Welcome to my blog, detailing my recovery from a heart attack at the relatively young age of 40 (though I'm told it also happens to otherwise healthy younger people who were previously unaware of a hidden heart condition), and hopefully working towards getting back on the bike and to the level of fitness I'd worked so hard to reach prior to this episode.

The aim of this blog is partly to pass the time whilst I'm not allowed to work, cycle, or do anything much, but more importantly to hopefully help others who unfortunately find themselves in the same position as me, as my biggest frustration at the moment is the lack of understanding of where I go from here. How quickly can I get back on the bike? How many miles can I ride? For how long should I avoid hills? Should I ensure I keep my BPM under a certain level? If I get any chest pains whilst on the bike, can I have a couple of sprays of my GTN medication and then carry on riding once it takes effect? Even off the bike I have questions; what pains should I be worried about? When should I call 999? Is it just Asthma or my heart again? These are all questions I am going to be asking during my recovery, and will pass them on through this blog.

IMPORTANT! I am not a medic. Anything I write in this blog is from personal experience only, and includes advice given to me by my doctors etc. Please speak to your GP or other medical professional if you suffer any symptoms/pains, and don't assume what is written here, including medical advice given to me, applies to your situation also (or even mine, it's not guaranteed to be correct).

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Sunday 16th September 2018 - An Introduction

The first day of September 2018 started like any other, nothing out of the ordinary. Rob, my regular riding partner, and myself had planned a 50ish mile ride to a new tea rooms we'd seen during a ride on Bank Holiday Monday earlier that week, with an early start so as to be back by lunchtime in time for the Leicester v Liverpool game, and to spend the rest of the weekend with our families. I got up, had some porridge for breakfast (with added protein - I was taking things seriously now!), then got my bike in the back of my car and drove to Cotgrave, just outside Nottingham. Still nothing out of the ordinary, I felt fine, and was looking forward to the ride.

We'd planned plenty of hills, and tough hills at that. In 3 weeks time we'd be taking on the Altura Beast Sportive in Cumbria, 100 miles of Lake District hills and stunning views. We couldn't wait, but I knew I needed a lot more hill training before that.

About 8:15am we set out. Within a couple of hundred yards was the first hill of the day. It's the hill out of Cotgrave which a week later the Tour of Britain would follow. We ride this hill a lot, it's one of our favoured routes out of Cotgrave and into the Vale of Belvoir as it gets us warmed up quickly on chilly mornings, and out to where the nice Country roads are. It often takes it out of me a bit - I've never been great at hills, but especially at the start of a ride when I've not had time to loosen up the legs. However, this Saturday morning it seemed to take it out of me more than usual - I got halfway up and shouted to Rob "this feels harder than usual". My legs weren't too bad, but my chest was starting to ache and I was struggling for breath. I didn't think too much of it - I took my inhaler that I have for my Asthma and pushed on. The pain was behind the bottom of my ribs, and was dull, a bit like cramp.

Usually within a couple of minutes I've recovered from a hill and am back into powering along the flats. Not this day though, I simply couldn't catch my breath, and had this nagging pain in my chest. Thinking it was just a stitch, or cramp, or my Asthma being a little more persistent than usual, I shouted to Rob that I was going to stop for a quick breather to try and catch my breath and hopefully get rid of the pain. We stopped in the car park of a pub in Harby for a couple of minutes, and sure enough I'd caught my breath and the pain was gone.

 It's not like on TV  

We continued, but discussed skipping Terrace Hill (#29 in the 100 Greatest Cycling Climbs by Cycling Uphill) and going for a longer but easier one. Within a couple of minutes the pain had returned, as had my breathlessness, but I didn't consider with any seriousness that it might be anything to do with my heart. "It's not like on TV" I thought, where you always see the victim clutching their chest and falling to the floor in agony. It was hurting, but not that bad. I rode slowly up Stathern Hill (or so I thought, I actually achieved my 2nd best time ever up it), got to the top, then carried on.

About 25 miles in I finally started contemplating whether it might actually be my heart. I stopped at the top of another hill for another breather, but I didn't feel pain anywhere else, wasn't sweaty or clammy (well, no more than usual), and my heart rate according to my FitBit watch seemed fine (120bpm). I got off my bike and paced around a bit to stretch my legs, the pain went, so we continued again. After a few more miles I decided there was no way I was going to be up for the whole ride, so we stopped at an earlier tea rooms for a longer breather. We then took the shortest most direct route back to Robs, where we sat down to watch the football. We totalled 42 miles on the ride, with 1,675ft of climbing at an average of 15.6mph. I even managed a few personal records, including up hills. You can see my ride below.

For a while I felt fine, but then part way through the first half of the match I started to feel really uncomfortable - not pain as such, just uncomfortable, like indigestion or something. It started to get worse and moved up into my throat. At this point I tossed a virtual coin in my head - tell Rob to dial 999, or go home, rest up and see if it subsides. As right at the start of the ride, I took the wrong option, and I went home, carefully. If I were to end up in hospital I'd rather it be in Leicester than Nottingham, as my wife and 2 daughters (aged 8 and 13) would find it difficult to get to Nottingham as my wife doesn't drive. I started to feel a bit better, then stopped and bought some Gaviscon, which seemed to clear it all up. Phew, I thought, it was just heartburn or indigestion all along (a common mistake apparently). But with this big Sportive coming up in a few weeks time I thought I'd best get myself checked out anyway, and made an appointment with my GP for Monday evening after work.

Monday morning I went to work as usual. I felt fine all day, except maybe a bit more breathless than usual at lunchtime when I went out to grab some food.

 A Horrible Dream  

I then went to see my GP that evening. The first thing she did was give me a blood pressure test, the next thing she did on seeing the results was to refer me straight to the Clinical Decisions Unit (CDU) at Glenfield Hospital. This was the point I started getting concerned, but was still fairly adament that I had not had a heart attack - if I had how could I ride 42 miles with it?? Even the first doctor to see me there said the same thing - if it was a heart attack it would have likely stopped me in my tracks. They put me on an ECG and took blood tests. The next doctor who came to see me was very blunt - "Mr Cox, your blood test has confirmed you have had a heart attack." At this point most of the rest of what he said was a bit of a blur, just a few words stood out including "Angiogram", "Stent", "Bypass", "Risk", "Stroke", "Death!!!". He then walked away, and I tried to go to sleep to pretend it wasn't happening (though there was an emergency going on at the time, with doctors and nurses rushing backwards and forwards attending to another patient who it appeared was in a bad way). I also kept trying to wake myself up, thinking (hoping) it was a horrible dream, but one that would jolt me into action in terms of eating more healthily.

After a couple of ward moves, I spent the next week in hospital waiting for a place on the list for an Angiogram. I felt fine, no different to usual. I was frustrated - I live 10 minutes down the road, why am I stuck in a hospital bed when I could be waiting at home and then pop back in for the test once I've got a place? Slowly it dawned on me that I was actually in the right place, and the reason I felt so normal was probably due to the medications that I was on. I was also being monitored; for most of the week I was hooked up to a heart monitor (though that was removed after a few days as it wasn't needed), and I was having my blood pressure taken twice a day and regularly stabbed in the stomach for blood thinning injections. If I did have another attack, there was no better place to be.

The lists for each days Angiograms were decided the previous evening, and were usually communicated to the patients about 6pm. On the Wednesday a doctor visited the chap in the next bed to me and told him he was on the list for the next day. I hoped he would come to me next, but he didn't, so I knew I wasn't on the list. The frustration grew. Thursday came and went, still not on the list, so at that point I knew I'd be in for the weekend at least. On the Friday, after what seemed like over a week in hospital (but was actually 4 days), a doctor came to me and confirmed I was first on the list for Monday afternoon. He advised that if it was clear and I didn't need anything doing, or I just needed a stent, then I could be out that night or the following day. I was overjoyed, finally a light at the end of the tunnel, though it also meant that I would be in hospital over the weekend, and it was the end of my (very faint) hopes of watching the Tour of Britain from the side of the road and the hill that put me in there.

The weekend passed slowly, but finally the time for my Angiogram came. I wasn't nervous at all, until I was actually laid on the bed with my right arm twisted into position, and could see all the doctors and other staff making their preparations. Usually, I'm reliably informed, this is a simple and relatively painless procedure - certainly the guy in the next bed to me came back no worse for wear. Unfortunately in my case it wasn't the most straight forward procedure they'd done, and they had to get a more senior surgeon down who took over and, in his words, "used brute force" to thread the catheter through from my wrist to my heart. At one point I was given some mild sedative to take the edge off the pain. Then came the verdict - I had one narrowed artery, and I would require a stent to open this up and allow blood to flow more freely again. I was relieved that I didn't need a bypass, and that it was just the one artery, but mostly that they'd found the problem and could fix it. They inserted the stent there and then, though even that took a few attempts. Due to the difficulties and the fact I had to have some mild sedation I was told I would need to stay in overnight.

Finally on Tuesday I was discharged, a bit sorer than I was when I went in but clearly in a better way.

Unfortunately on Thursday evening I ended up back in again, though this time at Leicester Royal Infirmary A&E after suffering dizzy spells and light headedness. I'd taken my own blood pressure measurement and passed this onto the NHS 111 service, who recommended I go and see an out of hours doctor as my blood pressure had now gone the other way and was too low. The doctor in turn sent me to A&E for another ECG. Thankfully after a night in there I was given the all clear, and just had to have one of my medications reduced.

It's now just over 2 weeks since my heart attack, and a week since my Angioplasty procedure. I feel ok, but if I go for a walk it does take it out of me a bit - I get some discomfort sometimes, though usually in my stomach, like a heavy or bloated feeling. I sometimes feel like I could get on my bike and go for a short slow ride up the road and back, but know I have to be patient and look after myself - doing anything just yet would be stupid (even if the doctor did tell me I could get back on the bike as soon as I feel ready).

I've not had an appointment with Cardiac Rehabilitation yet, but will be chasing one up this week as I feel I need loads of advice on where I go from here, particularly the questions I've listed at the top of this page.

  Respect and Thanks to the NHS

I'd like to add that I have nothing but gratitude and the greatest respect for the NHS staff who work tirelessly to provide the best care possible to their patients, despite the well documented issues they face. After my first full day in hospital I was astonished to see a young nurse still marching up and down the ward dealing with patients after an 11 hour shift (and more to go), with upmost professionalism, and an almost constant smile on her face. She wasn't the only one, all the other staff were amazing. I owe a massive thanks to them all.


Monday 17th September 2018 - Annoying Pains

It's been a week now since I had the stent procedure, but I've been concerned for numerous reasons. Firstly the medication - I've been suffering from my Asthma a little more than usual, and am having to take my inhaler every day, whereas previously I only needed it on odd occasions. This I thought might be down to the daily Aspirin (which generally they say not to take if you suffer from Asthma). Also, even slow walks are leaving me feeling under the weather, with pains in my stomach and back and also spreading into my chest, so I've had to take my spray a couple of times. I therefore made an appointment with my GP this afternoon to go through a few things.

It was a useful visit, partly because it turns out my GP works at the hospital a couple of days per week in the Cardiac unit, so he knows his stuff. He put my mind at rest a bit about the Aspirin and Asthma, explaining that he's not too concerned as I'm managing it with the inhaler, it's important I keep taking the Aspirin, but we can just keep an eye on the Asthma.

He also cleared up a bit the types of pain I should be concerned about, as I've been getting lots of short sharp stabbing pains all over my chest as well as my stomach and arms. These aren't anything to worry about apparently (but please see the important note at the top of this page), and are just muscular, the pains I need to be concerned about are the heavy/tight/dull pains across the center of my chest.

However he was concerned that I have also been experiencing these dull pains in my chest on short walks, and has upped the dose of one of my medications (which it turns out should be done after a week anyway, and again after a further week, until 4 weeks when I should be on the maximum dose). He was also concerned that the hospital reduced one of my other medications last week when I was in A&E - this medication apparently helps the heart to recover and repair itself, so I should be on the higher dose. Apparently he'll do this once my current batch has run out.

He also re-iterated what I've already been told, if I get these pains, I should sit down and spray my GTN twice under my tongue, wait 5 minutes, if the pain persists repeat this. If after another 5 minutes the pain still persists, call 999. He stressed in no uncertain terms that I will not be seen as an annoyance if I keep dialling 999 for chest pains after having a heart attack! I still can't help but wonder when I get the pains though whether it's nothing, just indigestion, or pain from the procedure itself, and should I just wait and see if it spreads which is more of an indicator that it's something more serious (my thoughts, not medical facts, again please see the important note above). I know this is the wrong way to look at it though, as if I wait until it spreads, that delay could potentially cause more damage to my heart.

It is frustrating and a bit of an early setback, as I'd been told by several people who have been through the procedure that you immediately feel better than before. The pains disappear the minute the catheter is pulled out of the arm, and you feel fitter than in a long time. I thought within a couple of days I'd be back at work, a couple of weeks I'd be back on my bike, and a couple of months I'd be back to the level of fitness I was at before the attack. Maybe that's true in many cases, but at the moment I don't feel like I'm close to any of this (though I am hoping to maybe start working from home soon to gradually get back into it).


Thursday 20th September 2018 - First Signs of Recovery

Yes, today I may have seen the first real signs of recovery

This morning I decided it was time to get out for a walk. I'm targeting a couple of short, steady walks each day for the next few days to test myself out a bit, if I'm feeling comfortable I'll up the pace a bit, then the distance. I'd then like to be trying out my first short bike ride early to the middle of next week, but one step at a time.

This mornings walk went well, it's the first I've done where I've not had any adverse effects - no pains or breathlessness, no need for my GTN. It was just under a mile, but when I tried the same walk on Monday I was only a couple of minutes in when the pains started, so this is a massive improvement.

The only disappointment from the above walk was that Strava didn't use my heart monitor, even though it is linked. So this afternoon I decided to try again, this time using the Samsung Health app on my phone to record the walk, then sync that through to Strava. This worked a treat - it was another 0.9 mile walk, and again no pains, so almost 2 miles walked today without an issue.

Tomorrow I aim to do the same again, probably a similar pace in the morning, and if that goes ok then I'll try increasing the pace slighty in the afternoon.

The light at the end of the tunnel did seem to go out for a while this week, but it seems it's been switched back on again - suddenly I can start thinking about getting back on my bike again, though I have a few hurdles to get over in the meantime.

Monday 24th September 2018 - Back to Hospital

Another trip to my GP, and another referral to hospital.

This time it was due to a pain I've been experiencing down my right hand side and around to the top-right of my back. It's a sharp pain, so I'd been told I don't need to worry about these, but it's gone on for a week now, and seemed to be getting progressively worse. It would be fine in the morning when I first got up out of bed, but towards late morning I'd start getting twinges in my back, it would keep getting worse, then my side would hurt when breathing. By evening it was really painful just to move.

So I went to see my GP. He carried out the usual checks; blood pressure fine, temperature fine, listened to the breathing and all clear. However, he was concerned that it might be something that has happened during the Angioplasty procedure to insert the stent, particularly as it was a difficult procedure that required some "brute force". Some of the conditions he was suggesting were quite scary and had me a bit worried, and he referred me straight back to Glenfield Hospital.

At the hospital I had all the same tests as when I first went in a few weeks ago following the heart attack. I had a couple of ECG's, a blood test, blood pressure, and a chest x-ray. Thankfully everything came back clear this time, and it was suggested that the pain is just muscular. I'm still getting it today, and it's starting to get worse again as I type and becoming quite uncomfortable, but at least I know it's nothing serious.

It did turn out to be very useful in the end anyway. I still had concerns in the back of my head about the pains I was experiencing, the slight problems breathing due to my Asthma, any sort of discomfort when walking. However, the fact all tests have come back clear, and show that I've not suffered any repeat episodes from my heart, really sets my mind at rest, and gives me the confidence to move ahead with my recovery and exercising.

Tuesday 25th September 2018 - Back on the saddle!!!

I said above my confidence has increased with my latest visit to the hospital didn't I?

Today I decided I was ready for a short ride on my bike. I'd planned 1 mile, just up the road and back, no hills, just a steady pace. However, once I got out and started riding I didn't want to stop

I managed 2.9 miles in the end, I wanted to stay out longer, but knew I had to be sensible and take it easy. I used my heart rate monitor for the first time on the bike, and averaged 104bpm (max 125bpm) - a bit higher than expected, but I didn't experience any pains or breathlessness so I'd assume this is fine.

I enjoyed it so much, and felt so good afterwards, that I've even now set myself a target of my first sportive since my recovery (albeit a small one). Evans Cycles have a local ride coming up in mid-November, with different length routes including 19 miles and 30 miles. I feel by then I could manage the 30 (but certainly not the 50 or 75 mile routes), but might need to be sensible and go for the 19 miler.

Tuesday 16th October 2018 - It's been a while

Ok, so it's been a while since my last post. I'm back at work now, though working from home most of the time with a couple of half days per week in the office as part of a phased return. But it's left me with less time to update this page.

As well as starting bac at work, a few other things have happened since my last post. I managed to get out on a second ride, this time 7 miles. Again it was flat and steady. I had no ill effects - no pains or breathlessness, just an easy ride. I didn't even break into a sweat. However, on speaking to a Cardiac Rehab Nurse, I was advised that I was overdoing it. I should be going no more than 5mph as a warm up, and a maximum of 11mph. At 5mph I'd fall off!

Following this confidence killer, I decided to invest in an indoor trainer, to which last weekend I fitted my mountain bike (it's knackered, and requires a lot of work, including brakes, so I'm not too bothered about wearing out the tyres on it). Unfortunately I then caught a bad cold, which appeared to go to my chest and set off my Asthma so I've not had chance to use it yet.

I am aiming to get started on it this week though, and have signed up to the 300 mile Cycling Down Dementia challenge so need to get in some miles over the next 3 months.