Month: February 2018

Cycling back to fitness

Mont Ventoux

Tommy Simpson rests on Mont Ventoux. The cyclist died (on my birthday – 13th July) while attempting this stage of the Tour de France in 1967. One passes his memorial on the way to the top with only 1 kilometre to go. This fact became particularly salient as I passed it while experiencing chest pain on 29th July 2017.

After a further 500 meters, I had to stop due to the chest pain. Sitting astride the cross bar, gasping for breath, I could look up and see the weather station at the summit which was a mere 500 meters away, including a hairpin bend with a 20% ramp. I had completed this ascent just the day before and so I knew what I was up against. My friend, Sean, was already up at the top no doubt enjoying the views. We had already cycled from Chartres down to the Alps (via Alpe D’Huez, Izouard and Galibier) and therefore had quite some miles in our legs. After about 10 minutes, I cracked on to the summit.

Angina. Chest pain. When coronary arteries become ‘clogged up’ they no longer can deliver enough blood to the heart itself when demand rises for oxygen during exercise. A complete blockage will bring on a heart attack as blood flow becomes occluded resulting in cell death. Angina can be a precursor, a warning, if you like that something is wrong with your heart. Being told by your GP that you might have had a heart attack and being prescribed drugs to address the issue, is a life changer. In my case, scans revealed the extent of the occlusions which meant that I needed an angioplasty with the insertion of a stent to improve blood flow to the heart.

Now I am in need of returning to fitness after a 7 month rest from cycling. This time however, the challenge is very different given the new medical condition. Few of you reading this will be in the same position as I am. You hopefully do not have a heart condition. Before I comment on getting back to fitness, i need to outline the medical bit just so that you are aware so as not to make false comparisons. I am 59, now overweight coming in at 12st 6lbs. I need to take the following for the heart: Clopidogrel (only for 12 months following the angio as a blood thinner), Aspirin (same but now for life), Bisoprolol and Ramipril (to slow the heart and reduce blood pressure) and finally a statin to reduce cholesterol. My resting heart rate is 50, and my blood pressure has been reduced to about 125-75.

The challenge is training using heart rate zones. Normally we can estimate my maximum and threshold heart rate to set up a training plan using something like training peaks.com. Grant (Cycle for Fitness) provides these structured plans using training peaks. A problem is that my heart rate zones have been reduced by 30 bpm by the the NHS’s cardiac rehabilitation team due to the medication I am taking. My new zones are 64-101!   This in practice results in a very very slow regime of exercise. You might already know what level of movement will take your heart up to 80-90. believe me, it is not much.

I am now finding cycling to those zones to be a nonsense. It is for me a non starter as far as training goes. The plan now is to complete the 8 week very gentle exercise regime given to me by the medical team before I make plans to whizz up Mont Ventoux.

A lesson here is that we should not under estimate what having coronary artery disease is, the effect of having a stent inserted, the effects of the drugs and the time it will take to recover. I have heard stories of bravado – men rushing back to work only to find fatigue setting in. Honestly, just don’t do it.

At one point in January, before I had seen the cardiac team to set down new heart rate zones, I thought I’d go for a cycle. Feeling great along the flat, I pushed the heart rate up to 135-140. I suddenly felt dizzy and had to stop for 10 minutes. Knowing now that my new upper limit should only be 101, it is not surprising that I felt ‘off’. I have had 1 more episode of dizziness while merely sat at the table.

So, for all you macho types that want to blast away getting fit again..great. Just don’t rush it. Discuss this first with your cardiac rehab team…then access Cycle for fitness to co create a training plan right for you but you must do this with your medical team.

Having a stent, an angioplasty, is not the end of your life on a bike. Well, I hope so because I have plans to return to France. First, I have to lose the weight gained and get fitter. I’ll be posting progress.

 

 

Down and Out

In the spring of 1928, aged about 24, Eric Blair (aka George Orwell) moved to Paris, a city in which the cost of living was very low. He tried to earn a living by writing and giving English lessons, but it hardly paid. He was then stripped of his possessions and money by “a little trollop he’d picked up in a café” leaving him with very little cash. His parents back home in England were spared the knowledge of his predicament, possibly due to his concern for their middle class sensibilities. He could have returned home to Southwold, but having previously chosen to leave a career in the Imperial Indian Police in Burma, that was not an attractive path. He had little option but to work in the foul kitchens of the Hotel Lotti on the Rue de Rivoli. His final impecunious 10 weeks in Paris provided the material for his book, Down and Out in Paris and London, the first draft of which was completed in 1930. This was no journalist’s assignment, research or a gimmick.

 

The following are observations on poverty in the early chapter of the book and reveal something of the life he led.

 

“…it is altogether curious, your first contact with poverty….you thought it would be terrible, it is merely squalid and boring. It is the peculiar lowness of poverty that you discover first…the shifts it puts you to, the complicated meanness, the crust wiping.

 

You discover, for instance, the secrecy attaching to poverty…you dare not admit it, you have to pretend that you are living quite as usual.

 

You discover what it is like to be hungry…everywhere there is food insulting you in huge wasteful piles…a snivelling self pity comes over you at the sight of so much food.

 

You discover the boredom…you discover that a man who has gone even a week on bread and margarine is not a man any longer, only a belly with a few accessory organs…

 

…but you discover the great redeeming feature of poverty: the fact that it annihilates the future…

 

And there is another feeling that is a great consolation in poverty. It is a feeling of relief, almost of pleasure, at knowing yourself at last genuinely down and out. You have talked so often of going to the dogs – and well, here are the dogs, and you have reached them, and you can stand it. It takes off a lot of anxiety”.

 

(Chapter 3, Down and Out in Paris and London 1933)

 

 

Squalor, boredom, secrecy, hunger, future discounting and relief from anxiety were the key features, for Orwell, of poverty. In 1930 in Paris there was no system of welfare benefits to fall back on. In London , the casual wards (‘The Spikes’) provided some refuge, although the conditions were far from salubrious. Orwell went hungry, and at times had absolutely no money. One lack, which was sorely felt, was that of tobacco, something he again experienced on the front line in Spain when he later joined the POUM militia (Partido Obrero de Unificación Marxista, or Worker’s Party of Marxist Unification) in the civil war in Catalonia. The privations in the front line caused by the conditions and the absolute lack of resources for the militia was another form of poverty.

 

“In trench warfare five things are important: firewood, food, tobacco, candles and the enemy. In winter…they were important in that order” (Homage to Catalonia 1938, p23).

 

Winter in the Catalan trenches, Spring in Paris, but in this list we can note the reduction of human need to Maslow’s base of his hierachy of need. Apart from the ‘enemy’ in Spain the similarity is of course there to see. Orwell in both books mentions the centrality of tobacco, and of course of alcohol, in daily life.

 

It might be tempting to dismiss Orwell’s observations as belonging to another age and therefore of little relevance to the experience of poverty today in modern Welfare States. That I think would be a mistake. The psychosocial sequelae of poverty remain the same; what it does to self, self esteem and the setting of priorities.

 

The ‘secrecy’, the ‘dare not admit it’, alludes to what Erving Goffman called ‘passing’ in his theory of Stigma. People with a stigma try to ‘pass’ as normal to avoid oppressive acts.

Poverty was and is a stigmatising condition. Orwell tells of sitting in parks in Paris but being very aware of the distaste expressed by women particularly, towards him.

A source of stigma, for Goffman, arises out of an actual or perceived ‘character blemish’. Another source is membership of a ‘tribe’. Poverty provides both sources. Currently, many believe the poor to be at fault for their poverty due to their poor moral choices and character weaknesses. The Moral Underclass Discourse emphasises that the fault lies within the individual. The poor may also be seen as members of a ‘tribe’ who live apart from the deserving and hard working families; they are the chavs, the skivers, the welfare scroungers.

Poverty can be a discrediting stigma as it might have an outward appearance, or it could also be a discreditable stigma as an internal invisible ‘mark’ known only to the poor themselves. It can, of course, be a felt stigma and an enacted stigma as society exercises certain sanctions and behaviours towards the poor. Family members and friends of those on hard times may feel courtesy stigma on their behalf.

Thus, as a highly stigmatising condition, those who today are in poverty may wish to hide away or use ‘maladaptive coping mechanisms’ such as smoking, drinking or drug taking. Orwell’s continual descriptions of the need for and centrality of tobacco illustrates this point. Many today would see tobacco as a dangerous luxury. His fixation with food illustrates the shifting of priorities, and the collapse of time to orientate to the present. Future discounting might explain why the dangers of smoking and the future threats to health just do not impact on present behaviour.  It also clearly illustrates is the exercise of one’s personal agency being highly mediated by (and mediating) the culture and the social structures one lives in. It may seem to today’s sensibilities that tobacco use would or should be resisted if poor. However, Orwell makes it plain to see how one’s psychological state gets reduced and focused in both time and space. His ‘annihilation of the future’ and ‘boredom’ are telling. It might explain why we make what seems to be irrational decisions in the face of hardship. Orwell of course would have a way out, but if one believes that the future is set, the discounting of the future to deal with the present may be a highly rational strategy.

The fear of poverty disappearing, because one is actually poor, is another seemingly irrational mind set. But if the dogs have turned up you at least know you can sink no lower. There is no such thing as status anxiety, or keeping up with the Jones’. The ‘psychosocial comparison’ thesis of poor health outcomes no longer applies to you because the fear of being compared and of comparing has been assuaged by the surety of the lowliness of status. What is left is survival today, not tomorrow, because tomorrow never comes.

Before we thus rush to judgment on the choices the poor make, or provide theories of why there is poverty based on individual failure, Orwell’s exposition provides a window into their world and might make us think twice.

 

 

 

 

 

 

 

 

 

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