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.