June 28: Had to fast this morning due to the impending stress test, so I had a bit of a tough time operating without my morning cup of java. Next up Judy dropped me off at home and then Mike chauffeured me into Clev. to the Clinic’s main campus. Then I amble down to the B level to the stress labs to fill out a questionnaire. This was followed by another session of questions etc. the nurse assistant of by Doc. Blackburn, the exercise physiologist. Then I had to fill out another couple of questionnaires, one on my psychological state, and the other about my current dietary habits. Now the first, the psycho exam, accesses how “bummed out” you are or are not post surgery. From what I’ve heard and read, some people get really down post open heart surgery. So this was a pretty thorough couple pages of questions to determine your mental state of health. I guess I feel pretty lucky to have not experienced any of the downer moods that are quite common. Have to say that I’ve been pretty upbeat about the whole process, this despite the little bumps in the road with respect to upper end HR restrictions etc. So I think I passed that one with flying colors. 

The second questionnaire concentrated on diet. And as soon as I’d looked at it I asked the nurse if I was answering based on pre or post surgery, because my answers would be very different for each! She responded that I answer based on post surgery. So that’s what I went with. And man, what a difference it was answering everything based on my dietary habits post-surgery. It’s the difference between eating as you’re on a Mediterranean Diet vs eating as you’re on a Roman Orgy Diet! Heck, read some of my old travel blogs - Roman Orgy eating every freaking day. Ok, so got that one done. 

So I reviewed all this with the nurse, and then a cardiologist came in to talk to me, asking me to take her through the whole long story about how this started and what I experienced with the heart during my riding in NV. I think the most interesting part of this was her response to my telling her my symptoms, or lack of symptoms actually except for that feeling in my shoulders that felt like I was holding up a giant oak beam that was crushing me from behind. She really seemed taken aback by that one, seeing I did not have the typical “left side chest pain and tightness with radiating pain down the arms and in the jaw”. And I told her that I just didn’t have the impression that day that I’d indeed had a heart attack. Nope, I described it more like I felt terrible all day and I just had a really “shitty day!”.

Next up was my stress test, which they were happy to change it to a bicycle instead of on the treadmill. And we’d talked about how hard they wanted me to go, let is their idea of all out like my definition of all out? I mean my def is to go till you puke! And in this case, with no breakfast I would only dry heave! Well, they told me that I was not going to the point of mass destruction on this, that they wanted me to go high and very hard, but not to the point to where I was slobbering and light headed. 

So this chick shaved a few spots on my chest for the EKG contacts, I got dressed in shorts and no shirt and they hooked me up. They were going to increase the wattage on the bike at 25W every two minutes till I failed to turn the pedals above 60rpm. One chick would monitor the EKG and the other would take my BP (blood pressure) every two minutes. Well, we got going and I described my RPE every two minutes based on an RPE chart on the wall: Not even noticeable up to VERY, VERY HARD. Now since I’m on a few drugs they told me my HR would be stunted a bit from what I’d remembered from the old days. 

And it was. I mean I went through the first 8 minutes just not seeing my HR up above 140, and my RPE at MODERATE. I fully expected to have a much higher HR response. Then after 8 min it got tougher, where I had to kind of go into the TT position to generate a high rpm and feel comfortable on the saddle. My BP was going up pretty good. By like 12 min in I was at about high 140’s with an RPE of HARD. Now shit…my TT HR for as 40K TT used to be 172-175bpm. Ok so that was 17 yrs ago and without these HR lowering drugs I’m currently on. But man, I was just amazed at how things have changed - plus, I’m pretty damned detrained after nearly 2 months off the bike. 

So for the last 4 minutes I started exhibiting these irregular HB patterns called “couplets” where it would be like a double beat thing. The one chick was kind of calling them out. I got concerned and asked, as I’m taking this stress test, asking what the hell is a couplet and is it bad? Told me it was ok unless they became really closely grouped together. But still, I was kind of like, WTF?

All right, like I’m getting worked pretty good by about 14 min in, and she up’s the watts again and I’m in the VERY HARD RPE range, but still, I feel like I still have a good “bit of suffering” left in me. I mean I wanted to just slam this damn thing! I got though 16 min, shifted my position to get more bit on the pedal as she upped the watts, and my rpm dropped to under 60 for like 2 seconds and the chick says we’re done. And I’m like,” WHAT? I just shifted position, I can get it back up above 60!” Nope. We’re done. She told me they got plenty of info at that point. So I was wondering if those GD couplets were the reason. They said no, that I had exceeded what is typically the highest amount of time by like 4 minutes - this is for a post operative CABG patient, and I had achieved my predicted max HR. Yet my thought was, “while still talking?”

I changed, went back into the examination room and waited for Doc. Blackburn to come in. I seemed pretty happy with my results, telling me I’d gone amazingly long on that bike for a guy who was just operated on 6 weeks ago. I achieved 97.5% of my predicted max HR. Then he went into the couplets, explaining that it is common for the heart to display some irregular patterns when recovering from open heart surgery. Said it’s very traumatic on the heart when stopping it, then operating on it, then restarting it. So he did not seem to be too concerned at this point about that. 

First of all, this guy is just great. Again, like Doc Phelan, I could just sit there and pepper these guys with questions for a couple hours. But I’m cognizant of these people having X amount of time per patient, so I really try to keep it rolling and not go on tangents. Doc Blackburn went over my new HR zones and running zones that he’d drawn up, and then we talked about my getting back to using a HR monitor for my training. Right now, based on my stress test results he wants me to stay in the 118-132bpm for cycling (which would equate to a Z3 for me), and 126-138bpm for hiking/jogging. I do NOT say running because that is just creeping for running - for me! So I’ll just use that for hiking - fast. 

And YES, I can begin to cycle! So Doc asks me what kind of bike I have, and I just stammered a bit, and asked him what kind of bike does he want? “I have twelve,” I answered, “and I’m sure I have the kind of bike you want.” He asked about me having a straight bar mt bike? Told him I had 4 of those! He wants a mt bike with straight bars OR a X bike where I ride only on the tops so as to NOT put undue stress on my sternum. He does not want me to get into the drop bar position. 

Then next up Doc wanted to know if I was willing to do a few “supervised” stationary bike workouts with him at the clinic to make sure all is well. He said I would just have to go this Fri, next Wed and Fri. I’d be hooked up to the EKG etc. to make sure my heart is performing as it should at this new Z3. He said I didn’t have to, but it might be a good idea nonetheless. I figured my sister would be all in for this, and what’s more I figured I’d have a good op to talk more with Doc Blackburn about training, so I agreed to give it a go. In the meantime I can still ride on my own in addition to these supervised rides. 

So next we talked about lifting. Nope! I had to wait two more weeks to begin lifting. They are VERY adamant about letting my sternum heal all the way before I put stress on it. Then, when I can lift I have to do unilateral exercises (one arm at a time) in order to NOT stress the sternum from both sides at once as you do with bilateral exercises like the barbell bench press and pushups. 

Driving? Yes, I can get back to driving on my own without the freaking chauffeuring thing Judy has been doing for me. Next, I asked if I could lead one of our Excel Adventure Trips I have scheduled for July 22, a day-hiking trip in the Black Forest of PA. Doc hemmed and hawed about this one, and based on the elevation gain I’d potentially be doing, 1000-1500, he was hesitant on this one. Told me that if I try to look practically on my situation, I’m just 6 weeks out of 5-bypass surgery, and since I’m just now given permission to go into mid to high Z3, he’d prefer that I get more conditioning under my belt before leading a trip. Those climbs could take me into Z4. And I get it totally. So I’m going to have to cancel yet another trip this summer. I have several people who all know what’s going on with me, so it won’t be a problem at all canceling or rescheduling this trip. More than anything I was just hoping to get back to normal again and get my business back to status quo to. 

Then we went over my diet, which based on my previously answered questionnaire, is really good. Now again, this is post surgery, which I told him about. He was very happy to hear, when he asked me if I could maintain it the rest of my life, this Mediterranean  Diet thing, I answered yes, but I wasn’t happy about it! Welcome to my life new diet!

So that’s the story, looks pretty good, though I’m still concerned about the couplet thing and the blockages thing that I’d described a few weeks ago. I’m hoping what with training, I can raise my HR Zones so I can get more work done at the same HR’s as right now. Kim keeps telling me it can take half a year to get back to full capacity, so I guess I’m impatient as hell - as I always am. 

Now Doc Blackburn DID tell me when I asked him about me doing American Dirt and more of my “goofy adventures”, based on where we’re at right now, he thinks I’ll be ok to finish AD in spring of 2017 and then do some rugged, tough backpacking trips thereafter. 

Well, this is where I’m at…and tomorrow by God I’m doing my first bike ride outside since mid May. I’m still debating whether I’ll get on the fixie, which I was feeling smug about jumping right back on, or be sensible and get on my duel suspension mt bike so it will decrease all the shock and vibration on my sternum. I’ll let you know tomorrow.