Mini stroke post exercise?

[Patsman07]

I met with my cardiologist today. It was my annual check up which luckily came soon after the events described above.

As you suggested Pellicle, he was none too helpful with regard to the source of the clot. He is confident that my valve is fine. I mentioned the article about the microclots etc+He wasn't too interested. Don't think he'd heard of it before.

He insisted that there was no reason why I shouldn't get back cycling and my temporary amnesia could be dismissed because it didn't last long. I asked was intensive cycling/ exercise alright+He reiterated that it was. Also seemed too imply that my stroke was virtually a non event as I have very little lasting damage+he couldn't see anything on my mri.

In one way I'm relieved that he seemed to think there's nothing to worry about although I won't take his advice too literally and I will only do moderate exercise until my fear diminishes.

On the other hand, it's a worry that I'm in such an incredibly small minority- mechanical aortic valve&exercising intensively&have had stroke like symptoms. As a result of this I'm getting different advice from different doctors.

Suppose that's what makes these forums so important.

 

[pellicle]

Hi

I met with my cardiologist today. It was my annual check up which luckily came soon after the events described above.

As you suggested Pellicle, he was none too helpful with regard to the source of the clot. He is confident that my valve is fine. I mentioned the article about the microclots etc+He wasn't too interested. Don't think he'd heard of it before.

well they have a bunch of hoops to jump through to fulfil professional development to stay registered, I'm willing to bet though that the information we discussed would fall under hematology , just like AntiCoagulation Therapy (he'd probably say that's not his specialty)

Just like in Rugby, beware of the dummy (buck) passing...

He insisted that there was no reason why I shouldn't get back cycling and my temporary

well that part I'd agree with ... if you have a GP that you trust you could work with them and do some blood tests to look for d-dimer enzyme traces.

As well I'd probably commence a baby asprin a day before an event (and perhaps steer your INR up too) and drop it off after.

Probably not an issue for "regular training"

.... Also seemed too imply that my stroke was virtually a non event as I have very little lasting damage+he couldn't see anything on my mri.

that's a positive thing ... it was perhaps just a TIA of some sort

https://en.wikipedia.org/wiki/Transient_ischemic_attack

won't take his advice too literally and I will only do moderate exercise until my fear diminishes.

I would agree with that, but I'd also seek information rather than just "build up confidence by absence" ... those tests I mentioned will give you information (even negative results assist diagnosis by deduction), and information is power.

As a result of this I'm getting different advice from different doctors.

all you ever get from a medical professional is an opinion ... how informed it is varies.

Best Wishes

 

[Patsman07]

Pellicle, in the example you gave of the ex marine, for you know why he was restricted to 160 beats per minute? Would any extra 30 beats per minute really make that much difference in the blood pressure?

 

[pellicle]

Pellicle, in the example you gave of the ex marine, for you know why he was restricted to 160 beats per minute?

He kept meticulous notes of his training and over time he observed this correlation.

Would any extra 30 beats per minute really make that much difference in the blood pressure?

It's not the blood pressure , I suspect it's the combination of far more "whacks" on each molecule (read those key points again) and that they are more likely to circulate more times at higher heart rates (which is the point of the higher heart rate, to circulate the blood faster and exchange CO2 for O2 faster).

​​​​​​What is your objection to my proposal? (I mean from a critical analysis point of view)

 

[pellicle]

From post #3

IMPLICATIONS FOR THROMBUS FORMATION
In the vicinity of mechanical aortic heart valves, where peak turbulent shear stresses can easily exceed 1500 dyne/cm2 and mean turbulent shear stresses are frequently in the range of 200–600 dyne/cm2, and platelet activation and aggregation may readily occur.

Data indicating that shear-induced platelet damage is cumulative are particularly relevant to heart valves.

During an individual excursion through the replacement valve, the combination of shear magnitude and exposure time may not induce platelet aggregation. However, as a result of multiple journeys though the artificial valve, shear-induced damage may accumulate to a degree sufficient to promote thrombosis and subsequent embolization.
...

 

[Patsman07]

I have no objection, I suppose my question is; why was 160 beats per min chosen? Why not 150 or 170?
Was it just a process of elimination, a case of trying higher beats per min, but this was the highest he could go to without causing any symptoms?

Furthermore, as I understand it, platelets regenerate every week, so presumably the cumulative effect is limited to a rolling 7 day period?

 

[pellicle]

Hi

I have no objection,

I was more asking from the angle of "do you see any mistakes in my methodology" or "do you think that strategy will answer the question properly"

Was it just a process of elimination, a case of trying higher beats per min, but this was the highest he could go to without causing any symptoms?

I never asked him to justify his observation, it had been made over some 5 or 10 years of dealing with mini strokes and working with top doctors (who were also as out of their depth as everyone really) and his wife kept notes and obsessively went over them as any epidemiologist would looking for intersections of events.

as I understand it, platelets regenerate every week, so presumably the cumulative effect is limited to a rolling 7 day period?

perhaps, but then thats probably just an average and some may live longer others less ...

You say you don't experience anything when normal training, but only in one or two specific events yes? If so then I would put forward that during those events you were "pushing your personal limits" beyond "just training". So if you have a record (garmin?) of that you'll now have some data as to what HR was associated with that event.

If its platelets then simply aspirin would quite likely help (100mg say as I mentioned in my earlier posts).

However we're playing "mystery guest" here without additional data like additional tests and you are having to "have faith" that if it doesn't rear its head again "it may be good" ... I'm not a man of faith by any means, I'm one of materials science and data. Faith gave us the Papacy ... Science got us everything you're typing on, using, driving, eating, powering your house with and the house you live in.

if you see my angle on this ;-)

 

[Patsman07]

I'm in complete agreement with you on faith v science.

Unfortunately i don't have heart rate data for any rides. That being said, I'd be amazed if the 3/4 times I've had issues during or after a cycle correlate with the 3/4 hardest rides. In fact I'm sure that's not the case.

what is certain, is that these issues are correlated with cycling. As a result I've no choice but to slow down and scale back. Maybe it's time I bought a set of golf clubs.

 

[pellicle]

Unfortunately i don't have heart rate data for any rides. That being said, I'd be amazed if the 3/4 times I've had issues during or after a cycle correlate with the 3/4 hardest rides. In fact I'm sure that's not the case.

That's a shame. Still you will know your situation better than me (i have only descriptions)

what is certain, is that these issues are correlated with cycling. As a result I've no choice but to slow down and scale back. Maybe it's time I bought a set of golf clubs.

Being a keen cyclist of days gone by I commiserate with you, it's part of why I'm working so hard in finding alternatives.

If you are willing to keep at it, why not dial it back a bit get a Garmin (and start getting ride data automatically), take a baby aspirin and see where it leads? Better than giving up something you love right?

 

[Patsman07]

The aspect of cycling that I love is the competitive side of it. Even if I'm out on my own I'll always try to get a pb on a segment if I can. Always loved pushing myself physically. I'll take the aspirin and go for gentler spins but I know I won't get the same enjoyment out of it.

Thank you very much Pellicle, you've given me better&more helpful information than any doctor I've met these past few weeks.

 

[pellicle]

The aspect of cycling that I love is the competitive side of it. Even if I'm out on my own I'll always try to get a pb on a segment if I can. Always loved pushing myself physically. I'll take the aspirin and go for gentler spins but I know I won't get the same enjoyment out of it.

While I'm a bit sad indeed I've faced similar "give up what you love" events in my life (as I age and progress), pulling out of Finland being one of them.

I'm glad I've offered helpful thoughts to your process.

Best Wishes and (assuming this place goes away) feel free to keep in touch at my hotmaill address ( my VR username@hotmail)