Perspicacious medicos

Cockrone Lagoon, between McMasters Beach and Copa,
and near our home, is one of my favourite places to walk.

I walked 5km this morning, and although not as bad as yesterday, still felt more breathless than has generally been the case in the last few weeks.  Maybe I've just had a bad couple of days.  I have read stories on the Web of runners coming back from Pulmonary Embolism (PE) who have bad patches.  Nevertheless, I was pleased I had an appointment scheduled for later in the morning with a Respiratory Specialist to get an expert opinion on my situation and some answers to questions.

Cockrone Lagoon.

As it turned out, the Specialist's opinion was that the worst of my Deep Vein Thrombosis (DVT) and PE was past, and that as long as I was taking the anti-coagulant, Warfarin, my prognosis was good.  In fact, if my heart wasn't an issue, he would have been OK for me to resume running, which was good news.  He spent some time checking my pulse, and said he was sure that the breathlessness I had been feeling was due to my heart which was beating irregularly, averaging about 60-70 beats per minute compared to my usual resting rate of low 40s.

Cockrone Lagoon.

He seemed keen that I see the Cardiologist (my appointment is four weeks away) as soon as possible and actually tried to get me an appointment today (they are in the same building).  I think the urgency was driven by his desire to help get me running again rather than any concern about my current condition, although he didn't actually say that.  He told me he was training for a triathlon, confirming to me the wisdom of getting a Specialist recommendation from my sports medicine friend, Dr Jon.  In my experience, medicos who participate in endurance sports have a much better understanding of obsessional distance runners such as myself.  They know how much it means if we cannot run, how much we test our physical limits, and how prone we are to ignore pain.

He prescribed another heart test, a Holter Monitor, and told me to call the Cardiologist when the results were available, mention his name, and I should be able to get an earlier appointment.  I called to arrange the test, and because they had a cancellation, was able to get an appointment this afternoon.  I'm now walking around with electrodes attached to various parts of my chest and connected to a battery powered recorder on a waist belt.  I have to note the time of any breathing or heart events I notice in the next 24 hours and return the device tomorrow afternoon.  Hopefully, I'll be able to get an appointment with the Cardiologist next week and make progress on the heart problem.  I sensed the Specialist I saw today thinks the heart arrhythmia will be correctable, but time will tell.

London

St Paul's Cathedral.

In total, I have lived ten years of my life in the UK and am very fond of the place.  In various blog posts (Frost Fairways,  Chappel, Isle of Dogs), I have described some of my favourite runs there.  The last time I lived in the UK was in 1992, but during the next eleven years when I lived in the US, I made many business trips there, frequently staying in hotels in central London.  Central London is a big place, and depending on where you are staying, the running options can vary.  During the latter part of my working life, when I was employed by Reuters, whose head office was in Fleet Street, my favourite place to stay was a business hotel close to St Paul's Cathedral.  It was easy walking distance from the office (passing an excellent Indian takeaway en route!), and close to the Thames River, a wonderful place to run.

HMS Belfast with Tower Bridge.

For my regular 10km run, I usually set out about 6:00am and headed east along Cannon Street past the imposing St Paul's Cathedral and then Mansion House, Cannon Street and Monument stations which were already disgorging early commuters before arcing around the northern side of the Tower of London and onto the iconic Tower Bridge.  I always enjoyed checking out the river traffic as I crossed the bridge and looking at the retired HMS Belfast anchored upstream.  On the southern side of the bridge, I descended a stairway to begin my journey westwards along the southern bank of the Thames.

Millennium Bridge and St Paul's Cathedral.

At first the route wound through some narrow back streets passing refurbished warehouses and stereotypical London pubs before joining the promenade along the river bank which I followed all the way to Westminster Bridge.  On the way it passed landmarks such as the Millennium Bridge, the Tate Modern, Southbank, and the London Eye, all the time providing superb views of the London skyline to the north across the river.  After crossing the river again beneath Big Ben, the route turned right to follow the Victoria Embankment downstream and back to the northern end of the Millennium Bridge from where it was a short run back to the hotel.

London Eye and Southbank.

It was a generally flat course along wide paved footpaths and promenades that made for a fast run if I was feeling good, which was often the case.  In summer, London had milder temperatures and lower humidity than my US abodes, and in winter, it was also milder and nice to run in shorts for a change after the winter gear required in the US.

I've been told that my recovery from the Pulmonary Embolism could be long and erratic.  Today served to emphasise the point when I struggled all of the way round what should have been an easy 5km walk in Copa.  I didn't feel my heart racing, maybe because I walked so slowly, but it was exasperating and a little alarming to feel so unfit.  My breathing was heavy and laboured and I even contemplated sitting down on a bench with a kilometre to go when I began to feel a little spaced out.  Instead, I just walked even more slowly and made it home OK.  The rest of the day was pretty sedentary and I had no problems.  On the plus side, I had a call from the office of the Respiratory Specialist I wasn't scheduled to see for another month to say they had a cancellation tomorrow, so I'm hopeful of getting a useful opinion about my situation and prognosis.

Guadalupe Peak

Guadelupe Peak, Texas.

Some races and training runs stick in your mind forever, while others seem to get assigned to the same memory space as hotel room numbers and totally disappear within a few days.  In between there are memories that can be resurrected by some external stimulus such as a conversation with an old friend or the sight of a photograph.

I have been reading through, and digitising, my old training diaries.  It is a nostalgic and self-indulgent pastime, but is a source of ideas for this blog and resurrects many memories of races and runs that I had all but forgotten.  Other runs are still quite vivid in my memory and I start anticipating them as I move through the diary towards the date on which they occurred.

The approach to Guadelupe Peak.

One such run was up Guadelupe Peak from Pine Springs Campground and return in the Guadelupe Mountains National Park near El Paso in Texas in January 1986.  We were the only campground residents on a night when temperatures dropped below 10°F after a stormy day characterised by high winds and snow.  When I went to bed I wasn't sure that the planned run to Guadelupe Peak (8740ft) the next morning was going to be feasible, but we woke to an icy cold but crystal clear morning with a three inch snow cover.

Looking south to Guadelupe Peak from the Bowl Trail.

The Campground was at 5800ft, so I knew that altitude would be one of the challenges on my run, but the distance was short, just 7km each way.  However, that 7km incorporated 3000ft of climb along an exposed and unfamiliar snow-covered trail, so even though the weather had cleared, I was a little apprehensive.  There was nobody about and I knew it would take a long time to be rescued if anything bad happened.

The trail to Guadelupe Peak.

The trail gained height rapidly as it switch-backed its way up on to the spur I would be following to the Peak, but I was feeling fit, and knowing the distance was short, maintained a good pace.  It was a little precipitous to the side of the trail early on so I paid a lot of attention to where I put my feet, but higher up the risks were fewer and I began to appreciate the beauty of the vistas and the tranquility of my environment, broken only by the padded sounds of my footfall and my steady deep breathing.  The mostly snow-covered trail was smooth and unmarked, apart from the occasional tiny animal track, and there was almost no wind.  The higher I got the better the views became.

View from Guadelupe Peak.

I reached the summit in a little over 50 minutes and took a break to admire the panoramic views in all directions.  The plains of Texas spread out below to the east, south and west, while the barren peaks of the Guadalupe Mountains dominated the view to the north.  Standing alone atop a mountain in the early morning light with views to the horizon in all directions is about as spiritual as it gets for me.  At the same time as you feel privileged and exceptional to have such an experience, it also emphasises your microscopic place in the world.  You  almost feel powerful and powerless at the same time.

The return trip was much faster and exhilarating in parts, though I still needed to take great care with my foot placement and the sharp switch-backs, and I finished in just over one and a half hours for the return journey.  It was a special and still memorable run.

I walked about 9km today, doing some more exploring around McMasters Beach and Bouddi National Park.  Although I managed the walk OK, there were occasions during it, and later in the day, when I could feel my heart racing and that wasn't pleasant.  On the plus side, my breathing remained steady and I didn't have to rest.  It did remind me, however, that I'm not the person I was six weeks ago.

Physical introspection

Quarry Track in Bouddi National Park.

Motivation was low today and I down-scaled my originally intended 15km road walk to one of 10km including bush trails and beach.  Part of my ennui stems from the feeling that I could do more exercise than is currently wise.  The 10km walks all week have been completed easily and I haven't strayed into the "Amber Zone" where I begin gasping for breath and feel my heart pounding.  Maybe this is because I'm getting better at managing my impaired cardio-vascular system, or maybe it's because it is gradually improving.

While not forcing the pace, I walked steadily at around 5km per hour, and after circling round the southern side of Cockrone Lagoon, followed roads and a fire-trail steadily upward to the highest point in McMasters Beach.  As I walked I found myself constantly reviewing how I was travelling, especially up the steeper climbs.  Was my breathing steady or was it becoming more laboured?  Was my heart racing?  Was that slight ache in the back of my left chest heart-related?  Was I at all light-headed?  All runners coming back from injury, or tapering for a race, will recognise this nervous physical introspection phase where every niggle and sign is examined to see if it is something more ominous.

View from Bombi Point in Bouddi National Park.

I continued walking towards Little Beach, then on reaching a trail junction, decided to change my planned route and followed the Quarry Trail up into Bouddi National Park.  It's a trail I have run along a few times over the past ten years, but it's not part of my regular training routes.  One advantage of walking, as opposed to running, is that you get more time to look around and appreciate your surroundings, and once up on the plateau, this trail passed through some beautiful and peaceful woodland, disturbed only by an encounter with Joe and Deirdre, some Terrigal Trotter friends out on a long bush run.

View from Bombi Point in Bouddi
National Park.

I was starting to enjoy my walk and decided to follow the Bombi Point trail, a dead-end trail that I have often passed, but never followed, when running through the Park.  After a gradual 1km descent on the sandy track it ended at the top of a precipitous cliff offering spectacular views along the wild coast and out to sea.  A heavy swell was crashing into the base of the cliffs and the spray was rising high into the air, though still many metres below my vantage-point.  It was a breath-taking location, and a little scary closer to the cliff edge.  I will be including it in future walks and runs.

My route home followed some familiar and lovely single track winding through sheltered and mossy rainforest, and then after some road walking, finished along the beach from McMasters to Copa.  It was low tide which makes the walking easy and there were lots of holiday makers out enjoying the Australia Day weekend and the end of summer vacation for many.

I have discussed in previous posts ("Getting out the door" and "Small explorations") the value to me of training somewhere more interesting when you have one of those days when you just can't be bothered, and today proved the point.  It wasn't quick, and there was a bit of dallying here and there, but I covered 13km without trouble.

Relays

Fellow Kew Camberwell team members for the
1980 New Zealand Road Relay Championships.

There is plenty of camaraderie in distance running, but it is not usually thought of as a team sport.  There are club competitions run by various State and National running organisations for road and cross-country running, but my observation is that it still ends to be an individual competition with the performances just aggregated to determine team positions after the event.

The exception is relay racing where each individual runner is very conscious of their team membership and expectations.  I have known runners who almost always perform better in a relay race than when they are running for themselves, and others who find the pressure too much and choke.

Start of the 1980 New Zealand Road Relay Chempionships.

Most of my relay running was done in the 1970s and 1980s when I was a member of Kew Camberwell District AAC and its antecedents.  In our heyday we were one of the strongest distance running clubs in Victoria and derived some perverse pleasure from our lack of national and international stars of the kind that characterised the ranks of the two best Victorian clubs, Glenhuntly and Box Hill.  We were a club of journeyman runners who enjoyed fierce, but good-natured, competition amongst ourselves then took great pride in our ability to be competitive with the best clubs in team competition.

Running my leg in the 1981 New
Zealand Road Relay Championships
(9.6km, 29:34).

Although there were some relay competitions in Australia, it was the annual New Zealand Road Relay Championships that really caught our attention after Glenhuntly returned from competing there in 1979.  The competition in New Zealand was of exceptionally high standard and the event, which called for a team of ten to run an average of 10km each, was very competitive and continues to this day.  As I recall, the super Glenhuntly team had only just got onto the podium.

We managed to muster sufficient members to run in the competition in three different years in the early 1980s, but it was the first trip that sticks most in my mind.  We travelled over as a group starting in Auckland where we competed in a local road race before driving south in a hired van to Wellington where the Relay was to take place the following weekend.  There were 23 teams in A Grade and our goal was a top ten finish.  Glenhuntly were there again.  Our early runners excelled themselves, and the rest of us lifted to match their efforts.  I was only a few months past major knee surgery and couldn't run very well downhills so was given a 6.2km all uphill leg.  I wasn't at my best, but can still remember the pressure I felt to maintain our good position on that long climb.  The junior runner in our team who ran the downhill leg after me, wore the soles off both his feet blasting down the hill and had trouble even walking in the days that followed.  I can still remember Chris Wardlaw, a two-time Olympian and Glenhuntly team member, complaining to us "that seven legs have passed and we still haven't caught you bastards", or words to that effect.  That made our day.  Their class ultimately told and they finished seventh overall, but we were just two places and two and a half minutes behind.

The Kew Camberwell team for the 1983 New Zealand
Road Relay Championships.

We never did quite as well in the subsequent years, but I'm sure all of us who ran in the Kew Camberwell teams still remember them fondly.

Being Saturday, it was the usual Terrigal Trotters run at 6:00am, and I went down to meet my friends who were running and went for a 6km walk while they were out.  I feel like I'm treading water, waiting for the specialist appointments and my body to repair itself.  Not much else I can do at present, but it's very frustrating.

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.