The Waterfall
Homeostasis - any process that living things use to actively maintain fairly stable conditions necessary for survival. The body's mechanistic for balancing out within the narrow confines established for survival and maintaining the delicate equilibrium that is life. From temperature to blood pressure, blood sugar to respiratory rate, there are preset "normals" and normal ranges for each physiological condition. The human body is amazing in its ability to detect and regulate when we fall outside the preset normals. One of the best examples is temperature control - if we get cold, we start shivering. If we get hot, we start sweating. If things start falling outside the preset ranges and the compensation strategies are no longer working, most normal people show predictable and linear declines in function, like a river flowing downstream at a high rate of speed.
As athletes, we've used training to modify where our preset normal range falls. It's not uncommon for an athlete to have a resting HR in the low 50s, well outside the medically defined normal of 60-100. Other physiologic metrics like blood pressure, blood oxygenation and temperature control are also affected throughout our training. We become more efficient, better at regulating and better at compensating for when things go awry. We've also mentally trained ourselves to handle the stresses and discomfort that come with training and racing, so we are willing to keep pretending things are normal much longer then any normal person. The body is used to the stress training and racing places upon it and will continue using the compensating strategies it has developed up until the bitter end. It's like a waterfall - a fit person will compensate and maintain "normal" until there is nothing left to compensate and go over the edge. The same river plummeting over the brink of the cliff.
What happened to me this past week is the perfect example of the waterfall effect. According to all the medical research on normal people, with the amount of blood and fluid between my right ribs and my right lung, I should not have walked into the ER on Thursday morning. Not only should I not have been able to walk in to the ER, I shouldn't have been sitting there, holding a conversation with the doctor about how yes, my heart rate, pulse ox and blood pressure were all "normal", but they weren't normal for me. I should have been nearly unresponsive and getting the full trauma call out treatment instead waiting until the x-ray showed exactly how bad it really was. I was so close to the edge of the waterfall, to crashing possibly beyond the point of no return.
Why?
The average guy weighing 155lbs has about 5L of blood flowing in his veins. The equivalent of five liters of soda. Obviously, that varies depending on size and a smaller woman (me) will have less blood in her body - maybe 4.5L. During the thoracentesis, the doctor pulled out 1.3L of fluid with a hematocrit high enough for it to be considered blood. In fact, the hematocrit of the blood in my chest cavity was higher then that in my veins per the lab work! So from that procedure alone, I was down about 26% of my blood volume. Add in the additional liter of fluid and material taken out during surgery on Friday and now we are over 2L of fluid. That's more then 40% blood loss, which falls into the critical status for blood loss. According to Health Line and my Dad - an ER doc for many years - once you start getting past 40% blood loss, the body can't compensate much longer. The heart can't maintain blood pressure or circulation. Granted, it wasn't all at once, but a slow bleed over the course of 5 days - but still. It should have been enough for me to be passed out on the floor, not hopping out of bed after the surgery to sit in the chair. Instead, my body utilized all the techniques and strength I've developed from years of endurance sports to keep me moving. My HR was 82 BPM - not my normal 56-60 as my heart pumped faster and faster to try to maintain circulation. The decreased pulse ox - 91% vs the usual 98-99% was a clear sign of the decreased perfusion from low hematocrit. My blood pressure, hovering between 85/55 and 94/58, showing signs of stress and the only marker that was outside the normal ranges.
When you look at it, it really is amazing. The fact that I was able to keep going, still walking around and doing my short trainer rides while all that was brewing in my chest. I really have no way of knowing how close I came to the edge, but from what I've read it was closer then I'd like. And just like the water flowing in that river, athletes can compensate for just so long, Then it's over the edge, crashing down the waterfall. Once that happens it's very difficult to recover - and often we don't.
As athletes, we've used training to modify where our preset normal range falls. It's not uncommon for an athlete to have a resting HR in the low 50s, well outside the medically defined normal of 60-100. Other physiologic metrics like blood pressure, blood oxygenation and temperature control are also affected throughout our training. We become more efficient, better at regulating and better at compensating for when things go awry. We've also mentally trained ourselves to handle the stresses and discomfort that come with training and racing, so we are willing to keep pretending things are normal much longer then any normal person. The body is used to the stress training and racing places upon it and will continue using the compensating strategies it has developed up until the bitter end. It's like a waterfall - a fit person will compensate and maintain "normal" until there is nothing left to compensate and go over the edge. The same river plummeting over the brink of the cliff.
What happened to me this past week is the perfect example of the waterfall effect. According to all the medical research on normal people, with the amount of blood and fluid between my right ribs and my right lung, I should not have walked into the ER on Thursday morning. Not only should I not have been able to walk in to the ER, I shouldn't have been sitting there, holding a conversation with the doctor about how yes, my heart rate, pulse ox and blood pressure were all "normal", but they weren't normal for me. I should have been nearly unresponsive and getting the full trauma call out treatment instead waiting until the x-ray showed exactly how bad it really was. I was so close to the edge of the waterfall, to crashing possibly beyond the point of no return.
Why?
The average guy weighing 155lbs has about 5L of blood flowing in his veins. The equivalent of five liters of soda. Obviously, that varies depending on size and a smaller woman (me) will have less blood in her body - maybe 4.5L. During the thoracentesis, the doctor pulled out 1.3L of fluid with a hematocrit high enough for it to be considered blood. In fact, the hematocrit of the blood in my chest cavity was higher then that in my veins per the lab work! So from that procedure alone, I was down about 26% of my blood volume. Add in the additional liter of fluid and material taken out during surgery on Friday and now we are over 2L of fluid. That's more then 40% blood loss, which falls into the critical status for blood loss. According to Health Line and my Dad - an ER doc for many years - once you start getting past 40% blood loss, the body can't compensate much longer. The heart can't maintain blood pressure or circulation. Granted, it wasn't all at once, but a slow bleed over the course of 5 days - but still. It should have been enough for me to be passed out on the floor, not hopping out of bed after the surgery to sit in the chair. Instead, my body utilized all the techniques and strength I've developed from years of endurance sports to keep me moving. My HR was 82 BPM - not my normal 56-60 as my heart pumped faster and faster to try to maintain circulation. The decreased pulse ox - 91% vs the usual 98-99% was a clear sign of the decreased perfusion from low hematocrit. My blood pressure, hovering between 85/55 and 94/58, showing signs of stress and the only marker that was outside the normal ranges.
When you look at it, it really is amazing. The fact that I was able to keep going, still walking around and doing my short trainer rides while all that was brewing in my chest. I really have no way of knowing how close I came to the edge, but from what I've read it was closer then I'd like. And just like the water flowing in that river, athletes can compensate for just so long, Then it's over the edge, crashing down the waterfall. Once that happens it's very difficult to recover - and often we don't.
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