Psychological effects

5:30am in Terrigal and the first Trotters begin checking
for the Saturday run or walk.

Like most Saturdays, today started with a 4:30am alarm and arrival at the Terrigal Surf Club fifty minutes later to join my Trotters club-mates for our weekly 6:00am run.  Only, I'm not running at the moment......but I'm not alone.

I have never analysed the stats, but my guess is that you could divide the Trotters population into quarters.  One quarter are fit and running well. Another quarter are running, but carrying an injury.  A third quarter are running, but coming back from injury, and the final quarter are unable to run because of illness or injury, some permanently.

Kurrawyba Avenue in Terrigal was on
my walk route this morning.

Many in that final quarter are not only dealing with pain associated with their ailment, but also dealing with the psychological impact.  Fortunately for me, there's no physical pain, but I do feel the psychological effects.

The easiest to deal with is the loss of routine.  Like most serious runners I have always relied on routine to help me fit training in with family and other commitments, and the loss of routine can be destabilising and depressing.  Replacing running with some other form of exercise, if at all possible, and using any additional spare time to work on other useful or meaningful projects has generally worked for me.

One of the most challenging impacts can be the loss of identity.  The thing that most people know about me is that I'm a reasonably good runner.  Although I like to think there are other dimensions to my character, I do also see myself as a runner.  In the last month, in my own eyes, and the eyes of those around me, I am morphing from a serious masters athlete to a senior citizen with cardiovascular problems.

Sunrise over Terrigal.

Along with the loss of identity can go a loss of self-esteem.  The podium finishes that I enjoyed in the past, and these days, just keeping up with younger runners, builds self-confidence.  Absorbing challenging training regimes and successfully planning and preparing for major races also contributes positively to self-esteem.  The longer I am unable to run, the less happy I am with myself, even when there's nothing I can do about it.  And the worse I feel about myself, the more likely I am to over-eat and put on weight and so the downward spiral goes.

I also have real fears that being unable to run for an extended period of time will lead to a deterioration in my overall health.  Of course, it seems likely that running caused my current cardio-vascular problems, and I recognise that running is not a guarantee of good health.  However, I have no doubt that the fitness gained through running has improved my quality of life and fended off other ailments that beset my demographic.  I now worry that all that good work will be undone if I can't get back to serious exercise.

Early morning stand-up paddle boarders.

Finally, I have always found that running refreshes me and helps me deal with life's stresses.  This was certainly true during my working life, where the morning run seemed reset my body clock and wipe away (or at least diminish) problems.  Maybe it's the lack of oxygen getting to the brain, but I always found it difficult to worry about things, or even do relatively simple mathematical calculations, while on the run.

While most of my club-mates ran this morning, I walked a comfotable 6km.  I'm still in a holding pattern.

JFK 50 Mile

Running the Appalachian Trail section of
the 2000 JFK 50 Mile.

I've never counted how many races I have run, but I'm sure it would be a four-figure number.  Some of those races stay in your memory for one reason or another.  One favourite, which I have only managed to run twice, is the JFK 50 Mile held each November in Maryland, USA, about an hour's drive north-west of Washington DC.

The race has an interesting history. In 1963, President John F Kennedy launched a national fitness drive that included a challenge to the nation's military officers to meet the standard set by Teddy Roosevelt in the early 20th Century of being able to cover 50 miles in 20 hours on foot.  Others were keen to test themselves against that standard and a number of 50 Mile races were organised around the US in that year.  Sadly, Kennedy was assassinated in November 1963, and the Maryland race changed its name from the JFK 50 Mile Challenge to the JFK 50 Mile Memorial in 1964 and has been run every year since.  It is the only surviving 50 Mile race from that time.

Looking over the Potomac near where the JFK 50 Mile
descends to the river.

Being so close to Washington DC and many US military bases, and with its military-related origins, the field always includes many service personnel, giving it another dimension.  For a long time it was the largest ultra race in the US, averaging around 1,000 finishers in the last decade or so.

The C&O Canal towpath.

Apart from my passion for trail ultra-running, the race appealed to me because a section was run along the famous 2,200 mile Appalachian Trail that I had hiked a decade earlier.  Being just half a day's drive from where I was living in Connecticut at the time was an added bonus.

The race is actually a varied mixture of terrain and surfaces.  It starts with a run down the main street of the small town of Boonsboro before climbing 1,172ft on mostly sealed road for the first 5.5 miles.  The field spreads out quite quickly.  The next 10 miles follows the lovely Appalachian Trail, paved with autumn leaves, southwards along a timbered ridge before descending 1,000ft to the C&O Canal towpath which follows the Potomac River upstream.  If you are going well, as I was in 1999, the first year I ran the race (64th, 8:02:17), the marathon-length dead flat towpath is an opportunity to gain time and places.  The second time I ran, in 2000 (118th, 8:48:47), the towpath stretch seemed demoralisingly endless.

The Potomac River along the JFK 50 Mile course.

After the towpath, there's an undulating 8.5 mile run through rural countryside, which can also be a tough stretch if you are running badly, to the finish in Williamsport.  The community support for the race, and the size of the field, along with the military dimension, help make it a special and memorable race, and I hope to do it again one day.

For my exercise today, I played my usual Friday morning 9 holes of golf.  Later, I was pleased to get a call from the Cardiologist's rooms offering me an appointment next week, three weeks earlier than scheduled.  I think I have the Respiratory Specialist I saw on Wednesday to thank for that, and am looking forward to finding what can be done about my heart arrhythmia, and when I can start running again.

Finding the boundaries

Coast Road in North Avoca tested my limits this morning.

The Holter Monitor involves having five electrodes, connected by wires to a battery-powered recording unit a bit larger than a smartphone, stuck to various parts of my chest for 24 hours.  The device will record my heart activity and I'm supposed to note the time of any periods when I feel breathless or notice heart palpitations.  I was worried the electrodes would become detached while I slept, but the technician did a good job of taping them down, and they were still there this morning.

Wamberal Beach from my walk this morning.

The Respiratory Specialist yesterday, while not encouraging me to run, implied that it wasn't necessarily dangerous, just that it would be difficult and uncomfortable.  I didn't want to confirm his prediction, but did want to get my heart-rate high enough today to provide good evidence of the occasional problems I have experienced in the last month.

Thursday, as usual, started with supervision of the 6:00am track session at Terrigal Haven on what was a beautiful sunny, and a little humid, morning.  I watched the twenty or so runners go through their paces (seven times 800m with a minute recovery between each) in the 45 minute session before they headed off to their breakfast coffees, or work, or to get their children ready for school, or all three.  I always feel a bit lazy, being retired, that they have to rush off while my day continues at a more leisurely pace.

Terrigal Beach this morning.

I returned to my car, donned my radio and headphones, and set out on a 7km walk that would include several hills I thought steep enough to test my impaired cardio-vascular system.  Rather than my usual stroll, I walked a little more briskly to encourage the symptoms.  The first significant hill climbs up the Scenic Highway out of Terrigal and I fully expected to succumb to breathlessness as I maintained a good pace, but I was surprised to reach the top without a problem.  It was good that I was feeling better than expected, but bad that there was no discernible heart arrhythmia for the Holter Monitor to record.  A little nonplussed, I continued on down Tramway into North Avoca, circled through the beachside streets and tackled the second steep hill, Coast Road.  This hill is steep enough to always be a serious challenge when running, and I couldn't envisage walking briskly up it without testing my current limits.

Terrigal Haven this morning.

Sure enough, after about 100 metres of serious climbing, I felt my heart racing and my blood pressure dropping.  I had to stop for fear of passing out, and just stood quietly for a minute, ready to sink gracefully to the side of the road if necessary.  After a minute or so, my equilibrium was restored and I continued on.  However, a few hundred metres later, at another short sharp little pinch, the same feeling enveloped me and I had to stop and stand still for a short period, again ready to cushion my fall to the road if I fainted.

It was encouraging, though, that once equilibrium was restored, I felt fine and could continue on at a good pace so long as the grade wasn't too steep.  I walked another couple of kilometres down into Terrigal before returning along the beach promenade to The Haven and my car, where I noted the times I felt unwell for the doctor to compare to the heart monitor.  I'm sure he will have something to look at now.

Perspicacious medicos

Cockrone Lagoon, between McMasters Beach and Copa,
and near our home, is one of my favourite places to walk.

I walked 5km this morning, and although not as bad as yesterday, still felt more breathless than has generally been the case in the last few weeks.  Maybe I've just had a bad couple of days.  I have read stories on the Web of runners coming back from Pulmonary Embolism (PE) who have bad patches.  Nevertheless, I was pleased I had an appointment scheduled for later in the morning with a Respiratory Specialist to get an expert opinion on my situation and some answers to questions.

Cockrone Lagoon.

As it turned out, the Specialist's opinion was that the worst of my Deep Vein Thrombosis (DVT) and PE was past, and that as long as I was taking the anti-coagulant, Warfarin, my prognosis was good.  In fact, if my heart wasn't an issue, he would have been OK for me to resume running, which was good news.  He spent some time checking my pulse, and said he was sure that the breathlessness I had been feeling was due to my heart which was beating irregularly, averaging about 60-70 beats per minute compared to my usual resting rate of low 40s.

Cockrone Lagoon.

He seemed keen that I see the Cardiologist (my appointment is four weeks away) as soon as possible and actually tried to get me an appointment today (they are in the same building).  I think the urgency was driven by his desire to help get me running again rather than any concern about my current condition, although he didn't actually say that.  He told me he was training for a triathlon, confirming to me the wisdom of getting a Specialist recommendation from my sports medicine friend, Dr Jon.  In my experience, medicos who participate in endurance sports have a much better understanding of obsessional distance runners such as myself.  They know how much it means if we cannot run, how much we test our physical limits, and how prone we are to ignore pain.

He prescribed another heart test, a Holter Monitor, and told me to call the Cardiologist when the results were available, mention his name, and I should be able to get an earlier appointment.  I called to arrange the test, and because they had a cancellation, was able to get an appointment this afternoon.  I'm now walking around with electrodes attached to various parts of my chest and connected to a battery powered recorder on a waist belt.  I have to note the time of any breathing or heart events I notice in the next 24 hours and return the device tomorrow afternoon.  Hopefully, I'll be able to get an appointment with the Cardiologist next week and make progress on the heart problem.  I sensed the Specialist I saw today thinks the heart arrhythmia will be correctable, but time will tell.

London

St Paul's Cathedral.

In total, I have lived ten years of my life in the UK and am very fond of the place.  In various blog posts (Frost Fairways,  Chappel, Isle of Dogs), I have described some of my favourite runs there.  The last time I lived in the UK was in 1992, but during the next eleven years when I lived in the US, I made many business trips there, frequently staying in hotels in central London.  Central London is a big place, and depending on where you are staying, the running options can vary.  During the latter part of my working life, when I was employed by Reuters, whose head office was in Fleet Street, my favourite place to stay was a business hotel close to St Paul's Cathedral.  It was easy walking distance from the office (passing an excellent Indian takeaway en route!), and close to the Thames River, a wonderful place to run.

HMS Belfast with Tower Bridge.

For my regular 10km run, I usually set out about 6:00am and headed east along Cannon Street past the imposing St Paul's Cathedral and then Mansion House, Cannon Street and Monument stations which were already disgorging early commuters before arcing around the northern side of the Tower of London and onto the iconic Tower Bridge.  I always enjoyed checking out the river traffic as I crossed the bridge and looking at the retired HMS Belfast anchored upstream.  On the southern side of the bridge, I descended a stairway to begin my journey westwards along the southern bank of the Thames.

Millennium Bridge and St Paul's Cathedral.

At first the route wound through some narrow back streets passing refurbished warehouses and stereotypical London pubs before joining the promenade along the river bank which I followed all the way to Westminster Bridge.  On the way it passed landmarks such as the Millennium Bridge, the Tate Modern, Southbank, and the London Eye, all the time providing superb views of the London skyline to the north across the river.  After crossing the river again beneath Big Ben, the route turned right to follow the Victoria Embankment downstream and back to the northern end of the Millennium Bridge from where it was a short run back to the hotel.

London Eye and Southbank.

It was a generally flat course along wide paved footpaths and promenades that made for a fast run if I was feeling good, which was often the case.  In summer, London had milder temperatures and lower humidity than my US abodes, and in winter, it was also milder and nice to run in shorts for a change after the winter gear required in the US.

I've been told that my recovery from the Pulmonary Embolism could be long and erratic.  Today served to emphasise the point when I struggled all of the way round what should have been an easy 5km walk in Copa.  I didn't feel my heart racing, maybe because I walked so slowly, but it was exasperating and a little alarming to feel so unfit.  My breathing was heavy and laboured and I even contemplated sitting down on a bench with a kilometre to go when I began to feel a little spaced out.  Instead, I just walked even more slowly and made it home OK.  The rest of the day was pretty sedentary and I had no problems.  On the plus side, I had a call from the office of the Respiratory Specialist I wasn't scheduled to see for another month to say they had a cancellation tomorrow, so I'm hopeful of getting a useful opinion about my situation and prognosis.

Relays

Fellow Kew Camberwell team members for the
1980 New Zealand Road Relay Championships.

There is plenty of camaraderie in distance running, but it is not usually thought of as a team sport.  There are club competitions run by various State and National running organisations for road and cross-country running, but my observation is that it still ends to be an individual competition with the performances just aggregated to determine team positions after the event.

The exception is relay racing where each individual runner is very conscious of their team membership and expectations.  I have known runners who almost always perform better in a relay race than when they are running for themselves, and others who find the pressure too much and choke.

Start of the 1980 New Zealand Road Relay Chempionships.

Most of my relay running was done in the 1970s and 1980s when I was a member of Kew Camberwell District AAC and its antecedents.  In our heyday we were one of the strongest distance running clubs in Victoria and derived some perverse pleasure from our lack of national and international stars of the kind that characterised the ranks of the two best Victorian clubs, Glenhuntly and Box Hill.  We were a club of journeyman runners who enjoyed fierce, but good-natured, competition amongst ourselves then took great pride in our ability to be competitive with the best clubs in team competition.

Running my leg in the 1981 New
Zealand Road Relay Championships
(9.6km, 29:34).

Although there were some relay competitions in Australia, it was the annual New Zealand Road Relay Championships that really caught our attention after Glenhuntly returned from competing there in 1979.  The competition in New Zealand was of exceptionally high standard and the event, which called for a team of ten to run an average of 10km each, was very competitive and continues to this day.  As I recall, the super Glenhuntly team had only just got onto the podium.

We managed to muster sufficient members to run in the competition in three different years in the early 1980s, but it was the first trip that sticks most in my mind.  We travelled over as a group starting in Auckland where we competed in a local road race before driving south in a hired van to Wellington where the Relay was to take place the following weekend.  There were 23 teams in A Grade and our goal was a top ten finish.  Glenhuntly were there again.  Our early runners excelled themselves, and the rest of us lifted to match their efforts.  I was only a few months past major knee surgery and couldn't run very well downhills so was given a 6.2km all uphill leg.  I wasn't at my best, but can still remember the pressure I felt to maintain our good position on that long climb.  The junior runner in our team who ran the downhill leg after me, wore the soles off both his feet blasting down the hill and had trouble even walking in the days that followed.  I can still remember Chris Wardlaw, a two-time Olympian and Glenhuntly team member, complaining to us "that seven legs have passed and we still haven't caught you bastards", or words to that effect.  That made our day.  Their class ultimately told and they finished seventh overall, but we were just two places and two and a half minutes behind.

The Kew Camberwell team for the 1983 New Zealand
Road Relay Championships.

We never did quite as well in the subsequent years, but I'm sure all of us who ran in the Kew Camberwell teams still remember them fondly.

Being Saturday, it was the usual Terrigal Trotters run at 6:00am, and I went down to meet my friends who were running and went for a 6km walk while they were out.  I feel like I'm treading water, waiting for the specialist appointments and my body to repair itself.  Not much else I can do at present, but it's very frustrating.

“On Death and Dying”

Looking towards Avoca Beach from North Avoca
during today's walk.

Serious runners with more than a few years behind them will be familiar with the psychological impact of injuries.  As discussed in my post titled "Punctuated Equilibrium", major injuries have derailed my running and racing plans and, perhaps, permanently inhibited my running potential.  Even soft-tissue injuries that later healed completely, were devastating when they thwarted plans for a big race. In dealing with such injuries, to some degree or another, I have recognized my own emotional progression in the stages identified by Elizabeth Kubler-Ross in her seminal work “On Death and Dying” - Denial, Anger, Bargaining, Depression, Acceptance.

With my recently-diagnosed health problems - Deep Vein Thrombosis (DVT), and associated Pulmonary Embolism and Atrial Flutter - I can feel myself travelling the same road again.  The territory is familiar, though maybe amplified by the potential whole-of-life impact of the diagnosis, and I am confident I will eventually reach the "Acceptance" stage.  In the meantime, I'm tracking my progress through the earlier stages of the process.

Avoca Lagoon.

Denial.  When, during the Terrigal Trotters' Santa Run just before Christmas, I first experienced unusual shortness of breath, palpitating heart and excessive fatigue, I didn't believe there was a serious problem.  It was warm and humid, I had been training hard, and I was wearing an Elf suit.  Worst case, I had picked up some kind of bug, which would pass in a few days.  I was still in denial a week later, but finally accepted something was seriously wrong when I struggled badly a week later in the monthly Trotter's 10km Time Trial.

North Avoca Lake Track.

Anger.  After the diagnoses, it appeared likely the originating DVT resulted from failing to drink enough following a warm long run before having a longish nap.  Low blood pressure, viscous blood, and inactivity combined to produce clots.  No doubt other risk factors were involved, but addressing these two may have prevented the problem.  I kept returning to the day in question and asking myself why I didn't stop at a store on the way home to buy a drink, as I would usually do, and why I recently started having post-run naps when for decades I had "pooh-poohed" the idea?  Why had the heart and lungs that had served me faithfully for 45 years of serious running now let me down?  Shouldn't the years of training have made them more resilient?  Would things have been different if I hadn't recently changed my shoe brand after decades with Nike Pegasus?  Overnight I had moved into a new demographic.  I was now discussing heart issues with my step-mother as an equal when a month earlier we had seemed to live on different health planets.  There was also anger that I could no longer exercise with the same intensity, perhaps impacting my health in other respects.

Avoca Lagoon.

Bargaining.  I have kept Googling, reviewing the medical websites and the experiences of others, and theorising on the quickest acceptable way to return to running.  Positive snippets of information are seized on, but often discounted or disregarded after rational consideration.  If I have larger lung and heart capacity than the average human, then even if they are functioning sub-optimally, I should be able to jog conservatively when others would be limited to a walk?

I'm still in the "Bargaining" phase because I don't have good information about my prognosis yet.  No doubt, I'll keep coming up with hypotheses that get me back to running sooner rather than later, but know that expert opinion based on my particular situation is needed, and that feedback will only start with my specialist appointments at the end of February.  I periodically experience some symptoms of the "Depression" and "Acceptance" phases, but feel those phases are yet to come, and I will discuss them in a future post.

Another 10km of easy walking for exercise today following the early morning track session at Terrigal Haven.  I tried walking somewhere less familiar to make it more interesting and that seemed to work.  If I want to keep walking 10km each day, maybe I'll have to drive to some varying locations.

When to run again?

My walking route this morning took me through the
Avoca Beach Markets.

When I went to bed last night I had decided that today's exercise would include some light jogging.  It's not so much that I'm desperate for an endorphin high, or even the satisfying fatigue that follows a run.  It's more that I was very fit four weeks ago and I can feel that condition ebbing.  I know these feelings are familiar to all injured runners, but this time around I'm conscious that a miscalculation on when to start running again could feasibly have fatal consequences rather than just a setback in recovery time.

Avoca Beach Markets.

So, this morning, while enjoying my cup of decaffeinated coffee, I surfed the Web and pondered the most rational approach to a return to running.  I don't want to take stupid risks, but I don't want to be too timid either.  Finally, I decided to just walk 10km today and use the time to work out a rational strategy.  I do my best thinking while walking.

The first conclusion I reached was that the Deep Vein Thrombosis (DVT) diagnosed seventeen days ago was still at significant risk of throwing off small clots that could impact my lungs and heart.  Many sites on the Web indicated a minimum of four weeks and usually six weeks for DVT's to resolve themselves.  I should probably wait another three weeks and possibly an "all clear" from another ultrasound exam of the lower right leg before resuming jogging.

Avoca Beach Markets.

The second conclusion I reached was that my exercise, whether walking or running (when the time comes), should be at a pace which does not push my heart/lungs into what I'm calling the "Amber Zone".  Twice during today's 10km walk, near the top of steep and longish hills, I could feel myself beginning to struggle for breath and an unpleasant sort of pressure (not pain) building in the base of my chest as my heart began to race.  It was as though the clutch was slipping and no drive was being transferred from the engine to the wheels.  This was the same feeling I had when running faster up hills just before being diagnosed with Pulmonary Embolism (PE), so I'm becoming familiar with it.  I didn't have to stop walking for the sensation to abate today, but did need to slow right down to a dawdle.  I would define the "Red Zone" as being the need to stop and sit down, and I have not reached that point yet, nor do I want to.

Avoca Beach Markets.

Like most chronic injuries, I feel like I'm starting to get a handle on how to manage it, but know it is not wise to look for the "edge of the envelope" as has been my inclination in the past.  I also know that, even after the DVT has resolved itself and the clots in the lungs are no longer an issue (which could take months), I will still likely need some sort of medical procedure to address the Atrial Flutter problem before I can start running hard again.  Patience!

[I have posted my Post-DVT Training Diary here, or it is accessible from the Links menu at right.]

Caffeine

45mg of caffeine in my
favourite tipple

Early in my running career I consumed quite a lot of caffeine.  In my twenties, I routinely drank six or seven cups of strong coffee a day, including a cup just before bed which didn't seem to affect my sleep.  At 150mg of caffeine per cup, I would have been consuming about 1000mg of caffeine per day, way above the recommended daily dose (600mg according to the New South Wales Health Department).  At some point, I decided that this was a bad thing because on weekends, when I didn't consume cups of coffee as regularly as when working, I tended to get headaches.  I went "cold turkey" and after two weeks of mild headaches and irritability, the addiction was gone and I did feel generally better.

My running regime makes it important to drink large amounts of fluid, and I have got into the habit of always having a drink at hand.  It's easier to keep hydrating if you enjoy the drink and I have never enjoyed drinking just water.  For a few years I managed to stay caffeine-free, drinking decaffeinated coffee and soft drinks, but when I began my expatriate working life in 1987, and was constantly travelling to different countries, these were not always readily available.

Gradually I settled into accepting the caffeine content of diet colas (Diet Coke seems to be available in most places), which I enjoy drinking (way too much, according to my friends), and trying to limit the consumption to about four cans a day.  I also accepted the occasional coffee.  This would have added up to about 200mg to 300mg of caffeine a day, not an addictive quantity and within the recommended daily maximum.

My "heart-starter" in the last 10 years has been my
pre-run cup of strong black coffee (~175mg of caffeine)

After retiring from work in 2003 and joining Terrigal Trotters in 2004, I changed my regime to having an early morning strong cup of black coffee when I got up and before going for my early morning run.  It helped wake up my body at a time when advancing age seemed to be making the early miles of any run harder and harder, especially the Trotters' 6:00am, or earlier, starts.  I calculate my morning coffee as having about 175mg of caffeine, which is quite a large dose, and though it had the desired effect of pumping me up for the run, it was not always a pleasant feeling and I could often feel veins pulsing in my temple.

The reason for discussing caffeine now is that my research has shown it can be a risk factor in the Atrial Flutter with which I have been recently diagnosed.  Although not the likely cause in my case, it has been a trigger for me to reevaluate my caffeine intake.  My sense is that eliminating the strong early morning coffee and limiting myself to four diet colas a day (or 200mg of caffeine a day), will be a positive move, and that is what I did from last weekend.  I noticed a head-achy feel the first few days and then yesterday morning, after a very early start for the Thursday track session at Terrigal Haven followed by a 10km walk, this developed into a full-blown migraine that had me in bed from about 1:00pm through to 7:00am this morning.  I can't say that it was a withdrawal headache for sure, and given the clots in my bloodstream and the Warfarin I'm taking, there's always a nagging concern it could be something more sinister.  However, today I feel a bit better, though my weekly INR test this morning showed my anti-coagulant level is significantly above the target range (4.8 when it should between 2.0 and 3.0) and I wonder whether this was a factor somehow.

Caffeine is a legal stimulant and research has shown benefits to long-distance runners.  I have experimented with its use and will talk about that in a future blog post.

Ron Clarke

Ron Clarke

Way back in the mid-1960s, I was living in London where my father had been posted for three years.  Like many young teenagers, I played several different sports and still believed, that one day, I could be world class in one of them.  Sadly, reality gradually dawned on the tennis court, cricket ground and rugby field as I recognised a lacked of the physique and ball skills to ever be a champion.

Like many expatriates I was proud when homeland heroes did well on the international stage and Ron Clarke toured Europe at just the right time to get my attention.  Just a few months after my family settled in the UK in 1965, Ron toured the US and Europe, breaking 12 track world records, including becoming the first man ever to run 3 miles in less than 13 minutes, 6 miles in less than 27 minutes and 10,000m in less than 28 minutes.  The times themselves didn't mean much to me, but Ron's style of running did.  Although he seemed to lack the finishing kick to win tactical major Games titles, he was a machine when it came to world record attempts.  He generally ran from the front and gradually burned off his competitors, often breaking world records by prodigious amounts.  Ron was indisputably the best distance runner in the world during the mid-60s.  Possessing the characteristics of toughness, discipline and excellence that I admired and aspired to, he was a worthy hero.  I don't want to overplay it, but he certainly got me thinking that running might be my sport.

Ron Clarke wins bronze in the 10,000m at the 1964 Tokyo
Olympics behind Billy Mills (USA) and Mohammed
Gammoudi (Tunisia)

After returning to Australia and getting more serious about my running, I became even more appreciative of Ron's talents and record.  I probably saw him at Victorian running events during this time, but have no specific memory.  However, when I began to reach my marathon prime in the late 70s and did well in some bigger races we had some brief interactions and he got to know who I was.  I remember being very proud when I won a small fun run in Melbourne's north-eastern suburbs and Ron, who was presenting the prizes, referred to me as one of Australia's up-and-coming distance runners.  I can also remember him giving me a toot on his car horn near the Tan as I ran to work during the morning commute.  His acknowledgement seemed to give my running efforts credibility in my own mind, and that was important to me.

Ron Clarke tracks Michel Jazy (France) during a
1965 two mile race in France in which Jazy
broke the world record

The sad thing about Ron's career was that it was brought to a premature end by a heart problem he believes developed during the high altitude Mexico City Olympics in 1968.  He faded quickly in the last few laps of the 10,000m final after being in contention with two laps to go, collapsed unconscious after crossing the line and was given oxygen.  A few years later he was diagnosed with a heart defect and in 1983, after suffering fibrillation during a run, had successful surgery to replace a faulty valve.  You can read an excellent summary of Ron's career here.

No fibrillation or flutter for me today as I walked a flat 7km for exercise.  I felt fine, but remain despondent that this is all the exercise I am allowed for the next six weeks.  It's very tempting to see if I can jog around my usual Copa 5km course at an easy pace, but I guess I'll follow the doctor's orders.

Fibrillation or flutter

Part of my walk around Copa today

I wasn't really anticipating any good news when I had a long consultation with my GP today, just a summary of the tests so far and referrals to some specialists.  If anything, I came away a little more positive.  She confirmed that all of the blood tests for more sinister underlying conditions had come back within normal range, and provided more detail on the cardiac tests and leg ultrasounds.

Apparently, the cardiologist diagnosed Atrial Flutter (AFl) rather than Atrial Fibrillation (A-fib) as being my heart condition, and according to the GP, this is the better diagnosis to have.  I gather A-fib is chaotic disorganised beating of the Atria while AFl is regular, but way too fast, beating of the Atria and may be a little easier to treat and sometimes stops of its own accord.

Looking north from Captain Cook Lookout
during today's walk

The leg ultrasound report found "some occlusive thrombus in one of the peroneal veins from 7cm below the knee crease to 20cm below".  The GP says her starting theory would be that the thrombosis in the leg has thrown off small clots that have impacted both my lungs (Pulmonary Embolism) and heart (AFl), but has referred me to a respiratory specialist and a cardiologist to try and confirm the diagnosis and prescribe treatment.  In the meantime, I continue with the Warfarin anti-coagulant.  The earliest specialist appointments are six weeks away, but I guess the fact that I'm not seen as an urgent case is a good sign.  It probably means, however, that my exercise is going to be limited to walking until at least the end of February and any prospect of returning to serious marathon training in time for the Gold Coast Marathon in July is remote.

Looking south from Captain Cook Lookout during
today's walk

I won't abandon the marathon goal until I speak with the specialists, and dearly want to resume regular running.  However, I am already mentally more focussed on the need to be fit for my next planned adventure, a 3500km southbound hike along the Appalachian Trail from Maine to Georgia in the eastern US starting in Autumn (October) and finishing in the Spring (March).  I know there is a possibility that this too could be scuppered by my current health problems, but I'm trying to be optimistic.

I walked about 8km today, not particularly quickly, and felt fine the whole way.  I gather that regular leg use is recommended in the treatment of Deep Vein Thrombosis, so being able to walk 8km without pain or other problems must be a good thing, I reckon.

Little (Beach) hiccups

Looking towards McMasters Beach

For today's blog post, I was planning to write about one of my favourite local 10km runs, the Little Beach circuit, and set off to walk it with my camera.  This was to be my longest walk since I stopped running two weeks ago, but I reckoned that provided I didn't push it I would be OK.  Going clockwise, the first section of this course goes along the beach to the village of McMasters Beach.  It was a beautiful sunny Sunday morning and the beach was busy with holidaymakers walking and jogging its length.  The fairly steeply sloping beach meant walking up on the softer sand to avoid getting my shoes wet by the occasionally larger incoming wave and I could feel I was working harder than if I had been walking along a road.

McMasters Beach

I didn't slack off, keeping up a good pace and left the beach at McMasters to climb a steep concrete path that would take me towards Bouddi National Park.  I walked quickly up the short hill, but near the top began taking huge gulps of air and could feel my chest pounding, as it had done on a few runs in the week before being diagnosed with Pulmonary Embolism (PE).  Not good!  Only a month ago, I would have run up this hill without even noticing it.  I slowed to strolling pace and decided to cut my walk short and head home.  On more gradual gradients at an unpressured pace, I was fine and got home without further concern, but the whole episode was quite depressing.  Not knowing whether the problem is the PE or Atrial Fibrillation (AF) or both, and what can be done about it, just compounds the problem.

I know I just have to be patient, and although I'm determined to keep walking up to 10km a day, this morning's episode reinforced the need to avoid pushing the pace.  According to my Web research, there's no standard time for blood clots to dissolve, whether in the legs or lungs and I must resign myself to several more months of limited exercise, at least.

Cockrone Lagoon at the end of today's walk

Today was also the day on which the 64km Bogong to Hotham race was held in the Victorian Alps, an event I had been training for before the PE hit.  Several times during the day, I thought enviously about where the runners would be on the course, and that hasn't helped my mood.  I have a consultation scheduled with my GP tomorrow, and although not expecting any new revelations, I do anticipate getting referrals to specialists where I'm hoping for more clarity about my condition and prognosis.  However, it won't be a speedy process.

More theories

I unexpectedly struggled midway through a long trail run
near the Barrington Tops four months ago.

The longer it takes to see specialists about my Pulmonary Embolism (PE) and Atrial Fibrillation (AF), the more time I spend on researching the conditions on the Web, talking to other people, retrospective self-analysis and theorising about my prognosis.

I was quite depressed following the surprise (to me) AF diagnosis, but after researching athlete experiences for yesterday's blog post (see Endurance athletes and A-fib), I'm starting to feel cautiously optimistic that I will be able to resume running.  Maybe I have had Paroxysmal (occasional) AF for some time, triggered by exercise fatigue.  Many people have AF and are unaware of it.  Maybe AF explains the unexpected and sudden onset of severe fatigue during some long runs in the past six months, including the Melbourne Marathon (see blog post Reality check).  I had put them down to lower back issues affecting my stride, for want of a better explanation.  When AF occurs, the heart beats inefficiently and less oxygen reaches the muscles causing fatigue.  The long runs when I had trouble were all at a time when I was building from a lay-off and possibly going a bit too hard for my level of fitness.  Later long runs, when I was fitter, but running within myself, were faster without trouble.

Struggling in the Barrington Tops

This is all amateur conjecture, and perhaps there will never be certainty, but it does make me think, that once the PE and Deep Vein Thrombosis conditions are resolved through time and Warfarin, I will be able to make a return to running, much more aware of my situation and more able to manage it.

It was a beautiful summer morning for the regular Terrigal Trotters Saturday run.  I was there early to take care of runner registration as Kev, the Club Registrar was away in Parkes for the Elvis Festival, and enjoyed greeting the 100+ runners who turned out.  Many kindly asked after my health and I later had the benefit of talking to a couple of club-mates who recently had surgery for similar heart issues.  My regret at not being able to join everybody for the 11km "Round Drive" run was somewhat tempered by a pleasant 6km walk with some great coastal views and the usual post-run bonhomie.

Endurance athletes and A-fib

Greg Welch

My diagnosis with Atrial Fibrillation (AF) has had me researching the subject of endurance athletes with heart conditions.  My friend, Dr. Jon, forwarded me an article called "Atrial fibrillation and atrial flutter in athletes" when he heard of my diagnosis.  It reviews a number of studies of the subject and concludes "There is growing evidence that long-term endurance sports participation can result in.......the initiation and maintenance of AF......although the mechanisms explaining the relationship between these conditions remain to be elucidated".

It's not hard to find examples of endurance athletes who have had to deal with heart problems.  Just in Australia, high-achieving triathletes, Greg Welch, Emma Carney, Erin Densham and Chris Legh have all had treatment for serious heart conditions and, in some cases, been forced to cease elite competition.  It can sound scary!

Emma Carney

But they are all a lot younger than me (making it much tougher for them, of course) and maybe they were predisposed genetically to their problems.  Nevertheless, without having any personal knowledge, I doubt that they would change much about their competitive lives, and particularly the intensity of their training.  They achieved great things by maximising their potential through hard and disciplined effort, and I admire them.

Erin Densham

We are all individuals and the medical studies point out correlations, possible explanations and areas for future study with respect to cohorts.  There are no certainties, or even probabilities, that long-term endurance runners will have dangerous heart problems affecting their quality of life.

I would like to see a study that quantifies the enhanced quality of life enjoyed by endurance runners over the course of their careers.  I believe the benefits would far outweigh any costs.

Perseverance is not always good

Deep Vein Thrombosis is the formation
 of a blood clot (thrombus) in a deep
 vein, predominantly in the legs.

There are whole worlds out there that I know little or nothing about.  I'm a bit of a current affairs nut, and an avid reader on a wide range of subjects, but there's nothing like a new injury or illness as motivation to expand your knowledge of a subject.

During my running life I have had serious injuries to my Achilles tendons, knees and lower back, as well as the usual torn and strained muscles, tendons and ligaments.  In each case, I've learned a lot about those injuries, including through missteps I have made in dealing with them.

I like to think that my own experiences allow me to offer soundly-based views on the running-linked injuries of friends when asked.  In the case of soft tissue injuries, I generally advise patience and the avoidance of activities that worsen the symptoms.  If something seems more serious or inexplicable, I usually suggest starting with a doctor.  They have a range of diagnostic tools at their disposal and a broader range of knowledge about the possible causes than ancillary or alternative health care professionals.  I'm not a fan of starting with the latter because I believe their field of knowledge and the tools they have available make it less likely they will consider all of the possible sources of a problem.  This can lead to misdiagnosis and a delay in recovery.

Pulmonary Embolism  is a blockage of the main artery
of the lung or one of its branches by a substance
 that has travelled from elsewhere in the body
through the bloodstream (embolism).

In the last two weeks, through doctors, the Web, and articles given to me by others, I've become a lot wiser about the subjects of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE) and Atrial Fibrillation (AFib), and their associated symptoms, treatments and prognoses.  Of course, there's much more I don't know about these subjects, but one thing I have learned is that runners need to be much quicker in seeking the opinion of a doctor if they start to feel inexplicably short of breath, dizzy or light-headed, or experience chest pains, hyperventilation or persistent leg pain.  There can be life-threatening medical conditions underlying these symptoms and endurance runners are at higher risk of developing them, especially if they have a long background of endurance training.

Atrial Fibrillation is the most common cardiac arrhythmia
(heart rhythm disorder).  The normal regular electrical impulses
generated by the sinoatrial node are overwhelmed by
disorganized electrical impulses usually originating in the
roots of the pulmonary veins, leading to irregular conduction
of ventricles impulses which generate the heartbeat.

Many runners, and particularly males, think seeking medical advice about these symptoms is a waste of time and/or a sign of weakness.  All endurance athletes get used to dealing with fatigue and injury "niggles" and there's a strong temptation to dismiss them as a "cost of doing business".  Two friends, both distance runners, have recently been diagnosed with PE, but only after persevering with their symptoms for much longer than me and ending up in hospital emergency wards.

I will now be quick to advise any runners suffering from the symptoms described above to urgently seek the advice of a doctor.  Early intervention is important and delay could be fatal.  It's just not worth the risk of persevering.

After mentoring this morning's track session at the Terrigal Haven, I walked for about 6km, feeling fresh and healthy the whole way, and wishing I could be running my usual post-track session 11km.