OK, no response, so I'll update as a possible resource for someone in the future, and also add some specific questions.

A week on and I've been doing 30mins zwift every other day (up to 180w average, but struggling to get the coordination for a cadence of 90, got my first swim in yesterday (1500m, embarrassingly not much slower than pre-stroke) and walked 7.5km this morning. Done a few rehab/pilates classes and am doing daily routine to work on balance and control. Still a little unsteady on occasions when I can't use my vision to counter the balance deficit, but feeling less 'heavy' and tired. Still resting a fair bit to help that recovery though.

Onto specific question. I have never added salt to my food, and whilst not fanatical, as a normal person then I eat fairly well. Friday is pizza day, but rest of week is pretty healthy pasta/salad diet. Blood pressure prestroke was normal, and during hospital quickly came down to normal/good.

But, I am wondering about how the elelctrolyte drinks (used to be nuun, then switched to SIS when nuun stopped being available about 18 months ago) effect the body. I'm pretty sure even with that I'm below the daily target, but I do suffer from cramps/muscle twitches and for now I'm off my magnesium tablets too.

I missed your first post. Very sorry to hear about this stroke.

Best info will come from dtoce p, so hopefully he’ll take note and respond,

+1 Hope you are able to figure out what you need to do to be happy with your health and fitness!

I have an aquaintance who is in his 70s. Several ironman finisher. He had a stroke last year and was paralyzed temporarily. I think it was only about 6 weeks later I saw him st the pool walking around and swimming like he was fine. I believe he's still countinuing to train for an event.

Stay strong

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IG - @ryanppax
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Use code ST5 for $5 off your order

So sorry to hear about this. I think you can "target" IMNZ, but you will almost certainly need to reframe any time goals you may have had. Gradual progression in training with a positive mindset while listening to your body (and consulting with your doctor/medical team) and you may be surprised at what you are able to achieve. All the best and please update this thread with progress reports.

Thanks all.

Recovering going well. Another swim yesterday and some walking around, even sat on the rideon to mow the lawn. Ok, only did half of it and few dodgy moments - makes me realise why there is a stand down for driving. And that also shows why I will be on zwift for a while as I need to be confident I can react to multiple situations in parallel and immediately.

Not increased the zwifiting above 30mins as still banging the top tube after 20mins, but am staying down on tt bars almost throughout now and in mid 80s cadence. Up to 180w average which was my normal easy recovery ride

But the pilates and rehab exercises are showing significant improvements. Work on now is control in the mid range (when arm / leg is neither fully bent nor straight).

Appointment with cardiologist next Friday which is quicker than expected.

2.5 weeks post stroke.

Had a good week - rehab is a full time job when you do all the exercises the physios give you ;-)

Building up the time doing thing, today was a 2400m swim done without pull buoy as a pyramid with 2x400m crawl in there at just over 2:00/100. Also some 1:50 100ms which is good for post stroke.

Zwifting I'm up to an hour now and critically more knee control.

But, I'm not ready to try cycling yet, even sitting on the MTB I can tell I've not got the balance. Will need to take the plunge at some point soon, but will be like a kid - off to a field and learn on grass with a few falls along the way.

Same as running, physio wants me to get a bit more strength before I try so as not to pick up injuries. So lots of heel raises, and steps with bands around knee.

Other thing I'm concerned about is my vision in right eye which is blurred and means I'll need to get some prescription cycling glasses before I do much.

Have you considered getting rollers to ride indoors? Maybe in a hallway or something so you can't completely fall over. Might be a way to work on your balance safely.

Thanks, it did cross my mind, but to be fair at the best of time rollers scared the crap out of me ;-)

I may go the roller way if in a few weeks I'm still struggling, but I'm hoping that I can get out by then. A bit like when I went swimming its a deep pool and so I had to just hope I could swim - jump in and thankfully I was OK.

Either that or I'm back to the first post and asking if speedworks/Enve to an aero stabilser wheel to fir my speed concept ;-)

I'm also hoping that when I re-learn how to ride and run then I don't get back to my old self but have put in a request to learn to ride like Tom Piddock and run like Patrick Lange.

Like I said, it's probably best if you try them in a confined space so you can't really fall over.

But the advantage is you can work 100% on balance and pedaling smoothly and evenly. No distractions like traffic.

 hope you’re feeling all good and on the mend.

Id not put pressure on yourself for imnz. Id just think I am not doing it but still keep working back into it and maybe aim for a few years down the track.

Walking, zwift, swimming and yoga / Pilates and strength stuff are all great for the body. If you are doing that now and getting small wins, you can be focussing on that. The focus on the incremental gains there and not the negatives of feeling like you’re not on the road on the bike yet or running

So doing those things which have more positives rather than doing things which have more negatives

For real nice more meditative swimming buy a snorkel is my tip

Oh wow ! That speed concept of yours is new too basically !

Dont worry you will be back. You have already progressed well by the looks. The trek will be ridden in anger once again

I wouldn't do it if I were you. You can try but it can be catastrophic which is death if things go wrong. Two people died from Galveston 70.3. A Canadian guy during the swim and a lady died a couple of days after the race and it's possible her death is linked to the race. Anyway, if you are not afraid of dying or leaving loved ones behind, go for it. You don't have to ask in the public forum. It's your life so it's all up to you. You asked, so that's my answer.

Ummm. Just to confirm IMNZ is in March. Advice from the hospital stroke consultant is highly intensity exercise is good for recovery. So this is in line with medical advice and gives the rehab a nice positive goal.

Honestly, that may end up becoming a 16.5hr walk to finish goal. Or the 70.3 on same day. Or if will be the sub 11hr I was always aiming for.

But there are some specific things I was looking for from people that may have been through a similar event, or have an appropriate background. And then thought someone else in the future may be looking for the same thing, so some record they can relate to would be handy. I note the well meaning intent, but some of the emotive language misses the mark a bit.

For the record, as you brought it up. I'm not afraid of dying, I'm afraid of existing without living life.

❤️

Cheers to that!

I don’t have any specific answers but want to cheer you on in your quest. My father had a very severe stroke and spent the rest of his life (16 years) trying to walk without assistance. His goals were different but his attitude was similar.

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Move on. Keep training. Be an adult.

Disclaimer: MD here but not a neurologist!
Thank you for sharing your experiences and providing a thread that others might be able to relate to in the future. From my years on this forum I have not seen many neurologists or neurosurgeons as regular users who might be able to offer advice or share experiences.
I don't have any pearls of wisdom to share in relation to specific tips for recovery after stroke, although I have a number of things I can share in relation to somewhat devastating injuries and having to readjust long terms plans and goals.
A few comments/questions: is there anything in particular which is making them think that a PFO is the potential reason you have thrown off a clot? Have they done a transthoracic echo? (I know you have stated they have a transoesophageal one booked, which is generally what is needed to check for one completely). Have they found a clot elsewhere? It is important to realise that the PFO is just the pathway that a clot takes to bypass some structures and head into the main circulation, it still means you have developed a clot somewhere and that in itself can be cause for concern.
You asked the question about is it realistic to target IMNZ next March.....I am a bit torn in how to reply to this question!
On the one hand, it is great to have stretch goals and if this is a bucket list race or something you had already planned your 2025 around then it may still be a realistic goal. Goals are great to help with motivation and to help give you something to focus on and look forward to.
On the other hand, this is still early days. Whilst in some people a stroke could be a "one off" event that was just an incredibly unlucky sequence of events, in most people it is the end product of some underlying medical issues that significantly change the risks of you having further issues and other medical issues in the future. As you have seen already, you have some risk factors you now need to address, such as your cholesterol, and there may be other things that need to be optimised for you moving forward. Your recovery seems to be going really well at the moment, but there may still be hiccups to come.
The reason I take the more conservative line above re this being early days etc is that in general, Ironman training and completion is not really an example of "ideal" physical conditioning and actually puts a massive inflammatory stress on the body (which can predispose and increase the risk of cardiac and all sorts of other events). It is important to know your motivation to do 2025.....if it is just to prove a point and show you can do it after a stroke then it may not be a good idea. If it is because of the impression that training and doing an IM shows excellent fitness etc then I would also say it is not a great idea.
Having been in these sorts of situations before personally (not with a stroke but with devastating injuries) I know both how motivating it is to want to be back where you were but then also how the recovery period is often filled with hiccups and unexpected occurrences.
Personally, I would take the approach that what you want is what is going to result in you being physically the healthiest specimen you can be (so you can decrease all those modifiable risk factors). Set targets for weight, blood pressure, exercise per week etc. Have a view to potentially get back to some events in 6-9 months time depending how your weakness etc it. See how things are in 6-9 months time and then depending on how things are start thinking about whether an IM could be on the horizon.

I guess the TL:DR response is no, I wouldn't target IMNZ next March!

Good luck for the recovery, be great if you can keep this thread updated with how things are going and where you are at.



I am including the "UpToDate" guidelines on physical activity after a stroke just for completeness. This website is a rather expensive medical site which has theoretically up to date, evidence based information on a wide variety of topics. It is not always cutting edge but generally provides robust information.
Physical activity and exercise — Patients with ischemic stroke or TIA who are capable of regular exercise should engage in moderate-intensity physical exercise performed for a minimum of 10 minutes four times a week or vigorous-intensity exercise performed for a minimum of 20 minutes twice a week. Moderate-intensity exercise is defined as activity sufficient to break a sweat or noticeably raise the heart rate (eg, walking briskly, using an exercise bicycle) [12]. (See "The benefits and risks of aerobic exercise", section on 'Benefits of exercise'.)
Increasing evidence suggests that low physical activity and prolonged sitting increases the risk of cardiovascular disease, including stroke [4,63,64]. Additional support that physical inactivity is a risk factor for stroke comes from studies showing the benefit of increased physical activity and exercise for reducing the risk of cardiovascular events [65].

I have nothing to add to this thread but want to commend you on this mindset. We all gotta go. May as well come to grips with that, and in the mean time, do things we really want to even if it has a risk of death, because everything including breathing does (eventually we all oxidize/rust out !!!). Sub 11 is in the card, only because you are saying you wanna do it. Step number one for anything in this world is convincing yourself it is possble. Generally we are are biggest doubters. Just be eliminating self doubt you already won.

Thanks for your post and the details within.

Odd thing with my cholestrol is I've had it checked regularly for years and the HDL has always been very low, and high LDL - this time last year TC was 2.59 and I had that tested in a chemist yesterday and 2.58. Full blood tests showed TC 3.6-4 but with LDL 1.7-2.6 mmol/l.

Regarding the heart then the normal echo showed some flow but need the transthoric to confrim. Not had that yet, guessing in next couple of weeks but will check on Friday. As for why the PFO, with historic low cholesterol, no family history, clear arteries in neck and through spine on MRI, good lifestyle and relatively young I think this is them almost running out of other reasons. But from reading then with 'young' strokes this is a common check / procedure to minimise risk of another one. In terms of things that I understand ca cause a clot then I have been travelling a fair bit with work of late, basically each week I've been doing a 4hour drive on a monday morning and same back home tuesday night. No flights of late. At work I use a stand/sit desk, tend to wander every hour or two. Drink tea not coffee, albeit a fair few mugs a day.

In the fortnight before stroke day I did have an odd calf strain that came from nowhere as I was cooling down, then came on 1km into some runs in the week after. Sharp pain when running, but was pretty fine when running and could still calf raise etc, so no loss of power. As a non medic then I do wonder if this was the clot in my calf (still doesn't say where it came from) and then it got to my heart and brain. Never ever had a calf strain before.

I say another one and not second one as the MRI showed I'd had a previous one in another part of my brain in the past (I think 3 years ago co-inciding with when I had Covid and worst headache in my life, massive fatigue, diziness and struggled to find words for a bit.

Interesting comments about the target. 100% it's to keep motivation to live a 'good life'. What I'd not considered is the cumulative load through training. I was mainly thinking of building strength in the muscles being the limiter for running. And there is an element of wanting to prove to myself that the stroke didn't end my life. As someone mentioned above, after over a decade of racing on my Argon I recently (3 rides) bought my Speed Concept, a new De Soto T1 wetsuit and a few other things as well and really really want to get use out of them (I'm a tight yorkshireman, so when I spend money I need to get value from it.

But I also know that I walked out of hospital 60 hours after being take in and 36 hours after I first moved my leg. My physical strength recovery has been so fast because of the shape I was in pre-stroke. And should I be unfortunate enough to have a 3rd one, and miraculously survive that I want to be strong enough to rebuild again. I don't want to increase the chances of having that stroke, but from what I can tell then movement, cardio exercise and all the other tri stuff will reduce the chances of both cardiovascular disease and strokes.

That sounds right, you really need a transoesophageal echo to fully assess whether you do or do not have a PFO. Hopefully they can get that done for you soon!


Whilst it would be nice to know, the reality is that you will almost certainly never know (apart from if the echo is negative for a PFO then this can be ruled out completely!). Also, the stroke happened in that time you were asleep, so that is essentially the exact moment the clot would have separated and crossed over (if this was in fact the mechanism). On that topic of mechanisms, have you ever been assessed for obstructive sleep apnea? (if you need a quick scoring system to check, google STOPBANG and see how you rate)

Honestly always hard to know. The things we find on MRIs that people often have no idea about!

I feel you! I brought an amazing new Cervelo P3X, had a semi-decent 70.3 (4th in age group I think), fractured my tibia 4 weeks later and have not been able to ride it again!!

Agree with all you are saying here, just have to add the caveat that you reach a point with training and fitness where the return on "investment" becomes minimal and then you fall over an edge where doing more and doing longer distance racing becomes detrimental to your health and wellbeing. If you look into the changes associated with running marathons etc, it puts the body through a massive inflammatory load and has a number of potentially detrimental longer terms implications for health and well-being.....


If I was a betting man my money will be on this not being a PFO, but will happily be proven wrong!

STOPBANG - 3 yes. Tiredess, stop breathing and male.

That said I have a very low respiration rate as a result of abnormally large lungs - always need 2 plates when I get them x-rayed ;-)

And I do wonder how many other people will find evidence of stroke damage if they have MRIs after covid.

There is no urgency to get a sleep study done but it would be advised to get one moving forwards. You score 3 out of the 8 risk factors, but will be 4 out of 8 soon (with age being 50 happening soon for you). That still keeps you at intermediate risk but only adding one more puts you at high risk (and it would be interesting to see whether they are wanting to give you any antihypertensive medications).

Re the MRIs and what we find post COVID-I think this has been really well shown in other areas that there is a lot of asymptomatic stuff which has been found further down the track.

Out of interest-did you attend a dedicated "stroke unit" hospital? The city where I live and work there are dedicated stroke units which have fast tracked ambulance protocols and immediate imaging and interventional neuroradiology to clear clots etc. My wife (who is a GP) came across another GP collapsed in a bathroom at the University prior to sitting an exam, it was about 1km from the stroke unit. They were transferred there immediately and straight into the interventional radiology unit for targeted thrombolysis.

I was fast tracked into the ED as the ambulance called a stroke code NIHSS score =2 and so on arrival then got instant care and almost immediately sent for a CT. However, as it was overnight there was no in hospital person to review the scans and so it was sent over to a site in Australia which took a couple of hours and then it didn't show anything. So they just gave me some asprin and clopidogril. I went to be at 8:30, woke with the paralysis at 1:30 so they decided that the 'event' was 11:00pm and so couldn't give me the clot buster stuff (4.5hr max) even if the CT had shown anything.

But, I did go into an Acute stroke unit (within the Health in Ageing ward). Was funny, the other 3 beds had a 96year old, a gut that was in his late 80s and a lady late 60s/early 70s. Where I live (Tauranga) healthcare system is set up more to deal with the significant elderly population. It is changing a bit in last 10 years, but when I moved here in 2010 someone described the City as a series of retirement homes connected by motorways.

When I left NZ (Waikato) for Australia in 2006 Tauranga was already had that retirement vibe about it!
I don't think there are many units in NZ that do quite the same work that we have here, but this is really big city stuff for those exact reasons in terms of all the support structures you need in place to be able to provide that care in a timely fashion. Will post a link below to a newspaper article about what they do etc-the clot retrieval stuff is the next level stuff that you need the more highly trained and skilled teams to do.

Medical wards always had a rather lovely vibe (and smell) about them!!

Well another week on. I managed to get back to swim squad a couple of times this week. And in farness in yesterdays session then I was swimming almost as well as before. My legs are sinking a bit, but I'm going to have a technique session (or 2) with my coach to try to get on top of that. Also, finding my strength to climb out pool is better too.

And today I learned to ride my (mtb) around the garden. Wasn't perfect, but gave me hope I will be able to ride on the road in the future.

I also had the rehab physio round in the week and she ran through some tests - walking, walk backwards, skipping, and even a run. Run was dreadful, and I can't walk 10m on my tiptoes as my right just ends up collapsing. But this was +3weeks, and even a horrendous jerky mechanical 'run' is progress. And now am up to 3hours of rehab a day. Not sure where the time to go back to work is going to come from ;-)

Cardiologist trip was a non event, just confirmed the TEU for next few weeks.

But, this week I've really noticed/found some things that I was overlooking as impacted. I'd focussed on the big stuff of can I move arm, or leg. That's now coming on well, but more I'm noticing my vision has been impacted, my right foot isn't 'lifting', my small two fingers on my right hand I can't control (so writing and holding things is hard) and I struggle to think when more than thing is happening (in a shop when trying to pay and someone is talking to me, making a sandwich and a drink at same time).

I still realise just how luck I've been. And I'm still making good progress with a lot of hard work in rehab. But equally, I am getting my head around the likelihood that no matter how hard I work then in this case that won't be enough and I will have some permanent disabilities. Now that just means to me I need to adapt how I do some things, a few pivots. I met a guy a few years ago who has been to 3 paralympics, climbed Kilimanjaro, broken land speed records and more, all after having both his legs amputated aged 7. He said that without legs there were quite a few things he was never going to do - play winger for the all blacks for example. But out of the hundreds and thousands of things in the world, a few hundred he needed his legs to do, and most of those he wasn't likely to do even with legs. So don't focus on what you can't do, but on how to achieve what you can do.