Notes From The Field

Notes From The Field

I want to invite you into the process of working on an actual serious health issue; not using drugs, surgery and platitudes but good old hard work and some thinking.

The patient is a 65-year-old male high-performance athlete. He has developed an irregular heartbeat. Not plain old atrial fibrillation or any other more conventional irregularity. We have done continuous 3 lead monitoring of his heart for a recent 3 week interval so we know quite a bit about his heart beats and rhythm. He has some runs of ventricular tachycardia, long runs of bigeminy and trigeminy, oh, and to make it more interesting, he has prolonged episodes of very slow heart rates in the 30’s. Now he and I both, in times of more accomplished athleticism, have had pulses this slow but when it made more sense so this is not ‘just a fit heart.’

Now it won’t be necessary for you to know what each of these irregularities is but it is enough for this exercise to understand that he had many kinds of irregular heartbeats.

The process I will describe is how to address almost any kind of health or fitness issue.

Our patient is known to have advanced atherosclerosis of the arteries to his heart; he is an ultra-endurance athlete, an activity known to accelerate ‘hardening of the arteries.’

In a simpler world and with a less motivated patient this guy is a perfect fit for a two chamber pacer, actually maybe even an implantable defibrillator, drugs and other approaches I won’t belabor. Suffice it to say we consulted some high-powered cardiologists and had a green light to try to ‘fix’ the problem by other means.

Now what were those means? First of all: “Don’t try this at home.”

Well, we set his Polar to its R-to-R recording and set to work characterizing his irregularities. We knew there was more than one bad actor driving the irregularities. We knew, or suspected at least, that his underlying atherosclerosis was primarily microvascular, small vessel disease rather than macrovascular, large vessel disease, and reasoned that whatever else was true the ‘bad actors,’ the points driving the irregular beats, were not dead tissues rather just sick ones. Chronic inadequate blood flow, chronic ischemia, had caused a form of hyalinization- partial replacement of some of the healthy cell components with less healthy components of the beat triggering cells. So, back off the endurance training and create an environment where the hyalinized cells would get sustained adequate blood flow without chronically deprived periods yet place enough demand on them that positive adaptive change would be possible.

OK, words: now what does that look like as work rather than talk?

You are going to see a series of heart rate profiles of a very similar contour as they reflect a nearly identical workout. After I show you what the contour looks like of the basic workout I will show you several further series and describe what I believe we are seeing and the hypothesis we generated and tested as we progressed. First there is a picture of the heart rate profile from the Polar file when the data is being recorded as a 1 second sample.

Then the files from the June workout in R-to-R format and as you see it looks like noise in many places. The next file is the same workout but as a blow up from the around 50 minute mark. You will see several jagged lines; they are similar in shape in some places and different in shape in other places. This is the signature of more than one ‘bad actor’ triggering the extremely variable heart rates. Our hypothesis at this point was to keep the athlete from his long training sessions, presumably to prevent prolonged relative ischemia of the bad actors, to see if healing could occur. The next file is from the July workout at about the same point in the workout. Now, there is only one ‘bad actor’ or at least most of the time. You can tell this as there are not as many different forms to the irregular heartbeats/profiles. Our hypothesis was if this was true and if the trend continued we would get to a place of binary probabilities: that is if we were really down to one bad actor and it was in fact healing we should soon see a completely normal heart rate profile at the R-to-R level.

It would progress from multiple bad actors and an irregular heartbeat/profile to a continuing irregular heartbeat/profile but initiated from only one bad actor and then to the point where it would just stop as the one remaining bad actor would retire from the field. Sure enough if you look at the workout from August 24th you will see, during the same point in the protocol, around 50 minutes, that even the R-to-R no longer has the same degree of variation. Bingo: he, on this one recording, no longer has the previously many months long documented irregular heartbeats.

Is he cured? No, not that easy. Is he better? Well it looks like he might be. But not yet, as he has since gone in and out of the singular and multiple forms of the ‘bad actors’ taking the stage and fouling the performance.  But in the context of many months of this and our seeing the progression I describe this was our line of speculation and reward for the query. It looks like we are on to something.

Now, I retell this story, not in the glorified state of announcing a miracle but in the excited state of inquiry and discovery. This process of data collection, hypothesis generation, testing and correcting has proven capable of reversing everything from diabetes to many forms of arthritis. If pursued in fine-grained detail it can make a lifetime of difference for all of us. For each of us. For you: When You Are Serious.

Have Fun, Smile, God Speed,

Dr. Mike

PS Due to a problem with the media upload on this site you will need to go to my facebook page to see the graphs referenced here.


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