I Walk to a Beat of My Own

“Follow your heart, but be quiet for a while first. Ask questions, then feel the answer. Learn to trust your heart.” ~~Unknown

August 15th rolled around all too quickly. There had been no word from the NSF in regards to the Icebreaker status. But it was time to make the long 2 1/2hr trek to Anchorage for my appointment with the Alaska Heart Institute. This was something I was not necessarily looking forward to.

As the saying goes, the "real" Alaska is just 20 minutes outside of Anchorage. And if you're not here for the real Alaska, then why are you here?

After having lived in a couple of more "remote" areas of Alaska, the city of Anchorage is an assault on one's senses. Loud noises, rush hour traffic, strip malls, crime, speed demons. I had to remind myself that the rest of the world isn't like sleepy little Seward with their Xtra-Tuffs and carhartts that still relies on good ole fashioned stop signs.

The motto when dealing with Anchorage is: Get in and get out as quickly as possible.

My boss Wendy wanted to meet me at the Heart Institute to sit with me while I went thru the stress echo. So I was supposed to meet her and Dave there around 10:30. Fighting mid morning traffic and some congestion caused by road construction, I pulled into the Alaska Heart Institute parking lot.

Walking into that building was about the worse part of the entire experience. I was the youngest patient there. The majority of the patients present had to have been at least in their sixties and  older. Nearly all were hooked to oxygen machines and moving to the slow roll of their walkers.

My skin crawled. I felt as though I was being walked to my death as they escorted me through the building. As I sat in the stress echocardiogram waiting room, each doctor that walked by me gave me a slight quizzical look, as if to say, “What are you doing here?”

Don’t worry…that question arose several times before the day was over.

I was finally ushered into the examination room where the nurse took my resting heart rate. She clucked to herself and wrote a few notes down.

She looked me up and down and asked, “So, why are you here?”

“Um…I was referred by a clinic in Seward that I needed a Stress Echo because I had an abnormal EKG.”

“Ah, an abnormal EKG. Ok. Well, you’re quite a bit younger than most of the patients we see in here,” she said as she busied herself with getting me hooked up to another EKG. I eyed the machine with trepidation. It looked as if it was the mother of all EKG machines. It was gigantic and it had about a million cords coming off of it, all of them strapped to various locations around my chest, above and below my heart.

“So what we’re going to do is get you into this gown, tape it up so you’re not exposing yourself and then we’re going to take an ultrasound of your heart at rest. And then we’re going to get you started on the treadmill. Now, you’re going to have to run for as long as you’re able. You’re young and healthy so we’re going to push you as far as we can. So pace yourself, and whatever you do, don’t jump off the treadmill.”

Ok.

Pace myself.

Don’t jump off the treadmill.

The ultrasound tech came in to take an image of my heart at rest. She took one look at me and snorted. “Should’a brought a book. She’s a young one. We’re gonna be here for a while,” she said sarcastically as she slung a glob of cold goo onto the ultrasound wand and rotated it over my chest.

I lay there on my side observing her watching the screen. I wanted to ask her, “Is there a heart in there? Do I have one?” But I managed to contain myself and instead lay there quietly waiting for the next round of instructions.

After the ultrasound, a man walked in wearing a long white jacket.

Ah, the doctor. Finally.

He was the man who was going to sit down with me and explain the results of the EKG and the ultrasound. He was the man with all the answers.

“Her resting heart rate is at 47 bpm,” the nurse piped up.

The doctor looked at me in much of the same way the nurse had when she first saw me. He strode over and looked at the image of my heart at rest, walked back and looked at me again. He shrugged. “You look fine. Do you feel alright?” he asked.

I nodded, a little uncertain as to how to respond. “I feel fine.”

“Well, this is how we’re going to do this,” he said. “We’re going to start you out at level one with a 8% incline. With each level, the speed of the belt is going to increase as well as the incline 2% each time. The first three levels you’re going to be able to walk through them. Around the fourth level, you might have to start at a brisk jog. We’ll take your blood pressure with each level and if at any point you need to stop, just tell us. Whatever you do, don’t jump off the tread mill. Okay?”

I nodded and stepped up onto the treadmill, ready for level one.

The first three levels were just as the doctor had said, an easy stroll through the park. I caught the ultrasound tech yawning. “Sorry,” I apologized.

“No worries, honey. You just do what you have to do. Remember to pace yourself, you’re gonna be running for a while.”

Level four passed by and I hadn’t broken a sweat or gotten out of breath yet. “How are you feeling?” the doctor asked.

“Fine.”

Level five slipped by and I was finally beginning to feel it in my shins. “How are you feeling?” the doctor asked.

“I feel fine.”

“She’s not even out of breath,” the nurse commented as she watched me run.

The machine had gone into level six where I was running at an 18% incline at 5 mph. This time I finally felt like I was getting a little worked.

“Do you want to keep going?” the doctor asked.

Sweat was starting to pour into my eyes and I could feel a twinge in my shins with each pound of my foot. I hadn’t run since April when I first got back into Alaska. I knew I was going to walk away with shin splints.

“Do you think I need to keep going?” I asked. “I mean, I feel fine. My heart doesn’t hurt. My shins hurt.”

“Alright, let’s stop the machine.”

With those words the team of three went into action. The treadmill slowed. They rushed me from the treadmill to the cot where I was laid on my side so the ultrasound technician could get a reading of my heart. Since there was no opportunity for a cool down phase as in most work out sessions, I was huffing and puffing for air as they flipped me on my side on the table.

This I felt was the hardest part of the entire ordeal. Attempting to hold my breath for them so they could get a good reading of my heart was a difficult task. My heart was beating like crazy and my lungs craved air to slow it all down.

But soon it was all over. I laid there on the table catching my breath, feeling my heart rate settle as the doctor and ultra sound technician looked over the images of my heart. They were comparing the ones of my heart at rest to the ones of my heart under stress.

I laid there watching them, searching for any tell tale signs of concern on their faces. Needless to say, this guy had a decent poker face; I couldn’t get a read on him at all.

“Everything looks good to me,” he finally said.

I exhaled. I hadn’t even realized I’d been holding my breath.

The doctor turned to me. “You’re healthy. There’s nothing wrong with your heart." 

"We were looking for possible thickening of your heart walls, a thing called Hypertrophic Cardiomyopathy (HCM), but everything looks good. Your valves look good, the walls of your heart look good. Do you want to see the images?”

I agreed instantly. Who would pass up an opportunity to look at images of their own heart?

He pointed out my valves working at rest and then under stress. Even to my untrained eye, they looked to be working the same. He then pointed out the walls of my heart. “I’d say you’re good to go. Maybe, and I mean maybe, later down the line when you’re like sixty, you might want to keep the possible thought of HCM in the back of your mind. But you’re fine. You’re well above the average for your age. You ran for fourteen and a half minutes when the average for women your age with this test is about ten minutes. Good job.”

With those words he left the room, probably to go see patients who actually needed his medical attention. The nurse gave me a glass of water to drink and started unhooking the EKG cables from me.

She leaned in and whispered. “You could have made it to level seven.”

I laughed. “But did I need to?”

The ultrasound technician and nurse shook their heads. “Doesn’t matter. You could have done it for us. We’ve never seen a woman make it to level seven. We wanted to see you complete level seven.”

Tribulations of the Heart

"Having an adventure shows that someone is incompetent, that something has gone wrong. An adventure is interesting enough — in retrospect. Especially to the person who didn't have it." ~~ Vilhjalmur Stefansson

It was another week before I finally got a call from the clinic in Seward. I knew as soon as I heard the voice mail they left me that they didn’t have good news. They wanted me to come in so Dr. Ursel could talk with me. 

I found myself once again, sitting quietly in the patient exam room; this time however, the lights were on, all machines functioning perfectly. I was soon joined by Dr. Ursel who had my paperwork and EKG results in his hand.

“So I chatted with one of the specialist at the Alaska Heart Institute. They said there definitely is an abnormality to your EKG. It’s relatively minor, but they don’t know what it is. Since the power was out when you were here the other day, we’d like to do a second EKG free of charge to see if by chance it was a faulty reading due to it being on backup power. It’ll be free of charge and if it’s still abnormal, we’ll go from there as to the next step. How’s that sound?”

I agreed. I soon found myself strapped to the innocent looking flashing machine that had jeopardized my chances of going to the ice all in the blink of a second. The same nurse came in to do the procedure. At this point it felt like we were old friends. We chatted, laughed and soon were under way. 

I laid there quietly on the cot, attempting to will my heart to speed up a little bit, thinking if my heart rate was higher; it would fool the machine into thinking that Irregular Sinus Bradycardia had miraculously disappeared. But it seemed my heart was not to be roused since it rested at a steady 50 bpm. 

Alas, even with willful thinking and crossed fingers, the damn machine still spit out the same results. The nurse took another reading as a “just in case.” I watched her face as she stood up from the machine. She was quiet with a sad smile as she stepped out of the room to speak with the doctor. 

A moment later she returned. She freed me from the machine, sat me up, and said the same thing she had said a week ago. “Dr. Ursel will be in in a minute to speak with you in regards to your readings.”

I can guarantee you they won’t take you…

Damnit, damnit, damnit.

Dr. Ursel’s words echoed over and over in my head as they had a week ago. “If you’re serious about going to Antarctica, the next step you will need to take is to do a stress test. That may not even reveal what the problem is,” he said. “Most likely they will make you do a stress echocardiogram. And then if that doesn’t do it, we’re talking thousands of dollars worth of tests. I could easily get your medical bill up to $10,000 or more. If the stress echo doesn’t do it, the next step would be a Cardiac catheterization and an angiography.”

“How busy is your schedule?” He asked me.

“Pretty busy. I don’t get definite days off. We get a day off when we get a day off,” I replied.

Dr. Ursel leaned back in his chair. “This is what I would recommend. Since you’ll probably have to drive up to Anchorage for these tests and you don’t know how many days you can get off, let’s get you scheduled for what tests we can. That way if the stress echo doesn’t determine what it is, you can just go ahead and get the next thing done since you’ll be there. It could all cost a lot of money. But you have health insurance; your deductible will be reached soon since you’ve already had all these other tests done, so it’ll probably cover the majority of these tests.”

“Do you really think I need all these tests?” I asked.

He shrugged. “It’s hard to say. We could just schedule you for the stress echo, but if that doesn’t determine it, you’d have to drive back into Seward, and you need all this information by August 1st. Correct?”

I nodded. I did need all this information by August 1st. I had to be completely finished with all my medical and dental testing by August 1st so that I could have it all submitted and then wait to find out if I was cleared medically. The next step would be ticketing. However, the idea of having a catheter snaked up my groin to my heart was amazingly unpleasant sounding. It was these words that made the monster of arrogance raise his ugly head.

I looked the doctor straight in the eye and said, “I don’t want to come off as cocky, but I’ve got a decent understanding of medical terminology since I’m a wilderness first responder. I’ve also got a pretty decent understanding of what an unhealthy body can do. I’m pretty sure that a stress test or the stress echo would tell us if there is anything. I feel pretty good. My heart doesn’t hurt, I’m not tired. I don’t have any signs of someone with heart disease or the possibility of a heart attack. I’m outside all the time. I can’t afford all these tests you want to sign me up for. I’m a kayak guide. I don’t make very much money and the health insurance I have is just short term traveler’s insurance.”

Doctor Ursel nodded. This was probably a story he had heard all too often over the years. “How about you do this? Why don’t you go home for now, think on it and in a week or so get back to me? We don’t need to make a decision right now. This is going to cost a lot of money, that’s true. Maybe you need to decide if going to Antarctica right now is realistic or not. As of right now, I know they won’t take you. You could save some money, get this taken care of in the fall, and try for Antarctica again next year. It will always be there.”

I agreed to this and again, was ushered out of the office. As I walked out of the building, I felt as though I was being paraded through a lineup of mourners, sympathizers to my plight. The nurse and office assistant all stood watching me walk by, sad smiles on their faces. My world was that of a penny jar containing one single penny, Antarctica. I’d put all my faith in that penny. Someone had just come along, turned that penny jar upside down, and rattled it all about, trying to shake it loose. It was still there, just pretty unstable.

I returned to the kayak shop uncertain as to my next step. Did I want to keep fighting for the chance to go to Antarctica? The odds were 50/50. I would either be 100% healthy and I’d get the go ahead, or I’d find something that could easily take my life later down the line. Or I could turn a blind eye to it all.

Deep down inside I didn’t fully believe the Doctor and I didn’t believe the results of the EKG. The doctor had rattled off a lot of technical terms I didn’t quite understand and he hadn’t been entirely willing to explain any of it further. Granted, he was just a physician’s assistant, but he had been so persistent in pushing me toward taking all these tests. It seemed overly excessive.

At the office in the kayak shop there are three chairs lined up against the wall facing Wendy’s (my boss) desk. These chairs for some reason have this amazing knack of attracting us guides to walk in and slouch there and spill our woes to Wendy, whether she really wants to hear them or not. Even on our days off when we could be out wandering the mountains outside of Seward, instead we can be found still in our pajamas sitting there talking with Wendy. I am all too guilty of this. I cannot count the number of times I have walked in over the two seasons that I have guided there, sat down, stared at Wendy, waited for her acknowledgement, and then let it all spill out.

At the same time, Wendy has this uncanny ability of knowing that we need someone to talk to when we come wandering in looking like a lost puppy. She will often look up at us, do a double take, spin in her chair and say, “Take a seat Frannie. Talk to me.”

When I got back to the kayak shop, that’s exactly what I did. She knew where I had been and she knew by the look on my face I hadn’t come back with good news. I spilled the beans and then sat quietly, waiting for another person’s thoughts.

Wendy is a person who loves to help people solve their problems. She’s full of all kinds of ideas. When I decided to stay in Alaska my first season up here in 2009, she was throwing ideas left and right to me. As usual, they’re always pretty good.

“Why don’t you talk with Darin and get a second opinion on your EKG?” she asked. Darin was the local ER doctor in Seward and a good friend of Dave and Wendy’s. “It wouldn’t hurt to talk to him and see what he says and then make your decision from there. He’s an actual doctor and Ursel is just a physician’s assistant. Antarctica will always be there. If it is something serious it’s your health and you could get it figured out and try again next year.”

Getting a second opinion was what I decided. I spoke with Darin and after a week or two of playing phone tag, we finally touched base on what he thought the EKG represented. He had good and bad news. He didn’t feel that I needed anything as intense as a Cardiac catheterization and an angiography (Thank God), but he did agree that I should get a stress echocardiogram. He said that just the stress test probably would not show what my heart was doing, but the ultrasound part to the test would give the doctor a good image of my heart at rest and under stress and they should be able to see what it was from there. He said pretty much the same thing that Dr. Ursel had said. The EKG indicated that my heart for some reason was not getting enough oxygen and that was a concern. At the same time however, he said that it could just be my makeup and my heart could be just fine.

I asked him if getting the stress echo was something that could wait or if it would be better to get it done as soon as possible. At this point I had made the decision that Antarctica aside, I had to know for my own personal well being if there was something wrong with my heart. I had been walking around for two weeks with the knowledge that my heart might have an abnormality, but I didn’t know what it was. It wasn’t helping my stress levels any.

All my paperwork had been submitted to the medical department at Raytheon. I had passed my dental exam with no major problems other than needing a simple cleaning. I had submitted the original EKG and had notified them that it had read abnormal. I had yet to hear anything on their end to state if I had been “PQ’d” or not, or if I needed further testing.

Darin didn’t hesitate. He recommended that I get the test over with sooner than later so that way if it was something serious I could prepare myself for the next steps.

With those words, I sucked my pride up, folded it away, and made an appointment with the Alaska Heart Institute in Anchorage for August 15th.