SOB Trail Run 15K Race Report: Atrial Fibrillation, Running, Beta Blockers – My First Impression

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SOB Trail Run

I have been in permanent atrial fibrillation for a couple of years now, but only been taking an anticoagulant (Pradaxa). But things have changed and for the past month I have been on a beta blocker, carvedilol.

Prior to starting the carvedilol, while in permanent atrial fibrillation, I had been able to run two marathons and one ultramarathon (50K) without any more trouble than the normal marathon type suffering, but over the past six months I have noticed things have been changing. I’ve slowed down, even for me, and distances are getting harder. My last half marathon was a joke and I was at the end of the pack within the first two miles. After a run or mountain bike ride of an hour or more I would have problems afterwards – my blood pressure would drop and my pulse would stay high. After a long run, especially if it was a hot day (which they all are, recently) I would get so light-headed after standing up I sometimes had to grip onto something to remain standing.

A visit to the cardiologist, and a subsequent echocardiogram, revealed that my heart rate was increasing and my ejection fraction was decreasing, and for that reason the cardiologist wanted me to start on a beta blocker.

A beta blocker, in this case carvedilol, is a drug that reduces stress on the heart by slowing the heart rate, decreasing the force with which the heart beats, and reduces the tone of the arteries throughout the body. The end result is that blood pressure is reduced, as is heart rate. The heart needn’t work so hard.

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SOB 50 Mile Course – tough!

Some non-endurance athletes actually use beta blockers as performance enhancing drugs – it is said that it calms a person, reduces performance anxiety, and is commonly used in less endurance specific sports such as golf, target shooting, archery, and even in music performance.

Clearly these drugs are performance diminishing for endurance sports like distance running and mountain biking. We like to stress the heart, raise the heart rate, and we don’t have very much stress – we’re long distance runners after all – the mellowest people around.

I generally am in at least half marathon shape year round. Even if I’m not training for anything my weekend long run is going to be between nine and twelve trail miles. Prior to starting the beta blocker I had signed up for the 15K at the SOB Trail Run at Mount Ashland (Oregon) – one of my favorite races. This relatively high altitude run is basically all up and down trails and fire roads (zero flat sections) and I have done it at least six times in the past, including completing it twice in atrial fibrillation. I was curious to see how being on the beta blocker would affect my race.

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DNF

The answer was I DNFed (did not finish) and dropped out fairly early in the race. That was terrible – most of my friends were running the 50K or the 50 mile and I DNFed the little 15K???

The course at the SOB is brilliant, really. A lot of trail races start out right away on singletrack, but the SOB has about a mile(?) of fire road at the start so everybody has plenty of time to figure out whether they are going to be running with the fast people or the slow people before they hit narrow Pacific Crest Trail. I ended up at the very back of the group that was running, but I was still in front of the few people who were walking the 15K.

I found that as soon as the course headed up hill I was unable to run. My chest felt funny – not chest pain, just felt weak, not right, and my legs felt dead. I wasn’t short of breath, I was just unable to do it. I decided, in my typical OCD mode, to continue running for five more songs on my iPod shuffle, and then turn around and drop out, thinking that I should at least get a little bit of a work out in, and that I could justify keeping the T-shirt I had paid extra for. I knew I could have walked the course, but that is not what I went there to do.

I was delighted that the fifth song on my iPod turned out to be an oldie from my high school days: Yours is No Disgrace by Yes. Not actually I song I still like very much, but in this context it seemed like a cosmic pat on the back.

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A Cosmic Pat on the Back

On the way back I met a woman who was also DNFing (sprained ankle) and we walked the last section of the race together, commiserated, and removed our numbers so they wouldn’t mistake us for the top finishers. At the finish line we informed the race officials that we had dropped out so they didn’t need to send a search and rescue team to find us.

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DNFing and commiserating together as we remove our race numbers

So this article is, basically, my first impression of being on a beta blocker, in addition to the atrial fibrillation, and trying to remain an endurance athlete.

So far I feel that the beta blocker is more of a hindrance to my running and cycling than the atrial fibrillation alone had been – but then again, because of the atrial fibrillation my heart function is gradually diminishing.

I should say, on a positive note, that the beta blocker is working, and is doing what it is supposed to do. I check my heart rate and blood pressure at least once per day and since I started the carvedilol I am right where the cardiologist wants me to be. And I can understand why people who aren’t trying to be athletes might like the med – it seems to have a mild calming effect. Furthermore I no longer feel like my heart is a fish flopping around in my chest, and my post work out blood pressure and heart rate has stabilized.

I am optimistic that the carvedilol will be worthwhile and will help me preserve and regain my ejection fraction. But really, what choice do I have?

So here is how things have changed so far (compared to just permanent a fib without the beta blocker):

1.) As far as mountain and road biking is concerned I have been able to ride all the hills that I used to be able to ride, although I am much slower. My wife now has to wait for me at the top of a climb, and that’s fine. I am delighted I can still ride and don’t have to get off and walk my bike.

2.) Running is more negatively influenced. My previous slow pace is even worse, and hills are quite difficult. Not surprisingly I do not like this one bit. A slow jog feels like a 5K effort. But I am still able to run – Yay!

3.) Long runs in heat are not possible. I am just not able to do a long run in heat, and lately every day has been warm. Understand that I am a big red-faced Irish-American who considers anything over sixty degrees to be hot running weather; plus I live in a very sunny place, a high desert climate without a lot of shade. It is not surprising that this is happening. A normal person running in heat will have a higher heart rate for a given pace, and will need to slow down. If you are on a beta blocker that reduces the maximum heart rate by a significant amount, well: “game over.”

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My goal is to continue running and mountain biking on trails like this: Brown Mountain Trail

4.) I suspect that the beta blocker might be making me lazy. I don’t know if that is the right word, but I had a full day off in the middle of the week a while ago and I had planned on, among other things, writing this article and going for a trail run, and next thing I knew it was late afternoon and I hadn’t done a thing. What? By that time there was a thunderstorm so I was not going out for a run – but the article still hadn’t been started. I hope this is not going to be the case from now on. Being lazy and depressed is far from my idea of fun.

I am going to wait until I have had more experience with the beta blocker and write a better informed article. I’m going to sign up for a relatively flat (downhill, actually) trail half marathon and try to redeem myself.

In the meantime I would love hear about other people’s experiences with the dreaded beta blockers. Please post a comment below.

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Joe’s Story: A Middle-aged Runner Deals with Atrial Fibrillation and Heart Failure – A Guest Post by Joe

This is Joe’s Story – a guest blog article based on Joe’s comment on this blog describing his fascinating experience with atrial fibrillation and subsequent heart failure. Joe has really demonstrated persistence and a positive attitude that, I think, a lot of athlete’s with atrial fibrillation possess. Joe is making a comeback from serious, life-threatening heart failure, and he has done a good job of accepting the new reality of his post a fib performance.

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Joe Triumphant

Hi Everyone – I’ve had A-Fib for about three years now.

I live in the tropics and cycle, run, do weights. I train five days a week but not hard or too easy. I believe I got into this mess when I cycled up our small mountain here on the island I live on three times a week back then. I would only drink reverse osmosis cleaned water consuming about four liters just going up the mountain. I’d do weights in the morning and cycle in the afternoon and believe me it gets hot and humid. It’d take me about two hours to cycle up to the top of this very very steep course. (approximately 5K to the top)

In hindsight now I guess I’d been over-training terribly and not putting back potassium and minerals into my body at all. I happened by luck (or fate) to be given a heart monitor and thought it was cool to use it on my cycle ride up the mountain. I set the max at 185 and started off – as soon as I started up the steep hill after a five kilometer preamble the damn thing started beeping – it was at 205 and I just started up the hill! Like an idiot (ha ha) I kept going and it would not shut up. Did it the whole way up and for the next month it was like that. Can’t believe it now I did that but as I’m in constant A-Fib now the reality speaks for itself.

Been put on beta blockers and have to take warfarin. I suffered a sever influenza sickness last year and it really took a toll on my ticker. My left ventricular ejection fraction (LVEF) was only 17% when I finally went to see the Cardiologist here as the echo showed.

Fast forward now to a month and a half and I’m back up to 35%. The goal is to get back to 55%! I love running and exercise and like some of you wrote would rather plonk on the trail then sit on the couch, so be it. I used to run with the goal of just finishing the run and was happy about it.

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This is Joe’s heart on heart failure

Then I got into times, was happy about that too. Before my illness last winter my times were at my all time best. Slow for a lot of runners but for me great. After all I run to please me so I accept what ever pace I come home at. Not a biggie. The doc was amazed at how fast my heart recovered and I even saw the difference on the screen of my heart’s movement. The echo I had before it looked like Jabba the Hutt sleeping. I think I attribute this to doing a LOT of research on the internet getting informed of what I was dealing with and trying it slowly with my Doctor always in the know. He was very skeptical of the supplements I was taking but has done an about face now. I also believe the coconut water I drink everyday now has helped in a big way. I noticed I don’t have an ammonia smell anymore when I sweat. I always had that smell when I drank the Osmosis water. I drink a mineral water now along with the Coconut water.

Anyways – I do prattle on. The thing is not to Panic and get informed!

I wear a Polar T-80 watch with GPS and follow the Zone rules. Yeah, I’m running about four minutes slower than normal but I feel great after a run now and do not dread the next one. Hoping my pace will kick up a notch as the info says it will as the body adapts.

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This forum is great may I add and it sure is reassuring to read of Peep’s in their 80′s who’s lived with A-Fib for 20 or so years and keep running. Hopefully one day soon someone will find a cure for this curiously annoying ailment.

When I had 17% ejection rate it happened really fast. The time line is like this: on a Friday I ran a very fast 5K run for me. One of my best times. Later that day flew to spend three days with a friend, and after returning home I got ill and by Wednesday was full blown into whatever ailment I had (Influenza?). I tried running a week later but could not even go further than 50 yards! Then I stopped and decided to rest a week, do nothing and fight this illness. Well, it got worse and worse – my lungs started filling up with fluid and at night I could hear bubbling in my lungs. Fast forward a week of no sleep, etc, etc, and went to a doctor was put on antibiotics. I didn’t get better, still the same symptoms. (Turns out the heart, because of it not beating properly causes the fluid to back up and then it seeps into the lungs so any of you with these symptoms see a doc. You can do a thumb press on your shin and if the indentation stays and is deep you’ve got fluid retention and need a diuretic).

After a couple more weeks of this I decided because of previous symptoms I felt there was something wrong with my heart again. Seemed to be doing the same old symptoms of A-Fib. I thought I was free of it for almost two years or else it was Silent A-Fib and I did not know it!

My cardiologist gave me an echo and all he said was “What did you do?” Man, you don’t want to hear that from your doctor!

Like I said before I even could see my heart wasn’t doing anything. Just sort of sitting there: legs up – arms crossed!

He put me on meds again and the dreaded warfarin. They worked almost right away! I was on Codarone (amiodarone) for only a month and everyone should know that this is a dangerous drug! Long half life and it’s like shaking hands with the devil. Used a lot as a last resort. But! – for short periods it works miracles. Using it over six months or more can have repercussions.

Well, that day I came home from the doc’s I tuned up my mountain bike and went for a very short ride. I was out of breath the whole time. Did this for a couple of weeks and got stronger. Started weights again, and just started using the bars with no weights. Did this very very slowly and now after two months I’m almost back to benching 200. (ha ha – good for me anyways) The last check up the doc said my heart (Left ventricular ejection fraction) was up to 35% and I saw the difference in the video as well! Made me feel very very happy.

So now I’m trying something I never thought I’d do. I bought a Polar T-80 Heart monitor with GPS and run and cycle in the Zone. I exercise according to my heart rate. I’m finding I’m no longer exhausted during the rest of the day and overall feel better, stronger. It’s taking time to lose that competitive spirit though – ha ha ha – I’ve got friends who are in their 70′s running faster than me. My slowest times in years but I’ll stick to it and see if my times automatically come back up as the research suggests. This has to be done. I love being active but I hate being dead more so I have to accept and live accordingly. Don’t Panic!

A heart pumping at 33% efficiency feels a lot better than 17% I can tell you. I do more things than most of my friends. It still amazed me though how I can do weights for a hour, run for an hour then eat, chill and later in the day walking up a flight of stairs takes my breath away. It’s like a reminder – oh yeah I’ve got heart problems. A friend wisely told me that it could be like losing weight: fast in the beginning; then slower. I hope my ejection fraction % will keep increasing till 55%. Considered normal. Then I’ve got to deal with the A-Fib.

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Joe still the life of the party – but no more beer for this guy!

A very important footnote: I used to drink beer everyday for years! Love the amber fluid. After my first A-Fib about five years ago I stopped for about three months. Then about two years ago I only drank on Friday and Saturday. For two years I did this. No exceptions. I’m 51 now and even this was taking it’s toll I believe. Now I’ve cut it out completely and will go the distance – sort of sucks but I’m close to the three month period now and will keep going. My next visit to the docs is in August so I’ll hopefully remember to post what transpires.

If anyone is interested in what I’ve been taking for supplements, eating, drinking, and exercising please leave a message on this blog and I’ll be most happy to share. One thing I’ve always found frustrating with most blogs is when I’ve read what someone has done and it worked there was no follow up. I’ll try and keep posting on this one. Great site! Peace out…………… don’t Panic : )

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Update (from Joe)

Hi everyone. Went for my one month checkup at the cardiologist today and the results were better and improving. The Doctor said my heart has shrunk by a noticeable margin which is a good sign. (had an echo) It’s getting stronger. The ejection fraction went up a bit as well to around 37%. Getting nearer to 40% then in a few months hopefully 50 or 55%!! I was also able to wean off one med by half. I felt it in my run today – a really great run. Will continue on meds and supplements plus exercise and diet as is for another month. See ya then!