This is an exceptional read and I hope you enjoy learning about Alexander's journey as much as I did.
I would never ride as fast as he can but I hope to race with him in the CLOT BUSTER #StopTheClot polka-dots some day!
Out Sprinting” a Silent Killer”
By Alexander Rapavi
Imagine being an hour and fifty minutes into a three hour solo training ride in rural Virginia – a region with spotty cellular telephone service, of course – when out of the blue, you begin to feel dizzy, disoriented, significantly short of breath and start having sharp pains in your chest, uncontrolled coughing, and a debilitating ache deep within your right calf. Definitely not a pleasant thought. A better description might be nightmare scenario. The script of a very bad dream, to be sure.
Two weekends ago that’s exactly what happened to me, and it wasn’t just a bad dream.
My thoughts raced. Am I dangerously dehydrated? Having an allergic reaction to something? Did I tear a calf muscle sprinting up that grade? Am I having a heart attack?
Luckily, I was able to get to the emergency room for treatment. I ended up hospitalized for five days and hooked up to a host of monitoring equipment. The doctors and nurses who took care of me at INOVA were fantastic. So was my wonderful fiancée Nancy – she didn’t leave my side for one second, sleeping on a makeshift bed in my hospital room every night. I can’t express in words how unbelievably thankful and fortunate I am to be with her.
My morale was high, despite the circumstances. I knew I was in good hands.
So What Happened?As it turns out, I had blood clots blocking portions of two veins in my right calf. Clots in the lower extremities are known as Deep Venous Thrombosis or DVT and are extremely dangerous if not treated properly. That’s not all, though. Portions of the clots in my calf broke away, ultimately lodging in my lungs, effectively compromising my pulmonary function. When clots travel to your lungs, it’s called a Pulmonary Embolism or PE. PE’s are life threatening. They preempt normal lung function, starving vital organs and tissues of oxygen.
PEs are sneaky, too. They mimic the symptoms of other health issues including bronchitis and asthma. Consequently, diagnosing PEs can be quite difficult. Thousands of people die from PEs every year – including athletes.
PEs are silent killers.
Hitting a WallInterestingly, my training had been going quite well the last couple of months. I increased my functional threshold power from 295 to just over 300 watts for 20 minutes and my five minute power was through the roof; my time trial field test times were decreasing, I was able to get my weight down from 185 to 177, I routinely ensured I was getting adequate rest, and was decidedly eating clean.
I had an especially awesome breakfast that morning (my without-‐a-‐doubt-‐soon-‐to-‐ be-‐famous cold muesli). It was so good I actually found myself looking forward to breakfast the following morning. Prior to starting my training session that day, I remember feeling positive about the 2014 race season, my prospects for setting some solid personal time records, and possibly hitting the podium at the Mid Atlantic Championships having missed the steps by one place in 2013.
About an hour and a half into my session, my heart rate began to skyrocket while my power numbers declined. Trying to maintain 300 watts for ten minutes felt more like trying to maintain 1000. Every pedal stroke felt labored.
I simply couldn’t get through my prescribed 10 and 15-‐minute intervals. Not even close. Not possible. Even backing off to power zones one and two in an attempt to recover brought no real relief, just frustration and concern. I hit the wall, totally fatigued.
Was I just having an extraordinarily bad day on the bike? If so, why? It just didn’t make any sense.
A bit further into my training ride, as I plodded along at a meager 17 miles an hour at barely zone 1 trying to figure out why the heck my output was so out of whack, the chest pain and shortness of breath started. So did the deep pain in my right calf. Fortunately, I was at a bail out point along my training route and was therefore, able to get back to where I needed to be in a relatively short time, and to the medical attention I desperately needed.
- Traveling long distances to and from competition by plane, bus, or car;
- Dehydration during and after strenuous sporting events;
- Significant trauma (Pro cyclist Chris Horner developed a PE after suffering trauma from a crash during the 2011 Tour de France);
- Immobilization (brace or cast);
- Bone fracture or major surgery (broken collarbone and related surgery anyone?);
- Hypertrophy of muscles (constricts veins);
- Excessive use of caffeine (caffeine is a vasoconstrictor with diuretic effects);
- Performance enhancing drug use (yes, pharmaceuticals to include Erythropoietin (aka EPO) which thicken the blood, and stimulants which constrict veins and increase blood pressure can contribute to clotting, development of DVTs and PE).
Here are some things athletes (and everyone else) can do to help prevent DVT/PE.
- Stay mobile, move around on long flights; stop, get out and move around during long road trips to and from races;
- Consider staying in a hotel before and after races instead of driving to and from within a day. I have driven to and from races in a day a multitude of times and yes, it is definitely cheaper, but could cost a heck of a lot more in the long run;
- Stay hydrated, stay hydrated, stay hydrated;
- Wear compression socks;
- Consider taking an 81mg aspirin every day. Aspirin helps reduce the body’s clotting mechanisms. Check with your health care provider prior to going on an aspirin regimen;
Waiting could cost you your life.
Looking AheadIt’s appearing more and more like I will have to remain on anticoagulant (blood thinning) therapy for life. I have to undergo more testing in the coming weeks to determine if I am genetically predisposed to hypercoagulability (increased clotting factors). As of this writing, I’m 90% certain I’ll be on anticoagulants for the foreseeable future.
As you can imagine, anticoagulants and mass start bike racing tend to get on poorly with one another. In short, if I’m involved in a crash, the impact could cause organ rupture, internal bleeding – and worse.
Regrettably, by necessity, I am now officially retired from mass start bike racing.
There is a silver lining, though. Notice I said I’m retired from mass start bike racing. I didn’t say I’m retired from racing Individual Time Trials. Far from it. In fact, once I get back on track, I fully intend on training for, and competing in time trials across the Mid Atlantic and Northeast regions again.
No matter the situation, there is always a bright side.
At least I think so.
I hope to see you on the road soon.
Thanks for reading,
The Clot Buster