It’s supposed to hurt. But it’s meant to hurt after you’ve given your all. Or during. It should be the kind of strain which, while not welcome, feels familiar and constructive.
If it hurts at the beginning, if it feels alien and unproductive, then something is wrong.
It’s one of my first track outings of the year and I can’t be pushing 150W, yet it feels as if my chest is being stamped on by heavyweight sprinter Harrie Lavreysen. Something is wrong.
For all that we let our legs do the talking, on the road or around the track, through the woods or along the trails, it’s the heart that makes the athlete.
There’s no organ we rely on more, to pump oxygen to the parts that push the pedals, before returning deoxygenated blood to the lungs to complete the circuit and restart the process.
When the heart weakens, or fails, so do we. To an extent, we cease to be. Reports of heart problems – and worse – within the ranks of professional cycling are as old as the sport itself. Too often, they have revealed themselves in the most profoundly painful scenarios.
Most cycling fans will be familiar with at least a few of those from the last decade alone: the tragic death by heart attack of promising 21-year-old Belgian Michael Goolaerts, mid-way through the 2018 edition of Paris-Roubaix; the 2022 career-ending collapse in Volta Catalunya of Classics winner Sonny Colbrelli; the story of Visma Lease-a-Bike’s Nathan van Hooydonck, whose own career was brought to an end by a sudden cardiac arrest that occurred while driving his wife near their home in Belgium.
Last year, the promising future of young GB rider Anna Shackley was brought to an abrupt end by the discovery of arrhythmia – an irregular heartbeat resulting from misdirected electrical signals – following an on-bike episode.
Serious but usually treatable, her case proved beyond the capabilities of modern medical science to resolve.
- Fit older male cyclists face these hidden heart risks – here's why that shouldn't put you off riding
A new reality
“Every athlete dies twice,” is the aphorism referring to the loss of self that accompanies professional sporting retirement.
It can sound hollow compared to near and actual death experiences. Goolaerts’ family would surely give anything to have him back.
Before turning their thoughts to his job, Van Hooydonck and his wife, Alicia, were primarily thankful the outcome wasn’t worse.
Which doesn’t make the maxim any less resonant for those to whom cycling is more than mere hobby, or mode of transport. For Van Hooydonck, the crash brought a new reality, one as hard to face as any in his short career.
“I really had this feeling that my life was over as soon as I had my accident,” he says.
There was a similar sentiment from Shackley: “To say I am devastated would be a huge understatement,” she wrote on Instagram in April. “Cycling has been my entire life for as long as I can remember and unfortunately it has come to a premature ending.”
And it is not only the sport’s best who source their sense of self from the hours they spend in the saddle. For any subset of the committed, cycling is not just something we do. We are “cyclists.”
Ryan Short, 35, was the sort of puncheur we’ve all ridden with, only stronger. The kind who thrives on riding hard all day, for whom the joy lies in the effort.
A highly rated amateur based in Washington State in the US, six years ago, he was taking part in a tough local race, the Ronde van Palouse, when, mid-way up one of the longer climbs, “all of a sudden I just felt like there was a fish flopping around in my chest”.
It was a frightening sensation, completely unlike the recognisable experience of a bonk, when the power goes out. Instead, “I felt like I was still putting out the power, but I was at walking pace”.
Had my own condition emerged as dramatically, or were I able to recognise it as 'pain', as opposed to discomfort, irritation or inhibition, I might have pushed the panic button earlier.
As it is, I convince myself I am suffering from nothing worse than long Covid, that I had got back on my bike a bit too soon after those two dark lines had faded to one. Not nice, but normal, relatable among my peers.
I treat it like I would a broken collarbone, trusting my body to repair itself given decent downtime, aiming at a few weeks, or a month tops.
Although it never becomes unbearable, nor does it get better. The irregular, effort-induced unpleasantness becomes constant, harder to ignore.
When I submit to making an appointment with my GP it is more to appease my partner, for whom a flat cluttered with unridden bicycles is only less insufferable than a boyfriend unable to ride them.
However gradual, that I was experiencing a mental and emotional slide was more evident to those around me.
The racing season had since resumed and I missed my weekly place at the back of the bunch, pining to make the odd futile dash off the front.
Moreover, I missed the banter and the belonging, the completeness and mental escape that only comes from two hands in the drops and with all pistons firing.
Investigating the issues
At our first meeting, the doctor humours my amateur diagnosis while making clear Long Covid will only be considered once every more serious possibility has been ruled out.
Although it did not occur to me at the time to ask what those might be, I have come to appreciate that the phrase 'chest pains' tends to trigger silent alarm bells between the ears of most medical professionals.
That's true no matter how casually you dress them down – especially when you are still, as one doctor in the cardiology unit kindly describes me, “relatively young”.
There were no sirens sounding on the other side of the pond, however. Despite Ryan fairly swiftly identifying an arrhythmia as the likely cause of his complaints, his age and fitness meant “I just couldn’t get anyone to take it seriously”.
That was, he says, “horribly frustrating”, only compounding the frustration of being barely able to train properly, or race as he would like.
He was eventually able to obtain the diagnosis of supraventricular tachycardia (an abnormally fast heartbeat originating in the heart's atria chambers), and later persuade someone to perform the textbook catheter ablation procedure.
The same operation undergone by Anna Shackley (who had a typically more serious ventricular arrhythmia, occurring in the heart's main pumping chambers), it involves using radiofrequency to burn a fence of non-conductive scar tissue in order to prevent abnormal electrical signals from reaching the heart. As with Shackley, it did not succeed.
“They couldn’t make my arrhythmia last long enough to track it, so nothing was done,” says Ryan. It left him back where he was, bereft.
For me, ruling out means tests and more tests. Devices are attached, numbers noted down. Progressively larger pieces of equipment are involved, requiring increasing numbers of staff to operate them.
Each time the invasiveness notches up, the “highlight” being a CT involving a dye that is flushed through my veins, producing a warm sensation akin to having wet myself.
This is the one that doesn’t come back clear. This is the one that triggers my crisis summer. Existential/identity/mid-life – why pick only one?
The assessment, imparted via phone call a week before I turn 40, is that my left anterior descending artery contains “50-70% non-calcific stenosis”. In layperson’s terms, that’s a blockage. Happy birthday, here’s heart disease.
In a fog of sorts, I take in what I’m told about treatment and further investigation. I will go on medication for cholesterol, blood pressure and thinners. All I want to know is what kind of riding I will be able to do.
The specialist understands what I’m really asking. She knows not to treat it as a trivial question. She knows how best to answer it. She, like my immensely empathetic GP, realises it wouldn’t be enough to tell me to ‘take it easy’.
“Nothing fun” is her clear instruction.
I am still, theoretically, allowed to engage any of the two-wheeled machines at my disposal, but I cannot ride them. This really hurts.
Following his own, more certain and certainly more permanent diagnosis, Van Hooydonck spent similar time contemplating what he had lost.
“I thought I'd never get to see my friends again,” he says. “I'd never get to rub elbows in the peloton again. All these kinds of things were taken away from me. But most of all [the thing that had been taken] was my passion. And that was very hard to swallow. It was very, very difficult.”
Rays of hope
I am assigned a date, some months away, for an angiogram. This procedure, another step up in seriousness, is the kind that comes with ‘risks of complications’.
It should, however, provide a better view of how bad the blockage is, while affording the opportunity to address it.
Meanwhile, I pop three pills a night, tolerating the nausea, fatigue, insomnia and other fun side-effects. For a chance the critical numbers might go down, I can handle my nightly transformation into an industrial smelter.
Pages fall from the summer cycling calendar. I volunteer a couple of times at track league, scoring and with sign-on.
On another occasion, I go down simply to spectate, which fails to even partly fill the void, or restore lost connections. Looking on from the stands only serves as a reminder of what I’m missing, however (hopefully) short-term that might prove to be.
In early autumn, I defy doctor’s orders by joining a friend for a 40k gravel ride through some of Surrey’s vineyards. As easy as I take it, I’m left feeling as if I’ve ridden a 24-hour audax. Mentally, it’s still the best I’ve felt all year.
My 40-minute angiogram is stressful (physically and in other ways) but, after an early admission and long day’s wait in the company of older, more vulnerable neighbours, it goes well.
It’s determined that the blockage is not as severe as the original CT had implied, and it's thus unnecessary to install a stent, the job of which would be to increase the artery’s aperture and improve blood flow.
The first woozy words to emerge from my one-track mind are to ask if I can ride my bike properly again.
It’s not quite an all-clear, but tentative approval is given. A subsequent round of tests provide further encouragement, but the sensation beneath my ribcage hasn’t gone completely, and nor has the trepidation.
Maybe I’m too attentively tuned to feel it. There’s only one way to find out.
One crisp Thursday morning in mid-November, I lift a dusty track bike off the wall and wheel along to the early vets training session.
Enough time has passed since I was last here that I’ve aged into eligibility. I take my place at the back of the bunch, where the small talk is unobtrusive but welcome. With each passing lap, the pace picks up.
It’s not comfortable – as expected, my endurance is through the floor – but my legs have lost less than they might.
Approaching what must be the bite point, I’m clinging on, awaiting the wrong sort of snap, crackle or pop. The lap bell, when it tolls, is music to my ears. A sprint of sorts and briefly into the red. It hurts, but only as it’s supposed to.
I’m back where I belong. I’m me again. It’s not a reset, but a reprieve of sorts. Compared to so many, I am immensely fortunate. Although Ryan still spends many hours each week on his bike, they’re long rather than hard rides, which just doesn’t hit the same.
“I’ve defined my life by how hard I can push myself,” he says. “So many of my proudest moments are days where I just break myself to the absolute limit. I keep trying to figure out how to fill that gap in my life.”
Work to do, then.
Van Hooydonck provides a lesson that we could all draw upon. “I started realising if I stay in bed every day, and I don’t make something happen, for myself, for my family, for my child, then yeah, nobody else is going to do this for me.”
In other words, you’re only down as long as you choose to stay there. It helps to have help, though.
This experience has taught me much about my own fragility and the need to equip myself with the tools to handle that hurt if, or when, it returns.
