Ironic Optimization

As an electrical engineer and college professor, I often have to correct my students' use of the words ironic and optimize. Lots of people use ironic when they're referring to what might be better called a curious or interesting coincidence. No, it's not ironic that Larry died on his father's birthday. Irony involves something producing a result the exact opposite of what was expected. Meanwhile, many people use optimize as a synonym for efficient or best. To an engineer, to optimize something means to trade off performance in areas deemed unimportant in order to improve performance elsewhere. For example, a portable electronic device may be optimized for long battery life at the expense of computing speed, weight, or cost. A car might be optimized for fuel mileage at the expense of acceleration or cargo capacity. This is all fine and dandy, but what does it have to do with the fact that I wound up in a local hospital's ER last night?

I am a runner; have been for decades. At 48 I still like to run, I still like to run fast, and I like feeling healthy. Granted, compared to guys like Tony Young, Pete Magill, and the venerable Ed Whitlock, I'm just an also-ran's also-ran, but in the past two years I've managed to run a couple 1:16-1:17 half marathons, two 53-54 minute 15k road races, and a few 5k's in the mid-upper 16's; not too bad for a guy with no particular pedigree closing in on the half-century mark. When you run a lot of miles, the body has a way of adapting to the stress. This is the cardinal rule of training, namely specificity of adaptation. In this case your leg muscles get stronger. You tend to lose body fat. Your resting heart rate and blood pressure tend to drop. At 5'10" and 142 pounds with a resting pulse of 50 beats per minute, I can attest to each of these.

Last night I awoke with an obvious pain isolated right behind the xiphoid process. I immediately assumed it was some form of acid reflux and got up to get an antacid. While standing in the bathroom I passed out. My wife heard the noise and came to see if I was OK. I wasn't. I was very lightheaded. She called 911 and we eventually found ourselves in the ER. Now usually, when a 48 year old male complains of upper abdominal/lower chest pain and passes out, the immediate assumption is heart attack. Needless to say, I was given oxygen, aspirin, nitroglycerin, and a bunch of other stuff. Although I still had the pain I was no longer dizzy. The monitors I was connected to indicated a pulse around 45 to 50 with a BP typically around 110/75, and so I made a point of telling the staff that these were pretty normal values for me. I was given an interesting cocktail of Maalox and two other ingredients that slip my mind (although one was a numbing agent, maybe lidocaine), and also a shot of morphine. In due time the pain went away.

Eventually, I had a chat with my physician (after he had talked with the ER doc). He sort of smiled and informed me that I was an easy case. He was sure that there was nothing wrong with my heart (initial blood tests had come back negative but they were going to take another at six hours in). He figured that I had some form of acid reflux. Although I wasn't aware of the precise mechanism, he stated that the pain could reduce my pulse and BP. As I already have a low pulse, this effectively pushed me over the edge when I was standing and moving about in the bathroom, causing vasovagal syncope. He predicted that the second blood chemistry would come back negative and that I would pass the stress test they had scheduled with flying colors. He was correct on both counts. In fact, the cardiologist was having a bit of fun during the test once he found out my race times. The test involved the treadmill getting progressively steeper and going faster in stages until I hit a target heart rate. Somewhere around level three the treadmill was going at 15 minute per mile pace (4 MPH) at an incline of 18% (damn steep but still walking). Eventually, he had to get me up to level six in order to reach the heart rate he wanted. I was then quickly placed on a stretcher while they used a Doppler echocardiogram. The cardiologist joked to the technicians," Watch this, he'll probably be down to 80 BPM in a minute or two". He later informed me that this was the first time in 10 or 15 years that he had anyone get up to level six.

Bottom line: My body is optimized to run distance races in an efficient manner. One reason I do this is to stay healthy. Unfortunately, my slow pulse was partly (ironically) responsible for me winding up in the ER. This, of course, should in no way persuade anyone to abandon an exercise program. I would much rather be the atypical 48 year old male who thinks he may have a heart problem but really has some stomach acid issues than the typical individual who suffers the opposite.