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CABGs & climbing - a random info thread ...

5:48:12 PM
A thread that will evolve as I update it along the way, in good old campfire (kind of trip report / discussion) fashion, ... but first to set the scene...
(Please be patient as it's an ongoing work in progress!)

O Oysters, come and walk with us!
The Walrus did beseech.
A pleasant walk, a pleasant talk,
Along the briny beach:
~ ~ ~
The Walrus and the Carpenter
Walked on a mile or so,
And then they rested on a rock
Conveniently low:
And all the little Oysters stood
And waited in a row.
The time has come, the Walrus said,
To talk of many things:
Of shoes - - and ships - - and sealing-wax - -
Of cabbages - - and kings - -
And why the sea is boiling hot - -
And whether pigs have wings.

~ Lewis Carroll; (excerpt; Through the Looking-Glass and What Alice Found There. ~ 1872).

So what has cabbage got to do with climbing I hear you ask?
Well more specifically CABG... otherwise known as an acronym for Coronary Artery Bypass Graft (can be one or more...), ie heart bypass surgery.

I just arrived home from having this done, and can now give feedback on how the condition affected my climbing beforehand, plus how the ongoing recovery from it affects my future climbing, for any that may be interested.
If your not interested, then do yourself a favour and hide the topic to help de-clutter your screen!
Heh, heh, heh.

6:04:03 PM
Okay, I know there isn't anything unique to my circumstances, though the topic hasn't arisen in any detail on Chockstone previously.

A couple of statistics.

1,400 CABG operations are performed per month in Australia with <2% of patients having issues arising from same.
The Australian health system if fantastic as most of the significant cost (around $50,000), of each operation is covered...

~ ~ ~

In the middle of August just gone, I went climbing to a beginner friendly location, as I was introducing a couple of semi experienced (some sport climbing background) climbers to 'trad' climbing for their first time.

The area had suffered from bushfire a couple of years back, and we had to bushwhack through regrowth over disappeared tracks to access the base of the climb we intended to do.
A good warmup it proved to be, though not overly strenuous.

At the base of the climb while we unpacked our gear in preparation for it, I then experienced a strong and highly irregular heartbeat...
When next I meet those folk, I shall have to ask them if they noticed anything unusual in my behaviour/demeanor at that time, though as events flowed on the day, they didn't indicate anything was unusual with me.

It (my heartbeat) was erratic but this only lasted for less than a minute.
It was a very hammer-like pounding (without pain, numbness, slurring of speech or any other 'classic' symptoms), thump, thump, thump, thump, thump. Then nothing! ... just long enough for my mind to think "is it going to start again"? It started again, but like ye olde clown car in a circus, you know the ones, they have wheels of different sizes and shapes, so that as they travel along they are wonking all over the shop...

Then thump, thump, thump, thump, thump again, once again followed by the pregnant pause, and clown car start-up.

And a third time, again the same; all up the total of the three combined was less than a minute.
I felt a bit light headed and slight nausea just afterward, but it quickly passed while I sipped on some water.
I was on my feet the whole time during this, as we were donning our harnesses etc.
It was mid morning on a pleasant day weather wise.

I then led an easy rope-length climb; slab start to a low angle finger crack, which I deliberately broke into two pitches by incorporating a semi-hanging belay at the base of the finger crack.
We swapped leads amongst each other, descending off the top double bolt anchor to the semi hanging belay each time, and ran laps on the upper half, practicing placing and cleaning gear.

We continued the learning / sharing of trad experience till late afternoon, and I experienced nothing further out of the ordinary on the day, nor indeed, ongoing to date; though as one will see with subsequent updates to this post / thread the further the incident was investigated the further into the 'boiling' I went!

To be continued.

6:32:19 AM
Best wishes for your recovery Rod.
7:17:22 AM
Wondered when you were going to post here... Got the all clear to go home last Friday M9?
12:29:35 PM
Jeeze M9, I already counted you as super fit... you'll be unstoppable if they've made modifications to your heart and circulation!
1:30:33 PM
Hey Rod! I hope you recover soon.You a tough minded dude. Keep it up.

4:09:51 PM
Thanks gfdonc, TimP and Johny. The sentiment is appreciated.

Dalai, yes escaped on Friday but after being opened up and repaired, I've decided they forgot to put the endurance I had back in before they closed me up again, as my daily routine since has been a little exercise and a lot of sleeping!

>super fit

This raises an interesting facet of CHD (coronary heart disease)...

After all the initial tests (MRI x 2, ultrasound x 2, treadmill stress test + others I forget now!), I was diagnosed with calcification blockages in three places of the heart arteries, ie the ones that return from the main body-supply artery to feed the heart.

Calcification is different to cholesterol, but similar in effect. A blockage is a blockage and when it becomes fully effective then a heart attack is the result.
Calcification is often associated with hardening of the arteries (simply age and stage wearing out of the heart), and usually presents in the 6th decade, however my GP, Cardiologist and Surgeon all told me that recent studies have proven the link between early age onset of calcification of arteries in those who subject their hearts to high work-rate loads; particularly athletes such as Olympians, Tri-athletes, Marathon runners, etc!

In my case, yes I like to remain fit, and so have been mountain biking regularly (truth be known, much more often than climbing!), in the past 18 months.
My strava times were improving with distances getting longer and times coming down, and I was feeling good about that with no noticeable negative side effects. I rode on average two to three times a week for two or three hours each time, mostly on single-track (imo about 3 times harder than road riding comparable distance), in hill country. A typical ride for me was 25+ km with approx 700 m height gain / loss within same.
Some hills were my 'yardstick hills' and I regularly pushed myself on them.
One hill in particular that initially took me 25 minutes to ride up, I got down to 8 minutes of sustained effort on, and regularly was achieving sub 10 minute times for it in the last 6 months...

To that end I bought a new mountain bike, but have since decided they tricked me and sold me a hovercraft instead!
... As every time I rode it I was hovering between this life and the next!!

My surgeon told me that the condition I had was what his mob call a widow-maker and it was only a matter of time before I had a heart attack, and that I wouldn't have survived it.
Every time I went mountain biking (or climbing), there was a real risk I wasn't going to return, and I didn't realise it; but was thinking by default that by pushing my limits (literally the detonate button) harder, that I was improving my fitness / perhaps climbing grade / health generally!

Scary eh?

One of my wag cycling mates when he found out I needed a bypass, asked me "How long would that be good for?"
I replied "They told me 25+ years."
He then said, "Why settle for 25? Ask for a double bypass and go for the 50 year warranty instead!"

One Day Hero
4:21:23 PM
Hi Rod, glad to hear that you're out of hospital. Sounds like a pretty decent excuse for a bit of rest. Let me know if you're up canberra way anytime.

4:24:42 PM
Very happy to hear youíre ok Rod. I think a simple ďIím busyĒ would have been an easier way to get out of the Buffalo aid weekend;)
12:57:32 PM
Good 2 C your still in the climbing game M9 after your recent distraction.
Keep on keeping on.

2:25:00 PM
Glad you're on the mend Rod! All the best for a speedy recovery.

8:43:18 AM
Hope your recovery is still motoring along mate and that you're not floating away with all the rain up there?

8:48:34 AM
Thanks ODH, M75, gnag, Sabu and ajf.

Recovery is slow but noticeable, though I am fortunate as I'm only recovering from the surgical procedure and not a heart attack prior to it as well.

Improvement has gone from taking 5 minutes to 'walk' 250 metres around a hospital ward, to now walking 5 kms in about an hour, at a month after procedure.
Hills knock the walking times around, but this is also due the c0cktail of drugs that I'm still on, some of which lower the heart rate considerably, so on a sustained hill the lungs play catch-up trying to compensate,... not unlike gasping after an all out sprint,... an unusual feeling when one has just done the equivalent of walking up a couple of flights of stairs!
Some of the drugs finish when the supplied box/s runs out, and others will be longer term.

Artery bypass grafts are 'harvested' from your own body and my surgeon was careful to point out that if needed they would take additional arteries from forearm/s, or veins from leg/s, to do the repairs; as once inside they don't stop till all repairs that are required are done.

From a climbers perspective he said that if forearm arteries were used that I could expect a certain amount of tingling sensation and loss of feeling in fingers / hand (due reduced blood supply), but no loss of strength, of the hands - arm/s involved.
I don't think he is familiar with the climber terms of flaming out, or forearms feeling pumped...

In my case I did not require any additional harvesting, as the primary go-to arteries for this type of procedure are taken from inside the chest cavity, ie (at least for blokes), the mammary ones that supply blood to the nipples (redundant), as there are sufficient other arteries in that region to provide sufficient blood-flow to that area.
From my experience it leaves you feeling like your nipples have gravel rash and much of the central portion of your chest feeling numb and card-board-like, though I'm told that this will diminish over time.

From a statistical viewpoint, I've learnt that recent studies indicate a 20% less-successful rate for those who receive leg vein grafts, even though they are strong and sizeable enough.
I don't know but strongly suspect that the lower success rate is also aligned with the fact that by the time surgeons are using leg veins they are dealing with triple / quadruple / etc bypasses; ie the patient is likely in a category that would have less overall chance of full success (?) anyway...

Since starting a rehabilitation program at a local hospital I have also had my expectations of recovery time revised considerably.

Upon learning that part of the rehab consists of using pushbike style apparatus in a gym I was hopeful of at least riding my pushie (deadly?!), again on non-technical terrain at around Christmas time, as after all what's the difference cycling outdoors vs indoors?.
It isn't the exercise per se, it is any vibration or worse still, jarring, associated with it, that can undo the good work the surgeons have done.
Horror stories of patients whose chests may have remained wired together, but underlying muscle / overlying flesh, etc separating due vibration, with consequent additional recovery time and enhanced scarring, have me erring on the side of caution, ... as I'm in for the long haul!

So, for the first 8 weeks (preferably 12), the following limitations (amongst others) apply;
- no lifting anything heavier than 2 kg
- no pushing or pulling
- no placing of both arms behind ones back
- no loading of one arm above shoulder height ... (maybe not such a big deal to forgo, as I've never been great at one arm pull-ups anyway!! Heh, heh, heh.)
- no vibration or jarring (includes using ride on mowers and pushbikes!).

9:38:59 AM

Having such a procedure done is a notifiable (legality) thing regarding ones drivers license, with VicRoads / RTA.

The normal limitation is no driving for 6 weeks, though my surgeon indicated I could drive again after 4 weeks, as long as I tell my insurance company that he said it's OK, and provide them with his contact details regarding same.

Rehab told me that notifying them involves obtaining a form from them that requires signing off by my GP.
Once they hand me the form it starts the clock ticking and if they don't get the form back within 10 working days my drivers license will be automatically cancelled!
A Class 3 (heavy rigid / commercial) license has even tighter restrictions... Having a combined multiple category license also means that if cancelled then it affects all categories.

Not good when living in a rural area; as to get to/from the motor registry requires being driven; and rural GP's are often booked out for 3 weeks ahead, and this without the added down-time of Christmas-New Year holiday period thrown in as well!
Solution is to make the Doctors appointment first, then get the form; ... not that I'm likely to be man-handling a heavy motorcycle any time soon anyway!

9:48:45 AM
Holy shit dude! I'm glad you're still bopping around, even if it is slowly for the time being!
10:54:32 AM
Rod you are hard as.

3:30:17 PM
Thanks bc and ww&s.

Recovery is still progressing well with longer walks most days of up to around 10 km (on every other), much of which are done either briskly if flattish country involved, or steadily if steep, and I also wear a 5.5 kg divers-(weight)-belt during same to enhance the exercise value after Cardiologist approved lifting of the 2 kg manual handling limitation to 5 kg.

Now at the 8 week mark and Surgeon has basically said I can do most things if I listen to my body feedback and keep progressing steadily rather than rushing my recovery.
Climbing thuggish routes is still off the agenda for another 6 months and a final verification x-ray will be required to ensure the knitting has been effective beforehand.
Mountain bike riding is still off the agenda for another month and even then will be at a lightweight level when I return.

I mentioned in an earlier post about vibration in relation to riding; however the penny didnít fully drop for me until I returned an empty shopping trolley to supermarket just before Christmas. Until then I still harboured ambition to ride asap, but after feeling like I was chest-shot every time the trolley clacked over a pavement crack it came home strongly to me that it really is too early, and wouldnít be a good idea. I now harbour ambition to repeat a long walk-up-style Buffalo slab route like Noblesse Oblige earlier than arrival of upcoming winter, so as to still think of myself as being a climber!
My GP reckons Iím a Physiotherapists dream but a Cardiologists nightmare due to being one of those types of patients that is rearing to go to the next level all the time. I laughed and said I'm not looking for new levels, but simply wanting my old ones back!

As a side note to vibration; while hanging around Southern Cross Station for a return train home after visiting the Surgeon, I have a newly enhanced respect for the power of large diesel locomotives. Iíve always enjoyed the low frequency rumble that they emit, but being able to listen more hyper-awarely to that rumble within my chest is great!

Vicroads has approved my car and motorcycle license but will knock back my truck license unless I get a further (to GPís original report), Cardiologist report to them saying that my condition is stable and meets National Standards for undertaking of same, within the next month. Hmm, this constitutes another unexpected out of pocket expense...
Itís interesting that they didnít mention my marine license even though itís linked by the same license number...

Perspectives... They vary a lot, and as a couple of examples...

One of my mountain bike riding mates is having a coronary artery bypass graft early February due stenting in his case was unsuccessful.
I don't envy him at all even though I have a new outlook on simul-empathy(!); ... though he should get through it OK because he is a lot fitter than I am, especially so as he has recently returned from 3 months bicycle touring in Europe and was fitter than I prior to that.

While in reception waiting to see the Surgeon at my recent checkup, there was another chap there who was an amputee with one leg. He had a scar from ankle to groin on his remaining leg due to harvesting required for his bypass operation. He was accompanied by a younger fellow who appeared to be his son and who had a heavily bandaged forearm... It caused me to wonder if some patients require 'donor' relatives for additional grafts... I don't envy their situation either!

I'm doing OK, as many people don't make it into the 2nd chance club...

salty crag
6:36:13 PM
Wow Rod, not been on chocky much lately and totally missed this thread, first read tonight. Good luck with the recovery and keep posting, I for one have learnt a bit from your comments and insights.

8:24:04 AM
Just saw this thread, great to hear recovery is going pretty well! Hope to hear more adventures soon... (but not too soon)

7:17:54 AM
Thanks salty crag & gordoste.

Another month gone by so thought I'd give another update, but first a couple of clarification points of things alluded to earlier...

The time frame from my initial incident/warning sign to having a bypass procedure done, included 2 months of down-time due to waiting periods involved in seeing GP's in this rural area, along with having initial tests done, and waiting for results.
If not already mentioned, half the results came back indicating nothing out of the ordinary and due to that my Dr gave the OK for me to proceed with a pre-booked month long holiday elsewhere, after which I again saw her to get the results of the tests that hadn't arrived prior my departure.
As a side note, that holiday included considerable exercise levels surfing!

The reality was that without the down time, I went from not knowing I needed the procedure to having it done within a three week period, and this included having the Coronary Angiogram where the stenting option was ruled out in the meantime.

Additionally prior to seeing the GP to get the unusual heartbeat checked out, I'd recently had my annual health checkup which didn't pick up anything other than I was in good health.
That combined with the good results from the various tests afterwards led her to the opinion that I was OK, and it was probably dehydration on the day, so nothing to worry about...
I've been dehydrated before, a normal suffering undertaken on multi-day wall ascents(!), and suggested it was definitely not that; so to tick all the boxes, given the activities that I undertake and the remoter locations of same, she referred me to a Cardiologist.

At the Cardiologist's I had a heart ultrasound and a treadmill stress test where the level of resistance/pace is increased every three minutes while one is wired up with leads measuring diagnostics of blood pressure, heart rate, etc.
I had only just been ramped up for the second time and was still at a level where I could comfortably carry a conversation with her and which is way below my usual mountain biking exertion level, while she was watching a battery of screens of various outputs, and said to me, "Did you feel that?"
Me: "No, what?"
Soon after she again said "Did you notice that?"
Me again: "No, what?"

I could see the screens that were like a large TV format flat-screen broken into squares joined together, but something different outputting on each, and to my untrained eye could see heartbeat blips (as expected), but nothing that looked spikey or flat-line!
She stunned me by saying; "I'm pulling the pin on this test, as there are way too many unusual heartbeats in there for my liking!"

I was given scripts for a c0cktail of medications that effectively wrapped me up chemically in cotton wool; told I wasn't to ride my push bike or climb etc; and that she was booking me in for an Angiogram in Melbourne next week!!
After doing that procedure, that surgeon said he couldn't help me and I needed a bypass...

TimP earlier said on this thread, something to the effect that there will be no no stopping me now due to being supercharged by comparison to before, but to my understanding, that isn't quite how things work, due from a hydraulic perspective the heart circulatory system is a closed system, ie the pressure within it is predetermined by heartbeats maintaining a given pump pressure.

Without blockages the circulatory system isn't back-loading the heart, ie having it pump harder or more often to maintain pressure, but it isn't as if once blockages are bypassed that it will pump any harder than it is capable of or needs to do.

As I understand it, the additional stress on the heart by having to pump harder or more often to maintain pressure has mostly dis-benefits compared to any advantages.
The only possible advantage is that the muscular heart wall, particularly the left ventricular side may thicken and become stronger, so in future (after a bypass), doesn't have to work as hard to maintain pressure, but this is offset by the fact that under such stressing beforehand the heart swells / enlarges, which is a bad thing, as once it is no longer placed under such duress it resumes it's original size and can actually be 'floppy' (for lack of a better description) due having been overly-stretched, and this leads to inefficiency of performance in pumping with each heartbeat!

OK, so this leads me to the current period.
I've now finished a 7 week rehabilitation program at the local hospital, where apart from exercise and dietary information, the main thing I learnt was some of the many and various ways a heart can stuff up, both electrically as well as mechanically!

I was also pretty amazed at the spectrum of people going through the same program and the various levels of normality associated with their lifestyles. Of the couple of others who 'graduated' when I did, I consider myself light years ahead of them for fitness and think that they may never achieve my current level which I consider quite underdone at present; and to balance that out, I'm aware of others who make my current state appear pretty ordinary by comparison!

Sleeping on my side/s is tolerable for varying periods now without actually hurting.
Yesterday I mowed 'some' lawn and appear to have had no repercussions from it, though did require assistance starting the mower.

To my chagrin the hypersensitivity awareness of chest / heart that I had post surgery seems to have faded, as I was enjoying that. This started becoming noticeable at about week 7 and at week 12 I'm now largely back to my previously dull by comparison - take it for granted - level of awareness.
Fair dinkum, I swear that I was actually aware of my heart moving slightly in a rotational fashion with certain beats, at the height of my sensitivity. I thought I was imagining things and asked various cardio-experts about this phenomenon along the way, and actually had it confirmed that it is possible, as the heart is kind of free-hanging within the chest cavity.

Regarding awareness, I am now back in the realm of unknown re sorting whether a twinge here or a tweak there is actually procedure related, or normal muscular stiffness etc that is due to activity, and quite unrelated in any meaningful way to my recovery.

None of the potentially negative emotional side effects of what has happened to me that I was informed about, have been evident as instead I have found the process rather intriguing!
On a side note, I did have a very dejavu moment back when I was in hospital in early recovery, but making sense of such things is beyond my ken so I just accept such things...

I lent a bit of body-weight onto my arms overhead in initial chin-up position a couple of days ago to test how that feels, and it twinged sufficiently that I did not pursue the matter, so that kind of activity is still off in the future for the moment.

I'm about to go for my long awaited first push bike ride in 4 months, on easy ground, to see how that goes...

~> Listen to your body if it gives warning signals!

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