A few years ago, I was introduced to the concept of heart rate variability and stress and this variability as a guide to wellness and performance.
I was fascinated, as I have always been passionate about measuring my health and performance. I logged tens of kilometres of running and cycling and subjected myself to painful VO2 max tests.
To start this new measure, my first step was to change my ageing Garmin to an Apple watch. And, as it turned out, this change was made extremely easy as it came as a gift from my youngest stepson, who commented,
“When you get to your age, you probably won’t get too many presents!”
What is Heart Rate Variability or HRV?
HRV is simply the subtle variations in the time between each heartbeat, reflecting the dynamic interplay between the sympathetic system — gearing for action and the parasympathetic nervous system, which helps rest and recovery.
A healthy HRV signifies a well-balanced nervous system, which is crucial for resilience to stress.
The Heart Rate Variability and Stress connection
A growing body of research has shown a clear link between HRV and both physical and mental stress.
Usually, during a stressful situation, the sympathetic system takes the lead, causing a decrease in HRV. Whereas, in a relaxed state, the parasympathetic system takes, resulting in a higher HRV.
But, as you can see from my story, there are exceptions.
Suffering from the “older man’s disease”
Up to age 75, my only prescribed medication was prostate pills for the dreaded “man’s disease”, benign prostate hyperplasia (BPH)).
For years, I had endured the symptoms of this scourge. Symptoms that made my experiences like long bus trips in Asia uncomfortably pee-pinching! So, to relieve the symptoms, I started taking one of the prescribed medications, which is a combination of dutasteride and tamsulosin.
A downside of this medication is the side effects. While on the one hand, they help relieve the symptoms, on the other, some of their side effects are horrible!
After taking these pills for years and still suffering unpleasant BPH symptoms, I knew there must be a better option.
We were settled in Portugal, and my overall health review became my priority. With marginally high blood pressure and cholesterol, I decided to see a cardiologist and a urologist. Also, before my visit, I stopped taking the prescribed BHP pills to see what would happen.
After stopping the BPH pills, there was one totally unexpected and unwelcome effect. My blood pressure started to increase.
Initially, this was confusing. But on investigating the side effects, I saw that for me with high blood pressure, this was a positive side effect of taking tamsulosin. Although never prescribed as a blood pressure control drug, it was reducing my blood pressure!
The first step in my health project was to have blood tests, an ECG, and a heart echocardiogram.
These were not pleasant experiences.
The instructions looked ominous. After drinking one litre of water an hour before the tests, it is excruciating trying to keep a full bladder while suffering from urinary urgency!
The test results were expected. The ultrasound showed a prostate of 64 grams, whereas an average healthy prostate is 15 to 20 grams! While the flow rate was so slow that it hardly made it onto the graph!
Based on these results, the urologist had no hesitation in recommending a TURP (transurethral resection of the prostate) — an operation he described as a “life-changing” solution.
It was an offer I couldn’t refuse — no more pills with their unpleasant side effects and no more unwelcome symptoms.
My TURP operation
Within a week, I was in the hospital and had the procedure.
TURP can be done either with general or epidural anaesthesia. Mine was the epidural method, and the operation took just under an hour.
For the next two days in the hospital, I was catheterised and did not enjoy this experience! Fortunately, this unpleasantness was short-lived, and after 48 hours, the catheter was removed. Then, after demonstrating I could pee, I was discharged.
The recovery period was longer and stricter than expected, with no exercise for four weeks and complete recovery in eight to twelve weeks.
Post-operation HRV and atrial fibrillation
During my time in the hospital, I didn't wear my watch. So, when I arrived home and looked at my HRV, I was shocked.
From a daily HRV range of about 11 to 80, it had shot up to between 137 and 298! Resulting in the daily average shooting up from 31 to 233!
I was confused. This was wrong. Why the extremely high HRV?
During stressful situations, the sympathetic system (action — fight or flight) should be taking the lead, causing a decrease in HRV.
So, finding no credible references online, I assumed that the anomaly resulted from the operation.
But my concerns would grow.
The following morning, my Apple watch beeped an alarm as I woke from a stressful night’s sleep,
‘Your heart has shown signs of an irregular rhythm suggestive of atrial fibrillation’.
I knew that this was not a good sign.
Despite these indicators, I was feeling as good as one could expect after an operation and two days in the hospital. So, I also attributed this atrial fibrillation to the operation and linked the abnormal HRV to the atrial fibrillation.
As I was not overly worried, I decided to monitor these over the next few days.
For the next four days, they persisted. I had atrial fibrillation, and my HRV was in the daily range of 138 to 377, with daily averages of around 280.
HRV up and down and back up again!
In the evening of the fifth day, the HRV plummeted as fast as it had risen. Within an hour, it went from 221 to 15. Indicating that the atrial fibrillation had become a normal heartbeat.
However, this did not stay normal for long.
A few days later, there was another incident — atrial fibrillation and extremely high HRV. However, this time, I believe it may have resulted from not following the doctor’s orders! After two weeks of inactivity and the readings returning to normal, I decided to go for a faster and longer walk.
It was the wrong decision. There was an increase in internal bleeding and within a few hours, my watch indicated that I had atrial fibrillation, and my HRV shot up again.
I’d learned my lesson. From now on, I would follow the doctor’s orders!
What I learned about HRV and stress from my operation
From this experience, I concluded:
1. There can be subtle but serious consequences at times of stress. Possibly with effects exactly the opposite of what is expected!
2. Apps that assume a high HRV level indicates readiness to exercise are completely wrong.
3. Atrial fibrillation has some serious implications, like
“Blood clots in the heart. The condition also increases the risk of stroke, heart failure and other heart-related complications — Mayo Clinic.”
4. As we navigate the intricate dance between our heartbeats and stress and recovery, understanding the language of HRV becomes critical. This valuable metric can help us gain insights into our body’s stress response and, more importantly, equip ourselves with tools to manage and mitigate the impacts of stress.
5. HRV is far more complex than heart rate or VO2 max. It gyrates wildly and is very personal and open to varying interpretations.
6. ChatGPT may not be the best immediate source of valid information.
7. My Apple watch is an invaluable source of understanding some of the imperceptible situations inside my body.
If there is anyone who has similar experiences of wildly fluctuating HRV or results after a surgical procedure, please share them.