Cardiac Quadrathlon – Don’t Try This At Home!
What, no blog posts for a while? The reason for this will be revealed below.
A Quadrathlon at Home
Sunday 13th June started like any other really with some training for me. I was up early, the weather was good and I had plenty of plans. Not having raced last year due to coronavirus restrictions I had a little personal Quadrathlon planned from home. Just a chance to see if I still had it…
I set up my running and cycling kit in the conservatory. With that ready to go I donned my swimming wetsuit and headed over to the beach with my surf ski. My plan was to swim, kayak, bike and run. Nothing too crazy just back to back sports at a steady pace for approximately race distances. As I was on my own it would all be quite chilled.
The Swim and Kayak
I left my surf ski, paddles and buoyancy aid on the beach and jumped into the calm waters. The sea was lovely and I started off my swim at a steady pace. I swam out to sea towards the 8 knot marker buoys. Here I turned left, swam parallel to the beach for a while then headed back. My pace was good, I wasn’t going hard but I wasn’t taking it easy either. The swim itself was a little over 1600 yds which I completed in a respectable 22:55.
T1 if you can call it that was a relaxed affair. I walked to my surf ski, took my wetsuit off and stuffed it into a dry bag. I attached the dry bag to my ski and then put on my buoyancy aid, sun glasses and cap before carrying my ski and paddles to the water.
Once on the water I paddled to Borth and back. Once again, this wasn’t at race pace. It wasn’t an easy pace either but it was a steady effort. Total distance was just over 5.5 miles which took 52 minutes. That’s an OK speed of 6.4 mph.
The Bike and Run
T2 was almost a whole discipline in itself. By the time I’d carried my surf ski home from the beach, put it away and got into my cycling kit it took 11 minutes. As this wasn’t a race, this included filling my pockets with a repair kit, phone etc just in case. I was after all heading out into the hills alone so always take spares and communication equipment with me. My ride took me off-road on my Mountain Bike into the hills around Artists Valley.
I was feeling good and didn’t see a soul. The trails were lovely, I was on my race bike which felt lovely too. It was now a glorious day. Temperatures were rising but it was still early in the day so it wasn’t yet hot. I also had plenty of fluid with me. I wouldn’t normally carry fluid with me in a race but I had the luxury of a full bottle today. I’d even taken a drink on the kayak with me.
The ride turned out to be 14.75 miles which took 1hr 7minutes. Not a bad time on a Mountain Bike. Again it had been steady all the way, but never hard.
I put my bike away, had a quick transition into my running kit and headed off for the final leg of my private Quadrathlon. I was going to do two laps of the ‘Boat Yard Loop’ to make it a 5 mile run but decided that one loop was enough. It was feeling quite slow so that would be plenty. I did notice that my watch was reading my heart rate incorrectly. At this pace it would usually be around 140bpm, maybe pushing 150bpm seeing as it was warm and I had essentially been going for 3 hours. My max is around 170bpm but it was reading 189bpm. I didn’t think much of it though as I wasn’t wearing a HRM chest strap but was relying on the optical sensor on my watch. This isn’t as accurate, especially when running as it tends to move around a little too much to get a good reading.
The run was indeed a little slow but again it had been a steady effort. My own private Quadrathlon was complete.
Time to Chill
That had been a fun morning and I was home and finished in time for brunch in the garden with Anna. There was still plenty of time left in the day for some gardening, walks on the beach and maybe some snorkelling with Morgan.
I packed some stuff away, checked the stats of each leg on Strava, had a shower, had a shave, got dressed and then went outside to sort out my surf ski and wetsuit. My chest started to hurt a little so rather than sort out my kit I sat in the shade of the parasol to chill for 5 minutes.
Anna came out and asked why I was being grumpy. I said my chest hurt and followed her back inside. It started to hurt a little more and before long Anna was calling an ambulance. I felt sick so moved to the bathroom. Here I pretty much collapsed on the floor where I sat having a full blown heart attack. Within no time at all I was sat in a pool of my own sweat. I was in agony, struggling to breathe properly and trying not to pass out.
Anna was on and off the phone talking to the ambulance control centre. Morgan was stood outside ready to flag down the ambulance. When Anna was not on the phone she was doing her best to keep me comfortable. Comfortable I was not! As well as the agonising chest pains, the difficulty breathing and the profuse sweating I was dribbling at times and my arms, hands and legs were cramping up so that I couldn’t move them. I’m sure I was panicking a little too which didn’t help.
I was only able to concentrate on trying to keep my breathing as calm as I could and trying not to pass out. I wasn’t very successful at the former but just managed to hold onto consciousness. I remember thinking at one point not to pass out as the last thing I wanted for Anna’s sake was for her to have to do CPR on her husband.
This is how we stayed whilst waiting for the ambulance. I also remember wondering if I should tell Anna to ask our neighbours Dave or Colin to go get the defib from the Visitor Centre or from Borth but I didn’t really have the ability to tell her.
I tried to listen in to the various phonecalls but it didn’t sound good. I just wanted the ambulance there and then but it didn’t sound imminent.
Off to Morriston Hospital
Eventually over 1½ hours after calling 999 the ambulance arrived. They gave me aspirin and morphine and hooked me up to an ECG to confirm that I was indeed having a pretty significant heart attack. They needed to get me to Morriston ASAP. The Air Ambulance was called to get me there in a helicopter but it couldn’t attend. So, after a fair bit of time making arrangements and juggling of ambulance crews, I was blue-lighted by road all the way to Swansea.
I was still in full-blown heart attack mode all the way there. Despite the morphine the pain never subsided. I still couldn’t breathe properly and just had to concentrate on staying conscious.
Having driven to Swansea loads lately I could tell they weren’t going the best way but couldn’t tell them and certainly wouldn’t have had the ability to explain the fastest route. I’m sure they wouldn’t have listened to a man in my state anyway. At one point the paramedic tried to give me Entonox but just half a puff had me vomiting and then I continued to throw up all the way to Swansea – that didn’t help!
Angioplasty in the Cath Lab
Finally about 5 hours after dialling 999 I arrived at the hospital and I was rushed straight into the Cath Lab and plonked on the operating table. Various things were done to me but by now I wasn’t really aware of what was happening. I just wanted them to fix it and thought the best I could do to help was to do nothing and let them get on with it.
After a while I remember thinking “they are actually doing this right now aren’t they”. Sure enough they were. I’m not really sure what I was expecting them to do as I’ve never been in this situation before and didn’t really know what was going on. I did know that they were ‘fiddling around’ in my heart via the radial artery on my right wrist. I couldn’t really tell if it was working, if they were happy with the way things were going or what was going on. I did try to look at the screens once or twice but it was all a little too much so once again I just lay there and hoped they knew what they were doing and all was under control.
After about an hour of being poked and prodded they were done. They had removed some clots from my right coronary artery and had inserted two stents. I was now at least breathing a little more normally and I think some of the pain had gone. They sat me up to show me the before and after images from the angiogram. The before showed that my right coronary artery had been completely blocked so no blood had been getting to this side of my heart. The after image showed blood flowing all the way through it again. They seemed in a hurry to get me out of there – presumably there was another patient waiting – so they didn’t really explain much. I was moved onto another bed where I threw up once again for good measure and was wheeled off to the Cardiac Care Unit (CCU)
This was to be my home for a few days. I was wired up to an ECG for constant monitoring, bloods were taken, drugs dispensed and questions asked. I made sure they let Anna know what had happened. It was only now that the doctors and nurses were properly aware of the unexpected nature of this heart attack and the fact that I didn’t tick any of the usual risk factor boxes. I’ve never smoked, I don’t really drink, I’m not overweight, my blood pressure levels are fine, my diet is good and I exercise more than anyone. The causes were a mystery.
It was also now that I realised I was here, miles from home with nothing but a pair of shorts and my watch. I didn’t have a T-shirt, I didn’t have shoes or socks and I didn’t have my phone. I could usually cope without any of these things but my phone would have been nice just to keep in touch with Anna. I was given a leaflet about the procedure they had carried out – I could just about read it without my glasses. As with all other documentation I’ve had since it was mainly going on about reducing the risk factors. Again, smoking, drinking, obesity, poor diet and lack of exercise – none of which applied to me.
I did manage to get hold of a toothbrush and toothpaste to add to my worldly possessions of my shorts and watch.
I was woken (not that I was asleep) at 2am by one of the nurses to tell me I was showing some strange rhythms on the ECG. She showed me the printouts, explained the anomaly and explained atrial fibrillation to me. She also gave me some medication that she hoped would fix it and reassured me that although not what they want to see it is quite common after angioplasty procedures. It was nice to have some things explained properly to me.
Not much happened over the next day or two. I sat there in my increasingly stinky shorts with nothing to do but watch the clock and try to come to terms with what had happened. I was able to speak to Anna and my Mum briefly each day on the hospital phone. The doctors visited each day and they too were baffled by the cause. There was some talk of too much exercise causing cardiac hypertrophy. This causes some damage to the coronary arteries upon which clots form eventually blocking the artery causing a heart attack. The only other explanations were the uncontrollables of genetics and plain old bad luck. Stress may have been a cause too and is probably something that can’t be ruled out and at least something I can try to do something about.
The only other things to look forward to each day were having blood samples taken, drugs dispensed – at least the high dose potassium supplements were tasty – and of course the hospital food. I did get taken off the main monitors onto a portable one after 24 hours so that I could at least go to the toilet and try to have a wash. I also had chest X-Rays and an went on a little trip elsewhere in the hospital for an echo-cardiogram.
The downsides were; the continuing chest pain and the worry that came with it, the random crying now and then and the consultants telling me that it was unlikely I’d ever be able to ‘train’ again but that I should be able to lead a fairly full life, just a very different one.
On Tuesday I was transferred to the CCU in Glangwili Hospital in Carmarthen for much of the same. The first night wasn’t great but I blame the two nurses on duty for that. The one that did take my observations and such like didn’t once ask me how I was. The other one didn’t even look at or acknowledge me. I asked the one attending me to phone Anna to let her know where I was and she spent the next two hours ‘bitching and moaning’ about colleagues to the other nurse before finally phoning Anna. She did at least sound nice to Anna on the phone and was quite nice about me when I overheard her handing over to the morning shift of nurses the next day.
The other patients in the ward were nice enough. I won’t mention names as they might not want me to but there was one elderly guy about to go to Morriston to have stents inserted. I did my best to reassure him that it wasn’t too bad and that having them fitted as a precaution rather than in an emergency like mine was a good thing. The other guy seemed like a really nice bloke. He was pretty deaf so had to be shouted at but once he heard always had sensible replies. He was also concerned that some of the drugs he was on were making him hallucinate. When explaining this to the consultant and his entourage he pointed at me and said “as an example you see that guy over there? I’m pretty sure he’s got short, cropped hair, but looking at him now he’s got a huge afro”. They all looked at me, imagined me with an afro and we couldn’t help but laugh. They did of course take it seriously and thankfully he could see the funny side of it too. But we did all also feel sorry for the him as it must be weird seeing things that you know aren’t there.
The morning shift of nurses was better. Good in fact. The doctors at Glangwili were a little more optimistic too saying that this was ‘just a blip’ and that if I take it easy for a few months I might be able to start some exercise again after that.
They also gave me the OK to go home. This meant I could come off the ECG and have a shower – bliss! I wasn’t allowed to close the door though just in case. It also meant that Anna could come to get me and that I got moved to the discharge lounge. ‘Lounge’ maybe a little grand as really it was just a room with some chairs in it that felt more like a bus station. They did give me some lunch at least.
Anna drove all the way to Carmarthen to get me. Once she found me and we headed home. Anna was of course driving as I wasn’t allowed to. The journey home was more uncomfortable than I had anticipated so I was feeling pretty rough by the time we got there. We were both a litttle anxious too as the life-saving Cath lab in Morriston was once again a very long way away.
Back to Bronglais
The trip home and an uncomfortable night meant that the chest pain had been getting worse again since leaving hospital. The GTN spray and painkillers did nothing to it so we phoned the GP just to check that this was expected. She wasn’t happy and told me to go to A&E at Bronglais. This time I took a bag with some clothes, my phone and a charger just in case.
They did some tests and an ECG, took bloods and decided to keep me in. To be fair, I was kind of glad with this decision as an extra night of monitoring to make sure all was OK was fine by me. I think it helped put Anna’s mind at ease as well.
The ECG wasn’t quite right and my levels of troponin were still increasing. Being Aberystwyth some of the nurses knew me and Gethin came to say hello as well. The male nurse here was really good and seemed to be in the perfect job. He didn’t have huge amounts to do for me but I could hear him dealing with other people and going ‘above and beyond’ the whole time. There were a couple of students who did visit me quite a bit as well. I think someone had decided that I was a good case for them to practise on. This also meant that I was used for the practice of cannulation too – she did fine even if she was a little nervous.
Rather than take me to a ward they left me on monitors in a resus room in A&E. There was then a fairly major trauma call for someone who had cut through an 11,000 volt electrical cable with a chainsaw and was in a pretty bad way. I was in the very next cubicle as shouting, screaming, panicking and general A&E mayhem went on next door. I don’t usually get stressed by such things but as it continued I could feel my chest pains getting worse. Needless to say I didn’t get any sleep. They did move me a little further away once he had been taken for a CT scan and things calmed down a little.
The following morning my ECGs were looking the same and my Troponin levels were still rising. The consultants decided that I could go home though and that the pain and test results were due to pericarditis which is somewhat expected after a major, prolonged heart attack.
This consultant wasn’t so optimistic about the long term recovery though, once again highlighting the need for me to reset my expectations and find new things to do other than training, racing and watersports. I don’t think I’m ready for golf yet, let alone tiddlywinks and Sudoku.
I headed home once again. The next step was cardiac rehabilitation.
It’s still early days so no one knows how much permanent damage has been done. The echo cardiogram shows that my heart is enlarged and swollen, especially the right atrium. How much of this is ‘normal’ cardiac hypertrophy from years of exercising is unknown. How much of it is simple swelling from the trauma of a heart attack that should reduce as it heals is also unknown. Some of it is likely to be permanent damage and until the extent of this is known it’s hard to say how I’ll recover.
I will have another echo cardiogram in 3 months followed by a third in 12 months which should allow them to determine this. Hopefully if there is sufficient recovery of the damaged tissue then I might be able to start some exercise. Until then I’ve been told to do nothing more strenuous than some gentle walking and to get plenty of rest and relaxation.
The main hurdle will be coming to terms with what has happened and feeling confident to return to something of a normal life.
The fact that there is little I can do to improve the usual risk factors doesn’t help. In some ways telling people I’ve had a heart attack feels like admitting a weakness. There is usually some blame attributed to a heart attack due to lifestyle choices. That’s not the case for me and I feel the need to tell people this.
I used to like the fact that people who knew me knew me as ‘Al, the fittest person they know’ or as some neighbours said yesterday ‘the fittest man in the world!’ That’s not nearly the case now and I don’t want to be known as ‘Al who had the heart attack’.
On the positive side, the fact that it was a fit, healthy heart in the first place means I was at least able to survive a major heart attack such as this, so I’m still here. I couldn’t have asked for better support from family and friends. Anna in particular was, and continues to be the greatest – I only pick the best!! And, I managed to walk a whole mile yesterday with relative ease. My chest does still hurt but the aim today is 1.5 miles with a climb up and over the dunes.
I don’t think I’ll be confident out doing my usual things for a while, especially on my own. You never know though, maybe it’s time for a swanky double surf ski so that Anna can come paddling with me. Hopefully not just a fun recreational one either, I’m thinking top of the range carbon racing weapon for two!! As far as the Quadrathlon on Sunday morning goes, I don’t think it had anything to do with that. It wasn’t anything out of the ordinary for me, but I’m not sure if I’ll ever be doing that again. We can only wait and see.