Jan 29, 2015Comeback Athlete: Breanna Walukevich
Sanborn Regional High School, Kingston, N.H.
By R.J. Anderson
R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected]
Known for her toughness, Breanna Walukevich has a heart that doesn’t quit when she’s on the basketball court. However, when she was rushed to a hospital three years ago, it was her overactive ticker that had doctors concerned.
For Walukevich, now a senior at Sanborn Regional High School in Kingston, N.H., playing hard can be a double-edged sword. While she knows no other way than to give all-out effort, an elevated heart rate can become hazardous to her health. But thanks to an implantable cardioverter-defibrillator (ICD) and diligent care from her comeback team, including Matthew Szelog, LAT, ATC, CSCS, CES, Head Athletic Trainer at Sanborn and Director of Dynamic Performance Sports Training in Exeter, N.H., Walukevich has learned to live with her condition and isn’t letting it hold her back.
Walukevich’s comeback story begins in her freshman year following a preseason soccer practice. After completing the second session of two-a-days, she complained to her coach of dizziness and shortness of breath. Checking Walukevich’s pulse, the coach discovered that her heart rate was around 280 beats per minute (bpm). “You could actually see my heart pounding through my chest,” Walukevich recalls.
An ambulance was called and the 14-year-old was rushed to a local hospital. Along the way, her heart rate returned to normal, but doctors felt the incident was serious enough to transfer her to Children’s Hospital Boston. She stayed for a week, undergoing an array of tests. Though doctors didn’t learn exactly what sparked the racing heart, Walukevich was diagnosed with a cardiac arrhythmia and the ICD was surgically implanted.
The ICD monitors Walukevich’s heart rate and delivers a shock whenever it reaches an unsafely elevated level. The device uses an electrode wire, which passes through a vein to the right side of Walukevich’s heart. With the ICD set to deliver a shock whenever her heart rate exceeded 190 bpm, as well as a prescription for Toprol (a beta-blocker), Walukevich was released from the hospital.
“They don’t really know what causes the arrhythmia,” says Walukevich. “I’m young, healthy, and athletic, so none of the traditional diagnoses really fit. They said it’s a case of me having an out-of-whack electrical system.
“For example, whenever I get an EKG, the readings are abnormal for a young, athletic girl,” she continues. “My doctors told me I have the EKG readings of someone with anorexia–and I’m not anorexic.”
Walukevich missed the first few weeks of classes as she recovered and got used to her new hardware and medication. Upon returning to school, she hadn’t been cleared to play soccer but rejoined her teammates as team manager and scorekeeper.
When basketball season rolled around, Walukevich offered to serve as the manager for the freshman team. Then, midway through the season, she was given the green light to return to athletics. “My doctor told me that the arrhythmia was under control and that it was safe to play,” says Walukevich. “He said to ease into it and everything would be fine.”
However, everything was not fine. An hour into her first practice, Walukevich was running through set plays when her heart rate hit 190 bpm. “I wasn’t even going that hard–I was taking it easy,” she recalls. “Suddenly, the ICD started beeping, and then it shocked me.”
Over the next three minutes, it kept shocking her–eight times in all. “The ICD is only supposed to shock you a couple times, but it kept going because my heart rate wasn’t returning to normal,” says Walukevich. “The shocks hurt so bad that it felt like I blew out my chest. The doctors said the continued pain of the shock probably caused my heart rate to stay elevated.”
Walukevich was taken back to Children’s Hospital Boston, where doctors spent three days examining her. They adjusted her ICD to go off at 210 bpm and sent her home with more powerful beta-blockers and a prescription for Lisinopril, which is commonly used to treat high blood pressure–and a medication Walukevich’s grandmother also takes.
Traumatized by the incident, Walukevich retreated from athletics and spent the rest of her freshman year worrying when her next attack would come. “I was too afraid to do anything that might get my heart rate up,” she says. “In fact, I would cringe whenever I heard any kind of beep, fearing it was my ICD about to go off again.”
In the fall of her sophomore year, at the urging of her parents and former basketball coach, Walukevich tried out for the golf team. Although she had never played the game before, she made the team as the only female on the roster.
“Sports are my life, and when they were suddenly taken away, I needed to do something. Golf filled that void,” Walukevich says. “It’s a tough sport, but I picked it up pretty quickly.”
When golf season ended, Walukevich still missed basketball–her favorite sport–so she joined the j.v. team as manager. Midway through the season, after watching Walukevich shoot around with the team, the coach asked if she’d consider playing again. She mulled it over and talked to her doctor. With her condition stabilized, he said it would be okay for her to give it a try.
Szelog was adamant that a return-to-play protocol be firmly in place at the beginning. “The first time she came back, she somehow ended up on the court that first day without any of us meeting to talk about the situation,” he says. “The coach didn’t know any better and I wasn’t there that day to tell him any differently. I don’t know if it would have changed anything, but in hindsight, I wish we had all sat down beforehand and drawn up a definitive program before she was allowed on the court.”
This time, Szelog would watch Walukevich like a hawk. “I told Bree we would follow a very strict program to condition her while also closely monitoring her heart rate,” he says. “We would take it day by day and slowly increase her workload to progressively get her back. Still, she was very hesitant.”
To help assuage her fears, Szelog printed out articles he found online about athletes with ICDs returning to sport. He also outfitted Walukevich with a heart rate monitor watch and chest strap donated by a local health club affiliated with his clinic hospital. Designed to act as an early-warning system that would head off the ICD shocks, the watch was covered by a sweatband. Szelog also gave Walukevich a padded undershirt to protect the chest strap, as well as her ICD.
“I set the monitor to sound an alarm when Bree’s heart rate got to 190 bpm, which was 20 below what her ICD was set at,” Szelog says. “I explained that if her heart rate ever got to 190, the watch would beep and she should immediately stop what she was doing and rest. Even if it were to go off during a game, we told her she should kneel down, calm her breathing, and not worry about the action around her. Thankfully, that never happened.”
For six weeks, Szelog worked with Walukevich during team practices to slowly build her cardiovascular fitness. The first week was extremely simple and low-impact. Walukevich started workouts by jogging two laps around the gym at a very slow pace, then transitioned into a dynamic flexibility routine, followed by a couple more laps, rest, then free throw shooting. Over the next few weeks, Szelog added more laps and some light agility work. After four weeks, he worked light sprinting into the routine.
“No matter what we were doing, I’d continually check her heart rate, which was always right where we wanted it–around 130 or 140 bpm,” Szelog adds. “We charted every workout, and her coach even had her write down her heart rate after phys ed classes. We never had any problems with it getting too high.”
Szelog says communication was the key in walking the fine line between getting Walukevich in shape and not letting her overdo it. “She was very honest and would regularly update me on how she was feeling,” he says. “She let me know right away when she needed to take a break and get a drink.”
By mid-December, Walukevich was ready to be slowly introduced to team practice activities, although in a very limited capacity. “We started her with 15 to 30 minutes of shooting and defensive drills, and built her up to being able to jump into scrimmages during practice,” Szelog says. “Even then, we only let her go for three or four minutes before bringing her to the sideline to rest.”
Walukevich got her first taste of game action in early January. It was only for a few minutes, but it meant the world to her. “It wasn’t long after I started playing that I wasn’t afraid anymore,” she says. “I realized that it was a lot more fun to play and not worry, than to not play and be worried all the time.”
Throughout the ordeal, she also gained an appreciation for the joys of participation. “Before, I might have complained about going to practice or having to run two miles or do sprints,” she says. “But once all that was taken away, I really wanted to get back into it. I realized I missed doing that hard stuff–I missed sprinting!”
After regaining her confidence as a sophomore, Walukevich enjoyed a fantastic junior year, especially on the golf course. After competing against boys during the regular season, she tied for third in the nine-hole division of the New Hampshire Interscholastic Athletic Association girls’ individual golf tournament. After high school, Walukevich plans play collegiate golf.
In the winter, she made strides on the basketball court, earning more and longer playing shifts. “I’d go full out for like three minutes and then the coach would take me out,” says Walukevich, who chose to play on the j.v. team so she could continue to take things slowly. “I could give a lot of effort, just not for too long.”
Szelog describes Walukevich as an incredible athlete whose trademark is grabbing a rebound and dribbling coast-to-coast for a layup. He says seeing her back in the game was rewarding, but not completely worry-free. “There was one game when the team decided to run and gun for three minutes straight without a break in the action,” he says. “Bree was full-out sprinting the whole time and our coach looked at me and asked, ‘Is this okay?’ I said, ‘Yeah. If her heart rate gets too elevated, the monitor will beep and she’ll back off.’ But it didn’t happen.”
As a senior, Walukevich hopes to keep improving on the links and believes she may be ready to play varsity basketball. “With ICDs, they discourage you from playing varsity sports, but my doctor says I’ll be okay as long as I’m careful,” Walukevich says. “The coach understands my limitations, and I worked hard all summer playing pickup games to maintain my conditioning. I’m pretty comfortable with the idea.”
Returning to athletics has been an incredible lift for Walukevich, who gives much of the credit to Szelog. “I probably wouldn’t be playing basketball if it weren’t for Matt,” she says. “He understood that I was afraid and helped me slowly work my way back.
“He pushed me by watching me and asking questions,” Walukevich adds. “And when I didn’t feel up to par, he encouraged me to rest. I owe a lot to him.”
Szelog says Walukevich taught him a lesson about true determination. “One thing I learned–and that I will share with other athletes–is you can’t let an injury stop you from doing what you want,” he says. “In Bree’s case, we saw that athletes can push themselves through something pretty serious if they put their mind to it.