HEALTH

Truly a Sport for ALL

Alan Springett M55 BKO (UK)

(reprinted with permission from CompassSport, July 2009)

Last year CompassSport mentioned in brief of an amazing occurrence with a happy ending in the Lakes District event. Now the main protagonist of the incident tells CompassSport the whole story:

ON 13th April 2008, on completion of the Hampsfell Regional event, I suffered Sudden Cardiac Death. On 13th April 2009, exactly one year later, I successfully completed the Medium leg in the Mixed Ad-hoc class at the JK Relays. A neat trick if you can manage it, but not one I would recommend if you can avoid it! Sudden Cardiac Death, or SCD to its friends (it doesn’t have many!), is pretty much what it says on the tin:

Sudden Cardiac Death (SCD): sudden death caused by a coronary event which generally degenerates into ventricular fibrillation (VF), a condition where the heart quivers rapidly rather than beats and consequently cannot supply the body with blood. SCD results in death in about 95% of cases with the chances of survival diminishing markedly the longer the victim is unconscious.

I was out for some minutes… So how did I manage to be among the lucky minority? Well, not through any efforts of mine, apart from my excellent judgement in collapsing at the feet of my wife, who is extremely competent at screaming for help, and adjacent to a defibrillator-equipped and doggedly determined St John ambulance team at an event where a specialist in resuscitation was also competing. So in the first instance my survival was thanks to Jean Barrett and her team from Ulverston, who would not give up, and to the medical expertise amongst my fellow competitors. But it took several minutes to get me back and there was some concern about the possibility of brain damage. However, no-one has yet noticed any difference in the before and after version! (Couldn’t orienteer before, still can’t now!) Then it was blues and twos to Furness General Hospital. So a vote of thanks also to the emergency ambulance team for their speed and for the treatment they gave me en route as I continued to have what was later confirmed to be a major heart attack. Next on the gratitude list are the team who received me at the hospital and who proceeded rapidly to intubate, deep freeze and totally sedate me for 24 hours. They then slowly de-frosted me!

Therapeutic Hypothermia is a relatively new treatment now recognised to reduce significantly the chances of brain damage in patients who may have suffered oxygen starvation.

Catherine & Alan Springett

I should say that I have no recollection of any of this. My memory seems to have been wiped from the evening before the heart attack through until a couple of days afterwards. My wife’s early visits were reminiscent of Groundhog Day with me making the same joke and observations each time I saw her. My jokes are pretty weak first time around, and there are only so many times you can say ‘that’s a pretty new top you’ve got on’ and get away with it! The body’s capacity to recover is truly remarkable. Less than 24 hours after being brought round from my induced hypothermia I was transferred out of Intensive Care and I was discharged within the week. Once home in London I took it easy and watched the bruises on my chest and arms recede until it was time for an angiogram.

An angiogram allows the doctor to look inside your coronary arteries and find out where and how severe any narrowed areas are. The patient is given a local anaesthetic in the arm or groin, where a catheter (a thin, flexible tube) is passed into the artery. Using an x‑ray, the catheter is directed through the blood vessels and into the heart. A special dye is then passed through the catheter and a series of x‑rays taken. The dye shows up on x‑rays any narrowed areas or blockages in the arteries.

The procedure was straightforward, but being informed subsequently that the arteries in my heart were in such a state that I should sit at home in my carpet slippers until I could be accommodated for by-pass surgery was pretty sobering. But I did that, and just on a month after the heart attack, on 12 May 2008, I underwent quadruple by-pass surgery at the London Bridge Hospital. By-pass surgery may be pretty routine these days, but not from a patient’s perspective. For a hitherto fit and active chap, finding oneself as weak as a kitten, short of breath after the shortest of walks and nervous of coughing because it hurts is quite difficult. I can laugh now at the memory of myself and fellow patients trudging around the hospital corridor in our thrombosis-avoiding flight socks, carrying our containers of body fluids linked to the drains in our chests and having wheezy conversations comparing progress; but it was not funny at the time! However, the hospital team did a great job and my recovery over the subsequent week, including the first physiotherapy to get my lungs expanded again and to start me walking, began

the process of getting fit again that has continued almost uninterrupted subsequently. The first three weeks at home were tiring, but I did my breathing exercises and daily lengthening walks, comfortably exceeding the suggested durations. At the end of the first month after the operation, the surgeon pronounced himself ‘well-pleased’ with how I was healing and said he did not need to see me again. Although he had become something of a hero figure for me, I think he understood when I said I hoped I did not see him again! My cardiologist, on the other hand, had the tricky task of delivering an unwelcome and totally unanticipated surprise. He explained that with the surgery done and dusted we now needed to address the life threatening arrhythmia (ventricular fibrillation or VF) that I had displayed on my collapse. Had the VF been a consequence of the heart attack or had it come first and been the cause? And, either way, with a now damaged heart but a determination to get back to a fit and active lifestyle, did I need some extra help to achieve this safely? Additionally, Catherine and I were now initiated into an amateur understanding of the Ejection Fraction or EF.

An Ejection Fraction (EF) is one of the measurements used to assess how well a patient’s heart is functioning. “Ejection” refers to the amount of blood that is pumped out of the heart’s main pumping chamber during each heartbeat. “Fraction” refers to the fact that, even in a healthy heart, some blood always remains within this chamber after each heartbeat. Therefore an ejection fraction is the percentage of blood within the chamber that is pumped out with every heartbeat. An EF of 55 to 75% is considered normal.

After the heart attack my EF was around 37%. Against this background of impaired heart function and accepting that I was unlikely to be happy as a couch potato, the clear recommendation of my cardiologist and his eminent colleague was that, in order to provide an insurance policy in the event of a future attack of VF while not standing in front of a St John team, I should have my own defibrillator (Implantable Cardiovertor Defibrillator or ICD) implanted in my chest. That news knocked us sideways. There I was, the model by-pass patient, healing in exemplary fashion and already exceeding my exercise regime, then I was at risk of fatal VF with the prospect of further surgery and living with an implant which needs replacing every 6-8 years.

An implantable cardioverter defibrillator (ICD) is a device which is able to give the heart electrical shocks. An ICD is little bigger than a matchbox. It is usually implanted under the collar bone. An ICD is made up of a pulse generator ‑ which is a battery powered electrical circuit ‑ and one or more electrode leads. The leads are placed into the heart via a vein. The ICD constantly monitors the heart rhythm and if it senses a dangerous abnormal rhythm it can deliver one of the following treatments: • Pacing to try and stop the abnormal heart rhythm. • One or more small electrical shocks to stop the abnormal heart rhythm and restore the heart back to a normal rhythm. • If that doesn’t work, or if the ICD senses a more serious rhythm disturbance, it will deliver a bigger electric shock to stop the abnormal beating and get the rhythm back to normal – this is known as defibrillation. ‘no-brainer’ – it might sit in my chest and never do anything or it might save my life, so why not........and how would you feel - or perhaps, more pertinently, how would your loved ones feel - if you did not have one and died as a consequence of a bout of VF? The flip side of that argument was the need for further surgery, the risks of infection, the continuing question mark over the extent to which I really was at risk of further attacks of VF, the psychological side of living with an implant and the natural belief that it would be possible to continue getting progressively fitter without any further intervention. However, at the end of the day the ‘why wouldn’t you’ argument proved irresistible and I agreed that I should have an ICD implanted in mid-September. Pending the implant, the advice was to continue building up the daily walks but to avoid anything else. On June 15th, two months after the heart attack and one month after the by-pass, I did my first Orienteering event, completing a yellow course in just over 11 minute km’s, and during the next few weeks I took part in four out of the five events in the annual Frolics series in London. We’ve always enjoyed the Frolics and last year they provided the ideal competitive but fun environment for building a little confidence. Then it was on to the Welsh Six Days. I had switched my entry to short courses and successfully completed two of them, but bottled out and did colour coded events on days when the Regional event courses were particularly long or hilly. Day 6 proved almost too much for me and I took nearly 90 minutes to complete 4k in very technical terrain and foul weather. With the ICD implant looming I relegated myself to the role of Catherine’s supporter for the White Rose and then it was back to hospital for the implant and a one night stay. The procedure went well, but it was followed by a frustrating month during which my movement was severely restricted in order to ensure that the wires from the ICD into my heart were not displaced while they integrated with the veins through which they ran. Leaving aside the recovery from the operation – more impressive bruises! – the ICD took a bit of getting used to as, in addition to its basic raison d’etre of zapping you if your heart goes too fast, it also ‘paces’ you if your heart is slacking. And having had my little companion installed, it is amazing how many people, of all ages and lifestyles, including fellow orienteers, have them.

At the end of the month of relative inactivity I was given the all clear to start proper exercise and I was also given the contact details for an organisation called Pure Sports Medicine who specialise in conditioning athletes after injury. We celebrated the all clear by making a late entry in WIGHTO’s NostalgiO week-end and that proved a great success – beautiful weather, a nice hotel and some magnificent views from the event venues. Then through the UK Autumn it was the usual string of Regional events with the unchivalrous highlight for me being the one at Hatfield Forest which was the first at which my mins per km beat Catherine’s! My target had been to complete six Regional short course before the year end to get me fully into the ranking system and I was well-pleased to achieve 8, plus one middle distance course. In the meantime I paid my first very nervous visit to Pure Sports Medicine (PSM). Why so nervous? Well, principally because the last occasion on which I had exercised anywhere near my limits I had dropped dead. A back-drop which had been emphasised by the fact that my local hospital refused point blank to allow me to attend their cardiac rehabilitation classes, which are generally geared to the needs of the obese and elderly, on the grounds that I was too high risk a patient. Additionally, and slightly perversely, although I now had my own internal defibrillator as an insurance policy, I really did not wish to do anything that would trigger it. But PSM were brilliant and have continued to be so. From the very beginning my trainer, David Smith, who has previously helped in the rehabilitation of a heart/lung transplant patient amongst others, showed a very clear understanding of my dual motives for attending the clinic: getting fit safely and re-building confidence. PSM have a highly distinguished international client list ranging from international sports personalities to the Spice Girls, but they apply the same level of care and dedication to lesser mortals. I now do one supervised gym session per week at PSM and broadly follow a tailored training schedule provided by them which is revised every ten weeks following a further fitness test. In a typical week now, as well as attending the gym at PSM I will also go to the local gym once, ideally compete both mid-week and on a Sunday and get out for at least one walk/run session. My training now is far more ordered than it ever was before the heart attack, which is due in part to the discipline instilled by PSM, but is also greatly helped by having being made redundant/ taken early retirement at the end of 2008. And all of that is paying dividends in terms of fitness and my orienteering performance. My orienteering is still a mixture of walking and jogging.......but then it always was! .........and I do get extremely puffed on hills. On the other hand, my navigation has also improved. So if I can hang on to that as well as keep getting fitter...................... Orienteering continues to play a great part in my recovery. The wide range of available events, all offering the stimulus of competition within their own boundaries, makes Orienteering an ideal sport within which to rehabilitate after injury or illness. The structure of events makes it easy to compete at Regional or National level in short or long courses according to one’s circumstances. The ranking system similarly provides interest and motivation at whatever level one is competing. While it is absolutely essential for Orienteering to change and stay fresh, we should be careful not to lose any of the features which really do make it an adventure sport for all. Then there are the people. Many people who we knew on nodding terms from event attendance over 25 years have subsequently stopped to speak encouragingly and with genuine interest. And, despite the drama I caused at Hampsfell, as yet no event organiser or first aider has taken one look at me and run for cover! On the contrary, fellow orienteers are simply pleased to see me back. The two Orienteering highlights for me so far in 2009 have been a LOC Regional Event at Bethcar Moor on 1st February and the JK Relays on 13th April. The significance of the JK is obvious – the anniversary of my collapse. At the LOC event I was able to meet for the first time – well, the first time while vertical and conscious! - the St John Ambulance team who saved me.

JK Relay 2009