Conflicts of Interest

With my old running friends at the 2012 London Olympics

In 2012 I travelled to London to watch the London Olympics with old running friends.  Although we attended many different sports, our primary interest was in the running events, and those we couldn't attend in person, we tried to watch live on TV.

Today there has been a lot of news coverage about the World Anti Doping Authority (WADA) finding that systemic drug cheating has been occurring in Russia, and particularly by Russian athletes at the London Olympics.  Despite Russia's protestations, I suspect that the drug cheating is even more wide-spread than WADA has described.  It's like the drug-testing itself, it only formally identifies instances where the proof of cheating is incontrovertible, and doesn't address those instances where it looks likely but cannot be proved.

The start of the Women's 5000m Final

Some months ago, there were stories in the press about the possibility that athletes trained by the former US marathon star, Alberto Salazar, were using prohibited drugs.  It has been denied and nothing has been proved, although I think there is a formal investigation underway.  Some of the allegations revolved around research being done to determine how much of some banned drugs could be taken before athletes would test positive.  I'll bet that there are coaches and organisations in other countries doing the same research.  I guess their self-justification is that if the athlete doesn't fail the threshold-based drug tests, then they haven't broken the rules or gained unfair advantage, but they are kidding themselves.

There have also been leaked IAAF documents in the past year suggesting that performance-enhancing drug use is widespread, particularly among African distance runners, and there have been recent instances of high-profile African marathon runners being banned for drug use.

The start of the Women's 1500m Final

The rewards for cheating athletes, their coaches and their managers are immense.  The kudos is often accompanied by huge financial rewards and increased opportunities.  Ethics and fair play will undoubtedly be ignored by some in the face of such incentives.  The only solution is regulation and high quality testing with severe penalties for transgressions.

However, the WADA findings also seem to suggest corruption on the part of those organisations responsible for enforcing the rules, including the top echelons of the International Amateur Athletics Federation (IAAF).  I suspect that there are other organisers of major athletic meetings and city marathons who will turn a blind eye, or even conspire with elite athletes to hinder drug-testing, in order to have big names at their events.  The rewards for them are similar - kudos, money and opportunity.

Everywhere you look there are conflicts of interest and the only solution involves top-down reform as is the case with other major sports that have been in the news.  Sadly, I've become incredibly cynical.  As much as I want to believe in the integrity of the world's best distance runners, I simply cannot get excited about their performances any more.  I'm not even interested in who the world's best marathon runners are because I simply don't trust in the integrity of the sport.

I joined my usual Tuesday morning running buddies today for 9km with a few hills.  My legs felt wooden in my warm-up and I was happy to follow the pack during the run, with my quads, in particular, feeling very tired.  However, I finished in reasonable shape and will try running a bit further tomorrow, but with no pressure.

Hoping

I met this guy on my walk today

The heel I hurt on yesterday's long run remains painful, but has improved.  By this afternoon, I was able to walk 5km without serious discomfort.  I'm hoping that by tomorrow it will have improved sufficiently to complete my usual Tuesday morning run with a group from Trotters.  It will be sore, but if I can get through without making it worse, some optimism will return.

However, I'm also trying to mentally prepare myself for a worse case scenario.  It's always important to know what your options are, and I have played out several in my mind.  One thing I don't want to do is to soldier on despite worsening pain.  All serious runners know the temptation when fit to keep on running, regardless of an injury, for fear of losing their fitness and wasting all the time and effort they have invested to get to that stage.

Thirty or forty years ago, I would have visited a doctor to get anti-inflammatories prescribed so that I could continue to train and race.  In retrospect, I cannot remember a time when this proved to be a sustainable solution.  Either I ended up needing to have more time off running, or in the more serious cases, surgery.  These days, I don't feel any temptation to resort to anti-inflammatories.  Better not to mask the pain so that you really know the scale of the injury.  If the injury seems bad tomorrow, I will be scaling back my training.

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.

Fatty acid catalyst?

The usual source of caffeine.

I'm successfully sticking to the caffeine limit I imposed on myself of 200mg or less a day (see blog post titled "Caffeine") after being diagnosed with an Atrial Flutter at the beginning of the year.  I do miss the "feel good" surge I used to get from that strong mug of coffee on days with an early start, but I don't miss the feeling that my blood pressure and heart rate were up.  Generally, I feel healthier without that caffeine and don't think I'll ever go back.

At the time of the blog post about caffeine, I mentioned that it is a legal stimulant that may have benefits for long-distance runners.  Apart from the value of heightened alertness and positive mood, there is evidence it plays a role in energy derivation.  I don't know when the research was first published, but sometime in the 1970s I read about the value of caffeine in releasing fatty acids into the blood stream.  In simplistic terms, as I understand it, during any long distance race, the body primarily derives its fuel from its glycogen stores.  This is the most efficient source of energy but supplies are finite and likely to be exhausted before the end of a marathon.  When the glycogen stores are gone, the body begins to burn fats, a much slower process.

The fatty acids stimulated by caffeine ingestion have been shown to bring fats into the energy fuel process earlier than otherwise, so that a marathon runner's stores of the more efficient glycogen will last longer, perhaps to fuel a late surge in the race.  I read somewhere that two strong cups of coffee about an hour before running was the best timing and dosage and I did try that a number of times during my marathon running heyday.  Of course you never know whether it makes any difference, and the risk is that when you can't do it for some reason (perhaps large race logistics) it can negatively impact your mental state.

I may be smiling, but I was very sick
after this Six Foot Track Marathon.

In recent years, I haven't worried about pre-race caffeine ingestion.  One reason is the negative experience I had in the Six Foot Track Marathon a few years ago, when I was fit enough to do very well for my age.  I drank too much caffeine beforehand and was feeling "wired" by the time the race started.  I never felt good as the race progressed and had difficulty in drinking fluids at the feeding stations.  When I finished, I felt very sick, though didn't accept offered medical assistance.  I just sat in a corner for two hours not doing anything until I felt my equilibrium begin to return and I could start sipping some fluids.

I don't doubt that there are benefits as the research has shown, but to get them, there are factors such as runner weight, usual caffeine consumption, timing, etc., that need to be accounted for in developing the optimal plan.  Now that I'm sticking to my new caffeine-limited regime, I doubt that I'll worry about taking pre-race caffeine.  In fact, I have always felt that if you train over the distances you plan to race, your body will adapt to become more efficient at fuel stores and sourcing anyway.  The more you depend on some pre-race rituals - caffeine ingestion, carbo-loading, sleep - the more likely you are to come mentally unstuck if you can't follow them as planned.

I ran a variation on my usual post-track session 11km this morning, running the length of North Avoca beach and the steep climb up Coast Road instead of the usual climb up Tramway Road.  I felt fatigued right from the start, mostly in the legs, so took it easy.  I have a demanding running schedule for the next three days, and the fresher I can be tomorrow, the better.

Caffeine

45mg of caffeine in my
favourite tipple

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

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

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

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

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

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

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

Katahdin

Mt Katahdin

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

Moose

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

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

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

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

Looking down Hunt Trail on Mt Katahdin

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

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

Fibrillation or flutter

Part of my walk around Copa today

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

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

Looking north from Captain Cook Lookout
during today's walk

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

Looking south from Captain Cook Lookout during
today's walk

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

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

Little (Beach) hiccups

Looking towards McMasters Beach

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

McMasters Beach

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

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

Cockrone Lagoon at the end of today's walk

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

More theories

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

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

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

Struggling in the Barrington Tops

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

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

Perseverance is not always good

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

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

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

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

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

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

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

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

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

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

Mental adjustment

The MacPherson Forest loop was my last long trail run

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

MacPherson State Forest trail run

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

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

MacPherson State Forest trail run

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

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

Trotters

Terrigal

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

Terrigal Surf Life Saving Club

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

Terrigal Trotters Santa Run

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

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

Terrigal Trotters Christmas Party

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

Some cause for optimism

Near the start of the Dubbo Gully Run

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

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

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

Crossing Mangrove Creek on the Dubbo
Gully Run

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

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

Part of the Dubbo Gully route

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

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

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

A new challenge

Terrigal Trotters gather after their Santa Run

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

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

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

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

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

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

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

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

Problem management

The path followed around the edge of Cockrone Lagoon at
McMasters Beach during this morning's run.

My right Achilles was still stiff and painful this morning as I headed out for an easy and flat 7km across the Cockrone Lagoon sandbar and through McMasters Beach.  I'm still wheezing and coughing a lot, but there is a very high pollen count on these warm spring days, and allergies may be exacerbating the problem.  Despite these two significant problems, I did feel like I was moving a bit better this morning, but I need to get these issues to a manageable level.

In the past, prior to surgery, I have managed chronic Achilles problems through the use of heel raises.  I recently purchased some at a sports store, but they are softish and more designed to cushion the heel strike.  I wonder if they make the problem worse, because there seems to be greater friction between the heel and the shoe as the pad compresses.  Thirty years ago, I used more rigid heel raises and often wore them for years on end.  The theory behind these heel raises is that the heel is higher relative to the front of the foot and therefore, with each step, the angle defined between the lower leg and foot is less acute.  We are talking millimetres, but it does make a difference.  I used to make my own heel raises by carving up the heels of old thongs (flip flops) and velcroing them to the inside base of my shoes.  Sadly, the thongs of these days seem to be made of softer and thicker material, and making my own heel raises hasn't been practicable.  An alternative I once used were Sorbothane heel pads and I've found they are still available on the web, so have ordered some.  If they don't work, I think I'll be visiting Dr Jon and getting an MRI.  I suspect there is a heel spur that needs to be removed, and that will put me out of running for months.

Cockrone Lagoon from the Copa side

The breathing difficulties I have been dealing with recently may be a consequence from ceasing use of the asthma medication I have been on for the last few years.  I stopped taking Seretide because it was giving me headaches, and before that, the doctor recommended I stop taking Symbicort which has had some adverse findings concerning long-term use.  Ventolin seems to help a bit, but I'm only taking it on days when I race.  I'm not sure that it is wise to be taking it before every run although a web search hasn't revealed evidence of any long-term use side-effects.  Two other major considerations for me are that I don't like the idea of taking anything long-term, and I don't want to take anything that is prohibited by the World Anti-Doping Agency (WADA) or the Australian Sports Anti-Doping Authority (ASADA).  The latter has a "Check your Substances" facility that allows you to make sure you are not contravening the rules and the FAQ on the Australian Sports Drug Medical Advisory Committee (ASDMAC) also provides good information.  Both of these websites show the medications I have been using comply with the rules, but that leaves the problem of avoiding long-term use.  I've made an appointment with my doctor next week to discuss the best option.

Drugs

Chris Wardlaw leading a race in his prime.

Drugs are a topical subject at present, in the news, and for me personally.

Asafa Powell and Tyson Gaye have just failed drug tests and won't be running in the upcoming World Championships.

Personally, I have been struggling with respiratory problems for a couple of years and had my latest medical appointment yesterday.  I had been using a prescribed asthma medication, Symbicort, and have now been switched by my doctor to Seretide.  Following a few recent respiratory issues, my doctor had also prescribed Prednisolone for a limited period.  However, as is my habit, I Googled the medications prescribed for me before taking them and discovered that a Therapeutic Use Exemption (TUE) is needed for Prednisolone if competing in sport.  Symbicort and Seretide are permitted, though the former must not be used excessively (700% more than prescribed).  I didn't bother filling the Prednisolone prescription.

Some argue that performance enhancing drugs should not be banned so that there is a level playing field for all athletes.  I think this is a flawed argument.  I believe there would be a race to the bottom and many vulnerable athletes would suffer permanent damage, and possibly death.  There are already celebrated cases of cyclists and runners dying in mysterious circumstances, possibly associated with the use of performance enhancing drugs.

A related question is the appropriate definition of performance enhancing.  An argument, made by a great Australian runner and coach, Chris Wardlaw, with whom I used to occasionally train and play golf in my younger days, was that anything that enabled an athlete to train harder, especially when injured, was a performance enhancing drug.  His view was that an important determinant of an athlete's competitiveness was the amount of training they were able to absorb.  If medical intervention was required to allow an athlete to continue to train or train harder, such as taking anti-inflammatories (even over-the-counter), because of a muscle tear, or similar, then Chris argued the anti-inflammatory was a performance enhancing drug.  I always thought Chris had a valid point, though it might be hard to draw the line.  For instance, what about knee surgery that ultimately gets an athlete running again, when otherwise, their career would be over?

I spent a lot of time mulling over Chris's argument, and agonising over my own occasional use of prescribed anti-inflammatory medications as I became a more serious runner.  I wanted to be ethically squeaky clean, but also thought the line Chris wanted to draw was too draconian and perhaps too blurry.  Ultimately, I came to the view that any drug or medical procedure that would make no difference to the performance of a healthy fully-trained athlete, was not performance enhancing.  This seems to be the principle underlying the WADA prohibited list as well.

I walked another 5km this morning, and will do the same tomorrow and start jogging a little on Friday.  There is still some minor discomfort in my right arch and I'm certainly not confident that I'm over the injury.  Fingers crossed!