Bring on the backless gown. Again.
Luckily, I had already contacted Dr Nigel Stephens – who has generously contributed to every lecture series we have ever run at Cyclefit. After being friends and having collaborated for ten years or more, I was now his patient. A further irony being, that a year previously I was part of his core rehab team after his own major hip surgery, following a horrible crash on his bike whilst training for the Worlds Pursuit Championships. Being middle-aged gives us the intellectual suppleness and humility to readily accept these different dynamics I think.
It was hugely reassuring to have Nigel at the helm, anchoring my care – to mix my nautical metaphors. He was incredibly calm but also took great pains to communicate clearly and thoroughly. The big risk, Nigel, pointed out, was that my sarcoid, an auto-immune condition, that appeared straight after my first (failed) spinal-fusion surgery, in 2013, was now attacking my heart. I assumed that this was not a ‘good’ thing but resisted the urge to google what it meant and concomitant prognosis/treatment ramifications. What was the point? I trust Nigel explicitly and completely. If I have learnt anything from my back surgeries, it is to put your trust in your consultant and be constructive and compliant in your own treatment. It is not a passive relationship exactly, but it is broadly a pedagogical one. Their job is diagnostic followed by treatment recommendation. Your job is to listen, learn, attend, respond, stay calm and follow advice to the letter. Mrs Cavell, however, did a bit of googling and went a bit pale for a few days.
MRI's and claustrophobia
The gold-standard test for cardiac sarcoid is a specialist heart MRI. Now I am an MRI pro – by that I mean a borderline claustrophobic who has developed coping strategies that just about last the requisite 30 minutes needed for a spinal MRI. This one was to be very different. Undertaken at a very welcoming and professional Paul Strickland Centre in North London. It requires one to be strapped down onto the scanner with a tray of equipment strapped to your chest and an IV line of different dyes being shot into your arm. It lasts for 90 minutes and one is required to undertake continuous breathing exercises. The only way I got through it without completely embarrassing myself and self-soiling was the obvious humour and downright humanity of the technicians in my ear-piece. And one of them gave me a pair of glasses that converted my upward vision into an image of my feet. An hour and a half happily wiggling my feet around was immensely reassuring and took me out of my body into another foot-based reality. If you have to have an MRI and are a little claustrophobic, then I recommend asking for these clever glasses.
Nigel pulled all the results together of all the tests he had commissioned in a meeting very soon after. It was a relief that I showed no evidence of cardiac sarcoid. His understated and quiet summary of being ‘relieved’ at this finding was enough for me to reliase I had dodged a bullet. Mrs Cavell recovered some colour.
The conclusion is that none of the symptoms is currently considered to especially worrying in a middle-aged man with an athletic history. But I have one final hurdle to clear before Nigel will clear me for highly exertive training.
He is putting me through a ramp test at Northwick Park this week to monitor what happens to my heart rhythms at upper heart-rates. Currently I can potter around at a lower level, but can’t think of anything more ambitious until I pass this last test. I will let you know how it goes.
Dr Nigel Stephens