Life After a Cardiac Event: An Athlete's Story

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy!

Michael Emery, MD:

Hello, I'm Dr. Michael Emery of the Cleveland Clinic Sports Cardiology Center. I'm here today with one of our outstanding patients, Mr. Kevin Kessler. We're going to have a conversation about his story with heart disease, playing sports with heart disease, and how he came to visit us at the Cleveland Clinic. So, Kevin, tell us a little bit about yourself.

Kevin Kessler:

My name is Kevin Kessler. I'm 47 years old. I live in Greenville, South Carolina, and had a heart issue back in 2019. A sudden cardiac death event that was kind of eye-opening, unexpected. It happened at a CrossFit competition, a large CrossFit competition in the Upstate of South Carolina, Fittest of the Upstate. It was in a very public place. I was working out, competing, and about the time I finished the competition, I was on my knee and stood up, and the room spun. And the next thing I remember, I was in the back of an ambulance. Long story short, I had gone into a torsade's rhythm and had some people there, a doctor, a couple of EMTs, and some emergency room nurses that worked on me, gave me CPR. The gym had an AED, thankfully, kind of a single AED shock, which kind of brought me back, and that's kind of the start of it.

Michael Emery, MD:

So that was a pretty marked event in your life, right? You were extraordinarily fit, very active, competitive cross fitter at the time.

Kevin Kessler:

Yeah.

Michael Emery, MD:

Has you had any warning signs leading up to that? Anything that you even, in hindsight, thought was suspicious?

Kevin Kessler:

Nothing at all, other than I didn't perform very well that day. On the first event, it had some rowing in it, and I don't want to get in too much detail, but I just felt like I couldn't go. And I even told my wife that morning, I just feel like a little off. I'm not sure why, but I had nothing, no other warning signs before that. I mean, and she even said, has said many times, "I wish I would've told you to stop." And I said, "I wouldn't have," because I had no reason to think that something catastrophic like that was going to happen.

Michael Emery, MD:

And we certainly all have bad days.

Kevin Kessler:

Sure

Michael Emery, MD:

Even in training. We'll have bad training days, we have really great training days, and it's hard to tease those all apart. Most of them are nothing. Unfortunately, maybe yours was something, so you had a sudden cardiac arrest. Thankfully, you were in a very public space that was probably prepared for such an event, which is rare. But I'll take this opportunity now to get on my soapbox, and hopefully you'll get on the soapbox with me how important these emergency action plans, and automatic external defibrillators, AEDs, are for sporting events because that saved your life. So that's lesson one for today. I can't overemphasize how important those are. So, moving past that, you got admitted to the hospital, worked up. Did we ever really delineate an etiology or a reason why you had this event?

Kevin Kessler:

No, I mean, nothing definitive. I do have a left branch bundle block, which I think was a contributing factor. It was pretty hot that day. So maybe some dehydration, but there's nothing that's a real smoking gun that's been identified.

Michael Emery, MD:

Yeah. So, you got a defibrillator for secondary prevention at that point in time.

Kevin Kessler:

Yep.

Michael Emery, MD:

How did it go after you got discharged from the hospital and with your defibrillator now after this rather traumatic event that was really unexpected? How did you handle that? What was your next steps in the phase of your recovery?

Kevin Kessler:

Yeah, well, it really began in the hospital. Obviously, I was transported by ambulance and spent five days in the hospital in Greenville, South Carolina. And I kind of went through the steps of phases of mourning. There was a lot of anger, a lot of denial, and some of that frustration right off the bat. And I found out that day, "Well, you'll probably have a device implanted and have to live with that for the rest of your life." And it still, at that point, kind of thought, "Well, this will never happen to me again." It's kind of a fluke thing, and I'm in good shape. Why would this happen? So that's kind of where it began. And over time, it is a process, I think, that never ends. Here I am four years later and still kind of processing it, and learning how to live with it, learning how to accept it, but at the same time, understanding that it's not my identity.

Maybe it's part of it, but it's not who I am. It's just something I have to live with and make the best of and mold my life and activity and the things I love around that.

Michael Emery, MD:

So how has life been afterwards? Have you gone through and fulfilled the self-fulfilling prophecy that this will never happen again? Or did something happen?

Kevin Kessler:

No, something's happened. So, over the four years, I've been shocked four times. So, the device has saved my life four times. I mean, the way I look at it, having the device implant in my chest, and they've all been kind of different. A couple of them. I was exercising one of them, I was running. One of them, I was doing CrossFit. One of them, I was dead asleep in the middle of the night. And the fourth one, I was just sitting on the couch watching TV. So, there's no single factor that I can say, "Well, if I wasn't doing this or if I was doing that, those wouldn't have happened." So, I'm very thankful to have it, and I'm thankful that obviously, if I could take it away, I certainly would.

Michael Emery, MD:

I would too for you, anyone.

Kevin Kessler:

But in some ways, I've grown a lot from it and just learning how to live with it, like I said, and learning that it's part of me and it's going to happen again. And another cardiologist that I've talked to said, "Hey, at some point, after one of the shock events," it was like, "How do we fix this?” I'm an engineer by schooling, and so I think, “There's got to be a root cause for everything, and we should be able to figure out some way to fix this. There's got to be some way a valve to fix or an ablation to do or whatnot” And I remember him just telling me straight up, like, "Look, Kevin, you didn't win the lottery. You kind of got a bum heart, and the sooner you kind of accept it and deal with it, the more fulfilling life you're going to have." And so that helped me a lot, and that kind of changed the way I looked at it. Instead of trying to fix it, let's realize it probably can't be fixed or it's difficult to identify, and so let's make the best of it.

Michael Emery, MD:

So, in terms of the athletic piece of this, you've had four shocks from your defibrillator and one primary cardiac event. Three of them are with exercise, two of them were not.

Kevin Kessler:

Correct.

Michael Emery, MD:

How have you approached exercise since your initial diagnosis and your follow-ups, and what have you been told by other physicians as well in the process?

Kevin Kessler:

Yeah. So, the cardiologist, I was kind of telling you this earlier, but when you have an event like that, you don't get to pick your doctor, they take you by ambulance, and you don't get to pick who you see, or the devices gets implanted, or all that. So, I had a really, really experienced cardiologist that met me at the hospital, and he told me, "You'll never do CrossFit again, and you'll probably never do anything beyond maybe power walking again." That's not what I wanted to hear the day that it happened. So, it took me a while to grasp that. I think that led to some denial and almost the anger, to the point that I trained even harder afterwards. I was back in the gym a week later after this event happened, and I'm going to prove to myself or prove to others that this is not who I was. And so that's evolved over time, obviously. I do a lot more than power walk now, but finding a sports cardiologist didn't understood activity and a balance of life.

Well, maybe you can't be quite as intense as you once were, but you could still do CrossFit, you can still be active, you can still be fit, and live a fulfilling life even though you have this heart issue.

Michael Emery, MD:

And we talk about: is sports, is athletic competition in these things, a modifiable risk factor that will reduce your risk or eliminate your risk? And you're a case example. You've had some with exercise, but you've had two shocks doing nothing. So, we can't tell you not to sleep but not do anything else, right?

So, part of this is the decision that we work through this sort of shared decision-making about understanding the risks to the best of our knowledge, mitigating as much risk as we can, and then accepting some risks. Because of sports and athletic competition, there's part and parcel of who you are, I mean, take away part of your soul, and I'm not necessarily making you a better person or then allowing this disease to define you, which we don't want to define you. It's part of you. We can't deny that. We don't want it to define you either. And over the years we've known each other, you've found a good balance mostly on your own because of somewhat of our guidance and things like that.

Kevin Kessler:

Yeah, for sure. I know one of the very first times we met, and I've came to see you, we talked specifically about heart rates. And as I got into that higher heart rate, maybe in that zone four, 90 percent and above, well, that's a lot of what CrossFit is, just how hard can you push? How intense can you do something? And you said, "Hey, you can do that, but just understand you're putting yourself at higher risk." And that really kind of came to heart. I've got a family, I've got two children, and I've been married for 23 years, and I've got a lovely wife and CrossFit is not all I'm about. So, putting them into perspective was important to me. And I've changed because of that. I've modified for the better a lot of the way I train, and it's a lot more zone two training, zone three training, and just kind of knowing, pushing that threshold of the 90 plus percent, it's not worth the risk, but that doesn't mean you can't do it at all. It's just understanding the risk reward.

Michael Emery, MD:

In some regards, us helping you understand and what you knew. I think we had to reiterate for you, but not everyone knows that you don't have to push the extreme to get the fitness benefit that you want for your lifelong health and wellbeing, right? Because we still want you to be a physically active, healthy person to gain health from exercise. And there are certain ways to work around that and understand that which we can help you do in a lot of regards rather than putting the blanket statement across you, "No." Because that didn't sit well with you. I remember that conversation. You relate to me.

Kevin Kessler:

Yeah. And it seemed like I always even dealing with my kids and everything, and that's kind of my way of looking at life. Like no is the easy answer. So why can't the answer to anything be yes, or at least maybe, or let's figure it out? Let's come up with a solution. And I think that's why I have so much appreciation for you, Dr. Emery, and coming up with, "Hey, let's figure out a solution. Let's figure out a way that you can have a full fulfilling life while at the same time understanding you have this limitation or potential risk."

Michael Emery, MD:

So, what sort of stood out for you? What are these sort of big moments, aha moments that you may have had over the past four years or moments of reflection? You're like, "I'm at peace now."

Kevin Kessler:

Yeah, it's still a process, honestly, and I've worked a lot with a therapist, and I have a sports psychologist I work with now, and a lot of it is, well, what does contentment mean? I don't really compete at a really high level anymore, but I've found some other ways. I still train, but I found some other ways. It's kind of an outlet, whether it be coaching or judging, or doing some other things in the CrossFit arena that have really been fulfilling. Kind of the biggest aha moment that was almost like a weight off my shoulders is the night that my very first event happened, I told my wife, "I'm going to go back to fittest next year. I'm going to win." And that was really an ignorant statement at that point in time. I could see that now.

Michael Emery, MD:

A knee-jerk reaction.

Kevin Kessler:

That's a knee-jerk reaction. And that was a little bit of that denial. But they didn't have the event the following year because it was COVID. But I did qualify two years later and finished second, and that was really kind of a pinnacle event that was almost like, "Okay, you're still whole, still who you are." And then it allowed me to almost, it was almost like I had proved to myself that I was okay, and maybe even to the community a little bit that had seen me go down in that kind of arena that, "Hey, I'm okay. I can still do this." And it almost allowed me to be like, "Okay, you can back off now. That's complete. You've kind of redeemed yourself in a way." And so that was a big, pinnacle event. And for me. And then, since then, I have learned a lot from every shock, and its kind always causes some reflection. And what could I do differently and always go to, "How could I fix this?" That's always my initial, and then it's back to that, "Okay, it's maybe not fixable or at least it's unknown." So how do you live with it in a positive way? I've told you this, I've never been one-to-one to go just sit on the couch and hope to make it to 70 or 80, life longevity has never been my goal. It's always to live a full life, kind of slide in sideways with the tires popping at the end of life. And so, it's a way that I can still do that, but in a responsible manner, not in a reckless way.

Michael Emery, MD:

Yeah. How has your family been through all this, right? Because you didn't go through this alone?

Kevin Kessler:

Yeah, I didn't. So, like I said, I've got a wife that we've been married for about 23 years, and I've got two kids. My son's 19, and my daughter's 16 now, so four years ago they were 15 and 12, and they were all there at the event. So, they all saw me go down. They all saw people bring ice. They thought I was having a heat stroke event first. So, people there brought ice and covered me in ice. And then, once they realized I didn't have any pulse and they were going to do an AED, they saw me dragged by the feet out of the pool of water to shock me. So, they saw all that, and it's been hard. We've taken my kids to counseling, they both adjusted really well, and they've been really supportive. My wife is very supportive, but I had to actually come to terms with, from a selfish standpoint, I was so like, "How am I going to live with that?"

I kind of neglected realizing that she had, as she was actually diagnosed with some PTSD from the event, and she had a lot of dreams of seeing me. While I was unconscious for the whole thing, they watched it all. They watched me get CPR and AED shock and all those kinds of things. So, you realize from this, it affects your whole family. It really does. And I train a lot with my son. He's in the Navy now, but before he left for the Navy, we worked out a lot together. My daughter's a competitive gymnast, and so they're very fit. We spent a lot of time having them checked out, making sure that there was nothing that I had that could have been passed down to them from a hereditary standpoint or anything. And thankfully, they're all good, but it definitely affects the ones around you. And it took me some time to realize that and stop being selfish and realize that "Hey, they're affected too. And they saw their dad, for all intents and purposes, die. They're on that floor." And it's hard on a young kid.

Michael Emery, MD:

And I think one of the reasons why I wanted to have this conversation with you is to let sort of other athletes know that this happens. It's unfortunate, we never want it to happen, but it does happen. But there are ways that we can help you as an athlete continue to maintain some level, whether that's full participation or some degree of fitness, and that peace and part of you, but also take care of you, Kevin, as a person and you and your family as a person that, it's okay to admit you need help to handle these emotions. And we've talked about that over the years too, seeing people to help you process all of these things, counselors and then family, support of your family. And one of the big things about, because you and I both CrossFit, is the community of CrossFit, but any fitness community can help you process all this. So, talk a little bit about then also the community, your bigger tribe besides your individual family, and how they perceived these events and how they may have helped you through the process as well.

Kevin Kessler:

Yeah, that's another kind of pinnacle moment, is when I came to see you last year. I had just recently had two shocks, and right off you kind of recognized when I think I sat in the chair in your office and you said, "You seem like you're not the same person. You seem like this has really gotten to you this time," and you recommended me doing some counseling. And that kind of spurred me on to find a good counselor back in South Carolina and a sports psychologist. So I have each kind of a traditional counselor that kind of helps me work through some of the stuff that still comes up, but then also a sports psychologist, it can kind of help me handle, there's a lot in the middle of a workout, like, "Am I having a heart issue, or is this really hard, or am I feeling sorry for myself?"

Some of that kind of stuff. So, she helps me work through some of that. And having those people on your team has been really helpful. And you recognizing that's kind of spurred me on to like, "Okay, let's pursue that." It's okay to kind of ask for help in that arena. As far as the CrossFit community or a bigger community outside your family, I think you always need people to rely on. At one point, I almost got tired of people ask, "How are you doing?" Because the first event happened in such a big community wide, hundreds of people from all the gyms. So, as we were doing competitions and stuff, I would see people that I hadn't seen in a few months. And that's the first thing they say, "Well, how are you feeling? How's your health? How are you doing?" And then I got a lot of, well, there must be a reason for this.

You've got a bigger purpose. You can share with people, you can help others, and stuff. And I almost got like, "Well, I don't know what that is. And that's a lot of pressure and that's a lot of stress." And so, I got even tired of hearing it. Everybody meant well and had good intentions. But having people, even in my gym when I would go back to work out for a while, I would see people out of the corner of the eye, is he okay? Is he going to be all right? And just kind of having to prove to people that you're just a normal person again, took some time. And that's probably a lot of taking that on myself but having those people around to support you and say you're doing a good job and high five you at the end, and a community of people that can support you, whatever that may be. And everybody's not a Cross Fitter, but whatever that may be, your group of people is really important.

I can't imagine trying to do it alone. Or even with just my small nuclear family of three, because they needed some help too. So, there was a lot of support from outside of people that could just come alongside and be like, "Hey, man, I got you. And we'll do this together."

Michael Emery, MD:

Well, Kevin, it's been a pleasure talking to you today and getting to know you over the past few years that we've been having this relationship. Is there any last sort of bit of wisdom you want to pass along to people that may be listening to this?

Kevin Kessler:

Yeah, first of all, kind of like you said at the very beginning, AEDs are important. They save lives. If you run a gym or you've got any kind of facility, I don't want to go too far into it, but the AED that was at the facility that I had was a result of the gym owner, who had had a heart problem himself, and he didn't understand why. And there was kind of a lot of, "I don't understand why God did this to me." He had to have open heart surgery. But out of that, he said, "I'm going to go get an AED." And he couldn't afford it, so he found a local charity, and they donated the AED that saved my life to that gym. And so, you kind of look down through the... and he told me, he came up to me and said, "You are my why. You are my why," after this. And that gives me chills even thinking about it. That would be the first thing I would say.

The second thing I would say is just, it's not a death sentence. As silly as it sounds, it's not a death sentence. And for a while, I thought it was. This is something I love to do. I loved to CrossFit. I was a really active person, and people are telling me, "You can't anymore. No, no, no, you can't." I would say find doctors that are willing to say you can. It might be modified, or it might be a change but find good doctors. Be your own advocate and continue to live your life because there's a lot more life beyond a heart issue or an ICD and what goes along with that.

Michael Emery, MD:

Great. Well, thanks for being with us today, Kevin.

Kevin Kessler:

Thanks for having me.

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