Friday, March 21, 2014

Update on recovery from ischaemia

Well as you may already know I had a heart attack on January 1 this year. To be perfectly honest, upon reflection, it was fairly minor as far as ischaemic events go - but ignoring it wasn't an option. Well 60-odd years ago ignoring it was probably the only option. I remember one of my grandfathers (who 'survived' in some senses service in 2 world wars) took 'angina tablets' when the pain came on. He probably had a blocked artery or 2 but there was little you could realistically - or affordably - do about it back then. Whereas in my case they simply inserted a few stents and inflated them, unblocking the blocked artery. It took 45 minutes (if you discount failed attempt number 1, an ambulance trip and brief stays in 2 hospitals). Fixed!

Well, mostly fixed. I'm not exactly the same as I was, psychologically or physically. I am unblocked,  with a renewed blood supply to the organ in question, but said heart now has muscle tissue damage, some of it irreparable, if to a minor degree. Nevertheless my heart beats strongly and regularly, and after almost 3 months of training on the bike (half on the trainer and half on the road) I am back to where I was in December last year - doing at least 200km a week on the road. Mostly flat and only 60% intensity, though. And just a few intervals at 80% or so. And no long, hard climbs for now.

Yet there remains a small, disquieting fear that the heart will be weakened, unable to cope with "normal" training (let alone racing) loads. And statistically that is borne out by those who have repeat heart attacks after their first. So I'm tentative, still. A new clot could form over the stents themselves, for example. But with each passing mile I get more confident that I'm OK. Indeed I feel "better" in many ways. Whereas I was grinding it out for the previous few months (before the attack) I am now refreshed and eager. My body is responding positively if slowly to the training load, whereas it was only slowing down and going backwards before.

Another realisation is that heart attacks can be - indeed often are - "silent". You may not notice you are having one. The one I had, whilst distinctive, was dull and incapacitating for a couple of hours, like dragging a heavy weight around, rather than endlessly sharp and totally, unavoidably crippling, if you can see the distinction. Indeed I began to feel "better" after about 3 hours of this crushing bore of a monumental chest and arm pain. I could see a way out. But by then I was in hospital, which is the best place to be if you want to get "fixed".

Still, I could see how ignoring it and just avoiding strenuous exercise forevermore may - in some cases - work out. But for me I wanted to ride again, and I didn't want to risk the statistically significant attack number 2, the one that would sneak up on me and do me in for good. And it made me ask, 'ok, this is different, it's really bad - but have I had one of these before, just milder?'. And my answer would be "yes". This was just a new level of pain and injury.

Hindsight is a wonderful thing but the last 3 months of training pre-attack, sometimes in terrible heat, often had me thinking 'what's wrong?'. And whilst I could do it, I could finish the rides - and the occasional races - I didn't push to my old limits. I backed off. I let the bunch go on the last lap. I gave in to the "pain" of the effort. Whilst it wasn't that distinctive full-on crushing pain, I now recognise that what I thought was "not enough training" or "just old age" was probably a very mild form of heart attack. I have no firm evidence, no blood tests or angiograms to back that up, but it's what I suspect. Whilst my heart attack represents a certain event, the rupturing of some plaque and for a time the complete blockage of a coronary artery, in truth that artery was significantly narrowed for years.

My heart was under attack from reduced blood flow for a long time. I just didn't read the signs.   

Do we need this? Darwin Bicycle folds forward for the climbs and sprints

Do we need this? Do we "need" anything (other than food, drink, shelter, love...) anyway? In some ways it makes sense, that you remain seated and stable in particular holds great promise. However it becomes rather tricky to keep an ideal, or perhaps optimal (shades of grey there) riding position when the bike keeps adapting around you. There's power output to consider, sure, as well as cadence, weight distribution and areodynamics to consider. To get all of that right on a moving, adjusting frame could prove tricky, especially for the rider who just wants to move forward a bit to stretch. Still, a bike that adapts to you sounds "right" somehow. As long as it doesn't weigh too much, of course.


Darwin Bicycle folds forward for the climbs and sprints