Recovery Week 6: The Stress Test

It's been about six weeks since I suffered a heart attack during a trail race.

Even when I was still in the hospital, the cardiologists told me that six weeks was a key moment in time. Why? Here's what I recall being told:

• For most people, any post-attack healing of the heart muscle is completed in six weeks
• Cardiac rehab will be useful until about six weeks, when I would probably be totally bored with it and ready to exercise on my own (please note: it was made clear to me that this was based on my 35+ years of steady exercise, my relatively young age, and my overall health - cardiac rehab for others who have different circumstances might last for a few months - please don't generalize to your situation, talk to your doctor).
• A cardiac stress test would likely be scheduled at six weeks to assess how I was doing, and to help chart the course for the next several months or even for the next few years. 

It would seem that the predictions were coming true. I was certainly bored with cardiac rehab - that's no knock on the facility or the staff, but flopping around on an exercise bike or elliptical machine at well below my usual physical intensity level for 20 minutes wasn't really engaging me, and I was rather tired of the 20 min. drive each way as well. 

Plus, the stress test was scheduled!

I looked forward to that test and dreaded it all at once. I didn't know exactly what to expect, but secretly I hoped I'd be a total outlier, passing with flying colors (they told me that I'd be on the machine between 6 and 15 minutes - I planned on at least 20 because, as I've noted before, I'm a stubborn mule). But to be honest I was also worried and anxious:

• What if something bad happened in this first instance of really testing my heart? Another heart attack? Having my druthers, I'd rather not go through that again.
• What if what they found was that I'd not healed at all? 
• Worse yet, what if the blockage in my left main - called the Widow Maker - had gotten more severe and I needed immediate surgery? Yikes!
• What if I turned out to be a total wimp and couldn't even put forth a minimal six minute effort?

Well, whatever was going to happen was, I guess, going to happen. Wait, is that some kind of tao concept? Hmm.

So, I reported to the cardiac clinic early yesterday morning and got hooked up. They placed me on a cold table and taped at least 8 electrical leads to my chest, and plugged in an IV for injecting me with "image enhancer" (which sounded like some kind of miracle cure for public relations disasters, but was actually just a sort of milky looking dye that apparently would make it easier for the ultrasound technician to get a clear picture of what was going on with my heart).

Source: www.glogster.com

Then they strapped me into some pedals, took some baseline measures, and got the thing whirring. Here is a photo taken during my stress test:

Well, maybe not exactly, but that's more or less what the darned thing was. In fact, there were no handles to grab (that would have helped), and the machine I was hooked up to had big, strappy pedals on it, but it did involve lying down and trying to exercise in a similar position. There was one really odd thing about it too: the pedal spindles on the machine were located closer to my heels than to the balls of my feet, which meant I'd be pedaling without any real way to engage my calf muscles. For the first couple of minutes, I kept making the machine go CLUNK-CLUNK because I would naturally use my calf muscles and thus jerk the pedals around wildly. I kept apologizing. Yeesh.

I don't recall where they started me exactly, but in essence I was instructed to pedal at 65 rpm (that's much slower than I'm used to with my cycling, which is typically 90-100 rpm) and they would add resistance every two minutes in increments that increased my effort by 25 watts until I hit the target heart rate (over 142 but under 168) or felt too fatigued. The first level I recall clearly was when it hit 175 watts, which I think was at 10 minutes. Before that, it all felt relatively easy - if extremely clumsy. I was just pedaling easily and chatting with the nurse about his upcoming 10 mile race. But when the machine hit 175 watts I started having to push pretty hard (with the weird spindle position, I was really only using my quadriceps so I could not spin in full circles, just stomp down hard on each down-stroke, which was a really unnatural movement). I started sweating. A lot. They turned on a fan. Full blast. Didn't help much. 

At 200 watts I was breathing harder, and starting to watch the clock a bit more closely, although my heart rate was still only about 115 beats per minute. At the 14 minute mark the machine hit 225 watts, and that's when I finally felt the burn for the first time in a long time, at least since before my heart attack. I was huffing and puffing like the big bad wolf, and sweating like a maniac. The nurse was pumping me with the dye and the technician was sliding the ultrasound wand all over my chest and snapping digital photos. It was a flurry of activity. Meanwhile, I was going anaerobic fast, and breathlessly told them so. I didn't think I could handle 250 watts, and it became clear I was correct as my rpm slowly dipped from 65 to 63 to 59 to 57 ... and then as my legs locked up they shut me down at 16 minutes. My max heart rate had been only 136.

I partly felt like a failure for not hitting my 20 minute goal and for being unable to get my heart rate up any higher. Yeah, I know that's stupid, but those old competitive fires don't go out easily. 

Source = http://dailyanimeart.com/2014/07/11/gray-defeats-silver-wendys-plan-fairy-tail-392/gray-must-win-against-silver/

It took me about two-three minutes to get my breathing back down and my heart rate back to 66 - until then my chest was really thumping away. But otherwise I felt pretty good, burning quad muscles aside. They gave me some water and a towel, and sent me away. I met up with my wife in the waiting area, and we realized that we had an hour before I would see the cardiologist to go over the results. It was a nice day, so we went outside and walked together for about 35 minutes, just chatting. I was probably chatting too much, because I felt the flush of a hard effort (yay!) but also the anxiety of finding out the results (gulp!).

The results: We ambled into the cardiologist's examining room and sat in eager silence. The doctor entered moments later, and was all smiles. He went over the results. While it was true that part of my heart muscle had been damaged by the attack, the overall measurements of my heart were within the normal range. My ejection fraction was 55%, and it increased with effort during the test, a very good sign. The overall flow through my coronary arteries was good, and my cholesterol levels had dropped considerably due to the medications. Things were looking good - at least I thought so.

Then the doctor said words that I'd been longing to hear, such as "this is looking good" and "it's time to resume your active lifestyle". Of course there were also words that I knew were coming but did not enjoy hearing, such as "don't even think about running a marathon" and "don't do anything crazy, like racing hard". Like I said, I knew that would be the instructions, but of course I wish it were different. Still, I'll keep saying that I'm just glad to be around to complain about all of this.

And I don't have to go to cardiac rehab anymore!

So I've got the green light start jogging a bit, and work up to an hour (or even a little more) of gentle effort aerobic exercise. I will probably never race all-out again, competing is now a thing of my past. Sigh.

Still, I'll definitely take it. I have to celebrate the good things, and look forward instead of backward. I have a lot to live for. Hell, we all do, if we just take the time to realize it. 

Happy running, whatever your pace. I just ask that you be kind when you pass me, or frankly when you pass any other runner/jogger/walker out there. We're all in this together, right?

Recovery Day 24: Scared Shirtless

Well, maybe "shirtless" wasn't exactly the word I was looking for. But I wanted to maintain my PG rating.

As an aside: what on earth are " ... some thematic elements"? Well, it turns out that there is actually a Motion Picture Association of America definition of Thematic Elements

Anyway ...

Late last week, I had a negative and scary follow-up visit with a specialist cardiologist. He went over all of my recent medical records, and especially the report from my catheterization procedure of June 14. What I understand is that the doctor who implanted the stent in my right coronary artery also basically took a look around the other arteries of my heart while he was in there via angiogram. Apparently he saw and noted several more blockages in my coronary arteries, which is in itself depressing. But worst of all, he noted that one of those blockages (estimated at 40%) gives me a terrifying double-whammy: it's located in a spot that can't be fixed with a stent (main coronary artery), and if a clot forms there I'm a goner within minutes - because it's the main artery that feeds most of my heart. They call this a Widow Maker. Insert intense and loud curse words here.

He told me that I will need open heart surgery and at least a double bypass surgery "soon". I will be getting a second opinion of course, but I suspect that this is simply my reality now.

From his perspective, I might be able to run again, but only at low intensity and for short periods of time. He also said I'd probably never run a race again. I will confess that looking forward to specific races has been an integral part of what I've relied on to feel happy for over three decades. Thus, I need to re-configure my life quite a bit now, especially to come up with other things to look forward to, which seems so easy to type here but at the same time feels so challenging. Should that embarrass me? Perhaps. Running has been such a steady companion through all of the ups and downs of my adult life, maybe I came to rely on it too much. My challenge will be to reformulate my coping strategies and keep moving forward.

I'm a bit depressed. I would imagine plenty of you are familiar with that feeling. I think ever since I reached age 40 I've been joking with my peers about how it sucks to get old, but now it's not really much of a joke anymore is it? What matters most now is sticking around awhile to be here for my wife, my children, my family. Certainly that's more important than even the most-awesome race in the universe.

Meanwhile, I continue to do cardiac rehab 2-3 times per week and some easy cycling in between. I'm getting outside and feeling the air on my face. For example, I managed to get out on my road bike this morning for about 12 miles at a fairly easy cadence, keeping my heart rate down under 110 bpm. What's hard for me is the inevitable comparison to what I used to be able to do. Psychologically, I need to move away from "I used to be so much faster" to "man, am I glad to be here and to be able to smell the damn roses".

If you are facing challenges in your life (and really who doesn't face challenges?), I hope you will join me in determination to defeat defeatism.

Recovery Day 17-ish: Recovery, Envy, and Mortality

I continue to work my way back from the heart attack I suffered during a trail race about 17 days ago. Okay, I confess, I've been trying to write this damn post for almost 3 days, and keep getting side-tracked!

I could whine about this whole rehab and recovery thing being no fun - which is true - but I choose instead to look forward instead of backward, to focus on improving and enjoying every breath instead of feeling sorry for myself or wallowing in frustration. After all, I have much to live for, such as my three wonderful sons

and of course my fabulous wife

So I'm planning on sticking around for awhile, and in fact not just being there but also on being vital and active during the time that I am around. One step at a time, one day at a time, but with the road clearly mapped - thanks in large part to many dedicated doctors and nurses. IMHO, it's always good to have a plan.

I am now alternating my daily "workouts" between (a) visits to the cardiac rehab facility or (b) working up a mild sweat on my own.

At the cardiac rehab facility I experience something that is at once both humbling and surreal. The facility at Park Nicollet Methodist Hospital is really very nice, and the staff have been terrifically friendly and helpful. But for me it's really odd to be attending sessions where I exercise alongside folks who are clearly decades older than I am and who have more than likely lived very different sorts of lives. I overhear discussions about diabetes, smoking cessation, dietary changes, and other very important topics for people who have not really taken care of themselves for decades (probably). I don't mean that be insulting or judgmental, and anyone who knows me also knows that I believe in the "to each his own" (or to each her own, I'm not sexist) approach to life: as long as what you are doing doesn't harm another person, then by all means feel free to continue. What's so weird for me is that I am surrounded by people who've experienced a serious cardiac issue just like me, but who are so significantly NOT LIKE me that it's as if I'm in the wrong place! At some level I know that's stupid and possibly narcissistic, because in truth all of us there are more alike than we are different, and everybody is trying to get better. We are a sort of club, or cohort. In fact, when one of us is finished with the rehab, the nurses jokingly refer to it as "graduation day". So we all strive together, and look forward to that symbolic diploma.

The facility is sort of like a mix between a semi-posh health club and mission control.

Actually, it's not either of those things exactly, but instead it's a series of concentric rings: in the center are the cardiac nurses who are manning banks of computers that monitor all of us via portable EKG devices; the next ring is made up of nurses and physical therapists who work directly with us, helping, measuring, encouraging; the next ring is an array of workout equipment ranging from fairly standard treadmills and stationary bikes to modified equipment that is very low impact and more appropriate for those who are less fit or possibly in fragile physical condition; finally the outer ring is a sort of track that encircles the entire encampment, used by patients to take monitored walks and to be tested on a timed six-minute walk (either as a pre-test or as a final measurement of improvement at graduation day). It all works like a well-oiled machine, and I'm there with my crew thumping away on the treadmill at 3.8 mph for all of 15 paltry minutes - wishing I could go faster and longer. Patience, patience, patience - not my strength I guess.

Conversely, when I'm exercising on my own, I've been focusing on cycling - gently - which enables me to open up my lungs, re-train my heart muscles, and to be OUTSIDE again. You never realize how much you miss the fresh air until you have it pulled away from you. Just feeling the wind on my face (and the occasional bug in my mouth) is bringing me such basic joy!

Of course, I'm only toodling along, and I'm being passed by EVERYONE: commuters with bulging messenger bags, mothers pulling kids in bike trailers, old ladies on their therapeutic tricycles, etc. Well, maybe I'm exaggerating just a bit there, but I do admit that I'm sitting in my seat, spinning a low gear, barely maintaining 14 mph and there are definitely people passing me left and right who would not have done so just three weeks ago (even on my easiest day). Well, I suppose the right attitude for me to take is "good for you, go for it". But I'm human, and mostly I just feel envy and frustration. Darn.

That time on the bike, going easy, sometimes zoning out, has given me some time to confront my mixed up feelings about this whole messy chapter in my life. Aside from dealing with anger/annoyance/frustration, feeling impatient, feeling somewhat emasculated, and whining about it all (those are the minor irritants, when you boil it down), what does bring me to my proverbial knees emotionally is confronting the reality of my own mortality.

In his seminal book The Denial of Death author Ernest Becker lays out a fascinating treatise that builds on the works of Soren Kierkegaard, Sigmund Freud, and Otto Rank. Becker's basic premise is the we humans embark on a sort of "immortality project", wherein we can overcome the dilemma of knowing we will die by a pursuit of becoming part of something that feels eternal. Yeah, I know, it's not simple or obvious, and frankly you'll need to read the book because I am admittedly no expert here. My totally amateur interpretation is that we need to create meaning and a sense of permanence, or else we'd all be in a psychological state of paralysis brought on by thinking something like this: "I'm going to die and disappear anyway, so why bother?" From that perspective, all that we strive for, find joy in, love/desire/lose, and all other personal experiences are enabled only because we can deny our own impermanence.

Thus, when that shield of denial is pierced by, oh say perhaps having a totally unexpected heart attack, it creates a great deal of inner emotional turmoil and chaos.

Perhaps the true measure of a person is how they then cope with that disruption.

I'm also no expert on Freud, but in reading ALL of his books (yes, I went to grad school), I think I was able to glean at least a surface understanding. If anything, Freud was recommending that all of us open our eyes to ourselves, confront our defenses, admit that life is rife with conflicts and disappointments, but then just get on with it anyway! His work showed that denial and other defenses could be -when taken too far - maladjustments to life, leading to all kinds of dysfunctional mental, emotional, and even physical states.

Interesting, right? But am I just intellectualizing here? And, really, this is a blog post, so enough already! All I'm really trying to say is that it's hard, at times, just readjusting to what amounts to a sort of new life. I'm getting my feet back on the ground, moving forward, but I'm not fully recovered yet - and that means not just my injured heart but also my tumultuous psyche. I remain confident that I'll emerge from this eventually, and I wish it would be NOW, but time is an essential part of the healing process, isn't it?

If you are healing from any difficulties in your life, know that you aren't alone and that we all have to face our own demons now and then. Let's all try to be patient - but let's also admit that our task is not simply waiting for time to pass. Instead, we have to work actively at getting better, and not just physically.

In closing this all-too-long post, I just want to re-thank everyone who has been on my side and wishing me well. Every single thought matters and helps. Thank you!