Wednesday, February 3, 2016

Heart Questions from the EC Campers

by Larry Creswell, M.D.

I had the opportunity to attend the recent Endurance Corner training camp in Tucson. I had a great time.

For me, one of the highlights of the week was the chance to give an after-dinner presentation one evening on triathletes and heart health. I shared three athlete stories from the past year that had caught my attention and illustrated some important points. We had a lively discussion about issues like sports-related sudden cardiac death, the possibility of too much exercise causing harm, and triathlon race fatalities. We finished on a bright note by recognizing 92-year-old Bill Bell who will be inducted into the USA Triathlon Hall of Fame this year. He took up triathlon at age 60, had a pacemaker implant at age 76, and is still active today after more than 300 triathlon races. As the saying goes, the heart takes a lickin’ and keeps on tickin’!

My presentation was early in the week and many of the campers had questions for me as the week went along. Let me share four of the most common questions and my thoughts:

1. What should be included in my upcoming annual doctor visit?

If you’re already visiting the doctor annually, great! At your next visit, you’ll want to review everything medical that’s happened over the past year. Be ready to explain any medical difficulties that you’ve encountered during training or racing, even if these problems seem minor in retrospect. In a previous column, I wrote about 5 questions you should ask your doctor. These questions will help frame your discussion. Outline your plans for exercise, training, and competing for the coming year. Make sure that your doctor understands exactly what you have in mind. Get a careful physical exam that pays particular attention to your heart and vascular systems. Then, during your wrap-up, take a moment to have a focused discussion with your about your heart health, specifically. Ask if your doctor has any worries, from a heart perspective, about your exercise plans. Finally, ask if your doctor sees any value to any additional diagnostic testing that might be helpful in further refining your risk.

2. Do we really exercise that much?

Yes! Thinking back about the week in Tucson, we spent more than 25 hours swimming, cycling, or running. That’s obviously a lot. In the scientific community, I don’t think we yet have a useful definition of “extreme exercise,” but there’s no doubt that many triathletes are among the 1% doing the most exercise. Obviously, there are reasons other than health alone that motivates these athletes. We need to pay attention to emerging evidence about the potential heart risks that might stem from too much exercise. Gordo’s recent personal blog piece, “Managing My Endurance Passion,” is a good read. We’ll see what develops on the research front.

3. How can I find a doctor who understands athletes?

There’s no single right answer. My best suggestion is to poll your athlete friends. Somebody in that group will have a doctor who is great. Don’t get caught up in the notion that your doctor must absolutely be an athlete. That’s not essential. You’ll want a doctor, though, that understands the value of exercise and will work together with you to make your athletic pursuits safe. And of course, you’ll want the doctor to be good at all the “doctoring” that’s not related to sport! If your friends can’t suggest a good doctor, check out my previous Athlete’s Heart blog post on this topic for a few other suggestions.

4. Cardiac screening is expensive. What can I do?

Think of this as an investment. Medical care here in the United States is expensive. During my presentation, I spoke about an initial office visit with the doctor, along with some simple laboratory testing, and possibly even an EKG and echocardiogram. Together, these items can cost many hundreds of dollars -- and potentially even a couple thousand dollars, depending upon where you get them. Even if health insurance might “cover” some portion of these services, many athletes will find that most of the expense is borne out-of-pocket. At your check-up visit, ask your doctor about ways to keep the costs of any laboratory and diagnostic testing to a minimum. The doctor may be able to suggest testing locations where the costs are less. For some additional ideas about how to curb the costs, check out my blog post about saving money on preventive care.


Larry Creswell, M.D., is a cardiac surgeon and Associate Professor of Surgery at the University of Mississippi Medical Center in Jackson, Mississippi. In addition to his regular column on Endurance Corner, he maintains The Athlete's Heart blog to offer information about athletes and heart disease in an informal way and to encourage exchange and discussion that will help athletes build a heart-healthier lifestyle. You can contact him at lcreswell@umc.edu.
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