runner2565 wrote:
Earlier I posted about a high school distance runner who was having unexplained bouts with fatigue during some training and certain races over the past year and a half. This runner was an AAU National Champion in the 1500 twice. He won the middle school state XC meet as an 8th grader and his freshman XC and Track seasons were mixed with good (16:17 and 4:30) and bad performances.
This year during XC practice this summer he would have a good hard effort followed by more than one that he just felt fatigued. Easy runs are no problem but anything with any duration plus intensity was difficult. The first race of the year he went out around 5 flat and fell back during the middle of the race and looked dead as he finished. The next race he paced himself in the first mile around 5:15 but fell back and lost it around the 2 mile mark. The first 2 races were very hot and humid. The third race was cool and on a relatively fast course. He went out in 5:25 and then went 5:50 and 6:06 finishing in 18:08. This was the course he ran the 16:17 on last year with a few minor adjustments.
Following this performance it was obvious that something was just not right. We had removed him from acne medication a year ago, treated him for anemia even though he was only borderline low, put him with a special nutritionist to help maximize his energy intake and none of it was working.
With a few connections I got him in to see a sports medicine specialist first thing the next morning who was also a former competitive marathon runner. After a consult with the 2 doctors in the office a full panel of blood was ordered again and a cardiac stress test.
We went to the stress test and had the echo done. After the echo was the stress test. As he stepped onto the treadmill I looked at the screen and before the test even started his heart rate was in the mid 80's. Half way through the walking phases he was already up to 160 and then 170 and then finally 180 while just walking on the heavy incline. The second they hit the step around 15 minutes that got him jogging his heart rate went to 190. He ran through this three minute stage and when they sped it up to like 6 mph on a 20% incline he went to 195. He fought this stage to just around 20 minutes total and stepped off when his heart hit 200 bpm. Doing the math for a 16 year old put his max heart rate at 203-204 although I know that is not the most accurate.
We followed up with the physicians later that night and determined that his blood came back normal and his stress test came back normal other than the elevated heart rate compared to what it should have been for someone able to run at his ability level.
It was decided since there were no breathing related issues he would try to hydrate and increase training to see how he handled it. After meeting with his coach and laying out an elevated running schedule for the following two weeks minus any XC meets I told him to put on his garmin while we were sitting at the table. I had the watch and noticed his heart was constantly in the low 80's to high 70 range sitting at the table.
His first two runs to ease back into training were 7 mile runs with drop downs. First one started at 7:30 and ended at 6:50 with drop downs every mile. At 7:30 his heart was at 160 bpm. As he went into the lower 7 min range his heart rate went to 180 and the last couple miles just under 7 were upper 180's to 190.
Last night he went 7:30 for the first 2 miles and I was with him on a bike with the heart watch monitoring his heart. Once again he was at 160 and went to 180 as he got into the lower 7 minute range. When he went to the mid 6 minute range he went to upper 180's and at 6:00 even on the 6th mile he was right at 190. His last mile was at 5:45 and the hbm was steady at 193-4. He was breathing ok and felt like he had no restriction of air. There was no wheezing no signs of vocal chord dysfunction and he said he felt ok during the entire run.
To me I think this felt ok because he has been use to running in this high heart rate percentage for long periods of time.
That night he wore his heart rate monitor to bed. In the morning I gently woke him up monitoring his monitor and watched his heart rate go from 51 to 102 as he slowly stood up and started to wake up. After a minute it settled in around the mid 80's but upon viewing his heart stats on the computer from the night, he spent most of the night in the low 40's hitting 39 at one point which is what you expect for a good distance runner.
After following up with his doctor the Orthostatic Tachacardia is being discussed and at this time he is going to continue to train, try to super hydrate, continue to eat as well as he does and hydrate some more. No meets for now but just curious if anyone has dealt with low blood volume issues and runners. If he was a baseball player it probably wouldn't matter.
My somewhat educated guess is that he goes to the line and when the gun goes off his low 5 minute mile start which he has used the past two year, tachs his heart to near 200 beats a minute and he spends the final 2 miles trying to recover and just get himself to the line so he can finish. This is like being a shot putter and having to throw a three pound shot every time you step in the ring. When he toes the line he has a 30-40 bpm disadvantage over all the other runners trying to win the race whether it is a 5k or an 800.
Any advice or helpful tips in regard to this type of condition would be greatly appreciated. I know this is similar to POTS but we don't have nor have we attempted to diagnose this condition.
Thanks and sorry for the length of this post. This has been a year and a half long search for what was causing his mid race fatigue.