“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. 

I now had something to challenge me from November to March.  That, and of course the pleasant distractions like FOCUS: Colors of Pari, Tour of New York, and the Black Celebration Series.

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?

What’s Happening?

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 

(source: secondscount.org)

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
• Squeezing
• Fullness
• 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.

After a very successful “Couch to Cat C” project, Boone is now well into the next training block: one we originally dubbed “C to Shining C”, but have since renamed simply “C to B”, as our new goal is to see him hit 3.2 w/kg in his ramp FTP test.

Here’s how week 4 unfolded…

The Plan

As a reminder: the basic plan we’ve settled on for the 6 weeks contains a mix of four different types of rides. (Many thanks to Alan Dempsey of HPP Coaching for giving us solid advice that sets Boone up for success).

• Races: Boone will race the C’s every week or two to check his progress, work on race craft, and of course get in a good workout.
• VO2 Workouts: this will be the cornerstone workout of each week. Nobody likes VO2 work, but we both agree Boone is getting a lot of benefit from these.
• Pace Partner Intervals: we’ll use the Pace Partners (Diesel or Cadence) to anchor a fun, interactive interval workout. Warm up with the pace partner, then sprint off the front for 15s. Or drop off the back, and put in a measured 2-minute effort to get back on. Lots of options here.
• FTP Ramp Tests: we’ll do at least two ramp tests to measure FTP progress.
• Recovery Rides: some days, Boone will just need an easier effort in the saddle. Since he’s still a beginning cyclist, even easy efforts are far from wasted.

Ride 12: Longest Yet

Today’s goal was simple: to set new distance and duration PRs. Boone’s previous longest ride lasted 1:17, and he hadn’t yet broken the 30-mile barrier. Time for that to change!

We jumped in with the C. Cadence peloton – Boone on his Wahoo KICKR Bike and me on my trusty Roubaix + KICKR v5. And he killed it!

In his first ride with C. Cadence, sometime in early February, Boone lasted about 25 minutes before he blew up. This time, 6-7 weeks later, he rode for 85 minutes, averaging 223W. And when he was done, he wasn’t destroyed like that first time. Instead, he proclaimed that he felt great. Ah, that Type II fun feeling!

Boone even scored the “Bigger than Jensie” badge – which is quite doable in the C. Cadence group, if you ride long enough. Everyone there is quite generous with Ride Ons!

The only bummer on this ride was Boone breaking the bolt of the quick release adjuster for his KICKR Bike’s handlebar height. We both agree this is the most obvious design flaw of the bike – because that quick release needs to be so friggin’ tight in order for the handlebars to be stable… it’s just a matter of time before the quick release gets broken, if you’re adjusting things very often.

Wahoo, of course, is shipping us a new one. Their customer support has always been top-notch.

See this ride on Strava >

Ride 13: Another Long Ride with C. Cadence

This was a fast day for Boone (not a day to ride fast, but a day to not eat much of anything.) As such, we wanted to keep the watts low, since the glycogen stores were already a depleted and a race-level effort or VO2 workout would have been a non-starter.

So we jumped in with C. Cadence again, for an “easy” 27+ miles and 70 minutes. He did some high-cadence spinups during this ride, working on getting those muscles to fire efficiently. He also worked on out of the saddle efforts, just getting that motion dialed in (and giving his butt a rest).

The long rides aren’t particularly exciting, but Boone is building endurance which will serve him well in long races. And he likes the calorie burn too, as he continues to work on dropping extra pounds.

See this ride on Strava >

Ride 14: V02

It was time for Boone’s weekly sufferfest: the VO2 session. This would be his first VO2 session since updating his FTP from 278 to 294… which meant the VO2 intervals jumped from 320W to 340W!

Could he handle it? Only one way to find out. But I tweaked the timings a bit, just to give him a chance – 3 minutes at VO2, then 3:30 recovery.

I didn’t join him for this workout – conveniently, I had led Sprintapalooza that morning, and had a long ride planned the next day. I didn’t want to fatigue myself going into that. Also, I didn’t want to do a VO2 workout.

He completed the first interval – but I could tell from what I was seeing and hearing that it took just about all he had. There was no way he had four more 340W intervals in him!

So I adjusted the FTP bias down to 95%, putting the interval at 320W. This was still 110% of his FTP, within the window of what’s considered a VO2 effort. He completed the next two at 320W, then I dropped the bias to 90% (305W) for the last interval and a half.

We debriefed afterward, and couldn’t decide if the first interval just burned him up, if he was under-fueled, or if he was just having an off day. I think it was a combination of the first two. He’s getting to the point where his hard efforts are tough enough that he won’t be able to complete them if his glycogen stores aren’t topped up, so he’s going to have to consider that moving forward.

See this ride on Strava >

Ride 15: Biking with Bowie

For the week’s final session, we wanted to get Boone into Bowie Brevet’s pain train, to see how long he could hang in. Jumping from C. Cadence to Bowie Brevet is a solid step up in terms of effort – here’s the difference between the two bots:

• C. Cadence: 65kg rider holding 2.5w/kg (163W)
• Bowie Brevet: 82kg rider holding 3.2w/kg (262W)

Of course, sitting in the pack requires different effort than what’s above. The C. Cadence pack chugs along around 40kph, while Bowie’s clan is closer to 43kph.

For me, riding with C. Cadence requires averaging about ~190W, while Bowie Brevet is more like ~225W. For Boone, it meant going from around 225W to 285W. That’s a big jump! (He didn’t help things by poking his nose into the wind a fair amount.)

I told Boone that riding with Bowie is about like riding a C race – maybe just a notch lower, and without the hard start. Which is actually pretty cool, if you think about it. In Bowie Brevet, C riders have an always-on C race they can jump into whenever they’d like.

We had a technical glitch on this ride – the KICKR Bike mysteriously changed its groupset settings, and since Boone wasn’t familiar with Di2, he got dropped in Titans Grove trying to find his gears. So we both stopped and I opened up the Wahoo app, set it back to Etap, and we used Zwift’s fancy new Return to Home functionality to exit the ride and rejoin Bowie.

In the end, Boone rode for Bowie for 25 minutes. Not bad for his first try. Then we did some free-riding around Watopia, finishing with me leading Boone out on Watopia’s reverse sprint so he could grab his first-ever green jersey. Victory! He hit 800+ watts after over an hour of riding, which is no small thing.

See the 2nd part of this ride on Strava >

Week 4 Takeaways

This week was all about lengthening the rides, and Boone did really well. He’s able to sit in and maintain solid tempo pace for a good length of time now, which means he’s building that aerobic endurance and mental toughness.

This week’s VO2 session was a real sufferfest, so we’ll tweak things for next week. I think we’ll make sure Boone comes into it adequately fueled, then we’ll leave the intervals at 320W, and give him equal VO2+ recovery time (perhaps 3 minutes each). This should be tough but doable, and if he’s able to complete it, we can look at bumping that VO2 wattage up to perhaps 325 next time.

Questions or Comments?

Post below!