The Prom

The boardwalk through Sealers Swamp on
Wilsons Promontory

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

Refuge Cove, Wilsons Promontory

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

Oberon Bay, Wilsons Promontory

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

Tidal River, Wilsons Promontory

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

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

Mixed feelings

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

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

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

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

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

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

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

Lost opportunities?

Boney Mountain

I joined the usual throng of Terrigal Trotters at Terrigal beach this morning for the regular Saturday 6:00am run.  I was sad not to be joining them for "Bob's Hill", another of my favourites, but reflected that I was lucky to be there walking and sharing time with friends.  Several Trotters who share my demographic are dealing with significant health issues, including one who recently suffered a more serious and life-threatening episode of Pulmonary Embolism than me.  Fortunately, he seems to be on the road to recovery, but it's another reminder to live for today, particularly when you get older.

A year ago, almost to the day, I enjoyed one of my happiest racing experiences for some time.  Sharon and I were on the last day of a three-week vacation in the western U.S., and ran in the Boney Mountain Trail Half Marathon west of Los Angeles.  After a steady start, I worked my way through the field in the second half, which included a 2000ft climb, and after a helter-skelter descent, finished in 18th place in a field of over 300.  The next runner in the 60+ division was 33 minutes behind.  I didn't believe I could still run so fast and thought then that it was likely to be the racing highlight of 2013 for me, and that's how it turned out.

Reaching the bottom of the descent
from Boney Mountain

I do get frustrated when I miss races and other running opportunities, but know that physical brittleness and vulnerability come with age.  I can accept the injuries and illnesses, so long as I don't feel I have given up my quest to be the best runner I can be, and don't incur them through making stupid choices.  All runners have those moments when injury strikes and they just wish they could have a "do over" and avoid whatever caused the problem.  Sometimes it results from doing something foolish, but often it's just plain bad luck and could not reasonably have been foreseen.  The challenge is to strike a balance between testing your limits and being foolhardy in pursuit of your potential.

I would like to think I didn't make any poor choices leading to injury or illness since Boney Mountain last January, but know I have learnt a few things about myself, particularly the growing need to warm up longer and/or start slower for anything fast.  Good choices or bad, I still had plenty of downtime and failed to produce any performances comparable to Boney Mountain.  However, it was only a year ago, and common sense tells me that not too much athletic potential can have been lost in just one year.  I still believe that if I can string together three or four months of consistent and smart training and racing, there's no reason why I couldn't get back to that form.  This is what keeps me going.

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!