Breathing Problems

[PatCH]

Hi all. I’ve been struggling quite a bit this year with breathing problems on brevets, and I’m wondering if the rando folks here might have experience with or thoughts on it. I haven’t quite figured out a pattern, but on the longer (>300k) rides, it seems that my chest tightens up so I can breathe only at, say, 50% capacity. By mile 200 on our local 600k this past weekend, I was breathing at much less capacity than that, and my chest was becoming so fatigued from just trying to force myself to breathe, I started wondering if it might be heart issues. There’s no wheezing involved, my legs still have plenty of power, I’m pretty mentally awake, and in the case this past weekend, there weren’t any hills.

               

I tried using an albuterol inhaler several times on a few rides, but that doesn’t seem to have any effect. And two days later, my breathing is still not back to 100% capacity. Is this common among the rando folks? I don’t remember having this last year in my bag of problems to be solved, but then again, I was probably too much of a newbie last year to remember any suffering. Randonnesia, perhaps?

 

Any thoughts and/or suggestions would be greatly welcomed!

 

--Patrick (RUSA #6365)

[alex plumb]

Patrick,   I had a very similar problem last year. My shortness of breath was not a steady problem, sometimes it was very bad in the morning and other times it would hit hard later in the ride.  After extensive testing, my somewhat apathetic doctor said flat out "There is nothing wrong with you". I fired him on the spot.   My new doctor, who is also a cyclist, said on my first visit to her,"It's just a hunch, but try eliminating dairy from your diet". After three days of being dairy free I was fully recovered.  I had absolutely no problem with dairy products my whole life until last year.  You should pursue all possible dietary causes, even if you have not had reactions in the past.   I miss my chocoloate milk on long rides, but I'll trade it for the ability to breathe when riding hard any day.    Alex Plumb --- On Tue, 6/12/12, PatCH <patc...@gmail.com> wrote:

--Patrick (RUSA #6365) -- You received this message because you are subscribed to the Google Groups "randon" group. To view this discussion on the web visit https://groups.google.com/d/msg/randon/-/-Bo32enktIMJ. To post to this group, send email to ran...@googlegroups.com. To unsubscribe from this group, send email to randon+un...@googlegroups.com. For more options, visit this group at http://groups.google.com/group/randon?hl=en.

[Bill Gobie]

You could have something very serious going on. Your symptoms resemble mine when I was walking around with pulmonary embolisms (PEs) -- no symptoms until I reached a certain level of exertion. PEs are blood clots lodged in the lungs. Mine originated from a blood clot that was developing in my right leg with no symptoms.

You should read the link Iron Rider provided about atrial fibrillation. I have copied his message here.

I hope you have nothing this serious. But you really need to get checked out by a doctor ASAP! Go to an ER if you have to. PEs can kill you in seconds, without warning. They can cause you to lose consciousness, again without warning. Get someone to drive you to a doctor, do not drive yourself.

Bill

On Jun 6, 2012, at 5:07 AM, Iron Rider wrote:

I wanted to share a link to a blog post regarding Atrial Fibrillation,
a condition that Randonneurs should be aware of for themselves and
fellow riders.

http://eprider.blogspot.com/2012/06/atrial-fibrillation-in-endurance.html

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[Lynne Fitz]

Do you have any swelling anywhere? Exercise-induced angioedema? Hard to breathe if your airway and/or chest is constricted by edema.

[RayO]

Having no prior allergies, I have exercise induced alergy asthma
on rides longer than 200k.

I take non-drowsey OTC Claritin (sp?) after 200k and my bronchials
remain open.

[Iron Rider]

Patrick -

I  strongly recommend that you see a doctor, preferably a specialist like a pulmonologist, as soon as possible. The fact that you are looking for advice on Randon suggests that whatever the problem may be, it is serious enough for you to be asking for help and suggestions. Plus, its been over two days since the 600K and you are still having symptoms. To me that means that the condition is probably (1) NOT heat related (2) NOT exercise induced (3) NOT a local allergen. Just looking at all the answers you received so far means that there are several things that could be going on and some of them are serious. Get checked out.

On a personal note- I once asked Randos for medical advice following a brevet and got all kinds of well meaning responses/theories before I finally went to a doctor. Turns out all of the theories were wrong and I needed medical attention promptly. So get checked by a good doctor if for no other reason than peace of mind. If you go and there is nothing seriously wrong - no big deal. If you don't go and something is seriously wrong - huge deal. And go now, while your are having symptoms so that they have something to check.

[Thomas Martin]

Patrick,

I can offer some friendly ideas but be clear that this is not a doctor patient relationship (standard qualifier).  These are just some thoughts to share with you and other readers.

 

Shortness of breath (SOB) can have many causes, some serious, some not.  However, it is nothing to ignore expecially if you are over 40 or have coronary artery disease risk factors.

Possibilities include but are not limited to:

 

Angina - insufficient blood flow to the heart relative to need.  SOB alone can be a symptom of coronary artery disease (CAD) but it is uncommon especially in an athletic male.  With CAD, symptoms classically come on with exertion and go away quickly with rest (unless you rupture a plaque and now have a fixed obstruction to the coronary (heart) artery).  If you have risk factors for CAD (high cholesterol, diabetes, smoker, high blood pressure, someone in immediate family had MI at age < 55 yrs), your risk is greater and you should have a lower threshold for being evaluated for this.  Just because you an finish a 600K brevet doesn't mean that you don't have significant CAD.  If you ride hard and fast it is much less likely.  If you ride slow and just finish within time limits, you could have CAD because you keep your heart demand at a much lower level. 

 

Atrial fibrillation (AFib) or other abnormal heart rhythms (SVT, PSVT, VT etc.) - Usually one feels palpitations with these especially if you are vital and healthy.  Sometimes a person doesn't realize that they are in one of these rhythms.  If you can continue to ride, you are not having a life threatening abnormal heart rhythm (VT) but could have a non life threatenting cause (AF, SVT, PSVT, etc.).  An EKG at the time you are SOB can help to diagnose that but sometimes we have to resort to 24-48 hr or even longer cardiac monitoring to catch these abnormal rhythms.

 

Exercise or Cold Air Induced Asthma - obstruction to airflow (expiration obstruction >> inspiration obstruction).  Wheezing in the lungs (sometimes audible at the mouth) is a classic finding.  (Classic meaning usual or typical but not always.)  This cause is easier to assess objectively.  If you buy or borrow a portable peak flow meter (light weigth & about size of empty toliet paper roll), you can determine your baseline peak expiratory flow at rest and when you feel SOB.  The accuracy of these measurements is dependent upon effort, which must be maximal.  If your peak flow drops by 25% (despite maximal effort) or more when you feel SOB, asthma is likely and formal testing including your response to bronchodilators should be considered.  Your failure to improve with a bronchodilator doesn't rule it out.  You have to be trained to use an inhaler properly and many people need a spacer to get effective drug absorption from an inhaler.

 

Low oxygenation via lungs - Pulmonary emboli (blood clot in pulmonary (lung) artery) and heart failure (fluid backed up into lungs) are possible causes and much less likely if you only have symptoms at 200 mi.  If you can borrow from a friend or rent a portable pulse oximeter from a mountaineering store, you could carry it with you and check you bloods oxygen saturation level whenever you feel SOB.  In some respiratory conditions, low oxygen levels are only or more easily detected with exertion.  In some cases blood clots in lung can have normal oxygen levels.

 

Anemia - is another cause of exercise induced SOB.  Occult anemia (unrecognized) is much less likely in a male than a menstruating female.  If you have black and tarry stools (possible blood in stools), anemia would be more likely.  A complete blood count would detect anemia.

 

A very common cause of SOB in patients presenting to the ED is anxiety.  I can not tell who has a serious cause of SOB and who is just hyperventilating because they are anxious (or very fatigued in a rider's case).  Deciding that SOB is due to anxiety is generally a 'diagnosis after exclusion of more serious causes'.  Sometimes a clinician can make a reasonably accurate diagnosis of anxiety induced SOB based upon a good history, physical exam and pulse oximetry reading.  Most times in patients > 40 yrs of age who present to an ED with SOB, we do an EKG, cardiac enzymes, complete blood count and sometimes a blood test or other tests for blood clots and often a chest Xray.  If your SOB is transient, a chest Xray is less likely to be helpful but in some cases it can pinpoint a diagnosis.

 

You didn't state your age, which is important.  If you are 30 yo and otherwise completely healthy and fit (finish in top 50% of brevet), serious causes are much less likely.  If you are > 50 yrs, have CAD risk factors or other medical conditions.

 

There are many more less common causes of transient SOB that are too numerous to list.  We have a saying in emergency medicine: "It is often hard to tell the worried well, from the sick as hell (without objective tests)." 

My advice would be to see your primary care provider about this problem and not to ignore it.  If you don't have a PCP and you are experiencing SOB, you should get a PCP.

Good luck,

Tom

 

 

[Jesse]

My bicycle fitter guy recently recommended that, while riding, I focus on:

* maintaining a neutral back position, 

* relaxing my shoulders, 

* and opening up my chest

while in normal riding position on the hoods.

I was rolling my shoulders forward and up -- shrugging, kind of -- which closed my upper chest.

These changes immensely improved my breathing on last weekend's 200k.

Good posture also helps immensely with cornering!

Also +1 see a doctor.

[Bruce...@gdc4s.com]

+1 on reducing or eliminating dairy; reducing or eliminating refined sugars may help as well.

 

An albuterol inhaler can appear to be operating properly but be ineffective if the albuterol has been used but propellant remains, if the inhaler is well past its expiration date, or it's been stored at elevated temperatures.

 

- Bruce

[thirty-six]

I've been short of breath for years and recently all but stopped
consuming cows milk. Abdominal pains have now reduced and
breathlessness almost gone for usual about the house stuff. I am
happy using cream and butter generously. I've also no pyoblem with
goats milk and cheese. Today I read that the casien in cows milk
frequently binds to the gut wall which eventually leads to
malnutrition. I don't know if the problem exists with raw milk or any
cheeses yet (goats cheese is good). Isuspect that cows milk cheese
will induce the problem if much is consumed.

On Jun 12, 5:59 pm, alex plumb <alexpl...@sbcglobal.net> wrote:
> Patrick,
>
> I had a very similar problem last year. My shortness of breath was not a steady problem, sometimes it was very bad in the morning and other times it would hit hard later in the ride.  After extensive testing, my somewhat apathetic doctor said flat out "There is nothing wrong with you". I fired him on the spot.
>
> My new doctor, who is also a cyclist, said on my first visit to her,"It's just a hunch, but try eliminating dairy from your diet". After three days of being dairy free I was fully recovered.
>
> I had absolutely no problem with dairy products my whole life until last year.  You should pursue all possible dietary causes, even if you have not had reactions in the past.
>
> I miss my chocoloate milk on long rides, but I'll trade it for the ability to breathe when riding hard any day.
>
> Alex Plumb
>

> --- On Tue, 6/12/12, PatCH <patch...@gmail.com> wrote:

>
> From: PatCH <patch...@gmail.com>
> Subject: [Randon] Breathing Problems
> To: ran...@googlegroups.com
> Date: Tuesday, June 12, 2012, 9:35 AM
>
> Hi all. I’ve been struggling quite a bit this year with breathing problems on brevets, and I’m wondering if the rando folks here might have experience with or thoughts on it. I haven’t quite figured out a pattern, but on the longer (>300k) rides, it seems that my chest tightens up so I can breathe only at, say, 50% capacity. By mile 200 on our local 600k this past weekend, I was breathing at much less capacity than that, and my chest was becoming so fatigued from just trying to force myself to breathe, I started wondering if it might be heart issues. There’s no wheezing involved, my legs still have plenty of power, I’m pretty mentally awake, and in the case this past weekend, there weren’t any hills.
>
> I tried using an albuterol inhaler several times on a few rides, but that doesn’t seem to have any effect. And two days later, my breathing is still not back to 100% capacity. Is this common among the rando folks? I don’t remember having this last year in my bag of problems to be solved, but then again, I was probably too much of a newbie last year to remember any suffering. Randonnesia, perhaps?
>
> Any thoughts and/or suggestions would be greatly welcomed!
>
> --Patrick (RUSA #6365)
> --
> You received this message because you are subscribed to the Google Groups "randon" group.

> To view this discussion on the web visithttps://groups.google.com/d/msg/randon/-/-Bo32enktIMJ.

[William D. Volk]

I had gone vegan months ago, for several reasons (had been eating egg whites, some dairy, occasional fish). A persistent rash on my face that cortisone could not resolve went away.

Then I was persuaded by a nutritionist that whey based protein drinks would not cause any issues. This turned out to be false for me. The rash came back. Have located some protein drinks based on brown rice,

Casien is implicated in a lot of issues.

Your milage may vary.

William D. Volk

[thirty-six]

Casien was used to glue Mosquito planes in WWII. It was reported as
being very tenacious even when softened by the rain. I'm drinking
much carbonated water right now and my belly is softening. I suspect
that the flattening of my abdomen is going to take some time. Quite
odd that something which has been touted for so long as highly
nourishing directly causes malnutrition through gluing up the guts.
Any knowledge of how to rid what is still bound in me? I'm suspecting
lemons or limes may be useful..