What made me go to the doctor?

by Volker Weber

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I keep getting asked the same question: how could you possibly tolerate the pain for so long? This is a hard question to answer. It's a combination of many factors and I am not going to try answering it. The more interesting question is why I decided to no longer tolerate it. The answer is easy: I could see that my body was failing.

Look at the two graphs above, both taken from Apple Health. The data originates from the heart rate sensor of my Apple Watch. I have been wearing it for years, 23 hours a day. That means I have a lot of data to compare against.

The left graph shows how my resting heart rate went from 62 to 85 over the course of only a few weeks. There is no good explanation. Your resting heart rate goes down over time as you exercise and your heart becomes stronger. Mine isn't particularly strong. I walk a lot but I have little cardio fitness. 62 is pretty good for my fitness level and my age, but it should not suddenly go up, especially not continously. My heart was not allowed to rest, not even during sleep.

The right graph shows my heart rate variability. In simpler terms: how steady is the heart beat. I average about 25 ms. At 62 bpm that means I miss the heart beat by about 2.5 hundreds of a second. And this one freaked me out. It suddenly went to 250 ms. (Graph only shows median.) A thousand percent increase! My heart was clearly in distress. Time to seek immediate help.

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Now my resting heart rate is down at 62, the beat is steady at 9 ms and I can see myself getting rid of some of the other meds I still need in the not too distant future. I am very thankful to my doctors and I attribute my strength and ability to heal to my exercise regime and healthy diet over the last four years.



That is a fantastic success story Vowe.

I am looking forward to the day when "condition monitoring" as it is known in industry in the context of pumps, turbines, air conditioners etc. is available to all and an intrinsic part of our health services.

sean cull, 2017-10-22

as far as i can see the heart rate data for rest time is only available with apple watch series 1+ - i’ve series 0 which doesn’t provide the data - maybe another reason switching to a new one ;-) good to have you back on deck! #dontbreakthechain

Seissl Anton, 2017-10-22

Sean, I am waiting for the first data privacy advocate who’d rather be dead than monitored.

Volker Weber, 2017-10-22

Pain is data, but it's too hard to measure and too easy for some of us to ignore. I'm very thankful that you were in a position to see something measurable and recognize that it was a warning.

Richard Schwartz, 2017-10-22

Next time (hoping there won't be a next time) listen to your body and don't wait for your devices to catch up, please. Don't ignore pain, especially if it is strong and/or unexpected and/or lasting longer.

Thomas Baschetti, 2017-10-22

Thomas, please don't jump the queue of people with good advice in front of my door. It's very long.

I am listening to my body, I have had more medical exams this year than most other people. Sometimes you do have to endure pain. And quite often the source of your ailment isn't immediately obvious. If it were, a lot of people wouln't have died last week. One of them saw his doctor Monday with an A-OK check and he was dead on Thursday. More on that later, after his family had a chance to announce his death.

And there is always a next time. For me and for you. We will all die in the end.

Volker Weber, 2017-10-22

Sorry Volker, i have missplaced my commment. It just should have been a reminder for the rest of us. I have seen to many of these „real men don‘t feel pain“ stuff with bad consequences in the last years.
If i could wear watches i probably would consider an Apple Watch myself

Thomas Baschetti, 2017-10-22

No need to apologize. Your advice is very sound.

Curious: why can‘t you wear a watch? Nickel allergy? I think Apple took care of that.

Volker Weber, 2017-10-22

Would you go as far as to say that the Apple Watch saved your life?

Pedro Meireles, 2017-10-23

No. My surgeon did. And my ICU guardian.

Volker Weber, 2017-10-23

No allergy, just can't stand it. Tried with watches and even a fitness tracker (jawbone). No way, drives me mad...

Thomas Baschetti, 2017-10-23

I understand this as “do not want” rather than “cannot”. But that’s OK. You should feel comfy.

Volker Weber, 2017-10-23

Ist die HRV Messung abhängig von der Version der Apple Watch?

Martin Funk, 2017-10-23

It is a watchOS 4 feature and it seems to be available on all Apple Watch models besides the original one. (Series 0).

Volker Weber, 2017-10-23

By the way: Does anybody know which parameter Apple shows as a HRV. Is it the standard deviation of the intervals?

Jan Pönighaus, 2017-10-23

Interestingly, in the few articles I found on HRV it says that a higher HRV is an indicator for better fitness and a healthier heart. (Example: https://lifetrakusa.com/what-is_hrv/)

Seems counter-intuitive to me and needs further research.

Oliver Stör, 2017-10-23

It's complicated. A steady heartbeat is important. But so is the ability of the heart to adjust to different loads.

Interestingly enough many doctors cannot explain an ECG/EKG readout but they know what it should loook like and can identify patterns that are wrong. And when that happens, they call in the cavalry. That's also what I did. Something was wrong. Go see an expert.

Volker Weber, 2017-10-23

@Oliver: Just read on HRV when it was introduced to the Garmin devices. Best explanation I found was the emergency mode of a pacemaker. You place a magnet on the chest and the device falls back to a certain heart rate to keep the patient alive, unconscious but transportable.
The calculation for a fit body overrules that basic mode. (fail safe operation)

Only difference is, the heart itself has a better basic fallback mode.
If brain capacity is needed elsewhere, the adjustments which sync to breathing etc. are dropped and the basic mode kicks in. Metabolism might not work in the sweet spot, but works.

Kai Nehm, 2017-10-24

"It is a watchOS 4 feature and it seems to be available on all Apple Watch models besides the original one. (Series 0)."
Okay, ... and I wondered why my watch would not show data for resting heart rate and variability. Thereby I accumulated two reasons to update (HRV, possibility to take it to the pool) and waiting for a third one. (But I like my black steel watch and don't like the red dot.)

Andreas Braukmann, 2017-10-25

I'm glad you are on the mend, Volker. The resting heart rate is always a good sign of trouble for me. I suffer from Atrial Fibrillation and like you have used my own data from my Fitbit to predict when I'm going to have good or bad days and show the graphs to the surgeon. A bad day is a distinct increase in the resting heart rate, so its the day to not go too far cycling. A good day is a lower resting heart rate which means I can hit the trails. In my scenario, there is even a monthly pattern. The value of this data cannot be underestimated and helps keep me fitter and still enjoy my hobby.

Andy Dennis, 2017-10-30

My heart rate goes up to 168 just by normally walking. And my hrv has gone up to 7ms then 9ms and average is 32 ms until today. Is this bad? I'm 24 years old .

Zulfiqar Ali, 2018-04-28

And my resting heart rate is 82-100.

Zulfiqar Ali, 2018-04-28

Are you overweight? Do you do any sports?

Volker Weber, 2018-04-28

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