Heart and Soul

Today was my first post-chemo diagnostic test.  One of the agents used in my biweekly chemotherapy regimen, Adriamycin (Doxorubicin), holds an 11% cardiac adverse event rate.  As mentioned in one of my previous blogs, this most commonly causes heart arrhythmias (heart rate issues) or cardiomyopathy (enlargement of the heart).   This being said, the side effects are dose dependent.  The more medication received, the higher the risk of cardiac issues.  However, most people will not incur chronic problems unless having repeated courses of chemotherapy with this medication (only 1.7% incidence rate).  Yet, two factors put me at a slightly higher risk of developing heart issues, my lower ejection fraction before initiating therapy and my hypertension (high blood pressure). 

If you recall, way back to January, my first echocardiogram (ultrasound of my heart) showed a slightly lower ejection fraction (EF), which indicates how much blood your heart pumps to the rest of your body.  It was presumed this was due to an “athlete’s heart” (a phenomena where heavy training/exercise actually reduces EF).  My initial EF was about 50% (normal is 55-70%).  As a consequence of this diminished EF, my echocardiogram was repeated after 2 months of chemotherapy to assure that this EF didn’t decrease any further (a sign of Adriamycin toxicity).  Fortunately, my second echocardiogram came in nearly exactly the same as my initial echo. 

Well, today I received my 3^rd and final echocardiogram, at the conclusion of this treatment regimen.  As I’ve continued to run and walk intermittently, and remained relatively symptom-free and normotensive (normal blood pressure), I remained hopeful.  My pace while running is currently 2-3 minutes slower than my norm and my mileage decreased by more than half (particularly as I have been walking more than running).  Yet, I have not experienced chest pain or shortness of breath with running or climbing stairs. So, I was eager to receive these results. 

It was nearly 5:00, when I received the call from my cardiologist.  “Well,” he said, “I think we can put to rest any issues with your heart from the initial echo.  Your ejection fraction actually improved and is now normal.”  Other than being ecstatic, several theories ran through my mind.   Were the enlarged nodes in the middle of my chest and surrounding my pulmonary artery to blame for my initial poor EF and now they’re gone?  Or did my “athletic heart” get deconditioned from my decrease in running and hard training, helping it to return to normal?  Is hard training and running 50 miles/week actually bad for your heart?  Reviewing the measurements (I always leave with a CD of my own), revealed a 5% increase in EF, actually putting me back into the normal range (barely, but I’ll take it!)  While I’ll likely never know the answer to my questions, I think these results delivered another message. More likely than not, the decrease in my training and intensity resulted in my improved heart function.  While I’ve been meaning to back off for years, once again, I needed a slap in the face to give me permission.  Running, while valuable due to the meditation and reflection time that it provides, can also become an obsession (ok, I know some of you are laughing).  Like vitamins, alcohol, and work, too much of anything can be harmful.  Finding a balance is key.   This will be my greatest challenge in the upcoming months.  But today, I rejoice in knowing that my heart remains strong. 

No beauty shines brighter than that of a good heart.  

The best and most beautiful things in the world cannot be seen or even touched - they must be felt with the heart.  ~ Helen Keller

These 2 photos were taken during recent "runs" (note the water droplets on the rose and antlers on the deer).  I see a lot of beauty (with my heart) on my runs.