Isn’t It Time We Talked About Hyperchondriasis?

Ted Guloien

“A fully committed runner will follow treatment for any problem provided it does not have as its goal cessation of running.”

Dr. Lowell D. Lutter, 1984

You probably already know the term “hypochondriac”. It describes a person who has excessive anxiety related to their persistent concern that they are ill, even in the absence of symptoms, and highly disquieted by any evidence of the same. It’s now called “illness anxiety disorder”. But what about its opposite, perhaps “hyperchondriac”? That is a person who denies that they might have a medical problem, even while symptomatic and in the face of pain (“illness nonchalance disorder”?). That well might describe a runner you know.

When I was diagnosed with cardiac ischemia, after experiencing angina (i.e., chest pains produced when the heart muscle is not getting enough oxygen to meet its work demands) while running, I was prescribed a daily regimen of a statin and baby aspirin, and “as needed” nitro-glycerin tablets. I was also told to keep my heart rate below 120 bpm. I tried to adhere to the heartrate limit but discovered that if I stopped running, after experiencing the angina, I could resume after a 1-minute rest and crank my pace up to 4:30 minutes per kilometre and my heart rate over 150 bpm, pain free. This is a sign of hyperchrondiasis, of being a hyperchondriac.

I wasn’t always so foolhardy, so how does one become a hyperchondriac? Based solely on my experience — no research, just reflection — I think it happens when you begin to take running, or any sport, too seriously. In my case, I fell in with the wrong crowd. My mother would smile if she heard me finally admit she was right, even if the context is so radically different from what she had in mind.

When I think about the group of runners I trained with, some of whom I ran with almost every day of the week, it now seems inevitable that I would not think twice about exceeding the heart rate threshold my cardiologist advised me to keep, as foolish as that now sounds. In our running group, and it was apparent in our discussions, certain attitudes held sway:

  1. The finish line was not the goal; beating your best time was the only goal. There was no time for the motivational mantra of “Enjoy the journey, not the destination”. Ours was “You’re only as good as your last race”. Some runners we knew would DNF a marathon if, during the race, they realized they would finish with a lackluster time. For them, walking away was better than a poor performance. That was wholly unacceptable. My sole DNF was the result of a sudden cardiac arrest during a half-marathon. I make no apologies.  Shaving off minutes or seconds from our finishing times was everything, and discussing strategies and tactics to accomplish this was all we talked about.
  2. Suppression and denial were as much a part of running as tying our running shoes. You quickly learned to suppress thinking about the pain in your calf or intruding thoughts such as “Maybe I’ll just run 15 km today, instead of 21”. A run would not be sacrificed for acute bladder or bowel distress if a suitable secretive spot was located en route. Necessity creates toilet paper for runners. You’d suppress thoughts of how you promised to take your children out for breakfast. You’d deny to yourself that running might be occupying too much of your time. You just kept running from one telephone pole or light standard to the next, convincing yourself “one more”, until you finished. “No pain, no gain” was seldom said but was an accepted truth. We would “run through the pain” and not stop. One of our runners ran a marathon with a hairline fracture in his foot; it was the only marathon at which I ever came close to besting him. I still kick myself for not pushing harder.
  3. Stoicism became the runner’s philosophy. You would believe that fatigue and pain were only a problem if you let your emotions allow them to be (that is, if you let them slow you down). Fatigue and pain were interpreted as excuses for a lack of mental fortitude and dedication to the sport and your goals. The group’s motto was “Your time is your time” or, in other words, “We don’t want to hear your excuses for poor performance because your finishing time is the only important part of the story”. Mental toughness was as important as physical. One of my cycling buddies got back on the bike too soon after his ablation for atrial fibrillation; his surgeon told him this decision may have helped and encouraged the ablated nerve pathways to restore or find new connections. He had a second ablation. Now he’s cautious and keeps an eye on the cycling computer for heart rate.
  4. Being in good running shape became conflated with being healthy. It was only after vomiting during the Columbus Marathon that my running and cycling partner discovered he had non-Hodgkin lymphoma. He continued running and cycling through chemotherapy and the successive recurrences of the cancer until he died 11 years later. Another running friend had a sudden cardiac arrest on the YMCA treadmill. He survived. And while it’s perhaps easy to fool yourself, others also perceive you to be healthy because you’re a runner or endurance athlete. When I told my GP that I was having chest pains at night, he said “We could put you on a treadmill but you run a stress test every time you run. It’s probably nothing to worry about”. And that diagnosis suited me just fine. I wanted to believe him. I wanted it to be true that I was healthy when faced with contrary information. A few years later, my GP was as surprised as I was when I was diagnosed with cardiovascular disease.

When I first experienced angina while running, I searched for and would have embraced any medical condition that shared the same symptoms I had as long as it wasn’t related to my heart or my running. Even armed with the diagnosis of cardiac ischemia, I rationalized my behaviour: “Angina is a symptom, not a life-threatening condition itself”, I told myself, and kept running. When I ran the heart-stopping half-marathon that I DNF’d, six months had passed since that first angina pain. By that time, I hadn’t experienced angina in a month and a half, and 4 days before the race my cardiologist said I could run the half if I “take it easy”. I didn’t give my heart a second thought. I was back.

Suppression and denial are close companions and running partners for marathoners and endurance athletes. They can pace you through a grueling marathon to a PB or, without them, to a DNF. They can also make the difference between life and death if you don’t pay attention to how they impact your running. As we age and keep running, engaging with these running partners becomes a fine balance between hyperchondriac and hypochondriac.

I’d like to say that I keep a close watch on my two running companions, but I don’t. Then again, I am not running with the same focused intensity as I used to. But when I run, I run without worry because worry accomplishes nothing, at least that’s what my two running partners say.

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