Every now and then

Some of the Terrigal Trotters team on the way to the
Woodford to Glenbrook 25km Trail Race.

It is nine months since my last Woodford to Glenbrook 25km trail run (it was postponed three months last year because of flooding), and my life during those nine months has been quite eventful, particularly on the health front.  Five months ago, when dealing with the Deep Vein Thrombosis, Pulmonary Embolism and Atrial Flutter, I was telling myself that if I could just run again, even a few kilometres a week, I would be happy.  I did not give myself any chance of running Woodford to Glenbrook this year, so was very happy to not only be on the starting line yesterday, but feeling well enough to race.

My right Achilles tendon and heel remain very painful, but otherwise I have been feeling fit, so I was keen to see what I could do without any great pre-race expectations.  Last year I ran 2:01 and was second in the 60+ age group.  I hoped to go sub-2:00 this year and win the 60+.

It was a cold morning in the Blue Mountains with an icy wind, but the sun was shining and once we started running the cold didn't seem so bad.  I started steadily with the goal of running within myself for the first 10 kilometres, and that approach worked well, though left me weaving through many of the 380-strong field on the rocky undulating fire trail.  I didn't push it up the hills, trying to keep my breathing regular, but still sensitive to a pressure I could feel in the centre of my chest as my heart rate rose.  This pressure may always have been there, but would have been unnoticed a year ago.  A little worrying nevertheless.

A whale wallowed just off Copa beach during my
slow recovery walk this morning.

Even running within myself, I was gaining a few places on the climbs, but was doing even better on the flats and steep technical downhills.  As last year, I really enjoyed letting myself go down the hills, trusting myself to react quickly enough on the loose rocky track as I slalomed through slower runners.  It made me feel young again, though in a concession to my health issues, I was wearing a medical wristband alerting any paramedics to the Warfarin (blood thinner) I was taking.  Cuts would bleed profusely and a bad head knock could risk a brain haemmorhage.

The last 10 kilometres of the race was on a gradual downhill section that seemed never-ending.  By this time, my bad Achilles was very painful and I fought to maintain an even stride though every step hurt badly.  I still managed to catch a few more people, though lost a couple of places in the last few hundred metres on the race to the finish line.

I was surprised and pleased to see my time of 1:52, and later to find I had won the 60+ age group by 20 minutes.  A very satisfying day, though walking today has been very painful on my sore heel.  I see a specialist this week to review my blood clot issues and hopefully get off the Warfarin.  I'm not getting my hopes up.

A year on

Still moving well at the 12km mark.

This time a year ago, I ran the Macleay River Marathon after just two weeks training following three weeks of hiking.  I was pleased and surprised to finish in 3:24, a good kick-off in my campaign to run a sub-3 hour marathon four months later.  What a difference a year makes.

On Sunday, with not a lot of confidence, I fronted up for my second Macleay River Marathon.  This time, a sub-3 hour marathon was not on the horizon.  It was more about proving to myself that life had returned to normal after the DVT, Pulmonary Embolism and Atrial Flutter episodes of six months ago.  I was confident I had done enough training to complete a marathon, but wasn't sure how fast.  In the back of my mind was a faint hope that I would run faster than last year, but a bruised and painful heel, probably associated with my chronic right Achilles tendon injury, sobered my expectations.  I kept telling myself that finishing with some kind of dignity would be sufficient.

Not quite so smooth at 25km.

I try to resist last-minute changes to pre-race preparations, but a couple of days before the marathon I decided that my heel was bothering me sufficiently to warrant wearing more cushioned shoes - my Hokas - that I hadn't raced in before.  Not ideal, but I told myself I would regret it if my heel became very painful early in the race.  In retrospect, it's hard to know whether this was the right decision.  The race went more or less according to plan until half-way, although I never felt I was running smoothly.  I didn't watch the clock and I didn't start too fast.  Instead, I was near the back early and then gradually worked my way through the field as I warmed up.  By half-way I had caught all of the runners who I felt should finish behind me.  Competitive arrogance can be hard to restrain.

Happy to finish.

However, during the third 10km of the race, as I started to get tired, I had trouble maintaining a good rhythm.  It seemed the cushioned shoes were not sufficiently stable as my muscle fatigue grew, and worryingly, I even found it hard to maintain a straight line.  My heel was also becoming very painful.  Around 30km, I realised I needed to slow down if I was to still be running at the finish.

I plodded along, probably more than a minute per kilometre slower than I had been running, wondering how many people would catch me before the end.  I was particularly worried about Ray, a fellow 60+ runner and tough competitor, and clubmates Jacqui and Greg.  I had passed all three in the second 10km of the race.

Ray came past with nine kilometres to go, running strongly, and gave me a pat on the back, but despite my fears and my slow pace, Jacqui and Greg didn't catch me and I was pleasantly surprised to cross the line in 3:39.  Not as fast as I had hoped, but not as bad as I feared during those laborious and painful last ten kilometres.

Since the race, my heel has been very sore, and I lay in bed last night, kept awake by the pain, contemplating surgery.  I'll leave it another couple of months, but I think something will need to be done.

Road running

An early part of today's run was along
Cullens Road which I enjoy so long as
traffic is light.

I'm getting fitter following my heart/lung problems at the end of last year and am continuing to contemplate running the Macleay River Marathon in four weeks time, just to see how I go.  One argument against running is that my legs still need some toughening up if I'm not to disgrace myself.

Although I enjoy running on trail more than road, my experience has been that if you want to race long distances on the road, you need to train over long distances on the road.  It is the hours of repetitive pounding on the road, with every step exactly replicating the preceding step's effect on the musculo-skeletal system, that builds the fitness necessary to cope with a marathon.  After training for long distances on the road, I have always been able to feel the growing strength in my legs, particularly the quadriceps.  Almost suddenly, I will feel stronger, fitter and faster, after a few long road runs.

Ward's Hill is steeper than it looks.

I know I need a couple of long road runs under my belt before tackling a marathon.  For my training today, I ran one of my favourite 21km courses from my home in Copa.  It has some long road stretches, some busy and some quiet, along with a few hills, including one really nasty one around halfway.  I felt good early, maybe the best this year, and was averaging 5 mins/km for the flat sections, but I could feel my legs getting very tired by the time I summited Ward's Hill.  By working harder, I maintained my momentum, but struggled on the last hill with three kilometres to go.

I finished comfortably, but am convinced I need to get in a couple of long road runs in the next two to three weeks if I want to reach an acceptable level of fitness for the marathon.  I haven't entered yet.

How much is too much?

Waiting for me the first time on the Bush Bash.

Any rational analysis would suggest running 47km on trails yesterday would be tough for me.  I've only been back running for two months after two months off while I was treated for some heart and lung problems, and on Saturday, I ran our club's 10km race in 44:01, 3:30 faster than on the same course a month ago.  I hoped, rather than expected, that the 10km hadn't taken too much out of me and that by walking the steeper hills I would cope with the 47km Brisbane Water Bush Bash.

One of the smaller hills on the Bush Bash.

A week or so ago, Terrigal Trotters was contacted by the producers of a television program, Search4Hurt, to ask whether we would take one of their rookie ultra trail runners on a 40-50km run to gauge his preparation for The North Face 100km in three weeks time.  I suggested the Bush Bash because it was easily accessible in a number of places to film progress, and enlisted some friends from the club to accompany him.  As a point of pride, I wanted to do the run as well, perhaps hoping that the rookie wouldn't be that fit and I could hang on.

Misty views over Brisbane Water.

The run started with a brief on-camera interview about Terrigal Trotters and then we were off on a drizzly, misty and overcast morning for the first bike path section.  Sadly, my quads were very heavy from Saturday's run and my early pace was slow.  The leaders, including the rookie, disappeared into the distance.  I caught them at the first fire-trail junction, 8km into the run, but only because they were waiting.  Thereafter, I managed to stay in touch with the group, partly because I was moving a little better, and partly because my colleagues occasionally waited a short while for me to catch up.

The course is a real mix of terrain.  There are scenic, but boring and hard-on-the-legs, flat bike path sections, and some short road sections, but most of the course follows fire-trails along the mountain crests surrounding Brisbane Water, including very steep ascents and descents.  The intermittent rain combined with low cloud and mist made for some great scenery and atmospheric forest.  There's nothing quite like the eucalypt forests in rain and some of the views, with forested ridges interleaved with low cloud, were breathtaking.

One of the steep descents on the
Bush Bash.

The company was good, but I gave up on trying to keep up with the bunch after 26km and drifted back to run on my own.  I suddenly felt very fatigued and slowed to a plod, wondering how I was going to manage another 20km.  Fortunately, the rookie, who had found $70 on one of the trails, bought us all a drink at the South Kincumber store (they waited for me again!), and the Coke revived me a little.  I told them not to wait for me any more, and they quickly disappeared on the steep climb up Kincumba Mountain.

One of the bike path sections on the
Bush Bash.

I expected to be on my own for the last 15km, but instead developed a symbiotic relationship with Kirrily, who had not run the course before.  I tried in vain to keep up with her, causing me to run more than I would have otherwise, and she had to keep stopping at junctions, unsure of the way, to wait for me to catch up.  This worked well until the final descent, with just 2km to go, when I started to lose my equilibrium and couldn't do more than walk most of the time, taking great care on the steep descents and stairways not to fall, and cursing the unreliability of my muscles.  There was a background concern in my mind that my problems were heart-related, but it was beating regularly, and my blood pressure seemed OK.  Kirrily was concerned, but I was still thinking clearly and was confident I could finish.  I told her to go on ahead.

Another steep descent on the
Bush Bash.

I finished safely in six hours, about an hour slower than my best, and even managed to jog the last few hundred metres.  The TV guys, who wanted to go home, asked for another short interview with the rookie and me.  I was a little worried I would fall over, and hoped I was making sense.  Towards the end, I noticed Kirrily gesturing towards my feet in the background and looked down to find my shoes seething with multiple leeches looking for a feed.  The cameraman got a last close-up of the predators before I adjourned to a wet park bench and began trying to pick them off.  It took some time, but I was lucky and none drew blood.

The run definitely tested my current fitness limits, but it was satisfying to finish with all body parts, except for my very painful right Achilles tendon, in working order.  It will take me a few days to get over it, and I tossed and turned in bed with aching feet and legs last night, but when I do I will be stronger for the effort.  For today, I just walked an easy 5km.

Quandary

The Terrigal Trotters crew at last year's
Macleay River Marathon.

It wasn't a big deal, but it's always good when a plan comes together.

For most of the past week I have felt stiff, sore and lethargic.  My right Achilles tendon has been particularly painful.  I have been paying the price for last Saturday's harder run, particularly the fast downhill technical sections, and Monday's 25km trail run.  Knowing I wanted to run the ANZAC Day run yesterday, the 10km Handicap today, and the 47km Bus Bash tomorrow, I decided after Monday to maintain my regular running routine this week, but to avoid pushing the pace, to run on roads and to tie my shoes more loosely.

Even surfaces and straight line running impose less strain on the Achilles, as does a slightly looser shoe, and the no pressure running was designed to address the lethargy and stiffness.  Even yesterday, I didn't feel that good, though there were some glimmers of better form near the end of the run.  But today, from the moment I started my warm-up, I felt looser and fresher, and my Achilles was the best it's been for five days.

Getting my timing chip removed after
last year's Macleay River Marathon.

Four weeks ago, on the same course as for today's 10km run, my time was 47:36.  My allocated handicap time today, based on performances last year before my heart and lung problems, was 44:00.  This ruled out any chance of a podium finish, which was a good thing. It eased what would otherwise have been self-imposed pressure to run as hard as I could.  Instead, I started the run believing that any time between 44 and 47 minutes would be good and was very happy to finish right on 44:00 after a slow start.  The plan had come together, though I still have to survive tomorrow's 47km Bush Bash.

After the run, a friend was talking about the Macleay River Marathon which is on in six weeks time.  Last year, fresh from three weeks of hiking, I ran quite well for 3:24 without getting serious about the race.  I can hardly believe it, but I'm entertaining the idea of running it again.  Three months ago, I was wondering whether I would ever run again.  Am I being stupid?  Today's race, not taken seriously, resulted in a reasonable time for my age.  With a few more miles, and a few less kilograms, it's reasonable to think I could knock a few more minutes off the 10km time and run a comparable marathon time to last year.  But am I pushing too hard?  I don't feel like it, my heartbeat has stayed regular, and I am healthy.  Perhaps I should just treat the Atrial Flutter episode as a bad memory and get on with my running life.

Leon's Run

Yass Golf Club.

No running yesterday, just the drive back to Copa from the mountains with a stop for nine holes of golf at Yass on a beautiful day on a very pleasant course.  I knew I needed time to recover from Thursday's longish trail run and have found that an easy walk of five kilometres or so (even if punctuated by some terrible golf shots) is a good way to work out some of the stiffness.

It's confronting, in my sixties, to compare how long it takes to get over a long hard run these days compared to thirty years ago.  There was always fatigue and some stiffness the next day, but these days I'm practically immobile when I first get up, walking extra carefully and slowly downstairs and limping to avoid undue stress on damaged joints.  I sometimes wonder if it's a portent of life in my eighties, if I make it that far.

Glimpses of Gosford from atop Kincumba Mountain.

On the other hand, it's gratifying and often surprising to find how much improvement comes with just a day's rest or easy walking.  The thought of running yesterday had no appeal whatsoever, while today I was keen to see whether the improved strength I felt running up hills on Thursday was real or imaginary.  Although still moving gingerly after my 4:30am rising, I had confidence based on experience that once I started running I would loosen up and feel fresher.

Part of the level fire-trail atop
Kincumba Mountain.

Today's Terrigal Trotters run was the popular 14.7km "Leon's Run" from the beach to the top of Kincumba Mountain and return on a mix of road and fire-trail.  I think it's popularity stems not only from the sense of accomplishment in running to the top of the mountain (and the ensuing exhilarating descent), but also from the contrasts it offers en route - starting from the surf-lapped beach, often in the dark, and traversing sleepy suburbia to reach the forests of the mountain in the early light.  It's a serious climb, but then you get to enjoy three kilometres of  relatively level running to the turnaround point and back along the mountain crest during which you get to say hello to your clubmates travelling in the opposite direction.  If you're having a bad day, you get to see how far they are in front and who's catching you, and if you're having a good day, you get to impress those following and see who in front might be caught.

I had a good day today, considering the past four months, despite wondering a couple of times whether I could sense undue pressure in my chest during the harder parts of the ascent.  Each time, I backed off just a little so my breathing didn't become too laboured, but suspect it was just my imagination.  I definitely ran my best since the heart and lung ailments of Christmas, though there remains plenty of room for improvement.  The tank was empty for the last few kilometres.

Returning to the scene

Crossing Mangrove Creek early in
today's run.

Perhaps irrationally, I was a little anxious about today's long run because it involved returning, for the first time, to the place where I think my serious health problems - Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), Atrial Flutter (AFl) - began sixteen weeks ago.  I was running the 25km version of the Dubbo Gully loop today, not the 30km version of that day, but the weather promised to be humid again.

Dubbo Gully.

The first thing I did was make sure that I was well-hydrated before the run and that I had another sports drink waiting for me when I finished.  My best theory is, that back in December, I completed the run dehydrated and didn't drink much afterwards before having a post-run nap.  Vein damage from my chronic right knee injury, exacerbated by dehydration and low blood pressure, caused clotting (DVT) some of which ultimately found its way to my lungs causing a PE.  The lungs lost function and placed excessive pressure on my heart, generating debilitating AFl over the subsequent week.  You've heard it all before, if you are a reader of this blog.

Dubbo Gully wetlands.

Anyway, despite taking the extra precautions, I remained somewhat anxious.  The run, with Sharon and some friends, started slowly down a very long descent, and I hung back, still a little stiff and sore from yesterday's run and not wanting to strain.  I never pushed the pace, but after warming up, gradually drew away from the others on the long climbs later on the run.  Despite sweating a lot and working hard, so far as I could tell, my heart continued to beat regularly.  Both knees hurt, particularly down hills, and I cursed the extra three to four kilograms I'm carrying - so easy to put it on and so hard to get it off.  I feel sure, that without the extra weight, I would be running faster with less knee pain.  Hopefully time will tell.

Almost finished.

The course finished with a steady 3km climb, which is always tough, but pleasingly I managed to run the whole way.  My time of 2:43 was slow compared to the 2:58 run in December for the 30km version, but not that bad.  I drank and kept moving after the run and don't feel like I have damaged myself in any way.  It gives me increased confidence that the bad times are behind me and I'm looking forward to my next Dubbo Gully run.

Benchmarks

Near the start of the Avoca Steps.

Benchmarks can be useful in gauging your running fitness, and perhaps more importantly, signalling possible problems.

These days, I tend to judge fitness by the time taken to run a regular course, and how I felt doing it.  In earlier days, I often used a time trial on the track, or something like the average times achieved running multiple 400m repetitions in a track session, as guides.  They're not foolproof methods, and subject to the vagaries of small sample sizes, but if a benchmark is achieved it gives you confidence that your training is going to plan and that, in turn, gives you the confidence to go for the time or place aspired to in your target event.

More of the Avoca Steps.

I have also employed benchmarks to gauge the seriousness of an illness or injury.  One sort of reverse benchmark I used for years was that if I was too ill to run, then I was too ill to go to work.  Of course, I never wanted to miss a run, and never had any really serious ailments, so never missed a day of work.  However, I probably infected many work colleagues with colds, and occasionally, influenza over those years.

Further up the Avoca Steps.

Running a much slower time for the Terrigal Trotters 10km Time Trial at the end of December last year (56 mins instead of the 44 mins my fitness level indicated), alerted me to health problems later diagnosed as Deep Vein Thrombosis, Pulmonary Embolism and Atrial Flutter.  Now that I'm on the road to recovery from those conditions, I'm very attuned to sub-par training runs, anxiously analysing them as possible indicators of health problem recurrence.

The final section of the Avoca Steps.

Several of my local "garbage run" courses, have very steep climbs that I almost always run up, regardless of fatigue.  In fact, the only times I have failed to run up them is when I have been ill.  These are my current benchmarks.  One of them is the "Avoca Steps", which is actually a series of flights of steps and footpath climbing about 80m over 500m.  It's always a test to run up them, no matter what the speed, but I almost always do.  This morning, however, as I approached the base of the Steps, 7km into my morning 10km run, I just couldn't face the thought of running all the way to the top.  Ultimately, these things usually come down to mind over matter, and there have been many times on this hill, and others, where I have just refused to stop running and taken it a step at a time all the way to the top.  I have prided myself on my ability to do this, and attribute my relative strength running hills to my refusal to shirk them in training.  However, my recent health travails are fresh in my mind and the worst effects were brought on by running, and sometimes just walking, up hills to the point of serious breathlessness.

This morning, my rational self won and I walked up the Avoca Steps, but it hurt my pride and worried me some.  I can't put my finger on a single problem, but can think of multiple reasons, none of them individually important enough to explain my excessive fatigue.  For the moment I'm assuming that it is the combination of these factors - lack of fitness base, a total of 45km solid running on the weekend, and a head cold that is now beginning to affect my chest - that explains my troubles this morning.  However, if the fatigue persists through to the weekend, I'll be considering whether another visit to the doctor is required.

Six Foot Track

Six Foot Track.

It's been hard not to be a little despondent today.  This morning, while I was struggling around the Trotters 16km Matcham Valley course at not much better than 6 minutes per kilometre, the Six Foot Track 45km race was starting from near Katoomba in the fabulous Blue Mountains with many friends in the field.

Blue Mountains.

Just three months ago "Six Foot" had loomed large in my training plans.  Apart from being a very challenging course in a beautiful environment, it's popularity with runners from all over Australia make it a benchmark race to see how good you really are.  I would have loved to run it in my heyday when my marathon speed combined with trail-running experience (in training) and strength on hills would have made me a podium contender.  But that's easy to say now.  Thirty years ago, there were few trail races and they were seen as something of a novelty event.  Marathons were everything to me, and I would never have targeted and trained for a specific trail race.  Even now, it's rare to find Australia's best marathon runners contesting trail races.  The reality is that, even if Six Foot had been a big race thirty years ago (it was just starting out), I probably wouldn't have run it anyway.

Six Foot Track.

Nowadays, my attitude to trail racing is different.  And three months ago, I was hoping to get a podium finish in the 60+ age group today, and maybe threaten the age group record.  I have come close in the past.  But it wasn't to be.  Health issues intervened and I must consider myself lucky to have been running anywhere today.  Nevertheless, I'm envious of my friends who are running and can't help wishing, as I write this, that I was making that helter skelter descent on the scary single track to the buzzing finish at Jenolan Caves, with legs begging for mercy and the prospect of a good time and post-race glow just minutes away.  Running just doesn't get any better than that, and it makes me sad to think I may never experience it again.

Changing expectations

Bouddi National Park coastline.

I can already sense my mindset changing, and much more quickly than expected.

When you can't run, you tell yourself you will be satisfied with just being able to jog 5km a day.  When you get to jogging 5km a day, you tell yourself you will be satisfied if you can just run 10km per day, with the occasional long run.  And so it goes.  Before long, you will just be satisfied if you can get back to the fitness level you enjoyed before sustaining the injury.

Lovely single-track in Bouddi
National Park.

This has always the pattern for me when dealing with a serious running injury, but somehow I thought the life-threatening health scare at Christmas might lead to an attitude change.  In some ways it's frightening, and in other ways comforting, to find that, post-injury, little has changed.  Scary, because it worries me that I'm not paying sufficient heed to the risks of reversion to heart arrhythmia and the impact that may have on my future quality of life.  Comforting, because it's good to know that my problems haven't changed me that much.

The fire-trail down to
Little Beach.

I made it around the 14km Trotters run on Saturday (see post titled Looking up) with no apparent ill-effects.  After two subsequent easier running days, I asked myself this morning why shouldn't I run a bit further today, and maybe hit one of my favourite local trails.  Part of my reasoning related to the psychological boost I would get from returning to my usual running haunts, and part of the reasoning was that the further I ran in training, the sooner I would regain fitness and the easier running would become.

The more I run, the less focussed I am on my heartbeat and breathing.  I'm finding that a conscious decision to run within myself is sufficient to keep my breathing controlled and my heartbeat within comfortable limits.  I'm wearing a heart monitor now for my runs and it confirms that my heart rate is averaging around 150bpm during runs, reaching a maximum of around 160bpm.  It seems to me that, though getting my heart rate higher would accelerate my return to fitness, I will still benefit from longer easier runs, healthwise and weightwise.

Little Beach this morning.

I ran about 13km today along trails to the deserted Little Beach on a warm and sunny morning.  I walked up the steepest hill, and stopped a couple of times for views and photos, but still worked up a very good sweat.  On the downside, my chronic right knee injury was quite painful at times.  It doesn't seem like the time off running, during which it was not painful at all, had done it any good.  But the pain is a price I'm happy to pay just to be running again.

Ouch!

Not good news!

After two months of no running, and despondency about my health problems, I know I have put on some weight.  The shorts are a little tighter, as are the T-shirts, and I can't see as many ribs in the mirror.  Up until today, I had tried not to worry about it too much.  Dealing with health concerns and the inability to run were stress enough without beating myself up about my eating or weight (see my blog post about Compensatory Eating).

On Saturday I managed to run 14km, and have now run every day for nearly two weeks.  Although not out of the woods, health-wise, it's time to get back to normal.  "Normal" includes weighing myself regularly and trying to stay at, or below, 68kg.  Not only do I feel healthier at that weight (and my clothes fit better), but it reduces the chances of injury.  I do have a chronic right knee problem (see post titled Adaptation), and it has been quite sore since I resumed running.  I firmly believe that weighing less will alleviate some of the strain.

Much faster and lighter at Croydon in the UK in 1975.

Anyway, after my run this morning, I stepped on the scales for the first time in over two months - 74.0kg!  It was demoralising to see this number, and a big wake-up call.  Even though I can't run the kilometres I would like, I can exert more discipline over what I eat.  It's time to get back onto my "no snacks, no desserts and no second helpings" diet with small breakfasts and lunches.  Occasional treats will be allowed, but I need to be much more strict overall.

My 5km run was a little faster and more comfortable this morning, though my right knee hurt and I'm still running slowly.

Warfarin?

My usual 5km while staying in Melbourne passes along
some of the leafy Malvern streets.

After six days of running about 5km a day, following two months of no running, I'm about where I expected to be in terms of cardio-vascular fitness.  My diagnosis of Deep Vein Thombosis, Pulmonary Embolism and Atrial Flutter at the start of January, had me worrying whether I would ever run again.  It was a scary time.  Now that my heart is back in sinus rhythm and I'm taking Warfarin to minimise the risk of further blood clots, running is again part of my life.

I have resumed running after injuries many times in 45 years, and generally know what to expect.  There will be two weeks, or longer if I have added a few kilograms, of feeling like a fish out of water.  After that, I will begin to feel like a runner again.  Then, the return to full fitness is generally a function of how long I had been unable to run.

The run passes by the John Landy Oval
(see post here).  

I'm mid-way through the initial couple of weeks and there's no problem with my cardio-vascular system.  I'm breathing easily and my heart rate seems to be behaving itself.  What is bothering me, is how stiff and sore my legs are.  Every morning, I feel like all my joints and muscles need lubrication as I set off.  I'm surprised I don't hear squeaking!  It's worse than I expected, and I have been tempted to blame it on the Warfarin I am taking.  If my blood is slow to coagulate, maybe the inflammation that must be occurring in my ageing and cartilage-poor joints is slower to repair and then dissipate?  Maybe there is some other side-effect?

Looking across John Landy Oval in Malvern's
Central Park.

I have searched high and low on the internet for information about the effects of Warfarin on runners, but instead of finding clues to explain my aches and pains, I have found stories of endurance athletes successfully returning to serious competition while continuing to take Warfarin.  Seems like I will have to accept the ageing process is the main culprit.

Just another 5km this morning at an easy pace, with no problems apart from the above-mentioned stiffness and soreness.

1:1 AV Conduction

One of my heart rate peaks, as measured by the
Holter Monitor.

Late today, I had my Cardiologist appointment to discuss my recent Echocardiogram and Holter Monitor results.  He was a fit-looking guy in his fifties and was sympathetic to my plight and my desire to resume running.

It seems that my efforts to give them something to look at while I was wearing the Holter Monitor a week ago were more successful, and risky, than I thought.  The two episodes I had of palpitating heart and lightheadedness while walking up a steep hill, matched recorded instances of my heart rate reaching around 230 beats per minute.

Diagram of the heart showing the path of the macro-reentry
circuit (wavy red line).

Normally, the upper (Atrium) and lower (Ventricle) chambers of the heart beat at the same rate.  However, with Atrial Flutter (AFl), the Atrium beats significantly faster than usual because of a sort of electrical short-circuit (macro-reentry circuit) and a proportion of these faster beats stimulate beats in the Ventricle.  The rate of conduction is determined by a physiological barrier between the chambers and is usually 2:1 for people with AFl (and sometimes 3:1 or 4:1).  When I walk too hard, or run, my ratio appears to change to 1:1 where every superfast beat in the Atrium stimulates a corresponding beat in the Ventricle.

One medical website I found says "Atrial flutter with 1:1 conduction is associated with severe haemodynamic instability and progression to ventricular fibrillation", so I need to keep my heart rate lower until I get treatment.  This diagnosis was a little more worrisome than I had anticipated.

The cardiologist is scheduling me for an Electrocardioversion within the next week aimed at resetting my heart's electrical system (in layman's terms) using externally-delivered electrical stimulus (the paddles, or similar).  The cardiologist warned that this procedure may not yield a long-lasting solution, so I shouldn't get my hopes up.  I will be able to resume my running, but the AFl could return, and I will have to stop again.

If that happens, then when I'm no longer considered at risk of further Deep Vein Thrombosis or Pulmonary Embolism, they will try a Cardiac Ablation using a catheter inserted into the heart through the femoral vein to cauterise the tissue where electrical short-circuit is occurring in the Atrium.  This procedure has a high success rate and provides a longer-lasting solution, but I know everybody is different and I'm not counting my chickens yet.

I walked about 5km today, with no significant hills, and felt fine.

[Disclaimer:  I have no medical qualifications at all and there may be significant errors in this blog post.]

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.

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.

“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.