How CPR Saved My Life

Okay. So I haven't posted for a while. Not because I've got nothing to say. Far from it. I just don't know quite where to begin...

My 2009 race season hasn't really gone as planned. Pre-season training was good and very consistent right through from October '08 to April '09. I capped off the pre-season by logging a massive week of hours and miles at the ABA Spring Bike Camp in Penticton, BC.

I don't want to sound immodest, but for where I'm heading with this post you must understand this: I'm a fit guy, especially for a 42-year-old. I've been racing on the road and track consistently for about the past 10 years. I can hold my own against many riders 20 years younger than me. I can consistently ride 40km time trials in under an hour. My resting heart rate is in the high 40's. I have a body-fat-percentage in the 6% range.

So what gives?

On May 9, an hour into the first race of my season, I got taken out by a crash right in front of me. At 50+kph I had no where to hide and down I went too. I expected to have some road rash, but not much else. When I stood up all seemed okay, but my bite was all wrong. Later in the ER I'd learn I broke my jaw. I was "looking forward" to a liquid diet for just over 4 weeks. That sucked - pun intended!

The same crash posted a bruise on my left leg, just above my ankle. I didn't think too much of it at the time until, after 4 weeks of it being sore and causing me to limp around, I learned I had broken my fibula (that's the smaller bone in your lower leg). At least it was well aligned, and no further medical work was needed. That explained why my plyometrics were hurting so much!

As you can likely imagine, my training got a bit goofed up, but I managed to stay almost on schedule. Power levels were increasing. I competed in another road race and didn't get crashed out - though another crash, this time at 60+kph, happened just far enough ahead of me that I was able to dash out of the way. I also rode a track meet and finished 6th in the omnium. I was starting to think my season wasn't going to be too bad after all.

Then the bombshell dropped...

I was all tapered and set to ride in the Banff Bike Fest Stage Race. But then, at about 4:30am on June 18 I awoke with a sharp pain centered on my solar plexus, radiating outwards to both sides. It felt a bit like indigestion, but without the burn of acid reflux. I stood up, thinking the pain would subside if I changed body position. I managed to walk around the bed and then I collapsed.

All I can say about what happened next is I'm damn lucky my wife is an intensive care physician. And she was right there by my side. Many times in the ICU Dr. Ella has seen fainting and cardiac arrests. She knows the difference. She's sure my heart had stopped.

I was rigid. My eyes were wide open and staring straight out. She could find no pulse. At first she felt utter disbelief. This couldn't have been happening to me, no? But she kept her wits, quickly switched into physician mode and immediately began CPR on me. One big thump and about 40 chest compressions later I regained consciousness. My first memories were simply trying to get my thoughts going while listening to Dr. Ella on the phone to 911. "Why's she calling 911?" I thought. Quickly I realized something bad had just happened to me.

Now you know why I wanted to tell you a bit in the beginning about the shape I'm in. I spent the next 48 hours in the hospital, hooked to a heart monitor, thinking, "What the F... ??" It didn't make sense, and still doesn't.

After the continuous monitoring, 3 blood tests (and enough needle tracks to make me look like a heroin junkie), a chest x-ray, an enhanced CT scan, a cardiac ultrasound, a treadmill stress-test and finally a cardiac MRI, all we've found is that I'm an extremely fit 42-year-old with super-healthy blood pressure, super-healthy cholesterol levels, and a "normal athete's heart", i.e., my left ventricle is enlarged but dilated as you'd expect in a healthy athlete (the left ventricle does all the work pumping blood to your body, so it grows a bit like any other muscle tissue that gets a good workout).

So why the cardiac arrest?

It's important to distinguish that I didn't have a heart attack. That implies a blockage in an artery of the heart leading to death of some heart muscle tissue. My heart is still completely intact with no indications of arterial blockages. But it did stop - hence the term "cardiac arrest".

My recent broken bones could have led to a blood clot thrown into my lungs or heart, but the blood work and numerous scans ruled that out.

At this point we can only say it was some kind of arrhythmia - an unusual sequence of heart beats leading to stoppage. Why did it happen? Perhaps this electrical engineer has an electrical problem in his heart. More tests by an electro-physiologist might point in that direction. And there may be a few other genetic scenarios that could explain things. Some genetic testing might provide those answers.

On the one hand it's great to know I'm "healthy". But really, WTF? Something happened and I really don't want it to happen again. I can't expect Dr. Ella to be by my side for the rest of my life. I don't seem to have an issue while I exert myself, so perhaps my training can remain intact. Is there a preventive solution? Sure. An Implanted Cardiac Defibrillator. Stay tuned - hey, that's a good excuse to subscribe to my blog - see the box on the right! I'll let you know if I become the Bionic Bicycling Blogger...

Does this mean anything to you?

Damn right it does. Two things.

First, being an athlete doesn't necessarily guarantee you a long, healthy life. Certainly a high degree of physical fitness should give you a high quality of life while you're here. But your fitness levels can actually mask other underlying health issues, issues that may have grabbed you from the face of the Earth sooner if you hadn't been athletic. Don't neglect to get annual physical checkups and blood tests. Work with your family doctor to maintain your health. If you've got small problems, issues that don't seem too bad but don't really correct themselves, don't ignore them. Keep an open discussion going with your family doctor. As athletes we tend to think we're invincible, that a little rest is all that's needed to get better. That's not necessarily the case.

Second and more important, learn CPR if you haven't already. Dr. Ella is actually the director of CPR training at the hospital where she works. Until you take a course yourself, she's provided these pointers to keep in mind - what they teach now is a little different than what was taught even just 5 years ago:

How To Perform CPR

1. Make sure the person is lying on their back on hard ground.
2. Check and double-check that there is no pulse and no breathing - the best place to look for the pulse is to position the person on their back, find the point on their jawbone just beneath their ear (it doesn't matter which side, left or right) and then slide your fingers - not your thumb - down onto their neck.
3. Find the bottom of the sternum, i.e. the bottom point where the ribs meet in the middle of the chest. Measure up 1 hand width from the bottom of the sternum. This point will become the focal point of your compressions.
4. Begin with 1 solid hard fist-blow to the focal point. Really hard!
5. Start chest compressions on the focal point. Put one palm on top of the back of your other hand, interlace your fingers, get yourself directly above the person's chest (not reaching towards them at an angle), and begin direct downward chest compressions. Keep your arms firm, and don't let them flex during a compression. Try to compress the chest about 2 inches with each press. Keep a tempo of about 1 compression per second, or slightly faster. Think "1 and 2 and 3 and 4..."
6. Now here's the key difference from what you may have been taught or seen in the past - do not stop to administer any mouth-to-mouth breaths. Just keep on compressing.
7. Call for help and get someone else to dial 911 if at all possible.
8. After about 1 minute of chest compressions check again for a pulse. If you're still by yourself at this point, call 911. If you still didn't find a pulse, don't waste too much time on the 911 call - get back to the chest compressions and just keep going until help arrives or the person starts to come around.

The key difference of not stopping to apply mouth-to-mouth is much like pumping up a bike tire. When you put a pump on the tire, it takes a number of pump-strokes before you build up enough pressure to break the valve seal and actually start to get air in the tire.

With CPR, the concept if very similar. It takes numerous compressions to actually build up enough blood pressure to get some blood flowing. And the most important thing you're trying to do with CPR is to keep blood flowing into and through the brain to preserve as much of it as possible. Any time you stop CPR compressions it's like taking that pump off your bike tire - you lose all the pressure gained, the flow you started, and open the person up to more possibilities of brain damage if they can ever get their heart started again.

Back On The Bike

I'm back training, doing my best to be ready for the Canadian National Track Championships at the end of August. I'm spending a lot of time second guessing myself, but I will not be defeated by this. If I'm not back racing this season, I'm certainly going to be back at it in 2010!

Photo "Heart anatomy" by: Patrick J. Lynch

TT Position Testing With Lance Armstrong And Tom Danielson

In late 2008, Lance Armstrong returned to the wind tunnel to test his Time Trial (TT) position. You can see a short video excerpt here.

The audio quality is a bit flaky, so I've made a summary of his comments for you.

What Armstrong Tested

Steve Hed had Lance try 3 hand positions:

1. Fully out on the ends of the TT bar extensions
2. Choked up half-way
3. Choked up all the way back on the extensions, close to the elbow pads.

Combined with these hand positions, they tested 2 sitting positions on the saddle:

1. Back in a normal position
2. Moved forward onto the nose of the saddle.

Note, sitting forward on the saddle with the hands choked all the way back in front of the elbow pads is just too compact a position to ride properly. Lance didn't bother with that position.

A Blend Of Athlete & Equipment

Hed makes some comments about how a good TT position is a combination of the athlete and the equipment. You can be 5% slower in the wind tunnel, but if you can pedal with 25% more power, you're going to go faster.

On one day, Lance tried to ride with the seat back, the nose of the seat up, elbows very narrow, bars low. He couldn't ride the bike.

The next day, he rode with the nose of the seat down, the seat forward, elbows a bit wider, and the bars raised some. He was much more comfortable.

Testing On The Velodrome

Around the same time, Lance also tested his TT position on the velodrome. You can see that video here. The goal was to ride various test runs in different bike positions yet holding a constant speed. The required power output was the measured success variable. A lower power that produced the same speed pointed to a more optimum position.

4 UCI Rules For Your TT Set-Up

According to the UCI rules there are 4 key points that most commissaires will be checking. You need to keep these in mind for your set-up:

1. Your forearms (not your hands though) must be parallel to the ground when the commissaires assess the legality of your position.
2. The top-most portion of any piece of your TT bars (except the shift levers) must be equal to or lower than your seat height.
3. The ends of your TT bars (except the shift levers again) can extend no further than 75cm horizontally forward of the center of your bottom bracket.
4. The tip of your seat must be at least 5cm horizontally behind the center of your bottom bracket.
   

You can only qualify for "morphological" exceptions to points 3 and 4. That is, excessively long legs or arms can allow you exceptions to these rules. The commissaires will put you on your bike and assess the following measurements:

If you exceed the 75cms in point 3, your elbow angle must be less than 120°. Even considering this point, your bars ends can be no more than 80cm ahead of your bottom bracket. The commissaires will make sure you're sitting normally on your saddle and that your hands are extended all the way to the ends of the extensions, as you could normally grasp them - no choking up on the bars to tighten your elbow angle.

In point 4, your seat can be closer than 5cm to your bottom bracket only if your knee remains above or just behind the pedal axle when your right foot is in the forward 3 o'clock position and you sit normally on your saddle (again, the commissaires will make sure your don't scoot yourself way back on the seat to change the angle of your knee).

The previously extreme "praying mantis" positions of Floyd Landis and Levi Leipheimer are now technically illegal.

I remember when I first saw Landis' position in the 2006 Tour de France, the ends of his bars were well above his seat - and that alone made his position illegal as it violated point 2 above.

Tom Danielson On The Road With His TT Position

And look here what Tom Danielson is doing with his TT position.

In this video, the side-angle shots show Danielson's bars are horizontal, and he can get his forearms parallel to the ground. But in the front-on shots he has moved his hands up high, so the bases of his palms are resting on top of the shift levers. His forearms are no longer parallel to the ground; they are approaching the praying mantis position, allowing him to "hide" behind his hands, like Armstrong commented in his video.

You might be able to get away with this change in hand position during your time trial, so long as a commissaire doesn't see you make the move. Otherwise, do your best to keep those forearms horizontal, certainly while your position is being assessed pre-race.

Test, Make Your Own Refinements, & Train In Your TT Position

Like Lance, you'll need to experiment to find what works best for you. Check out my earlier post, Free Speed In Your Next Time Trial, for some ideas to test the aerodynamics of your position.

Remember, you'll need to train in your TT position to get the best power in that position. If you're serious about your time trialling, you should be training at least once a week in your TT position.