Just keep swimming

I haven’t written for a few weeks as I have been off in Bali with my family so I thought I’d get back into the swing of things today by talking about my chest.  Ok don’t get too excited, while I have it on good authority that my chest is certainly worth noticing it is not in fact my frontal anatomy that I wish to discuss, more what’s behind it; my heart 😉

As the anatomy lesson goes; the heart is connected to a mass of blood vessels both big and small that carry blood around your body – blood is important.  If we don’t have enough blood we can die.  Blood carries all sorts of important things from one place to another like oxygen, antibodies, hormones, chemicals, white blood cells and platelets etc.  When everything is working normally the heart should beat at somewhere between 60-100 beats per minute at rest and blood pressure should be between 100-140/60-90.  The two values for blood pressure are taken by measuring the pressure that blood exerts on the main arteries when it is being pushed through by the heart (when the heart contracts) and the pressure when the heart relaxes.  All this stuff is regulated by the autonomic nervous system and central nervous system and can be affected by stress placed on the body by infection, exercise, emotion, pain, fever, anxiety, drugs, fluid and electrolyte balance and oxygen and carbon dioxide levels.  Here’s an interesting link so you can check out your blood pressure and see where it sits on the chart.

Thanks for the anatomy lesson Claire, it’s great to learn something new every day but why is this relevant, you ask!  Well it is relevant because it helps me explain a few things.  My two main medical issues at the moment are my low blood pressure (which drops when I stand up) and my over-excitable heart rate (which tries to compensate for the drop in blood pressure but gets carried away and doesn’t realise it is at the same time being completely useless in the helping stakes and actually making it worse).  I don’t qualify for the POTS (postural orthostatic tachycardia syndrome) diagnosis on account of the drops in blood pressure so I’m not cool like the yellow wiggle, but I also don’t fit into the ‘typical’ presentation of recurrent vasovagal syncope because of my tachycardia – the usual vasovagal response is a drop in blood pressure and heart rate.  So I am special, an honorary ‘POTSy’ and an unusual NCS’er – well, we wouldn’t want to be normal now would we 😉

Some people don’t quite realise how much these conditions can affect you and to be honest even though I have been feeling pretty crappy on and off for the past 7 years and it has had a major impact on my life I never really thought of it as being particularly dangerous until a few weeks ago.  Sure there have been times when I maybe shouldn’t have been driving or shouldn’t have gone out but I have been pretty careful with it in that respect.  Allow me to illustrate;

In June 20 metres up a particularly steep hill just outside Sarria in Spain and 15 minutes into my 115km Camino de Santiago I had to stop because I felt dreadful.  I couldn’t catch my breath, my heart was beating out of my chest, I felt dizzy and nauseated and was quite concerned I would not be able to go any further.  Sure I was de-conditioned and occasionally had asthma but this was ridiculous.  I checked my heart rate and it was 187bpm.  This is not good.  I know that my heart rate jumps from somewhere between 78-98 to 120 just on standing to compensate for the drop in blood pressure but I had never realised just how far it could go and how awful it could make me feel.  It’s possible it had been doing it all along and I never realised why I was so tired, out of breath and dizzy with exercise on some days but not others – I always assumed it was due to my blood pressure.

This experience wasn’t so concerning, I made it up the hill eventually and didn’t have another experience quite like it for the rest of the hike.  The worst one happened a couple of weeks ago.  I went scuba diving in Bali with my family.  Ah yes I can hear it now, how incredibly stupid was that?! Why would you put yourself at risk so much? and blah blah blah.  Well, I’d done it before and I will do it again and the problem was a rather singular one.  We had dived the previous day and apart from my usual adjustment period (where I have to remind myself that I can in fact breathe under water with the regulator and the huge tank of oxygen on my back) it was fine, fantastic even.  We were swimming around a huge garden of soft coral with spectacular fish and the hope of seeing a sunfish (no such luck I’m afraid) – it was glorious and felt wonderful to be back under the water again where I have always suspected I actually belong.  Despite some sea sickness on the way back I was fine, a little tired but hey, I did it and here’s a photo to prove it – there is me ascending and there is my hair in my face…

Then we decided to go again the next day, this time to a different place that, due to the boat of snorkelling relatives and the massive tide/full moon scenario we hadn’t been able to visit the first time.  The Dive Master insisted the current would be better there, it would be more sheltered and the time we had picked (early in the morning before our boat to the main land) would be perfect.

We got off to a good start, a huge Titan Triggerfish was mucking around nearby minding his own business (thankfully), and there were schools of brightly coloured damsel fish crowding around the coral plates.  This dive would be 20m, my deepest dive.  We went down and I discovered I didn’t have enough weight, it had been difficult to stay down properly the day before but the conditions were fine so it wasn’t a huge problem.  This time the current was rather strong and I had to fight more to stay down.  It was a drift dive (we didn’t have to swim, the current would carry us along) but the current was so strong we hardly had time to really look around and you had to be alert to stop yourself from colliding with the coral.  I was ahead and didn’t know which way we were going so I slowed myself down to wait, then I was behind and had to catch up.  That was what did it.  Fighting to stay at the right level, then to catch up and keep on the right track in the strong current I started getting out of breath.  My lungs felt wrong because of the pressure and compressed air – I could feel my breathing and it was too much and not enough at the same time.  I needed more air, I needed to calm down and regulate my heart rate.  When I get tachycardia from exercise, no matter where I am I can rest and relax, regulate my heart rate, take deep breaths etc but this time it was not possible.  There was no stopping, no closing my eyes, no relaxing.  If I did that I could lose the group.  Normally that would be ok, I would search for a couple of minutes and then slowly surface as is the usual plan for that kind of thing.  This time it was different, I could search for them and end up a long way away and not be able to signal the boat to pick me up.  That’s when I started to panic a bit.  I caught up and signalled to the Dive Master that I had to surface.  I think this is possibly the first time I have ever given in to fear and as soon as I did it got worse.

I had to get up, to have a huge lung-full of real air and a break for a minute then I would be fine but I HAD TO GET UP.  Scuba law tells us that you ascend slowly, breathing regularly and not too deeply.  Well I kinda didn’t and that’s bad.  I’m very lucky I didn’t do any damage, it wasn’t excessively fast but it was certainly faster than it should have been.  My poor cousin on her resort (not qualified) dive was dragged along with us as we surfaced.  After a minute I felt ok and was ready to go back down again.  That was a HUGE mistake.

Not enough weight, remember!  I couldn’t get down, the Dive Master and my Triathlete cousin were powering ahead against the current and i couldn’t get anywhere, in fact I felt like I was going backwards.  Apparently if I had looked down I would have seen the other 3 divers below me but I didn’t.  Once again I was working hard, breathing hard and my heart was racing from the effort.  I was tired and had had enough.  I couldn’t catch them so once again I started to panic.  That was it, I was done for the day.

Looking back I know that if I had known the current was going to be so strong I wouldn’t have gone.  Even the Dive Master confessed that it was bad that day but that’s beside the point.  I can’t compare myself and my efforts to those of normal healthy people and triathletes 😉
For an open water diver with 5 dives in total under her weight belt the dive was too complicated.  I didn’t have the skills, my equipment was insufficient (I wish I could remember how much weight I had on my belt when I did the course!) and my fitness and health were lacking.  Dysautonomia has never really scared me before, apart from the whole ‘oh my god it’s going to be there forever and I’ll never get better and blah blah blah’ but that’s a different kind of fear.   It took me about 10 minutes of sitting in the boat feeling sorry for myself to remember that and remember what I learned on the Camino; stress about the stuff you CAN change.  Don’t beat yourself up about the things you can’t do – you’re not superhuman, you can’t do everything no matter how much you would like to.  Don’t compare what you can and can’t do to what others can because that just gets depressing.  You’re in Bali, I mean come on, Bali, yeah!!  And finally, Santiago will always be there (so will scuba diving, I can always do it again) I get there when I get there.

I’ll be back in the water as soon as possible and hey, when you can see stuff like this I really don’t understand why anyone wouldn’t want to!

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