Abstinence Makes The Heart Grow Stronger

Ramp-test, Reprieve, Daring-to-Dream

At the end of the last Journal I was being gently frog-marched by Sports Cardiologist, Dr Nigel Stephens, into a ramp-test to see what shook out with my wonky heart as it revs to its redline. Actually there is simply nothing inviting in that sentence but apparently it had to be done. With more than a little trepidation I sidled into Northwick Park’s ground-breaking cardiac testing centre that Dr Stephen’s founded twenty years ago. It was Friday evening and I was tired and empty at the end of a very hard week. Jules and I have seen enough ramp-tests during our time at Trek Factory Racing at team camp, to know it is highly unpleasant and unnatural. Professional cyclists dread doing them and they get paid for their pain.

Strapped In

After being covered in monitors, I am strapped into the GE recumbent trainer and set off at a benign 60 watts. The intended protocol is an increase of 25 watts every couple of minutes until I hit my theoretical max of 163 beats per minute. I really was not in the mood and my body quickly kicked against the exertion. At 20 minutes we were in a tug of war – my heart steadfastly refusing to go anywhere near 163 and yet the General Electric torture device kept auto-generating an extra 25 watts every two minutes – the unstoppable force met the immovable rock. Machines don’t yet have empathy – so the pain in my increasingly Popeye legs was building to an intolerable crescendo. I was just about to scream, or wet myself, when the charming cardiac technician called time as my heart finally clicked over the requisite 162bpm threshold.

At that point the machine started beeping as I developed some extraneous ectopic heartbeats as I tried in vain to catch my breath. The technician was extremely relaxed and reassuring under the circumstances.

A packet of biscuits and a can of coke later and I am back out on the Harrow streets covered in thin sheen of sweat – mental note to self – never do that again.

Pulling It all Together

Forward wind and I catch up with Nigel at his office and he pulls together a whole battery of tests – bloods, heart MRI, ECG, 72-hour ECG and the dreaded ramp-test. He meticulously examined what the tests all reveal in the context of the three issues that I have:

• Bundle branch block
• Extraneous ectopic heartbeats
• 1st & 2nd degree AV block

Bundle branch block is a failure of one of the electrical cables to the heart for whatever reason. But the heart is over-engineered and has its own work-around in the form of alternative cabling. The ectopic beats have all but completely stopped now – and the only treatment has been total abstinence from alcohol at Nigel’s strong recommendation – more of this later.


And lastly the 1st and 2nd degree AV block – which would be serious but for the fact that I am one of those people for whom the Vegas Nerve interfaces with the parasympathetic control of my heart at night when the sympathetic system drops out. The intention of the ramp test to red line, was to ensure that sympathetic system would react and ramp up naturally along with increasing effort, and it did.


So I have a weird heart and there is certainly some funky stuff going on, but it is all explainable, somewhat predictable and almost certainly benign. Nigel has given me a green-light to exert myself to increasingly ‘normal’ efforts.

Dare-to-Dream and Testing Times

This brush with mortality has made me want to maximise my cycling now I am in clear air again (for a while at least). My back is welded together, my heart is idiosyncratic but not in a dangerous way. I want to ride more, get as fit as possible and I want to start time-trialling again. Why testing? Because I can measure and control my efforts – I won’t get sucked into riding too hard at someone else’s pace, which would happen in crits or road-racing or sportives. But testing is still definitely competition and that improves the breed as we all know. To that end Cyclefit has invested in a company Trek Speed Concept (size M) with Bontrager Aeolus 5 wheels and an Ultegra groupset. I will be hopefully racing it in local TT’s but it is also a test bike if anyone want to take it out for a ride? It is 20 years since I shrink-wrapped myself into a TT position and it will be interesting to see how my back copes – it will be flat at least - it has no choice it is fused that way!

Abstinence Makes The Heart Grow Stronger

A man as sinning as me would do well to find it themselves to be the last to proselytise. I have enjoyed drinking red wine for many years. It has accompanied many great moments with wonderful friends. But I am now six months dry. I had long luxuriated in the prevailing wisdom that the flavonoids in red wine helped buffer against heart disease, provided one drank in moderation. The first time I saw Dr Stephens after my cardiac issues started just after xmas, he carefully took me through the latest research points to a positive correlation between alcohol consumption and cardiac arrhythmias. I walked out of the consultation with my wife and the decision was made. I felt no difference at all in terms of general health or indeed the prevalence of arrhythmias. But neither did I miss or crave drinking as much as I assumed I would. Yes of course there were crunch moments – the bags-down moment on Friday evening when a bottle of something broad-shouldered and preferably Italian sits on the kitchen table waiting to be opened. Or a dry crisp white late in the afternoon on a Saturday or Sunday. It isn’t helping writing this by the way!

Trust The Doctor!

Six months on empirical evidence has proven Nigel right. I hardly ever feel the arrhythmias anymore and only very occasional ectopic heartbeats. Regardless of the long-term benefits of abstinence, the medium-term cessation of symptoms has made abstinence a thoroughly compelling proposition. I don't think I will ever drink again. I deliberately haven't made any rules for myself but the idea that I might send my heart wonky again with just a few glasses of wine reinforces a lifestyle choice.

Postscript:

Months and months ago, before the wonky heart issues started, I agreed to ride a leg of a local triathlon for one of our local schools teams. The expectation was of course that I would be fitter and faster than I am. But getting the virtual all clear from Nigel last week (within the realm of natural caution), I decided to honour the commitment on the weekend and race!

32kms in 34 degrees of heat felt like a questionable decision whilst I waited of our seal-like swimmer Justin to emerge from the water. Unfortunately he is a brilliant swimmer and came out the water right at the pointy end of the first-wave. That put me out on the bike with all the fast riders drafted in to lend their legs to the communal cause. And to start with it felt amazing - we were whipping around the Dorney Lake course. And then the heat, a lack of fluid (I blame Trek - neither their bottle-cages or bikes come with bottle-bolts bolts) and the passing of at least a decade since I last pinned on a number, suddenly hit me like a hammer. All at once my mouth and throat felt rough and parched and the power flowed out of my legs. There was no way back now. I had to just hang on for another three laps (15k) before handing off to our runner, Simon.

I don't actually think my heart-rate was very high (I was riding on feel) it was more the cauldron of heat and almost instant dehydration, even though I consumed 3/4 litre of water before I got on the bike. I crawled to the finish riding slower and slower every lap. The course was closed soon after as people were collapsing with 40+ degree temperatures! In the end we came 13th out of 65 teams and I came 9th on the bike, covering 32k in 54 minutes. A long way off my historical (very historical) best, but the fact that I care at all suggests I may want to pin a number on again this summer? If I do it will be on our fabulous Cyclefit Trek Speed Concept - which is available for clients to ride as well by the way.