Cholesterol and Heart disease

Lately I've come across a few articles that question the relationship between Cholesterol and Heart disease. I've also read some articles which states that Statins (Cholesterol lower medication) are not necessary a good thing.

Below are some links to articles about these topics.

Cholesterol and Heart disease

Saurated fat not major issue

Sweden rejects low fat diet

Statin nation

Does Cholesterol cause heart disease

Do you take any of these 11 dangerous statins

The reason for my post is that before my heart attack I didn't have high Cholesterol and even now after the attack my cholesterol is low but I am on statins. The Doctor prescribed it as a precaution after attack and not because I have high cholesterol. 

My question is just why take medication if you’re not sick, only for precaution? Isn't a healthy diet and exercise the medicine you really need?

The other day I was at the doctor and suggested that I want to stop using the medication as what I've read and understood from the articles I am doing more damage than good and it is also now proven that if I should have had high Cholesterol it is not necessary a bad thing or the cause of heart attacks. Needless to say the Doc said no, I must still use them.

My question is who to believe? Do I stick with “old school” believes and studies or go with new studies and believes

Would welcome your comments and opinions

Starting all over Again

It’s been a week since I’m back at training and trying to make some sort of comeback.

So last Saturday I started training again and it’s been going well. Kim reminded me that I must “start over” and not try and start where I left off, end of February.

After my visit to the Cardiologist beginning of August when he told me no more competitions and only training socially, I totally lost interest. Think I was mad and disappointed at the same time with this whole situation. Leading up to my visit I was training strictly according to his guidelines and was waiting for the green light come August to get back at racing.

When he gave me the news I didn’t want, I continue training but slowly lost interest and skipping the one session after the other until I wasn’t training at all.

Almost two months later and one month of NO training at all, I decided it can’t go on like this. Must also thank Kim for keeping me motivated to get back at it and help me going through this bad patch. Besides used bikes don’t have any value so I can’t sell them and I hate seeing them just stand there.

Thinking back, my biggest mistake was I thought I can just continue where I stopped in February. I do realize now that it’s not the case and I must start over again, from scratch. Recovering from a heart attack ain’t no easy job, much harder than Ironman training itself.

Needless to say I’ve done more swimming, biking and running this past week than the past month and I love that feeling again, being tired and on a “high” after a training session. Something you can’t explain and need to experience yourself.

Hope to be back at it soon and to do a triathlon, even thou it would be a short distance Tri and not at the pace I am used to, I am looking forward to doing a Triathlon soon.

Pic at top is one of my runs this week, happy to record a 5km, sub30 in first week back at it, and that with heart rate sub 130bpm

"If you don't want to take me for a run, I'll go on my own" -Eddy

Endurance Athletes and the signs of a heart attack?

Whenever people and especially athletes discover I had a heart attack when they talk to me, the first two questions that pops up every time are.

“How will I know when I am having a heart attack” and

“Are there any long term symptoms leading up to a heart attack”

Getting these questions all the time I thought it might be worth writing a post about it.

I am not a Doctor and my advice is not based on medical evidence but it’s my personal opinion and what I've experienced.

The first question I did answer in one of my previous post heart attack symptoms and won’t go into detail now. 

But the symptoms are basically feeling dizzy, nausea's, pain on the inside of the arms (biceps), having heart burn but higher up than the usual heart burn. Eventually breaking out in a cold sweat and not able to walk up straight and going into a fetal position due to the extreme pain.

What I’ll try and answer today is how you know if the heart is not functioning as it should be and are there any medium/long term signs. Personally I don’t think there are definite signs but thinking back to the time leading up to the attack and what I've experienced I came to realize that I was not my usual self. I didn't take note of it and thought it was just part of endurance training.

What I've noticed is that it felt like I had asthma and I even complaint to Kim, saying that I must go to the Doctor (which I never did). I struggled to breathe (tight chest), especially on my runs and also just as I started running. This would then go away later during the run. I also struggled to do my once a week fartlek session and could do it but was the odd 30 seconds slower than my usual rate and going slower as the weeks tick on.

The advantage of training with a power meter is that I've noticed that I was losing power during my bike sessions especially when I was doing the shorter interval sessions. When I was doing my endurance rides or recovery rides I could hold my target power zone without any issues but when it came to the short all out 1 minute sessions or the 5 minute sessions above threshold I just couldn't hold the numbers. My power was steadily declining with each session and nothing helped no matter what I tried doing to improve the numbers.

Thinking back I am sure that those sessions where the heart need to pump extra hard were the ones where the heart showed that there is something wrong and just could not perform at that high level.

One other thing I also noticed was the week before the Xterra race when I had the attack, I did a half Ironman and after the race I had some heartburn and pain inside my arms. No issues during the race. The energy drink supplied during that specific race was not what I was using and I thought that was the reason why I experienced the heartburn. The pain inside my arm, I thought was my lack of swim training the past couple of weeks. 

How naive of me but an issue with my heart never crossed my mind, never did I know that it was a heart attack on its way.

I've read lately that a lack of sleep over a long period can also lead to a heart attack. With me having a full time job and not neglecting my family my day started at 4am and ended at 11pm. My typical day was training before work, working long hours in a stressful environment, spending time with the family after work and then training again until late at night. Getting 5 hours of sleep a night and some nights less over the past 6 years must have taken its toll on my heart.

They've said it many times in articles but only do I realize now that sleep is very important and one thing one can’t neglect.

This week on Twitter I saw a lot of tweets from people entering Ironman South Africa and for the first time the event is sold out long before entries close. This is great news and I am glad that Triathlon is growing at such a rate in South Africa. It’s great being caught up in the moment and entering Ironman or being challenged by a friend to do it but training for and racing an Ironman is very demanding and puts your body to the ultimate test.

One concern I do have is that a lot of entries are first timers and when I look at some of these people’s tweets they haven’t done a long distance triathlon before and some are new to the sport and haven’t done a triathlon at all. I would urge these athletes or for that matter even the seasoned endurance athlete to go for a proper medical exam once a year which include a proper scan of the heart (EKG, Sonar, etc.) This might not help everybody but will show any defect there might be that you are not aware of.

In my case they might have picked something up or maybe not but now it’s too late to know and all the “what if’s” can’t turn back the clock.

My conclusion is that I don’t think there are specific signs leading up to a heart attack but listen to your body. What I do believe is that every endurance athlete should do a proper medical exam once a year to prevent any possible issues to ensure that you can do the sport you love for many years to come. 

Never think that this won't happen to you, that's what I thought.

Oh and get enough sleep every night!

And what would a post be without a pic of my buddy, Eddy

Heart Attack Check-up: Not the news I wanted

It's been almost six months, (23 weeks to be precise) since my heart attack and last Friday I visited the Cardiologist for my check-up.

Going to the Doctor, I was very positive and believed that I would get the green light to up the training and even get the go ahead to return to Ironman racing or at least Half Ironman racing. The week before I had some blood test done for him to get the results in time.
Since the attack I followed the Doctors orders to the T and taking my meds without missing one tablet.

(Picture above is what the meds do to my Blood pressure, my new low BP, day in and day out. Some days it drops to 90/60) 

Training wise I also followed his orders and didn't go over (the ridiculous low) 130bpm that was set as the maximum.

When I got there he did a resting EKG as well as one while I was running on the treadmill. When the Treadmill test was at it's peak my heart rate was peaking at 159bpm. I was a little worried but thought if the heart should stop now I am at the right place, at the Hospital in the Cardiologist consulting room, not in a car on my way to the airport. After this he did examine me and also did a Sonar of my heart.

While doing the Sonar he told me that there is some damage to the heart but it is very little. Then it was back to his office where he studied the EKG and giving me the feedback.

According to him I must be thankful that there is almost no damage to the heart. I thought that here comes the good news but instead he told me that his advice to me would be to never do racing again.

He said I can continue the way I am training now and can slowly increase the time/distance but very slowly and he would advice me to stick to 130bpm but can go to 135-140 max but just for short stints and not often. But no more training/racing as what I was used to.

That is not the news I wanted to hear, I was there to get the green light. What I don't understand is that he said he is very happy with the blood results and the EKG looks very good and there is almost no damage to the heart. He even reduced my medication but no more endurance Triathlons or racing!!

When I asked him if I can up the heart rate to the 150 range and if I can do at least a Half Ironman in the future his words to me was, "Now don't be silly"

I suppose that is reality, training 3 to 4 times a week at 130bpm max, become a social jogger, biker but that is not me. He is a very good and well respected Cardiologist and I have a lot of respect for him and he is probably right but I don't want to believe him.

This weekend I've decided to get a second opinion. I know you don't get Cardiologist specializing in athletes with heart issues but I am going to see if I can get one who might be working closer with athletes with heart issues. One thing I noticed at the consulting rooms was that my age must have brought the average age in the room down by about 30 years. I was the only "young" guy there, all the other patient looked 70+. Not saying that this is influencing his decision but surely I am in better shape than his average patient.

For now I will stick to his advice and enjoy our Holiday to Norway coming up end of the month but will then see if I can find another Cardiologist for a second opinion.

The hardest part now is to stay positive. Leading up the the check up I believed that I would be 100% but not getting good news is a big blow. Triathlon is not everything in life but it is something I enjoy immensely.

 The important thing however is that I am still alive and enjoying my family everyday and is Blessed by their love and care.

14 weeks of Ups and Downs

It's been 14 weeks since my heart attack and just a quick update on how things are going. To say that everything is 100% will be a lie. I have my ups and downs but luckily I've had more ups than downs.

Like I said before the Mental side of the recovery for me is harder than the physical side, maybe because I was very fit before the attack and the physical recovery is going well. Mentally it is hard not to train like I used to train and also the mind games and all the "what ifs"

I had three anxiety attacks during this time and with one I ended up in Hospital as I thought I am having another heart attack. Only to be assured by the Hospital that my heart is fine. You see the problem is with any chest pain or something feeling weird, your mind start playing games with you and you think you're having another heart attack and the more you think about this the more you start to panic.

The Doctor did give me medication to take if I feel that I am starting to panic but I don't like to take the medicine. Don't want to become dependent on it.

That's the negative, on the positive my training is going well and I struggle to keep my heart rate below 130bpm during training. I feel so good, I just want to go out and train like I used to, very frustrating training at low heart rate.

Another positive during the past week weeks is me and Kim could celebrate our 19th wedding anniversary end of May. I am so thankful for having her and motivating me and looking after me, not only after the attack but for the past 19 years.

On my bike ride today, going outdoors

Like I said training wise it is going well and I do all of my training on the treadmill and on the indoor bike trainer (Computrainer). I've seen that I can control my heart rate better indoors than if I go outside.
I did however went out for an outdoor bike ride today. Indoor training can become boring/frustrating and Kim told me today, why don't I take you outside and you can bike outdoors. Must say it felt great and although I had to take it easy to keep the heart rate down, it was great cycling on the open road again.

Pictures above is of my view on trainer and treadmill, just not the same than outdoors but will have to do.

I've also decided to finally work on my swim technique, seeing that I can't swim endless laps at this stage. I bought a swim program and is starting to swim from scratch. At this stage it is only drills and very basic drills.

And what would my post be without a picture of my best friend, Eddy. Always happy to see me and never a dull moment in his live. Just want to play. Here he is ready to chase Kim

TSA Medical commission response

Here is a copy of an email I send to TSA (Triathlon South Africa) regarding the issue whereby a medical commission will propose measures to prevent deaths in endurance triathlons

The link to TSA website article: http://www.triathlonsa.co.za/Public/ViewNews.aspx?id=725

Good day

Hereby my response to the TSA website bulletin regarding the investigation by the Medical Commission relating to the recent deaths in Triathlon and proposed plans to but safety issues in place.

I appreciate the effort TSA is putting in to prevent future deaths in triathlon races, especially due to heart related issues, but I believe that the new proposal to implement a rule that one must qualify at an Olympic distance race before participating in an endurance triathlon event would not add value or prevent future deaths. In my view this will only enrich race organizers and put a financial burden on athletes to enter races of which entry fees are already very high.

I am a competitive endurance athlete who have done six Ironman events and also completed in more than a dozen half Ironman events over the past seven years. This year alone I have done two half Ironman races and two Xterra off-road triathlons. I specialize in long distance triathlons and do not compete in sprint or Olympic distance races. In the majority of these endurance events over the past couple of years I have finished in the top ten of my age group and have also competed in the Ironman World Championships in 2009.

My reasoning behind this is that I suffered a heart attack just after finishing my last race (Xterra Grabouw, 24 February)

I would propose that in order to "qualify" to do an endurance triathlon an athlete would need to produce a doctor's certificate after completing a medical/physical exam to clear the athlete to participate in such an event.

In my case this wouldn't have help as they still don't know what caused the heart attack as I don't have a heart condition, history, any medical condition or high cholesterol but in many instances through an exam, ECG, etc. it may be determined if an athlete do have a medical defect and if such athlete will be capable to participate in an Ironman race.

Most athlete’s do have a medical aid and this won’t put any additional financial strain on the athlete. One might see a drop in participating numbers but it might just save a live or two and might make a specific athlete aware of a medical condition they might have.

One might consider the following criteria whereby an athlete must qualify for an Ironman event by doing a Half Ironman distance race as there is a huge jump from a half distance race to the full but to do an Olympic distance race to qualify for a Half Ironman distance race won’t prevent deaths in my opinion.

Regards

Johan Stemmet

How do you feel?

 

Me and Eddy, my training partner on our walks

 Lately I've been asked the question a lot. "How do you feel" and I appreciate every one's interest about how I feel after the heart attack. It's already been four weeks since the mishap and there's two parts to this, one is the physical side and the other the mental.

Physically I am doing great and I am glad that the recovery is going well. The Doctor told me that I will recover faster than the average person due to me being very fit and healthy and I am glad he was right. I've started walking with Eddy the week after the heart attack and started with 100 meters a day and slowly building it up and is now up to 2.5 km. I must constantly remind myself to walk slowly and take it easy.

Physically I feel like I can almost start running and need to force myself to walk slower than what I want to. According to the Doctor I can start training again after six weeks (two weeks to go) but only at 70% of max heart rate. Can't wait!

Picture above is my Training Peaks performance management chart and the blue line is the Chronic training load (CTL), [basically it is my fitness level and it is quite disturbing seeing the chart taking a nose dive the past four weeks].

Even with the alarm switched off, the body clock still wakes me up at 4am after all these years

Mentally it is not going that well. Being used to train twice a day for seven days a week most of the time and now only walking once a day at turtle pace for half an hour is hard. I really miss the training and that feeling you get after a hard training session or a race.

My emotions is also divided in two. One moment I am so thankful that I am alive and been given another chance. The next moment I am upset that this has happened to me and ask the question, Why?
Living healthy, being active, no health issues, no signs of an attack coming and then Bam!
Cancelling all my flights, accommodation, race entries etc. for upcoming races I've already booked was also not helping.

So unfair but then I think back to that day and am thankful again and realize that this will be a long road to recovery but I must enjoy every day being alive.

Tomorrow I am going back to work after my forced "holiday" and am exited to be back at the Dealership again but am going to miss the extra family time with Kim and DJ which I got so used to