Wednesday, August 12, 2015
When Biking Alone Does not Work: Tinkering with the Ticker
"As they pull you out of the oxygen tent you ask for the latest party..."--Bowie, Diamond Dogs
As I lay there I was reading an article in the latest issue of Bicycle Times. "From Couch Potater to 50 Stater" or something like that. Some American decided to get off his overweight ass and ride a bicycle to save his life. Lost a ton of weight, bought a better bike and has ridden in every State of these here United States of America. Reminded of a book entitled Hurt City by Bob Voiland, another fat guy who purchased a bike and saved his life. The BT article had a sidebar listing the accomplishments of Murray Fishnell, former couch potater. In that list was surviving a heart attack because bicycling had him physically fit. I stopped reading and laughed. Thought to myself, "damn, for all intents and purposes I can now say the same thing." I was in the ER hooked up to an automated blood pressure machine and an IV. My heart attack never came.
Back in March and April I was strong. In March I narrowly missed having a 1000 mile month by 250 miles. Two good weekends and I could have added the 4th digit. Joe Hildreth egged me on, "You gonna ride 1000 in April?" Challenge excepted and met. Record mileage year in the making but something was going wrong.
Allergy season was hitting early. Timmy came down with bronchitis and pneumonia. And then I got ill. Felt like I was breathing sand, Climbing hills or any sudden demand for extra air hurt. All the possibilities were going through my head. Exercise induced asthma or bronchitis were among the top. My mileage began to dip. Due to vacation request mix up at work our South Dakota tour was nixed. Just as well. By early June I was hacking up phlegm. Time to visit the doctor.
Sure enough, I had bronchitis. X-ray revealed that my lungs were good. No pneumonia. But to my great surprise my blood pressure was high, very high. Every time they came back to the room it was higher. This is why I need an anti-anxiety drug before every visit to the doctor. For a while I thought they would not let me leave but eventually they did with prescriptions for antibiotics, steroids for my breathing tubes and a beta blocker for the blood pressure.
"These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force."--Mayo Clinic Staff
People complain that they make them tired. "Go visit your regular doctor" he told me.
Easier said than done. My regular doctor was booked until after Ragbrai. Another doctor that I used to see retired. I waited and waited and made an appointment with another doctor in the same building. I wanted to get the residual issues of the bronchitis cleared up before the big ride and I was running out of the beta blocker.
Of course I rode my bicycle there. My Trek 2200 carbon roadie. Needed a fast bike and one that could climb hills since I was still feeling weak. I took the "quiet street' of SW 14th but missed the first turn and had to climb up Park Ave in effort to find the quiet street again. The sign informing riders of the left turn was blue and obstructed by trees. Green was the color of sign I was searching for. This was apparent on my return.
When the nurse took my BP he was amazed. "This is higher than the BP of a man who was having a heart attack when I checked him. I laughed. It was something like 204 over 130. "I am taking medication for this," I retorted once my laughter subsided. Further checks were lower but not by much. Honestly, performance anxiety. The doctor brought in a EKG machine for a look at the heart's output.
"Do you have a headache?" No
"Do you or have you felt dizzy or confused?" No
"Do you have chest pains?" No
"ect, ect, ect" No No NO
"I ride 30 miles everyday Monday through Friday and haul home the lion share of groceries. I feel fine. The only reason I am here is because my bronchial tubes feel like sand is being forced into them whenever I climb a hill. I need to determine if I still have bronchitis and get that treated an now obviously get a better blood pressure pill."
"Well you do have sinus drainage going down your throat right now but who does not in Iowa? Your lungs sound good. You do not need further treatment in that area."
She seemed very concerned when looking at the EKG results and showed me.
"Do you have someone that can take you to the ER?"
'No. I will ride my bike there. it is all downhill from here and I need to stop at home and tak care of something since I am free from work at the moment."
Another concerned look.
"No I feel fine."
She then left the room. Mercy South has notoriously thin walls. On previous visits I have heard kids scream and cry. This time I heard the doctor talking to someone else. Getting a consult. Something about "he is insisting" and "it will not be your fault." Finally she returned and told me that Mercy ER will be expecting me. In retrospect this is what really pissed me off.
They did three things in the ER that could have been done by her and saved me and my medical insurance company money (not Barrycare). First an x-ray of my heart. Second, an IV with a few test tubes of blood drawn first then the "calm the F down" drug that lowers blood pressure quickly. Third, a call to Iowa heart to set me up with an appointment there.
So I ride home and take care of what I needed to do there and then rode uphill to Mercy proper and check myself in. Shirt off gown on, lay on bed and wait forever while connected to an automatic electric BP checker. Finally a nurse comes in and sticks the IV needle and tubage in my right arm. I think that is when she took blood for analysis. Wait and wait.
Two people walk in with a portable x-ray machine and take a photo of my heart. Because I had the green "isolation" wrist band on, do to a staph infection I had in 2010, they ran out of the room and put their biohazard gear on. I guess x-rays cause the penicillin resistant germ to escape me and attack them 5 years almost to the day it was removed in surgery. The doctor said that I can still donate blood, however.
One Dr. Poole comes in and he is the first doctor I've seen lately that is calm about this matter. "I'm going to lower your BP." Another lengthy period of time passes before the nurse returns with the drugs. "Not all at once, don't want to stop your heart." Two doses and further checking before they let me go. They did allow me to get up and use the restroom without assistance. But they never allowed me to get a glass of water. This may have been before the drug was loaded into my IV.
Finally they are satisfied that my BP is good and they let me go. Dr Poole doubled the dosage of the beta blocker and told me that I should be getting a call within 72 hours from Iowa Heart Center. He also said that the blood work revealed no damage or kidney problems. A hearty handshake and I wander around the ER trying to figure my way out. Nobody seemed concerned.
I drove to Iowa Heart because I had to go to work afterwards. Met with the good doctor who prescribed another drug, an ACE inhibitor. This drug acts against the hormone that increases BP.
"Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system by narrowing your blood vessels and releasing hormones that can raise your blood pressure. This narrowing can cause high blood pressure and force your heart to work harder."--Mayo Clinic Staff
I was also told to start the Dash Diet--low sodium. low fat, more potassium and calcium. More fiber. Please burn my taste buds off now. I told him that I have eaten more veggies and fiber in the past two years than in my entire life. I also told him I bike 30 miles a day. Did not mention that I was leaving for Ragbrai in 3 days. "Good, you must have great tolerance." Then the bad news. I have an enlarged heart. First thing to do is get the BP down. Gave me a return visit date and I was gone.
Ragbrai was hot as hell. Of course I turned down an offer to ride with the Road Pirates on their bus. I could have taken a light road bike. Of course I turned down Rocky's offer to take turns driving a Ford Excursion and riding a road bike. Instead I loaded our touring tandem up and went self contained. Of course I saved money and instead of a set of Connies that could hold 100 psi I settled for a set of Kenda Kwest tires that max air was a mere 65 psi. Comfy, yes, fast, no. Focus on staying hydrated and take breaks as needed. Our bike tipped the scales at 480 lb with both of us on it. I lived. No heart attack. Most likely did not do myself any favors except for losing a shitload of sodium through sweating. I'm glad we cut it short and returned on the fifth day. Sleeping on a Thermorest gets to wear one down. A few days in a/c without sweating was paradise.
Time to get serious. I hit every Hy Vee on the way home from work to use their BP checker. Carefully record it for the nurse practitioner who is scheduled to meet with me. When I do she sees that the BP is still a jet too high. Tells me to continue laying off the sodium and sends me to the lab for more blood work. Funny thing is that I ate a ham sandwich with two thick slices of ham that morning before the blood work. Did not occur to me that ham is among the highest sodium laced meats. Suddenly I am reading labels like a paranoid person. Not that I did not do this before. I made an effort to avoid the Big S. Stopped eating bacon and sausage and other salt laden items.
They called two days later. Kidneys good. Thyroid good. Potassium good. Sodium low. "Cut back on beverages so you do not suffer the consequences of low sodium." Why not add bacon? No mention of fats and cholesterol ever since the beginning of this other than low fat foods only. "Take a second dose of the ACE inhibitor. We're not going to increase the beta blocker because you are tired enough."
I laughed after the phone call. Then I got mad. They have no fucking clue what is wrong with me. They need to understand that exercise during summer significantly lowers sodium levels. It's called sweat. I told them that I rarely drive and how much I ride. I told them I rode 10,000 miles last year.
"Now that I realize how it's all gone wrong, gotta find some therapy, this treatment takes too long."--Joy Division, 24 Hours
I did that immediately, take the second hit of the ACE inhibitor. I felt stoned after work Friday but my BP was 3 points within normal. AMEN. At the end of the month I have another round of testing. Echocardiogram to look at the heart. A stress test and a sleep study. Yeah, I may have sleep apnea and they may recommend me sleeping with one of those Darth Vader machines. I will refuse. My family has said that my snoring has dropped dramatically since I have been taking pills. The people I did Ragbrai with said that my snoring was much better and that Mary was louder than me!
So here I am. Still riding the bike to work. Today on my day off I rode 77 miles. My legs are a bit sore which is a good feeling. Was I the fastest? No. Was I a dog on hills? No. Did I have a heart attack? No but I took it easy when I felt tired. Kinda funny but I felt the worst during the downhill from Baxter to Ira. Felt great on the climb out of the Skunk River Valley to the trailhead (Chichaqua Trail). Then again I was on a light weight roadie. My weight will start dropping. I've lost a few pounds already. If I have reduced horsepower then a lighter body I need. Terrible motivation.
"Crawling down the alley on your hands and knees. I'm sure you're not protected as it's plain to see. The Diamond Dogs are poachers and hide behind trees. Kill you to the ground they will. Manniquins with kill appeal"--Bowie, Diamond Dogs