Can't use my "red" zone

timbob67

I'm interested (and slightly worried) about being able to push on my bike - and seem to have a recurring problem.

As a bit of background, I'm a month shy of 30 years old, 5'9", under 12 stone, otherwise healthy (rarely drink, don't smoke, plenty of fresh veg/home cooked meals etc). I had asthma as a kid, but "grew out of it" and haven't used an inhaler for nearly 15 years now.

I've been riding for a few years now, nothing mega, but from spring through till autumn, I head out at least once a week for anywhere from 1-3 hours, averaging around 15mph in flattish (with lumps) north Bedfordshire.

My problem is that I can't seem to push into my red zone (at all) without side effect. There's one hill near me which knocks the speed down to 10mph, and I need the lower few gears on the small ring to get up. If I take it easy, it's fine,a me I can carry on riding. If I push the speed up into the "trying hard" zone, I seem to blow up, even though the hill only takes a few minutes to get up. Two or three times I've felt so light headed (seeing flashing lights in the periphery of my vision) that I've had to get off for a 10 minute sit down at the top. On one occasion I rolled down the following descent, pulled over into a layby feeling properly dodgy and promptly passed out, hitting the floor and waking up wondering where I was. All this after 4 or 5 minutes of effort that I'd only call the high side of moderate effort - certainly not pushing for all I'm worth.

Today, going up the other side of this hill (which is a short and sharp ascent, rather than the gentle drag going up my usual way), I stood up in a mid gear on the low ring and really felt I was "dancing up" the incline - the best I'd ever felt going up! Only 30 seconds or so of moderate/high effort. Yet at the top, the light headedness came back, and I had to spend 15 mins sat on the verge, head between my knees before I felt good enough to carry on.

I try to make sure I eat and drink enough. I always have some food (sandwich/crisps/etc) 20 mins or so before going out and a pint of water just before setting off, take a banana/malt loaf with me, and drink my full litre bottle of water in a 90 minute ride.

Any ideas?

imposter2.0

Off you go to the docs for an ECG. Passing out after moderate/hard effort is NOT normal, as I'm sure you probably realise. I personally would not get back on a bike until you've had some tests.

sungod

^^^ this

timbob67

The thing is, I had a full "lay down and plugin" ECG and a 24 hour ECG pack to wear only 18 months ago when I went to see the doctor. Absolutely nothing out of the ordinary was found, and my blood pressure is apparently slap-bang in the middle of normal. The picture of health, apparently.

I have only passed out the once, but the light-headedness and the need to stop for 10 minutes to recover is a pain.

I wonder if I might have something heart related, where I can't keep the blood pressure up under exertion, or something. Are there such people as "sports doctors" you can see?

sungod

if the problem only happens during heavy exercise, then it may only be diagnosed by undertaking tests that stress you, a normal ecg won't do that

there are good doctors, there are average doctors and there are bad doctors

you need a good one, they may refer you to somewhere for an exercise tolerance test etc.

dilatory

Just keep pushing the issue. See a different doctor. Some are absolutely appalling and should be stripped of their jobs because they don't give a damn.

Stick8267

What does your heart rate do during this?

You may have a fixed cardiac output state. In other words your body tries to increase blood flow but your heart cannot increase the blood coming out of it enough.

You need an echocardiogram and possibly stress test under controlled conditions.

And you need to not exert yourself until you know what's going on.

ozzzyosborn206

I have a friend who has a similar problem at the gym but she actually passes out alot, went to the Dr had tests but was nothing they noted to be wrong, gym instructor didn't know what it was. I suggested trying energy drinks and it seems to have done the trick, think it was just having low blood sugar levels which become further depleted when pushing harder. What do you eat and drink on the bike?

Escher303

I'm not at all negating the advice to get properly checked out by a professional, this you must do ASAP. But I'm replying as bananas have a really weird affect on my metabolism. If I eat one before a ride or a run I get really wobbly and light headed and I can't get going properly until I eat something else sugary. It mimics a 'bonk' where I haven't eaten enough but can happen in only 15 minutes. I see stars and feel wobbly and light headed. This only happens when I eat a banana and then exercise. It doesn't happen when I just eat a banana. It doesn't happen when I eat anything else before a ride. It doesn't happen on a ride when I eat other sugary food (gels, jelly, cake, cereal bars, energy drink etc all fine). I'm quite happy riding hard or long, centuries, hilly routes whatever, but if I eat a banana beforehand I feel really wobbly and weird, with everything else I'm fine. I can't explain it but it always happens. Is something similar happening to you?

dilatory

It sounds just like you have a banana allergy...

davidof

Stick8267 wrote:

What does your heart rate do during this?

It would be worth getting a watch or bike computer that can record your HR on a ride to see what it does. Maybe you just need to back off a few bpm, although your symptoms sound quite severe.

timbob67

I'm not sure what my heart rate does during any of these episodes - I've not got a HRM, but be worth getting one?

Since posting the thread, I've been thinking back - 10 years ago whilst at uni, I tried going to the gym (with a friend) as a bit of a fitness drive. After 10 minutes on the stepper machine at the start of my warm up, I ended up in an ambulance. That was put down to not eating properly.

I also sometimes ring the church bells in my village, which isn't particularly strenuous, but ringing the bells "up" prior to ringing is hard work, especially on the one-tonne big bell. I fainted after doing that the other year - but seem to remember I'd had a mad day and hadn't eaten dinner.

I wonder if it might be blood sugar related possibly? Can certain people be overly sensitive to blood sugar drops during exercise? Feeling faint isn't an everyday occupancy - I just have to remember to really pace myself up hills, and then I'm fine and can carry on my ride. My previous ECG ruled out any physical heart defects, and the five syringes of blood they drew ruled out anemia or similar problems...

Anyhow, I will ring the surgery in the morning to book myself in to see someone this week.

Legolam

if the problem only happens during heavy exercise, then it may only be diagnosed by undertaking tests that stress you, a normal ecg won't do that

This is spot on. You need an echocardiogram and possibly an exercise stress test. A normal rest ECG doesn't rule out some structural abnormalities. Go back to your GP and ask them about referral to a cardiologist.

Best wishes
Hannah (a cardiologist)

Stick8267

So that's a Cardiologist and a Sport Physician voting for an echocardiogram!

Good luck and best wishes

chrisaonabike

I'll another voice to the clamour of "get yourself properly investigated".

Even if there were "reasons" for the episodes in your past, most people do not faint when they exert themselves, even if they're hungry. They feel tired or weak and stop, or are forced to proceed at a slower pace.

If I push hard up a hill towards my MHR, I feel awful if I try to sustain it, but I don't faint or feel light-headed (I feel sick, in fact), I don't see stars, and it's self-limiting - I have to slow down.

Seriously, you owe it to yourself and the people that care for you to get to the bottom of it.

Best of luck.

ai_1

Yep, get a referral to a good cardiologist. Ideally one used to dealing with younger patients involved in sport.
I was having some intermittent chest pain a couple of years ago and one day the chest pain was worse than usual and accompanied by some pain in my left arm (i.e. typical heart attack symptoms). I reckoned the two were unconnected but decided to take no chances and went to the nearest emergency room just in case. They don't hang around if you go into A&E with chest and left arm pain! Anyway they gave me an ECG which came up normal and they ruled out a heart attack via a blood test within a few hours. I was released with appointments to come back and do a stress ECG and heart echo. After the stress ECG I was told they were concerned about some anomalies and that I needed some further tests. They scheduled these for a date 6 months later - this was all through public health. If there was anything wrong I didn't want to hang around 6 months to find out so I went to my GP and asked him for a referral to a cardiologist. He made a point of finding a cardiologist who worked primarily with younger patients and athletes and I'm very glad he did.
I made an appointment and got my previous test data and reports sent on to the cardiologist. The cardiologist dismissed any concerns about the stress ECG. Apparently the hospital had misplaced an electrode and she suggested they had interpreted the data as though I was a sedentary 60 year old not a very fit 36 year old, the results from which can look quite different! She was confident that there was nothing concerning in the results. After going through a full history and doing some further checks she was confident there was nothing wrong with my cardiac system and although neither she or my GP could find a cause for the chest pain I was told it was most likely a musculo-skeletal problem and would probably resolve itself in time. The cardiologist said she was confident there was nothing wrong but if I wanted to put my mind completely at ease a CT coronary angiogram was the most definitive way to rule out any blockages etc. I did the scan and got a clear bill of health. Told to come back in 20 years for my next check-up.

Anyway my point is, all doctors and cardiologist are not the same. Find a suitable cardiologist.

I actually had what sounds like a similar issue to you last week after a swim but it's an isolated incident for me. Never had it happen before and hope never to again! I've just started swimming with the intention of doing some triathlons. After a session in the pool I finished off with a few fast lengths. Since the pool was just about to close for the night I didn't do any sort of cool down and got out of the pool a bit out of breath. By the time I got to the changing room I was feeling pretty light headed and had to sit down for fear of toppling over. I had to sit with my head down for maybe 10 minutes before I was starting to feel normal again. It was a scary experience - I certainly wouldn't be taking it lightly if that happened repeatedly! I think in my case it was a combination of slightly iffy food intake that day, dehydration, a VERY warm changing room and the sudden stop from hard effort. I felt fine while working, it was only when I stopped that I suddenly felt awful. Never had that happen on the bike. After a really flat out sprint I might occasionally feel slightly light headed for just 5-10 seconds as I spool down but I think that's normal and I don't get dizzy or feel like I might pass out.

Best of luck, I'm sure you'll be fine but it's worth getting yourself well checked out so you know where you stand.

DeVlaeminck

Possibly controversial but I'd say it's happened more often than it has - exaggerate a bit so they take it more seriously - I knew a few people who are dead that might be alive today had they not accepted the first diagnosis they were given when in truth they didn't really think it sounded right but when a doctor tells you something it's hard to say actually no I want a second opinion.

timbob67

Ai_1 wrote:

I actually had what sounds like a similar issue to you last week after a swim but it's an isolated incident for me. Never had it happen before and hope never to again! I've just started swimming with the intention of doing some triathlons. After a session in the pool I finished off with a few fast lengths. Since the pool was just about to close for the night I didn't do any sort of cool down and got out of the pool a bit out of breath. By the time I got to the changing room I was feeling pretty light headed and had to sit down for fear of toppling over. I had to sit with my head down for maybe 10 minutes before I was starting to feel normal again. It was a scary experience - I certainly wouldn't be taking it lightly if that happened repeatedly! I think in my case it was a combination of slightly iffy food intake that day, dehydration, a VERY warm changing room and the sudden stop from hard effort. I felt fine while working, it was only when I stopped that I suddenly felt awful. Never had that happen on the bike. After a really flat out sprint I might occasionally feel slightly light headed for just 5-10 seconds as I spool down but I think that's normal and I don't get dizzy or feel like I might pass out.

Best of luck, I'm sure you'll be fine but it's worth getting yourself well checked out so you know where you stand.

That does sound like my symptoms - thinking back, each case of fainting/near fainting has happens very soon (1-5 minutes) after stopping exercise.

Everyone is right though, "normal" people get tired out/sick and don't pass out after exercise. I have booked myself in at the Local surgery for an appointment, and will ask for a referral to a cardiologist.

In the meantime, I won't stay off the bike - I've managed nearly 500 miles this spring spread over 20 odd rides, so as long as I keep a lid on my exertion it won't be any different to the last three years. I've ordered myself a Garmin 510 for the HRM capability, so I can at least see what my heart is doing, and for its "track me remotely" feature, which my other half felt happy about it having.

Legolam

Possibly controversial but I'd say it's happened more often than it has - exaggerate a bit so they take it more seriously

Please don't do this. By all means, question your doctor if you're not happy with the diagnosis or explanation. We also don't mind if you ask for second opinions - medicine is an art, not a science and we all get it wrong sometimes. But don't lie - that just makes it harder for us to get it right. 99% of the diagnosis is made in the history ie what you tell us.

Any GP or cardiologist worth their salt will take you seriously with the information you've already posted. If I were you, I wouldn't be going anywhere near my "red zone" until I'd had an echocardiogram.

ai_1

DeVlaeminck wrote:

Possibly controversial but I'd say it's happened more often than it has - exaggerate a bit so they take it more seriously - I knew a few people who are dead that might be alive today had they not accepted the first diagnosis they were given when in truth they didn't really think it sounded right but when a doctor tells you something it's hard to say actually no I want a second opinion.

Give them the wrong information to ensure they get the right answer?
I think that's a very foolish suggestion. If you're not happy you're being taken seriously, tell them. Lying about symptoms can only harm their understanding of your condition and your faith in their diagnosis and advice.

tazmon

Hi

I suffer with the very same thing with really hard physical exertion both cardio and weights. For me it's a plummet in blood sugar levels that causes the problem and I manage it with energy drinks - I would not risk riding with just water.

Had the stress ECG performed too and no issues found.

Cheers
Rory

timbob67

A bit of an update, having been to the docs:

Nothing too serious apparently - a vasovagal syncope (faint) brought on she thinks *after* hard exertion where the bloody vessels stay dilated too long instead of contracting causing a blood pressure drop.

Staying properly hydrated will help (and seems to have done already), and going by some reading, actually keeping on pedalling after hard effort rather than stopping pedalling and coasting to cool down will alleviate the blood pressure drop too. I ordered a Garmin 510, and have been doing some rides of 2 hours, keeping my heart rate right down in the 120-135 range (and no higher than brief 150 peaks on the steep bits). These have actually been some of my most enjoyable rides of the year, despite the 11mph average speed

I've asked to be referred to a proper cardiographer for a stress test, and after a standard "lay down" ECG at the local surgery (which they have to do the eliminate basic things before referring me on), I'll be off to the hospital.