Keeping Pace
or how I came to be a cyborg cyclist
For those not familiar Star Trek: the Next Generation featured an alien race called the Borg. They were a sort of humanoid-machine mash-up - a future Frankenstein. I’m not as advanced as Locutis here but as of last April I do feature some titanium encased hardware on board. Specifically the MRI SureScan™ Pacemaker by Medtronic.
How did this happen? Even after many months of doctor visits and tests I am still not too sure. Likely it is an inherited condition as I learned last winter that I am the fourth generation in my family to be fitted with such a device. It’s kind of amazing this technology exists much less that it was used to treat my great grandmother! One takeaway for me through all this was to reach out to my cousins and let them know about my situation. Some of them, like me, had no memory or knowledge of this family history. It helps your doctor if you can share family medical history so talk to each other people!
For years now my health has been good - the only medication prescribed targeted some moderate blood pressure problems - another family legacy. These meds have in the past made me dizzy and that is the symptom I noticed first on a solo mountain bike ride last August. It was my first time riding Kinnickinnic State Park near River Falls Wisconsin - a lovely park dipping in and out of a river valley. On the back end of the course working my way up a long slope I got light headed enough to step off the bike. The sensation passed and I chalked it up to afternoon heat - but I did note it and remember thinking how bad it could be if you lost consciousness while riding.
About three weeks later it happened again. This time a group ride just a few miles out of town. Again it was later in the day and warm for September. A couple of friends noticed me stopping in the middle of a gravel road and doubled back to check. When I told them I was feeling light headed they insisted I call for a ride home and all waited till my partner arrived with transport. I’d been doing some heavier work out in the yard that day and convinced myself I was spent and maybe dehydrated from the earlier efforts.
Days later I was at the start line for one of the moderate distances on offer at the Winston County Gravel Cup. This course was new to me but highly recommended by friends who tried it the previous year. The weather looked sketchy but still dry at the start and I rolled out of town in a group of a hundred or so along a paved road for a neutral start. The pace car pulled off when we reached the gravel and we started up out of the valley on a long easy grade. I was chatting with another Northfield rider near the back of this group when I felt that fuzziness again.
Over the course of the last months my wife and I came up with a euphemism for crashing bikes - the unexpected dismount. Sounds like a gymnastic move right? This time I stopped the bike okay but did not successfully dismount. I went face down in gravel and was out for a few minutes - maybe less. My Northfield friend was up the road not yet noticing my disappearance. Lucky for me another rider stopped - a health care worker as it happened. He had someone call 911 and got me settled, elevated my legs. I came around spitting gravel and embarrassed but otherwise unhurt. I soon felt good enough to stand and now was wondering if we could cancel the ambulance. Honestly I felt good enough to ride but here was the ambulance wanting to do my vitals and transport me to a clinic in La Crosse - the wrong way for me! I accepted the first but not the second. My heart rate, temperature and blood pressure were normal. No other signs of distress so I waved them off - promising to check with my regular doctor as soon as possible. I accepted a lift back to the start line from one of the organizers. He was concerned about me but also about the other riders on course as the weather was turning very dark and threatening just then. By the time we got back to town heavy rain started and I decided to sit tight for awhile before trying to drive home. A silver lining to the incident might be that I was the only dry cyclist in Houston Minnesota that morning. After hanging out an hour or so with no symptoms I drove home. Spending four hours in the car (two each way) for a five mile bike ride was not how I expected that day would go.
I was able to get into see my doctor the next week and I went in expecting to talk about blood pressure medicines. For those not afflicted there are many treatment options out there for high blood pressure and they all seem to have side effects - for me the dizziness had been a topic of discussion with my doc before. I’d even cut the dosage to mitigate occasional dizzy spells. But those spells only ever happened to me when standing up quickly from a chair - never before on the bike.
To my surprise - and my doctor’s credit - he ordered a series of heart tests. He also referred me to a cardiologist. Here begins the waiting for some kind of diagnosis. My first possible meeting with the cardiologist was right before Christmas - remember we are in early October at this point! My doctor told me I could still ride but to take it easy until we figured things out. I bought a heart rate monitor that connected easily with my bike computer and proceeded to nerd out on this new stream of data. Plus there were a ton of standard tests needed to evaluate heart condition and my regular doctor was able to queue most of these:
Baseline blood work up - 10/3/23 - similar to what happens in any thorough general physical. My numbers here were all good.
Stress Echo - 10/10/23 - walk/run on a treadmill till you hit a targeted HR then quickly lie down while a technician looks for problems with ventricular size and function using an ultrasonic device. I aced this.
Holter Monitor - 10/17/23 - here they shave your chest - the first of several in my future as it turned out - then a sticky patch about the size of a playing card is attached for two days. You mail it in and wait for diagnosis. Even though I did some riding during this time I think the results here were not conclusive.
Echocardiogram 11/17/23 - a longer study similar to the stress echo but no treadmill (yay!)
14 day Zio Patch - 12/20/23 - another shave - this time self-administered at least. The test is very similar to the Holter monitor described above - this has a longer recording span and led ultimately to a diagnosis - but wait!
CT Coronary Angiography - 1/11/24 - a CT scan for the heart. You lay on a table and a giant imaging camera whirls and hums while a robot voice tells you to breath or not breath. Very Borg like despite the bright windows and cheerful technician.
The really hard part for me was not the testing - most of my results were favorable and the medical team sometimes complemented me on the results. And at least we were doing something. Personally I get a lot of satisfaction making lists and checking things off but in this example we seemed to be running in place. After all the waiting my initial meeting with the cardiologist was disappointing as well - in a twenty minute meeting we reviewed what tests had been recorded so far and I was quickly referred to another doctor. None of the physical functions of my heart seemed to be affected so I was to consult next with an electrophysiologist. But that official diagnosis would have to wait another eleven weeks! That is the queue time for specialists around here these days I guess.
During this long wait time I tried my best to stay positive - after all my restrictions were minimal. Since the symptoms only ever appeared during vigorous (uphill) cycling avoiding additional problems seemed simple enough. Don’t do that thing that makes you get dizzy and pass out (duh).
For a lifelong cyclist it is not so simple. My fitness went backwards yes, but in wintertime that is not unusual. Rides are shorter and indoor time and holiday eating makes the fitness equation problematic in any winter season. More than pure physical fitness my mental and social life also took a hit. That is why I was so happy to be invited on a winter getaway to Cuyuna for a biking weekend with friends.
I’d been doing my best since October to ride just hard enough to keep up with friends and not take chances that would cause me or others any hardship or concern. Since I ate gravel that day in September I’d experienced symptoms three more times. Dizzy enough to stop and but not tipping over or passing out. I decided early on to share my situation with my riding partners just so they would know what was going on - and know to give me some room on the group rides. Turns out a couple of them had battled similar issues in the past - it’s comforting to have support like this and I definitely leaned into it this winter.
That weekend was a balm in many ways. We were missing snow here in Northfield most all winter but a few hours north there was just enough to play in and have fun. I was the oldest and least fit person in the group but on the MTB trails it is less consequential. Rides naturally break apart and come back together. In the end I got a ton of trail riding and the food and friendship and campfire made it that much sweeter. We did stay indoors in some pretty deluxe trailside cabins. It was January after all!
Coming out of this weekend I still had six weeks before my next cardiology appointment and using my heart rate monitor I was pretty successful in avoiding more issues. I had one close call on Hopper Hill but I’d learned more or less where my (new) top end was and did my best to stay below that. I was alternately impatient and grateful. Impatient over the many months of waiting but grateful to be in good health and otherwise fully functional. It seems you alway know about some friends or family with bigger health burdens and this story is no exception - there are several regulars in our cycling group dealing with worse - so I am grateful too!
I’m sorry you need a pacemaker.
When I finally got to see the electrophysiologist this is what was said to me. I wasn’t feeling sorry even a little - I was happy there was finally a diagnosis and a proven therapy to address it. Going for this strategy right away was not necessary according to the doctor. I answered that my physical, social, and mental health were telling me otherwise. This physician had treated cyclists before and he seemed to understand what I was talking about. In fact he said cyclists were often the first to notice anomalies like this given the routine ways we tap into and rely on good cardio function.
The problem as he described it involves what is called an AV Block. There are three electrical pathways in the heart where your brain can regulate the heartbeat - lifting your pulse as needed and then moderating when its not needed. For me two of these pathways had ceased to function properly. The third one was adequate for daily life (so far) but not up to the task of riding bikes in higher stress conditions. The pacemaker would provide two leads that replace the missing pathways and most importantly remove the danger of dizziness or passing out. Probably a pacemaker would be a necessary intervention for me in the future anyway so doing this now was the obvious answer.
The last stretch from the long awaited diagnosis to the surgery itself was easy. I had to wait a couple more weeks before heading into Edina to a surgical center near the Centennial Lakes area. I was not surprised I had to submit to another chest shave. Next I was sedated but aware somewhat during the surgery. I remember not being enthused about the soundtrack playing during the procedure - ‘Living on a Prayer’ - really? Not what I would play for somebody under the knife. Post op was smooth and I was released in time for us to visit a favorite lunch spot nearby. I doubt my great grandmother’s procedure involved a nice post surgery Italian lunch!
A week of taking it easy followed - letting the stitches heal. The only incision is maybe an inch long sitting just below the collarbone. I have a noticeable bump there now but as I said before not really fully alien monster material yet. The feelings on the bike are great and I am super grateful to be in this place after a time of uncertainty.
A couple weeks post surgery my first real test was a long weekend of mountain bike riding in Bentonville AK.
Ken & Steve were the perfect partners for this outing - we are at a similar level (age and skill-wise) so nothing too crazy happened and we got a good dose of riding in some spectacular spring weather. I did shred a sidewall on the first day riding the sharper rocks found in the Ozarks - picture above shows the new Maxxis Rekon tires I was happy to find at Phat Tire Bike Shop in Bentonville. They did the install while we had lunch - awesome service!
PSA - make sure your tires are new and ready for some sharp stuff if you head to Arkansas.
I’m so grateful to all my cycling friends who helped me through this time - you know who you are. Grateful too for doctors and modern medicine where you can get fixed up and back on your way with little or no down time. Last and most important thanks to my wife for putting up with me during this long and weird process - its so helpful to have an understanding and supportive spouse to help ground me during the dark months.
Be happy for your good health and watch out for those unexpected dismounts.
Thrilled you finally got your robo-heart and proud of you for sticking through all the chest shavings.