How important is running

Keith (in green hoops) just ahead of me in a 3000m race in
Hamilton, NZ, in January 1979.

I have a long-time friend, Keith, who was a talented runner in his prime and with whom I have run many miles over the past forty years.  He has struggled with a knee problem over the last decade that has severely limited his ability to run, and despite doing some swimming and cycling for fitness, is desperate to get back to running.  Like me, running has played such a large part in his life and self-perception, that its absence really is depressing.

Keith has tried arthroscopy and various other treatments, and can walk without significant problems, but misses his running so much that he has booked in for a partial knee replacement next week.  If you Google "running with a partial knee replacement", you can find instances of runners doing so successfully.  You can also find a study that suggests no difference in knee replacement failure rates after seven years between two groups, one of whom exercised more vigorously than advised by their surgeons.  However, I couldn't find any website where doctors recommended running, especially long-distance running, after a partial or total knee replacement.

Partial and total knee replacement diagram
[Source:  Wikipedia]

I'm concerned for the welfare of my friend.  Although I understand completely what is driving him to have this surgery, I fear that his post-op resumption of running will risk failure of the joint replacement and maybe even leave him worse off than at present.  However, I also know that I don't know what I would do in the same situation.  Given that I hope to keep running for many years to come and already have one knee with problems, I suspect I will find out at some point.  In the meantime, I have my fingers crossed for a successful surgical outcome for Keith, and do hope he can realise his ambition to resume running.

Changing shoes

I usually rotate my running shoes
on a regular basis

One of the ways I have managed my chronically injured heel as I have sought to get running again has been by trying to manage my footwear.

For the past twenty years I have primarily used Nike Pegasus shoes and before that various other Nike shoes, a favourite being the Nike Elite.  I'm not dogmatic about using Nike's, and have occasionally used other brands for various reasons, including New Balance and Brooks shoes for years when they sponsored me in the early 1980s.

One reason Nike shoes has found favour with me is because they have tended to have higher heels with a larger drop between the heel and forefoot.  This decreases the range of Achilles tendon movement and I have always had problems with my Achilles (three operations on the left and one on the right).

However, even wearing the Nikes, my right heel was exceptionally painful a year or so ago, and not just because of Achilles tendonitis.  It was also highly sensitive to touch, often with searing hot pain on the surface of the back of the heel, even when just lying in bed, and there was a dull deep pain under the heel.

I have got back to running, despite medical advice that the heel was just worn out, by trying to treat all three problems after initially having nearly six months off running in the hope rest would fix it.  I'm sure the rest did help, but the methods below also made a big difference when I resumed trying to run.

The Nike Elite was my favourite training shoe for many years

Firstly, I decided to raise the heel even further, and after experimenting with various brands of heel raises found some hard 6mm raises that self-glue onto the heel of the shoe under the insole.  This means that my heel drop has gone from the standard Nike Pegasus drop of 12mm to 18mm, not ideal because it places extra strain on the tendon under the foot, risking plantar fasciitis, but workable for me.

Secondly, I decided I needed to reduce pressure on the heel from the shoe and increased my shoes size by a half and tried some shoes that gripped differently on the heel.  After research I found the New Balance 880v4 had the same heel drop as the Nike Pegasus (12mm) and I tried running in them for a change.  I also tied the shoe on my right foot exceptionally loosely (the usual test being the ability to put two fingers between the shoe and my heel) and got in the habit of smearing vaseline on the back of the heel to reduce friction.  It felt strange at first and my foot has come out of the shoe while running on a couple of occasions, not to mention more debris finding its way into the shoe during trail runs, but it's manageable.

Thirdly, I rested the underneath of the heel, which felt deeply bruised, by modifying my running style to favour the heel and try to avoid unnecessary pounding, particularly down hills.

Over time, the heel pain has generally diminished, though always there.  To reduce the chances of recurrence, I have also bought some larger Nike Pegasus shoes and now alternate so the shoe grip pressure changes regularly.

My latest heel pain setback occurred wearing the New Balance, so I am wearing the Nike more often, though still changing every couple of days.  This morning, after four or five days of New Balance, I switched to the Nikes for my short 6.5km run, and the pain was much reduced from yesterday.  Enough to convince me that I can get around the Deep Space Mountain Marathon on Sunday.  It's a two-lap course, so I can always pull out after one if the heel is bad.

Tempting Fate

Waiting for the start of my comeback race in
March 2015 near St Louis, Missouri.

It has been more than fifteen months since my last blog post and for much of that time I have been unable to run.  The right heel problem referred to in my last post worsened and scans revealed significant damage. I was told that my serious running days were over (not for the first time in the last 30 years!).  The best I could reasonably hope for was to jog 5km a few times a week.

The pain was significant in multiple areas of the heel and I stopped running and started mountain biking as a means of keeping fit.  In March of this year, I resumed jogging, strongly motivated by the opportunity to run, three weeks later, a favourite event in the US for the first time since the mid-1990s. Through experimentation and experience, I have learned to manage the heel in a number of different ways.  Much to my astonishment, I have been able to run, relatively uninterrupted, for the last six months and reached a level of fitness sufficient to resurrect the faint hope of running a good marathon time.

The heel still causes me problems, along with all of the other niggles a 64 year old runner endlessly gets, but I am enjoying my running and still seeing improvement.  I have picked out a marathon in April of next year, six months away, and will now chart my progress towards that race in this blog.  To run a good time, I will have to remain relatively uninjured for the six months, an unlikely prospect.  Just restarting the blog makes me feel like I am tempting fate!

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.

Reliving Boston 1982

I walked 5km today to give me aching joints a chance to recover after yesterday's exertions.  My right Achilles remains quite sore and concerns me a little, but hopefully the day off running will see it improved tomorrow.

The results of this year's Boston Marathon were on the news this morning, reviving memories of the two times I have competed there (1982 and 1986).  Although I have previously written blog posts about the 1982 race, I thought I would use the occasion to reprint an article I wrote for my club, Kew Camberwell, newsletter after the event.
======================================================================
BOSTON MARATHON - 1982

Crossing the line (2:22, 49th) in the
1982 Boston Marathon.

Early in February I received a telephone call from Ted Paulin at the 'Big M' Marathon Committee.  Apparently Andy Lloyd, winner of the 1981 'Big M' had declined his first prize of a trip to the 1982 Boston Marathon and as runner-up I was next in line.  Having had an Achilles operation in late November with little training since and none in the preceding three weeks I had some doubts as to whether the eleven weeks remaining to the ‘Boston' (19 April 1982) would be sufficient to get at least reasonably fit.  My surgeon gave me the green light so I mapped out a training schedule which saw me go from 0 to 120 miles per week in four weeks and totalling 1224 miles over the eleven weeks.

I took a few extra days leave and spent five days with clubmate, John, and his wife, Brenda, in California en route.  They were very interested to hear all the club news and send their regards to all their old friends.  Despite some injury problems, John is training and has recently started competing in a few fun runs.  They are living in a house in the Santa Cruz Mountains, an area not unlike the Dandenongs, where it seems to rain all the time.  In the first three months of this year they had 89" of rain (Melbourne has 26" per year) and roads were closed, rivers flooded, and landslides commonplace.  If rain wasn’t enough, John took me on some very muddy tracks and in three days I had used my entire supply of clean running gear.

The Prudential Center basement carpark
after the 1982 Boston Marathon.

From California I flew to Boston arriving four days before the race with the first vestiges of a heavy cold - the product of sunny California.  For four days I trained lightly twice daily, tried to fight off the worsening cold, watched television and attempted to read all the articles published in the press about the forthcoming marathon.  The coverage was of ‘VFL Grand Final’ proportions culminating in direct television coverage of the entire race by four different television stations.

Race day, a public holiday Monday, dawned bright and sunny and I set off by train to the Prudential Center in town from where a steady stream of buses was transporting runners to the start at Hopkinton, 26 miles away to the west.

Winner, Alberto Salazar, speaking at the medal presentation
after the 1982 Boston Marathon.

The atmosphere in Hopkinton was electric.  All roads leading into the town had been blocked by the police at 9 a.m. - 3 hours before the start - and the only motorised traffic was the buses delivering their cargoes of 'psyched-up', animated athletes.  In the town centre you could hardly move for runners and spectators whilst overhead circled four helicopters and four light planes beaming television pictures to the entire U.S.A. There were 7623 official entrants for the race plus an estimated equal number of unofficial runners (entrants must meet stiff qualifying standards before being accepted) on the narrow road for the start at midday.

The first 800 metres is steadily downhill and everyone sets off at a furious pace.  Despite holding myself back and despite it taking me 10-15 seconds to get past the starting line I still reached the first mile in 5:05.  I had resolved to run the first half of the race steadily because of the question mark over my fitness but this proved impossible.  I was literally passed by scores of runners yet went through 5 kilometres in 15:50.  It was very warm with the temperature in the low 20’s complemented by a bright sun and a slight following wind.  By 10 kilometres (32:00) I was holding my own but getting decidedly warm.  The course was lined by thousands of spectators who cheered, clapped and held out cups of water to the competitors.  For the first few miles the course passes through a series of villages which is where the crowds are at their thickest until the suburb of Wellesley is reached after eleven miles.  Here crowd support reaches new undreamt of dimensions as the runners pass the Wellesley College for women.  The girls leave a gap about one to two metres wide for the runners to pass through and scream.  If you can imagine what it is like to run quickly down a hallway lined with giant stereo speakers you may be getting close.  You start to lose touch with reality.  Unfortunately, reality just around the corner as I had feared when passing through 10 miles in 52:07.  My next seven miles were miserable as various ailments assailed me and the crowds witnessing my demise grew thicker and thicker.  By now every inch of the course was covered by onlookers often three or four deep and usually only a couple of metres apart.  At 17 miles I heard a time which indicated that at my present rate of decline I would run 2:25 or over and also that I was in approximately 130th place.

Showing off my "First Hundred" finishers
medal after the 1982 Boston Marathon.

My big ambition, apart from beating Greta Waitz, was to run in the first hundred and earn a medal.  The course now entered the Newton Hills, a series of four hills climaxing in the world-renowned Heartbreak Hill at 21 miles.  For some reason my pace began to pick up and I actually began passing people.  The heat was taking its toll and a lot at fast starters were now paying their dues.  The crowds on Heartbreak Hill were unprecedented and the noise indescribable.  To pass a runner was often difficult because of the narrow path left by the spectators who were reaching out to touch you and give you much needed cups of water.  I was really starting to motor now and set out to run the last five miles hard.  Coming down from the hills on the winding course the closeness of the crowd often meant that a runner only five metres in front of you could not be seen.  Thousands of people crowded around the last 400 metres and I found the energy to catch a few more competitors before crossing the line in 2:22:39.  My relief at the time turned to joy upon receiving a note congratulating me on being in the first hundred.  It took some hours to find out I had come 49th.

All finishers were directed into the cavernous basement car park of the Prudential Center where they could collect gear left at Hopkinton, get refreshments, have a shower and receive medical attention if necessary.  The warm conditions resulted in a lot of stretcher cases (about 600) and the underground hospital resembled a scene from the Crimean War.  The winner, Alberto Salazar, received intravenously three litres of fluid after his temperature had dropped to 88°F following the race.

Two old Kew-Camberwellians also competed in this year’s race – Trevor and Kishore – but, unfortunately, I do not have their results.

I cannot hope in this article to convey the atmosphere and excitement present at Boston. However, I do encourage all distance runners to take part in this unique event at least once for an unforgettable experience.

Just can't help myself

My run this morning circled Avoca Lagoon.

I ran my usual post-track session, 11km loop from Terrigal Haven this morning, and although I felt tired the whole way, my form was OK and my time three minutes faster than last week.  At one point during the run, Chris, a very well-performed triathlete and fellow Trotter, cruised past me easily, but he didn't outpace me as quickly as expected and I could imagine that in another month or two I could be training at the same pace.

When I resumed running following my DC Cardioversion in late-February, I announced to everyone that I was going to become a "recreational runner" rather than a "competitive runner", in a self-imposed attempt to reduce the chances of a recurrence of my Atrial Flutter heart problem.  I recognised that 45 years of competitive running was going to be a hard habit to break, but thought that the downside of the heart problem recurrence would be sufficient motivation.

Avoca Lagoon.

After five weeks of a gradually increasing running load, I'm almost at the point of admitting defeat in my quest to remain "recreational".  My comeback just feels like any other comeback from a running injury, and my limiting factors seem to be musculoskeletal as much as cardiovascular, i.e., my legs as much as my breathing.  And I just can't help pushing at the edge of the envelope to see if I can coax further improvement.  It's proving impossible to turn off that competitive gene.  Even though I am managing to avoid completely trashing myself in any one run, I now find myself running up hills much the same as I used to, going as hard as I can while running "within myself".  I would define the latter as being very tired, but not losing form or breathing regularity.

I described walking and running while suffering from Atrial Flutter as being like driving a car whose clutch was slipping.  The engine (my cardiovascular system) was working hard, but the power was not being transmitted to the legs.  I haven't had that feeling once since the DC Cardioversion.  Instead, I feel that everything is operating as it should and always has, apart from the Atrial Flutter episode.

As each week goes by, my confidence is growing that there will not be a recurrence.  I have scoured the online literature for information about the risks of recurrence, but there is a frustrating paucity of studies pertinent to my age and physical condition.  It does seem that the longer I go without a recurrence, the less likely one is to occur, but it can't be ruled out.  Nor is it possible to identify any risk factor I have that makes a recurrence more likely.  I'm starting to tend towards the view that I should just return to my life as though I had never had the heart problem, rather than imposing boundaries (that may make no difference) on myself.  If the worst happens, then a Catheter Ablation is a very viable, and usually successful, option already suggested by my Cardiologist.  I'll continue to gradually increase my running load, but won't target any races, thus avoiding the pressure to train that accompanies a looming event.

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.

Signs are good

It was a little gloomy at Terrigal Haven this morning.

It was heart-warming at this morning's 6:00am Haven track session to have so many friends say how pleased they were for me on my return to running.

It is good to be running again, though I started my own 11km run after the track session with some apprehension.  Yesterday's heart monitor read-out after my 5km run showed a very irregular pattern for the first ten minutes, and I had felt a little uncomfortable during that time.  Today's run started with a good-sized hill, which I knew would be a good test of my heart rhythm, even if I took it slowly.  I reached the top without incident, as happened on the second long hill near the end.  Although I felt tired and unfit the whole way, it was satisfying to return to another of my regular courses.  Once home, I loaded the heart monitor data, fearing the worst, but found no evidence of any problems.

Looking north from Terrigal Haven this morning.

The next test for the day, about which I was also apprehensive, was a noon appointment with my cardiologist to check progress since the cardioversion three weeks ago.  He started with an electrocardiograph and followed it with a blood pressure test.  The former showed my heart continues to beat in sinus rhythm and the latter read 115/78.  All good!  We then had a conversation about my prognosis during which he said I could resume my normal life.  I was particularly interested in the viability of a long backcountry hiking trip I hope to make later in the year down the Appalachian Trail in the US.  He said that, subject to carrying some precautionary medication, there was no reason to cancel, though he wants to see me again before I go.

Terrigal Haven this morning.

The possibility of reversion to Atrial Flutter remains (as high as 50% according to some research), but apparently my risk factors are low.  The way forward is becoming clearer and my optimism is growing.  I will continue running, but avoid racing, and resume planning my hiking trip.  It could be a lot worse.

Imagination?

Murray River.

Most of today was spent driving the 1,000km from Melbourne back to Copa.  I was on the road by 5:00am, after a night during which I woke several times.  I suspect the real reason for the disturbed sleep was that I knew I had an early start, but each time I woke, I found myself lying there, very conscious of my heartbeat and trying to determine whether the beat was regular.

After my 5km run yesterday morning, I was checking my pulse and it seemed that there was a double beat about every 20 to 30 seconds, although it could have been my imagination.  I hadn't experienced any breathlessness or palpitations while running, but nevertheless I'm now a bit worried that the double beat, if it's real, signals the early stages of the return of my Atrial Flutter.

Bike path along the Murray.

As I drove north along the Hume Highway in pre-dawn darkness, I wondered about the wisdom of running again today.  However, after three hours of driving and feeling a little tired, I stopped in Albury and set out along a bike path by the Murray River.  It was a pleasantly cool morning and I was pleased to feel more like a runner than earlier in the week, though somewhat apprehensive.  I wasn't running hard, but was moving faster with less stiffness in the muscles and joints.  The faster speed meant my lungs were working a little harder, and I was breathing in on two steps and out on one, but still controlled.  Nevertheless, I was constantly self-assessing myself, looking for any sign that my heart was racing or my blood pressure dropping.

Billabong at the turnaround.

After about 3km of following the full and fast-flowing river, I reached a billabong and the end of the bike path and turned round.  It was nice to see the Murray River looking so healthy after a number of dry years.

Hovell Tree Park.

The path returned through the Hovell Tree Park, where I had finished my 440km three-week hike along the Hume & Hovell Track about ten months ago.  The Hovell Tree was marked, nearly 190 years ago, by one of the explorers after whom the walking track was named.  I could vividly remember finishing there at dusk, completely exhausted after compressing the planned last two days walk into one 50km day.  Despite my exhaustion on that last day, I had a great trip, and being there again made me wish it was a year ago when I was preparing for the trip, with no heart or lung problems in sight.  Just another reminder to make the most of my time.

I was again checking my pulse again after the run, and still wonder if there's an occasional double beat.  Generally, it seems regular and strong (and back under 50bpm at rest), but I still have a nagging concern.  I have an appointment with the cardiologist next week anyway, and he'll confirm one way or the other.  For the time being, I think I keep running daily.

Walking and pondering

The backlots of McMasters Beach on this morning's walk.

I walked about 10km this morning in misty, drizzly, and almost autumnal weather along some less-travelled roads and trails around nearby McMasters Beach.  Walking gives more time to look at your surroundings, and I've enjoyed a closer examination of the forests and properties that I often pass more cursorily on the run.  It's all relative, of course, with walking better than running, and running better than biking, if you want to absorb your environment.  All are better than driving.

The gravestone of Allan McMaster, the first European
settler in the area named after him.

Another advantage of walking, for me at least, is that it is the best time for thinking.  I'm a stroller rather than a power walker, and the gentle perambulation seems to stimulate my analytical brain cells.  As I walked this morning, experiencing no breathlessness or heart palpitations, I wondered about the chances that my heart problems were behind me.  If not, how would the return of the Atrial Flutter (AFl) be triggered?  By running too hard?  And if it was triggered, would it suddenly be as debilitating as it was before the Cardioversion, or would the onset be slower?  What were the chances of reversion, and what were the risk factors?  Wouldn't the cells through which my heart was passing the errant electrical pulses still be there, just a dormant pathway waiting to be reactivated by stress or some other trigger?

Umbrellas were optional on a drizzly morning walk.

There was lots to think about, inconclusively, and I returned home to do some more Googling.  Nothing I could find gave me more certainty, but there were clues.  One study in particular, of men a similar age to me, found that 55% had recurrent AFl within six months of their Cardioversions.  Underlying heart disease, previous episodes of AFl, and enlarged left atriums all seemed to be statistically significant factors in those who reverted.  I'm not conscious of previous AFl events, and my cardiologist found no evidence of heart disease, but he did find "mild Left Atrial dilatation".

Cockrone Lagoon on an autumnal morning.

Other studies have found enlarged left atrial size to be more common in long-term endurance athletes, than others of a similar demographic, and that this seemed to be associated with great incidence of Atrial Fibrillation (AF) and AFl.  So, it seems reasonable to assume I remain at significant risk of reversion.  The great unknown for me, though, is whether the enlarged left atrium was the key factor in the development of my AFl, or was it the Pulmonary Embolism (PE) placing undue pressure on the heart's function that was the trigger.  Although I'm probably stuck with the enlarged left atrium, the PE should be gone soon, if not already.  Does that mean there's a good chance I won't have the problem again?  Probably not, but only time will tell, although there will never be a point at which I can say there is no further risk.

Eggshells

Cockrone Lagoon on this morning's walk.

As I approached the first hill on my walk this morning, I felt my heart was racing in anticipation of whether it would start racing as my effort increased.  Then, as my cardiovascular system worked harder on the steepening grade, I was constantly assessing my body's reaction.

Part of my walk through McMasters
Beach this morning.

The symptoms I had experienced when walking up steep hills prior to Monday's Cardioversion included breathlessness, lightheadedness bordering on fainting, a hollow pressure in the centre of my chest and, as described on some medical websites, a real feeling of dread or impending doom.  There would be a sort of tipping point, where in a matter of seconds, I would go from the familiar feelings of mild fatigue associated with walking up a hill to a sense of the clutch slipping and my internal engine spinning faster and faster in a fruitless attempt to keep my body functioning.  It wasn't a pleasant experience, and I was hoping, rather than expecting, this morning that the Cardioversion had done the trick and my Atrial Flutter was gone.

Bounty Hill steps on this morning's walk
through McMasters Beach.

Since the procedure on Monday afternoon, it has been hard for me to tell whether or not the Cardioversion has made a difference.  I had been taking it easy, and a head cold, blocked sinuses, and a mild headache have made it hard to judge my overall well-being.  However, regular pulse-checking, and a vague feeling that my body was working more efficiently, have been encouraging signs.  The possibility of reversion to Atrial Flutter remains very real, though it will diminish over time, but it will be a while before I stop worrying about the consequences every time I start breathing harder on a walk or run.

Pumice stones on McMasters Beach which
have floated more than 4,000km from an
underwater volcanic eruption north of
New Zealand.

I didn't push it too hard on the hills this morning, and so far as I can tell, my heart is still beating normally.  The 6 kilometre walk passed easily enough, finishing with the bonus of watching a pod of dolphins gambolling just outside the shore break on the Copa beach.  I would like to think it was a good omen, but I don't believe in such things.  Now I need to work out a training plan that will gradually return me to running in a methodical way.  Such a plan will help prevent me trying to do too much too soon, if I feel that things are going well, but I also need to have the common sense to back off the plan if it appears too optimistic as time passes.

Googling the future

Representing Croydon Harriers in a National League
3000m Steeplechase (4th, 9:43.8) at Brighton, England,
in May 1975.

Around 3pm yesterday, I had my DC Cardioversion (DCC) and Transoesophageal Echocardiogram (TOE).  Apparently the DCC went smoothly, and my heart is now beating regularly again (Sinus Rhythm).  It's a very routine procedure these days (you can see a video here), and the anaesthetist referred to it comfortingly as a "barbecue" as he prepped me.  I only saw the hospital cardiologist once, when he shook my hand before I went under, and I didn't get any feedback later apart from the discharge nurse who said my heartbeat was stable in Sinus Rhythm.  On the assumption that "no news is good news", I'm guessing the TOE, with which they were looking for clots and flaws in the heart structure, didn't reveal anything untoward.

I now have a follow-up appointment with my cardiologist in three weeks time, but don't really have any guide as to what I can do, or not do, before then, other than being told to take it very easy today.  Consequently, I have been Googling extensively, particularly on the subject of returning to running after DCC.

Competing in the VMC Marathon (2nd, 2:31) at Tyabb,
Victoria, in June, 1976.

There's no shortage of papers identifying long-term endurance athletes as having a much higher risk of Atrial Fibrillation or Flutter than people of similar age, but it's hard to determine what is the outlook for those returning to the sport after treatment.  There are opinions expressed that they are more likely to have future heart and related problems, but no studies I could find.  Every individual is different, and there would be few people in the world who have trained and run endurance events over as many years as me, so there are unlikely to be any specifically relevant medical studies, anyway.

A good friend and long-time endurance athlete, Bill, suggests I accept my lot and cut back to roughly an hour's non-competitive running a day and be thankful that I can do that.  Time and energy freed up can then be devoted to other interests, such as writing.  I can see the sense in this suggestion, but am not yet convinced that it is the best course for me.  I'm still in the "Bargaining" stage referred to in a previous post, and want to believe there's some middle ground.

Comparing hamstring flexibility with Bill after the VAAA
Marathon Championship (4th, 2:22) in March 1983.

Part of the problem is determining what sort of running increases the risks for me.  Racing, and training to race, definitely generates more heart stress than running as a non-competitive recreation.  A race gets my adrenalin pumping and I always perform significantly better than I could manage in a non-competitive time trial. Likewise, upcoming races, get me to training harder and longer than I probably would otherwise.  I love competition and the preparation for races, but believe I could live without it, if it lowered my risk of further heart problems.  I think I could be satisfied with moderate short runs during the week, the regular Saturday Trotters run without getting too competitive, and a relaxed long trail run on a Sunday.

I'll continue walking for the next couple of weeks and then try some jogging just before I see the Cardiologist.  The statistics show that DCCs are 99% successful, but have a 50% reversion rate.  I'm assuming that I will be one of those 50% reverting, and my Cardiologist has already said he thinks I may ultimately need a Catheter Ablation.

Over with

1982 Montreal International Marathon (46th, 2:29).

Motivation was low today, and after several days with less sleep because of early morning commitments, I stayed in bed procrastinating.  Not really sleeping, just dozing, with a mild headache giving me another excuse to dally.  Maybe it was my imagination, but I sensed my heart was racing some of the time, even when lying in bed, and that wasn't good news.

Eventually I rose, watched one of my favourite political programs over a late and light breakfast, and headed out for a 5km walk on a very warm and sunny morning.  The walk started with a moderate hill and I was a little disturbed to already feel out of breath and conscious of my heart racing.  After another hill on which I again struggled mildly, I had to stop and hold the railing on a short flight of steps and even toyed with the idea of returning home.

The leading bunch in the 1983
Victorian Marathon Championship
(4th, 2:22).

I feel my condition has gradually deteriorated over the six weeks since I was first diagnosed with problems.  Just a few days before my first doctor's visit, when I was already dealing with the symptoms of breathlessness and a racing heart, I had been able to run an easy-paced 30km along mountain trails without major issues.  It seems inconceivable that I could do that today.  As I walked this morning, it was pleasing to know my DC Cardioversion was scheduled for tomorrow, and that I wasn't still waiting for the originally scheduled specialists appointments in two weeks time.

I haven't been optimistic about the permanency of the cardioversion, but feel more hopeful after a discussion with a doctor friend last night at a social gathering.  She saw no reason why a cardioversion might not be a long-term solution and cited her own father as an example.  Nevertheless, I think it's prudent to be a little cautious.  I don't feel anxious about the procedure, though that may change as the hour approaches (2:30pm tomorrow afternoon).  I just want it to be over with.

The episode on the stairs passed after a minute or so, and I decided to continue with my walk and completed it safely, despite a few more minor occasions of breathlessness.

In a perfect world, the cardioversion will immediately improve my quality of life as my heart returns to normal, but it's not a perfect world.  Fingers crossed.

Little nuisances

Terrigal Trotters doing leech inspections after a trail run.

After yesterday's somewhat heavy blog post, I thought I would talk about something lighter today, the little creepy crawlies that I have encountered while running.

Probably the worst are leeches, which are quite common on the NSW Central Coast where I now live.  In fact, I don't recall ever encountering them while running before moving here ten years ago.  You can get leeches on any long run in the nearby forests, but they are usually worst after rain and in the moist rainforest gullies.  Runners have various home remedies for keeping them at bay, but I don't think any are fool-proof.

One of the offenders.

The leech bites themselves are not painful, but the sight of an engorged leech, or one looking for somewhere to latch on, is always a gruesome find.  Getting them off can be tough, though I have usually managed to flick or pull them off.  Alternatives are salt or flame, I hear.  Often you do not know you have one until you see blood on a shoe or sock, and I have seen some very bloody socks revealed when shoes are removed.  There are also plenty of stories about leeches being found on other parts of the anatomy that I won't go into here.  Initially, the main problem is the anticoagulant used by the leech to facilitate feeding which causes their bites to bleed continuously.  However, the worst impact comes a few days later when the bites begin to itch savagely.  I have woken up at night scratching furiously at badly bitten, red and swollen ankles.  In some cases, the bites can even lead to blood poisoning and a trip to hospital, as happened to Sharon a few years ago.

A Golden Orb spider.

Spider webs are an occupational hazard for trail runners and it often pays to run behind someone else when you are the first runners along a trail.  I'm not aware of ever having been bitten by a spider while out running, but the encounters can be scary.  Locally, we have the Golden Orb spider which is quite large and builds strong and extensive webs, often across trails.  The large spider then sits in the web waiting for something to be caught.  They generally feed on moths, beetles and insects caught in their webs, but they have been known to catch and eat small birds and bats.  I have had the experience of running into one of the webs and then, while scrambling to extricate myself, finding the huge spider almost sitting on my face.  They're not dangerous, but can give you a good scare.

The country lane in Essex near where I was stung
by the wasp.

Perhaps the biggest scare I had from a small animal happened when I was out for a long Sunday morning run through the Essex countryside one Spring Sunday morning.  A wasp flew into my mouth and bit me on the very back of my tongue near my throat before I could spit it out.  Initially, it was just painful, and I continued running, but a few kilometres later, I could feel my tongue swelling up and my breathing becoming restricted.  I decided that discretion was the better part of valour and swallowing my pride (actually I couldn't swallow anything by this time), I found a public telephone in a small village and called my wife reverse charges to come and get me.  I was a bit anxious for the next couple of hours, but the swelling gradually subsided and there were no other symptoms.

Voyageurs Provincial Park, near Montreal in Canada.

Flies and mosquitoes can also be irritating, but not particularly dangerous.  I can still remember a long run in a Voyageur Provincial Park near Montreal in Canada in the late spring when the mosquitoes were voracious and biting me incessantly through the back of my sweaty T-shirt, no matter how fast I ran.  You just have to try not to think about it or it drives you nuts.  Apparently caribou lose half a pint of blood a day to mosquitoes in the spring and early summer.

I walked about 6km today, taking care not to get my heart rate too high when walking up hills.  I learned that my Electrical Cardioversion procedure will be this coming Monday.

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.]

Staring into the abyss

Queenstown, New Zealand.

Back in January of 1979, while touring New Zealand, three running friends and I decided to circumnavigate Ben Lomond, the mountain that overlooks Queenstown.  We planned the route on a road map in our campsite, but didn't have a good idea of how far the run would be, or what we might encounter.

We set off westwards at a good clip on the road following the shore of Lake Wakatipu.  However, the easy running ended as we turned north up Moke Lake Road, climbing 300 metres in just 3km.  At this point, 10km from Queenstown, Keith decided to turn back, and the three of us continued over the saddle and down to Moke Lake.  After the Lake, what was now just a four-wheel-drive track followed a gradually narrowing valley, frequently crossing back and forth across the shallow gravelly creek.  JB and I, both handy steeple-chasers and occasional long-jumpers, were keeping our feet dry with huge leaps across the widening creek, while enjoying the sight of the less agile Pratty occasionally landing short.  Our amusement waned further downstream when it became too wide for us to clear and we all continued on with wet feet.

Moke Creek valley.

We were now in remote and barren mountainous country with few tracks and no signposts, and began to get concerned about the route back to Queenstown.  I felt confident that we would be OK if we just kept Ben Lomond to our right, but without maps and a birds-eye view, we couldn't be sure of exactly where we were, or even our direction of travel.  After two hours, we reached a point where the track we were following veered leftwards to cross the creek and head in what I thought was the wrong direction.  High up on the mountain to our right, I could see a faint goat track crossing the slope that seemed to be going in my preferred direction.

JB and Pratty weren't too keen to climb up the steep heath-like mountainside to reach the track, preferring the four-wheel-drive track we were on.  After some good-natured debate, we split up and I began climbing the steep slope.  About half-way up, while scrambling on all fours across a patch of heath and vine, I became aware of a cold draft coming from below me.  Peering down through the vegetation, I was alarmed to see nothing but a black abyss, an old gold-mine shaft!  I inched forward, holding on to the most substantial stems and branches I could find, hoping they did not give way. After a few terrifying minutes, I reached terra firma, pondering the wisdom of the route I had chosen.  Too proud to follow my mates, I continued on very slowly up the steep slope, carefully making sure of the ground beneath my feet.

Moonlight Creek and Arthurs Point.

I finally reached the track I had seen, which turned out to be reasonably well-worn and quite runnable.  I followed it round the contour of the mountain, increasingly confident I had made the right choice, and eventually reached Arthurs Point and the road back to Queenstown.  I arrived back at the campsite just under four hours after I had left and spent the next few hours wondering and worrying about JB and Pratty, who I now knew had headed off in the wrong direction.  Finally, they appeared and told their story.  After they left me they eventually reached the old gold-mining area of Moonlight, where some four-wheel-drivers confirmed they were heading in the wrong direction.  Eventually, they got a series of lifts back to Queenstown.

My exercise today was literally more pedestrian.  I walked about 9km around Copa and Whinney Bay.  There were some long hills, but my cardio-vascular system stayed in the "green zone".  I see the Cardiologist late tomorrow afternoon and am getting a little anxious about what he will say.  I'm prone to optimism, but know I need to be ready to deal with some less-rosy scenarios.