D-Day

Okay, so I have seen Dr Stobie the Cardiologist. I now officially know more and have some clarity on some issues. Strap in, here we go:

As regular readers will know this week I have had an MRI done and worn a Holter Monitor (small portable ECG) for 24 hours. The various tests have given a bit better idea of what is happening with my heart.

The MRI was to check for any damage to the heart, scar tissue, structural issues etc and that came back pretty much clear. There was a few areas of uncertainty about the structure of the heart, but they are fairly sure that was due to a condition called Athlete Heart. Athlete Heart is a common condition in athletes where the heart gets enlarged because it gets so much work. After you stop training the heart shrinks back to normal size. To give you an idea currently my heart’s capacity is about double what it is supposed to be (it pushes out about 165ml per beat, the average is about 70mL). I am sure that is probably pretty typical for an athlete. It is one of the reasons that an athlete's heart rate can be so low, the heart is pushing more blood,so it doesn't need to beat as often to supply the body with the blood it needs. Because the heart is bigger than it is supposed to be, structurally it can look a bit weird and it also shifts a little in the body. Freaky stuff right? All up though the doctors were happy that the MRI was clear, which was very good news. Issues on the MRI would have been a whole different kettle of sushi. 

The Holter Monitor results came back a bit worse though. The Holter monitor showed that I am getting ectopic beats every 3 or 4 beats (about 20000 a day), so pretty constantly. An ectopic beat is simply a disturbance in the cardiac rhythm. Everyone gets them, some people even get them pretty often, however, they aren’t supposed to happen all the time, which is what is happening at the moment. While I was training on the bike with the Holter Monitor I got one incident of non-sustained ventricular tachycardia (I think that is what it was called), which basically looked like my heart went mad for a bit. That had the cardiologist a little more concerned since it can be an indicator of greater cardiac risk, but since it only happened once in 24 hours they weren’t too worried about it.

The fact that I am getting ectopic beats isn’t so much of a worry, as I said, most people get them. What has the doctor concerned is the amount of them that I get. 

So anyway, that is what the heart is doing.

What caused it? Well it can be just one of those things. There is definitely a link between long, intensive exercise and heart problems, but these issues also happen in people who don’t do sport at all. What the doctor did run me through was that once you are doing more than about 2 or 3 hours a week of moderate exercise, the greater your risk of heart problem is. The more intense that exercise, or the longer you have done it (2000 hours in your life is apparently the magic number), the greater the risk. Basically we aren’t really meant to do Ironman training, it just isn’t that good for you. 2 to 3 hours of moderate exercise a week reduces a lot of health risks, but more than that starts to increase your risk again. Your risk is still lower than it would be if you did no exercise, but it isn’t a case of some is good, more is better. Everything in moderation I guess. Interesting stuff.

What can they do about it? Well, the treatment options are much the same as I have always known. Firstly I can do nothing. If I do nothing then I really need to stop intensive exercise. Completely detrain is the term they use. If I detrain, studies show that the ectopic beats will significantly decrease, although they are unlikely to stop. I like being active, but what level of activity I can sustain without the ectopic beats returning, I am not really sure about.

What about do nothing and keep training anyway, just put up with it? For now I have been given permission from the doctors to do some training, but I have to be careful to keep the intensity down and I find I am limited on the volume I can manage. What if I was to try and push on and train at full intensity? Well besides being very uncomfortable, in one study where 48 cyclists did just that, within 5 years 18 of them had had significant cardiac episodes. Some of them simply passed out, but a few had heart attacks. Hmmmm. Not a great option down that path.

Medication is a second option, but that isn’t a great one if you want to do sport. The Beta Blockers they give you lower your heart rate. This can make intense exercise difficult and can make you feel a bit rotten. Not a great option there either.

The third option is a catheter ablation where they insert a catheter into a vein in your leg and head up to your heart. Once the catheter is in your heart (yep inside your heart) they have a look around and see if they can find the fibres that are causing the ectopic beats and then they burn that fibre to see if that stops the ectopic beats. It sounds kind of bad, but the risks are very low and it doesn’t impair the function of the heart at all. It is surgery, but considered fairly minor surgery. On your heart...

At the moment, the recommendation from the Doctor is that I get the catheter. From the tests I have had they are pretty sure that the ectopic beats are all coming from the same area of heart so an ablation has a good chance of getting rid of it. Even if they don’t do the ablation he has recommended doing an investigation with the catheter because apparently there are some checks they can do into the hearts condition internally which are worthwhile.

If I do go for the ablation then the process after that is that they monitor the heart for a bit to see if they were successful. If they are successful, then they let me recover and then put me through a stress test (run on a treadmill while connected to an ECG). If that comes back clear then they give me the okay to start exercise again. Whether I can exercise back to previous levels is an unknown, so it isn’t a guarantee of returning to racing. Success rate of ablations is about 80%.

If I want to go for the ablation it could be happening pretty soon, as in on Tuesday.

So that is that. Needless to say I have a bit to think about.

For now I am leaning towards ablation. I don’t want this decision to be motivated by a desire to return to racing since I think that is very short term thinking. I don’t think that is my sole motivation, although if I am honest it is a factor. I don't want to give up racing, but in the end it is just a sport. That is a reality that I am currently coming to terms with. Even if an ablation is successful, racing as a pro could be done with, there is simply no way of knowing for sure at the moment.

I think I am leaning towards ablation because I don’t want this issue for the rest of my life. Even if I stop racing, I still want to be able to go riding with friends, go swimming etc and I am not sure I will be able to do that in the way I want with this going on. The Rottnest Channel swim is on this weekend and whilst I am not sure I will ever want to do that particular event, I hate the idea of not having the option. That is where I am currently sitting, although I am not entirely convinced either. 

Part of me is saying to just let it go and let the body settle down. This whole episode has made me consider life and all the things that are important. Perhaps I am ready to stop the madness of racing and focus instead on the family and all the cool things that come with that. 

Lots of thinking to do.