Atrial Fibrillation Podcasts?

 

For many years I’ve been running with an iPod and truly enjoy listening to music while running – I wrote about it in a previous entry about Runner’s High – nothing like some nice stoner music to listen to while you’re high on life, right?

I realize that listening to music while running is controversial for many people; but I am an unabashed YES when it comes to running and music. Because I live in rural, mountainous Southern Oregon I do 95% of my running on trails of one sort or another – and yeah, yeah – bears, mountain lions, dogs – I get it – but I’m not changing anything. I’ve been running with music ever since my first Walkman cassette player in 1984!

Even worse – I’m Mr Bad Example and ride my bike with an iPod going, and again 95% trails but still not really a good idea.

Lately, with my atrial fibrillation requiring more and more medication to control (the high dose of the beta blocker carvedilol really takes the wind out of my sails), I am doing more hiking and less running – but still with an iPod.

Since “runner’s high” is a rare event with hiking compared to running I’ve been listening to more podcasts than music playlists. Podcasts are sort of like radio shows, either professional or homemade, that can be downloaded from the iTunes store and elsewhere, in MP3 format to be listened to using an iPod, smartphone, or even on your computer. They are mostly free, but many have commercials, and there are a few podcasts that cost money.

There are millions of them. Over the past couple of years here are the ones I’ve found most entertaining:

All of these recommendations are unrelated to atrial fibrillation

Dirtbag Diaries – a “dirtbag” is something along the lines of a Yosemite rock climber who lives in his or her car and lives for climbing. The term has a broader application and this excellent podcasts primarily deals with outdoor adventure, mostly done econo!

Outside Podcast – if you like Outside magazine you’ll like the podcast – the Science of Survival episodes are particularly great.

My Dad Wrote a Porno – The funniest podcast I’ve ever encountered – but truly dirty and probably offensive to most people – you’ve been warned. A young British man discovers his dad wrote a clueless porno novel so he reads it with his two friends and they basically give it a sort of Mystery Science Theater 3000 treatment.

Dan Carlin’s Hardcore History – probably my favorite podcast ever – fascinating and detailed episodes about various historic eras like World War I, Genghis Khan, the Roman Empire, etc. The episodes are long – like four or five hours long – and never boring. The narrator reminds me of Steve Dahl (only other Chicago natives will know who that is) merged with a historian who loves guy movies. Okay – if that doesn’t make sense just try an episode or two – it’s a great show.

Revisionist History – a Malcolm Gladwell podcast – very thoughtful and as with all his work always an amazing twist near the end.

The various NPR podcasts (Snap Judgement, TED Radio Hour, Radiolab, Invisibila, etc.) are consistently excellent, maybe a little too slick.

I think most people who listen to podcasts have already listened to Serial, Dirty John, and S Town. If not, what are you waiting for? They are among the best ones out there.

Others I’ve found interesting include Rich Roll Podcast, Beautiful Stories from Anonymous People, Judge John Hodegman, WTF, and the Nerdist.

Actual running podcasts include Trail Runner Nation and Ten Junk Miles.

But what about podcasts specifically about atrial fibrillation? It seems like any topic, no matter how esoteric, has a number of podcasts. If you don’t believe me do an iTunes store podcast search for your hobby, your favorite TV show, favorite band – and you’ll see what I mean.

I was surprised when I did an iTunes store podcast search on “atrial fibrillation” I found zero podcasts that were anything like this blog – that is to say produced by somebody with atrial fibrillation for non-clinicians who deal with their own AF. All I found were atrial fibrillation episodes for technical medical podcasts directed toward clinicians. Just have a look at the screenshot at the top of this post. It amazes me that with all the people dealing with atrial fibrillation none of them seem to be podcasting about it, although, as you know, several people blog about it.

Rich Roll Podcasting

If you know of any atrial fibrillation podcasts, or if you just want to discuss podcasts in general, please comment. Thanks for reading.

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A Casualty of My Atrial Fibrillation: My Single Speed Cross Bike

I miss my Bianchi San Jose.

It’s true that a person could easily get by with one bike – most people in the world do just that. If I only was going to have one bike it’d be a nice mountain bike – because it could be ridden in all conditions, four seasons, on or off road, and it’s usually a comfortable ride.

But I’m a typical middle aged (employed) male cyclist – I have three bikes – a mountain bike, a road bike, and a cross bike.

Okay – I‘ll admit it – I actually have four bikes. My fourth bike is my “legacy” bike – the first fine bike I ever owned that I had to  save up for about a year as a poor graduate student – my 1981 Trek 930 Sport Touring road bike with the Columbus tubing and the mix of Campy and Sun-tour components. I haven’t ridden it in nearly twenty years but I just can’t part with it – we had so many incredible road rides back in the eighties! My old bike is actually featured on the Vintage Trek website.

Alright – full disclosure – I still have the frame and (non-suspension) fork from my 1990 Fischer Supercaliber – still my favorite mountain bike of the several I’ve owned for the past thirty years.

But out of the three bikes I actually ride the most frequently ridden is my full suspension cross country 29er mountain bike – a real beast built for the clydesdale that I am.

I also have a carbon Giant Defy (their knock off of the Specialized Roubaix) that I bought as a retired rental fleet bike from the local bike shop. Yes – I know that you’re never supposed to buy a used, god forbid a former rental fleet carbon framed bike – but the extra large sizes are so infrequently rented that it had very few miles on it.

But my Bianchi San Jose is the one that was a casualty of my atrial fibrillation (AF). A single speed cross bike – perfect for cruising on our local Rails to Trails (OC&E and Woods Line State Trail) geared perfectly for the relatively flat trail (Trains can only handle so much steepness – no more that a 2% grade) and because it was a cross bike it was ideal for the nine miles that are paved as well as the ninety unpaved miles. Although it’s a single speed it had brakes – it wasn’t quite a hipster messenger fixy. I think those things are nuts – especially now that I’m anti-coagulated.

If you’ve never ridden a single speed – give one a try – a very smooth and quiet ride. My San Jose was a little tricked out. I upgraded the tires to a more aggressive set, and I had a beautiful Brooks Saddle (which I kept) and some matching but really over-priced Brooks leather handle bar tape. That bike just had a terrific look and feel – the most comfortable bike I’ve ever had. I could ride in the drop position for a long time without getting sore.

But regrettably as my AF got worse and the medications were going up to higher dosages (Thanks, Carvedilol!) I could no longer ride it up to the hill to our house. It isn’t the biggest or steepest hill in the neighborhood (we live in the mountains, after all) but it is about a 250 foot climb in about three quarters of a mile (75 meters in 1.2 kilometers). It never was an easy climb on the single speed, but currently it is impossible for me.

To be honest I never was a good single speed cyclist. I’ve always had a fast cadence and used a lower gear, and I tend to shift constantly maintaining an even power output. I’ve ridden with guys who just stay in the higher gears and grind – not my style. It was always a challenge getting up that hill in the single 42/17 gear.

I considered getting an after market three speed hub for the back but that would be too dorky. I  still rode it on the bike trail but I’d have to drive to the trailhead schlepping the bike on my truck’s bike rack. Eventually I traded it in at the bike shop when I bought my most recent bike – a Specialized AWOL – sort of a gravel grinder meets full touring bike.

I like the AWOL well enough, and ride it frequently; but compared to the light, sporty, cool looking San Jose the big, clunky, awkward looking AWOL seems more like riding around in a UPS delivery truck. Oh well – life changes as you go – I’m grateful to  still be riding.

Please feel free to share your comments.

Is Digoxin a Good Choice for Treatment of Atrial Fibrillation?

Is Digoxin a Good Choice for Treatment of Atrial Fibrillation? I want to make it clear, once again, that I am writing this blog as an endurance athlete dealing with atrial fibrillation (AF) – not as a clinician. I’m not a cardiologist or a primary care physician. I’m simply posing a question and not answering it. It is important for you to be in agreement with your cardiologist and primary care provider about your treatment plan Whatever you do – DON’T STOP TAKING ANY MEDICATION YOU HAVE BEEN PRESCRIBED BECAUSE YOU READ ABOUT SIDE EFFECTS ON SOME GUY’S BLOG!

Also – full disclosure – I take a low dose of digoxin.

Digoxin is the generic name for Lanoxin which has been actually been used for hundreds of years as an herbal preparation (Digitalis) from the foxglove plant, seen above, which is a lovely plant, don’t you think?

Digoxin is used to treat atrial fibrillation, atrial flutter, and heart failure. My cardiologist told me that many of the younger cardiologists don’t generally even prescribe it any longer.

Digoxin has a narrow therapeutic index, which means that at too low of a dose it isn’t very effective and at higher doses it is toxic. Because of this it has many side effects. It is unknown whether digoxin is safe during pregnancy. Digoxin works by improving heart function by strengthening the contractions and slowing the heart rate.

A 2018 paper published Journal of the American College of Cardiology concluded that digoxin increased mortality in patients with atrial fibrillation regardless of heart failure.

Conclusions In patients with AF taking digoxin, the risk of death was independently related to serum digoxin concentration and was highest in patients with concentrations ≥1.2 ng/ml. Initiating digoxin was independently associated with higher mortality in patients with AF, regardless of heart failure.

Yikes!

Also consider that several of the authors of the study disclosed that they had financial ties to pharma and medical device companies, including pharmaceutical giants Bristol-Meyers Squibb and Pfizer who funded the study.

But look! Runners and other endurance athletes need to ask their cardiologists about digoxin toxicity because both dehydration and low magnesium increase the chance of toxicity. Who among us hasn’t been dehydrated?

I’m going to be asking my cardiologist more questions about digoxin next time I see her. As I mentioned I take a small dose and when we did lab work my digoxin level was low, below the therapeutic window, which she said was fine – she just wanted to make sire it wasn’t too high. Me too!

I’d love to see your comments!

Dehydrated Trail Runner – me!

Coffee and Atrial Fibrillation – Update

A couple of years ago I posted an article on this block entitled Does Drinking Coffee Cause Atrial Fibrillation?   

It had been determined that drinking coffee, even in fairly large amounts, did not increase the risk of an individual going into atrial fibrillation.

 

In their analysis, the researchers found that coffee consumption was not associated with AF incidence, even in more extreme levels of coffee consumption.

 

The article went on to state that while drinking coffee does not cause atrial fibrillation individuals who have no history of atrial fibrillation, it was thought that coffee may be related to recurrence of atrial fibrillation and individuals who have the arrhythmia intermittently:

 

“These findings indicate that coffee consumption does not cause atrial fibrillation,” Larsson says. “However, high coffee consumption may still trigger arrhythmia in patients who already have atrial fibrillation.”

 

 

It was stated that more research was necessary. 

A recent, widely reported Australian study, a very large review of existing studies, determined that coffee is likely safe for people with atrial fibrillation.

 

“Although coffee increases your heart rate, it does not make it abnormal,” explained senior researcher Dr. Peter Kistler.  . . . “We found that there is no detrimental effects of coffee on heart rhythm and, in fact, coffee at up to three cups per day may be protective,” he said.

 

Protective?  That sounds like terrific news!  It is always nice to find out that something that is so enjoyable, but which you have assumed is possibly unhealthy, turns out to be not only safe but good for you also, reducing, to a small extent, episodes of atrial  fibrillation.

 

 Kistler’s group found that, among more than 228,000 patients, drinking coffee cut the frequency of episodes of atrial fibrillation by 6 percent. A further analysis of nearly 116,000 patients found a 13 percent risk reduction.

One cup of coffee contains about 95 milligrams of caffeine and acts as a stimulant to the central nervous system.

Caffeine also blocks adenosine, a chemical that can trigger atrial fibrillation, Kistler explained.

 

This study did, however, go on to recommend that people with heart arrhythmias avoid caffeinated energy drinks.  Furthermore, people who are sensitive to caffeine, should still avoid coffee.  Again there are certain people who identify caffeine is a trigger for atrial fibrillation and those individual should, by no means, return to drinking coffee.

 

Please comment with respect to your experiences with coffee, energy drinks, and atrial fibrillation.  Thanks!

The original study can be found here:

 Peter Kistler, MBBS, Ph.D., director, electrophysiology, Alfred Hospital and Baker Heart and Diabetes Institute, Melbourne, Australia; Byron Lee, M.D., professor, medicine, director, electrophysiology laboratories and clinics, University of California, San Francisco; April 16, 2018, JACC: Clinical Electrophysiology

Whatever Happened to AFIB Ultrarunner?

Sunrise at the start of an ultramarathon

So, whatever happened to “that one guy?” The one with the AFIB Ultrarunner blog?

When I decided to start this blog I had, of course, scanned the internet for similar blogs, and I found AFIB Ultrarunner. This was a somewhat short-lived but excellent 2010 blog by an unnamed man who was an ultrarunner, who like me, was dealing with atrial fibrillation (AF).

Afibultrarunner” was actually the name I originally chose for this blog, but it was taken so that’s okay, I’d be simply “afibrunner.”

I’m particularly interested in contacting him for two reasons.

First of all, at the time I was starting this blog I was personally just starting to train for ultras. In fact, I went into permanent AF right at the end of a twenty mile training run while trying to train for my first 50K.  I didn’t really know how to train so I was simply running a twenty mile trail run every weekend and I truly loved those long, slow training runs; but evidently that wasn’t a good idea given what happened!

Second of all the AFIB Ultrarunner guy had had an ablation, and has an excellent description of his experience. I have never had an ablation and likely never will (I’ve been told my chances at success are poor) and wanted to find out how he did on a long term basis. At this point I’d really like to find somebody to write about the experience for this blog – but I’ve never been able to find out who he is or how to contact him.

His blog is excellent and ends, I think, on a very sad note:

My cardiac procedure was painful or uncomfortable in constantly new ways for 20 hours.  I think I took it

pretty well, but at the time I thought that that day would be amongst the worst in my life, as in up

there with losing a spouse, child or dying yourself (although this just might be my inexperience with death speaking.)  Also I tried two drugs and nothing worked. Also my condition effects my day to day life more, such as it is now harder to carry dog food from the car without an attack, and my running has suffered.

Lets hope 2011 has more adventure running, and less heart problems.

 

And that was the end. I’m curious. How’s he doing now? Still running? Still dealing with AF? Maybe he doesn’t want to talk about it anymore – he is a little secretive about his identity, although there is a photo of him during a 50 mile race but there’s no contact info. A fifty mile race while dealing with AF – not too shabby!

Hey, man, if you’re out there let me know!

Famous Athletes with Atrial Fibrillation

Famous Athletes with Atrial Fibrillation

This quick article is presented here just so you don’t feel you are all alone with your athlete’s heart in atrial fibrillation (AF).

This article from Everyday Health, which you may have already seen, reveals nine well known athletes who had AF.

1.) Billie Jean King, the iconic tennis hero, went into AF in 2015 and had a successful ablation. “Today, King says she continues to eat well and exercise, and she’s teamed up with Janssen Pharmaceuticals to educate patients about their afib-related stroke risk.”

2.) Basketball legend Larry Bird evidently had AF symptoms while he was playing (tachycardia, lightheadedness, disorientation) but never reported it to his team physician. After he retired in 1992 he was formally diagnosed with AF, which the article states he now has “under control.” (Whatever that means)

3.) Canadian professional triathlete Karsten Madsen was diagnosed with AF in 2010 and was successfully cardioverted, and reportedly continues to compete.

4.) World Class tennis pro Mardy Fish dropped out of the 2013 French Open with a mystery illness later diagnosed as AF, and treated with ablation. I’m not sure if he continued to play, but he is currently retired from tennis.

2014, Tour de France, tappa 10 Mulhouse – La Planche des Belles Filles, Belkin 2014, Trek Factory 2014, Mollema Bauke, Zubeldia Agirre Haimar, La Planche des Belles Filles

5.) Spanish pro road cyclist Haimar Zubeldia was sidelined for three months with AF, but with rest and treatment he was able to return to competitive cycling and finished sixth overall in the Tour de France that same year. Wow!

6.) Olympic rower Nicola Coles (New Zealand) developed AF weeks before the Beijing Olympics, and was cardioverted.  Because many common AF treatment drugs are banned  for Olympic athletes her treatment options were limited and she ended up using magnesium and fish oil to control her symptoms. her symptoms did not recur and she competed in Beijing with her teammate and they finished fifth. She subsequently retired from competition.

7.) US astronaut Deke Slayton, one of the original Mercury program astronauts was diagnosed with AF; but he continued with his astronaut training program. In 1970 he had his AF under control and was reinstated to full flight status and eventually was able to pilot the first Apollo Docking Module for the Apollo Soyuz Project. 

8.) Eight time Olympic champion canoe racer Brigit Fischer was diagnosed with AF and forced to drop her plans of qualifying for the 2012 London Olympics at the age of fifty:

Though she believed she was in better shape than in her last Olympic comeback, Fischer admitted that being told she had atrial fibrillation confirmed her suspicions that something was wrong. Already the most decorated Olympian in German history and only the third woman to win at least eight gold medals, Fischer decided her health was more important than another medal. 

9.) Fourteen time NBA All-Star Jerry West played with AF symptoms believing them to be panic attacks. He was eventually was diagnosed with AF, was cardioverted, but continued to have to deal with AF.

If that isn’t enough you can check out this site:

53 best Celebrities with A-Fib images on Pinterest  Although I haven’t really taken a long look at this site, and can’t attest to it’s accuracy it’s oddly comforting to think that we’re not only in the same boat as folks above, but also with people like Gene Simmons and Barry Manilow.

 

Alcohol, Athletes, and Atrial Fibrillation

Alcohol, Athletes, and Atrial Fibrillation

 

Beer drinking with my buddies at Marster Springs Campground

Does alcohol cause atrial fibrillation (AF)?

We’ve been reading for years that a glass of wine or two can reduce the risk of heart attack and stroke; and it’s pretty clear if you’ve been hanging around at the finish lines of marathons, ultras, and long distance bicycling events that endurance athletes like to drink alcohol. Also, some studies have shown that endurance athletes have up to a five-fold increase risk of AF

So . . . is alcohol consumption a risk factor for endurance athletes dealing with AF?

Uhh . . . yeah.

Drinking alcohol frequently raises the likelihood of developing AF,  and more alcohol means more risk. One to three drinks (considered to be “moderate drinking”) increases the chances of AF, and “heavy drinking” (four or more drinks per day) increases the odds even more. It’s been suggested that every extra daily drink increases the risk by 8%!

Even if you aren’t a daily drinker so-called binge drinking, defined as five or more drinks in a day, also increases the chances of AF. (Some call it “binge drinking,” I might call it any weekend during my college years!)

Typical weekend from my college days

So how much alcohol is safe? Once you’ve been diagnosed with AF one or two drinks per day is probably safe, but three or more may be likely to trigger an episode. Also – make sure you figure out how much alcohol is one drink – a standard glass of wine versus a large glass of wine. A bottle of American light beer is going to be less alcohol than a bottle of craft brew IPA or stout.

My personal advice is that once you are diagnosed with AF the best move would be to quit alcohol altogether. That’s what I did. But consider that this advice is coming from a guy who is in permanent AF.

A very helpful WebMD article advises that even with moderate drinking you should avoid drinking every day: 

Even if you drink moderately, experts suggest you take a few days off from drinking alcohol every week.

  • Limit yourself to one to two drinks a day.
  • Try to have 2 to 3 alcohol-free days every week.
  • Talk to your doctor if you have an episode of AFib within an hour of drinking alcohol.

 

Exactly how does alcohol increase the chances of AF?

It isn’t clear why, but it is thought that hit might be related to increasing vagal tone. The more alcohol you drink, the higher the vagal tone. Another idea is that dehydration caused by alcohol triggers AF. A lot of people with AF know that alcohol can trigger their AF. Let’s face it – alcohol is basically a toxin with some pleasant side effects.

If you already are being treated for AF alcohol can interfere with the treatment – increase blood pressure, interact with anticoagulants, etc.

What is “Holiday Heart”?

Basically it is a nickname for the way heavy drinking around the holidays, so called “binge drinking” can trigger AF. According to Medscape:

Holiday heart syndrome most commonly refers to the association between alcohol use and rhythm disturbances, particularly supraventricular tachyarrhythmias in apparently healthy people. Similar reports have indicated that recreational use of marijuana may have corresponding effects.

 

The most common rhythm disorder is atrial fibrillation, which usually converts to normal sinus rhythm within 24 hours. Holiday heart syndrome should be particularly considered as a diagnosis in patients without structural heart disease and with new-onset atrial fibrillation.  Although the syndrome can recur, its clinical course is benign, and specific antiarrhythmic therapy is usually not indicated. Interestingly, even modest alcohol intake can be identified as a trigger in some patients with paroxysmal atrial fibrillation. 

Finally – what is meant by “Drinker’s Heart” (a.k.a “beer drinker’s heart”)?

That’s cardiomyopathy, a serious disease of the heart muscle, related to chronic heavy drinking. Don’t let it happen to you. It’s bad.

 

beerMPG

I would love to have any readers with comments post them below. I’d love to hear from  athlete’s with atrial fibrillation who have had experience with alcohol as a trigger. Thanks for reading.