Do We Pay a Medical Price to be Elite Athletes?
If you are a person who exercises regularly, you are undoubtedly aware of Dr. Kenneth Cooper, the founder of the Aerobics Center in Dallas, TX and the person who some believe started the exercise revolution in the 70s with his book “Aerobics.” Dr. Cooper has considerably changed his recommendations regarding exercise intensity over the years. He used to preach that more intensity equated to more fitness. He now recommends a regimen of walking as opposed to running in that he indicates that excessive exercise causes excessive free radical production in the body. It is those free radicals he proposes that is the cause of many medical issues including heart related issues and cancer.
In his book “The Antioxidant Revolution”, Dr. Cooper, MD emphasizes that excessive exercise is a major cause of oxidative stress. He became very concerned when he began seeing several of his super exercisers who had been coming to his aerobic center in Dallas dying from heart disease and cancer at an early age. Dr. Cooper points out that when we exercise excessively, the production of free radicals goes off the graph, or in other words it increases exponentially.
A good friend of mine and Dr. Cooper was Dr. George Sheehan, cardiologist, prolific author, world-class runner and the erstwhile medical editor of “Runner’s World” magazine. As an aside, one of the most enjoyable days I have ever experienced in competitive sports was at the Eastern Regional AAU track championships at Princeton University, circa 1980. George was my teammate on the Shore AC, and he wanted to break the American age-group (55-59) record for 1500 meters. In that I did an incredible amount of track interval work and had a built-in stop watch in my head from all of that work, the plan was that I would use the race as my warm-up for the 5000 meters (which I went on to win) and pace him to the record with his desired splits. He broke the record. I spoke with George via telephone frequently during his office hours in that he was always more than willing to chat if the subject was running.
One day during one of our conversations, he expressed the opinion that because of our athletic lifestyles, we were probably causing ourselves to be immune from cancer. I am about to argue to the contrary. Apparently his supposition was not terribly accurate – George died of metastatic prostate cancer and I had a prolonged battle with malignant melanoma about a dozen years ago. Fortunately, I won my battle. As a coincidental aside, it was Dr. Cooper who discovered Dr. Sheehan’s prostate cancer during a routine physical in Dallas. I have gone on however, to experience numerous other skin cancers including every form of it. I joke with my dermatologist that I am a poster boy for skin cancer. I also suffer from at least an annual bout of AFIB – atrial fibrillation – something quite common with aerobic athletes.
Having said all of the above, the catalyst for my writing of this piece is the extraordinary number of elite athletes that I personally know who are suffering from serious heart issues or dealing with metastatic cancers. Specifically, my encounter with one national champion triathlete the other day with the telltale large, rectangular hump under the skin of his chest indicative of a pacemaker. In addition to him, two Kona Ironman finishers that I know, one of whom is a world champion, both sport pace makers as they continue their participation in their chosen sport. Another world champion triathlete suffered from ventricle fibrillation (much more serious than AFIB) and underwent a medical ablation procedure to correct his problem.
Speaking of heart issues, one local, very successful, young bicycle racer died of heart failure during a recent bicycle training ride. My significant other’s husband, an athlete all of his life and a very active triathlete, died of cardiac arrest at the age of 55 during a formal swimming workout with the local triathlon club, The Mad Dogs. Another local champion cyclist was the recipient of a stent in one of his arteries to deal with his heart issues. AFIB is a common phenomenon among active aerobic sport oriented athletes.
Just in the past year, two of my associates, both nationally ranked cyclists and both state champions (in the 65-69 age group) have been diagnosed and treated surgically for metastatic prostate cancer. A third, a champion runner, is also fighting metastatic prostate cancer. All three are on Lupron, a medication that medically castrates the patient to rid the body of testosterone. All three continue to compete. At least three other avid local cyclists I know have been treated for prostate cancer.
Although my main concern is disease potentially caused by excessive exercise, I would be remiss if I overlooked the incredible number of ex very serious runners I know now sporting new hips and knees and the number of current serious cyclists I know with chronic back issues.
Back to my original question, do we pay a medical price to be elite athletes? Decide for yourself! If you are interested in the pursuit of health, a program of vigorous walking, good nutrition, sound supplementation and adequate sleep will serve you well. If you want to be an elite athlete, understand the potential risk/rewards.
Addendum: Understand that the above was written by a 73 year old inveterate athlete who is about to leave for a 3 1/2 hour cycling training ride in 90 degree heat with excessive humidity. Just as I knew that I had to save my life each of the 657 times I have jumped out of a an airplane, I have an insatiable need to kick competitive butt and I am more than willing to roll the dice to achieve that wonderful goal!
ADDENDUM – 9-24-13
Little did I know when I wrote this piece that I would become one of the prime examples of the phenomenon to which I alluded. One day I was kicking butt at the Georgia Golden Olympics turning in a time 20 seconds faster in the 5K time trial than was my time in the previous two years where I turned top time for all age groups. I mentioned in the above piece that I typically suffer one incidence of AFIB annually, and that AFIB had always stopped with no medical intervention typically within a few short hours.
The morning after two days of competition where I raced my heart out (pun intended), as I began to sip some OJ in the morning, my typical morning pulse of the mid to low 40s began racing at 134 beats per minute. By the end of the day, I had seen little improvement and by the next morning, I found myself still in AFIB. I suspect that as a card-carrying member of Mensa, if I tested now I would assuredly be denied membership. I decided that perhaps the catalyst of a gentle 45-mile bike ride would restore my normal heart rhythm. As I pedaled out of my driveway, I encountered a neighbor who waved me over and as he was congratulating me for winning my latest state championships, I glanced down at my heart rate monitor noticing much to my dismay that I was pumping along at 154 beats per minute even though I was standing still. Being the incredibly intelligent guy that I am, I continued on my bike ride, and continued to justify that action to myself when I noticed that when I pedaled, my heart rate would come back to a mere 144 beats per minute. Even more encouraging was that when I really mashed down on the pedals, my rate came down into the 130s.
As I rode along, I apparently began thinking a bit more clearly when I decided to stop my ride after a paltry 35 miles. Although I fought against the concept, my significant other forced the issue insisting that we go to the Largo Medical Center, a place renowned for their cardiac unit.
In the ER, a team of about 6 personnel swarmed me when a monitor revealed not only my very rapid heart rate, but also showing substantial arrhythmia. Rather than the outcome I assumed—get some drugs and go home– the ER physician insisted that I be admitted to the hospital’s cardiac unit. There I discovered that my heart rate was not the 150 beats per minute that I was assuming – a heart rate monitor displays the beats per minute of the ventricles, but my atria were racing along at an incredible 300 beats per minute and in a very arrhythmic manner. My body was infused with various medications through an IV including blood thinners and calcium channel blockers, and the cardiologist scheduled me for two procedures the next day, both of which would require general anesthesia.
When the atrium is beating with great rapidity as was mine, the blood tends to pool in the atrium leading to potential strokes and or heart attack caused by blood clots. My first procedure would be a so-called TEE procedure – a trans esophageal echocardiogram. A tube is placed down the patient’s throat bringing a transmitting device close to the heart with the mission of determining if there were any clots waiting to do their potentially catastrophic damage. If the answer was “yes”, it called for one tack and if the answer was “no”, then an ablation procedure would be scheduled the same day administered by a cardio electrophysiologist whose specialty was dealing with arrhythmias of the heart through various interventional procedures.
Rosie, my significant other, calls me Dr. Scott, because, as someone who intended to go to medical school from the age of 3, I am always studying medical literature – I find it quite fascinating. I had self-diagnosed myself with AFIB, but the “real” doctors disagreed with my diagnosis – I was suffering from atrial flutter. With atrial flutter, the right atrium sets up a circular pattern of electric impulses causing confusion of the signal to the left atrium. The result is a rapid, arrhythmic, potentially fatal heartbeat.
The procedure used to restore the normal electrical impulses is called an ablation in which incisions are made on either side of the groin and catheters are run up through either arteries and/or veins to the heart. The patient undergoes a diagnostic procedure using a fluoroscopic X-ray device, which can map out the impulses in the heart such that the electrophysiologist can determine what part of the atria the offending signal is emanating from. The cardiologist then uses RF energy to zap the offending heart tissue, in effect destroying it such that it can no longer send erroneous signals. But I digress.
Fortunately, it was discovered that I had not managed to generate any blood clots, although I certainly went through some very efficient means to do so while riding with atrial flutter! The next afternoon, I underwent general anesthesia for the second time within a very few hours and the wizard, Dr. Norris, was able to successfully zap the offending heart tissue leading me to be rolled out of the operating room with a beautiful EKG pattern with my heart beating at a normal rate. Of course I was kicking and screaming through everything insisting that in under three weeks, the most important cycling competition event of the year was looming – the USCF, Florida state time trial championships where I hope to win the title for the 7th year in a row. I didn’t have time for this stuff – I had to get out on the road and train!
I finally escaped from the hospital after 4 long days of incarceration; I am on blood thinners and have surgical wounds that must be taken into account. I still hope there is a way I can make it to the line at the state championships on October 13th.
Any lessons here? I think the reader can glean a few, but those of you who are used to thinking of yourselves as super human, I have some bad news for you – we are all human, and I again maintain my thesis that elite aerobic athletes have very high odds of experiencing medical issues – especially heart related. I must have taken it a bit too seriously when my friend and teammate, Dr. George Sheehan, pronounced me as having one of two of the strongest, most athletic hearts he had ever seen in his rather long practice of cardiology. This has always made me feel particularly immune to heart disease and failure. It seemed to override the practical advise from my practical mate, Rosie, and my intellectual side in that the symptoms were taking me to a stroke or heart attack and not to a cycling podium (top step of course) finish.
Addendum – 7-29-14
I had occasion to re-read this article this morning and I realized that I never told the rest of the story. I did in fact go on to contest the Florida State Time Trial Championships two weeks after the above described procedure. I won for the 7th year in a row with a winning margin over the second place finisher of 2 minutes!