T-shirts

T-shirt Quilt - Side 1.

I am a bit of a hoarder and in 45 years of running have collected quite a lot of trophies, finisher's medals and T-shirts.  The trophies and medals are mostly stored away in a cupboard and just don't evoke the same sentimentality as the T-shirts.

Some are treasured because they were from a memorable race, such as the London to Brighton in the early 1990s, my first serious ultra.  Others date from early career, such as the All Weather Running Club from my school in London.  Still others are valued because they are reminiscent of a particular era in my running life, such as the Bacchus 12000 shirts earned on the trips with club-mates to Griffith in the early 1980s.  Many just have a great eye-catching design, such as the Quivering Quads and Pere Marquette trail races from St Louis in the mid-1990s and several were given to me by people returning from events such as the 1981 World Cross-Country Champs.  A number don't relate to running events at all, but are still meaningful, such as the souvenir US T-shirts that were all I could find to buy and run in (along with some fleecy shorts!) when my baggage got lost on a business trip to Washington DC.

T-shirt Quilt - Side 2.

The common denominator with all of these T-shirts is that they have covered many kilometres, visited many places, and been laundered to within an inch of their lives.  Even as they shrank and lost their shape, I still loved them and couldn't bring myself to throw them out even though they were no longer wearable.  So, a couple of years ago, I asked a friend whether she would be willing to cut them up and sew them into a quilt.  The result is a superb piece of art and artisanship that fills me with pride and memories whenever I look at it.

No specific walking for exercise today, but I did play nine holes of golf which equates to about 5km (probably longer, the way I play).

“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.

Labertouche North run

Countryside near Labertouche with Bunyip State
Forest in the distance.

During the late 1970s and 1980s, we had a holiday shack in an area called Labertouche, about an hour's drive east of Melbourne.  The shack was on the edge of what was then State Forest and is now, Bunyip State Park, ideally located for running, especially in the days when my then wife, Barb, and I were serious long distance athletes.  Many weekends and vacations were spent with a crowd of our running friends, training twice a day, interspersed with board games, volleyball and cricket.

I had many great running courses, of varying lengths and degrees of difficulty, most of which I could still find my way around, 30 years later.  When tuning up for an approaching marathon, a favourite course was the Labertouche North Road 31km loop with moderate grades that could be run hard the whole way, occasionally at less than 6 minute mile average pace (3:45/km).

Our shack at Labertouche.

It started out southwards with a gradual downhill run out of the forest into an area of hobby farms with some great vistas along the way.  It passed the small local rural school, before flattening out as it swung north-west along Labertouche North Road through grazing properties to the halfway point.  Here it entered the forest and climbed the first of two major hills before descending into the forested Bullock Creek valley.  The dirt road was mostly bordered by towering eucalypt trees, but occasionally provided sweeping views to the south, and at other times wound round the side of spurs passing over small creeks hidden in groves of tree ferns.

The route passed by the rustic and remote Brighton Grammar School outdoor education camp, nestled on a couple of hectares in the forest, shortly before crossing Bullock Creek and beginning a steady climb out of the valley.  From the top of the climb, a gradual 5km descent along the gravel forest road winding through the forest and wildflowers allowed for a fast run back to the finish.

A firetruck flees the 2009 bushfire near Labertouche.

One reason this course lives large in my memory is that for a long time I considered my best time of 1:55 a time worthy of a good athlete (on a training run).  Then, one day when I had arranged to run it with an accomplished marathon running friend, he turned up at the shack in a sombre mood.  His wife had left him the previous day, along with their two children, and there were lots of emotions bubbling just below the surface.  He still wanted to do the run, but I didn't see much of him after we set out.  He smashed my best time by six minutes!

On another sad note, one of the devastating 2009 Victorian bushfires burnt out much of the Labertouche area, including our old shack (we sold it in the 1990s) and the Brighton Grammar camp, along with huge swathes of my cherished forest.

For today's exercise I walked 5km through nearby McMasters Beach.  I originally intended to do 10km, but wasn't very motivated and returned early, despite feeling physically fine.

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.]

Frosty Fairways

The frosty fairways of the West Herts Golf Club

For a year or so in the late 1980s, I was living near Colchester in the UK and commuting most days to a business park near Watford, a little north of London.  My route, along the A12 and the M25, London's orbital motorway, became very busy during peak hour and I developed the habit of leaving home around 5:30am and driving to our small office, before setting out on my morning run shortly before 7:00am.

Whippendell Woods

I soon found a 10km circuit that remains one of my favourite morning runs, and I still love to run it whenever I get back to the UK these days.  I christened it "Frosty Fairways" because there were many clear crisp winter mornings on which I would leave my footprints, the first of the day, on the frost-covered fairways of the West Herts Golf Club that formed part of the route.

Bluebells in Merlin's Wood

The run started within the exceptionally mundane precincts of the stereotypical Croxley Green Business Park, but after a kilometre or so, entered woods on the western edge of the magnificent Cassiobury Park.  From there it followed a narrow tarred path northwards through woods and beside the gentle and shallow Gade River before crossing the narrow Grand Union Canal and climbing onto the elevated fairways of the golf course.  By this time I would be warmed up and often enjoyed bounding along the mown grass, up and down small rises, skirting bunkers and greens.

Across the wheatfield

Then came a totally different experience as I entered the often gloomy, and sometimes misty, ancient Whippendell Wood, running along undulating foot and bridle trails past atmospheric oak, beech and ash trees for several kilometres before crossing a lane and traversing Merlin's Wood whose floor would be carpeted with bluebells in the spring.  Exiting the Wood, my route crossed a wheat field on a public right-of-way, before rejoining the fairways of the golf course after a short steep lung-busting climb.

The Grand Union Canal

From the other side of the golf course I used a narrow country lane to reach the Grand Union Canal and then turned southwards along the towpath past quaint cottages, moored long-boats and a small marina back to the Business Park.  If I was feeling good, I would often fly along this section and particularly enjoyed passing under a main road invariably clogged with commuters.  I did not envy them one bit.

My exercise today consisted of a 6km walk from Terrigal while my fellow Trotters ran the Muzza's Run course, another of my favourites.  I did envy them.

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.

Ron Clarke

Ron Clarke

Way back in the mid-1960s, I was living in London where my father had been posted for three years.  Like many young teenagers, I played several different sports and still believed, that one day, I could be world class in one of them.  Sadly, reality gradually dawned on the tennis court, cricket ground and rugby field as I recognised a lacked of the physique and ball skills to ever be a champion.

Like many expatriates I was proud when homeland heroes did well on the international stage and Ron Clarke toured Europe at just the right time to get my attention.  Just a few months after my family settled in the UK in 1965, Ron toured the US and Europe, breaking 12 track world records, including becoming the first man ever to run 3 miles in less than 13 minutes, 6 miles in less than 27 minutes and 10,000m in less than 28 minutes.  The times themselves didn't mean much to me, but Ron's style of running did.  Although he seemed to lack the finishing kick to win tactical major Games titles, he was a machine when it came to world record attempts.  He generally ran from the front and gradually burned off his competitors, often breaking world records by prodigious amounts.  Ron was indisputably the best distance runner in the world during the mid-60s.  Possessing the characteristics of toughness, discipline and excellence that I admired and aspired to, he was a worthy hero.  I don't want to overplay it, but he certainly got me thinking that running might be my sport.

Ron Clarke wins bronze in the 10,000m at the 1964 Tokyo
Olympics behind Billy Mills (USA) and Mohammed
Gammoudi (Tunisia)

After returning to Australia and getting more serious about my running, I became even more appreciative of Ron's talents and record.  I probably saw him at Victorian running events during this time, but have no specific memory.  However, when I began to reach my marathon prime in the late 70s and did well in some bigger races we had some brief interactions and he got to know who I was.  I remember being very proud when I won a small fun run in Melbourne's north-eastern suburbs and Ron, who was presenting the prizes, referred to me as one of Australia's up-and-coming distance runners.  I can also remember him giving me a toot on his car horn near the Tan as I ran to work during the morning commute.  His acknowledgement seemed to give my running efforts credibility in my own mind, and that was important to me.

Ron Clarke tracks Michel Jazy (France) during a
1965 two mile race in France in which Jazy
broke the world record

The sad thing about Ron's career was that it was brought to a premature end by a heart problem he believes developed during the high altitude Mexico City Olympics in 1968.  He faded quickly in the last few laps of the 10,000m final after being in contention with two laps to go, collapsed unconscious after crossing the line and was given oxygen.  A few years later he was diagnosed with a heart defect and in 1983, after suffering fibrillation during a run, had successful surgery to replace a faulty valve.  You can read an excellent summary of Ron's career here.

No fibrillation or flutter for me today as I walked a flat 7km for exercise.  I felt fine, but remain despondent that this is all the exercise I am allowed for the next six weeks.  It's very tempting to see if I can jog around my usual Copa 5km course at an easy pace, but I guess I'll follow the doctor's orders.

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.

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.