How Pushing to Extremes Led an Amateur Cyclist to Ventricular Tachycardia
cyclingtips.com
cyclingtips.com
On the other hand he does a great job describing the PTSD the accompanies the torture and pain the device can deliver. There's something psychologically unique to the fact that this device is embedded inside you, capable of delivering a horrific blow enough to knock you off your feet at a moments notice. From a PTSD standpoint it's as if your assailant is always with you, but permanently implanted within. You can't ever escape it, there's no opportunity to remove yourself from the environment or the factors causing the PTSD. You have to learn to come to grips with that, I've found that makes the recovery much more complicated.
Beyond that, glad to see the cardiac risks of extreme athletics start to get some public attention. There is a certain pull in extreme athletic circles to chase numbers, a sort of oneupmanship to push the limits of what the human body is capable of. Unfortunately at times it's not pretty when some find exactly what those limits are.
Edit: To give it some perspective, I was 31 years old when I had my device implanted.
He told the story in an almost comical way, and I nearly started giggling because of how I imagined this would seem to an onlooker. But I quickly realized how absolutely fucking terrified he would feel. I don't think I can fully grasp the long-term emotional impact this might have on somebody who forever knows they've always got that thing in their chest and that it's statistically the most likely way they'll exit he world.
Seems you have some idea of how to cope with that, but I bet a lot of people don't have those facilities.
My _first_ priority (in the back of an ambulance) with someone who had an AICD fire is to get some significant sedation on board. I've seen multiple patients where the the anxiety of anticipating another discharge is amping up their SNS enough trigger their arrhythmia (triggering another shock).
For starters, there _are_ ways to disable it externally, but they use a fairly specialized magnet. Secondly, even if they could shut it off, the patient isn't really in a position to know if it's shocking them for a legitimate reason or not. Shutting it off may simply shut their heart off...
Finally, the security properties of Bluetooth aren't exactly up to the standards I would like to see for a "can deliver a fatal shock to someone's heart" type device.
I got a little jolt when a patient knew hers was going to go off... so she grabbed my arm just before it happened. ZoT :/
I was shocked to learn that many weekend warrior friends have sophisticated doping regimes just to stay competitive on group rides. I'm not sure there is an answer.
I'm aware this isn't quite true, but in a large sense I truly believe I'm capable of learning anything given enough interest. And probably time
Of course, everything in moderation.
But I had ablation at 43. So it is not clear to me that it is about pushing beyond boundaries.
Certainly my story is anecdotal. But I guess I'm just saying that while bodies are amazing, sometimes they are amazingly frail.
It doesn't really make sense to tell people to be less competitive when pretty much everyone and everything else tells them to be more so.
The fact is, I don't care who you are, there are limits imposed on the 50 year old body. There just are. If you want to keep active, that's great, but what ever happened to being reasonable? Why is everyone in such a rush all the time to have more fun faster and harder than anyone else?
Maybe this is an artifact of civilization? Since we are no longer being chased by tigers we need to "fun" ourselves to death. Who knows.
To be fair, the article makes it clear that he never felt like he was "pushing" too hard before the incident. It may be he didn't notice his body talking to him, or maybe it just didn't until it was too late, which sucks. Everyone is different. I can tell you that I'm over 50 and have definitely noticed the effort and recovery challenges that accompany my age. I'm active and love to run, bike, etc. But it certainly feels different than it did when I was 15. I have to be reasonable about how much I do how fast.
Be reasonable, people.
There is a value to competitiveness but only if it's kept in check and allowed to operate in service to, rather than in replacement of, goals of self-actualization, self-betterment, happiness, kindness, etc.
It does make sense to tell people to question what society is forcing down their throats. How will society change otherwise?
Be your own man and control your ego. Life is sooo much better when you do something for joy, not because you feel compelled to impress someone else. "Look ma!" is for kids (and now, Presidents apparently).
I would re-label talent as "genetics". [0] There is a genetic profile of people who have the advantages of speed and endurance over mere mortals. [1] Then there is the rest of us. With respect to "drive and determination" I agree. Taking into account age (youth is another measure of fitness), no amount of training, preparation, conditioning or pharmaceuticals make up for this genetic deficit.
Reference
[0] For example the relationship between ACTN3 and sprinting: "Top sprinters may have key gene" (2003) http://news.bbc.co.uk/2/hi/health/3183119.stm
[1] "Physical Performance Predictors of Success in Special Forces Assessment and Selection" http://dtic.mil/dtic/tr/fulltext/u2/a245729.pdf
As cynical as it sounds, people who're motivated like this are not going to just give up overnight on something they've worked incredibly hard for several years, even decades. I've personally experienced some of this...
As cynical as it sounds, if they drop dead from a heart attack (or come close), they will (just give up overnight).
By better I mean with more finesse: a good challenge for example would be riding a tough trail without ever putting a foot down.
Mountain biking also adds an interesting element less present in road cycling, the need for traction control.
Pulling off a tough mountain biking climb involves controlling traction, over loose crumbly soil or roots and rocks. If you try to just mash it the rear wheel will only spin out and you'll blow the climb.
It's not necessarily the guy with monster quads who will be the best at mountain bike climbing, but the guy who can feel where his rear wheel is at all times, and how much traction it has.
http://road.cc/content/news/84948-judge-dismisses-lawsuit-ag...
I've never descended quite so aggressively since.
It might seem reasonable when you consider they spend kilohours riding, moreover in the company of other world-class athletes, but it's astonishing and terrifying to watch.
Of course, most of them also have war stories to tell, and all of them have shattered ribs, clavicles, vertebrae, pelvic bones at some point in their career. Because beyond the envelope there's nothing but injury and pain and occasionally and very tragically, death.
The very best bicycle descender of my personal acquaintance is a former Moto GP competitor. He has lightning reflexes and an amazing feel for the dynamics of any two-wheeled machine. I'm glad to say he shares his knowledge and occasionally runs free cornering workshops. My ability to read a corner has been greatly enhanced by his teaching, I think he saves lives.
Strava cyclists have also killed innocent pedestrians by sprinting through red lights in their attempts at bragging rights.
http://road.cc/content/news/89218-us-cyclist-who-killed-pede...
I do agree that many Olympic runners have a gruelling training regime though.
The same thing can be seen programming as well. Some people struggle for months to do basic things while others take to it like fish to water.
People don't like talking about how much genetics impacts things because it ruins the "you can be anything you want to be" BS
Hahaha, made my day! I know it's true, but it never stops making me laugh. I bounce between preferring "cat-6" and "cat-nothing" to refer to those guys.
The bigger problem is likely not solvable, I mean if you want to dope to win a race that isn't actually a race, we probably can't make you right. And to be clear, those people do have problems, they werent loved enough or something. Larry Bird described it best in his book, you can practice, you can select the shot perfectly, you can square up perfectly, and then you can release the ball perfectly, that's all you can do. The ball either goes in to the hoop or it doesn't and he sounded remarkably at peace with it all, which is shocking for how competitive he was conceived to be. Maybe that's easier when you've won everything like he had. I've raced bikes and it's very fun, at times very stressful, but mostly fun, when you're getting paid I understand the motivations are different but I find it hilarious when folks cheat to win nothing, it's like that cringe stuff that is sort of funny because it's so sad.
So why does the ICD strike without warning? Falling over unexpectedly is pretty dangerous even if you're just standing or walking, and can easily be crippling or deadly if you're older, as I imagine many patients are. Wouldn't it be a lot safer if it gave you some kind of warning so you can stop and sit down before the big jolt--a mechanical nudge or tiny tickle of current to some heart-adjacent tissue?
The reason there isn't more warning is that you want to shock VT before it degenerates into ventricular fibrillation, which is much more serious.
Your question about falls is a good one and it comes down to how much of a trade off you strike with risks of VT/VF vs risks of the shock.
Ahhh, the good old DC-DC converter whine: https://en.wikipedia.org/wiki/Coil_noise
Some get no symptoms at all and can just cook along like that all day. This doesn't happen often, but I do see it from time to time. Usually my first thought is "it's not V-tach," but we usually have a good telemetry record of it. Of course, telemetry is supposed to pick that up and sound an alarm, but it isn't perfect and there are rhythm alarms going off all the time.
It's a tricky situation sometimes. The ACLS guidelines are pretty good. They basically say: if someone with V-tach is "unstable" or having a lot of symptoms then shock them right away. That's generally the right approach, but it's a mean thing to do to somebody who's wide awake, but has some shortness of breath and a dip in their blood pressure. So depending on where the patient is (surgical unit, regular hospital bed, etc), some tricky logistical issues can arise (do you sedate them on the spot, which most doctors are uncomfortable doing; do you transfer them to another unit first,; do you call a code blue; do you call a rapid response team). It's why we can't put every patient into a perfect algorithm. You have to be a thoughtful human being to access the need for immediate intervention sometimes.
"An intensivist, also known as a critical care physician, is a medical doctor with special training and experience in treating critically ill patients. An intensivist completes a fellowship in critical care medicine after finishing a residency in internal medicine, pulmonary medicine, anesthesia or surgery."
An obvious conclusion is that the threshold for exercise-induced VT is variable across individuals.
There are lots of other genes linked to sudden death during exercise. Examples: long QT genes, hypertrophic cardiomyopathy genes. It's not hard to understand why they are rare. :-)
I decided that was a monumentally stupid thing to do and never did it again. I jog regularly, but never push it past a modest point.
However, it could see it having less accuracy with an activity with more arm motion, like running. And I have no evidence that my Polar sensor was very accurate itself.
But even if you're not using a HR monitoring device during your workout, being vigilant on your resting HR provides a good clue. Too high and you need to rest, whether from overtraining or illness.
But in my 43+ years of living, I've known enough of all of the above to come to think that the specific what of addiction matters less than the core pathology itself. The patterns are too similar across the board.
...
“For years it was like the hints were there in all the studies, and [researchers] always conclude that more research needs to be done. And they’re still saying that" ... "I’ve done the research, folks. It happened to me. I’ve had friends that are either dead or alive that it happened to. [Trust me.]"
No.