TMBRA - Rider Board

[Anonymous]

Doc,

Usually I hit up my personal doc(asthma/allergy guy) or my good buddy(Pediatric trauma) but my personal doc does not seem to listen when I talk and my buddy says this is outside his knowledge.

I grew up suffering from nearly annual bronchitis and treated it with various inhaled steroids (short term until I was back to 100%) over the years. I also was diagnosed as a kid with the standard dust mite allergy (after stabbing me in the back 50 times those brutes told my folks to take away my stuffed animals). I never found an allergy med that worked for me. Claritin and Allegra did nothing and while flonase worked sort of, I still had a wicked drippy nose. Benadryl has ALWAYS worked for me, so I stuck with it.

I was a swimmer for 8 years and had/have above average lung capacity (annual tests for work put me in the upper 95% for my age). I also have an above average MHR. When I was a teen swimming I could hit 220 no problem. Now days, 25 next month, my max observed is 205. When I get above 200 I can really feel it, but below that and I can usually keep going hard. When riding my road bike I used to ride for 1.5-2 hours with an average HR of 180-190 at a speed of 20-21mph while going 75-90rpm.

I recently decided to work on my HR, so I re-geared my fixie so now I can spin 90rpm and my AHR stays around 160, of course I am only going 17-18mph. When I ride a geared bike I have noticed my HR is a little lower compared to before, but 30bpm higher than my riding buddy who has the same build as me only more saddle time in the past(not present though).

I usually ride around 100 mile a week.

Last weekend after a 5 hour ride, not terribly hard but SS MTB, I could only breath shallow. To breath deep would cause me to cough uncontrollably. This is fairly common.

When I run my HR spikes quickly and breathing is almost always a problem. Albuterol only sort of helps.

I feel like the fact that I have a really great set of lungs makes it easy to over look the fact that I have asthma.

So the questions I have:

Is a MHR of 205 something to worry about? Is the fact that I can hit my max/operate just below it a concern?

If my max is really 205 does that mean that most of the time (165+) I am operating anaerobicly? What does this mean in terms of my historical asthma? How about the effect this has on my training, shouldn’t I train aerobically?

If I had to explain my asthma I would say I have junk at the bottom of my lungs and that as long as I breath slowly and don’t go to my max capacity I have no problems. But if I run or MTB really hard it starts coming loose and I have breathing problems. Does this make sense/is this something that happens?

So I need a new Dr. but am tired of the crappy Dr’s I find at the Asthma and Allergy Center of Houston. I also suffer from sleep apnea and would like to find one Dr that can help me with my breathing all around. So what kind of Dr should I look for? Pulimnologist or an ENT?

[The Bike Doc]

Rek:

Hasten thee to a Pulmonologist! You are not likely hitting your true max heart rate because you are limited by your lungs and underlying asthma. Do not accept it as being "normal" to experience coughing and feeling short of breath when you try push yourself to the max. You should be able to ride to the point of exhaustion without your lungs being you limiting factor. It is very likely that you have underling airway inflamation that is causing you to have these symptoms. Albuterol does not address the airway inflamation, it only treats one of the problems, bronchospasms, that is triggered by the airway inflamation. You likley will benefit from being placed back on daily inhaled corticosteroids to supress the inflammation. Please note that it takes two to four weeks for the full effect of the inhaled corticosteroids to build up. You would immediately benefit from a combination inhaled corticosteroid/long acting bronchdilator fluticasone/salmeterol, commonly known as Advair.

In regards to your dust mite allergy, there are control measures that you can pursue now. If you sleep on a conventional mattress (not a water bed or adjustable air mattress, cover your mattress with a vinyl mattress cover and your pillow case with a vinyl cover as well. Then cover the mattress with a matress pad and the pillow with double pillow cases to keep from feeling like you are sleeping on vinyl. Wash the mattress pad, sheets and pillow case once a week in hot water and dry in a hot dry to kill the dust mites.

For your allergies, there is an excellent over the counter allergy (OTC)medication that can help many an allergy sufferer. Clemastine, (brand name Tavist) use to require a prescription until about 10 years ago, then it went OTC. It is what I use in my tough allergy sufferers, including myself, when allergies are flaring. On dusty rides get a NIOSHA rated dust particle arrestor mask, the type that you can buy at a paint or hardware store that have two straps and a 1/8 inc thick fiber mask. This can help reduce inhaled pollens and dust and decrease the asthma triggering effects of them. It can also help prewarm the air when you are riding in cold conditions.

Seek out one of the Pulmonolgist affiliated with Baylor School of Medicine; I have used them before and have been pleased with their care. Once you have good control of you asthma then you can find out what your true max heart rate is and fine tune your training based on it. (Just in case you are wondering, I am a Pulmonolgist and an Asthma sufferer, so I speak from two view points that you can appreciate.)

Thanks,
_________________
Paul K. Nolan, MD
AKA: The Bike Doc