Jim and Alison’s Story – a Guest Post by Alison

Note: I had originally intended to post the article about atrial fibrillation and alcohol today, but I’m going to hold off and post, instead, this excellent guest post from Jim and Alison. Wow – I can’t relay relate to their story! Please comment below.

Jim Competing in a Triathlon

My husband Jim started running 35 yrs ago.

He and a neighbor were doing races for fun. At 6’2 with a swimmer’s build he had always been active with distance hiking as a teenager and as an adult he added martial arts, weight lifting and biking.

Once the kids were on their own we had more time to devote to our love of running and hiking, soon discovering the incredible joy of trail running and hikes rated ‘Very Strenuous’. We traveled across the US to hike and even started to explore trail running and hiking in the Alps. Jim added triathlons and spent most of his free time working hard to maintain that level of fitness. Then he began “hitting a wall” during runs and hikes. We would laughed it off, he would eat an energy gel, and then pushed on through it. We had all kinds of reasons for “The Wall”. We even changed the term to a “Flat Tire”. Some excuses were: Didn’t sleep well the night before, needed more carbs, exercised too much the day before, and the list goes on.

What raised a warning flag was when we ran a simple 5K fund raiser where he worked. It was an out and back and as always he quickly disappeared ahead of me. Soon the fast runners began appearing on the return side, but no Jim. As I approached the turn around point there he was walking and looking awful. We both didn’t laugh this time but he seemed fine later that day. Something was wasn’t right, but he was fine…right? The “Flat Tire” problem continued on and off. Then one day while lifting weights in the basement he came to the top of the steps looking ash grey, swaying unsteadily and saying “Something is wrong with me! My heart is beating weird.”

Pumping Iron

 

At the General Practitioners office the Nurse Practitioner brushed it off that he must have stood up too fast. She never took his pulse or blood pressure. After all he obviously looked in excellent shape!

I called a cardiologist group from a University in our area for their take on this and when I briefly explained what had happened they said Jim needed to be seen the next day. Wow! I felt a twinge of anxiety. At the cardiologist office there were no smiles from the doctor seeing Jim. Jim was given an EKG and asked many questions about his medical history and life style. Then oddly the doctor asked him how long had he been an athlete. We both looked at each other and chuckled ! Jim quickly corrected him, “Oh no! I’m not an athlete! I’m just having fun running, doing triathlons and hiking. It’s a good stress release too.” I was nodding with a big smile in agreement.

The doctor unsmiling replied “Triathlons too? So your an endurance athlete then with many years of distance running.”

We both stared at the doctor confused. Then the doctor grabbed the EKG paper and waved it at us sternly stating, “You have serious heart disease!! Your heart rate is very high, blood pressure high and your heart is in arrhythmia!”

“That’s impossible!” I protested, “Jim is in really good shape! He doesn’t even have a gut and he’s only 56!”

The doctor glanced up from his paperwork at my shirtless husband sitting on the examination table and said, “Yes he is in good shape, but his heart isn’t!”

I found myself starting to argue with the doctor and stopped. He was obviously used to the denial routine and was ignoring me.

So we sat there slack jawed for about 15 minutes as the doctor explained how Jim had gone way passed the point of moderate exercise benefits. He told us about the scarring, inflammation and the damage caused by not resting during long runs and pushing through tough workouts. And how many other people had, and were, doing the same thing to their hearts. Oh, and that shot of fine bourbon he so enjoyed every night? No more. We learned that alcohol is poison to the heart muscle. 

We’d never heard of any of this before, nor did we even consider ourselves athletes. The years of Jim enjoying his passions weren’t adding years to his life but were shortening it! I wondered if I’d damaged my heart as well. I get “Flat Tires” all the time, jeez…. Hiking was our joy in life together! We couldn’t just stop running and hiking. It was part of who we are!

We left the doctors office silently with scripts for blood work, several different cardiac tests, and prescriptions for a blood thinner, as well as a medication to reduce his heart rate. All of this to lessen his chance of stroke. Appointments were made with other doctors in the cardiology group as well. (Our care was excellent, by the way.) Jim was told he could still workout but not to push. With any luck he could stay this way for the next three maybe five years before needing an ablation. That sounded very scary! Your going to burn what?!!Where?!!

Jim was handed a wallet sized laminated card with a copy of his EKG on one side and the doctor’s business card on the other.

“Please call us immediately if you have any problems. One of our team will meet you at the hospital. Give this card to the ER personnel.”

Really?!!! Wow!!! WTH?? Well, at least he might have three to five years, so everything’s ok….I guess… right?

One of the tests revealed a slightly enlarged heart. We were told again the ablation would help the AF, a temporary fix, but there was no cure. The ablation surgery could also make it stay the same, or it could make it worse. We both figured he had a few years before it got worse so we decided to wait. Unfortunately we didn’t have the five years or even three – Jim’s problems increased rapidly. He started having trouble going up the stairs at work. He was getting more and more tired. There were days where his face looked grey and haggard. His heart beat wildly in his chest. He began spending more and more time having “lazy days” where he would spend all day laying on the sofa watching tv, too dizzy and exhausted to do much else. Sleep was difficult as his hearts crazy beats kept him awake.

Interestingly family insisted he was fine! Not Jim! He’s in great shape! Wish I looked like him! He’s just stressed and needs to take yoga classes! So we had no much needed support. His episodes of AF were soon lasting for days. He was in AF more then out. I stopped tracking it on the calendar. Jim’s mood tanked. During the autumn of 2016 he decided he wasn’t going to let this best him so we went away to hike in the Blue Ridge mountains. The ascent that should have taken us three hours took almost six. I watched my husband frustrated and angry as he struggled to get up that mountain. I don’t know how many times I had to stop and wait for the man who always used to have to wait for me. The next day he was too weak to leave the car for an easy three mile hike to an overlook. I realized our time in the outdoors was now over and so were all our plans for good times.

Jim decided he wanted the ablation surgery.

He retired from his job before the surgery. Having already buried our son, Jimmy, several years ago from the war, mortality wasn’t the stranger it is to most people. We even had an intense discussion with the surgical team right outside the operation room over the forms Jim had signed. Apparently they don’t tell you everything that they are going to do during the ablation! Jim had a DNR order.

“I don’t want to be resuscitated if my heart stops,” stated my husband. But as it turns out, if the heart doesn’t reset itself after the ablation then the doctor will shock it back into rhythm, which in fact stops the heart, albeit but a moment. It was finally agreed that as long as Jim didn’t come out of the operating room worse then before he went in the team could do whatever they felt necessary.

 

He’s Primarily a Hiker Now

It’s been almost a year since the surgery and Jim only has that flipping feeling several times a week and his energy is back. He prognosis is: If he goes one full year post surgery without going into AF then he has a 70% chance of staying AF free for another three years. So we are back enjoying our hikes! But now we have put a limit on them. Six hours or ten miles whichever comes first, pace: 2.5 mph, not 4 mph. Plus the doctor recommended break every hour. We both gave up running. The doctors said he could still run but we already know he has damaged his heart enough and don’t need to hurry the AF back any faster then need be. As it will return! One of our doctors said, “Once in constant AF the heart wants to stay in constant AF.”

Advertisements

Cycling and AF Blog

John’s Bike

I’d like to recommend that readers of this blog take some time to check out the Cycling and AF Blog , if you haven’t already done so.

In this easy to read blog, with generally short entries, you’ll read of the personal journey of a middle aged road cyclist /club rider from England.

His atrial fibrillation (AF) began with some vague  symptoms in 2015, eventually diagnosed as AF. Follow his personal journey dealing with alcohol, coffee, diminished cycling performance, beta blockers (and other AF drugs), two ablations (!) and an Atricip procedure.

I think readers of this blog will find his journey interesting. Based in England the healthcare system is different, as are some names – a TEE (trans-esophageal echocardiogram), for example, is a TOE (trans-oesophageal echocardiogram).

I would certainly like to learn about the Atriclip procedure – I’ll research that and post about it in the future.

Speaking of alcohol – I’m planning my next blog post to be about alcohol and AF.

I hope you enjoy the Cycling and AF Blog as much as I did.

This is me, in AF, riding around Crater Lake

Endurance Sports and Atrial Fibrillation – WHY?

Endurance Sports and Atrial Fibrillation – WHY?

starting a long run on the local PCT. We saw a bear that day – fun.

Exercise is supposed to be good for you, good for your heart, right? Then why is that endurance athletes have two to ten times the rate of developing atrial fibrillation compared to “normal” people? Is a little or moderate exercise good but excessive exercise bad? As an endurance athlete (marathons, trail running, long distance mountain and road biking) who has permanent atrial fibrillation (AF) I would certainly like to understand “WHY?”

There is a terrific article on Europace entitled Endurance Sport Practice as a Risk Factor for Atrial Fibrillation and Atrial Flutter . By internet standards it’s a long read but I will review it here.

The studies aren’t large, and male athletes predominate – but it is clear that endurance athletes have, as mentioned above – 2 to 10 times the likelihood of developing AF. It is not actually known why but it is thought that ectopic atrial beats, chronic inflammation, and larger atrial size are all risk factors.

Personally – the story checks out – I started having runs of “premature atrial contractions” years before ever going into AF, and because endurance athletes train more frequently and tend to avoid rest the atria are chronically inflamed, which leads to fibrosis (scarring) of the atrial muscle. And of course my left atrium has been severely enlarged for decades – not as much because of sports but because I had previously had mitral regurgitation (repaired surgically 1994 but the atrium never shrunk back to normal).

But even without the mitral valve issues endurance athletes tend to have enlarged atria. And we don’t rest enough leading to inflammation and scarring. The Europace article cites several studies that link long term endurance sports with AF, compared to sedentary individuals.

Moderate exercise may actually protect against AF.

Ringo after a long run – Fremont Trail

The Europace article also cites studies that show a correlation with “occupational physical activity” and AF – meaning people that have difficult, physically demanding jobs are also in the same boat as endurance athletes.

I didn’t know this – there is also a higher rate of AF related to how tall a person is – damn! I’m 6’3” (or 6’4” – depending on what year was measured.)

The article discusses, speculates, as to the mechanism of AF in the athlete’s heart but much of this is a bit technical for this blog. Feel free to explore the article if you are curious.

The typical clinical profile of sport-related AF or atrial flutter is a middle-aged man (in his forties or fifties) who has been involved in regular endurance sport practice since his youth (soccer, cycling, jogging, and swimming), and is still active. This physical activity is his favourite leisure time activity and he is psychologically very dependent on it. 

Interestingly the AF rarely occurs during running:

They almost never occur during exercise. This makes the patient reluctant to accept a relationship between the arrhythmia and sport practice, particularly since his physical condition is usually very good. The crises typically become more frequent and prolonged over the years and AF becomes persistent. Progression to permanent AF has been described by Hoogsteen et al .

Again, for me, the story checks out. I certainly recall long episodes of palpitations at rest that I now can identify as AF – until the day when it became (dreaded) permanent AF!

The article suggests that abstinence from sports is helpful for athletes having episodes of AF, although it isn’t curative. The problem, as any endureance athletes knows, is that it is nearly impossible to get us to give up our long runs, bike rides, etc.

Other therapeutic measures are also discussed – but that is a talk that is best left to the runner and the cardiologist.

Although ablation seems to be quite effective, endurance sport cessation associated with drug therapy seems to us a more suitable approach as an initial therapy, particularly in non-professional, veteran athletes.

To conclude I’m just going to quote their conclusions right here:

Vigorous physical activity, whether related to long-term endurance sport practice or to occupational activities, seems to increase the risk for recurrent AF. The underlying mechanisms remain to be elucidated, although structural atrial changes (dilatation and fibrosis) are probably present. There is a relationship between accumulated hours of practice and AF risk. Further studies are needed to clarify whether a threshold limit for the intensity and duration of physical activity may prevent AF, without limiting the cardiovascular benefits of exercise.

I’d be interested in others opinions and experiences with these issues. Reading this article was a little emotional for me – like I said – the story checks out! I guess that if I knew what I know now I might have cut down a little on the endurance sports before I was forced to do so by permanent AF. Truly, for me, a day long run with my dog, on a trail, in a local wilderness area was the most enjoyable thing I can imagine. And at this point it isn’t even the AF preventing me from still doing it – it’s the  high dose of beta blocker I take for rate control – really takes the wind out of my sails.

 

 

“C’mon Boss, let’s go for a trail run!”

Bariatric Surgery Lowers the Risk of Atrial Fibrillation

Bariatric Surgery Lowers the Risk of Atrial Fibrillation

I’m not sure how much this applies to endurance athletes, but I found this interesting. As, I think, everyday knows, obesity increases the risk of cardiovascular disease, and that includes atrial fibrillation. Researchers in Sweden recently published a study where they followed 4200 obese individuals with normal sinus rhythm (ie. not in a fib at the beginning of the study) for an average of nineteen years. During that period approximately half of the subjects had had bariatric surgery – basically various surgical procedures to rearrange the internal organs to force the patient to eat less and absorb less resulting in significant, life-changing weight loss.

The study found that 12.4% in the surgery/weight loss group experienced atrial fibrillation compared to 16.8% in the non-surgical/still obese group. That’s a 29% lower rate of developing atrial fibrillation for the surgery/weight loss group. Furthermore the study also concluded that, “Compared with usual care, weight loss through bariatric surgery reduced the risk of atrial fibrillation among persons being treated for severe obesity. The risk reduction was more apparent in younger people and in those with higher blood pressure.”

(Citation is HERE)

Other studies have shown that weight loss can be helpful in reversing atrial fibrillation and that ablation success rate is improved with weight control. I don’t have literature citations but I read this here.

So what does this have to do with endurance athletes with A fib? All endurance athletes are already thin, right? Well, obviously that isn’t true; but probably very few endurance athletes would meet the criteria for bariatric surgery. So we should be in the low risk group to begin with – so why do so many endurance athletes end up in a fib?

Well, as everybody knows distant runners and other endurance athletes often gain weight when they have to quit or reduce exercises because of, say, atrial fibrillation. These studies suggest better outcomes with weight control regardless of method.

As to why endurance athletes have a higher rate of A fib – I’ll address that in next weeks post.

Thanks for reading – please feel free to post comments below.