Physician, Heal Thyself:

Learned lessons in toughness and self care from a literal hole in my heart

Author: Kris Hunt

Insta-therapy is a weird place. I say “insta-therapy”, but really I mean “popular culture” therapy. There’s always a new push for a new catchphrase and then a counter movement for the opposite one. For example, co-dependency was once considered a bad thing to have in relationships. Now, some therapists say good relationships are meant to be co-dependent because the co-dependency movement just caused people to isolate themselves. “Inner child” work is a thing now, but it is probably causing people to push their parents away and lose out on meaningful relationships with them. Well, what the hell is the answer then?

I bring this up because there is a big “resiliency” movement right now in popular culture. If you just expand your capacity for resilience, you can handle life. This seems to be getting closer to reality in terms of how to cope and continue to grow. We see this concept in powerlifting all the time - build up your tank, work on your capacity, grind through some harder reps, and your strength will increase. Of course there are exceptions to this in powerlifting - injuries are the obvious - but also life circumstances: birth of a child, death of a parent/spouse/etc, divorce, mental illness, and the list goes on. These chip away at your work capacity and your ability to handle intensity, but if you have a baseline tank to draw from, you probably can work your way back into some quality training when the obstacle is over.

But what if life throws something at you that would be quite difficult to be resilient to?

I’ve been competing in powerlifting for over 20 years. I’ve had good years, bad years, and everything in between. I’ve set an open american squat record (which has since been beaten), competed in the USAPL national prime time, competed in the Arnold enough times to lose track, and now set a master’s squat and total record (the total record has been beaten by a bodyweight tie, ugh).

I’ve had more injuries and life obstacles than I care to reflect on. Medical school and residency were big hindrances to training purely because of time, but they taught me good time management and how to prioritize training. Having a child was also a big time management lesson, and it was an even bigger lesson in expectation setting with limited recovery. Breaking my wrist in wrestling enough times to require a wrist fusion was a lesson that taught me to prioritize grip training. Completely tearing my adductor off my femur (it’s still gone) when I tried to beat the IPF open squat record some years ago taught me that the last squat session 1.5 weeks out from a big meet might not be mission critical if your leg hurts a ton. I learned to be kinder to myself closer to a meet and really prioritize sleep and recovery.

Starting about 4 years ago, I started getting terrible coughing fits and spitting up fluid with extra hard training sessions. “Meh, this just goes with the territory,” I told myself. “I’m asthmatic, I have bad reflux, and I’m getting older.” Thus began the justification. I was still strong. Wasn’t really meeting a lot of goals I set for myself, really plateaued, but I was about to age out into the master’s category anyway and crush it.

Crush it I did, setting some records right out of the gate. I was able to complete some real marathon training sessions, but my top end strength still really stalled. The only thing that seemed to progress was my deadlift due to a high prioritization of grip training. Up until recently, I was closing in on a 700lb deadlift.

Last training cycle, Mike T joked, “You know how sometimes you wonder if your coach is trying to hurt you? Well, now you don’t have to wonder!” Mike says stuff like this sometimes, but really the challenge is all auto-regulated - up to the athlete to calibrate the difficulty. He had me set up for some strip method squats for about a month. I was so psyched - I love a good challenge and sessions where my soul leaves my body temporarily. I finished a few weeks of this, but the strip method squats were quite difficult. Usually I wasn’t lying on the floor in a ball just trying to breathe for ten minutes after something hard, but this time around I was. “Well, I’m older, and this’ll just be an awesome training stimulus.” MORE justification.

Then some mini strokes started. I had an episode on vacation with my dad in Italy where I had a dense numbness in my right arm and face for about an hour. “Meh, I had too much wine last night and espresso today,” I justified. Two weeks later, after having a 60 second inability to use or recognize my right arm, I still continued to justify. In fact, I went to work that night and told myself, “Well, I had a mini stroke. I work in a stroke center tonight, so if something bad happens, I’ll be right there.” I waited a full four days on my wife’s persistence before I saw a neurologist in clinic.

After a thorough workup (and a “you’re a dumbass for not getting in here sooner” from the neurologist, who was actually quite good), it turns out I have an Atrial Septal Defect - a hole in the top part of the heart that separates the right and left sides. These are present from birth and typically show up earlier in life, but in some cases don’t show up until someone is elderly. In my case, I was starting to get some pulmonary symptoms and very early right heart failure. My resting oxygen levels are around 96% right now. A well trained athlete should be living at 100% basically all of the time. Because of heart shunting of deoxygenated venous blood during valsalva, my oxygen levels dip into the low 90’s after a hard set (I did this as an experiment at home). Left unchecked, a couple years down the line, I would be looking at a heart transplant. The mini-strokes were from a phenomenon called “cryptogenic strokes” and can, in individuals with a heart defect, be caused by tiny venous blood clots entering the arterial side due to the hole. Normally, tiny blood clots in the legs from, say, a transatlantic flight to Italy, get filtered out in the lungs, and many go unnoticed. The brain doesn’t tolerate any clots well at all, and those clots show up as strokes, even in people with pristine bloodwork and blood pressure just like mine were in a disability exam some months prior.

Thankfully, the fix for this is a no brainer with modern medical technology. A catheter is inserted into the groin and a patch is put over the hole. I am being told I will feel “better than ever” and that I can return to lifting in four weeks post operatively.

I started this article with a discussion on insta-therapy and resiliency. I’m resilient. There’s a lot of people out there that are, especially powerlifters. Continued resiliency can crack and fail at some point, even like the strongest of dams. I think a better term for our purposes might be “framing”. I don’t know what my training will look like going forward. There will be rehab, then some resumption of normal training. I will have to be kinder to my body. Will I be able to compete ever again? Remains to be seen.

The “framing” I’ve landed on is two things:

  1. I have started coaching my wife and my brother-in-law.  Watching them progress has been one of the coolest endeavors I’ve ever been on.  They did their first meet together and absolutely crushed it.  I am super pumped to see them compete next year.  If I can never compete again, I can coach and impart the wisdom that I have learned.
  2. I set some USAPL master’s records with a hole in my heart and dipping my oxygen levels every time I valsalva hard, which is damn near every hard training session.  If this patch works, how much stronger can I get?

The first option accepts the fact that resiliency can fail.  It absolutely can.  One cannot get through every single obstacle.  Some are just too large.  But we can walk around the obstacle to find another path.  

The notion of having something wrong with my heart at 40 years old after having been so healthy my whole life was initially terrifying.  However, when I think about the second framing option, I moved myself from being scared to being very, very excited.

Those of us that train hard, and there are many of us out there, need to take time out for re-framing every time an obstacle hits.  Also, know that you don’t have to push through everything all the time; sometimes there is something wrong and you must stop to get it addressed and improve.  Last, for the men out there: get that thing checked out that your partner keeps nagging you about.  Mine was a cough.