for my trip to Sacramento the next morning.

The Marathon
I flew to Sacramento on Friday to run in the California International Marathon on Sunday. I visited the expo on both Friday and Saturday and got together with several running buddies from Seattle before the race. All in all, I felt pretty good going into the race except for some GI troubles and the fact I got little sleep the night before the race. I ran the marathon on Sunday. I was hoping for a Boston Qualifying (BQ) time of 3:35 but alas the one thing I really feared did end up bothering me. I was on BQ pace and hovering between the 3:30 and 3:35 pace groups through mile 20. But around mile 20 the sciatica pain became too much; I could not maintain the 8:12 pace I needed to qualify at 3:35. I had to stop and stretch and walk. This continued for those last 6 miles: Stop, walk, stretch, start running again. Stop, walk, stretch, start running again. But I wasn't going to drop out, that's for sure. I finished that day with a time of 3:50, not what I had been hoping for, but not bad for a guy who spent Wednesday night in the hospital for chest pain.

PostScript
Although I might have felt foolish, I did the right thing: checking into the ER when I experienced chest pain. I had someone drive me, but if the pain is especially severe or you are alone, you should call 911! The signs and symptoms of heart attack and stroke.