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.

Katahdin

Mt Katahdin

One of my favourite places in the world to run or hike is Mt Katahdin in Baxter State Park in Maine, USA.  My then wife, Barb, and I first visited the Park in 1985 when we were touring the US for a year.  It's worthy of a visit in its own right, but my interest had been piqued by a former work colleague's wife, a native of Boston, who had told me about the 3,500km Appalachian Trail which had its northern terminus on Mt Katahdin.

Moose

The place had an early impact on me.  While running from our campsite on the first morning, I encountered a moose.  Every visitor to Maine hopes for a moose sighting, but my first was completely unexpected and very exciting.  I was just cruising along a deserted park road through a conifer forest at the base of Katahdin when, in the misty early morning light, I saw what looked like a very tall man walking along the road towards me.  As I continued on, the shadowy figure got taller until I finally worked out that it was a moose strolling obliviously in my direction.  They're not generally dangerous, unless you hit them while driving (22 people killed in Maine in the last decade), but they are intimidatingly large, often reaching a height of more than 2.5 metres.  Finally, the moose woke up to my approaching presence and crashed off into the forest.

Reaching the top of Katahdin after 3,500km and
4 months of hiking in August 1986

Later that day we climbed the spectacular Mt Katahdin (1606m), a 17km strenuous round trip along the Hunt Trail.  It involved some taxing and scary boulder scrambling, and a very exposed plateau-like top, but the views from the peak of the isolated mountain were spectacular and rewarding.

Fifteen months later, I was back there again, completing my northbound Appalachian Trail hike (and spotting a few more moose on the way), but this time the views were limited and the weather deteriorating.  After four months of hiking it was, nevertheless, a profound moment in a spiritual place.

Looking down Hunt Trail on Mt Katahdin

Another thirteen years passed before I saw the top of Katahdin again, this time during a family camping trip to Maine while we were living in Connecticut and I was working in New York.  I managed to squeeze in a return run from our campsite to the peak before the day's activities, and enjoyed having the whole mountain to myself in the morning light.  Despite the steepness and difficulty of some sections, the return trip only took about 2.5 hours.  It brought back many memories, as I'm sure it will when I set out southwards from there this coming October (fingers crossed!).

I managed to comfortably walk 10km for exercise this morning, including some significant hills.  I felt good all the way and spent the last half rationalising a return to gentle jogging next week assuming my INR blood test shows my anti-coagulant levels are in range.

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.

Mental adjustment

The MacPherson Forest loop was my last long trail run

It is a challenging (character-building?) time for me.  I find myself constantly re-evaluating my situation, looking for plausible positive scenarios (while trying not to fool myself), and fending off the darker morbid thoughts that must come to anybody who suddenly finds they have a potentially life-threatening medical condition.  I always assumed that my serious running career would be brought to an end by some major joint failure.  I did not expect it to be threatened by a cardio-vascular event, and it's taking time to get my head around the consequences.  With joint failure, there were always going to be alternative forms of endurance exercise such as cycling, hiking or kayaking to fill the running void, but a cardiac problem will be just as much of an issue for those activities.

MacPherson State Forest trail run

It's amazing how quickly your perspective changes, especially with the resources of the Web and Google to inform you.  I'm already thinking about changing the title of this blog to "The Futile Pursuit of a Last Sub-3 Hour Marathon" as it's hard for me to believe that I will ever be able to subject my heart to the stress necessary to run that fast again.  New goals are formulating.

Of most importance to me is the ability to exercise most days and feel good about my health, well-being, and quality of life.  It would be great to include occasional long "no pressure" trail runs, and be able to go for extended hikes/rides in remote places.  Compromises will be needed, along with patience.

MacPherson State Forest trail run

I have already decided I'm willing to reduce daily and weekly distances, give up the pursuit of age-group podiums, and even walk up hills.  If it seems likely to reduce the risks, I'll cut out caffeine (despite my well-known penchant for Diet Coke and Pepsi Max) and stop using my asthma inhalant, Symbicort.  All of these things - too much endurance/hard running, caffeine, steroid-based asthma medications - are statistically correlated with Atrial Fibrillation and cited as possible risk factors.  Age (I'm 63) is another significant risk factor, but I can't do much about that.

There will be more tests and doctor consultations to come, and there are still plenty of "unknowns", but it will help me deal with the situation if I've started mentally adjusting to the life-style compromises that may be required.

Trotters

Terrigal

Last night was the monthly Terrigal Trotters Committee Meeting at the Terrigal Surf Life Saving Club.  I always get a sense of privilege rocking up to the Surf Club on a Monday evening during holiday season.  Terrigal is a very popular holiday destination and during the summer you have to make your way through throngs of holiday makers knowing that by next month's meeting they will all be back at work or school and you will still be here, continuing to enjoy the delightful beach, hinterland and weather that have attracted them for their vacation.

Terrigal Surf Life Saving Club

Over my athletic career, I have belonged to a succession of running clubs - Melbourne High School Old Boys (defunct), Kew Camberwell District (defunct), Croydon Harriers (UK), Colchester & Tendring (UK), Watford Harriers (UK), St Louis Track (US) - and now Terrigal Trotters.  Along the way I have served in various Committee positions in some of these clubs and Terrigal Trotters stands out as unique.  Most Clubs seem to rely on two or three people to do much of the work assisted occasionally by other club members.  At Terrigal Trotters, without counting the numbers, I would guess that there are 20 people who make a very significant contribution to the Club's activities and many more who are willing to help out with particular events.

Terrigal Trotters Santa Run

The Committee is energetic and the Club inclusive.  Membership is growing and there are new people showing up for every Saturday's run, many of whom soon become hooked on the format and camaraderie.  It's fun to be a part of and volunteers enjoy involvement in professional and successful events.  Such success feeds on itself, drawing in more volunteers and participants.

Each month, one of the Committee Meeting agenda items is to nominate people who have made an exceptional contribution to the Club in the previous month and then select a Club Person of the month.  It is illustrative that there were 30 members nominated for their efforts in the past month.  Surely a sign of a vibrant club doing it's bit to promote fitness, health and fun.

Terrigal Trotters Christmas Party

My exercise today was another 5km walk around Copa.  I felt good and really wanted to be running.  Unfortunately, resumption still seems to be some way off.  My Echocardiogram this morning revealed significant Atrial Fibrillation in my heart and the specialist immediately sent me off for an Electrocardiogram (ECG) which confirmed his diagnosis.  The results still have to be reviewed by a Cardiologist, so I don't have a detailed report, but Googling the condition makes it plain that I have been lucky, will remain on Warfarin to reduce the risk of Stroke, and will need to consult some specialists before daring to run again.

The Prom

The boardwalk through Sealers Swamp on
Wilsons Promontory

Not unexpectedly, I was unable to get my Echocardiogram done today.  The first day back at work for the clinic after the Christmas/New Year break was always going to be busy.  I was lucky enough, however, to receive a call from the clinic later in the morning to say they had a cancellation and I'm now booked for the test tomorrow.  The chest X-Ray last week found that my heart was "borderline enlarged" but it seems reasonable that it would be in an endurance athlete.  If I did an hour of chin-ups most days for 45 years, my biceps would be "borderline enlarged" as well.  There is a condition called Athletic Heart Syndrome (AHS) that would explain the size, but it's hard not to be a bit anxious about what they will find.

Refuge Cove, Wilsons Promontory

My exercise today consisted of a walk around my usual 5km in Copa listening to an audio version of "The Economist", one of my favourite reads/listens.  Walking by the beach on a nice sunny morning, it was easy to think about better things and I recalled one of my favourite long training runs that included some great beaches.  I have only done it a handful of times, because it is on the remote Wilsons Promontory, the most southerly point of Australia's mainland, and one of Australia's best National Parks.

Oberon Bay, Wilsons Promontory

There are a number of running routes available on The Prom, short and long, and over the years I have spent weekends and weeks camping there with family and friends.  All of the runs are worth doing, but my favourite is a 43km loop that includes beaches on the western and eastern side of The Prom and two climbs over the spine that provide views and some quintessential Australian bush trails.

Tidal River, Wilsons Promontory

Going in a clockwise direction the run starts with a steady climb up to the Oberon Car Park along a tarred road for 4km before joining the walking track to Sealers Cove that starts with some hillside running, crosses Windy Saddle, and then descends to boardwalks across an eerie swampy world behind the spectacular Sealers Cove.  From there the trail follows the coast southwards past Refuge Cove to Waterloo Bay, offering some fabulous views over the pristine coast before turning westwards, back across The Prom to Oberon Bay.  It's easy to imagine that nothing has changed here for thousands of years as you run along the flat hard Oberon beach with the breakers to your left and the imposing Mount Oberon ahead.  The last section of the run returns to the starting point at the Tidal River campground around a rocky cape and you can finish along the beach or along a trail through the ti-tree.

I have run the course quite quickly in days gone by, but it is just as enjoyable at my slower pace of today, and I look forward to my next visit.

Mixed feelings

Ultra-running legend, Pat Farmer, running
with friend, Dina, near the end of the
"Round the Bay"

Today was Terrigal Trotters' "Round the Bay" run, which is traditionally held on the first Sunday in the New Year.  At just over 37km of roads and concrete bike paths, and usually in humid conditions, this a tough run.  Three weeks ago, I had been planning to use it as a long training run, but the Pulmonary Embolism diagnosis a week ago changed all that.

The event, which circumnavigates Brisbane Water, and is followed by a picnic breakfast, has become increasingly popular within the running club, and today was no exception.  Fifty-five people completed the circuit, including one group of walkers who began at 2:00am!  Some slower runners started at 4:00am while the main bunch set out at 5:00am.

Despite injury, Wayne nears the end of
his 13th consecutive "Round the Bay"

To get some exercise, I drove down to the start in Gosford and then walked 4km out and 4km back along the last section of the course with my camera, photographing the runners and walkers as I encountered them.  It was inspirational to see so many of my friends out testing themselves, including some suffering from injuries and/or a lack of preparation.  In just about every case, I managed to coax a smile out of them, despite their exhaustion.  My friend, Wayne, who is the only person to have run every one of the twelve editions so far, and has had a bad couple of years with various injuries, still found the determination to finish and preserve his record.  We have had a few good tussles on this course in past years.

Trotters gather for breakfast and a low-key presentation
after the "Round the Bay"

The inspiration provided by my friends this morning was, sadly, somewhat offset at frustration with my own situation.  It was only eighteen days ago that I ran the same course on my own without pressing the pace in quite a reasonable time.  I need to remind myself that eighteen days is not that long, and that I was still running up until a week ago.  Assuming next week's Echocardiogram is clear, I may be jogging in another week, and won't have lost much fitness.  Other people with my condition would just be thankful to still be vertical, and I need to remember that too.

Some cause for optimism

Near the start of the Dubbo Gully Run

As the early test results come back, I'm becoming more positive about a return to running.

So far, no evidence has been found of more sinister underlying conditions that could have led to a blood clot forming in my veins and migrating to my lungs.  However, I still need an Echocardiogram early next week to rule out any heart disease or other heart issues, so am not out of the woods.

On the other hand, an Ultrasound Doppler examination of my right leg yesterday, found a small clot just beneath my right knee and close to the site of severe knee pain I experienced following a 30km trail run on the Dubbo Gully course three weeks ago.  There is no pain there now, and there hasn't been for several weeks, so it seems reasonable to surmise that the clot may have been larger when the pain was greater.

Crossing Mangrove Creek on the Dubbo
Gully Run

What led to such a clot forming, and why didn't I pay more attention to it?

Firstly, I have had significant right knee pain for more than six years now (see Post titled "Adaptation"), so I expect it to be sore after a long run.  However, I recently switched from wearing Nike Pegasus shoes, a model I have worn for decades, to another brand that promised more cushioning.  I was wary about changing shoes because I know different brands and models can change the stresses and strains imposed on the legs making you potentially more vulnerable to injury.  However, I have also been struggling with a painful chronic right Achilles tendon injury and been stymied on several long runs, including the Melbourne Marathon, by lower back pain and associated sciatica.  A shoe offering a softer ride and different pressure on the heel was worth trying and I bought a pair.  After a couple of weeks and several long runs in the new shoes, positive signs were that my Achilles tendon was less painful and there had been no back trouble.  Offsetting this was a minor worsening of my knee pain, which seemed to have moved to just below the patella on the inside front of the leg.  Following the Dubbo Gully run, the pain was particularly intense, especially on the hour-long drive home, and was sufficiently painful to cause sleeplessness the next two nights.  It now seems likely this pain was associated with deep vein damage.

Part of the Dubbo Gully route

Three risk factors probably compounded the development of a clot in the vein.  I was dehydrated after the run, but drank sparingly in the next four or five hours, increasing the viscosity of my blood.  Unusually, I had a three hour nap (while still dehydrated) on my bed when I got home, during which my heart rate would have dropped to its usual low resting rate (~45 bpm).  Finally, I have low blood pressure anyway.

My guess is that the coincidence of the new shoes changing the stresses on an already damaged knee, dehydration, a post-run nap, and low blood pressure led to Deep Vein Thrombosis.  The next ten days saw parts of the clot break off and travel to my lungs and the development of Pulmonary Embolism.

Through gradually increasing the daily dosage of Warfarin, my International Normalized Ratio (INR), a measure of the clotting tendency of my blood, has reached 2.1 (the desirable range is 2.0 - 3.0) and the daily Clexane injections have ceased.  I'm still not allowed to run, but I played golf this morning and have been walking about 5km per day this week without ill-effects.  I haven't discussed it yet with the doctor, but I'm hoping I can resume unpressured jogging after a scheduled visit in a week's time, provided the Echocardiogram doesn't yield any concerns.  Fingers crossed!

A new challenge

Terrigal Trotters gather after their Santa Run

The New Year has brought some additional challenges in my quest to run a last sub-3 hour marathon.  When I started this blog, I thought my goal was possible rather than probable, and now it seems closer to impossible than possible.

Following my underwhelming Melbourne Marathon effort back in October 2013 (see post), my training was consistently around 100km per week up until Christmas and I could feel my fitness improving significantly.  Enough, in fact, to begin plotting my race calendar for 2014, culminating in another sub-3 hour marathon attempt at the Gold Coast Marathon in early July.  I entered races such as the Bogong to Hotham 64km in January and the Six Foot Track 45km in March, optimistic that, barring the unforeseen, I would do well in both.

Unfortunately, "the unforeseen" has arrived.  At the Terrigal Trotters Santa Run, on the Saturday preceding Christmas, I struggled around the 10km course for no apparent reason, breathing particularly hard on the hills.  It was warm and humid, I was wearing an Elf costume, and I had run 37km (comfortably) in training three days earlier, so I wrote it off to a combination of those factors.  Over the next three days, I ran just 10-15km daily, and didn't push the pace, but still felt fatigued and short of breath.  I even walked up a couple of steeper hills, a rarity, and quite demoralising.  I survived a long-planned 35km Boxing Day trail run with friends by running conservatively the whole way, and hoped that successful completion might have signalled some kind of recovery.

Me (centre) getting ready for the Trotters Santa Run,
unaware of my Pulmonary Embolism and how hard I
was going to find the run.

Sadly, two days later, I could only shuffle around the monthly Trotters 10km Hill Time Trial in 56 minutes, some 13 minutes slower than I should have been able to manage.  This convinced me something was wrong, and not getting better.  On returning home, I spent some time Googling my symptoms.  The most likely explanation seemed to be Pulmonary Embolism (PE) a condition that can quickly become fatal and requires urgent medical attention.  I didn't feel "on the edge" so resolved to visit my local Medical Centre the next morning.  The duty doctor thought PE unlikely, since I had no symptoms of Deep Vein Thrombosis (DVT),  but alarmingly, thought some kind of heart condition probable.  Nevertheless, she took my concerns seriously and prescribed a series of tests to check for heart and lung issues.

Being the Sunday between Christmas and New Year, I had to wait until the next day to get the first tests done and a Pulmonary Angiogram found evidence of PE in both lungs.  Often this would lead to immediate hospitalisation, but since I seemed otherwise healthy and stable, I was sent directly back to the doctor where I was given an injection of the anti-coagulant Clexane in the stomach and prescribed another anti-coagulant, Warfarin.  More tests were prescribed to try and determine the source of the original clotting, which I gather could include cancer, heart problems or injury.

Now, three days later, I'm still trying to come to terms with how this is going to change my life.  After more extensive Googling, it seems the best case scenario is that the clots are resolved by the anti-coagulant and I cease taking the Warfarin in three months and return to my pre-PE life.  The worst case scenario is that the PE is symptomatic of a more serious condition.  I feel healthy, when not running up hills, and have a sort of instinctive confidence that there is nothing seriously wrong.  On the other hand, I strive to be a rational being and know I'm getting older, I frequently test my body to its limits, and some time, barring accidents, a medical condition will lead to my demise.

I'm restarting this blog with the intention of tracking my progress through treatment and towards the Gold Coast Marathon in July.  At this stage, I really have no idea whether I will be running.  Chances are that I won't bother unless I feel fit enough to threaten 3 hours.  Right now, this seems a very slim chance, but I'm keen to try.

Tapering

Start of the 1977 ACT Marathon (I'm in there somewhere)

Tapering for a marathon used to be one of my favourite times.  The training pressure comes off, and you can run for less time and less intensely without guilt.  If your training has gone well, pleasant anticipation of the race builds and visions of success become almost palpable.  As your body freshens up and minor injuries abate, you feel stronger and more capable as each day passes.

Conversely, tapering can be a worrying time.  Rationality can go out the window and emotions can take over.  After training hard for months, you wonder about the wisdom of reduced training intensity and fret about losing your edge, or putting on weight.  A lot of self-examination goes on.  Small niggles becomes potentially serious injuries.  Every training run becomes a test of your readiness, and if the run is hard work, you question whether you are ill or over-trained, or maybe under-trained.  If anybody coughs near you, or complains of feeling unwell, your first thought is of your own health, and not theirs.  There is a temptation to modify your diet to include more carbohydrates and build your energy reserves, maybe even precede it with a depletion phase.

Nearing the end of the 1977 ACT Marathon (2nd, 2:32)

Over the years, I have fallen foul of all of these concerns, and maybe still do (see post titled The idea forms).  However, when asked by others for advice about tapering, my response tends to be more rational.  I think two weeks of taper is enough, with training distances and intensity reduced to 75% of full load in the first week, and 50% in the second week.  However, it's hard to generalise about the appropriate level of tapering, and some runners need not cut their training intensity by that much.  Having said that, I don't think I have ever felt, post-race, that I tapered too much.

Otherwise, I like to keep things as normal as possible, sticking with the usual training routines and diet.  The very act of tapering will lead to a build-up of the body's energy stores, and there is risk attached to changing diet and habits.  It's worth staying away from sick people and catching up on any sleep deficit.  Finally, I would advise having faith in the training you have done and not fretting about losing condition or feeling over-tired on any runs in the taper period.

For reasons discussed in yesterday's post, Get fit quick, I only plan a one week taper for the Melbourne Marathon on 13 October, and am still training relatively hard this week.  I expected this morning's run to be difficult after yesterdays 37km road run, but it went better than hoped.  It wasn't fast by any means, but the 11.5km  passed by easily enough and my legs did not feel too fatigued.  My right Achilles tendon was quite stiff and sore, but that was anticipated, and my right knee was less painful than expected.  Overall, the run was encouraging and I feel my short-term fitness strategy may be working.

Who's up and who's down

Down - walking dejectedly away from the
finish of the 1982 Montreal Marathon
(46th, 2:29, "possibly my worst
performance ever") where I struggled
with an Achilles problem and the effects
of anti-inflammatories

I didn't get time to warm up much this morning for the Terrigal Trotters Flat (mis-named) 10km Time Trial, so started slowly and nursed my sore Achilles and knee through the early kilometres.  Consistent with the feeling I've had this week that I have somehow "bottomed out" in my running, I felt I was moving better and running more strongly than for the past month or so.  Nevertheless, I lack race fitness and stamina, flagged on the hills and found the last half hard.  My time of 44:52 was about what I had expected, though I had feared it might be worse as I slowed during the second half.
The monthly Time Trial is always a good bench-marking event, though you can't get too excited about who you beat and who beats you.  This is because nobody is at their peak or nadir all of the time.  There were runners in front of me this morning who I might have hoped to beat if fit.  At other times, when I was running well, they would have had the same thoughts about me.  Running and fitness is cyclical, maybe because of illness or injury, or maybe because of work or family commitments.  For some runners, staleness becomes an issue, training and racing become chores, and they seem to lose their "mojo" for a period of time.

Down - dealing with a serious lower
back injury in the early 1980s that
 cost a lot of running time

At a race like today's it is possible to identify people at all stages of the cycle.  You feel pleased for those on the upswing or at their peak, and sad for those whose performances are sub-par for some reason.  Within Trotters, it's great to see some people running very well at the moment who have struggled for the past year or longer.  They are loving that sense of capability and potential that comes with race fitness and are relishing the opportunity to compete in events denied to them in the last couple of years.  I feel very happy for them, but also want to tell them not to overdo it and to savour this period when everything is going well.

Up - running well and centre picture in the first
Melbourne Marathon in 1978 (2nd, 2:23)

Then there are others struggling to keep running with injuries or illness, or maybe just resigned to walking until they feel better.  At this stage it's easy for them to feel depressed and dispirited.  Every runner knows (and most non-runners don't) the frustration that accompanies the inability to run regularly for whatever reason.  Continuing to associate, socially, with those who are running regularly can make the pain even more exquisite, though those same people are also best equipped to empathise.  I feel sad for those who are struggling, but also want to tell them that their time at the top of the cycle will come again if they have patience, that they should use their downtime wisely, and that, believe it or not, there are more important things in life than running.

Barrington Tops

Sharon tackling one of the obstacles on
the Link Track

Being in the Barrington Tops area for a couple of days, I just had to search out a nice long trail run for Sharon and me to do today.  Neither of us is in great form at present.  My problems have been documented ad nauseam in this blog and Sharon has been making a slow comeback from shin stress fractures.

The route we chose was the Link Track that connects the Gloucester Tops to Barrington Tops via a forested ridge, a 34km out-and-back trip, starting at about 1300m and climbing to about 1500m at the Carey's Peak turnaround.  It was forecast to be a warm day, so the idea of running at altitude had some appeal.  It was also quite windy, so that helped keep us cool as well.

The track wasn't that hilly, but was narrow and technical in many parts.  The terrain varied from glades of Antarctic beech to more tussocky open alpine forest.  We had the place to ourselves and saw no-one at all, despite it being school vacation time.

Beautiful trail running on the Link Track

It turned into a run of two halves, with me leading on the way out, waiting at the top of hills for Sharon to catch up, taking pictures, and walking the more significant hills.  Sadly it was quite hazy at Carey's Peak, so the views were restricted, but it was still impressive.  I started to feel very achy and sleepy as we began the return trip and soon it was Sharon waiting for me on the hills and taking the photographs.  The further I went the more liberal became my interpretation of what was a hill, and therefore walkable.

With a few kilometres to go, I caught Sharon making hand signals at a distance to indicate the presence of a snake on the track and I got a good picture.  From there, I pretty much walked all the way back to the car, feeling absolutely exhausted.

Some wildlife on the Link Track

I shouldn't feel this bad, so will write it off to remnants of the illness I had on the weekend.  By contrast, Sharon was very happy with her run, being easily the longest she has done for some time.

On the plus side for me, my Achilles pain wasn't too bad and the knee bearable during the run.  Neither seems to be worse post-run, but I did kick a rock or stump during the second half of the run and felt sharp pain in the right arch that was giving me problems a couple of months ago.  Hopefully, it will be fine.

Despite my exhaustion, I count myself lucky to have been able run/walk through such an environment, and will relish the memory.  I think the Australian bush is in my DNA and I always feel right at home there.  Despite going quite slowly, we essentially completed what is supposed to be a two-day hike in just 5.5 hours.  Trail running gives you many more options in wild country.