"Well, that'll be a good thing."
"I've never not completed a training run before. No matter what. Surely there must be something wrong? It can't just be the heart rate monitor."
"Maybe it's psycho somatic?"
"Yeah. I don't think so. I just feel bleugh. Awful. I don't just think it's jet lag."
Somewhat perversely my biggest fear was what if I was making a fuss over nothing, as I rode pillion on the back of Mrs R's shiny red scooter, cradling a surprisingly relaxed Jack on my lap. He stuck his tongue out, catching flies, and let it flap in the breeze as we headed back home.
I'm not sure what I had expected when I headed out early that morning. It was a glorious day, already warm at 6am, when I rose and put on my heart rate monitor, linked to my Garmin. My resting heart rate was 170 beats per minute. I turned it off and on again, and got the same result. But I felt ok. A bit tired maybe, but then I had only arrived back from New York late in the afternoon the previous day.
I had noticed a problem with the heart rate monitor in New York. A friend was there for a bike race, and I was training for the Ironman, so I rented a bike, probably made of lead, and attempted to keep up with him on his fancy carbon fibre job. My pulse had begun the day at 170 and stayed there or higher for the duration of the ride, but I hadn't felt any side effects. I was just annoyed because the heart rate monitor was new - 75 Euros worth. I assumed it was broken. Ok, I got tired later in the day, and I noticed my pulse was quicker than normal, but I put that down to a stressful lead up to a stressful business trip. I had spent just over 3 days in NYC, and had been travelling for the 10 days to two different countries before I arrived. My normal regime on a business trip is to sleep 4 or 5 hours a night, monitor the European market open (about 3am NY time, answer emails for an hour or two, go for a run or to the gym, and then have a day full of as many meetings as I could cram in, before heading out to a boozy dinner with clients or prospects. I subsisted on snatched sandwiches, coffee, adrenaline and alcohol. This trip was no different. I felt rough, but then I always do. I could recover when I got home, I thought.
Turns out that I was right, but not in the way I thought.
After dropping Jack at home, Mrs R took me to Urgences at the Princess Grace hospital. I was still in my sports kit and wearing the heart monitor. I explained in my best, breathless, French what the problem was. I had been for a run, gone a paltry distance for me, sat down, and couldn't really stand up any more. And my heart rate was still 180 bpm in the waiting room, sitting down.
Within a minute or two I was taken in to a cubicle. I explained the problem again to a paramedic, elaborating I had just flown back from a business trip. I said I wasn't sure whether it was the HR monitor, or me. I was quickly attached to an ECG machine, and as she grabbed at the paper spewing out the bottom there was an "oooh la la".
Turns out that my concerns about over reacting were misplaced - there was definitely an issue with me. Although that then gave me something else to worry about. My heart was in arrhythmia, beating erratically and fast.
A cursory once over from the Dr on duty in Urgences, with the associated questions about drug taking "Are you absolutely sure sure, Mr Rolfe?" Raised eyebrows when I shook my head for the fifth time.
I shook my head again.
"Ok, well you will have to stay with us for 24-48 hours, Mr Rolfe. In 50% of cases these things fix themselves and we never find out why it happens."
She still didn't believe me about the drugs thing.
"And don't worry, we test for drugs." She didn't say, but might as well have done. Luckily I had nothing to hide. They did check my blood. Twice.
A few minutes later I was having a drip inserted, blood taken, gown slipped on. On my right wrist they attached a plastic wristband with my name, date of birth and barcode, and was then wheeled on my stretcher up to the Cardio Ward and room 1113 / bed F (for Fenetre / Window, to distinguish from bed P, for Porte / door), which was to be my home for the next seven days. Periodically I checked my pulse and could detect a definite irregular heart beat.
8am Saturday morning. Not the best time to get admitted to hospital. It quickly became clear that the initial expected 24 hours would be more like 48 hours in hospital, until the cardiac specialists came back on duty Monday morning. In the meantime I was put on blood thinners and some anti arrhythmia drugs.
I had some visitors to break things up. Mrs R came in with a small bag of clothes. As I was hooked up to a drip and a wireless heart rate monitor the hospital gown was the most practical top half. I found Bermuda shorts the most practical bottoms. My room had a great view, but the windows did not open and it was a very hot day. It was sweltering. The electrodes kept falling off me as I perspired in my bed. Father Walter came to chat and say a prayer.
Sunday arrived. At 4am. I was woken pretty frequently either by my grumpy roomie or a nurse to check one or other of us, but at 4am I was shaken awake.
"Mr Rolfe, are you ok?"
"Not really. It's 4am and you're waking me up. Again."
"You feel ok?"
"Ok, go back to sleep." So I did. Turns out my heart had stopped due to the drugs I was on. A "pause" it was described as. I don't remember it, and apparently my heart continued after a short rest. It was not the last "pause", but fortunately they took the same form as the first - I was asleep, and blissfully unaware.
Number One's 15th birthday was the Sunday. I texted her happy birthday, and they came to visit me that afternoon with a cake. I was allowed out to the garden, drip and heart monitor still attached, with special dispensation from the Dr in charge. We lit some candles and sang happy birthday. It was fun, but also quite sad. I had two slices of cake. The meals in the hospital were hit and miss. Lunch had been a definitive miss. Some grey meat in gravy with pureed celery. Later on that day I had one of the best omlettes I have ever tasted. Go figure.
Naps, visitors, checks from nurses. Someone brought chocolate, another trail mix, and I caught up on sleep and tv series. It wasn't all bad, although I was confined to my room. Any attempt to leave it brought consternation from the nurses and a firm finger pointing me back to 1113 F. And no, I wasn't allowed a shower.
Monday. I was getting more practised at going back to sleep after the 6am blood pressure, pulse and hydration checks. Brekkie at 8. At 10am I saw a cardiac specialist. My ECG, ultrasound and consultation would all be taking place on Tuesday. I definitely had Atrial Fibrillation, but I also had tacchycardia and something else which could be related to somewhere else in the heart. And my heart continued to "pause".
More naps, visitors, text messages. A lot of text messages. I had to let the guy I work with know that unfortunately I wouldn't be in the office for his rostered day off the following day. I looked wistfully out the window at one of the hottest days of the year as I quietly waged air conditioning war with Victor Meldrew in the P bed. Every time I went to the loo I would turn it on, my actions shielded by the door. The room would cool down to a temperature just about bearable where the electrodes wouldn't fall off me. As soon as he noticed he would turn it off, surreptitiously. Electrodes would start falling off again. At least I was allowed a shower eventually - taking my drip on a stand with me. One of the wheels was broken and it kept twisting, almost pulling the drip out. The tube filled up with blood, but I wasn't allowed to just carry the bag, I had to use the recycled shopping trolley.
Tuesday. Victor Meldrew checked out. They had made sure he was ready to check out at 5am in the morning. Lights on. Blood pressure. Blood taken for tests. Dr with stethoscope. I turned over in a pool of my own sweat, cursing as the iv drip pulled causing an intense pain in my arm. I moved the the heart monitor out the way, and looked forward to breakfast.
Just as I finished my Corn Flakes I was summoned to the examination room, a short walk away. Yippee! A walk! Albeit with the drip trolley, but a walk. My ultrasound showed an underlying healthy heart but with a variety of electrical issues - Atrial Fibrillation, Taccycardia and possibly something else. ECG the same. Essentially the nice regular and uniform hills on a normal print out were not apparent on my print out. There were irregular hills of varying size and shape. But occasionally there would be a violent series of massive spikes and troughs, four or five at a time. This could be AF or something else. Back to the ward to have an additional monitor fitted for 24 hours. Two heart monitors and the drip.
I tried to catch up on sleep. If this carried on I would be entirely nocturnal.
Later on the consultant came. I asked what had caused the problem, and she explained that athletes have a higher likelihood of AF than other people. But alcohol, coffee, lack of sleep and stress are also triggers.
I asked whether I should give up sport and she patiently explained that AF is a quality of life issue. It makes you feel bad, and you don't sleep as much or as well, but it does not affect longevity.
Unless you have a blood clot. These occur because the heart is not beating efficiently and the blood pools. Once the heart starts going again, and most AF's seem to settle down with no outside intervention, the clots move to the brain and there cause havoc. Hence the blood thinners. I had clearly been in AF since at least the previous Thursday and my heart was not fixing itself and nor were the drugs helping. I had also flown long haul.
I would therefore need some help fixing my AF. Depending on the results of the second heart monitor this would be cardioversion - the jump leads, essentially shocking the heart, or an ablation - cauterisation of some of the electrical synapses around the heart.
Back to the sport. A lot has been written by Dr Google about sport and AF. Possibly spending a long time at higher heart rates meant that the heart would misfire and go into AF. However, exercise brings down the resting heart rate which can help prevent AF. Sitting on the sofa and doing no sport will result in a higher resting heart rate and could bring on AF in people susceptible to AF. I was told that in all likelihood I would have got AF at some point no matter what lifestyle I was leading. The consultant mentioned age 45 to me. Only a couple of years from now, anyway.
There is also a quality of life issue. Sport helps longevity, but it also helps the mental state. Asking someone who is at least partially defined by their chosen sport is not an option. Endurance exercise has been linked to better concentration and higher intelligence. It has helped arthritis sufferers and cancer patients in clinical trials. We sat down and went through a typical week's training. And a race plan. Her conclusion was that I should carry on. Mainly because it made me healthier and happier than not doing it.
To paraphrase Dr Google, a healthy heart is a happy heart.
Wednesday. Einstein was woken up at 5.30am for tests and checks. And so was I. At least he didn't object to the air conditioning and all 12 electrodes had stayed on in the night. He was wheeled out whilst I kept my fingers crossed for some good news and tried to nap until the Dr came around.
The second heart monitor was removed, and I was allowed a shower. When I came back Einstein had been replaced by another fellow, just coming in from intensive care with arrhythmia. He was a kindly 85 year old from Roquebrune. I worried a little about Einstein - there was checking out and checking out. As my new roomie commented dryly, you always leave hospital, just not always upright.
I waded through Series 1 and 2 of Broadchurch, and munched on supplies donated by very kindly visitors, chatting occasionally to my roommate. We got along but there was a definite language barrier. Finally the consultant came around and confirmed that I would be having a cardioversion the following day. They would put me to sleep, stick a camera down my throat and check for thromboses. If everything clear, then they would shock my heart - giving it a reboot. Hopefully that would put it into normal sinus rhythm. The procedure was colloquialised as a "shock" and seemed routine. Although I didn't ask, the credentials of CHPG to deal with arrhythmia were also proffered - they are one of the leading units dealing with arrhythmia in the world, publishing more papers than anyone else and consulting to other units.
My fate sealed, I went back to my dvd and an apple after filling in several hundred disclaimers. On the plus side, they took my iv drip out and I only had to wear one heart monitor for the night.
Nil by mouth from 8pm on Wednesday evening with a procedure scheduled for some time on Thursday morning. I picked at my plate of boiled spinach and ham, drank some water and switched my lights off at 830pm. I slept until 4am when I was woken by the nurses preparing for the shift change and checking I was still alive. In turn I made sure my roomie's chest was rising and falling. Normally quite a "vociferous" sleeper, he had been unusually quiet during the night.
By the time 1130am came around my mouth was drier than the Sahara desert and I was contemplating eating the plastic sheet from my bed. Eventually they wheeled me to the operating theatre, the porter organising a five a side football match and stopping to recruit everyone he met on the way. Would be far more than 5 a side.....
The theatre staff looked like they were about to clock off when I was wheeled in. There was a scrum of people discussing something in hushed tones, by the door. It was also bring your child to work day, being a public holiday, and a couple of kids slouched against the wall looking bored. The porter reminded the people in scrubs they had one more "shock" to do before lunch. They looked as hungry as I felt.
One more blood pressure check and I was arranged into position with another iv inserted, and a brace to hold my mouth open for the camera. Pads were stuck to my chest and back for the "shock". No sooner had the anaesthetist injected something into my iv than I was asleep.
"Put me back to sleep; I was having the best dreams. You were in it..." Apparently I said as I came around, pointing at one of the nurses.
My chest felt like it was supporting a house, and I had a visible scorch mark where the patch had been stuck to my skin. Very woozy, I lay there listening to the gripes of the theatre staff, as my blood pressure and pulse recovered. An hour later I was back in my room, heart monitor on, drip attached, begging for something to eat and drink. It was about 2.30pm. I had been unconscious for the better part of an hour, and felt pretty beaten up for the rest of the day. A late night visit from the consultant told me the procedure had been a success and I could go home the following day.
It was difficult to hide my euphoria from my roomie at the thought of leaving. He was similarly keen but was going to be spending the weekend there despite his arrhythmia settling down with drug therapies.
I was to take a couple of arrhythmia drugs, and blood thinners to prevent clots, for the next 30 days, and to come back as an outpatient on 25 June. I was free to gradually ease back into sport, but not to stress the heart too much, keeping it in very low thresholds. Alcohol and caffeine are a no no until 25 June. Both are triggers for AF and should be avoided as a general rule anyway. I should try to avoid stress and get more sleep.
The likelihood is that if it happens again I'll go straight to an ablation.
There is a wealth of information on Google about Atrial Fibrillation, and it is possible to prove virtually any point of view if you search long and hard enough. Certain people have tried to tell me that my chosen sport is to blame. Is that true? It strikes me, given what I have been told by the experts, as extremely unlikely to be the sole factor. My consultant seemed very interested to hear that my father suffered from AF when he was only a couple of years older than me, and has had infrequent instances since.
However, as I have mentioned before, the thought of giving up my chosen sport would actually be counterproductive. I get so much pleasure out of it, not to mention the fact that it has almost come to define me. And when I look back at what I used to look like before I took up sport....it doesn't really even bear thinking about. Endurance sport has also been proven in medical studies to hold depression at bay. It becomes a quality of life issue. Do I want to have a long and miserable life? Or risk shortening it a little bit in return for a much happier and fulfilled life?
So, I have got myself a wrist mounted heart monitor that I wear all the time. I am nervous, not to mention a little frustrated and annoyed. I only really picked up the issue in the first place because I was wearing my Garmin for sport anyway. I went out for a little jog/walk with Mrs R and the dogs on Sunday, and enjoyed it thoroughly.
As a by product of my HR monitor, it has a pedometer and in line with popular perceptions it is targeting 10,000 steps a day for me to be healthy. I went back to work on Monday, and put my monitor on as I got out of bed and did not take it off until I went to bed that night. I covered 2900 steps during the day. The whole day.
My heart rate also fluctuated dramatically during the day. At one point it was higher than 150bpm. Sitting down. I work from 7.45am until at least 6 pm every day and don't leave the office except to pick up a sandwich. Unless I have something delivered. Which is often. So I lead a sedentary life with periods of high stress. I wonder where I would be without sport.
I hark back to my third CHPG roomie's comment about everyone leaving hospital at some stage. Either standing, or not. The crematorium was all that stood between my window (bed 1113 F) and the Stade Louis 2.
Today I ran a little longer. I kept my HR below 125 bpm the whole time. I enjoyed the view, the fresh air and my time with Jack.
Tomorrow I might go a little further still.