Thriving Post Trauma

I am in many ways a medical anomaly. 9 months ago I suffered a Traumatic Brain Injury that should have rendered me with significant cognitive deficit or worse still serious physical impairment. However, four months later I was back operating as a Chief Executive and a few weeks later competing in a Triathlon.

Despite investing heavily in my own physical fitness and having competed as part of the GB Triathlon Vet squad at both European and World Championships I then bizarrely suffered a rare type of heart attack referred to as Spontaneous Coronary Artery Dissection. Apparently completely unrelated to the head injury.

I suffered no pain or discomfort and at no time felt un well. What prompted me to visit A&E was a mild but persistent feeling of muscle tension in my upper pectoral area and my back, which by the way I put up with for over an hour on my bike, followed by a meal in my back garden and a late summer walk with my wife. I didn’t travel to the hospital until 11.30pm.

The A&E staff carried out an ECG at about 1am, which was normal, but identified elevated Troponin levels and rushed me to an acute assessment area just after 3.30am and then eventually onto the cardiology ward later that morning. It’s hard to describe the emotional turmoil I went through for the next 24h. Hearing a consultant cardiologist inform you that you have essentially suffered a Heart Attack to me felt like an imminent death sentence and the end of life as a knew it (it slowly became clear that the outlook was not nearly as bleak).

I spent a day and a night on the Cardiac ward with some incredibly brave individuals. All were at least two decades older than me and again all without exception about to undergo very significant heart surgery with relatively uncertain outcomes. But they were all so accepting of the fact and far more interested in my wellbeing. They calmed me down, provided reassurance but most importantly made me laugh with their matter of fact attitudes and banter.

I spent a restless night knowing that an angiogram and eco-scan would follow the next day. The words of the Cardiologist stuck in my mind “Stephen the way you present is “Atypical, it’s not normal to ride through a heart attack, god knows what we are going to find”.

The night came and went, followed by various bits of monitoring by the nurses, a bit of breakfast and some more banter with my patient colleagues. Soon it was time for the angiogram. The senior consultant cardiologist, Dr Cooper, explained the procedure and offered me some literature on the associated risks. I was not at all inclined to cause myself any further anxiety and signed the consent form without reading it.

Soon after I was in theatre and being administered the most wonderful sedative. The anxiety washed away and for the first time in over 30 hours, I was in a place of calm, tranquillity and peace. I was fully conscious but in a utopian state. I was able to see the catheter as it progressed through my arteries – I was essentially looking at the inside of my own heart, wow!

The process was over relatively quickly and with absolutely no pain or discomfort. In fact, with the sedative I would argue the whole process was extremely pleasant and incredibly fascinating.

An Echo Scan followed, this was far less dramatic and very straight forward.

Then came the verdict. The news was a double-edged sword. It did confirm a type of heart attack, all be it minor/mild/ less significant (difficult to find the right adjective) in nature, but also confirmed a healthy heart with no signs of vascular disease or valve problems.

So what was it? What did all this mean?

What Dr Cooper and his colleagues identified was a small dissection(s) in a small branch artery that had probably caused enough of a blockage to damage heart cells locally and hence raise the Troponin levels in the blood. In other words, this caused a minor heart attack.

The treatment is straightforward. No surgery but a few bits of medication to be reduced after a year.

The prognosis appears good and the damaged area should self-heal with 8-12 weeks. The extent to which this has/will affect the efficiency of the heart going forward will be determined over time but early indications suggest not much damage has been caused. The likelihood of reoccurrence again is uncertain but statistically the chances are low to negligible.

I have also commenced dialogue with Leicester University who are conducting extensive research into SCAD. I am sharing my progress with specialist cardiology registrar, Alice Wood.

Following my discharge from Bedford hospital I was referred to the Cardiac Rehabilitation team.

The Cardiac rehabilitation support offer by Bedford hospital’s resident rehab specialist, Corey Beecher, has been immensely valuable to me. I was always going to present a unique rehabilitation challenge as my general level of fitness is better than the average. Ensuring the rehab stretched me sufficiently to aid recovery but not too much as to aggravate any existing heart damage would require careful and skilled judgements.

I have listened carefully to Corey’s advice and increased workload and effort incrementally over a 5 week period, tracking and logging BP, HR and symptoms. I have managed 40 minutes of exercise every day culminating in a vigorous 30 seconds run section yesterday where I comfortably took my heart rate to 132 beats without incident, discomfort or any breathing difficulties. Whilst this is still some way of my normal training heart rate levels this is incredible progress so soon after my cardiac event and is an enormous confidence boost. Running at 132 bpm following a cardiac event is not to be taken lightly, I was full of doubt and anxiety and only with Corey alongside me was I able to muster the courage to test myself at that level. But what an immense sense of accomplishment followed!

With both my head injury and now the more recent cardiac event anxiety has been a greater challenge than the condition itself. But as my confidence grows and I learn to trust my body again, gradually the anxiety is subsiding.

In summary two traumatic events within a twelve-month period have taught me a few important lessons in terms of mental resilience, trust in the professionals and the power of optimism.

• It’s important to know who to trust and who to ignore.
• Understanding the relationship between risk and reward – not to be reckless but also not overly cautious.
• Understanding the dangers of looking for answers and of poorly informed/ amateur research (beware the internet).
• Stats are only relevant if you understand the context.