“The CT scan indicates you have…”
What? Seriously? That can’t be…I’m a cyclist! Well, I didn’t actually say those things when the doctor conveyed the news. But I did think them, along with Samuel Johnson’s famous line about how news of one’s upcoming execution concentrates the mind rather wonderfully.
A Little Background….
I’m a lifelong cyclist living in the cycling paradise of Victoria, Canada. Never a competitor, just another person who loves the freedom of two quiet wheels and a long road on a sunny morning. That pretty much described me until almost 13 years ago when neighbour Dave invited me out on a group ride with his club, Tripleshot Cycling. Tagline: Pre-dawn café destination cycling.
One exhilarating ride with these fun people was all it took. After that, it was the usual progression: first nice carbon road bike, then a winter training bike, Bike Shed 1.0, wife tired of being a cycling widow and gets nice road bike(s) too, son gets into serious cycling, along with his buddies, daughters join the peloton, N+1 additional bikes, Bike Shed 2.0, family reunions built around cycling, vacations the same.
And lots of Tripleshot rides. The club started over 20 years ago as a group of cycling physicians called the Spin Doctors. One enduring benefit of this origin is that there’s usually a doc or two on most rides: when I got sloppy in 2015 on a fast Friday ride, overlapped wheels and went down hard, I had a couple of ER docs checking me over in less than two minutes.
In the first two months of 2020 my wife and I did a home exchange/cycling holiday to Tucson – our first time in Arizona. We fell in love with the Sonoran desert, the welcoming bike clubs, and the seeming endless mixed-used trails and exciting mountain climbs including the legendary Mt. Lemmon.
All of this is to say that the past 12 years featured a lot of cycling, and that doesn’t include winter spin classes and workouts at the local Y. I had done Maui’s Mt. Haleakala four times (never quickly, I might add), Gran Fondos and “Big Rides” (275 kms/day) so I thought I was in good shape. And I was. But I had no idea about a quiet, patient assassin lurking in the shadows (cue ominous music).
COVID + Cycling = Zwift
With COVID came the early 2020 border shutdowns; we drove home from Arizona just under the wire in the first few days of March. When it became obvious that the Canada/US border would remain closed for at least 2020 (no return to Arizona!) and the infection risk would be high, my wife had an idea. “You have a hard time with Victoria winters (winter darkness, grey skies, rain, occasional snowfall), so why don’t you get one of those smart trainers?” “I’m on it. Consider it done”, I replied.
My wise wife also suggested this in the middle of summer, which gave me time to order equipment before the mad global scramble in the fall. I managed to assemble the entire Wahoo trainer ecosystem, along with a nice 4K video unit to stare at (the tv was the least expensive component).
Then came the Zwift subscription. I loved it. Every ride was a learning experience – and remains so now. My avatar is a much better bike handler than I’ll ever be, taking steep hairpin turns at 80 kph. My job is to manage my limited energy in the face of the “Zwift Effect” where (almost) every ride is a race. I quickly realized that I was a tiny fish in a very big pond: although I rode B1 with Tripleshot – a brisk, respectable pace – Zwift was different. With a global talent pool, trying to hang with the leaders on any Zwift ride for more than a few minutes was like trying to win the Friday A group road ride at home. Not happening.
Building Me Up
But I could at least try to build my watts/kg with Zwift’s training programs… and what better program than “Build Me Up”? These rides produced results, although they did feel fairly punishing, (Dylan Johnson has some insightful thoughts on Zwift training plans; his video is worth a watch) and even in an unheated Canadian bike shed the sweat was prodigious.
As February approached I did my best to keep up with the training program but found that the most I could manage were the 90 minute sessions, and those were tough. I didn’t even try the handful of pre-graduation 2-hour sessions with their extreme demands. The fact that I could for the most part hit the watts/cadence numbers with my KICKR in erg mode made me think the training was working and I was getting fitter (a dangerous assumption). I was pushing myself hard.
Course “Graduation day” approached in early February, with the FTP test that would show exactly how much my Functional Threshold Power had increased since early November. I focused on getting some extra rest and good nutrition before the session. During the test it felt like whatever power I generated was just moving my legs rather than making watts. Try as I might, with a herculean effort I couldn’t hit my November FTP number.
That didn’t seem right – why was I going backwards?
When you’re confronted with screens of data – Zwift is good at that – the tendency is to go into analysis mode if things don’t go as planned. Perhaps it was technique: maybe I went too hard too soon? Have I overtrained? Looks like I need to carry on and get some more data!
So, more rides – get some rest and push hard again! Except that an 80 minute ride ridden at a Zwift C to C+ pace left me feeling more dragged out than ever, with a week (rather than the usual day) of recovery time needed before I wanted to go anywhere near the bike shed [CLUE]. After several of these experiences I was dragging myself around the house, feeling progressively more exhausted [CLUE]. Cycling indoors or out held no attraction. [CLUE]
With this deteriorating condition, my thoughts turned to the most high-profile suspect: I had somehow contracted COVID-19. While the numbers on Vancouver Island have always been low relative to the rest of Canada (being on an island helps), we still have daily infections and the occasional death. I seemed to meet the symptom criteria for testing so booked the drive-through gargle test (much nicer, I’m told, than having your brain flossed). The results were online that same afternoon: Negative.
Ok, what now? That night, around 3 am, I told my wife that with the heaviness in my chest I was convinced I had pneumonia (self-diagnosis. I studied law, not medicine). The way I was feeling, I thought staying in bed wouldn’t help much – it would be just as good sitting in emergency where someone could have a listen to my chest. (My first good idea so far!)
A Hospital Visit
3am was a great time to avoid the usual lineups at Royal Jubilee Hospital emergency department a few minutes up the road. The triage nurse took a quick listen to my chest then said, “Follow me.” What happened after that was a rapid succession of chest x-ray, ECG, blood samples, more examinations, insertion of an IV connector (good to have it should the need arise suddenly).
It was clear to the staff: I had a heart issue. Heart? Not even on my radar. The following day came an ultrasound echocardiogram (fascinating to see my heart valves flapping) and a CT scan where I got the fateful news: 100% blockage in the right coronary artery.
Terrifying information, yet the docs felt I probably had no permanent heart damage given my general fitness level and “athletic heart” from cycling (45 bpm resting rate that set off the “Low HR” monitor alarm beside my bed) that likely also developed a robust collateral circulation system. A similar blockage in the left coronary artery – called the widowmaker, if it’s at the junction where the left artery splits into two branches – might have meant I wouldn’t have been here to write this.
Perhaps the most important factor in avoiding serious heart damage was the fact that I had not tried to “tough it out” – getting out of bed and coming in was the right call. (Although some would question the wisdom of driving myself to Emergency; then again, I did think it was a respiratory infection.)
Two days later came the angioplasty: an assembly-line procedure with dozens just like me waiting their turn. Local anaesthetic at the wrist, insertion of a guide and probe directed by real-time X-ray in the radial artery snaking through the arm and shoulder to the heart, inflation of a balloon catheter at the blockage followed immediately by implanting a tubular drug-coated wire stent to hold the artery open and keep that blood flowing. In 30 minutes, the lower half of my right coronary artery went from a dry riverbed to a fully flowing river of pulsing life.
The doc had made an interesting observation before the procedure: “This blockage has probably been developing for the last several decades.” And all this time I thought my lungs were my weak point.
My Takeaways from this Experience
#1: Assumptions are Dangerous
Athletes may be the last to realize they have heart disease or recognize their symptoms (says T. Jared Bunch, MD, who directs heart rhythm research at the University of Utah).
This truth is worth one more anecdote to prove Dr. Bunch’s point: a recently-retired doc buddy of mine has a brother who is by all accounts an elite amateur cyclist: 25,000 km/yr average (that’s 15,000+ USA miles!), ultra-endurance races, you know the type. Lives on the bike. This fellow calls up his doc brother and says, “I’m just not getting much out of my workouts. Like I have no energy. I’ve got this heavy pressure in my chest, and weird stuff like pain in my jaw when I’m going up stairs. What’s going on?” To which my doc friend replied (I’m paraphrasing): “Dude, do you want to call 911, or should I? Get your ass to emergency RIGHT NOW!”
This athlete is a highly intelligent fellow (practicing lawyer) but, like the probable majority of extremely fit individuals, had a blind spot when it came to acknowledging his own symptoms. Yes, he had a significant coronary blockage.
#2: Pay attention when something out of the ordinary happens
Unexpected lingering exhaustion, unusually long recovery times, etc should be red flags. Consider following this up with your doctor. In a data-rich environment like Zwift, performance numbers that are in decline or going in reverse (combined with a physical feeling that’s “something’s not quite right”) may be a clue. Listen to your body and don’t rationalize the matter away like a typical cyclist!
#3: Learn the signs of cardiac issues
Again, don’t self-diagnose like I did! And it’s worth noting that for women, these signs can be more subtle and difficult to analyze. But you don’t have to take my word for it: take a few minutes to digest the summary that follows.
And with this new awareness (and maybe an overdue medical checkup?)… Ride On!
Warning signs of a heart attack
Many heart attacks involve discomfort in the center of the chest that lasts longer than a few minutes or that goes away and comes back. It can feel like:
- Uncomfortable pressure
- Stabbing pain
However, not all heart attacks are proceeded by chest pain.
Heart attack symptoms include:
- Chest discomfort
- Discomfort in other areas of the upper body: one or both arms, the back, neck, jaw, or stomach
- Shortness of breath with or without chest discomfort
- Pounding heart or changes in heart rhythm
- Heartburn, nausea, vomiting, abdominal pain
- Breaking out in a cold sweat
- Dizziness or lightheadedness
Warning signs of heart attacks in women
These heart attack symptoms are more common in women. They may occur without chest pain.
- Sudden onset of weakness
- Shortness of breath
- Nausea, vomiting, indigestion
- Body aches
- Overall feeling of illness
- Unusual feeling or mild discomfort in the back, chest, arm, neck, or jaw (Remember, these may occur without chest pain and still be a heart attack)
- Sleep disturbance
People who have diabetes or are elderly may also experience atypical heart attack symptoms.