last night's feeding

(more on Rocky later)

July 4th fireworks like you've never seen them

...so I was feeling a bit guilty about our July 4th dinner party. You see we advertised it as a rooftop barbecue with fireworks, great food, drinks, etc etc. There was even a picture of fireworks exploding over a city skyline on the evite. Shortly after I hit send and blasted said evite to my guests, I decided to look up the time of the light show for the Sunoco Welcome America Festival and discovered that in fact the fireworks on Penns Landing were the weekend BEFORE the party. Ooops. The main attraction in Philadelphia on July 4th was the Sheryl Crow/Roots concert at the Art Museum. But I was cooking my little heart out and hoping that my guests would be so busy eating and drinking that they would not much notice or care.

What unfolded was a magical evening. We were a small group up on the rooftop, and as usual when people walked in my shit was not together and I was still in the kitchen sweating and cooking, but that's OK, I was pretty much finished by 7:30 and was able to enjoy dinner with my guests, which is a world record for me. The menu; rainbow salsa and chips, proscuitto & melon, assorted olives and nuts, jerk chicken, coconut ginger rice, orange pan-glazed tempeh, grilled vegetables (Mark spent an hour out there on these and they were amazing), tomatoes and mozzarella, corn on the cob, a variation on caesar salad, blueberry cobbler and blackbean brownies with vanilla ice cream--turned out well and it made me happy when everyone kept emptying their plates and heading back for more. As the sun dipped we were treated to a fabulous sunset:

and then....with darkness finally upon us as we talked and ate and laughed into our wine glasses, it started. The first of the fireworks. First just a smear and sparkle of lights from the northeast, then a couple of bangs from north philly, and then....there were little sparkling lights everywhere....I mean everywhere. What ensued was this surreal eruption from every corner of the cityscape that encircled Mark's rooftop deck. It was incredible. We stood there and could not believe how much firepower one city could shoot up towards the heavens on one July 4th in 2009. I think all of us marveled at just how much we Philadelphian Americans love exploding things; while we took a guilty pleasure in how freaking cool it was, even if not quite environmentally sensitive. Even Mark, who had never spent a July 4th on his rooftop since he as always down in Margate, was really delighted by the show. Northeast Philly, by the way, far outweighed it's counterparts in the amount of chinese-made firecrackers it exploded that night, if anyone is keeping score.

Then Mark unveiled his anniversary gift to me: portraits of Gryphon, Madison and Chloe that he had professionally done while I was away at Cadence Camp. Can you imagine what this man went through carting 3 dogs off to Belmont Plateau to a professional photo shoot, calming 2 of them while each one was being photographed? And I had no idea! here I am realizing just how sneaky my innocent looking boyfriend really is....

It was an incredibly thoughtful gift and it makes me happy to know my kids will be memorialized long after they are gone. And to make the evening even more special, Colin decided to pose in front of each of the portraits in mimicry of each canine. Have a look:

here he is getting even more into his role:

see all of the pictures here.

%@#$&^

I have been really tired and grumpy lately. After I got back from the Cadence Camp, which I have been meaning to write about but have added it to my quasi-trash heap of posts I have started but have not had time to finish, I was tired, which is expected. I took the next day off, stuck at work catching up. The weekend afterwards it rained and rained, and after doing a couple of 10-minute LT intervals on Friday I took another day off, and the next day I went to the gym, because as I said, most of us cyclists were comtemplating building an Ark at this point it was just so disgusting out.


So in an attempt to make up for my lazy weekend, on Monday I went to the gym and worked out like an animal for 2 hours, moving quickly and pushing heavy weights to the point that the pacer kicked in several times. I worked legs, chest, biceps and core, then went home and rode my bike to work. It took me about an hour; I felt good. On the ride home I was feeling drained and in retrospect, most likely what happened next was a result of it being my 4th hour of training legs.

When I passed in front of the old trolley depot on Island Avenue, where about 15 sets of tracks converge and the edges are imbedded in cracked and deeply rutted cement, I jumped the light to get ahead of the cars. My wheek got caught in one of the tracks which normally I would have hopped over, and to my horror me and my commuter bike were flung sprawling across the road. I jumped up to avoid getting run over, grabbed the bike and found myself in the bizarre scenario of directing the hesitant traffic that was stalled behind me with my one free arm. Not one person stopped to see if I was OK, I might add, but then I jumped up so fast most of them probably had not seen the accident. I had to carry my bike onto the sidewalk because the brakes were knocked out of whack and neither wheel was turning. After a minute of minor adjustments I was back on the bike and heading home with some bleeding road rash and my first pair of torn-up shorts.


Anyway, I rode into work 2 more days last week, and each time it took me longer and longer to get there. By Friday, after taking a detour around the site of Monday's debacle and missing a turn which brought me into the deep 'hood with the wind whipping up from a storm brewing into quickly fading daylight, it took me 1:30 to get home. I only rode 2.5 hours this weekend in an attempt to get my legs back. Today I opted not to ride in after the gym.


I have also been a bit irritable and depressed. I am not sure if it is hormones, or the fact that I have been exhausted, or the fact that my mountain bike is again in the shop, or perhaps something more anbiguous. This past year with a broken collarbone and a bum heart I was unable to race or ride hard, and I took it in stride. I even had a pacemaker put in so I could continue to train hard and maybe even race again. I think now that I am 2 months post-op and the opportunity has presented itself to ramp up the intensity and get myself into racing shape, my body and mind are telling me...

"not so fast..... chill out."

I have a good aerobic base but no high-intensity in me right now, but that could quickly come in a matter of a few months. But my body seems to be resisting my increased training load, and to be honest I have no desire to race at this point. I am feeling a bit lost this summer, as it seems like there are so many things up in the air and I don't do well without a plan. I do know that it is counter-productive to heap guilt on myself because I am not getting pcyched to schlep back out to central PA to do the Wilderness 101.


So because I have been feeling a bit low, I have decided to spread my misery a little by sharing with you a few photos from Mark's recent surgical adventure. He was asked to test out a new medical device on a cadaver. Yes, that's right, actually the arm of a cadaver. Mark agreed, after all, this was in the interest of the advancement of medical science. He did manage to get a few photos from his iphone and today I share them with you.



someone's sawed off arm sliced open like the mango I had for dessert today, yum

Afterwards I asked Dr. Mantell what it was like. He said it was totally weird, because instead of blood there was formaldehyde in the veins, the arm was cold, (not warm as he was used to), and the tissue was not in an orderly fashion as it would be in a live arm, it was all jumbled up and this made it harder to do the surgery. He said he was thankful that he did not have a burger for lunch or he might have been queasy.

"Really?" I asked, quite surprised. I mean I could not even look closely at the second photo without some discomfort, but here was the Clinical Associate Professior of Surgery and Best of Philly surgeon Mark Mantell MD saying it grossed him out.

I will spare you the litany of arm jokes that ensued. You know.... armageddon, the surgery cost and arm and a leg, and on and on.

I am still tired, but my depression has lifted after yesterday's gardening. I am not dwelling on too much today, just looking forward to a nice dinner for our anniversary and even some sort of well-earned chocolate dessert.

pride

someone is quite happy to be graduating from pre-K.

the Holter monitor

7.10.08

X stapped my electrodes on tightly with adhesive tape and we set up to replicate an episode. I hit the hill at Bryn Mawr avenue like I was possessed. We flew past these other riders like they were standing still. X hung in there with me almost to the top. My heart rate went to 165, then 168, and I was sure I would have an episode. It went to 177. Still no episode. 177, damn I sprinted up that hill. We discussed the next hill I would try. That was a longer, steeper climb in Gladwyne. My heart rate went to 174. No dice. I could not believe it. Maybe it would not happen anymore! So I did not kill it on anymore climbs until we got to the one by Radnor High, my alma mater no less. I ran out of road before I could keep my heart rate up long enough. And X was being a dick so we yelled at each other as was we were descending Matson Ford at 35mph. Anyway, I decided to really push it up river road. I flew up and watched my heart rate climb into the 160s and then into the 170s, it did not happen, and then I was going downhill, so I sprinted as fast as I could--and boy it hurt because it was about 100 degrees out, and finally my heart rate dropped--from 172, to 83. X caught up to me in the parking lot and I told him my heart was at 83. "Its so weird, I just don't want to stop riding, but I don't want to push it either." But I was not satisfied with that, because it was not the classic episode. My heart rate took a full 2 seconds to drop, and it only stayed down for 1 minute before it shot back up to 132. So I started hitting the gas where Shamont hits Umbria, and I kept turning it on until my heart rate, with X trying to stay on, until my heart rate was between 160 and 170 for 2 minutes, I mean I was giving it everything I had and it hurt. Finally--boom--I felt that telltale rush, like an adrenalin rush, and my heart palpitated, and then I looked down and my heart rate was 81. X came up and I coasted, and I told him what was going on. I told him when I turned the corner at the bottom of Main Street was where it usually popped back up again. Sure enough, it stayed around 80 until I turned that corner, 3:20 later, and then it shot up to 127. So we stopped in Manayunk, and got a water ice, and I had to hear that the water ice that I had been so excited to introduce him to (and I bought) was not as good as Ritas. He did apologize for his behavior in Radnor though, guess that's something. We rode back slowly, stretched, and a few hours later I was able to take the Holter off and shower, yay.

[Uploaded 7/20/2008 8:23:36 PM]

struggling to understand

7. 12 08

I set out to do a recovery ride but I was bitter about it because I was missing class and I "knew" that my heart was not going to give out on me during an hour class. So I did the usual main line route, and as I was slowly winding up Falls road this Sturdy Girl passed me going up the hill. I did not care, after all I was warming up and doing an easy ride but I looked up and noticed her slowing down halfway up the hill after passing me. So I slowly followed up the hill and saw her at the light at City Line. I rode about 10-15 feet behind her for 4-5 miles or so, not close enough to get her draft. Then on the winding climb of Bryn Mawr Ave I set out doing the climb and felt really good. Climbing is much easier now--so I stayed behind her nipping at her heels and she picked up the pace a little as I got closer. I watched my power climb and stay around 200 watts, 4b, and then it happened, almost at the top of the climb. I felt a fluttering in my chest and felt like I was blowing up, but it was not in my legs. She turned and went a different way and I did the rest of the ride in recovery. I was really spent after that. Ran into Max in Conshe and then the entire Sturdy Girl team rode by as well, with whats-her-name in the pack. Funny. My heart rate was only at 157 when this happened. And it was only 26 minutes into the ride, not 2.5 hours like the other times. I wish I knew what was going on.

[Uploaded 7/12/2008 10:58:50 PM]

commuting via bike to save the planet

Today was pretty cool because I completed my first round-trip via bike from 3434 to work in Lester. I used to commute about 3 days a week to our old location in Cinnaminson, NJ, primarily when I had torn my hamstring and was out for the 2006 season. Yes, I end up sitting out just about every other season for one thing or another; torn hamstring in 2006, broken collarbone & heart arrythymia in 2008, and now in 2009 with a heart that suddenly and unexpectedly works with the help of [insert pacemaker contest winner's winning entry here] , I am not sure what to do with myself as I slowly climb out of my hole and back into some semblance of racing form. Some would say I should just hang it up and make use of those ovaries that God gave me but I'm not sure I am ready for all that nonsense; besides, one thing our overpopulated and overpolluted world does NOT need right now is another kid. Furthermore, I am having issues with an incontinent elder dog and I can't even imagine dealing with diapers and poo.


Anyway, um, regarding the bike route to work, it's awesome! Half of the route I am on a bike path, meaning there is 50% less chance that I will get hit by a car. I cut through Fairmount Park near the Mann Center (this time did not get lost, see below), then I go west to 63rd street, take that south through the 'hood (don't love this part of the ride I must confess) and then I hit the Cobbs Creek Parkway and it is smooth sailing until that one crappy 4-5 block section of Island Avenue where I have to hop my bike sideways over deep rutted trolley tracks and gigantic potholes on a stretch of road with no shoulder and some ornery drivers. I might be able to figure a way around that though.

On my first attempt last week I got lost in Fairmount Park because I neglected to take into account the one-way roads when I was google- mapping it. With my tail between my legs I set down the bike and walked into this cool-looking historic building right by the Mann and sheepishly told them I was lost. This woman came out from behind the counter and went over the directions with me 6 times, even telling me the safest route through the 'hood. She lives in the 'hood I was about to ride into and I was very touched by the care she showed me. Anyway, I googled the place and it looks really cool; I would like to go to lunch there sometime. Check out a review here.


I love how bike commuting suddenly multiplies the hours in my day; as my formerly wasted commuting time in the car now becomes training time. I can come home and feed the dogs, cook dinner, relax in my garden, and feel good about the fact that I have just reduced my carbon footprint. A little. At least it's one more small step towards a sustainable world.


A journey of a thousand miles begins with a single step
-attributed to Lao-tzu (c 604-c 531 bc), founder of Taoism

Saturday June 6th, 2009

hope

Today I did the gladwyne-villanova-paoli loop the old way I used to do it with more climbs. I felt good and I killed it. Rode for 3 hours hard (as hard as I can take right now) and even though my PT showed me blocking several times, I did not block, the PT gets confused sometimes when I am paced; I can feel when I block. So since they adjusted my pacer for the 5th time last friday, this was my only real test since the class this week was microintervals and I did not block so it seems like they have it ironed out. Awesome. I afraid to celebrate yet, I got burned the last time.

[Uploaded 6/8/2009 10:06:02 PM]

oh soooo depressing

Jamie and Holden Comeau, pro triathlete who sometimes pretends to be a mechanic. Here he is pretending to be a clown and doing a damn good job.

My beloved Yeti, here being used as a shirt rack and tire hanging device instead of it's intended use as my racing & riding bike. It's my own damn fault for not having it serviced while I was laid up for 6 weeks following heart surgery; but I had bigger fish to fry; namely recovering and whining about it.

Besides, I was short on coin and could not afford my pricey Scrub rotors.

how my co-workers see me

Pearls Before Swine, by Stephan Pastis

(please click on picture for full strip)

the 6 week milestone at last

Yesterday marks my 6 week anniversary with my [insert name for implanted medical device here] This means I no longer have any restrictions such as raising my left arm over my head, or only lifting 20 lbs on that side. And the best part...I am allowed to ride my poor neglected mountain bike again. I am much less sore and my scar has healed up nicely too, as you can see in this before and after pic.

I feel really good and am slowly getting back into shape after getting my ass whooped on the Cadence Women's ride/Quadzilla's DirtyDozen on Saturday. Today I am going to ride into work and I am really excited about not wasting commuting time in the car, even if I have to dodge scattered thunderstorms and irate motorists who think I should be riding on the sidewalk or on the glass-strewn edge of the road. My only problem now is that my Yeti, which has been parked at Cadence awaiting my Scrub racing rotors and Juicy7 brake rebuild kits, is now waiting for organic brake pads because the composite material on the Scrub rotors requires organic resin pads. Come to think of it; the Stans lightweight aluminum rotors I was using before were supposed to be ridden with organic pads too; this may be why I tore them to shreds in 6 months. Anyway, the bottom line is I now have medical clearance to ride but I am f%$ked because even of those brake pads come in today, Jamie and Woody are slammed, this being race weekend in Philadelphia. So, despite my gift of 2 bottles of Maudite and 2 bottles of Delirium Tremens, I don't think they are going to get a chance to work on her for awhile.

It's cool though; my new motto is "let it go." Life is all about patience for me lately; and that drill has gotten a bit easier since I have stopped medicating with caffeine. And if my only problem right now is that my mountain bike is still in the shop; well then I guess life is pretty good.

warren at the woodmere!

sounds like a perfect pre-bike race gathering.....who wants to carpool?

name-my-pacemaker contest

I need a name for this thing. I am sick of writing:

pacemaker

or

pacer

or

my little device

or some such crap. Some of you probably think the solution to that is for me to just stop writing about it. I will consider that. But in the meantime I would like to come up with a name for this little Medtronic Adapta that suits me. Anyone care to submit ideas? If your name is chosen it will land you a $20 gift certificate to Amazon, or, if I really like you, an invitation to dinner. You might want to take me up on that after I am done being gluten, sugar, caffeine, alcohol and animal free. A

The Quantum Wellness cleanse, day 1

Several weeks ago the X and I were talking and he told me about this new book from Kathy Freston which apparently is all the rage on the talk show circuit. Everyone knows by now I watch no TV, and that means none, I only have a TV in my house for boyfriends and petsitters; furthermore, it pisses me off to pay the cable bill each month just for the aforementioned two reasons. And really, when SOs have been over the house now and in past lives, they are/were not sitting around watching TV. But anyway, I have basic f'ing cable, and I had no idea who Kathy Freston was. You can check out her website here, where it discusses the book in more detail.

Essentially Kathy has figured out a way to package the advice of many health gurus, practioners, and authors who have come before her (she quotes many of them) and she recommends doing a 3-week cleanse at least once a year. During this cleanse, you banish the Big 5 from your diet for 3 weeks. These are:

1. alcohol




2. caffeine




3. sugar (all forms except Agave Nectar, which is unrefined and has a low glycemic index)




4. animal products (meat, fish, dairy, eggs, etc.)




5. gluten (wheat, barley, rye) oats are OK
   

Anyway, Max said that he and two of his clients were going to take the challenge of the Quantum Wellness Cleanse. Now I had not been feeling right since the surgeries. Perhaps it was being on Darvocet for a week, or not exercising much for 2, or a result of my hormones being all wacky lately...whatever, I have gained 3-4 lbs since the surgery and I am just not feeling right.

So I surmised that for me, the cleanse would not be a huge undertaking. Really, a plant-based diet of no sugar, gluten, animal products, caffeince or alcohol was not such a huge change from my normal diet....with a few exceptions. Yes I do probably eat as many or more vegetables than your average vegan, whose diet might tend to be heavier on the grains than on the green leafies. I love to eat all vegetables, especially non-starchy ones, so much that when I have dinner guests they often tell me how, um, regular they are for several days following the repast. Alcohol I basically stopped drinking because it made my heart block more often. It's a habit I have not gotten back into since I got my pacer. I eat much less meat than I used to, and enjoy cooking meals using tofu, tempeh, or beans instead. Refined sugar is practically banned from my regular diet....although...I do like to have a big mug of coffee in the morning doused with 3 heaping spoonfuls of, you guessed it, raw sugar. When I go out to breakfast on a weekend, as soon as I walk into the establishment I scan those little ceramic sugar holders on all the tables to make sure they are bursting with little brown packets. If not I ask the waitperson to bring me some; and if they return with 2 or 3 packets I sheepishly apologize for being a "sugar whore" and I tell them I need 5 more packets. Really.

Caffeine is going to be the hardest sacrifice for me, mainly because it is my only addiction, and it is a strong one. Even though I only have one mug of coffee in the morning, or in the afternoon on the weekends following a 5-hour ride, I shamelessly use it to regulate my moods. I had started taking Wellbutrin to help with life's stresses lately, but the combo of wellbutrin and caffeine is too much for my dopamine and norepinephrine receptors to handle. If I have too much coffee I have a very hard time concentrating on anything; I am so revved. Anxiety then sets in for a person who often defines her self-worth based on how many items she can cross of her to-do list. I need to work on that.

So I was looking for some excuse to experiment by cutting it out....and here was a good one. On Saturday I changed to tea before the ride, and then I went home without stopping at La Colombe for my usual double latte afterwards. I was gardening later and I felt like I had rubber for arms and legs, I mean I had NO ENERGY. Ugh, and I had had tea that morning. Sunday I did the same, a cup of tea, and yesterday, well yesterday I went cold turkey on Memorial Day. No coffee. And no barbecue for me. I am a bit irritable and have had headaches on and off...but I am pretty excited about the cleanse and all the new recipes I will be making in the next 3 weeks. The next few days are going to be tough without coffee....especially at work and before morning workouts, but I am really looking forward to being free of it. More on the Cleanse in coming days.

pacer adjustment #4 - the field test

ha ha Dr. Mark Mantell, MD, FACS Clinical Associate Professor of Surgery and Director of Vascular Access relegated to "my personal trainer"

....so after this latest dissapointment I emailed Callans and offered to bring my bike into the lab so they could see what was really going on with my heart; the PowerTap HR monitor was just not cutting it. I thought of this while on the phone with Zola (that night at Tangerine) and he said that they probably would not let me do it because it would take up too much time. To my great delight Callans thought it was a capital idea and he arranged for me to come into the lab with Mel (Melissa Cliver, CRNP Nurse Practitioner Cardiac Electrophysiology) and Dr. Riley as Callans was going to be out of town at a medical conference. So Mark helped me carry my bike and trainer into 9 Founders and they hooked me up to a monitor and the Medronic machine and I started pedaling. It was really hot in the room, so my HR rose very quickly.

Within 3 minutes I was able to block at a heart rate of 174. No shit! It was hot in that room. And so it went, for an hour, with me blocking three times and Valerie, Mike Riley and Mel Cliver gathered around the monitor. It was pretty cool being in there and finally being able to show them what was going on out on the road in an attempt to get the device dialed in. Also it allowed me to compare what the PT monitor was showing as opposed to the Medtronic monitor, which is more accurate. I could glance over when I was riding and see exactly when the pacemaker kicked in. After an hour I got off the bike while they conferred, called Medtronic, and moved through the various screens of the software over and over as they intently studied the printout generated from the machine. They asked for a higher level of support at Medtronic, and Valerie seemed a bit irritated when she did not get that immediately. I was just taking it all in, wondering if they would ever really be able to dial this thing in for me or not. And if they could not; I wished they would have told me that so I could have made a more educated decision. I was told that the pacemaker was going to cure this disease of my conduction system and I would be 99% as good as before. But Dr. Callans, who is, after all, Director of the Department of Electrophysiology at HUP, was very encouraging, so I put myself in his hands. No negative thinking at this stage.

hopeful and fearful at the same time...and a little tired.

the crew at an impasse, asking to speak to bypass the plebians and jump to top level support; I feel like I have been there a thousand times when calling verizon dsl. Anyway...

So after about a half hour I got back on the bike and started pedaling again. This was, after all, today's workout. I blocked at 172, and then they made another adjustment. They asked me to try one more time. At this point, my legs were tired. My heart was tired from blocking. And I was a little depressed. I cranked it up more gradually this time, instead of spiking up to 440 watts, I just brought it up gradually over 200, then up by 20 watt increments...on up to 260...I felt the flutter which they later told me were PVCs, and my PT showed a block (HR stepped down to 82) but all of them were standing around saying "that's all you! you are not blocking..." It seems one thing I learned from this test is that the PT HR monitor was reading my instrinsic ventricular beat and not picking up the paced beat. I needed to be aware of that and go by feel, or else I could be losing power not from a physiological phenomenon but because of a psychological one. In other words, I am psyching myself out in anticipating of the block.

So the good news is that they made another change, still left me in DDD mode, and were waiting on a couple of questions from the techs at Medronic. They told me there was still tweaking to do but to go out and ride and report my findings; the change they made today should make it much better.

Go forth and ride. I can handle that. It's just a process; that's all. I just have to be a patient patient. Not so easy for me.

DDD mode

Rode my regular main line route w/saw mill climb. It was so great to be riding outside on a beautiful day. Kept in in endurance zone but did push it a few times and I blocked. The pacemaker and my heart seem totally out of sync, it is sort of disheartening, I guess that was a pun. ugh. They reset the mode to DDD (dual paced) on thursday but I am still blocking, although this time it was different, it went from 160, to 130 and that was it (it still sucked) the second time I dropped to 143 for a full 30 seconds, then stepped down to 105. I'm not blocking 2:1. Texted Zola and he said that they just need to change some settings, not to worry. I am still bleeding heavily from LEEP and period so I got tired midway through ride. Lost a ton of blood the past 3 days.

[Uploaded 5/11/2009 10:34:16 PM]

need I say more? I was a little upset on saturday night, Mark and I went out to dinner and then he got annoyed that I was on the phone with my cardiologist while sitting in the lounge at Tangerine. All I can say is when a cardiologist calls me I pick up the phone.

the beginning 7.6.08

I rode alone, but because of the impending rain opted to do the shorter, 60-mile route. This is a pretty hilly route (at least the first 30 miles) and I was pushing pretty good on the hills. The 7-lb weight loss has made a huge difference on the hills. I feel really good climbing for the first time in forever. On the way back on the bike path I passed a guy and he grabbed my wheel. I was pushing pretty good into a headwind at subLT and after 10 mins I got that weird flutter in my heart, then my heart rate drops like a stone and I feel weak. It happened several times on this ride, starting at 2:23. I have to pull back because my heart is not beating fast enough to get blood to my legs or something. This also happened on 6/28 at 2:39. I definitely like riding by myself because I can push hard when I want to and not worry about dropping anyone, but this heart thing is freaking me out.

I did the last half hour at recovery pace down to art museum and back.

[Uploaded 7/7/2008 11:43:49 PM]

note the red heart rate line dropping in half, and then shooting back up again.

pacemaker adjustment #3

Got to HUP on Thursday the 7th with my laptop in tow to show Dr. Riley what had happened in class that morning. I knew he was a cyclist, so I figured he would have a very good understanding of the demands of my heart.

I got into the office and the Tracey Munson the nurse-practioner greeted me.
I showed her my power files and explained the difference between what happened today and what happened before the surgery. I explained that today it was like there was a little battle going on between my heart and the pacer. But there was no doubt in my mind that I had blocked, and that at least one time I blocked 2:1, because I had felt it. Sometimes the Power Tap HR monitor does not catch my correct heart rate all the time, but there is no mistaking that feeling in your chest, and then in your whole body, when your heart rate drops from 164 to 82 in about a second. I also complained about the pulsing I was experiencing in my diaphragm, perhaps from a stimulation of the phrenic nerve, although Zola later told me this was bullshit, it was not the nerve. Anyway.

She listened intently, and had the Medronic "suitcase" next to me and placed the programmer transponder over my incision. First she paced my heart with each lead independently to see which one was causing the pulsing, despite the fact that it is usually the Atrial lead, on me is was RV (right ventricle). Hmmm, I do not fit into the normal pacemaker recipient profile. Go figure. The RV lead created the pulsing which I had her feel just by putting her hand on my ribs. It was pretty severe, like having a case of the hiccups. She then adusted the voltage down from 4.0 volts to 1.25 until the pulsing stopped. One obstacle cleared.


She checked frequency and impedance and it did not appear that either lead had slipped. I was greatful for this, because my biggest fear was having to go through that surgery again. She was looking at the screen, then she stopped, looked up at me, and said, “wait! I think I know what is happening here.”

She explained that the Medtronic Adapta has a function called MVP mode to prevent the ventricle from being paced all the time. This mode prevents this RV pacing unless you really need it. (see below)

Dr. Riley came and was very grateful for the Power Tap graph because he was able to compare pre and post op graphs. It seemed as if (from the graph) that what happened today this morning in class was not 2:1 but 4:3, then 3:2, so there was some discussion about what mode they needed pacer to be in to keep me from dropping like that. He put a call into Dave Callans who is in surgery all day and they left the room.

Then Dr. Riley came back and sat down with me and explained to me that the pacer was defaulting to MVP mode because they normally do not pace both chambers of the heart at once. The reason they do not pace both chambers at once is twofold. First off, since any pacing of the heart is not the organized cascade of impulses that occurs with your intrinsic impulses from the SA node, when you are paced it can feel as if your heart is a little out of sync, and this is even more of an issue when the heart is paced from the atrium and the ventricle. Bascially, the heart is being paced from the muscle, not from the natural nerve conduction system. The second issue is that there is a slight risk of the heart actually weakening if the heart is dually paced. They are not sure why it happends in some patients. Later I spoke to Zola about this and he said it is a non-issue in an athlete.

So he turned off the MVP mode, and I was now in DDD mode. I was hopeful. More to come.

guess it was more like "rude awakening"

...perhaps I spoke too soon, with my effusive thank you to all 7 of my cardiologists. The very next morning after I posted I got up at 5:30 and drove to Cadence (because it was still raining after something like 10 days) I decided to take class. I heard it was a tough one.

Got to Cadence a few minutes late so did not get a great warm-up, but did some overgear intervals. I was giddy in class; there had not been a class in the last year 8 months that I did not leave at best, incredibly frustrated and at worst, demoralized and in tears. Then we started doing LT and superLT intervals, the kind I have not been able to do in ages, because it is the extended ones at high power/HR that make my heart block.

The first interval took place and it was about 4 minutes at my new LT of 180 (LT now stands for low-T) A long drop from 208 in October but like I said before; who cares I'll get it back. Then there was a break, and we moved into the second interval, which was superLT.

I felt my heart rate rising as usual, then gradually I felt I was being paced atrially, and suddenly....I felt that telltale flutter and I thought; OK, I am being paced...or am I? .... because I felt weak and then my heart and the pacer seemed to be having a power struggle.

Then my heart rate dropped to 132....for about 40 seconds while I backed off the interval (because I was too weak to continue) and then it came back up to 144. Great. I thought I went through all this hell and twenty thousand dollars to prevent this shit from happening....

The second block happened from 165 down to 97, then it dropped further. At this point I wanted to make sure I got a good reading to show the doctors; so I kept pushing as hard as I could for as long as I could, so that the graph would show that at the same power output my heart rate plumetted on its own. This is exhausting.

I sent an email to my Mark, as well as my friend and cardiologist Ben Zola, who had first diagnosed me. He told me not to freak; they just had the settings wrong. I got home and emailed Dave Callans and literally 10 seconds later my cell phone rang. It was a phone number from HUP.

Whoa, I had not expected a response that fast.

It's easy to lament the physical limitations you have when some organ in your body is not performing properly; or when you succumb to some illness. But the emotional strain can be even more painful, if not more debilitating.

In those moments after I had hit "send" and I skipped down the stairs to feed the dogs--it hit me that the journey was not in fact over. After spending the frenzied hour after class sending urgent though somewhat comical text messages to Kuhn and Mark and others about how my pacer was not actually working, (ha ha how ironic!) I had just, for a second, allowed myself to burst into tears.

And as I mentioned above, at that second the phone rang. It was Dr. Callans. Probably not such a bad thing for a doctor to become face to face with the raw emotion of his patient. I am lucky enough to be in the care of a doctor who is not only very skilled but is compassionate and a good listener. But then he is extraordinary.

He told me that he would be in surgery all day but I could come in and see his associate, Dr. Riley. Mike Riley is a cyclist, and a friend of Alaina Gurski's who I had met on a ride earlier this year. I was delighted to be able to finally meet him. So I packed up my laptop and headed back to HUP, quite hopeful.

Mark had called it a week ago. He told me there was a 50% chance that the pacer would need to be adjusted for it to work properly for me. They are just not used to pacing someone with my weird heart block.

So it iis just a matter of trail and error I guess. Stay tuned.

5.6.09 the awakening

Today, the long nightmare that started on 6.28.08 came to an end.

Because of a miracle of modern western medicine, a tiny little device the size of two silver dollars pressed together; I was able to overcome a rare heart arrhythmia and will now be able to resume my active life.

Today we tested the pacemaker in a lab at Cadence, as I was finally strong enough to ride at more than a recovery pace. For the first time I felt what it was like to be paced for a duration of over 15 minutes.

Having the pacemaker create the contraction in my ventricle is not the same pathway as if my intrinsic conduction system caused the heartbeat. It actually hurts a little when I am paced for an extended period. There are a lot of electrical impulses going through those leads in my veins and into my heart muscles.

My LT did drop 30 watts since December. But who the hell cares? I can actually train now. In another month I will be back on the mountain bike and I can't even imagine how sweet it will be to bound up the rock steps in the Wissahickon without going into heart block.

I am truly incredulous. And grateful.

This whole story, which I will be writing about as the next several weeks unfold, has been a long, confusing, frustrating, and disjointed journey. I am truly grateful to everyone in my life who helped me during this process; and who supported my decision to be able to continue my cycling lifestyle by getting an implantable medical device.

Especially Mark, who has been an incredible caregiver (I can see why he is "Best of Philly"), Benjamin Zola, M.D, who understood the complexities of the endurance athlete's heart (being one himself)

David Callans, M.D, the pacemaker guru who implanted my device;

my parents, who feared I was making a poor decision and who loved me enough to tell me so; my sister Sabrina, who really is the best little sister one could ever be stuck with;

Grant Calder, who connected me with Dr. Zola,

James Wilson, M.D., Ph.D., who I ride with on Tuesday nights and who connected me with Dr. Callans;

my coach Mike Kuhn,

my brother Colin; and many more who helped me along the way**

Thank you from the bottom of my bionic heart.

** some others
Donald Yih, MD
Steven Rothman, MD
Charles Leng, MD
Dr. Scollan
many many cycling friends
and last but not least, Max Calder, who was there at the very beginning, when we were both totally in the dark

rocky and bullwinkle

I got home from work Thursday, dog-tired. My body needs to rest, but work has been very demanding and I just can't take a few days off. So I walked in the front door to the usual cacaphony of dogs barking with delight at my arrival. I had noticed that the hole in my porch roof that had hosted a starling nest for the past 3 years had now become a squirrel nest. The other day I saw a mama squirel clabbering down the old drainspout on a quest for food. I am not very fond of squirrels. They are the bane of gardeners everywhere, myself included.

I walked back out on the porch to grab the mail, and suddenly there was the scurry of little feet. I glanced over to see a tiny baby squirrel diving off the side of my porch. Wow, they were cute. A closer glance and I saw what looked like a dead baby squirrel dangling from one arm from beneath my plantstand. I walked over to get a closer look. The poor little thing must have fallen off and it's claw got caught in the joint of where the two metal pieces fused together. I cradled the little guy in my hand. He was breathing. I wondered how long he has been hanging there. Probably only seconds... he would not last long this way.

I reached my other hand over and tried to gently pry his little hand loose. It was really wedged in there. I tried to use my right hand to see if I could pry the metal apart. It was not budging. I knew Mark was on his way over, so I waited. And waited. I talked to the little guy and got him to calm down. Ten minutes went by. He looked like he was sleeping. Although he did not weigh much, I was supporting him with the arm that had just been involved in my pacer surgery, so I knew I could not stay there indefinitely. After another ten minutes with no help in sight, I gently coaxed his little claw open as it had finally relxed enough, and suddenly he was free, with only a tiny nick that was barely bleeding.

Boy was he tiny. And tired from his ordeal. I put him down on my planter beneath the nest, but I was afraid the cats would get him. He was not moving. So it was getting late, so he spent his first night in captivity because I could not bear to have my neighbor's cats eat him. Then again Madison would love to eat him I am sure, so he spent the night in the vestibule with the dogs ocassionally sniffing underneath the door to let me know that they were aware that something TASTY was right behind the door. He seemed pretty happy to curl up and go to sleep:

Mark named him Rocky.

The next morning I refilled his food and put him out on the porch. I thought I should let him go, so I lifted him up and put him on a planter. He ate some food, then fell asleep, right in an area frequented my cats! He was exhausted, so I picked him up and he decided to crawl inside the sleeve of my sweater:

Finally I pulled him out and decided it was not safe to leave him exposed like that.

I made a little cardboard house for him with a very soft blanket inside and a little baby-squirrel-sized door and I kept some water and peanuts next to it. Soon we discovered that Bullwinkle liked the nesting idea too:

The next thing I knew we had 4-5 tiny squirrels nesting in the box. I fed them for several days until they were strong enough to go out on their own, which they did. I still see them around sometimes, getting fatter by the week. Anyway, it was a fun distraction from other matters.

small world

so today I was having procedure #5 (yes, that is 5 surgeries in 2 weeks) at the gynecologist's office. This was not exactly an elective procedure, but I did elect to have it when I was convalescing from my heart surgery as well as the incision on my saddle where, a pressure cyst that causes me pain at various times in a typical year where I ride 7000 miles directly on top of it, was removed.



So the progression of misery coalesced this way:



1. I decide to get the pacemaker, after having the EP study the week before


2. I was banned from bike/gym for a week so I decided to take care of that nagging little cyst mentioned above


3. once I am cleared to ride from #1 above I take a short ride and open up my stitches from step #2, ouch.


4. since I can't do anything anyway I decide to have pre-cancerous cells on my cervix lopped off with an electric wire loop, which they are doing today.



Basically since I am miserable from not exercising, trying to work, cook, clean, take care of dogs, etc in chronic pain, as well as having a deformed upper torso resulting from an elective procedure, I might as well check everything off my list that requires me to take it easy, and do it all in the same month. We will call that month April, 2009.



So I am in the waiting room and I hear my regular Gyno is late coming back from her C-section surgery. Great, now I have to sit in the waiting room, or Baby Central; aka today's Portrait of Hell. Crying babies, fat pregnant miserable-looking women, completely clueless fathers-to-be-looking like they would rather be ANYWHERE but here, a Stupid Box that spews out nothing except videos about what to do when your new baby cries at night blah blah blah. You get the picture. I have an ipod on and am glibly typing away. The nurse practically has to throw something at me to get my attention.

She calls me in and asks me if it is OK if another Dr. does the procedure. I say "no problem" since I was intending to drive to work after this. Which I did. They numbed me up nicely, even giving me a little shot of epi in the lydocaine, nice touch.



So I am there in the stirrups, propped up on two pillows so I can continue writing the poem I had been working on for the past week. Dr. B asks me who made the incision (still with little stitches sticking out) next to where she needs to "do her work". I tell her that my boyfriend did it; I asked him to slice me open since for the first time in 10 years I was off the bike, and he is a surgeon, after all. Might as well make himself useful! She asks me his name, and when I tell her, her eyes get wide and she starts laughing. "Wait--I know you....you sent that funny party invitation! My husband and I are old friends of Mark's....we were so sorry we missed your party!"



So the two of us yammered on, and the procedure was done, and I was told not to exercise for a month. You have to be kidding me. There is no way; I am testing out this pacer in the lab at Cadence this wednesday so this thing better heal right quick.



It is a small world...and it does seem that doctors all know each other. Anyway, it was fun getting the dirt on your new boyfriend at the gynocologist's office. Kind of makes the whole business of having the tip of your hoo-haa cut off a bit less draconian.

despite what you might think after having read this I do love kids, even if they lack fur

4.21.09 the implantation

Today was the D-Day. I showed up at 7am , super-irritable because I had had nothing to eat or drink since 10pm yesterday, and I did not get home with my poor dog Madison until 8:30 pm, racing down from Skippack on the turnpike in the pouring rain. She was supposed to be in an Elizabethan collar for 3 days after emergency surgery for an absessed tooth (that cost her momma $1200) while she wore a Fentanyl patch for pain. I just could not leave her in the collar because not only could she not get out through the dog door with the collar on, but she looked so damn depressed in it; the collar dragging on the floor as she weakly stumbled into the furniture. So off it went, but I was worried she would chew off the patch. If either she or the other dogs ate it they could die. So needless to day there was not much time to calmly reflect on how my life was about to change.

At 6:58 am, Mark and I walked into the EP reception area there was an older couple checking in before me. They both were in their seventies, and the reception lady told them to have a seat. Mark whispered in my ear that he was pretty sure that that old guy was getting a pacemaker today, go figure. After the man was called up we could hear him answering the receptionists' questions.

She asked him his date of birth.

“November 11th, 1930.” Mark and I started hysterically giggling.

Like I needed one more reminder that I was too young for this shit.

There they are behind me:

....so the surgery was supposed to take about an hour, but it takes about an hour just for them to prep you. First they take you to a bed and hook you all up with all the leads for the monitors and the blood pressure cup, and put you in a hospital gown ( I was able to keep on my boyshorts and smartwool socks, because last week I froze my toes off.)

I had done the entire EP test with no sedation at all I had toyed with the idea of doing that again this time. ....but after all they were making an incision in my shoulder. Dr. Mark used his surgical expertise to advise me to take as much sedation as they would legally allow.

A number of people came down and talked to me about the procedure and made me sign a bunch of forms. They told me I would have light sedation, or "twilight" but would be awake the whole time. Then the Head Nurse, an Asian woman whose name I cannot remember, marched in. She stuck my IV in and this time it hurt, even with my large easy-to-navigate veins. I found out later that she stuck me with an 18 guage needle, probably because she was in such a damn hurry she did not want to wait for the IV to drain. I was brought on a stretcher to the OR.

(They take latex allergies seriously here)

Then I climbed off the stretcher and into the bathroom, where I peed into a cup so they could see if I was pregnant. I'm not. They lifted me on the operating table where 5 nurses immediately started to work on me, with the asian Head Nurse cracking the whip. She told them, “we have to move fast today because we have two cases.” I mumbled that they did not need to move toooo fast....

They hooked up the IV, put all of my monitor leads and blood pressure cups on (yes, again) then proceeded to scrub my left breast and shoulder with this green cold liquid that felt great running down my back. The OR is kept very cold and I swear they store those plastic patches they use to hook you to the monitors in the refrigerator. Finally I was hooked up and Monique my nurse adjusted some blankets over me. My wool socks kept my feet nice and warm and this was good.

checking the equipment as I was wheeled in

I squinted to look at the monitor and asked the nurse what my heart rate was since they had taken my glasses. My blood pressure was about 110 over 69 or something. My heart rate was 43. Keep in mind that I had no coffee or food this morning; if I had had a cup of coffee it would be 55 or so. I explained to them that if I fell asleep it might drop into the 30s and they should not worry, that was my normal rate. Then they took my glasses away and covered my upper torso with a surgical drape so I could not see anything anyway. Soon Dr. Callans came in and said hello and they told me they were going to add some sedation to the IV since they were "ready to rock and roll." It felt cold going into my arm. Then it felt really nice.


Then Dr. Scollan, the Fellow who works with Dr. Callans, started injecting the site of the pacemaker insertion with lidocaine, "big stick and some burning." They got it all numbed up, then they opened up the site, which was in my delto-pectoral groove my just above my left breast below my shoulder. I was awake the whole time, and could feel the pressure of the incision but not the cut. Monique, my nurse, asked me if I was OK and did I feel any pain. I said I was fine.

We were going to insert the pacer under the muscle, so this was a little more involved surgery than the typical beneath the skin type, but if I did it that usual way you would be able to see the pacer sticking up right underneath my skin since I have very little subcutaneous fat in this area. So to place it beneath the muscle they make the incision, part the pectoralis major muscles, and slide the pacer in between. Needless to say it was not so easy with my anatomy.



The first thing they do once they have you opened up is to lacerate the cephalic vein and thread the 2 leads down into my heart, one in the atrium and one in the ventricle, as in the pic above. The leads are actually about 15 inches long as it is a circuitous route. As this was happening, Monique would monitor my stats and ask me how much pain I was feeling. I was fine for the most part, I would occasionally twitch when the leads hit a part of the vein which brushed against a nerve. They had some difficulty getting the leads where they needed to go. Then the leads needed to be screwed into the pacemaker, which is pictured here
just about actual size, although mine is slightly larger since they wanted to add an extra couple of years of battery. Then the pacemaker needed to be shoved into that little space that they opened up in my delto-pectoral groove. I think is was during this prcess that they hit the nerve that goes down into the funny bone in my arm and from then on I was uncomfortable.

They had some trouble getting it into place. Perhaps they cut the incision too small in an attempt to keep my scar as unnoticeable as possible. It seemed like they were shoving the pacemaker into that hole, tugging and pushing on my flesh. I imagined them grabbing onto my pec muscle with both arms and tugging, stamping on the pacemaker with their feet in an attempt to fit it in, but then they were flushing narcotics into my veins so I was sometimes in a quasi-dreamlike state. Then Dr. Scollan sewed me up, and Dr. Callans made a joke that even Mark would approve of the beautiful job he did. The surgery had already taken longer than expected. I could feel what seemed like dull needles pierce my skin as the lidocaine was starting to wear off. They tested the pacer, I did briefly lose consciousness at this point, and came around to the sounds of strange numbers being called out by a female voice, an exchange of digits that I did not understand, as they did not correspond to heart rate or blood pressure or oxygen. Valerie, the Medtronic rep, was testing the pacer with Dr. Callans. I guess it was the frequency corresponding to voltage readings or something. A this point I was feeling more discomfort. Monique leaned down and asked me if I needed anything. I was picking up on some negative energy in the room, frustration or irritation or something. I heard the doctors speaking in hushed tones to each other.

Apparently the lead in my atrium was not reading.

This means they had to rip open the sutures and basically start over again. They should have injected more lidocaine at this point, because Mark told me later that it only lasts about an hour. Monique asked me if I needed anything for pain. I am not sure why I kept saying, “I’m OK.” I think part of it was I wanted to see if I could get through this procedure with minimal sedation, I had my camera with me and I whispered to Monique that she should take a picture while I was still all bloody and cut open. She whispered back that she did not think she could legally do that. The other reason was it had been my experience that the medicine they used to block pain receptors always make me nauseous. So I said I was fine.

They pulled out the pacer and threaded a new lead into my atrium. Then they screwed it back on the pacer and there was what seemed like a tremendous amount of pushing and pulling to get the pacer back into the pocket. They apologized to me for all of the manhandling. I mumbled cheerily that it was OK, but the combination of the pain and my squeamousness was starting to get me agitated. I believe that at this point the HN realized that they were going to be very late for the second case. I never saw her again.

Then Dr. Scollans sewed me up again, and this time I felt every needle prick. Ouch. I decided I needed to tell Monique they needed to put something in the IV for pain, although at this point the surgery was essentially over. Monique responded and announced that she was giving me x grams of Fentanyl. (yes, the same med that Madison the dog was on)

Valerie called out her numbers again, as this metal mouse-shaped piece of metal was placed over the incision, I felt an electrical current and my heart responded with a flutter, and the voltage was tested, frequencies were adjusted. I guess this time everything came out ok. I barely remember that part, because all of a sudden I was incredibly nauseous. I told them I was feeling really sick, and they looked up at the monitor and said they were going to give me something for the nausea. I found out later that I had gone vagal and my blood pressure had dropped to 60/40 or something, and my heart rate dove well into the 30s. Dr. Callans said to give me Atropine.

Which they did, and whatever else, and the nausea subsided. I was getting very strong hiccups in my diaphragm from the electrical current of the pacer stiumulating my phrenic nerve. This was really annoying. The doctors had left the OR and many of the nurses as well but Monique had to call Dr. Callans back to make another adjustment. Finally they were able to wheel me out of there….around noon.

As I was wheeled out of the OR onto the stretcher the nausea hit me again like a wave. Steve, my nurse from the EP test last week, came over and asked how I was doing. I was sweating profusely, drenched all of a sudden. I mumbled "OK", staring weakly at him. I was sure I was going to throw up. I had turned a ghostly shade of green, my pressure had dropped again and my heart rate monitor was screeching it's alarm. Someone grabbed a plastic hat-shaped thing that you would use to collect a urine sample from someone who had no aim. Suddenly there were 4 nurses hovering around me, and one of them set one of those portable defibrillator units down on the end of the stretcher. I clutched at the plastic dish, and someone injected something else into my IV to bring my pressure up as they wheeled me into recovery. The nausea subsided, I was put into a bed and hooked to everything again, and my mom was called in.

Finally at 12:30, the procedure was over. I was very sore and stiff, but happy to not be throwing up.

I did doze for few minutes, and when I opened my eyes Mark was at my side. He gave me a hug and I asked him if he was between surgeries. He was. He had talked to Dr. Callans and had gotten the scoop about the dead lead. He stayed for about 20 minutes and then had to go back to save someone’s life.

For the next several hours my mother stayed at my side, and we chatted. People would call and I was able to hand her the phone, I did not feel like talking to anyone. About an hour later a nurse wheeled a portable x-ray machine over to me to check to see if during the surgery they had punctured either my heart or my lungs. They had not. Awesome.

I was still getting strong hiccups in my diaphragm so Valerie came back a few hours later and performed some adjustments to the pacer.















Basically the unit was pacing me when it should not be:




As you could see here was I was lying in bed and being paced artificially. It is important that we adjust the pacer so it does not pace me unnecessarily; since 1. it feels weird and 2. it will prematurely wear out my battery. A battery change means more of this stuff that I went thought today; I am in no rush to repeat this drill again.

the view from Valerie's strange suitcase

So finally at 5pm they discharged me, and I was sent home with a prescription of Darvocet. I thought I would only need a couple of days of pills. ha. that's a whole other story.

Anyway, Mark made me fried skate with capers and leek and shiitake mushroom risotto, and then Colin and Michelle came over and there was more food and many laughs. I convinced Michelle to help me make chocolate chip cookies, which we did. I ate 4.

And so ended a very long and life-changing day for me. I slept well that night. I was still under the effects of the sedation (what little there was) and looking forward to mending up and being able to test this new little device of mine on the bike, cauz God knows I am not going to win any beauty contests now with this thing:

before.......and after......