In early November, Jeremy Powers, 34, let the world know, via Facebook, that he had been experiencing some issues with his heart. Since that time he has posted further updates about his condition. As the author of “The Haywire Heart,” a critically important guide to heart care for athletes and the first book to delve into the relationship between long-term endurance athletics and heart health, I was particularly intrigued to learn more about his condition and prognosis. Here are excerpts from that interview.
VeloNews: Jeremy, take us back to when this all started.
Jeremy Powers: I remember the first time I had a palpitation very well because it freaked me out. It was at the USGP in 2007 [the first USGP event Powers ever won -Ed.], and I was coming around this corner when I felt a jolt in my chest that made me go, ‘Oooooh, okay, okay.’ That was the first time I noticed something with my heart. And I had palpitations for a long time after that, that I had looked at many, many times, including with Holter monitors and things to make sure there wasn’t anything significant or dangerous going on. Most of this, after about 2010 or 2011, was at Mass General Hospital with Dr. Aaron Baggish. They’ve worked with a lot of cyclists and are the place to go in this area of the country.
This spring I was getting these run-ons: I was doing base training, and doing a lot of climbing at about 150bpm, and then suddenly it was at 200bpm. The first time it happened, I thought I had a panic attack. I had never had a panic attack before, but I came home and I looked up what that was. I remember it well: I was laying in the yard beside this guy’s house and he had the Confederate flag blowing there. And I remember thinking to myself, ‘Okay, this is how it ends!’ [laughs] I was out in the middle of nowhere, this flag is blowing in the wind, and I’m just laying there freaking out. I couldn’t get my heart rate to go down. It probably lasted five or six minutes like that.
I was pretty spun from that. I stopped doing big loops away from the house and instead did micro loops to see if I could get it to happen again around the house. It would kind of happen and I’d back off, and then again and I’d back off. I didn’t really think much of it. I just assumed it was about stress because I was about to become a father. ‘Maybe I’m going through this and it’s all just anxiety.’ I went to the doctors, they offered some solutions, but I didn’t want to take them up on them — they offered me ‘chill pills’ essentially. They thought for sure it was anxiety related. I started meditating instead. We didn’t even talk about the heart stuff.
[Coincidentally, as reported in the New England Journal of Medicine, female heart patients in their 50s and younger are seven times more likely to be misdiagnosed than our male counterparts. -Ed.]
It’s not a revelation to say that I’m a pretty high-strung, type A personality. But I think I’m also well-balanced and have gotten a lot better at that. I’m a big proponent of people that do have anxiety, consider therapy. I immediately went to therapy. ‘I’m dealing with this, this sucks, and I don’t like what’s happening here so I’m getting help.’
VN: This season has been up and down, and you’ve been dealing with more issues.
JP: After doing a number of things to fix some gut issues I was having, I felt a lot better. I didn’t have any palpitations basically after that until this September at Rochester. I went really deep. During that race, I had another run-on, and I just faded to the back of the group. I just thought it was a fluke thing because it had never happened to me in a race. I just assumed it was stress; I had not thought it was a heart-related thing in any way until this race when it lasted about a minute. But I had been reading up on some of this stuff and I remembered reading about this maneuver where you bear down like you’re going to go to the bathroom. [The Valsalva maneuver is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one’s mouth, pinching one’s nose shut while pressing out as if blowing up a balloon. – Ed.] I did this in the race as hard as I could, and it went away. I ended up sprinting for third, but even after the race, I couldn’t get my heart rate down. I obviously went really deep, but I said, ‘ God, I almost died in that race!’ My heart rate was over 220bpm. It was insane.
It happened again but in a slightly different way at the Friday night race in Iowa before the World Cup. It happened again in Baltimore on the first day [where he finished second in a sprint -Ed.], and by this point, I was wearing my heart rate monitor all the time so I was able to capture it. I did the [Vaslsalva] maneuver again during the race, it went away, and I just kept on, I didn’t stop. I sent the data to my doctor. He said it looks like low-risk supraventricular tachycardia (SVT) and would be surprised if it was anything else. That’s based off my history, the data from the Holter monitors, and so on. What’s interesting is that my heart rate will be at 178bpm, then it goes to 213 and stays there for the duration of SVT, and then it drops back directly to 178bpm.
It happened again at the Pan Am Championships in Louisville. I think the one constant about all of these incidents at Rochester, Baltimore, and Pan Ams, is that the races took place in 70-degree weather, or much warmer. Another thing that could be triggering these episodes is that when I hit the ground with my foot when mounting or something, that can start them. From other cyclists I’ve spoken with, that is something that triggers things for them too. Maybe they hit a walnut in a corner and had to put their foot down, and that is enough to provoke the SVT.
In Louisville, I actually smacked my face really hard to try and make it go away. My doctor says that was the wrong thing to do because it produces more adrenaline and can make it worse. If I had stopped and done a handstand, that would have been an appropriate thing to have done.
At this point, since this had never really happened to me at this level at this intensity in a race, I could only, unfortunately, go toward ‘what ifs.’ That’s the worst place to go. I stopped in the pit with my mechanic.
VN: You recently went through another battery of tests. What did you find?
JP: I’ve had an echocardiogram and a stress test done every year there, and all of those things show no change this time compared to what has been seen before. My echo from five years ago is identical. During my stress test, I went so deep, just to try and mimic a cyclocross race, for an hour. I’ve never done that much of an effort in my life on a trainer. I almost vomited. And nothing happened. During the test, I even got off my bike and jumped up and down and started stomping on the ground. I just couldn’t get it to do it. Which was actually nice for me, to have that confidence that it may or may not happen to me.
Basically, it came down to the fact that I can either ablate or not ablate.
[Catheter ablation is a minimally-invasive procedure used to remove or terminate a faulty electrical pathway from sections of the hearts of those who are prone to developing cardiac arrhythmias. -Ed.]
VN: To ablate or not to ablate, that is the question. What is your current thinking?
JP: We’re just going to roll with this for the time being. As I’ve gotten a little more educated, I’ve concluded the perceived danger is not as great as what I thought before I became educated. [Read about the warning signs and symptoms of heart arrhythmias here.] When this happens to you for the first time, it would be unnatural for you to not have a nervous response to that. Now I know the maneuvers and other things about it, and I know even when it happens, I’m not going to die from it. I think most people at first say, ‘Holy crap I’m having a heart attack.’ At least I did! [laughs]
I may deal with this down the road especially if it gets worse. If I was told this would stop the palpitations too, I’d definitely do it. The palpitations are annoying; they’re really obnoxious, and they can get really bad. But that’s not the case. I’ve spoken to a lot of riders and none of them thinks that it’s a big deal. Everyone that I’ve talked to has had a successful ablation.
What has really been beautiful is how many people have reached out to talk to me and tell me about what they went through. It’s been really cool, and humbling in a sense.
I’m in a place in my career where I understand my place and the impacts I can have, and I didn’t ever really think much about the heart thing other than explaining why some races have gone well and some races haven’t. I just wanted to let my fans know that I’ve been going through this, and it’s not allowing me to ride at 100 percent all the time. Because I constantly have people asking me how I’m doing, I wanted to bring attention to the fact that there’s something else going on and I’m working to figure it out. I was really green when I wrote that initial post on Facebook. Then, 100 emails later, I realized this type of thing is a lot more common than I ever thought it was.
I’m almost certainly not going to have an ablation before the national championships. I don’t yet think it’s necessary. That said, mentally I’m getting back to pushing myself. In cyclocross you have to go really deep, you have to go insane. I’ve just been feeling like I’m holding back a little. It put a little block on my mental fortitude. I want to ease my way back into this mentally and physically.