Things Change and thus Plans Change - Part 7 of Series on Journey to see what is up with my Heart/Health

I had not planned to do a next part in this series so soon since had not had any issues and the plan from my Cardiologist was to just keep an eye on things.  As with most things plans change when the situation changes and one has to just go with it.  You don’t gain anything by dwelling on the “might have beens” or the “what abouts” so just need to deal with “what is.”

 
So, what did change: well since my issues on a 100 mile ride then a rowing workout about 13 weeks ago where I had an accelerated HR a number of times with the rowing workout being the highest at 206 I had not had any issues to speak of.  I had my CTA scan done (see part 6 ) on August 10th that set out what was the current plan of doing what I usually do and keep an eye on things.  Due to this I was planning a long outdoor ride September 12th with my last long outdoor ride the first weekend in October and was working my miles up some to get ready.  Then came this past weekend and my first recorded AFIB event.
 
I had gone down to Gatlinburg on Thursday, a week ago, as was meeting up with someone on Friday and just figured take a walk around Gatlinburg and have dinner.  This will play in soon but I was a little tired and going up three flights of stairs to a restaurant I felt a little out of breath.  So that is what we did then when got back to the hotel I did my usual check of my heart with my Kardia 6L  and for the first time got a reading of AFIB.  As usual when I get what seems an abnormal reading, for me, I took another one and it too said AFIB.  I just relaxed and right before bed took another reading and again AFIB as did my retake of it.  I really did not feel any flutter or heart racing but was tired and thinking back the stairs earlier makes more sense.  Unfortunately, I did not bring my Frontier HRM so could not use it to get a continuous reading.  The next morning I again had an AFIB reading and again did a few other scans before we left the hotel and they all showed AFIB.  During the day I did not feel much as far as heart rate but going up stairs was more tiring than it should have been.  When I got home in the late afternoon I checked again and still showed AFIB and did so till around 9:30PM.  I was able to get some readings on my Frontier as put it on when I got home and it showed the same till about 10:30PM when I got my first regular reading and the end of the AFIB.  Since then have not had another AFIB reading.
 
I sent all the data I had from the scans to my Cardiologist but as it was a weekend and I did not feel it was an emergency had to wait till at least Monday to hear back.  When they did get to me on early Tuesday the answer – sort of what I was expecting – was to start on Eliquis, more on this in a moment, and to be scheduled to use a 3 day halter to record what is going on, well for at least those three days.  As far the Eliquis, which is a blood thinner/anti-coagulant, it is to help stop the chance of a stroke/heart attack.  The issue with AFIB is that due to the irregular heart beat the chamber does not empty and then the blood can pool and if it creates a clot – what drugs like Eliquis are intended to stop – and that clot then later gets ejected it can then create a stroke.  The issue however is that drugs like Eliquis create a greater risk of excessive bleeding in the case of a fall or other event that causes bleeding internal or external.  I am not excited about taking them right now but will for a bit but do not see that being on it for along time is realistic, let alone its cost as it is expensive.  There is one other issue, I am sure there are more, but if you need say a dental procedure or medical procedure with Eliquis you have to stop Eliquis 24-72 hours before depending on the bleeding risk for procedure then can’t start up again for 1-3 days.  So, you can’t just go in for a procedure. One thing I did find, as it is relatively new for Eliquis, is there is an antidote for reversing bleeding caused by Eliquis called Andexxa.  I did listen to a presentation on a new drug that is such that it deals with the kind of clot you get in the heart but does not stop, well at least allows some, clotting in the case of injury.  It is called Factor XI and is in Stage 3 trials so is 1-3 years away from regular use.  The other option out there but not a lot of trials on it is to use is a natural blood viscosity regulator like Nattokinase, which I already was taking, at a therapeutic level (10,800FU), don’t use now as would not be good.  But for now that is hard to get a doctor to prescribe as less data on it.  For me I have heard that if you get an ablation and it clears up your AFIB you can go off the thinners but we shall see.
 
With all this going on and being on the anti-coagulant I have canceled out on a plan to ride a 77 miler in early September and a 109 miler in early October as riding is just not safe.  While I do not fall very often – actually the last time I fell was in a parking lot talking to someone and my cleat not disengaging – any fall can be dangerous especially if you get unseen internal injuries as the clotting effect that should happen does not.  Actually, when I got the Eliquis I was told that if I hit my head they have to do a scan and then do one every few days after to make sure there is no bleeding.  Sorta, bummed and was on a site where I saw the question come up on riding outside while on thinners/anti-coagulants and some said they would not give up riding.  I do not think that seems wise since while I enjoy riding outside with others and alone it is not worth my life and since I can still run and row I have outlets for my competitive side.  Let alone I can still ride and race on Zwift – so for now will stick to that while I work through the rest.
 
As I write this I am into the last of the 3 days with my Zio  Monitor and while I have felt a off a few times my Kardia did not show anything but we shall see.  I did do a 30 minute row to get in something with an elevated HR and did a Zwift ride with a hard effort.  Once done I send the monitor back and they send the results to the doctor and then we move on from there.  Sort of a Catch 22 as while I really do not want an AFIB episode having one while on the monitor gives useful information.  One of the treatments for AFIB is an ablation – the one I think that seems the best is a Pulse Phase Ablation – but I guessing they need to be able to know where to ablate and thus need AFIB to take place somehow.
 
That is where I am now and hope I will get info back from the cardiologist after Labor Day - maybe sooner – but we shall see.  As I have said before I know that in this God is working on me, especially in the area of patience.  One key to patience is a well-grounded trust in God in the midst of the good times and “what we may see” as bad.  Earlier, in Part 2, I mentioned Romans 8:28 which says God uses “ALL” things for our good as believers and his Glory.   That verse really helps me to truly see God as my strength and refuge in times of turmoil where things do not go as I planned – but as God desires and will use as we see in Psalm 46:1.
 

“God is our refuge and strength, A very present help in trouble.”

 
Being a Christian is not meant to be simply a moniker one claims but is to be integral to life and that means relying on His Word to guide and give hope.  While I know I may fail to do as I need to do I also know the road God has me on is not promised to be smooth but is to be one He is with me on.  I always think about John Bunyan’s Pilgrims Progress where he talks about how Pilgrim more than once is faced with what looks like an easier path but when taken leads away from the desired destination.  Thus it is with life, we are often sold that life should be smooth and easy but that is a trap.  This does not mean if things are going well we are to worry but that we are to be content no matter as long as our focus is on moving forward to be all God desires us to be and in the process glorify Him.
 
More to come as God works in and through me!
 
By the way I hope all this is helpful not only if you are in a similar situation but also to help you see that no matter our situation in God there is hope no matter the situation.

Posts in Series

• Part 1 – Plans Change: Be Ready for Them  
• Part 1B – What I Meant to Add to Part 1  
• Part 2 – All Means All  
• Part 3 – Sleep, Helmets and Anxiety
• Part 4 - Learning Patience
• Part 5 - No Excuse to Not Exercise
• Part 6 - The All Clear and Needing to Trust God
• Part 7 - Things Change and Thus Plans Change

  Click on images for more information and if you want more info on OFM check out this post: 

• What is OFM (Optimized Fat Metabolism)

To order Vespa you can go here and use coupon code - tkonvalin15 -   for 15% off.

The All Clear and Needing to Trust God – Part 6 of Series on Journey to see what is up with my Heart/Health

After no heart issues in the last 8 weeks it was time for my CT-Angiogram (Heart Scan with Contrast) as my cardiologist wanted to rule out blockages or other issues in the heart itself.  With my Cholesterol being high by the standards most follow – even with great HDL and low Triglycerides and very low LPa – and a CAC score of 103 he wanted to rule out issues usually attributed to those things.  In truth in looking at the CTA and what it can find I would say they should just skip a CAC if they are concerned – more on that when I talk about the results – but it is usually the case that to get a CTA covered by insurance you need a CAC over 100, high cholesterol and other factors – I guess thankfully I have those as it was covered.  I did listen to a doctor talk about why Insurance does not like to pay for the CTA initially is that 40-60% of first heart attacks are fatal, I did look up some info and saw 30-50% but close, thus while a CTA might help if they do not do it they save as often it is after a heart attack when a CTA is approved.  Bottom line if you are having issues a CAC test may be good but try and advocate for a CTA if you are concerned.  The other reason I would push for a CTA is my CAC score during the CTA was 10 – a 90% decrease – and not sure if it is because a different and more precise machine, actual drop or some other reason.  My initial guess is the CTA was more accurate.  The issue is if you get a CAC above 100 most doctors go into the “standard of care’ process and Statins are prescribed among possible other medications.  Again, this was just for info so you can ask the right questions.

 

A little info on a CTA as I had a scan with contrast for another issue a year or so ago and had no issue.  For this one they warned me that there would be a bad taste in my mouth, might get a little headache and that I may feel like I wet myself.  Did not have this when I did one before but sure did this time.  Thankfully the test is quick as the bad taste made me a little nauseous and did get a little headache.  As for the feeling of wetting myself  - well that warm feeling sure did happen – thankfully they warned me.  One thing the technicians were commenting on was that most people they deal with need medication to slow the heart down as it needs to be, I think I was told, under 60bpm.  With my resting HR at low 40’s my cardiologist said I would not need them.  Well, on the table during the test my HR was 43 and that helps with better pictures since the heart is not moving as much so the technician was happy and I was happy as did not need medication.

 

Here is the info from my CTA:

Coronary artery calcification findings:

·      The total calcium score is 10 indicating mild (CAC 1-100) calcified plaque in the coronary tree.

       o   Left main 0

       o   LAD 10  (Was 70 on first CAC)

       o   LCx 0  (Was 30 on first CAC)

       o   RCA 0 

 

Grading Scale for Plaque Burden: Angiographic Findings: 

·      The coronary anatomy is left dominant.

       o   An interesting one as puts me in the minority at like 8%

       o   Also, can have implications with surgery as there is a higher have a higher risk of perioperative myocardial infarction during cardiac surgery

       o   So good to know this 

·      Left Main: No significant disease gives rise to LAD and circumflex

·      LAD: Mild nonobstructive extraluminal plaque gives rise to 1 bifurcating diagonal 

·      LCX: Mild luminal irregularities dominant vessel posterior circulation gives rise to 4 obtuse marginal branches and PDA

·      RCA: Small nondominant vessel posterior circulation with mid free wall bifurcation bifurcation 

 

Noncoronary Cardiac Findings:

·      Cardiac valves: Aortic valve is trileaflet. There is no thickening or calcification in the aortic and mitral valves.

·      Pericardium: The pericardial contour is preserved with no effusion, thickening, or calcifications.

·      Left ventricle: Calculated LVEF 67%

·      Left atrial appendage: No thrombus

·      Non-cardiac findings reported separately by radiology. 

IMPRESSION:

·      Minimal (1-24%) 1 vessel disease. CAD RADS 1

·      Coronary calcium score 10

·      No non-atherosclerotic coronary abnormalities

·      LV systolic function (calculated LVEF 67%)

◦ A normal LVEF is typically between 50% and 70%.

◦ An LVEF of 67% is considered normal, indicating that the left ventricle is functioning well and effectively pumping oxygen-rich blood to the body.

◦ A LVEF of 67% suggests that the heart is in good condition and is not showing signs of heart failure.

 

The takeaway from all this, and the direction my cardiologist wants to go, is to just keep an eye on things and no need for medication.  I will say I was pleased with my doctor on the initial consultation that while he talked about Statins – this was before my CTA and based on my blood test and CAC score of 103 – he did not push them and even commented that with me as an athlete I would not likely react well to them.  I was very thankful for this as means that while  he might have a Standard of Care protocol he also listens and understands my situation.  Also, while there may be minimal plaque at 67 and not having always been one who ate well this shows my high Cholesterol which most would say puts me at great risk shows I am not as they would assume by simply looking at individual numbers.  A big reason the things need to be looked at holistically and not mechanistically as the usual “Standard of Care” does.

 

I was told I can go back to training and I did ask if I can also ride, row or row, hard as I did before and was given the go ahead.  But was told to keep an eye on things and continue to use my Frontier HRM and track with the ECG it creates my activities.  From this I will continue as was starting to work at before and move to a more Polarized plan but likely at a  70/30 level till work back up to more time/miles as when under 10 hours the 80/20 is not the same.  I need to be careful to not overdo it as I am pretty good at doing and know when to push and when to not.  I may do a long ride in October and even then I need to do it for fun and not speed so as to simply enjoy the ability to take part.  I need to realize that at the end of the day I ride, row and run because I enjoy it and need to do all I can to keep doing so.  Will I race, probably but with an eye on my health and being ready to throttle back as need be.

The other areas I will be working on in the next 5 months is my sleep - as it has not been good for quite some time - and making sure I get enough electrolytes.  If I have the begginings of AFIB finding the trigger is important.  As far as sleeo I sleep well once I get to sleep but no matter when I go to bed I do not fall alspeep till between 1:30am - 2:30am.  The problem there is I have to get up for work so hard to get in much more sleep.  Just need to figure out how to fall alspeep sooner as do feel tired but just do not fall asleep quickly.

I also need to make sure I get enough electrolytes in and the correct ones.  The interesting part is knowing what is the right amount and while there are all sorts of tests they are really only as good as the time they were taken.  I do know magnesium  is important and was told to ask for a Magnesium RBC test during my next physical tells how much magnesium in the Red Blood Cells and a much better indicator of if there are issues.  Bottom line AFIB can be triggered by dehydration or not enough electrolytes so will be wokring on that as well.

 

In all this as I move forward I need to, as Proverbs 16:3 says, 

 

“Commit your works to Yahweh
And your plans will be established.”

Proverbs 16:3

 

to commit my plans to God and trust He will guide.  Now while some may wonder how this can be and is it some sort of incantation theology.  Well, it is not as to trust in God and is plans is to use wisdom, God granted wisdom, to seek out what needs to be done and trust God will reveal the path. While God can, and does still, perform miracles and divine leading more often than not HE simply uses means to reveal what needs to be done.  This happens by reading, studying and discussing all I can on what I may be dealing with and seek wisdom in putting it all together in a manner that glorifies God and leads to what God has for me to do.

 

I will post more on this as things take place that relate to it.  But may be longer between them but for sure will share more after my follow up visit in late January of 2027.

Posts in Series

• Part 1 – Plans Change: Be Ready for Them  
• Part 1B – What I Meant to Add to Part 1  
• Part 2 – All Means All  
• Part 3 – Sleep, Helmets and Anxiety
• Part 4 - Learning Patience
• Part 5 - No Excuse to Not Exercise
• Part 6 - The All Clear and Needing to Trust God
• Part 7 - Things Change and Thus Plans Change

  Click on images for more information and if you want more info on OFM check out this post: 

• What is OFM (Optimized Fat Metabolism)

To order Vespa you can go here and use coupon code - tkonvalin15 -   for 15% off.

No Excuse to Not Exercise, How Much and How Hard is a Different Matter – Part 5 of Series on Journey to see what is up with my Heart/Health

I have heard over and over in my 54 years of running and 45 years riding:

• Running will ruin your knees
• Riding that much is bad for your heart – oh I can hear that one now:)
• We were not made to do such extreme things – might ask those in the past who did extreme things just to survive.

Oh, and there are others but the point is people all too often take the bad outcomes of others and instead of seeking an in-depth reason as to why they happened so as to learn use them as reasons/excuses to not partake in the activity at all.  The fact I am having what appear to be heart issues and have been running for 54 years and riding for 46 is not so much, in my opinion, related to having taken part in those activities for such a long time but that I was not wise in how I undertook them.  Truth is many that started when I did no longer do so but I see my longevity as a blessing from God.  Also, and this is important, my dietary habits for much of the time I have participated in sport was not the best and my being in shape and young, well for a while, allowed me to overcome the issues my diet was doing inside.  Changing how I eat has only been in the last 8-10 years and while it can halt or slow issues it is hard to undo what one did in the past – although I think that is still up for debate in some areas.

 

What I want to address here is that more often than not when one gets injured or has other issues with running, riding or even rowing it is not necessarily the activity, it can be, but how one went about it.  These activities when done correctly do not harm but will often reveal weaknesses and if one does not work to strengthen or correct those areas of weakness then yes partaking in activities can exacerbate the issues one already has.  Then there is the issue is that when one is not smart about training then, again, that can lead to issues.  In looking at most all my past issues – ruling out ones where I have had a physical accident that injured me – I do not know any that came about when I was riding or running wisely, sadly being wise about my training was not the norm.

 

How I trained started in college running at the University of Arizona which I went to as was in town, cheap (Yea cheap for in-state) and had a good team but was not on scholarship and to be very honest was way over my head.  As I was not on scholarship I did not really get any coaching but was just expected to do whatever everyone else was doing.  A topic for another post but if yu are younger and looking for a place to compete in college be wise and seek a lace where they actually have coaches and not managers – there is a huge difference.  This led to over training – yea I had some good races but largely not what I could have done if I trained wisely.  This led me to riding and even then I rode hard a lot more than I should have but thankfully riding is easier on the body so had fewer injuries.

 

This mentality, of riding and running hard more than I needed to, stayed with me as I got older and hence as I tended to get sick often and had a few injuries.  You think I would learn but never really having had a coach – even though I knew rest was needed – I just went as I felt which usually meant running or riding hard till I could not any more.  I have kept this up for many many years and was only in the past year I was trying to do a more polarized system with more easy rides/runs but still with hard efforts but not as many.

 

Using wisdom in life is of utmost importance but all too often I defaulted to just pushing forward.  Sadly, I often knew what was best but did not do so.  In Scripture wisdom is spoken of highly but when it speaks of having it the implication is you will use it.  Knowing what to do and not doing it is far from wisdom.  Proverbs 8:11 speaks to the value of Wisdom – nothing can compare to it:

 

For wisdom is better than pearls;


And all desirable things cannot compare with her.  (Prov 8:11 LSB)

 

It is also important to realize that while wisdom is often assumed to come with age –  in truth should but often does not.  Wisdom also comes from learning from others who have trod a path before you.  This is not simply head knowledge but learning from all you can see around you and applying it as is wise – that is wisdom.  Simply ignoring what you see and thinking it will not happen is not wise. 

 

I share all this as I do not think it is my 54 years running or 45 years riding that may have played with my heart/health but the effort I put out during that time.  To be truthful I have made it much longer than many I have ridden and run with so feel blessed with that.  I also pray my current issues can be taken care of and I will be able to still race and do some long rides and runs.  However, if not I am good with it as just want to be where God wants me to be.  I also hope these posts and what I have experienced can help others learn lessons from my mistakes and successes and work to increase their wisdom.

 

As an update to my current health – I have my CTA (Scan with contrast) on August 10th so hopefully answers will come.  That said I have to admit the scan is one of those things that I hope they find nothing but then we have to go back to look at other things and other tests. We shall see as just have to wait on God for his timing in this.

 

As far as training I have been pretty much riding easy with one day a week of rowing.  I have done a few rides with short hard efforts in them and have had no events show up heart wise.  I have also been trying to walk at least 20 minutes a day barefoot.  The reason for going barefoot is to strengthen my feet and to also get in 20 minutes or so of grounding.  Grounding is one of those areas that some may ignore but I think it has merit and in truth nothing to lose doing it. The other fun is as 5 of my grandkids live at the end of my drive I often get company on my walk.  So, with one more week till my test will just do the same this week and re-evaluate when I get my test results and consult with my cardiologist.

 

More to come.

Posts in Series

• Part 1 – Plans Change: Be Ready for Them  
• Part 1B – What I Meant to Add to Part 1  
• Part 2 – All Means All  
• Part 3 – Sleep, Helmets and Anxiety
• Part 4 - Learning Patience
• Part 5 - No Excuse to Not Exercise
• Part 6 - The All Clear and Needing to Trust God
• Part 7 - Things Change and Thus Plans Change

  Click on images for more information and if you want more info on OFM check out this post: 

• What is OFM (Optimized Fat Metabolism)

To order Vespa you can go here and use coupon code - tkonvalin15 -   for 15% off.