Don't Get Weak!
“Do what you can, but don’t do nothing.”
I got weak. I couldn't help it.
This past January I found myself barely able to walk 4 laps (a 1/4 mile, more or less) around the cardiac wing at Vasser Brothers Medical Center, in Poughkeepsie, 90 miles north of New York City. This was only two and a half months after I completed a pretty challenging 2 day, 23 mile hike through the Utah backcountry with a 50 pound pack on my back.
I was in the hospital for a very unpleasant procedure called a (medical jargon alert!) pericardiocentesis, during which 850ml of bloody fluid was drained from my pericardium, the sac surrounding my heart. But I'm getting ahead of myself.
A couple weeks before that December 2023 hospital stay I had been experiencing minor discomfort in my chest. Pressure and shortness of breath, mostly, as well as an elevated resting heart rate. But my EKG was normal (yay, healthy heart!), viral antigen tests for flu, RSV and COVID were negative (yay, no active infection!) and a chest x-ray was clear (yay, no lung disease!).
But there was something seriously wrong with me, something which went undetected in that initial battery of tests. I got sicker, much sicker, to the point that I was waking up in the middle of the night struggling to breathe. A few days later, in the ER, a CT scan revealed a diagnosis of pericarditis (inflammation of the pericardium) and a pericardial effusion (the aforementioned fluid in my pericardium).
This pericarditis (which subsequently spread to my lungs and caused pleural effusions which also needed to be drained) cost me 10 days in the hospital between mid-December 2023 and early January 2024. And when I wasn't in the hospital I was at home convalescing, which meant a lot of time lying down and sitting and hardly any movement.
For two months I was barely able to walk around the block. I could feel my muscles withering, atrophying, but there was nothing I could do about it; I had no stamina to sustain physical activity of even the mildest intensity.
Once the inflammation spread from my pericardium to the pleural sacs, my lungs became compromised. It was during my early January hospital stay that I was diagnosed with a bilateral pleural effusion and 1.75L of fluid were drained from my left pleural sac (this procedure is called a thoracentesis). There was so much fluid in there that my left lung was essentially displaced and significantly reduced in volume because it was unable to expand fully. This explained why I had been struggling to breathe.
I began to feel relief from my symptoms (shortness of breath, chest pressure) immediately after the thoracentesis, although it took several weeks for my lungs to regain their full capacity.
The medical team at the hospital - cardiologists, infectious disease specialists, pulmonologists, oncologists - were flummoxed by my case, which they referred to, unhelpfully, as "weird" and "interesting." In the frustrating absence of any conclusive test results the consensus seemed to be that it was some kind of post-viral immune response gone haywire. The pulmonologist heading up my care put me on Prednisone, a corticosteroid, to treat the inflammation and hopefully stave off any future effusions.
It wasn't for another couple months that I was finally able to sustain any consistent physical activity, and even then it was at very low intensity and low volume (e.g., walking and yoga). Then, at the end of May, the inflammation disappeared as suddenly and mysteriously as it had first burst on the scene. I discontinued the corticosteroid after a cardiac MRI (1.25hrs and over 3,000 images!) didn't detect any pericarditis.
The road to recovering my full strength (that's right, I'm back!) has been slow but steady, and now, finally, nearly a year after my initial symptoms, I'm feeling like myself again. But several months of an imposed sedentary lifestyle had left me dramatically deconditioned. I was weak, I had put on weight (not muscle) and I had just turned 60 and was terrified that this was what my 60s were going to be like.
Fortunately, after decades of regular strength training and cycling and running and hiking and yoga my body remembers how to respond to exercise. It's like there's some ingrained muscle memory, so much so that before long my body began to crave the generative stress of exercise.
I started slowly, walking greater and greater distances, upping my step count with each passing week. Then I added hills, which really got my heart rate up and contributed to regaining full lung capacity. Once I started feeling stronger (and was confident that I wasn't going to relapse), I added some bodyweight resistance training (squats, pushups, etc.) because, well, feeling weak sucks.
The real turning point came when I got back on my gravel bike for a short ride around town. It was hard - my legs felt like they were made of wood and my lungs burned - but I persevered, and eventually, over several weeks, began pushing myself further and harder - more miles and more hills. Once I had confidence in my strength and stamina I signed myself up for the Shawangunk Grit, a 50 mile gravel ride coming up in November.
