We Need To Develop Do’s And Don’ts For AAA, Cardiac Stents, And Everything Else For That Matter

training, coaching, workoutlog, ironman

My coach, Chris Haute, sends my workouts via http://workoutlog.com/log/

Boy, these old posts are badly written and constructed – that’s how you learn!

Hi folks,

You hear of exercise being touted as a cure-all, whereas it can clearly be risky in certain situations. For instance, if you are diagnosed with Type II Diabetes are there amounts and types of exercise that are contra-indicated (not good in your situation)? I bet there are! This is true of age (too much bouncing on a trampoline when you are young may induce Osgood-Schlatter), when you are short of sleep raising kids (too much added exercise may induce stress and all of it’s ramifications), and when you are older (excessive training is rumored to account for older athletes dying in their swimming trunks or running shoes during competition, not to mention knee injuries and the like).

weight training, leg press, strength training, Ironman, coaching

On of the two types of leg press machine at my gym http://goo.gl/YP2p4. Notice the similarity of the action to that of a rowing machine.

[As an aside: the latter reports of a miniscule number athletes dying during races is never matched, as far as I can tell, by an exciting frontpage headline account of some fat, lazy dude in front of a TV eating potato chips with his fifth beer, and keeling over from a heart attack. Or add smoking and his dying of lung cancer or slowly ‘drowning’ with emphysema. These events just aren’t exciting anymore, just like the average road fatality, as it happens all the time. If it is headline news, I suspect that it is not common whatever it is, including athletes dying in their tracks (happy tracks for that matter!). When people find out that I still enter Ironman races they’ll often tell me some story they read of a person dying in a race, as if it is some kind of wise advice for me to back off from my training, whereas I suspect that they are using the ‘news’ to justify their own inactivity. No, just get a good coach and enjoy your life. You know that old bumper sticker: ‘Work out; Eat well; Die anyway! Well, live well, I say.]

weight training, quads, Ironman, coaching

Squat cage at my gym http://goo.gl/YP2p4, which avoids the need for a spotter as the side bars will catch your weight bar if you have to ‘let go.’

I guess the real question from my perspective is how do you obtain information on do’s and don’ts for your specific condition? In my case it was an abdominal aortic aneurysm (AAA) stent graft. I was told that I could exercise after a few weeks, but not to overdo it. That was it! I wasn’t happy about that limited piece of (mis)advice, so I did some research and then published the one useful paper that I found on this issue on this blog. This paper indicated that a number of things are best avoided if you are in my situation as you may move your stent; a potentially fatal event. These things included car wrecks with a lap belt, a Heimlich maneuver, and intense rowing. You can avoid using lap belts, I doubt risk benefit analysis would induce you to reject the Heimlich maneuver, even if you were able to, whilst you would be well-advised to forego rowing, which is why I dropped the rowing machine from my regular warmup routine at the gym.

I am currently undertaking strength training as I prepare for my next Ironman season, and I recently received a weight room workout from my coach, which included the following exercise:

12. Leg Press (glutes and quads; most important exercise for developing power on bike). Beginning position: Start seated on the sled with your knees bent and feet roughly shoulder width apart. Ending position: Legs extended fully.

So I climbed on the seat of the machine that I preferred (reclined diagonal, not the one in the picture!) before I received my stent, started the exercise, and then I thought, “this is a bad idea, it feels a lot like the rowing machine.” So I stopped immediately as I was feeling pressure in the lower abdomen, even if I kept my knee angle at 90 degrees and above. Here was a clear example of my body saying “DON’T DO THAT!” Was my coach going to know this? No, why should he?My surgeon? Bet he isn’t even that interested as he is too busy! It was, therefore, up to me. I’ll report it back to my coach, so he can keep it in mind for my later workouts. Oddly enough this lower abdominal pressure sensation does not occur in the ‘squat cage,’ so I’ll pick up extra quad work in there in addition to increasing my leg extensions and lunges. No problem and no unnecessary risk!

The bottom line: we generally will have to work it out for ourselves, unless there is a helpful website or online forum (see Useful Links on this site for examples), and even then it is your decision as to what you do at the end of the day, as each case is an individual not a statistic. The real trick is to understand your condition and listen to your body.

-k Your Medical Mind



  1. Major Baleegh says

    Hi, I am Major Baleegh from Pak Army, PAKISTAN aged 42, I have under gone angioplasty in Sep 2012 at a military hospital in Pakistan and a drug eluded stent was placed in my LAD artery. I developed chest pain on 8th Sep 2012, and after the stress test a drug eluded stent with the name of Xenix prime was installed on 12th Sep 2012. I used to go for jogging on daily basis which was stopped by my physician. He directed me to go for evening walk which is still failed to do so. I was a heavy smoker i.e. 40 to 50 cigarettes a day which after the procedure has been reduced to 15 to 20 cigarettes. I have a blood sugar problem as well which is taken care of with the use of Neodipar on twice a day usage. I was overweight but now I have reduced a bit and I am almost within range. I develop pain a couple of weeks ago on my upper part of right foot, in my left wrist and left forehead, could you please guide me something regarding these issued; more so I tried to quit smoking but failed miserably, how to quit do advise something for this issue as well. My cholesterol remains within range but my triglycerides are way up the limit; do advise something to control them as well. I hope I have taken a considerable time of yours but if you reply with some details I will be highly obliged. Now; as regard my breathlessness was concerned I have no problem at all and there is no problem in the stent as well. I am taking Lowplat Plus 75 (1 x Tablet), Neodipar 500 (1 x Tablet) and Carsel (1 x Tablet) in the morning while in the evening I am taking (1 x Tablet) of Neodipar 500 and (1 x Tablet) of Lipirix 10 mg. Apart from all this I am heaving constipation and gas in my body, hope you can help me with this. Thanks once again, take care.
    Major Baleegh

  2. Hi Major Baleegh, boy, you are going through it. From what I’ve read, LAD coronary stents are pretty effective with a good prognosis long-term. My immediate advice to you (as a veterinarian athlete, not a doctor) is to make all changes slowly, including giving up smoking. Smoking cessation is pretty stressful, all by it’s self. I’m in a hotel right now, and about to have breakfast, which closes in minute. I’ll write my detailed thoughts later today. Watch out for all those pills. Getting in shape is key, but you have to be careful, consistent, and patient. Be back soon, sorry for the delay. You’ll make it out of this. The GI problems could be diet, lack of exercise, drugs, or possible diverticulitis. which comes along with AAA. Will get back to you soon. Keep good records of all symptoms, though you seem to have that nailed. Hang in there, as you have quite a challenge, I can see. Kind Regards, Kevin Morgan aka FitOldDog.

  3. Glenn Jones says

    The LAD blockage is sometimes known as ‘the widow maker’ because it can be fatal first time around and often gives no warning. I had a stent Inserted in my 75% blocked LAD earlier this year and am gradually on the mend. I recently finished my 17th third of a marathon running race and while I didn’t break any records, it gave me a huge feeling of satisfaction.

    My first advice to the major would be to keep working at giving up the cigarettes. The carbon monoxide in the smoke out-competes oxygen in the bloodstream robbing your body of th oxygen it needs to stay healthy. I realise that quitting is very difficult. I gave up 30 cigarettes a day some40 years ago and still dream of having a cigarette. Nicotine is highly addictive so don’t be hard on yourself if it takes time and you have setbacks. The aim is to keep working on cutting back to reduce your body’s reliance on the nicotine reward.

    My second advice is to persevere with the walking. Try to vary your route to give yourself interesting sites as a way of relieving the boredom. May be listening to music on an iPod might help. Walking helps build your circulation,it raises your metabolic rate and gradually builds up your cardiac endurance. It also helps with bone dnsity as you get older and osteoporosis becomes more of an issue.

    I am not familiar with any of the drugs you listed, but I presume that amongst them is an anti platelet drug such as clopidogrel (plavix) sold in Pakistan under another name. Some people have no problems tolerating these medications. Others can end up with all kinds of side effects, including problems with th digestive system. I hav had such problems, along with feelings of instant fatigue and raw lungs. I put up with these negative side effects because they are slight compared with h positive side effect of having survived the cardiac problem.

    There will be times when the after-effects will get you down. When that happens, recognise it as being part of the rehabilitation process and remember that it won’t last forever. Remember that time is part of the rehab. Take time, listen to your body, and forgive yourself if you occasionally lapse. Good luck.

    • Hi Glenn, thanks for your advice to the Major, and I agree with your comment about carbon monoxide, as it’s a inhibitor, blocking uptake of oxygen by hemoglobin – in fact, I just found this interesting article on the matter http://goo.gl/rqH4io. I think the reason researchers were unable to induce cancer in rats was because carbon monoxide limited exposure levels. I have no idea whether the Major follows this comment stream, but if he does (Hi Major!) an update would be great. Hope he’s (you’re) well, and thanks again Glenn. If you ever want to tell your story on this blog, just let me know, as it is all about inspiring others to get on with life, in spite of it all. You are an inspiring example. Cheers, Kevin

  4. Terry Hunley says

    It appears these are very old posts and I hope “old dog” is still around to help me answer some questions. I had a abdominal aneurysm that ruptured about 3 months ago. Obviously I was one of the few who survived and I am now the proud owner of a Gore Tex graft or stent. I read the article talking about mechanical trauma and vigorous exercise (rowing) being issues for long term use, but I love skiing and want to get back into triathlon and was wondering if the new generation of stents/grafts have the same issues? I have read that the Gore Tex Stretch stent/graft moves with your body and has a better patency rate. Any comments or advice?

    • Hi Terry, no, I’m not dead yet.
      Well done on surviving, you sure dodged a bullet that time.
      You are the lucky owner of a modern aortic graft. I’ve got a stent graft, a much more fragile beast. I see no reason you couldn’t ski, but maybe you should first talk to Pauline, of this post, a great athlete and nice person:
      All the risks that apply to myself don’t really apply to you, though I would still reduce hip flexion somewhat and protect that region as best I can. Especially until the whole thing settles in. The risk will be at the graft-tissue junction. I’d research that for history of failures, and why, as I worked on my training. You could do a benefit risk assessment, just to be sure you are considering all variables, as you move forward:
      Have fun skiing, lucky man (girl?),

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Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.