July 20, 2018 6 Comments
By: Scott Amtsberg, 2018 Pactimo Brand Ambassador
I turned to cycling a little over 5 years ago. At 5’7” and 205 pounds I was at a crossroads in my life where my clothes no longer fit, I got winded walking up the stairs to go to bed, but I still considered myself an athlete based solely on past accomplishments. Not willing to buy all new clothes, I quickly embraced cycling and everything that went with it as a means to free the athlete inside me and set a better example for my children. I remember that first ride as if it was yesterday. I rode 2 miles, felt like I was going to throw up or die, and didn’t think I’d return the next day to ride again. I did return the next day out of shear embarrassment, and the rest is as they say, history.
I quickly embraced everything about cycling culture and results began to follow. I set a goal to ride a century that first year, which seemed impossible given my lackluster beginnings, but I was successful and eager to set the bar higher. That experience drove my passion for goal setting and working through the process to achieve them, and I would never look back. In 2014 I set my sights on the Triple Bypass (a 120 mile ride from Evergreen to Avon in Colorado with 10,000ft of climbing). It seemed a bit ridiculous given that I was an infant cyclist who lives at sea level in Salisbury, Maryland, but I trained, sought out every headwind I could find, and when the day came I finished with a sense of pride and accomplishment that only fueled my addiction. 2015 brought Ride the Rockies and sparked a passion for climbing and endurance that has stuck with me ever since. In 2016 I completed a 200 mile ride close to home, and took another trip to Colorado which included the Copper Triangle, Trail Ridge Road, Mount Evans and Pikes Peak in a 5-day period that made me feel anything was possible. While I felt I could accomplish anything I set my mind to, something felt a little off.
I was not able to travel in 2017, but I rode 25 century or longer rides that included a 200 and 215 mile rides. I tackled the single most difficult day I’ve ever had on the bike that year with the Garrett County Grand Fondo - Diabolical Double which included 125 miles and 16,850ft of climbing in western Maryland. I again felt like something was just a little off as I set my sights on finishing the year with 9,000 bike miles (to go along with 50,000 commuting miles which as another story in itself) before setting new goals for 2018. I finished 9,000 miles having to ride at night, in blizzard conditions and in some insane winter winds, but I succeeded and set the next goal to ride the trip of a lifetime; a 7 day bike adventure in Italy with my brother. Throughout it all I noticed I could not sustain the power I was used to easily producing, and began to get dropped on some group rides that I easily was able to handle before. I’m a cyclist after all so I kept repeating Rule #5 in my head and pushed through it all knowing that it’s what Eddy would do. During that time, I applied to be a Pactimo Brand Ambassador even though I never thought I had a chance with all the amazing cyclists out there that would surely be applying as well.
On Thursday, March 8th I got the email that confirmed I was picked to be a Pactimo Brand Ambassador and I was elated. A few friends that had secretly applied contacted me to offer their congratulations and we planned our weekend group ride schedule to celebrate. Sunday, March 11th began like any other day. I got up early while my family was still asleep, kitted up and rode the 5 miles to the start of what would be an average group ride at a moderate pace. The first pedal stroke out of the parking lot felt different. It was if my legs were heavy and I had been riding much more than I actually had that week, and as the group headed out with a slight tailwind the usual witty banter began to permeate the air. As I rode next to an old friend I found it difficult to talk without getting out of breath, and my heart rate was mysteriously in Zone 4 which seemed odd given that the pace was something I easily maintain on my own, let alone in a pace line. I continued to struggle when one strong rider decided to ramp up the intensity before we made the turn for home at the half way point, but I chalked up my struggle to over training since I hadn’t taken my usual time off at the end of the year. When the group made the turn back into the wind my life changed. I was at the back of the pack and found myself getting dropped on a simple re-acceleration back up to speed as the group pushed on. As I sprinted to catch back on, I began to feel a sharp pain in my throat and my heart seemed to be pounding out of my chest. I evoked Rule #5 and continued grinding until I was at the front of the pace line, but things started to turn gray and I knew I had to stop pedaling. The next rider to pull off the front noticed that I was fading fast as he drifted to the back of the line, and he signaled for the group to slow down to see what was going on. We soft pedaled for a few minutes and he told me that I didn’t look well. As we chatted (actually as he chatted and I tried not to pass out) he asked if I had any pain, and when I mentioned the throat pain he said, “Dude. That’s exactly what happened when I had my heart attack. You should get that checked out when you get back. It may be nothing, but it could be serious.” While no one suggested I stop and call for someone to pick me up, I invoked Rule #5 and tried to press on when the group began to motor once more. It was obvious at that point that I could not keep up and a friend of mine graciously came back and rode with me the 15 miles back to my house to make sure I made it back safely. Embarrassed, exhausted and a little dizzy, all I wanted to do was take a shower and sit down for a while to recoup. My heart rate was not coming down and I felt a bit nauseous as I walked upstairs to put the laundry in the dryer. When I almost passed out at the summit of a 10 foot climb I knew I had to go to the emergency room.
The emergency room physician was suspicious of a heart attack or stroke and began to run some tests, but as the tests came back normal one by one he quickly turned his focus to getting me discharged to follow up with my family doctor at a later date. Fortunately, a physician’s assistant on duty that day took an interest in my case and intervened. At 49 years of age and with my physical conditioning she felt that something serious was wrong that had just not been found at that point. She suggested an ultrasound of my neck arteries to make sure there were no blockages, but was scolded by the head emergency physician because, “We don’t do that on Sunday!” She negotiated with him and eventually got the Ok to do a CT of the neck with contrast which was ordered and performed. “Your arteries are so wide open we could drive a truck through them…” he said as he began to get the discharge paperwork together to get me out of there. With the doctor’s station right outside of my room I could again hear the physician’s assistant negotiating with him. “Something doesn’t look normal on the bottom of the neck CT. Could we please have the radiologist take a look at it before we send him home?” The head physician reluctantly gave his permission and the images were sent. 10 minutes later the head emergency doctor, radiologist and physician’s assistant were all sitting on the foot of my bed saying, “Well Mr. Amtsberg, you are a very interesting case! It seems as though we caught the top of your ascending aorta in the neck scan and it’s far bigger than normal. We’re going to have to do another CT of your chest and keep you overnight for a heart catheterization in the morning to see exactly what’s going on in there.”
The CT revealed an aneurysm of my ascending aorta that measured 4.7cm and the heart catheterization showed a small myocardial bridging of my left anterior descending artery (the LAD aka the Widowmaker). Both would explain the symptoms I was having, and both can be fixed surgically if necessary. The aneurysm was in the worst place possible and is commonly found on autopsy, and the myocardial bridging is frequently associated with athletes who mysteriously die on the court or field, but are in otherwise great physical condition. Since I was only symptomatic while under physical exertion I was put on medications to regulate my heartrate and blood pressure and told that we would re-evaluate the situation in 6 months since 5cm was the textbook size for surgery to repair the aneurysm. The cardiologist told me I was allowed to continue to ride my bike, but only if I kept my heartrate in check and did not do anything extreme. Although I was bummed, I was still able to ride and shifted my goals and training to fit my new reality. I got used to the horrible feeling of the medications fighting the physical effort needed to ride a bike (it’s very similar to riding at high altitude), and was able to go to Italy with my brother as planned. While I didn’t ride as far or as hard as I would have liked in Italy, I still managed 345 miles in 6 days and created memories to last a lifetime. Everything seemed to be going well on my way to the recheck in September, that was until May 20th.
I love to take pictures while riding my bike since it helps me focus on the beauty and solitude when it is so easy to obsess about the competitive nature of the sport. On May 20th I set off on a century ride with a friend on one of my favorite routes to a tiny Colonial fishing village in Saxis, Virginia. From the time I left the house that day it was a challenge, I took very few pictures, and I was never able to enjoy the ride as I physically struggled to just get back to the house. Something was different. I cleaned up and relaxed, but quickly felt better that afternoon. The following morning, I got up at my usual 4:30am and was in the car at 5:30am for the 120-mile commute to work. It was payroll Monday and the slow pace of business the week before resulted in being over budget and I knew the email lectures would begin about mid-day. As noon approached, the anticipated emails started and I began to feel very ill. My skin was clammy, I began to get dizzy and short of breath and I had to put my head down on my desk to keep from passing out. It was time to go. The doctor’s said now that I was symptomatic at rest it was time to consider surgery and the procedure (open heart surgery to remove the aneurysm and replace it with a fabric graft with a bypass to fix the muscle bridging) was scheduled for June 13th with no work allowed prior to then. To say I was intimidated is an understatement. Of all the people I know who’ve had open heart surgery, none have had 3 months to think and obsess about it. Let’s just say I did one Google search to see what I was in for… just one.
Surgery began at 7:00am on Wednesday, June 13th. My heart was stopped for about 90 minutes as I was placed on a heart/lung machine so the surgeon could remove the weakened aorta and replace it with a Dacron graft. The initial plan to bypass the LAD bridging with the mammary artery in my chest changed when they saw that 4 inches of my heart muscle was growing over the artery and restricting blood flow to more than half of my heart, so the surgeon skillfully “unroofed” the artery to free it from the blockage. Due to being in great cardiovascular shape, having none of the risk factors for these issues, and being 25-30 years younger than anyone else the surgeon had performed the procedure on, I was finished and in recovery in 4 hours and not the 6-7 hours that was originally planned. While recovery was no picnic, I could hear my Cardiothoracic ICU mates, all of whom were 80 years old or older, and knew that I had it easier than everyone else. I was up and walking less than 24 hours after surgery, and even though there were a series of ups and downs throughout my hospital stay I was discharged 6 days’ post-op and I’m now recovering in the comfort of my own home. I have an 8-inch scar and some pretty intense stories to tell, but I will make a full recovery and be a stronger cyclist than ever before. As I sit here writing this 12 days after surgery I look forward to the time I can focus on training again, even if it’s cardiac rehabilitation prior to being able to get back on the bike.
My story is a cautionary one. When I first started riding I wholly embraced Fausto Coppi’s notion that “Cycling is suffering.” As I progressed in my training, became faster and set my goals higher I adopted Eddy Merckx philosophy that, “Cyclist live with pain. If you can’t handle it, you will win nothing. The race is won by the rider who can suffer the most.” Rules #5 and #9 later became my creed. What happened to me has made me take a step back and rethink all of that. How many times did I look at someone who was dropped on a group ride and unfairly judge them as not having the fortitude to push through the pain? On March 11th did other riders in my group look at me at think, “He’s just weak…” or “He’s just not tough enough to hang with the group.” Even though others thought I might have been having a heart attack that day no one stopped the ride or suggested I call for a ride home, and neither did I. I pushed through the pain and warning signs that day and was lucky enough to get away with it. In retrospect the signs were there for at least 18 months, but they were all easily dismissed as an off day, fatigue from over training, or a new sensation as I entered a higher level of training than I had reached previously. The scariest thing about my specific situation is had I not pushed my training to such a high level I never would have experienced symptoms, and likely would have died suddenly and unexpectedly.
My brothers and sisters in self-inflicted suffering, I would like to leave you with these two thoughts. Look out for yourself and your fellow cyclists and don’t be afraid to voice a concern, because Lord knows not many others out there on the road are watching out for us. Ask yourself the two questions my father used to ask me when he was my little league football coach… Are you hurt, or are you injured? Pushing through the pain when you’re hurting is what Fausto Coppi and Eddy Merckx were talking about, but please don’t mistake it to mean it’s Ok to push through an injury or ignore warning signs, either subtle or obvious, that could jeopardize your health or even your life. Monitor your health with the same passion you pour over your power files, Strava posts and race results, and do it with a critical eye free of ego. You owe it to yourself and the multitude of people that love you.
Husband, Father, Son, Friend and still a Cyclist
P.S. I’ll see you out on the road in a few months. You can count on that.
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