A triathlete’s breathing mystery, solved
Special to The Denver Post
Triathlete Tyler Evans kept pushing himself harder as he trained with a high performance team at the U.S. Olympic Training Center in Colorado Springs.
Then, the 24 year old from upstate New York hit a wall. And not just any wall. As he pushed himself harder, he found it difficult to breathe and suffered chest pains. Things came to a head last year in a race in Florida.
“I tried to push through the symptoms. I was not physically tired. I know I’m in good shape,” he says. “I was in a good position (in the race), then out of the water, I got onto the bike and couldn’t hang on to normal power levels. I couldn’t finish the race.”
Looking for answers, he kept training.
“I was trying to push myself harder in practice to prove it was a fluke,” he says. “As I worked harder, it got worse. When I was in the pool, at times I was at the point of blacking out. Things would get closed in, and I couldn’t breathe.”
He went back to New York and saw a doctor there, who gave him a 10-minute stress test. Evans completed it with ease.
“The doctor looked at the result and said, ‘I don’t know why you’re here,’” Evans says.
He began seeing various doctors, even as his condition worsened. Some thought it was asthma, which he had been diagnosed with as a child. He knew it didn’t feel the same.
On a run in March, Evans suffered severe chest pains. He tried to jog back to his car and found he couldn’t even do that.
“I had to walk slowly back to my car,” he says. “I didn’t know what was happening. I thought I might be having a heart attack. It was the ultimate low point.”
Evans went to Cleveland Clinic, where he underwent test after test on his heart and lungs. Doctors found nothing wrong.
“Of course it was good that nothing was wrong with my heart and lungs,” Evans says. “Psychologically, it was a very horrible thing. These doctors are the best in the world, and they’re not finding anything. Was it really all in my head?”
On the last day in Cleveland, he saw an ear, nose and throat specialist who observed that Evans breathed more with his head and neck than with his diaphragm. The doctor suggested he go to Denver’s National Jewish Health.
Discouraged and tired of the many tests he had undergone, Evans almost didn’t call for an
appointment. When he did go to National Jewish, the nurse did a stress test while drawing arterial blood to look at his oxygen levels.
The nurse then told Evans: “I know what you have.”
She asked if he objected if she brought in Dr. Tod Olin, director of the Pediatric Exercise Tolerance Center at National Jewish. Olin had Evans begin the treadmill stress test and then put his phone camera up to his face to record what was going on.
“He said, ‘I’m 95 percent sure I know what you have. Come back next week,’ ” Evans says.
That’s when, after more testing, Evans learned his diagnosis: exercise-induced laryngeal obstruction, also called vocal cord dysfunction. In those who have the condition, the throat inexplicably closes during very strenuous exercise. The first problem, though, is getting a diagnosis. Most people never exercise hard enough — above 85 percent of capacity — to know they have it, Olin says.
He adds that awareness of the condition is higher in Colorado, where many elite athletes train, than in some other areas of the country.
“Tyler is such an elite athlete that no one could cause the problem to observe it (in a clinical environment), Olin says.
Vocal cord dysfunction was discovered at National Jewish in the 1980s, and European studies put its prevalence at about 5 percent of the population. The condition has been treated with speech therapy, and overseas, surgery is sometimes used. Olin, however, has pioneered a new treatment. It begins with allowing the patient to see his own throat in real time during strenuous exercise. Olin then teaches the patient a breathing technique