How I found my Abdominal Aortic Aneurysm (AAA)

In January of 2010, whilst lying quietly in bed, I noticed a prominent pulse in my lower abdomen. At that time I was at an intense level of training for my favorite sport, Ironman triathlon, and I was thus very lean. My resting pulse at that time was 38 beats per minute, indicating a high level of cardiovascular fitness. The low pulse rate meant that my heart was putting out a lot of blood on each stroke, called a high stroke volume.  A lean state, combined with a high stroke volume, caused me to dismiss the abdominal pulse as a consequence of my ability to feel the pulse in my aorta.  A person with plenty of fat and a low stroke volume would be unable to do this, so I let it go and actually forgot all about it until August of that year. It just became normal!

Distinct abdominal pulse was clue number one to my life-threatening AAA.

In July, 2010, I completed the Lake Placid Ironman (IMLP) for the fourth time with my best performance ever, thanks to coaching by Chris Hauth of AIMP, and lots of support from training partners, family and friends. This race would have taken me to the Hawaii Ironman as a qualifier if I completed the race first in my age group. But this was not to be as you will see! The race is 140.6 miles, comprising a 2.4-mile lake swim, 112 miles of cycling through the Adirondack Mountains and a 26.2-mile marathon. It is a tough race and I was ready for it.

My partner, Deb, went with me down to the transition area, where I checked my bike and was given number markings – this is one of the most exciting parts of Ironman training. Pre-race nerves haven’t hit yet. It’s all energy and focus.

Just before 7:00 am I got into the cold water in my wet suit and off went the gun. I had a great swim, which is a good start!

The wetsuit strippers pulled off my suit,  I chucked it over my shoulder and ran barefoot along a green mat for about a quarter mile to the transition bag area.  There I collected my swim-to-bike bag, changed in the tent, and started on to the next leg of the race – a 112-mile ride through the beautiful countryside of the Adirondack Mountains around Lake Placid. I love that ride! First thing I did once I found my bike was to chomp on a Power Bar (I have to eat 250 calories per hour on the bike or risk bonking).

 Onto the Bike

I then completed the grueling 112-mile bike course in less than 7 hours, my best time ever on the bike. When I came bouncing off of that bike I was ready to complete a marathon in 4 hours and 15 minutes (my expected time). Early in the run, Deb told me that I was first in my age group and that I was about 40 minutes ahead of the second guy off of the bike, a wonderful runner named Roger. The race was in the bag – but it’s not over ‘till it’s over! My friends were delighted to be seeing a trip to Hawaii in their minds.

Then the trouble started: I felt strong when I headed off on the run, and everything was fine until around mile ten when the soles of my feet started to ‘burn.’ They felt as though they were on fire. This didn’t change for the next 16 miles, even when Roger went by me three miles from the end of the race. I remember thinking, “One day I want to be able to run like that,” and I still use that image to improve my running today. Deb was spurring me on, I knew that something was wrong. I didn’t know what was up but the pain in my feet was almost unbearable. I had never experienced this type of foot pain in thousands of miles of running.

Foot pain in the IMLP 2010 was clue number two to my life-threatening AAA.

Just look at the expression on my face as I finished that race in 2010, in excruciating foot pain. Roger gained 12 minutes on me during those last three miles, and I came in second totally relieved to stop running, which was all I really cared about that point. Once I stopped running the burning sensation vanished in no time. ODD? Still the light didn’t go on.

I’m a veterinary pathologist by training. We think about disease and our job is to link symptoms with a disease process (pathogenesis). Well, I was lying in bed quietly about 10 days after the race, when I noticed that my abdominal pulse was lifting my abdomen up and down. I turned on the light and I could see the movement. “What the hell?” Like any trained pathologist would do, I started to create a differential diagnostic list (possible causes of symptoms in order of likelihood) for two symptoms that appeared to be extremely odd and unrelated:

Prominent abdominal pulse combined with burning soles of feet during Ironman race?

My first thought was stomach cancer, as cancer can come with some very odd symptoms indeed. I thought, “Maybe a mass in my stomach is attached to my aorta and transmitting the aortic pulse to my hand. But it doesn’t feel right – not percussive enough, and why is my abdomen moving up and down?” Onto the next choice!

My second thought was, “@!#!, an abdominal aortic aneurysm!!!!” [Excuse my language but that is exactly what I thought]. I didn’t get any further. It all came together in an instant – bulging aneurysm moving my abdomen up and down, and burning in my feet due to impaired blood flow. Energy (blood pressure) lost moving my abdominal contents around would not be available to drive blood to the very end of my legs, notably the soles of my feet, whilst running. You know, humans hate to be wrong, but this was one of those times when I really hoped that I was wrong, but I wasn’t wrong. I was right!

An ultrasound the next day confirmed the presence of a life-threatening abdominal aortic aneurysm with a maximum diameter of 6.9 cm.

It could have burst at any time, and I knew that as soon as I saw the MRI scan two days later. Why it didn’t rupture and kill me during the last 15 miles of the bike leg when I was holding over 200 watts most of the time I had no idea. Luck, basically!

My life changed the moment I saw that massive, S-shaped, paper thin, AAA in the MRI in the office of Endovascular Surgeon, Dr. Jo Fulton.  I underwent surgery four days later, having an about 9-inch long endovascular stent inserted in my aorta, which saved my life.

As a result of my aneurysm and other circumstances, I left a forty-year long career in science to start blogging about AAA and safe exercise for better health, as ‘FitOldDog’. My blog contains more of my story, which has been a journey through fear and uncertainty to a new life, providing guidance on safe approaches to exercise and insights for those with aortic and other health issues. My horizons have expanded thanks to Jo Fulton and his team and my fortunate self-diagnosis. It sure was a close call.

A year later I finished IMLP for the fifth time, but I did it very carefully and slowly (>16 hrs), just to be sure that it could be done.   Now I am back in training for IMLP 2012 and very glad to be alive.

Thought I would finish by saying that I am back with my old coach, Chris Hauth of AIMP, having just completed his Spring Training Camp in Tucson with a bunch of young whippersnappers. Here I am celebrating the end of camp after biking back down from 6500 ft on Mount Lemmon.