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.

Nelse-Bogong Loop

Bogong High Plains near Mount Nelse.

In December 2011, I decided to stop off for a few days on the Bogong High Plains on my way back from Melbourne to Copa after visiting relatives.  I booked a small apartment for my stay with the intention of getting in a few long runs at altitude on the High Plains as part of my preparation for the Bogong to Hotham 64km the following month.  I was coming back from injury and felt some long runs would build my stamina and confidence.

For the biggest long run, I mapped out a 50+ kilometre loop that incorporated part of the course of the upcoming race and set out at 7:00am on a cool sunny morning from near the Rocky Valley Storage Dam.  The half-way point was to be the summit of Mount Bogong (1986m), and although the last half of the course was along familiar trail, the first half of the loop wasn't, and I was excited about running some new trail.  I headed north towards the barren Mount Nelse for the first 8km which climbed gradually away from the Dam on easy running fire-trail.

Mount Bogong from Grey Hills.

I expected the run would take me seven to eight hours and I was wearing a Camelbak containing a couple of Snickers Bars, a map, my phone, a rain-jacket and a cup for getting water out of streams to drink.  Before leaving my apartment I had a slice of toast and jam and figured that the Snickers Bars would be sufficient nutrition for the time I would be out.

At Warby Corner, near Mount Nelse, I turned left onto the Spion Kopje track which followed a high spur westwards with expansive views north and south of fog-shrouded valleys in very still conditions.  I was fresh, the running was easy, and not a soul was in sight.  I felt privileged to have the place to myself, and lucky to be fit enough to do the run.

Quartz Ridge from Mount Bogong.

Things started to change after 5km when I turned north along the much harder to follow Grey Hills Track which followed a scrub covered spur over a series of knolls.  In many places the wiry scratching scrub obscured the track and the going was slow with the occasional short climbs sapping my energy in the thinner air.  The views were still good, but a lot of my time was devoted to watching where my feet were going, especially near the end of the track which descended steeply to Bogong Creek Saddle.  After a brief section of firetrail, I began the steady ascent of the Quartz Ridge Trail towards the summit of Bogong and the half-way point.

Around this time, the sky clouded over and the weather began to look more ominous, a common pattern in the high country.  It was also around this time that my lack of fitness and the harder work along the Grey Hills Track began to kick in, and I found myself walking the steeper sections.  As the trail approached the Hooker Plateau, near Bogong, it passed along an exposed ridge near Quartz Knob with sheer drops to the west.  It was quite runnable but the trail wasn't always obvious and a few times I just headed cross-country in what I surmised to be the correct direction until I again picked up the trail.

At the summit of Mount Bogong (1986m).

At the summit of Mount Bogong, rain seemed imminent and the wind was picking up, so I didn't stay long before heading south-east along the bare ridge to Cleve Cole Hut and some more sheltered trail.  It soon began to rain steadily and I donned my rain-jacket, starting to feel a little cold.  The rain continued on the long technical descent to Big River through the mountain forest.  This is a beautiful section of trail and the rain just made it more atmospheric.  There's nothing quite like running or hiking through rain in an Australian eucalypt forest.  Despite now being way behind schedule, I was still enjoying myself and stopped to get a drink from a small stream just after crossing the raging Big River, hanging onto the wire safety cable.

Roper Hut.

I knew the long climb up Duane Spur would be tough - it always is in the Bogong to Hotham race - and it did not disappoint.  I was soon walking and starting to feel very hollow.  My Snickers Bars were long gone and I had had nothing else to eat for eight hours.  Half way up the climb I began to feel light-headed and could feel myself bonking.  Fantasising about Mars Bars is always a sure sign I have exhausted my glycogen energy supplies and am starting to slowly burn fats, and I was ravenous for a Mars Bar.  I started to doubt my ability to finish inside of twelve hours, thinking I would have to walk all the way back to the car, when the trail passed near Roper Hut.

From experience, I knew that hikers sometimes left unused food in mountain huts and I wasn't disappointed, though the choice was limited.  There was a glass container containing a small amount of sultanas and nuts of uncertain age, and several small sealed sachets of dried apple, something I had never previously tried.  I started eating the sultanas and nuts, which definitely tasted very old, wondering what kinds of unseen fungus they might contain and what would be the health consequences.  After a few more, I decided I would be safer with the dried apple and left with the sachets.  They weren't very big and didn't last long, but I could feel my energy levels lifting and resumed running the level sections of trail with about 10km to go.  Before long, I was wishing I had taken all of the sultanas and nuts to eat, but was saved by the gradual downhill run after Mount Nelse and finished back at my car eleven hours after I had started.  I'm sure I could run this course a lot faster if fully fit and maybe a bit more nutrition en route, but it was satisfying nevertheless, and the completion of such runs often gives my training program a kick start.

I only managed a 4km walk this morning because of time constraints, but did it comfortably.

The other side

Running near Moab in Utah in 2012.

There's little doubt now that I will never run another sub-3 hour marathon.  So, you may ask, why is this blog continuing?

I always had at the back of my mind a plan to use these blog posts as raw material for a book that would organise the content more coherently, and hopefully, encourage people to run and explore their potential.  In a perfect world, the climax of the story would have been a sub-3 hour marathon, but life is seldom perfect, and this blog has morphed into a diary of ageing and its challenges to the obsessed runner.

Writing a blog post almost every day is not necessary, of course, but it's a good discipline on me to generate content and it also serves as a diary to record my thoughts and emotions on this part of life's journey if I do ever come to write a book.

Running the half-marathon leg in a relay Half Ironman
with my siblings in Geelong in 2010.

You never know how you will deal with serious health issues when they arrive.  I have had recent first-hand experience of friends diagnosed with cancer and pulmonary embolisms and it's hard to know how they are feeling about their condition, or what to say to them without seeming patronizing or out-of-touch with their reality.  Now I'm starting to see it from the other side of the fence.

One thing that has surprised me is how fatalistic I feel about it all.  Of course, I will do everything I can to get well, run again and have a long life.  But, suddenly, it's conceivable that none of these things will happen.  When you learn that the mortality rate from undiagnosed pulmonary embolisms is 26% and you have episodes when you feel your heart beating at 235 beats per minute (that's nearly four beats per second!) and your blood pressure crashing, a new reality dawns.

A member of the Tiffin Boys Grammar School Cross-
Country team (sitting on the grass) in 1967 in London.

Much to Sharon's concern, I have started getting my life in order, making sure my records aren't in too much of a mess, that my will is current, and that everything important can be found relatively easily.  If the worst suddenly happened, and it could always be an ill-timed truck, rather than a health problem, I want the clean-up to be as easy as possible.

"What ifs" don't figure at all in my thinking.  I have always been an advocate, when decisions arise, of gathering as much information as feasible, making a careful analysis, and choosing the best apparent option.  Once done, no regrets and no looking back wondering "what if".  Although there are many things I still want to do, experience and see, I can honestly say that I have had a full and interesting life.  If the lights went out tomorrow, I would be more worried about the impact on my loved ones than any missed opportunities of my own.

My exercise for today consisted of nine holes of golf with friends, Dave and Bruce, on a beautiful sunny morning.  Sadly, the conditions were not matched by my form.  I played quite badly for the first six holes, and more worryingly, had some episodes when I could feel my heart pounding and my blood pressure dropping while dragging my buggy up small hills.  This was a new and disheartening (literally) experience on the golf course, but my mood lifted somewhat as I parred the last three holes, something I can never remember doing before.

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.

Psychological effects

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

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

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

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

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

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

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

Sunrise over Terrigal.

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

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

Early morning stand-up paddle boarders.

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

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

“On Death and Dying”

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

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

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

Avoca Lagoon.

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

North Avoca Lake Track.

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

Avoca Lagoon.

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

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

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

The Warrumbungles

The Breadknife.

A favourite Australian running destination of mine, which I don't get to visit often enough, is the Warrumbungle National Park in central New South Wales.  It's a long way from anywhere, which explains the paucity of visits, but it has excellent hiking (running) trails and wonderful camping.  In the 1970s and 1980s, we spent a number of vacations there, often with friends.  There would usually be a morning run and an evening run, with the day filled with hiking, reading, volleyball and cricket games, and the evenings devoted to board and card games around the campfire.

Belougery Spire.

In any stay, my favourite run was a 23km loop that incorporated some of the Park's main hiking trails and scenic highlights.  From the campground, the first few kilometres followed Wambelong Creek across the open grassy valley floor and past small groups of kangaroos, before crossing the main road and climbing to join one of the Park's main hiking routes, the Pincham Trail.  The Trail then followed the small babbling Spirey Creek upstream towards the mountains through the shady dry eucalypt forest for about 3km before leaving the Creek and ascending more steeply, including some steps, to the Warrumbungles signature landmark, the Breadknife, a thin slice of towering rock, and the High Tops, where the vegetation is occasionally more heath-like.

Our group camping in the Warrumbungles in May 1978.

The views are spectacular from the High Tops and sometimes we could hear and see roped-together rock climbers slowly ascending the sheer Belougery Spire across the narrow deep valley to the east.  As the trail continued westwards, generally following the ridge to the Western High Tops, there were more views, sometimes taking in the distant flat grazing lands of the Western NSW plains.

After 15km, the running route joined the Burbie Firetrail which it followed downhill through the dry eucalypt forest, occasionally steeply, back to the valley floor and an easy run back to the campground along Park roads.

Post-run wash in the Warrumbungles in
May 1978.

It is not a particularly long run, but is technical in parts and has the steep and taxing main climb that make it a good work-out.  It's another of those runs which I used to fly along in my prime, but would now be happy to just jog around, stopping occasionally for the views.

No jogging for my exercise today, but I did manage another 10km walk, including some long hills, without any ill-effects.  I'm finding walking for two hours along well-known routes quite tedious, mentally, despite listening to the radio or podcasts as I go.  I would like to walk this far most days until I can jog again, to maintain leg and joint fitness and to raise my heart rate at least a little, but I'll probably alternate with shorter daily walks in the interests of having a sustainable regime.

Punctuated equilibrium

Hanging upside down was one of
the treatments I tried for my chronic
back injury.

When I was in my running prime, I gave little thought to athletic decline.  I knew many veteran (masters) runners and recognised my potential as a runner would decline as I aged.  However, I never thought much about the process.  If anything, I expected the decline to be a smooth glide path.  Each year would see slightly slower times for benchmark distances and I would be chasing podium places as I entered each new age group.  It was a naive and simplistic view of the process, and my only defence is that these issues seemed remote and I didn't give them sufficient thought.

Now, with ageing parents and my own ageing body, it has become obvious the process of ageing and athletic decline is more akin to the evolutionary biology theory of "punctuated equilibrium".  This postulates that, over time, long periods of stability with little change are punctuated by events causing significant change.  Rather than being on a gradual descent to our ultimate demise, or the end of our running career, we have periods, often lasting years, when our abilities and capabilities remain relatively static.  As runners, these stable periods may include various soft tissue injuries and oscillating fitness, but our basic capabilities are essentially unchanged.

Looking towards North Avoca from Avoca Beach
during this morning's walk.

Significant events for runners are those injuries from which we never really fully recover, despite how hard we train.  There were no more Personal Bests for me after a back injury (spondylolisthesis) sustained  in 1979 brought to an end the steady improvements I had seen in the preceding years.  Likewise, a serious knee injury in 2006 meant a lot of time off running and a limit on training load I could sustain in subsequent years.  I could plot other significant injuries over the years that have also had a lasting impact on my running capability.

Looking from Copa, low cloud covers Mount Bouddi
during this morning's walk.

Now I'm trying to reconcile myself to the capability change that will result from my Deep Vein Thrombosis and associated Pulmonary Embolism and Atrial Flutter.  I'm still in the midst of this "event" and don't know the level of capability I will emerge with, but it will almost certainly be less.  Goals will have to be recalibrated, or frustration will build.  I'm not reconciled to these changes yet, but can sense I am in the midst of the process and will eventually accept what must be.

This morning, I walked a comfortable 10km in misty rain beneath low cloud.  It was a nice change from the relentless summer weather of the last three weeks.

When to run again?

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

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

Avoca Beach Markets.

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

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

Avoca Beach Markets.

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

Avoca Beach Markets.

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

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

Little (Beach) hiccups

Looking towards McMasters Beach

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

McMasters Beach

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

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

Cockrone Lagoon at the end of today's walk

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

More theories

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

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

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

Struggling in the Barrington Tops

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

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

Endurance athletes and A-fib

Greg Welch

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

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

Emma Carney

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

Erin Densham

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

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

Perseverance is not always good

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

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

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

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

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

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

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

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

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

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