We continue our series in which Consultant Interventionist Dr Michael Norell takes a sideways look at life in the cath lab…and beyond. In this column, in case it is not immediately obvious, he considers cardiovascular fitness.
For UK healthcare professionals only
I didn’t have a bike as a kid. I suspect this was simply because I didn’t need one. Being brought up in North London, the roads were not exactly free of traffic, and school was only a two-mile walk away making it easily – and probably more safely – accessible on foot.
However, moving to Beverley in order to take up my first consultant post in Hull, I was seduced by the quiet, fairly straight and usually flat country lanes of East Yorkshire. This was the perfect opportunity to explore the possibilities of pedal power, and I later transported that enthusiasm to the Black Country when I moved to Wolverhampton and took up residence on the borders of South Staffordshire and Shropshire.
One legacy that derived from the London Olympics in 2012 was the exponential growth in recreational cycling. This expansion may have received an extra shove with British success in the Tour de France, as well as the peculiar events preceding the resignation of the government’s chief whip, Andrew Mitchell, when he and his bicycle attempted to exit Downing Street last autumn.
The exact words used during that altercation with police officers remain a matter of mystery (if not sub judice), and so it has since been referred to as ‘cycle-gate gate’. This is akin to most high level, damage-limitation exercises and named after the infamous 1972 US Presidential cover-up of an attempted burglary at the Democratic headquarters in the Watergate offices, Washington DC. I prefer to dip into my scant knowledge of biochemistry and just call it the ‘Pleb’s cycle’.
As I used to pedal frantically in an attempt to whittle down the time for my 13-mile circuit, I listened to my radio via a pair of earplugs. This was not a sensible habit as seasoned peddlers among you will know – a view now shared by a small body of Shropshire motorists who crawled along behind me, unable to overtake.
I was, of course, unaware of their existence, such as might be hinted at by their car’s engine noise or ultimately their horn, as my lugholes instead were happily focused on Radio Five Live.
Currently, rather than just use one earpiece, I have adopted a more sensible approach and omitted this distraction altogether. However, with nothing of interest on which to concentrate now, my mind has been allowed to wander, and the result is that I have pondered upon some aspects of the physics and physiology involved with this form of transport.
It is exceedingly clever. Jogging for instance, is high impact and hard work, and much effort is required to generate any meaningful speed; you get hotter but your pace is insufficient to allow wind to provide any temperature-lowering effect. In contrast, cycling – which is low impact, pleasant and far more efficient – ensures that any increase in effort to generate speed results in just the correct amount of cooling breeze.
This can be a disadvantage; cycling into wind is frankly unfair. There is only so much I personally can do to reduce the surface area that I present to an oncoming gust. Bending low over the handle bars is the usual response, but then forward vision can be compromised – as another group of Shropshire drivers have noticed.
This brings me onto the subject of slipstreaming. Apparently, tucking in behind a motor vehicle or another cyclist can increase your speed significantly as you pass through the ‘hole in the air’ made by your predecessor. I have no problems with the theory, but it does require you to match their speed in the first place, and that usually counts me out.
The right gear
Another subject that has occupied my mind – usually at around mile eight – is the whole question of gears. Is it better to pedal slower in a high gear (albeit with more effort) or faster (and thus easier) in a lower gear?
My own analysis is that you are seeking the fastest speed at the most acceptable (not necessarily, comfortable) cadence – a word I interpret as a combination of pedal revolutions and rhythm. Clear? I thought not, but it gives you an idea as to what life is like without being able to listen to my radio and Danny Baker’s iconic ‘Sausage Sandwich Game’. Let’s move on to something a bit closer to home … like personal safety.
I divide this section into two: acute and chronic. As for acute, I have always avoided wearing any form of head protection, my excuse being that I tend to avoid roads in which there is heavy traffic assuming that any injury is usually related to a third party interaction. I know; a big mistake of which I was reminded one morning last winter.
Bright, sunny and minus one. Although most of the snow that had fallen during the previous few days had thawed, there remained the odd frozen patch. I was on mile four, and riding flat and straight at 14 mph, give or take. Suddenly, I was on my bonce having presumably hit some ice; the lane’s slight camber was enough to mean that any lateral friction from the tyres was insufficient to counteract the moment of my centre of gravity (i.e. I fell over).
No major injury resulted, although I sustained a ‘beurmp’ on my head (as Detective Inspector Clouseau would say, courtesy of Peter Sellers in his 1964 classic, A Shot in the Dark). This injury was strikingly similar to one I had received years previously while sailing on the Solent on a 30-foot Beneteau, helmed by a long-standing friend, now a Professor of Interventional Cardiology, whom I won’t name – although he never reads this stuff anyway.
With a following wind and a corkscrewing sea, we gybed. The swinging boom delivered a clunk to my nut of sufficient sustenance to send me sprawling across the cockpit, lacerating my scalp to form a scab that would occupy my idle fingernails for weeks.
So, author’s message: always wear a helmet while cycling – and when sailing if he’s on the tiller.
Bringing up the rear
The other chronic, pathophysiological issue is more delicate, such that if you are under 18 years of age you should only read this after the nine o’clock watershed. Sustained pressure from the saddle on the more sensitive aspects of the male anatomy can result in a degree of neurological dysfunction. Believe me, this is not a mild case of ‘pins and needles’; we are talking total anaesthesia, equivalent to a lignocaine ring-block, if – God forbid – such a technique was ever allowed.
I have discussed this ailment with fellow cyclists, mostly male, and including my old sailing pal referred to above. The cause appears to be pressure on branches of the pudendal nerve and can be relieved (thank goodness) by occasionally taking weight off the seat, some cleverly placed padding (integral in most cycle apparel), a saddle specifically moulded to suit one’s individual anatomy and angling the seat very slightly downwards.
I have adopted some of these measures and am happy to let any interested readers know the outcome in a future column.