Training With A Heart Condition

[mitchless]

Long ago in a forum post far away, Dr. Sullivan posted his guidelines for rejecting a gym member which included:

> 2. Abdominal aortic aneurysm, any form of aortic or vascular dissection, or any form of aortic graft

This list was also described as "absolute contraindications to barbell training." Strong language.

My father, whom I love dearly and have been training now for over a year, just informed me he has a thoracic aortic aneurysm. This revelation was prompted by a visit to the cardiologist (whom he has been seeing since his mild heart attack 20 years ago) who told him he ought not be lifting over 100 lbs. My dad's current squat PR is 150 lbs (4x3) and he has rack pulled 220 lbs (1x5). His press and bench press are still under 100 lbs. His cardiologist's concern was raised because he noticed a 0.1 cm increase in diameter of the aneurysm. My dad does take beta blockers in low dose.

I asked my dad to ask his cardiologist how he arrived at that 100 lbs value. He received a non-answer, but he also didn't ask the question directly. Normally I would tell him to soldier on because he very much likes the changes to his body from training and he still needs more muscle mass. Dr. Sullivan's advice, however, gives me pause. He trained today (squat 135x5x4, rack pull 200x5) and plans to train at reduced weight on Friday. We train at my home and neither he nor my mother are likely to sue me should anything go wrong.

Is his aortic aneurysm an absolute contraindication to training, or should he carry on? To put it more bluntly, how likely is it that squats or rack pulls will kill my dad?

[Mark Rippetoe]

Why would you write a post like this and leave out your dad's age/height/weight?

[mitchless]

There’s no excuse for such behavior on my part. 65 years old, 6’ tall, 225 lbs.

[Mark Rippetoe]

If I were him, I'd get this fixed by the best surgeon I could find. Now. He's too young to be walking around with a bomb in his chest.

[mitchless]

I spoke to him more about this today and got some more information. He’s not certain when the aneurysm was diagnosed, but it seems to have gotten smaller since it was first measured. It is presently smaller than surgical guidelines indicate for a repair (guidelines are greater than 5cm and his is 3.5cm). The surgery is open heart, and he does not want to take on that risk.

It is disappointing, but I can’t decide for him. For now we’ll limit loads to 100lbs — that gives him plenty of room for growth on his press and still some on bench. It is a significant deload for his rack pulls and squat.

I’ve asked him to speak more to his cardiologist about the recommendation. Is he also going to recommend cardio restrictions? What about all the lawn care he still does? He needs activity to keep achieve his goals (losing the spare tire, keeping his sugar and lipids under control). Eventually he will see the cognitive dissonance and/or realize he needs to pick a risk and live accordingly.

[Jonathon Sullivan]

If I were him, I'd get this fixed by the best surgeon I could find. Now. He's too young to be walking around with a bomb in his chest.

Concur. I stand by my earlier assertions: This is an absolute contraindication.

[Mark Rippetoe]

I spoke to him more about this today and got some more information. He’s not certain when the aneurysm was diagnosed, but it seems to have gotten smaller since it was first measured. It is presently smaller than surgical guidelines indicate for a repair (guidelines are greater than 5cm and his is 3.5cm).

So, his aneurysm is healing up. Right. That's what they always do. He needs a better cardiologist, very soon.

[mitchless]

Concur. I stand by my earlier assertions: This is an absolute contraindication.

Thank you for confirming. I assumed it was splitting hairs to say "Aha! This is a THORACIC aneurysm and not an ABDOMINAL aneurysm!" but I'm glad to have confirmation.

Any tips on how to convince his cardiologist (provided my dad is willing to assume the risks) to do the surgery?

So, his aneurysm is healing up. Right. That's what they always do. He needs a better cardiologist, very soon.

I speculated about the same, and got still more information. The reduced size reading was not from his cardiologist but from a stand-alone imaging place. His cardiologist told him he should demand his money back.

Not that I should throw too many stones, but one of these days I'm going to get all the necessary information out of my dad for something in the first shot. If you ever read this, Dad: what the hell?

This also feeds into my frustration with medical professionals in general, and combined with the difficulty of finding an endocrinologist who will actually BELIEVE my wife when she brings her diet and training log makes me SO PISSED.

[Mark Rippetoe]

Any tips on how to convince his cardiologist (provided my dad is willing to assume the risks) to do the surgery?

Read this out loud, and tell me if you think it makes any sense. Why would you use a cardiologist you had to convince to do a procedure? He doesn't want to drive two hours to a better clinic? Sounds to me like he's going to die of a AAA dissection. Make your plans.

[mitchless]

Read this out loud, and tell me if you think it makes any sense. Why would you use a cardiologist you had to convince to do a procedure?

I know full-well that it is ridiculous.

He doesn't want to drive two hours to a better clinic?

He might, especially if I can get him to reflect further on the YET NEW FACTOID he told me: this was diagnosed in 2006 and his cardiologist apparently didn't tell him. What I run into is: how the hell does he (or I) find a better cardiologist? Is there a reliable registry of high-quality doctors? Hence my ridiculous question: in the absence of knowing the quality of the provider, how do I get what I want?

I hope to one day find this all amusing, but right now it just pisses me off.