Wrap up visit with GP

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Having been discharged and given the all clear by both the neurologist and cardiologist I went for a final visit to my GP. I think we’re back to what the A&E Dr said to me hours after my accident “Everyone’s allowed to faint once”.  There’s  nothing wrong with me and no obvious cause of my faint.

I may have been slightly dehydrated, though given the hassle of stopping for a comfort break on a short ride, I’m not really inclined to drink much more.  I may have been slightly stressed, and I think that’s under control now.  I had thought that paying more attention to my heart rate might be relevant but the first cardiologist I saw said not to worry, and my heart rate has been higher since my accident without ill effects so I think that’s a blind alley.

There may be something in monitoring resting heart rate.  I have recently been checking mine with an optical sensor and it seems all over the place: the average is around 45bpm with a variation from 42bpm to 50bpm.  The cardiologist told me that the 24hr ECG measured it at 39bpm which is lower than the optical sensor generally measure it.  So room for further investigation!

One possible contributory factor to my resting heart rate being variable is that I still find it uncomfortable to sleep on my injured shoulder.  The joint is taking far longer to get back to normal than the bone took to heal.  It actually seemed to get significantly worse over Christmas so the GP referred me back to physiotherapy.  I don’t yet have an appointment but it of course feels much better now I have a referral.

The GP also thought it worth getting an annual blood test which I will do.  I also continue to take (non-prescribed) Vitamin D.  The number of times I have been asked how much alcohol I consume has also made me try to drink less alcohol and I almost managed a “dry January” (from just after midnight on the first until the evening of the 31st).

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Final visit to the Cardiologist

Two months after my first visit to the cardiologist, I went back for a follow up visit.  In the meantime I had been for an ECHO Cardiogram (Heart Ultrasound) and had also been fitted with a 24 hour ECG.  The 24 hour ECG was another lesson in how the NHS doesn’t really consider the patient experience.  I wasn’t warned in advance that I would have to come back to the hospital the following day to have it taken off, and when I did go back I was asked to take it off myself as the technician wasn’t around.  I also wasn’t warned in advance that I couldn’t shower with it.  I cycled back home with the ECG attached and made a point of cycling hard to take it back, into a headwind, as I wanted to make sure I pushed my heart as much as possible while wearing it.

When I returned to see the Cardiologist, I was disappointed to find that I was seeing a different Doctor as I had liked the first one.  The nurse took my blood pressure while I was waiting.  She told me I had the blood pressure of a teenager (120/70), which is presumably a good thing, perhaps unlike the blood pressure of a teenager’s parents.

The cardiologist basically said that I was absolutely fine. The ECHO Cardiogram showed a normal thickness heart wall.  It was slightly thicker than average due to the amount of exercise I do, but well within the expected range.  The 24 hour ECG also didn’t show any abnormalities.  I asked if it would be worth having a treadmill test, but he thought that this wasn’t worth doing given how fit I was: he said the point of the test was to provoke symptoms but I was clearly pushing my heart without showing any symptoms.  He thought the most likely cause of my faint was morning dehydration.  He made the point that over an 8 hour sleep one would drink nothing, i.e. a lot less than over an 8 hour period awake, so having a single cup of tea in the morning wouldn’t really compensate.

So that’s it and I’m not really any wiser though at least I know that there is nothing definite wrong with me.  Having read about some of the heart and brain problems that can manifest themselves in sport, I’m glad not to have any of them, though I think they usually show up well before the age of 50.

Goodbye 2015

veloviewer 2015It’s been an eventful year, with my accident and all the visits to medics.  The important thing is the cycling and the graphic above sums up my year.  I’ve gone just over 5000 miles for the first time in my life, which is much better than last year when I just failed to make 4000 miles.  I’ve also cycled up Everest 11 times which is pretty meaningless.  Unfortunately the stats on my biggest ride are an underestimate due to my Garmin freezing on both of my biggest rides, resulting in the recording being split in two.  Anyway a pretty big year on the bike and one that I enjoyed.  It fittingly ended with a very wet and slightly windy ride last night with Tim and Andy from ICC.

Happy New Year!

In praise of cycling lessons

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We’re all familiar with the saying that you never forget to ride a bike.  There’s a lot of truth in this, in that the basic skill of balancing on a moving bike is something that, once learnt, stays with you.  As far as I remember, between leaving University in 1993 and starting to cycle to work in 2007, I only cycled on 2 occasions.  I don’t recall any process of relearning to cycle when I started cycling to work.  I test rode the bike the evening I bought it on a 1 mile loop round the block and then struggled to work a few days later.

However, cycling safely in London traffic is a different thing.  The basic bike handling skills are a given, and you need to be able to ride the bike unconsciously.  Dealing with traffic, road positioning, signalling and anticipating are all added complications. Drivers have an obvious advantage, in understanding the “rules of the road” and, probably more importantly, knowing how other road users are likely to behave and where the danger points might be.  There are obvious differences too, changing speed takes longer on a bike and you can’t rely on physical presence to assert yourself on other road users, or at least you have to be more subtle to do so.  Positioning yourself in the lane is also different, but a driver undoubtedly understands a lot of the basics and a regular driver gets the feedback of seeing how cyclists appear to drivers.

It must be so much more difficult for children.  Especially children who barely know how to cross the road, like my own.  As we’ve been cycling more to school, I’ve allowed my boys onto side roads more.  I was really pleased to discover that our local Council offer free family cycling lessons and we have now had 2 sessions with the same instructor: the excellent Nick Hamilton.

For our first session, in October half-term, me, my wife and 2 boys met Nick in a local park and we spent an hour slaloming around a basketball court, practicing signalling, turning and braking sharply. After the first hour we ventured onto the road and learnt to start off and stop safely and turn right at a T-Junction.  Nick talked us through it all and was really good at engaging the children with what they needed to do and why.

I learnt about the importance of holding my lane and not allowing cars to overtake unless it is safe to do so.  The idea is that if you squeeze to the side, you are more likely to get a car squeezing into the car sized gap to the right of you, so you should only leave such a gap if it is big enough.  And the other danger of being too far to the left is that you are in the “door zone” which is pretty self-explanatory. This has made for some hairy moment with the children cycling along the centre line of the road on the way to school, but with cars parked on both sides of narrow road in most of London, there often isn’t the space for a car to overtake safely wherever you are, so you might as well be more visible and not tempt a car to overtake in a gap that might be just wide enough, or not.

Yesterday was our follow up lesson, without my wife, so the three of us practised our route to school under Nick’s expert eye.  We consolidated what we had learnt in the first lesson and the children practiced a right turn on their own with Nick and I watching on.

We’ve all come out of it learning something, the children’s confidence and competence is massively improved.  Sometimes the best things in life are free.

 

 

Dr Brain departs with a whimper

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Just over a week after my MRI I contacted the medical secretary for my results.  Dr Brain had said to me that I wouldn’t see him again unless there was a problem, so it wasn’t clear to me how a negative result would be communicated to me. On chasing, the secretary responded to say that a letter was in the post saying my results were normal. Great, so I awaited the letter with interest to see exactly what it would say.

The long-awaited letter was in fact a bit of a let down “I’m pleased to inform you that your EEG recording and MRI scan are both entirely normal”.  I should be pleased.  Better than having some rare and possibly incurable condition.  Somehow, it would have been nice to have some pictures or graphs, but I suppose there are times when “normal” is all that there is to be said.  And surely being “entirely” normal is something to be celebrated.

And I am now able to drive again, the DVLA have taken normal at face value and not conducted any further enquiries.  Though they have taken the opportunity to remind me that I need to wear my glasses when I drive and add this onto my licence.  I suppose someone who is “normal” rather than “exceptional” might forget to drive with their glasses.  Unlikely in my case, since I probably wouldn’t find the car without my glasses.

Holland comes to London

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There is a great article in today’s Guardian about the recent campaign for better cycle paths in Enfield – the so-called mini-Holland scheme.  This and the recent addition of an extra cycle lane (i.e. East-West to join the existing West-East one) on Tavistock Place seem to have become iconic battles in London.  The key battle being that many car drivers, particularly taxi drivers, cannot countenance increased provision for cycling at the expense of space for motorists.

One point that really resonates in this article is that children really value the independence that cycling gives them.  My driving ban means that I have been cycling the children to or from school most days, in all weathers and in the dark.  I asked my youngest (Max) on a horrible rainy day, as he was struggling up a hill, if he still preferred cycling to being driven to school.  The answer was a resounding yes.  And anyone who knows Max, knows that he says what he thinks rather than what he thinks you want to hear.

My first visit to the Cardiologist

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So 6 months less 2 days after my accident, I’m braving the A5 from work central London to Edgware Community Hospital.  This must be one of the most horrible roads to cycle on in London.  Gridlocked even early in the afternoon and few stretches with bus or cycle lanes.  Just before I crossed the North Circular there was a stretch of cycle lane.  However, I soon realised that it was taking me away from the flyover over the North Circular, down to the horrible roundabout that I had previously decided that I might use the pavement to circumnavigate.  The main reasons for going that way would be to join the North Circular or, illegally as a cyclist, the M1.  Fortunately, gridlock meant it was easy to cross the lanes of traffic to the flyover.

Nevertheless I arrived for my cardiology appointment in one piece.  As I explained in my last post, this appointment was unexpectedly early and I felt slightly underprepared.

After a short wait, I was taken by a nurse who weighed me and measured by height.  It was 1.5cm than I expected though, translating it into Imperial measures, I’ve lost an inch so I’m both taller and shorter than I thought.  She also weighed me, measured my blood pressure and then took me for an ECG.  This involved having lots of sticky pads put on chest and lower legs and then a short measurement, which took a lot loss time than sticking on the pads.  She warned me that the pads would take my hair off, but that she didn’t want to shave me.  This made it sound as if she was using superglue.  However, the pads came off very easily, probably less painfully than most plasters so I’m not sure what all the fuss was about.

After another wait I saw the Cardiologist.  He asked various questions and was interested in where I had got to with the neurologist.  He used the analogy that I was it was like a detective novel, with various specialists trying to by a process of elimination to find out what was wrong.  However,  he cautioned that with a one-off faint, the likelihood was that no cause would be established and, without a cause, there could be no treatment.  Dr Heart also listened to my heart with a stethoscope.  This was nice counterpoint to Dr Brain’s bangy thing.

Dr Heart then said that my ECG might show a potential issue with my heart, but stressed that the ECG was a poor indicator of this, particular given my tall, slim build.  He has therefore referred me for an ECHO Cardiogram which will give a more definitive measurement.  The ECG may be showing LVH – increased thickness of the left ventricle.  Dr Heart stressed that I should not worry what this meant, given the possibility of a false result from the ECG.  As I said I would to him, I have obviously googled it and it seems to be a thickening of the heart in response to having to do more work.  This could either be due to the narrowing of the arteries or to doing a lot of exercise.  So whether or not its a real condition, it seems unlikely to be a problem for me, especially since I know that I do not have high cholesterol nor high blood pressure nor a family history of heart disease.  The ECG may be giving a false reading because my build means there is less of me between the heart and the probes.

I have an appointment in 5 weeks time for the ECHO Cardiogram and also a 24 hour ECG so we’ll see.

I prefer Kraftwerk’s earlier stuff

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Last week, on Monday 30 November, I finally had my MRI scan.  Dr Brain had decided that I needed an EEG and an MRI after discussion with his boss.  I had an MRI 20 years ago on my knee.  Back then I was told to bring a CD to listen to during the scan, as it involved lying as still as possible in a dark tube.  Unpleasant for a claustrophobic, just boring for me.  If I remember correctly, I nearly fell asleep during my knee MRI.

A brain MRI is a totally different thing.  It consisted of a series of scans – from a few minutes to 10 minutes over a 40 minute period.  I was given headphones, not to listen to a CD but to protect my ears from the noise.  The noise is an unpleasant rhythmic banging, more Einstürzende Neubauten than Kraftwerk for connoisseurs of German avant garde music.  It varied between the scans and there was certainly no danger of falling asleep. 

I had listened to a BBC podcast on Stockhausen’s visit to Huddersfield the previous day and I spent the first half of the scan trying to take my mind off it by musing on whether the banging of the MRI was more Kraftwerk or Stockhausen.  I must admit it is some time since I heard any Einstürzende Neubauten.  After 20 minutes or so I just wanted it to end.  The radiographer asked me between each scan, through the headphones, if I was OK.  I could see his distorted image through the periscope in the machine which is presumably so they can see if you become really distressed.  Having to say I was fine every few minutes (“just bloody get with it”) only added to my irritation. By the end, I just wanted to get out of there.  When I was slid out, I said to the radiographer that I was guilty and would sign any confession.  It took him a while to realise I was joking.  I guess one should be careful about humour in the presence of brain doctors.

I have clearly been too busy to write this blog recently and didn’t write up my EEG.  That was less exciting, and culminated in flashing lights, presumably designed to trigger an epileptic fit if possible.  I have nothing to report.

So I await my results, which I think will be negative.  I also await my cardiology appointment.  I could write a very boring blog about the numerous phone calls I have made to 3 separate hospitals to ensure that this referral doesn’t get lost in the monstrous bureaucracy that is the NHS, but I won’t.  The latest when I started writing this contribution was that I should receive an appointment in the next few days, for some time in February.  I just had a phone call (at 8.30pm) asking me if I would be happy to move my appointment from 15 February 2016 to next Monday.  I obviously said yes.

Finally, those of you who have read this far deserve a link to some Kraftwerk.  On a cycling blog, there is only one suitable album.  Kraftwerk originally split up, because they concluded that being Kraftwerk wasn’t allowing them enough time to do what they really wanted to do. Cycling, obviously.  So they could be said to have shown more passion in the leaving of their music than they ever did in its performance.

 

 

Comparing Cycling in Holland to Cycling in London

When I have time, I want to write up some reflections on our 2 weeks cycling in Holland.  In the meantime, there’s a great article in the Guardian about it.  I think there are 3 key things that make a difference:

  1. Safe and largely separated cycle paths, which we are slowly making some progress on in London.  However, even with massive political will and financial investment it would take decades to catch up.
  2. Strict liability laws – so if a car hits a bike, the car driver is assumed to be at fault unless they can prove otherwise.  I think that would make the many motorists who overtake me too closely or try to bully their way out in front of me, think twice.  As this article says, this also protects pedestrians from cyclists.  The law protects the most vulnerable road user so it is not carte blanche for cyclists to be responsible.  It simply enshrines what I think is basic common sense and a moral responsibility into law. I am always telling my children when we cycle on the pavement to school that they need to give priority to pedestrians.
  3. The above two, mean that so many more people cycle, so that motorists respect cyclists because most of them cycle too.

I am looking forward to 2 cycling experiences over half-term:

  1. Cycling along the Dollis Valley Greenwalk as a family. Trying to find out where you can cycle on this walking path has been an effort which I will write about another time.
  2. A free family lesson with a cycling instructor.  Organising this has also been a saga.