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  1. #1
    Senior Member k7baixo's Avatar
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    The doctor says I'm not normal.

    I've been on a tear for the last few years to get back in shape. I lost about 45 lbs, hit the gym for a few years, kayaked and just started cycling again last year. I finished Ragbrai last year with no issues and I concluded this year by going from never having completed a brevet to finishing the full series and a 1200.

    I've been having some issues with getting a little lightheaded and dizzy when my heart rate exceeds 175-177. My father died of congested heart failure so I went to see a cardiologist who put me through the typical tests, echocardiogram, stress test, etc. I'm in my mid-50's.

    The dr's office called and said I have some amount of ischemia. I believe they used words like anterior and posterior lateral also and requested that I come in this week.

    When I asked if this was bad, the tech kind of dodged the question saying that if the dr was worried, he'd have me come in today. To me, this must be medium-bad since he wants to see me this week.

    My sister is an RN so I called her and she blamed it on hereditary factors and stress. I guess I'm kind of a worrier as was the old man who died just two years ago. Other than that, my weight is fine, I almost never drink, no smoking, cholesterol is good (but not great), and I exercise...a lot.

    Hopefully, we can get this treated - not cycling will suck otherwise. If you've gone through this and can share your experiences, I'd certainly appreciate it.
    Cheers, Gerry
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  2. #2
    Senior Member David Bierbaum's Avatar
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    There will be no "not cycling"! There may be a "conversational-level cycling" go-slow restriction, though. I wish you the best.

  3. #3
    Email for new group DnvrFox's Avatar
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    Good luck and keep us informed. I had to look up Ischemia on google.
    Gone - email me at dnvrfox@aol.com for new group of old 50+ folks

  4. #4
    Senior Member volosong's Avatar
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    I wish you the best with your conference. Don't be surprised if the doc tells you to start taking baby aspirin.
    Deut 6:5

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  5. #5
    Senior Member rumrunn6's Avatar
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    good luck.

    whatever you do, don't google for pictures of it!
    cycling is like baseball ~ it doesn't take much to make it interesting

  6. #6
    Semper Fi, A way of life. qcpmsame's Avatar
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    Hope they can get things straightened out for you.

    Bill
    "I Can Do All Things Through Christ Who Strengthens Me" Philippians 4:13

  7. #7
    Senior Member DGlenday's Avatar
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    Quote Originally Posted by k7baixo View Post
    I've been on a tear for the last few years to get back in shape. I lost about 45 lbs, hit the gym for a few years, kayaked and just started cycling again last year. I finished Ragbrai last year with no issues and I concluded this year by going from never having completed a brevet to finishing the full series and a 1200.

    I've been having some issues with getting a little lightheaded and dizzy when my heart rate exceeds 175-177. My father died of congested heart failure so I went to see a cardiologist who put me through the typical tests, echocardiogram, stress test, etc. I'm in my mid-50's.

    The dr's office called and said I have some amount of ischemia. I believe they used words like anterior and posterior lateral also and requested that I come in this week.

    When I asked if this was bad, the tech kind of dodged the question saying that if the dr was worried, he'd have me come in today. To me, this must be medium-bad since he wants to see me this week.

    My sister is an RN so I called her and she blamed it on hereditary factors and stress. I guess I'm kind of a worrier as was the old man who died just two years ago. Other than that, my weight is fine, I almost never drink, no smoking, cholesterol is good (but not great), and I exercise...a lot.

    Hopefully, we can get this treated - not cycling will suck otherwise. If you've gone through this and can share your experiences, I'd certainly appreciate it.
    Damned straight you're not normal!. How many "normal" people can, or would even try to, do the things you've done?

    I hope your condition isn't severe, though it obviously hasn't prevented you from some pretty serious achievements so far.

    You could never have completed the super-rando series without having a pretty solid heart. (Congratulations on that. I did not manage this year despite having a "normal" heart, have the series as a goal for next year.)

    I'm a similar age (55) and I think almost anyone of our age can expect a bit of dizziness when the HR goes above 175-177. Our theoretical max HR is supposed to be 165 - for whatever that opinion is worth.



    Viva non-normality

    That said - don't take the medical concerns too lightly. If there's a hereditary condition, be careful - and good luck.
    Regards,
    Duncan

  8. #8
    Senior Member GeorgeBMac's Avatar
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    I suspect that some clogging of the cardiac arteries in a 50 something is more normal than abnormal. But that doesn't mean that it's good!

    And your sister the nurse the nurse is right: Heredity and stress are two of the factors that increase the chances of clogged arteries. But there is actually quite a long list of things and the more they learn about it the longer the list grows...

    A healthy lifestyle (including healthy eating and effective exercise) can improve your chances of not getting heart problems but there are NO guarantees. But it does improve your chances...

    If you are already in pretty good shape and getting a lot of exercise I would be surprised if your cardiologist would tell you to stop.

    But one concern COULD be: Congestive heart failure is most often caused by either a heart attack or by chronic high blood pressure -- which makes the heart work harder which causes it to enlarge (LVH = Left Ventricular Hypertrophy) and that leads to congestive heart failure.

    Weirdly, strenuous endurance activities like repetitive all-out centuries can also cause the heart to enlarge as it tries to oxygenate the body. It's called "athlete's heart". Cardiologists seldom consider that to be bad like they do the pathologic variety of LVH -- but physically it is much the same.

    It is that "remodeling" that sometimes leads to arrhythmias (electrical malfunction) in some endurance athletes.

    So, he may suggest you cut back from some of the extreme stuff... But you are obviously in pretty good shape so I would be VERY surprised if he told any more than: "Don't get crazy about it".

    Moderation.
    --------------------------------------
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  9. #9
    Senior Member k7baixo's Avatar
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    Thanks all. Hopefully, this isn't a big deal and having taken steps toward the positive has helped to mitigate the impact.


    Quote Originally Posted by rumrunn6 View Post

    whatever you do, don't google for pictures of it!
    ruh roh. .....
    Cheers, Gerry
    gerryelam.wordpress.com

  10. #10
    Senior Member k7baixo's Avatar
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    Quote Originally Posted by DGlenday View Post
    Damned straight you're not normal!. How many "normal" people can, or would even try to, do the things you've done?

    I hope your condition isn't severe, though it obviously hasn't prevented you from some pretty serious achievements so far.

    You could never have completed the super-rando series without having a pretty solid heart. (Congratulations on that. I did not manage this year despite having a "normal" heart, have the series as a goal for next year.)

    I'm a similar age (55) and I think almost anyone of our age can expect a bit of dizziness when the HR goes above 175-177. Our theoretical max HR is supposed to be 165 - for whatever that opinion is worth.



    Viva non-normality

    That said - don't take the medical concerns too lightly. If there's a hereditary condition, be careful - and good luck.
    Exactly why I went tot the dr....better to head it off now than allow the condition to slowly grow worse over time.

    Quote Originally Posted by GeorgeBMac View Post
    I suspect that some clogging of the cardiac arteries in a 50 something is more normal than abnormal. But that doesn't mean that it's good!

    And your sister the nurse the nurse is right: Heredity and stress are two of the factors that increase the chances of clogged arteries. But there is actually quite a long list of things and the more they learn about it the longer the list grows...

    A healthy lifestyle (including healthy eating and effective exercise) can improve your chances of not getting heart problems but there are NO guarantees. But it does improve your chances...

    If you are already in pretty good shape and getting a lot of exercise I would be surprised if your cardiologist would tell you to stop.

    But one concern COULD be: Congestive heart failure is most often caused by either a heart attack or by chronic high blood pressure -- which makes the heart work harder which causes it to enlarge (LVH = Left Ventricular Hypertrophy) and that leads to congestive heart failure.

    Weirdly, strenuous endurance activities like repetitive all-out centuries can also cause the heart to enlarge as it tries to oxygenate the body. It's called "athlete's heart". Cardiologists seldom consider that to be bad like they do the pathologic variety of LVH -- but physically it is much the same.

    It is that "remodeling" that sometimes leads to arrhythmias (electrical malfunction) in some endurance athletes.

    So, he may suggest you cut back from some of the extreme stuff... But you are obviously in pretty good shape so I would be VERY surprised if he told any more than: "Don't get crazy about it".

    Moderation.
    Great. I can't thank you, Duncan and everyone enough for the advice. I called the dr's and managed to move the appt from Thursday to tomorrow so I'll have the doc's input and course of treatment in about 24 hours. I'm happy they had an opening.

    Life is good. I plan to seek treatment and follow their directions. And ride.
    Cheers, Gerry
    gerryelam.wordpress.com

  11. #11
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    Since you're a relatively young, active guy, I think the cardiologist is going to want to do a cath on you in the very near future so he can see exactly how bad your disease is. He may find that the stress test was falsely abnormal (you can only hope), or there may be areas of partial obstruction that can be repaired with stents. Or, depending on the extent and location of the disease, you could be referred to a surgeon for bypass surgery.

    The terms anterior and posterolateral refer to the areas of your heart that appeared to be inadequately perfused during your stress test. This suggests certain coronary vessels, but the only way to know the extent of the disease is with an angiogram (cath).

    If your cardiologist finds significant disease, I would also predict that he will want to start you on some new medications, including aggressive treatment of lipids. The parameters for what is acceptable re: lipid values become much more strict if you have known coronary disease.

    How long you're off the bike depends on whether they do the cath through the groin or the arm, plus what they find. Short of needing bypass surgery, I would guess you'll be back on your bike a few days following the study.

    Good luck!

  12. #12
    Senior Member k7baixo's Avatar
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    Quote Originally Posted by Ranger Dan View Post
    Since you're a relatively young, active guy, I think the cardiologist is going to want to do a cath on you in the very near future so he can see exactly how bad your disease is. He may find that the stress test was falsely abnormal (you can only hope), or there may be areas of partial obstruction that can be repaired with stents. Or, depending on the extent and location of the disease, you could be referred to a surgeon for bypass surgery.

    The terms anterior and posterolateral refer to the areas of your heart that appeared to be inadequately perfused during your stress test. This suggests certain coronary vessels, but the only way to know the extent of the disease is with an angiogram (cath).

    If your cardiologist finds significant disease, I would also predict that he will want to start you on some new medications, including aggressive treatment of lipids. The parameters for what is acceptable re: lipid values become much more strict if you have known coronary disease.

    How long you're off the bike depends on whether they do the cath through the groin or the arm, plus what they find. Short of needing bypass surgery, I would guess you'll be back on your bike a few days following the study.

    Good luck!
    Thanks my friend. That's good input and very much appreciated.

    Oh, my wife confirmed the doc's findings - she said that he's correct and I'm not normal.
    Cheers, Gerry
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  13. #13
    Semper Fi, A way of life. qcpmsame's Avatar
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    Quote Originally Posted by k7baixo View Post
    Oh, my wife confirmed the doc's findings - she said that he's correct and I'm not normal.
    You should have asked her first, and saved a lot of money for the co-pay. My wife regularly tells me I am not normal, no doctor's input required.

    Smart move on going ahead and getting in to see the doctor, keep us posted on what you find out.

    Bill
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  14. #14
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    I went to a cardio doc as a precautionary measure. When he found out I was a Type 1 diabetic for 50 years, he nearly had a coronary. He said he never gets to treat patients with diabetes for that long because they don't generally live that long. He took me off the bike and did an angiogram. Then we scheduled a stress test. In the end he said keep on doing whatever you've been doing, but he also put me on beta blockers...I hope to ride a lot more this coming year, but I have no aspirations to accomplish what the op has done this year!
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  15. #15
    Senior Member GeorgeBMac's Avatar
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    Quote Originally Posted by bwfox View Post
    I went to a cardio doc as a precautionary measure. When he found out I was a Type 1 diabetic for 50 years, he nearly had a coronary. He said he never gets to treat patients with diabetes for that long because they don't generally live that long. He took me off the bike and did an angiogram. Then we scheduled a stress test. In the end he said keep on doing whatever you've been doing, but he also put me on beta blockers...I hope to ride a lot more this coming year, but I have no aspirations to accomplish what the op has done this year!
    I'm curious. Did he give you a reason for 'taking you off the bike'? And was that to be temporary or permanent? In any event, I'm glad to hear you are in such good shape and still riding. It says a lot for your drive, determination and self control to be able to manage the diabetes so well.
    --------------------------------------
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  16. #16
    Senior Member k7baixo's Avatar
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    Quote Originally Posted by bwfox View Post
    I went to a cardio doc as a precautionary measure. When he found out I was a Type 1 diabetic for 50 years, he nearly had a coronary. He said he never gets to treat patients with diabetes for that long because they don't generally live that long. He took me off the bike and did an angiogram. Then we scheduled a stress test. In the end he said keep on doing whatever you've been doing, but he also put me on beta blockers...I hope to ride a lot more this coming year, but I have no aspirations to accomplish what the op has done this year!
    Great story! You have, by far, accomplished more than me. I did a couple of long slow rides with friends. Big deal. You, on the other hand, have managed your health in an active, proficient manner for over 50 years! Every type 1 diabetic should know your story and understand that good health, diabetes, diet and exercise aren't mutually exclusive. Simply a great job!
    Cheers, Gerry
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  17. #17
    Senior Member climberguy's Avatar
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    OP--Good luck getting this diagnosed and treated. Let us know what the doctor says.

  18. #18
    Senior Member trackhub's Avatar
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    Good luck to you sir, hope it all works well. I'm also 55. I'm beginning to think that a lot of doctors simply don't understand cyclists, at all.
    Why I say this: My previous PCP was a cyclist, and he understood. (He rode to his office on most days) There was some turnover, and my present
    PCP does not seem to like cycling much. I've already been asked if there was some other form of exercise I could be interested in. He has that "Bicycling, at
    your age?" look about him. Apparently, we're all supposed to take up golf, in the minds of some Doctors. (No offense intended to people who play golf)

    I told my present PCP that the bikeways around the charles river basin were named for Dr. Paul Dudley White, a long time chief of cardiology at
    Mass General Hospital, and that his bike was on display in the Museum of Science. He looked at me totally plank-faced.
    "The People will believe what the Media tells them they believe". George Orwell.

  19. #19
    Senior Member k7baixo's Avatar
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    DF's visit went well. He confirmed that I do in fact have a heart but he wants to do an angiogram on Thursday. Hopefully, it'll show the issue was a false positive or, perhaps I simply need a stent or two. Maybe when this is done, I'll be stronger, faster and able to leap small lawn objects in a single bound.
    Cheers, Gerry
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  20. #20
    Senior Member GeorgeBMac's Avatar
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    Quote Originally Posted by k7baixo View Post
    DF's visit went well. He confirmed that I do in fact have a heart but he wants to do an angiogram on Thursday. Hopefully, it'll show the issue was a false positive or, perhaps I simply need a stent or two. Maybe when this is done, I'll be stronger, faster and able to leap small lawn objects in a single bound.
    Congratulations Tin Man!

    ... Hope all goes well with the Angiogram.

    (And keep us posted!)
    Last edited by GeorgeBMac; 12-18-12 at 08:33 PM.
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  21. #21
    Senior Member David Bierbaum's Avatar
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    Quote Originally Posted by k7baixo View Post
    DF's visit went well. He confirmed that I do in fact have a heart but he wants to do an angiogram on Thursday. Hopefully, it'll show the issue was a false positive or, perhaps I simply need a stent or two. Maybe when this is done, I'll be stronger, faster and able to leap small lawn objects in a single bound.
    Just so long as you don't start moving in slow motion, while making Steve Austinish "chingchingchingching" sounds! Here's hoping your tests come back negative, so you can get back to feeling positive!

  22. #22
    Senior Member k7baixo's Avatar
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    Quote Originally Posted by David Bierbaum View Post
    Just so long as you don't start moving in slow motion, while making Steve Austinish "chingchingchingching" sounds! Here's hoping your tests come back negative, so you can get back to feeling positive!
    Thanks.

    My echocardiogram was normal so structurally, my heart is healthy.

    The stress test, at normal HR, was also fine but under duration, it’s showing some parts of the heart that aren't getting a good blood flow. That might explain a little of the dizziness when my HR exceeds 175.

    The angiogram’s outcome will have three possibilities:
    1. The stress test provided a false normal and there are no issues.
    2. There’s an issue and the doctor can identify some small amount of blockage. They’ll decide on the spot if it can be treated with medicine OR if they’ll need to insert a stent or two. If a stent is required, I’ll be in the hospital overnight but the recovery is fast…on my feet the next day.
    3. Worst case: the blockage is severe and they’ll refer me to a cardiac surgeon.

    If I were already at the 3rd case, I couldn't exercise at the level that I currently work at so I’m not worried that I need surgery. My guess is that I have a little blockage and it’ll be easily resolved.

    They’re sure these are hereditary factors – I’m not sure what else I could have done to prevent this other that watch my cholesterol level a bit closer.

    I’ll update you guys tomorrow or Friday but again, I don’t expect any issues.
    Cheers, Gerry
    gerryelam.wordpress.com

  23. #23
    Spin Meister icyclist's Avatar
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    That's reasonably good news. I was on the phone a few minute ago with a friend who needs open heart surgery for an aortic valve replacement, and some blocked arteries.

    "If I were already at the 3rd case, I couldn't exercise at the level that I currently work at"

    Don't be so sure. I had two stents placed in a coronary artery after I felt some chest pain while riding my bike. I was awake for the angioplasty, as you will probably be, too. At some point the surgeon walked over at told me I had two blockages, each chocking off approximately 80 to 90% of my artery.

    I asked the doctor how that was possible, given I'd ridden my bike 100 miles in a day, two weeks earlier, and ridden, con brio, at 10,000 feet the week before (with some chest pain). The answer: "You must be in good physical condition." In fact, most people don't notice a problem until they are at lest 70% blocked, because arteries are fairly elastic.

    The good news is that this is a fairly minor operation. I was back on my bike - and not holding back much - three days after the operation.
    This post is a natural product. Slight variations in spelling and grammar enhance its individual character and beauty and are in no way to be considered flaws or defects.

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  24. #24
    Senior Member k7baixo's Avatar
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    Well, that was easy.

    They rolled me into the cardiac cath lab at 0825 and I was back in the recovery room at 0905. They found no blockage which is a great relief. I need to watch my cholesterol and we need to determine why I get dizzy when my HR goes over 175 or so but, with a family history of heart issues and atherosclerosis, it's great to have confirmation of no blockage and confirmation of no structural issues.
    Cheers, Gerry
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  25. #25
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    Gerry,
    Glad to hear, this is good news. Thanks for getting back to us. Did the Doctor recommend any limitations to your training?

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