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Can't decide if I'm out of shape or something is wrong

Old 01-02-20, 09:34 AM
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gattm99
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Can't decide if I'm out of shape or something is wrong

About a year ago I made a post about an issue I was having. At the beginning of rides I usually feel a tightness in my left arm or chest. I was strongly encouraged to get it checked out. They ordered a echo stress test. Of course during the stress test I had zero tightness symptoms and my heart was functioning properly. Getting the test and getting it paid for was an ordeal, and I felt like I was about to go through an endless barrage of tests to find out I was just out of shape so I never went back.


I went on with a weak Jan and Feb in 2019 only riding outdoors twice and accumulating about 40 hours of indoor rides on Zwift. I headed into Spring 2019 feeling really weak, and dealing with horrible starts on most rides. I did a few hard outdoor gravel rides with TSS scores over 300 according to Strava. By June I was feeling better and getting more rides, I still occasionally had the weak start issues but felt a bit more like myself. Had a good July, but terrible August, Sept, October getting less then 60 hours.


I realized in late October I was really letting myself go, I was up to 250 pounds, meaning I had gained about 10 pounds since July. I've upped my activities to 63 hours for Nov and December, but I'm not performing well, finished the year with 4500 miles. This Tuesday I had my first ride where I sort of felt like my old self, but I could feel all the weight on the climbs, but I had great energy levels and didn't have chest tightness.


Wednesday I went on a big gravel group ride with some significant climbs. I was off the back on the first hill, breathing was shallow, arm and chest tight. I recovered a bit and managed to get back with a few riders, but totally blew on the last big mile climb and hobbled in.


Just a little context, been riding my whole life with various levels of intensity, in 2009 I weighed 300 pounds and was feeling horrible. By 2012 I was at 220 and won a Cat 5 race. Got in 6000 miles in 2012. Life changes caused lots of issues in 2013, and new job in 2014 with 3 hours of commuting has killed alot of my training time. Gained 30 pounds in last 4 years. I'm 40, normal blood pressure, never smoked or drank. No medications.


So big issues

I need about 30 minutes of low intensity warm up to avoid the arm tightness. Doing pre ride warm ups works, but I usually don't have time.


I keep getting fatter.


The arm tightness seems to be worse in winter, worse on trainer. No where near as bad in summer. Besides left arm and shoulder tightness I have shallow breathing, usually strong thirst, and just general feeling that I need to stop.


Often when I do stop and chill for a 5 minutes and restart I feel better.


Any ideas?

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Old 01-02-20, 09:53 AM
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Well, talk with a doctor first. Find one that listens to your concerns, and ask questions about his/her opinions! There's no way around that. Evaluating your diet and your relationship with food can help you tip the scales (not intended) in your favor so you can slow or reverse your weight gain without getting unhealthy. It's not for everyone, but I've found the Whole30 plan to be useful for recognizing stress eating patterns and habits. You don't have to be on board with the autoimmune theories, but cutting grains (baked goods, pies, breads, pasta) dairy (predominantly fat), added sugar and sweeteners, and the easy grain replacements like beans and such for 30 days helps you develop a taste for things we should eat more of but don't, as well as providing practical experience to avoid prepared meals and stay full, instead of getting a cappuccino and croissant at 3:00 in the afternoon.

Second, if a better warm up helps, do it! It's part of the race or exercise, so make time for it.
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Old 01-02-20, 10:29 AM
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First, I would say go see a doctor. It may well be nothing, but you don't want to mess with your heart... it's kind of important.

Second, losing weight is almost certainly going to help. Being 250 is not healthy regardless of how much exercise you're doing. That's a lot of extra work your hear (and the rest of your body) is forced to do 24/7. There's no secret to how to do this. You have to consume fewer calories. All the different diets out there are essentially ways to do this without feeling like your starving too much. Pick the one that you think would work for you.
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Old 01-02-20, 01:01 PM
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Well yeah, you've seen a doctor. My doctor says when you get a doc's opinion with which you are unsatisfied, see another doctor. They're not all the same. Way too many docs just stick with what they learned in med school. One assumes you had an EKG?

I've frequently had very similar symptoms: upper left chest pain, lungs don't feel like they're opening thus quick shallow breathing, do fine after a 20-30 minute warm-up. But then my BMI is ~24, which might be 90% of your issue. My doctor thinks it's a muscle cramp, happening for unknown reasons, but possibly related to some old injury. I had a very complete heart workup, the full thing, took all day. The cardio did find a couple things, but nothing that explained the chest pain. He also told me not to worry about it: if I had experienced a heart issue that many times, it'd stick out like a sore thumb.

My diagnosis was partial left bundle branch block of unknown origin and a fair bit of arterial calcium, which turns out to be normal in older endurance athletes, low risk. Otherwise, I'm fine.

I work out either on the bike, in the gym, or other outdoor 6-10 hours/week year 'round. I advise the same. Just do it. Really bad idea to go on a competitive gravel ride without deep base. That's asking for it. I see you have Zwift. Nothing interesting happens on the bike in less that 45 minutes. So go for 1 hour indoor rides, some easy, some moderate, one hard, every week for the foreseeable future. If you can go outdoors, say 1 outdoor, 4 indoor/week in winter. In summer of course, more outdoor. You want to lose weight. Not a bad idea to go to the gym for an hour twice a week right after your hour on Zwift and do whole body workouts.

Do not go on a diet! Instead, change your lifestyle. The reason people bounce around in weight is because they go on diets. That's actually more unhealthy than staying at a steady weight. Instead, change how and what you eat. Basically eat smaller portions and change to a mostly plant-based diet. Whole grains, beans, vegetables, dairy, eggs, olive oil, fish, basically what's called a Mediterranean Diet. Very little meat of any kind. Find recipes for foods in that category that you'll enjoy eating, plus experiment with foods you've never eaten. Eat that way for the rest of your life. Lose weight slowly but steadily. Track it on a scale every day. A pound a week is doable, but 1/2 pound/week is probably better because you won't be stressing at that level. That's 25 lbs/year, which is really good.
https://www.webmd.com/diet/news/2018...t-diet-of-2019
https://www.allrecipes.com/recipes/1...erranean-diet/

On the trainer, about 15' in, try a 3' hard interval, or two 1.5' intervals with a bit of rest between. See if that sorts your tightness. I never get that on a group ride, I think because they accelerate right out of the parking lot and one has plenty of adrenaline.
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Old 01-02-20, 05:13 PM
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My wife and I are working together on the healthy lifestyle change, she was the driving force behind my 80 lbs of weight loss in 2010-2011 and she herself lost 100 lbs. As I mentioned several things occurred between 2013 and now which derailed the healthy lifestyle we had developed. All of these are excuses, but still if they hadn't occurred we both wouldn't be back where we started.

We are back at the gym, did our second day today. Hoping to do around 2-3 days a week.

Carbonfiberboy, that is exactly how I'd describe my problem,

A relative recently was hospitalized for a COPD which was treated with a stent. She is 62, heavy smoker, drinker, on a lots of meds and has never exercised. She described feeling chest pains with light activity for some time, these pains wouldn't last long and she didn't think much of it. Soon the pains became more frequent and more severe. I've been dealing with this for years and never once actually felt pain, so I really don't think I have a serious issue, just annoying thing holding me back.

As far as doing a competitive gravel ride without a solid base that's where I'm miffed for two reasons. This wasn't suppose to be a competitive ride, but I feel like every ride is competitive these days. There always used to be sprints and segments that we'd hammer but there would be mellow recovery in there, EVERYONE would wait up to regroup a few times on a ride. Now it's like everyone is riding for Gold and if you get spit out the back.

More importantly I've got a far deeper base then many of the riders that were there, at least when it comes to miles, I was doing an A group road ride in summer and hanging with the fastest riders. Yesterday I couldn't hang with the B group riders, of course the road ride was 30 miles with a 500 feet of climbing and yesterday was 30 miles with 2500 feet of climbing. I think it all comes down to weight. I remembered doing loaded tours back when I weighed 225 with 25 pounds of gear. That's where I'm at right now.
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Old 01-02-20, 05:22 PM
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Neither an echo or EKG will show clogged arteries. EKG is for rhythm problems and echo is for valve or other heart structure problems. The test for coronaries is angiogram

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Old 01-02-20, 05:55 PM
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Originally Posted by Darth Lefty View Post
Neither an echo or EKG will show clogged arteries. The test for that is angiogram
An EKG shows electrical activity, which can have a problem, as it did in my case. Quick and Inexpensive. My EKG resulted in a visit to a cardiologist. He ordered a cardiac nuclear stress test, then an echocardiogram, and then a cardiac MRI before and after nitroglycerin. The cardiologist will recommend a test or tests if they think a test is needed. An angiogram is the most invasive. Most insurance will pay for tests ordered by a cardiologist, or in the case of an EKG, by your PCP.
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Old 01-02-20, 06:01 PM
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Originally Posted by gattm99 View Post
My wife and I are working together on the healthy lifestyle change, she was the driving force behind my 80 lbs of weight loss in 2010-2011 and she herself lost 100 lbs. As I mentioned several things occurred between 2013 and now which derailed the healthy lifestyle we had developed. All of these are excuses, but still if they hadn't occurred we both wouldn't be back where we started.

We are back at the gym, did our second day today. Hoping to do around 2-3 days a week.

Carbonfiberboy, that is exactly how I'd describe my problem,

A relative recently was hospitalized for a COPD which was treated with a stent. She is 62, heavy smoker, drinker, on a lots of meds and has never exercised. She described feeling chest pains with light activity for some time, these pains wouldn't last long and she didn't think much of it. Soon the pains became more frequent and more severe. I've been dealing with this for years and never once actually felt pain, so I really don't think I have a serious issue, just annoying thing holding me back.

As far as doing a competitive gravel ride without a solid base that's where I'm miffed for two reasons. This wasn't suppose to be a competitive ride, but I feel like every ride is competitive these days. There always used to be sprints and segments that we'd hammer but there would be mellow recovery in there, EVERYONE would wait up to regroup a few times on a ride. Now it's like everyone is riding for Gold and if you get spit out the back.

More importantly I've got a far deeper base then many of the riders that were there, at least when it comes to miles, I was doing an A group road ride in summer and hanging with the fastest riders. Yesterday I couldn't hang with the B group riders, of course the road ride was 30 miles with a 500 feet of climbing and yesterday was 30 miles with 2500 feet of climbing. I think it all comes down to weight. I remembered doing loaded tours back when I weighed 225 with 25 pounds of gear. That's where I'm at right now.
My wife works out with me, rides trainers with me, and rides tandem with me, so she's supportive and that really helps. She's also been a natural foods person since college and a good cook. I've always been a lucky guy.
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Old 01-02-20, 08:15 PM
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Just a thought. And by no means am I suggesting you should not work with your doctors in potential heart/health problems.

But what about stress? You mentioned life changes impacting things. Do you feel stress could be affecting things. Like your breathing? And worrying about things just compounds the worry.

Great you are in the gym. Some strength training could help the tightness in your arm.

I donít know. Just throwing out ideas. Hope all works out and great youíre putting in the work on your health.
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Old 01-02-20, 11:38 PM
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Originally Posted by Carbonfiberboy View Post
An EKG shows electrical activity, which can have a problem, as it did in my case. Quick and Inexpensive. My EKG resulted in a visit to a cardiologist. He ordered a cardiac nuclear stress test, then an echocardiogram, and then a cardiac MRI before and after nitroglycerin. The cardiologist will recommend a test or tests if they think a test is needed. An angiogram is the most invasive. Most insurance will pay for tests ordered by a cardiologist, or in the case of an EKG, by your PCP.
ok. Iíve had a diagnosis of enlarged heart (HOCM) for ten years, an ICD for eight, last year had open heart surgery and this year am headed for first replacement of my ICD. Iíve had all these tests including a really badly designed cycling echo. I canít have the MRI anymore thanks to my ICD and nitro is contraindicated for me. The only thing insurance didnít cover was a genetic test that could have been avoided with one verbal question that no one thought to ask me. My insurance budget is max OOP every year.

So, itís not out of line for me to classify problems as rhythm, pumping, or coronaries. But I also know that symptoms can be confusing. My discomfort at first was kind of like tunnel vision and didnít resolve to angina until I was on medication. And I didnít have clogged coronaries, rather turbulence in my heart was killing pressure entering my coronaries.

My GP, fwiw, was an idiot about all this. He tried to diagnose me with bronchitis. I had to demand the EKG. I was very lucky in my and his ignorance to get a referral to a good and curious cardiologist. Cardiologists as a rule do afib and clogged coronaries and other common problems all day and may be at a loss for anything else. If it turns out you do have something esoteric itís worth your while to find a specialist thatís more special.
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Old 01-03-20, 12:11 PM
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Originally Posted by Darth Lefty View Post
ok. Iíve had a diagnosis of enlarged heart (HOCM) for ten years, an ICD for eight, last year had open heart surgery and this year am headed for first replacement of my ICD. Iíve had all these tests including a really badly designed cycling echo. I canít have the MRI anymore thanks to my ICD and nitro is contraindicated for me. The only thing insurance didnít cover was a genetic test that could have been avoided with one verbal question that no one thought to ask me. My insurance budget is max OOP every year.

So, itís not out of line for me to classify problems as rhythm, pumping, or coronaries. But I also know that symptoms can be confusing. My discomfort at first was kind of like tunnel vision and didnít resolve to angina until I was on medication. And I didnít have clogged coronaries, rather turbulence in my heart was killing pressure entering my coronaries.

My GP, fwiw, was an idiot about all this. He tried to diagnose me with bronchitis. I had to demand the EKG. I was very lucky in my and his ignorance to get a referral to a good and curious cardiologist. Cardiologists as a rule do afib and clogged coronaries and other common problems all day and may be at a loss for anything else. If it turns out you do have something esoteric itís worth your while to find a specialist thatís more special.
My cardiologist was also a bit at sea with my case. Older endurance athletes are seldom seen unless they present with one of the things you mention. However he was thorough and that was good.
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Old 01-03-20, 10:45 PM
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Originally Posted by CyclingBK View Post
Just a thought. And by no means am I suggesting you should not work with your doctors in potential heart/health problems.

But what about stress? You mentioned life changes impacting things. Do you feel stress could be affecting things. Like your breathing? And worrying about things just compounds the worry.

Great you are in the gym. Some strength training could help the tightness in your arm.

I donít know. Just throwing out ideas. Hope all works out and great youíre putting in the work on your health.
I've thought of that alot, I'm not getting enough sleep for sure.

In other news I think I overdid the gym yesterday, got some massive muscle pain.
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Old 01-05-20, 08:09 AM
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Being overweight is an obvious issue but for you it is also a constant. When you are having variable performance, think about what may be different on your rides. I've found something as obvious as nutrition makes a difference. For me, an energy gel at about 20 miles is a big help. I'll eat more and other stuff on into a ride, but that early gel is something I try to always include. Of course what and when one eats is very personal but it's an example of something to experiment with. I also benefit from a 10 or so mile warmup. I don't know any way around that.
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Old 01-05-20, 06:13 PM
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Dieting is bad for your health if done for weight loss. To maintain a desired weight, reduce use of sugar to near zero. The rest of it has been said many times. Meals should be mostly plant based and portions moderate. There is a mental shift that must take place that promotes good eating habits. I'm at my high school weight and an important aspect of what motivates me is seeing elderly people, much younger than myself, shuffling along at slow speed, obviously in discomfort. Whatever their remaining years are to be, they will be spent in misery. Maintaining a healthy life is good for the present but also so that out later years are as active and meaningful as possible.
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Old 01-05-20, 07:39 PM
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Originally Posted by gattm99 View Post
I've thought of that alot, I'm not getting enough sleep for sure.

In other news I think I overdid the gym yesterday, got some massive muscle pain.
Massive muscle pain isn't really a sign of overdoing it. Rather it's a sign of a past record of underdoing it.

No matter what one's doing, the last rep of the last set should be almost, if not impossible. The way one manages that is by starting with lighter weights and more reps, but still observing the instruction in the previous sentence, always only 1' rest between sets. A short rest increases endurance and helps prevent injuries because one will have to use lighter weights. A good start is with 3 sets, starting with 20 reps, 3 X 20, then 3 X 15, 3 X 12, 4 X 10, 3 X 8 3 X 6, 4 X 4. this progression occurring between say October and May, so say 4 weeks for each progression. Twice a week. Enough exercises so that the whole thing takes about one hour or not much more. Obviously as the reps go down, the weight to produce near failure goes up. But because of the previous conditioning, shouldn't be a problem, but form always needs to be perfect and the lifts done through full range of motion, strictly. There are usually knowledgeable gym rats to help with form.

A good reference for cyclists is Friel's Cyclist's Training Bible.
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Old 01-05-20, 09:36 PM
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Interesting topic and problem.

have you tried Yoga for areas that target your pain/discomfort? YouTube vids are numerous and easy to try at home. I’ve had some great benefits lately for my neck and trapezoids.

i also suffer from weight issues, I’m a Clydesdale. I’m 6’4” 270#, Gained 10lbs over the holidays, ugghhh! Was at 252# last summer and am going to get back there but need to do it carefully.
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Old 01-06-20, 12:24 PM
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3 hour commute sounds brutal. Would try to change/solve that if possible
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