Part II: My Advice for All You Healthy People
by Dave Atwood

Dave Atwood's wood truck.

As you may recall, last year I wrote an article about receiving a heart catheterization and a couple of coronary stents due to a cardiac "event." The event took place while I was running in October 2004, and the stent placement was completed in November 2004. Several people have since asked me to write an additional article in the hopes that what I have learned will help someone else. So this article is for all the "healthy" people out there who exercise regularly, eat right, and try to keep their daily stresses to a minimum -- but who could still find themselves in a similar situation.

Although I did not have a heart attack, the heart event was very close. According to Dr. Joshua Cutler of the Maine Medical Center, as my heart rate approached 95% of maximum capacity, the soft blockages of plaque in one of my arteries were forced forward with the blood flow until the artery was constricted. This resulted in so much discomfort for me at the time that I slowed down to finish my run. Despite that painful experience, I continued to exercise right up until I had a treadmill stress test, which showed anomalies. Specifically, the test showed there was a small release of enzymes, which indicated a heart event had occurred. But there was no damage to my heart muscle detected during the inspection of the coronary arteries. Treatment was given as if a heart attack had taken place. But the great news was there was no rupture where the blockages had occurred!

Looking Back and Learning

After the "event" I learned there were a lot of signs beforehand that I didn't recognize. The shock of reading about my friend Bill Pinkham, a life-long runner who died in 2005, at the finish of the Bangor 4th of July road race, really got me thinking. Did he know something was wrong? Perhaps the signs were there for him, but like me, he may not have read them. Several people who ran with Bill saw signs of something, but said nothing, perhaps thinking he had things under control. Some of us who exercise know someone who has died suddenly while exercising but thought they looked healthy beforehand. Do you know someone who's complained of feeling not quite right and can't figure out why?

Here are some things I urge you to consider if you are wondering about your own heart health:

• Are you tired a lot?
• Are you out of breath climbing stairs or using muscles other than your biking or running muscles? Looking back, I can offer the following as an example of a sign I missed. It might have taken 50 miles of riding to make me feel tired. But I'd get out of breath going up a flight of stairs, and sometimes felt a little light-headed.
• Does exercise seem like a lot more work than it used to? Before heading out to exercise, do you have a feeling of general malaise?
• Do your rides or runs consistently take longer to complete, or are your distances decreasing for the same perceived effort?
• Are you avoiding the doctor's office for any number of reasons, but mostly because of what you don't want to know?

Should you decide to visit your doctor's office, here are a few things-in my opinion-that you need to mention and make your doctor understand. First, you will need to tell your doctor what you do for exercise and how much. Whether you bike 25 or 200 miles a week, it's important for your doctor to know as much as possible about what you do for exercise. If you have such specifics, indicate how long you work out and what your heart rate is when you do. These can be important pieces of information. Don't discount what you do! Many of us treat our exercise as something everyone does because we hang out with people who do what we do. But everyone doesn't do the same things.

Before you have a cardiac stress test, find someone who understands exercise physiology. I believe it makes a huge difference in whether a problem is found or not and in how your treatment goes. I've learned that I have a condition known as "athlete's heart" or "exercise-induced enlarged heart." Exercising hard for over 20 years has enlarged the left ventricle's wall and also made my heart walls thicker, like a weight lifter's biceps. I'm told by medical professionals that this is a normal result of exercise over time and is simply an indicator of good fitness. This does not mean to say that if you started exercising a month ago and have an enlarged heart that it's necessarily a good thing. The point here is to tell your doctor what you do for exercise, and be honest so the best evaluation possible can be made.

You'll also want to talk about your medications. While I'm not a medical professional, I have learned a bit about medicines and their effects on the body. Some medicines, for example, appear to work differently depending on what you are doing, what temperature it is, or how hard you might be working out. I've asked many doctors about doing long-distance exercise while taking medicines commonly used to treat heart patients, including asking about the effect of the body's endorphins on such medications. I've been told that there are no studies on such matters. So, if you see a doctor, see one who understands your individual situation and medications, and who can work out an effective exercise program that is beneficial mentally and physically.

Biking Brings the Good Times Back

Finally, I've also been told many times that ceasing my exercise is not an option! It's important for individuals to maintain a healthy lifestyle physically for many reasons, not the least of which is so that your mental balance is maintained. If a problem does crop up and you have to have major treatment, it's a major downer. So you'll want to get back on your bike when you're able. Remember that it will take some time to make a personal comeback, but it can happen. On August 23rd this year I rode my first century in two years, and, two days later I climbed Mt. Katahdin. Twenty months after everything came down around my ears, I'm on my way back toward living a normal life, and biking is a major part of the recovery.

All of us who belong to the BCM know that by making cycling part of our lifestyle, we can be healthier. Sometimes our best efforts aren't enough to overcome genetics or some other risk factors. But you can pay attention to how you feel. When you think something's not right with your body, take care of yourself -- find someone who can help you get checked over.

Thanks to everyone who has given me good wishes over the past 20 months. It has been a struggle to "get back on the horse." But the support and caring is very much appreciated. Ride hard and often! Good health!

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