Triathlete Pushes the Envelope

She is one of those people that can make you feel tired just being around her — a type A personality. The kinetic energy thrown off by the sheer force of her enthusiasm for life seems to engage anyone nearby in a physical way. Just listening to her talk 90-miles-an-hour about her plans for the rest of the day — plans that make your week look puny — or what all she did before she got to work (probably an hour early), or everything that’s going on in the volunteer project she’s coordinating will make you want to sit down and rest for a while.

Hilary Ann Petersen, M.D., a second-year resident in Emergency Medicine, crams so much into every day she’s already done enough to fill her 29 years twice. In fact, you might say she’s the UAMS version of Forest Gump. Her mother, Carlene Petersen, is a college tennis coach and a former professional who played against Billie Jean King. She grew up an all-around athlete, but focused on soccer. After graduating from Columbine High in Littleton, Colorado, Petersen accepted a scholarship to the University of Arkansas, where she played in a game against Mia Hamm. There she provided academic tutoring for the 1994 Razorback basketball team that won the national championship. All the while she has fed the craving to take part in the most masochistic of athletic endeavors, the triathlon. She’s finished two full-length iron man triathlons; that’s a 2.4-mile swim, 112-mile bike ride, 26.2-mile marathon, one right after the other.

Even with her demanding schedule as a resident, Dr. Petersen manages to bike into work from west Little Rock (about 13 miles), bike back after a 12-hour shift, then meet someone for a couple of hours of swimming or weightlifting, or both. On her days off, she’ll spend eight hours working out. On many weekends, she’s off to compete in a triathlon somewhere within a day’s drive. You’re likely to find out all those things about Petersen before you learn the one thing that is impossible to compute:  She should already be dead from Cushing’s Disease.

“It was kind of shocking,” emergency room  staff nurse and workout partner Glenda Gaston said about learning of Petersen’s condition. “The way she presented it was like, ‘it’s just what I deal with.’ It wasn’t a big deal to her. But, yeah, it made me more appreciative of who she was, and her attitude.”

Cushing’s Disease is caused by a tumor in the pituitary gland just under the brain, which creates an overproduction of cortisol, the substance that controls much of the body’s metabolism and white blood cell function. An unregulated supply of cortisol can be fatal. The short-term symptoms are bad enough: rapid weight gain in the torso and face while the arms and legs lose muscle mass and strength; a thinning of the skin that leads to easy bruising; a weakening of the immune system; muscle soreness; an extreme fatigue and disinterest in physical activity. A triathlete with Cushing’s is about as rare as a surfer on the beaches of Antarctica.

“I’m a very strange little creature,” Petersen said. “You know, cortisol and steroids cause cardio-myopathy, which is a breakdown of the heart, where it doesn’t function properly. We aren’t seeing mutations along those lines in me yet, but there’s no guarantee. I have to pursue the exercise or I get sicker and sicker.”

Cushing’s Disease occurs in approximately 10 in every one million people. Left untreated, the five-year survival rate is around 50 percent. Petersen figures that’s about how long she had the disease when it was finally diagnosed in her sophomore year at Vanderbilt Medical School in 1997. But her case is even rarer.

Surgeons first went into her pituitary gland through an incision in her mouth in September 1997. She says 70 percent of patients are cured after the first surgery. However, Petersen’s tumor returned two months later, requiring a second brain surgery in September 1998. “With the second surgery — 50 percent of the people should be cured, and I wasn’t. So, if seven of those 10 out of a million that originally had Cushing’s (were cured with the first surgery), that leaves three. If 50 percent of those three were cured with the second surgery, that leaves one and a half. So, I’m a one and half in a million case.”

The next option is brain radiation treatment. But that’s not something Petersen is jumping into. “I spent $150,000 on medical school,” she says. “I’m not really eager to let any of that information leak out.”

On the advice of her doctors, Petersen shunned physical activity before her first surgery and six weeks thereafter. By the next year, her attitude had changed. She competed in a triathlon the weekend before her second surgery, and ran a marathon three weeks afterward.

Petersen claims her condition and inability to suppress overt signs of it, makes her socially indecisive. “It’s intimidating in that when people want to get to know me. I think ‘how much do I really tell them?’ You don’t start out with, ‘Oh hi, my name’s Hilary Ann, and by the way, I’ve had two brain surgeries and still have a brain tumor.’ It really doesn’t take you very far.” 

But co-workers say she suffers no ill effects in her personal life, and in fact has recruited, one by one, about eight emergency department staff members to take up biking and go on the road with her to triathlons. One of them is Gaston, the staff nurse, who says of Petersen, “She’s completely… infectious is a good word. Yeah.”

Although Petersen has been featured on ESPN and in several newspaper and magazine profiles, few of her co-workers are familiar with the battle she fights every day. It has changed her into a highly empathetic doctor. Chronic illness sufferers can wear on the patience of many physicians. But she knows the physical toll regular brain tests take and the loss of control that a demanding treatment schedule brings. Gaston noticed, “Her motivation is optimism. She’s an encourager. That is her gift.”

The aspiring sports medicine doctor wants to study the effects of iron man triathlon competition on the functions of the body. “These people undergo a pretty phenomenal stress,” Petersen said. “I would like to apply those adaptations occurring in these athletes, not just to the triathlon population to help them perform at even a higher level, but also to allow people who have diabetes, who have heart disease to benefit from the changes that are happening in these athletes.”

As the director of the Arkansas Diagnostic Exercise Physiology Trust (ADEPT), Petersen plans to lead a team of about 25 to Florida to conduct the study at the Iron Man Florida race next November. The team will use 50 competitors and a control group of 50. They’ll take data from blood and urine samples, heart ultrasounds and electrocardiograms before the race, within the first hour after the race and between 24 and 48 hours after the race.

Most inspirational stories have a crossroads moment. Petersen points to the death of her father during her junior year in college. An aerospace engineer at Martin Marietta in Denver, Fred Petersen died of leukemia, an experience she would later apply to her own life-and-death battle. “One of the things I learned with my dad was a deepening of my faith. My perception of God was grounded in the idea that God was good, regardless of circumstances. He taught me that.”

Now others are learning lessons just watching the way Petersen lives.