Wednesday, June 25, 2014

Recovery Day 11: Cardiac Rehab

It's now been 1.5 weeks, more or less, since I was hit with a heart attack during a trail half-marathon. I'm still trying to explain - to myself, to doctors and nurses, to friends and colleagues - why this could have happened to me. I'm supposed to be the guy who's more fit than everyone else, the guy who seems so much younger than 52 years. Sigh.

After all, I had basically NONE of the common risk factors that are under one's control:
1. Smoking tobacco - I've never smoked a cigarette, not even one, honestly
2. High cholesterol - only once in all of my life did I have a number above 200, and my HDL ratio is usually good
3. High blood pressure - never
4. Physical inactivity - please! I've done some sort of exercise, on average, 350 days per year for over 3 decades
5. Obesity - nope
6. Diabetes - never
(By the way, if you have any of these risk factors then PLEASE start working with your physician to reduce them as quickly and as permanently as you can. Not only will you reduce your risk of heart attack, but you'll have a higher quality life too.)

There are also three "uncontrollable" risk factors, but even they fit my case only a little:
1. Increasing age - but not yet hitting 65, which seems to be the magical number for heart attack
2. Being male - can't do much about that, I suppose
3. Heredity - my father has had bypass surgery, but the rest of the family has no real heart issues

I guess whatever factors were involved, even though technically minor compared to the overall statistical average, ended up being enough to trigger a heart attack for me. Darn.

Anyway, I had my first session of cardiac rehab, and I think it went pretty well. After checking in and providing all of the information (again), I took a short quiz to test my knowledge about my condition. I did okay, but didn't nail it. I wasn't sure what the appropriate level of exercise should be, and (embarrassingly) I was a bit unsure on some questions about heart attack v. cardiac arrest v. cardiovascular disease. Not a bad approach to start with a quiz, getting things "wrong" helps me to focus on learning what's right.

The American Heart Association has a ton of great information on their website. I highly recommend you spend some time there, and especially a good idea to do an honest self assessment of your risk.

After a chat with the nurse, they hooked me up to a portable EKG unit and had me do a six minute walk test while they monitored all of the readouts. I circled the perimeter of the indoor facility and ended up passing with flying colors, I guess. They said I was moving at about 3.5 miles an hour and that my heart rate never exceeded 85 beats per minute.

Next up was the treadmill. Just walking, but gradually increased from 3.2 mph up to 3.8 mph without too much strain. They asked me to keep my RPE within 11-13, and really I was probably around 10 or 11 most of the time (about 15 minutes in total).

Having succeeded at that (heart rate, blood pressure, and cardiac rhythm all fine), we next moved to a stationary bike. The nurse set me up to maintain first 90, and then 100 watts of output. That put me at about 80 rpm and maybe 12-13 mph. Pretty comfortable. This was the first time that I started to just barely break a sweat, so I think my RPE went up to 12. Again, no major alarms went off, so after 15 minutes of spinning I walked a little to "cool down", and then scheduled up about a dozen more appointments for the coming weeks. The goal: to try a short jog at the rehab clinic while hooked up to the EKG by the end of July! Fingers crossed on that one.

They encouraged me to repeat a similar effort on my own daily, between appointments. I will admit to some trepidation - I don't want to experience another heart attack! The nurse assured me by putting it like this: two weeks ago, I was basically a ticking bomb waiting to go off, clueless and unconcerned. Now, not only is the blockage in my right coronary artery opened up, but I'm also on medications and being monitored regularly, so it's actually SAFER for me to exercise now than it was two weeks ago!

Hmm. I'll ponder on that one.

In the meantime, I'll overcome my anxiety and get about 30-60 minutes of light aerobic exercise daily (probably by walking briskly or cycling at an easy spin) to see how it goes. This is all in the service of healing and re-invigorating my damaged heart muscle tissue. 

Taking it day-by-day, inch-by-inch. I'm a runner at heart and by experience, so I just need to convert this process into the familiar pattern of a "build-up" in training - adding just a little bit at a time, slowly increasing the workload until it becomes easy, then adding a little bit more, in a carefully choreographed cycle. 

I assume many of you have had to work your way back from one injury or another, or a major life setback or two ... maybe even multiple times. If you are doing so right now, at the same time as me, then let's be kindred spirits and tackle the physical, emotional, and psychological challenges together. Best of luck to us all!

Friday, June 20, 2014

A Very Bad Day - or - Lucky to be Alive?

Last weekend started off like a lot of weekends for me: an early alarm, a quick bite and cup of coffee, then a drive to a nearby trail race. In this case, I'd be running the Sour Grapes Trail Half-marathon for the third year in a row. The race was part of the 2014 UMTR Trail Race Grand Prix Series, a competition that I did well in last year but for which I had a lot of catching up to do this year.

I arrived in plenty of time, found a decent parking spot, picked up my number, and went about a typical warm up: a bit of walking, a mile or so of easy running, a few basic stretches, and heading for the start. Nothing out of the ordinary, in fact I was feeling pretty good.

The organizers got us lined up and sent us off. As usual, the faster-younger-more talented types rocketed off the line, leaving me and the rest of the pack to follow. I was probably sitting in about 15th place, more or less, about where I'd expect to be. With 13.1 miles to go, no need to push the pace early.

We rounded a couple of corners, and hit the first tiny little hill. We weren't even half a mile into the race at this point, but "something" happened to me right there. I felt a kind of flutter in my heart, and started breathing a bit heavier than I'd expect to be. Hmm. No pain. So I slowed down, thinking maybe I'd overdone the caffeine that morning, just needed to get my breathing under control and I'd be fine.

About a mile later I felt some tightness across my chest muscles. What the hell? Could I be having a heart attack? No way, I'm still running, only a few people have passed me, this is just a bad day. Maybe I was tense on the steering wheel during the drive, so I shook out my arms, slowed a bit more, tried to control my breathing.

Boy, did it feel like a bad day. For the next 3 or 4 miles I was forced to slow down to about 8:25 pace, well off what I thought I'd be able to do. But I was able to keep running, so I ignored my sensations and plugged on.

In fact, I plugged on all the way to the finish, which was a disappointing 20th place in about 1:47:00. Results. Compare that to last year's second place in 1:32, and you can see it was a bad day.

It was about to get so much worse.

I really felt crappy after the race. Super-tired, nauseated. and a bit woozy. Maybe I was bonking? I grabbed a banana, had some electrolyte replacement drink, toweled off, changed into dry clothes, and hit the road home. Still felt awful.

About 20 minutes into the drive, I finally admitted to myself that something was really not right. Stubborn fool. I pulled off the road, called my wife. She said, "Get to a hospital". She was right. I asked Siri to find me the nearest one, she obliged and I pulled into the parking lot of St. Gabriel's Hospital in Little Falls, MN.

I strolled in, sweating profusely and feeling light-headed. I told the receptionist that I might be having a hard attack. Within a couple of minutes I was on a bed and chewing children's aspirin, as the staff ran preliminary tests. It wasn't long before the doctor told me that I was indeed having a heart attack.

Okay, let me just pause here for one second. I was having a heart attack, one which had started almost 2 hours before, in fact I just ran something like 12.5 miles on trails WHILE HAVING A HEART ATTACK. Clearly, my capacity for denial is pathological, and my pig-headedness about finishing races had now put my life in danger.

I was so scared, it's hard to describe. Alone, and informed that I'd now have a wild ride in an ambulance for about 30 miles to get to St. Cloud Hospital, where they had specialists in cardiac catheterization waiting to help me ... I put my life in the hands of the professionals. I guess the fact that I'm writing this proves that it was the right thing to do.

The next few hours were a surreal and painful and frightening blur. I recall moments, like banging through the hospital corridors on a gurney, having my pants pulled off fast, receiving anesthesia, feeling almost out of my body, being told that I'd had a significant heart attack, and that I'd had an angioplasty and a stent implanted in my right coronary artery.

Then, I was in a recovery room. My typical, beloved type of trail race weekend had begun so normally, and now here I was.

My heart, shocked by this whole thing, couldn't seem to find a rhythm. After a couple of hours of my EKG bouncing all around, they sent me back to the Cath Lab so that they could insert a temporary pace maker for the night. I spent the wee hours in and out of a restless sleep, my heart pounding out a faster-than-normal and heavy-feeling beat, while intense thunderstorms pounded outside of my window. Like something out of a bad movie.

Eventually, I began to bounce back a little. On Sunday morning they turned off the pace maker, and my heart hung in there (mostly, still some funny beats now and then, they told me that was to be expected). I finally got a bite to eat. They came to my room Sunday evening to remove the catheters from my femoral artery (painful, very painful). By Monday morning I was able to take a few tentative steps out of bed, and by Monday evening I was able to be moved to a step down unit called Telemetry, which I always thought had something to do with launching satellites into orbit but apparently is basically a way to monitor things from a distance.

By Tuesday afternoon I could head home. Still scared, and now with a body filled with new and probably-long term chemicals (medicines) to help keep me alive: blood thinners, beta blockers, ACE inhibitors, and statins.

I had almost zero of the risk factors, and had just had my annual physical about 5 weeks ago - passing with flying colors. I do have a father who's had bypass surgery, but he smoked for years, didn't really exercise, and loved his eggs and bacon. Still, those darn genetics are just enough to get you. A heart attack? Me? Never!

Well, wrong!

I've now got a long road ahead, to work on recovery. The cardiologists said that my overall heath and fitness will not only help me make a "complete recovery" (well I hope so), but that in fact without it I would have suffered this episode earlier in my life and might not have survived it. So there's that.

I start cardiac rehab next, and if all goes well I'll be back running in several weeks. Not sure about any of this right now, of course, because I'm still wobbling around in a mixed up emotional and physical fog caused by fear, dread, anger, indignation, embarrassment, and drug-induced side effects. I know I've got to give it some time and work through everything. Of course I wish it had never happened in the first place.

I want to thank my loving wife for being strong and taking care of so many things through this crisis. And for someone who hates driving on the highways, she managed to come see me every day even through blinding rain storms and terrible traffic. Of course I'm also very grateful to the nurses, doctors, and everyone else at St. Gabriel's and the St. Cloud Hospital. The latter really was a top-notch experience.

As the weeks unfold now, I'll try to be more diligent about sharing here what I experience and what happens to me on this next leg of my life journey. I've got to get back up off the ground, dust myself off, and move forward again. I'm a pretty determined fellow, so I am confident that this hurdle can be overcome. But I'm damn glad to have help along the way, and I'm lucky to be alive.

Take care of yourselves, our time is so short and so precious.

Hope to see you out on the trails in a few weeks time, fate willing.