In March of 2008 I began treatment for a potentially fatal heart arrhythmia whose cause was unknown. I was fit and healthy, having spent a good part of my adult life as an elite cyclist, much of it racing in Europe.
After 5 years of fence-sitting on the part of my doctors, I have been given a diagnosis of ARVD/C (Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy). I lack the known genetic markers for the disease as well as some of the structural changes that accompany ARVD/C, and my condition has shown no indication of being progressive (yet).
There is a growing population of current and former endurance athletes who end up with acquired arrhythmias, and a diagnosis of ARVD/C. But by placing these athletes in the ARVD/C patient population, we are potentially ignoring the very real likelihood of an acquired condition, similar, but different, from ARVD/C.
This blog is written as a resource for athletes with acquired arrhythmias, as well as anyone about to undergo endo or epi-cardial ablation, or the implantation of a ICD. It is also written to help generate some critical mass of interest in support of further research into acquired arrhythmias in endurance athletes and others. Feel free to contact me through the comments page if you have any questions or wish to make a written contribution to this blog.

Thursday, June 25, 2009

Seriously, don't call it a comeback...

Back in the day when I could kick it...(photo copyright Marco Quesada, nyvelocity.com)

Apologies for the inconsiderate blogging. My last post was Saint Patrick's day, and the luck has been coming thick and fast since then, with not much time to process it all or any real interest in dwelling on my good fortune lest I lose it. First thing: As of mid-April I have been declared ARVD-free, leastways I don't have any of the currently identified genetic markers. As I detailed in other posts, this was the last hurdle to pass over in my return to health. To some doctors, the lack of genetic ARVD markers does not mean one is in the free and clear regarding exercise, but because of my athletic background and my continued improvement over the past months with regular moderately strenuous exercise, I have been given the OK to start a full training regime. And, providing I take precautions (see photo below) even with my ICD, Doctor Marchlinski says there is no clinical reason why I shouldn't race again.
Now, since this news, there have been many limiting factors to my return to competition. The greatest is, of course, that I have a life off the bike which is somewhat demanding. Architecture school greatly limits the time one can devote to extracurriculars. Then there is the question of motivation in a 40 year-old whose best years are surely behind him. The biggest motivation to race again is to prove to myself that I can get back to some semblance of what I was, minus some snap and speed. Lastly, I still have a fear of the "top end", operating at or above my threshold, and the sharp accelerations that one must endure in bike racing. Acceleration and max-threshold training are the two things I have not yet done since I started riding again. But let me give you something of a chronology...

My homemade ICD protection: an old chamois and an Ace bandage

January to March continued as I had detailed in prior posts (Extreme Cardiac Rehab), in which I did a light load of training 4 to 8 hours a week max, much of it running. In April, with the weather improving and more hours of daylight, I increased the load to 6 to 10 hours a week, phasing out the running mid-April and throwing in an occasional 3 hour ride. My body responded well, I would have occasional PVCs while training, but there would be days when I'd not notice a single errant beat. The cardiac "noise" -occassional discomfort- would come and go. I've since accepted these phenomenon as facts of life, they don't really bother me. Rarely I'll have a flurry of PVCs, particularly if I have to stop short from a sudden effort, but they are few and far between. I make a point of checking my pulse at my neck (the best place to detect PVCs) each time I have to come to a stop, say at a red light. It's an odd posture, having one's hand on one's throat at every light, but it's reassuring to know everything is smooth, and when it isn't I am more attentive and trim my efforts.
When I got my genetic testing back I released myself from the 165bpm limit I had set. From mid-April on I would let my heart get up into the high 160s low 170s, but only in a gradual, controlled manner, never in a rapid acceleration or sprint. And these efforts were rare, they'd happen organically, as on a hill, or on a rare instance when I felt like doing a cruise interval. Basically I stuck to whatever felt good and didn't push myself inordinately.
Now, for the past month or so, more and more feels better and better: more distance, more speed, more effort. And I am having a standard issue training response: my training data is exactly as it should be, I can do more and more with less and less. My weight has come down, my speed over certain test-circuits has gone steadily up. Everything is exactly as it should be for the amount of effort I have been putting in. My training has held steady at 8 to 12 hours a week since mid-May, a fraction of what I used to do, but I couldn't be happier for it.
I had a follow up visit with Dr. Marchlinski at the end of May. My ICD is set to record my heart at 166bpm, and sure enough, starting in April I had many moments of monitoring recorded on my device. It is reassuring to know that I can compare the data from my Garmin GPS/ heartrate monitor that records my training with my ICD data and see that both devices are spot on accurate. (actually the Garmin seems more sensitive to moment by moment changes, the ICD is looking for arrhythmias and all its getting is healthy sinus tachycardia, it doesn't differentiate between 166 and 168 bpm for example. I would like to know if it can print out rhythm strips of my heart when I am at that level of effort, if only to see how frequent the PVCs are. At anything above 150bpm a PVC is hard to discern unless it comes with friends.)
So that is the status as I prepare for my race debut this Saturday. It will be a club race in Central Park, the place I began racing and the territory I am most familiar with. I am nervous mainly because my riding to this point has been predominantly solo and having to respond to other peoples accelerations and the ebb and flow of a peloton will be new.
My two concessions to my condition will be: a) my homemade ICD protector (a chamois pulled out of an old torn pair of shorts (clean, I swear)) and b) a promise to myself to not get too distraught if it all proves to be too much.
I promise to keep this channel updated....


RatherBeBiking said...

Hey Craig, I was looking forward to seeing you at the race this saturday but I've been forced into a family function in Dover, MA.

See you later this summer,


Alexander Miele Bremer said...

it was sooo good to see you out there craig! i hope it felt really good to be back in the peloton and that your body didn't complain too much. hopefully i'll be seeing more of you around at races once i'm back...

wishes for continued progress,
- a