Rejoice – Not All Runners in Atrial Fibrillation Are Slow

Posted on December 27, 2013 by michaelpmccullough

The thing I enjoy most about the afibrunner blog is comments from other athletes who are dealing with atrial fibrillation. A recent comment from a runner (we’ll call him “Lon”) really caught my attention – here is a runner who, while in atrial fibrillation, was able to race at six minute mile pace (or better).

Here are some excerpts from his comments:

Way to Go!!!
Since 1983 I’ve run/jogged 59 full marathons and have suffered with A-fib on and off for the last 12 years. I’ve finished the Boston (2001 in 3:23) and NY City (2005 in 4:15) marathons while in constant A-fib while carefully monitoring my heart rate. My cardiologists encouraged me to run marathons and also triathlons. One cardiologist told me that my heart is so strong that it laughs at A-fib and that I have the heart of an olympic cyclist. For the first 6 months of this year my heart was in constant A-fib that no drugs or multiple cardioversions could put it back into normal sinus rhythm. On July 9, 2013 I had the “Wolf Mini-Maze” (at the International A-fib Center of Excellence in Indianapolis) operation done on my heart. It was a great success and my heart has been in constant normal rhythm ever since (nearly 6 months now and I’m not taking any medications). In the Mini-Maze they removed my Left Atrial Appendage (LAA) so that if my heart ever goes back into constant A-fib I will NOT meed anticoagulant therapy. As you likely know life threatening blood clots tend to form in the LAA when your heart is in constant A-fib. The risk of stroke over the life time of an A-fib patient is huge. 3 out of 5 A-fib patients will suffer a stroke in their life even while taking anticoagulation meds like coumadin. That is a statistic that your doctor will not likely tell you about. Coumadin is over rated and is simply not very effective for some people which should be a terrifying realization to anyone dealing with A-fib. Anyway, as much as I love marathons, I’m laying off the long distance jogging for a while and am just jogging 10K’s (one per moth and 3 sprint triathlons this Summer) as well as several other physical activities.
Good health to you!
Lon

I have lamented that atrial fibrillation has made me slow, while openly admitting that I started out slow – I’ve only ran, as far as I know, one six minute mile in my entire life – and that was thirty years ago.

Finish Line – Eugene Marathon

My understanding about atrial fibrillation is that the atria no longer preload the ventricles, and most people have a decrease of about 20% of their cardiac output. While sedentary people might not even notice this athletes certainly would. I do!

But I have heard that in some patients, certain athletes, there is little change in cardiac output and atrial fibrillation will not affect performance much. Lon seems like one of these fortunate people. Lon’s point about the increased risk of stroke (even if you take your Coumadin, Pradaxa, or Xarelto) is well taken – and I’m guessing that that is why he continued to pursue an effective treatment for his atrial fibrillation.

Finish Line – Haulin’ Aspen Marathon

But after all those marathons Lon states he is no longer running endurance events – he goes on to elaborate:

Here’s a little more. I tried not to make a long story short above. I left out mentioning that I had a radio-frequency catheter ablation in June 2010 in Seattle that worked great in keeping my heart in normal rhythm until December 2012 when suddenly for no apparent reason went into persistent A-fib. (During that 2 1/2 year period I finished 9 full marathons and 8 sprint triathlons) My heart stayed in persistent A-fib even after 4 cardioversions and large doses of amiodarone. My cardiologists in Seattle told me that I should accept my persistent A-fib and they offered to ablate my hearts pace makers (AV and SA nodes) and give me an electronic pacemaker so that my heart rate can be controlled. That told me that I needed a second opinion so I started communications with Dr. Randall Wolf in Indianapolis about his Mini-Maze procedure. After consultations with an E.D. doctor (and a championship Iron Man triathlete) who had the Mini-maze operation and was very happy with the results, I decided to get the Wolf Mini-Maze and of course I informed my Seattle cardiologists of my intentions and they said to go for it. Absolutely the main reason that I went for the Wolf Mini-Maze is that it removes the left atrial appendage which brings my risk of stroke down to that of a healthy person with a normal healthy heart while not taking any anticoagulation drugs. The fact that I now enjoy a normal heart beat is just a huge plus factor.

From 1983 until December 2012 I completed 61 full marathons a most of which ran with all out efforts (I’ve averaged sub-6 minute pace all the way). I’m now finding out that long distance running is simply not good for the heart and most likely caused my A-fib problem.

Google Dr. John Mandrola’s 18 minute video called “Cycling Wed: I told you so…”. It is very illuminating and a must see for all endurance athletes. Please check that out.
Cordially,
Lon

I don’t know much about the Wolf Mini-Maze procedure and don’t necessarily advocate it for everybody, but clearly it worked in Lon’s specific situation. Here is some information regarding the Wolf Mini-Maze.

Finish Line – Lake of the Woods 15K

No need to Google the video by Dr O’Keefe (posted on Dr Mandrola’s blog) I have the link right HERE.

Here’s the video:

If you don’t feel like watching the eighteen minute video I will summarize it for you – Exercise is good for you but in moderation. Too much or too intense exercise causes chronic inflammation of the heart and can ultimately harm the heart (atrial fibrillation, among other risks).

But if you are an endurance athlete dealing with atrial fibrillation you already know this – surely you have had a dozen or so friends and relatives, possibly sedentary and/or obese, kindly forward you information about the study he refers to – as if to justify their seemingly wise choice to avoid marathons and triathlons and replace it by watching other people play sports on television. Yes, this study was in all the newspapers and magazines last year.

Finish Line – Avenue of the Giants Marathon

Please understand, and I paraphrase here, that Dr O’Keefe states that exercise is good for your heart, and being obese and sedentary is bad for your heart – but that overdoing it is a problem. He didn’t say people should avoid exercising.

My choice – I understand the concept of the “law of diminishing returns” as well as the next guy; but for me, well, I enjoy long, slow trail runs and mountain bike rides more than just about anything else I can think of – so I chose to continue.

Finish Line – Bizz Johnson 50K (I completed the 50K in atrial fibrillation)

Oregon Outback Bike Tour and the OC&E Woods Line State Trail

Posted on December 13, 2013 by michaelpmccullough

(Sorry about the lack of atrial fibrillation content in this post.)

I am considering participating in the 2014 Oregon Outback bike tour. I love the concept of the Oregon Outback tour – it is a 360 mile unsupported bike tour, most of which is on remote dirt roads (and trails) in the barely populated Eastern part of Oregon (commonly referred to as Oregon’s Outback).

The best part is that the beginning of the ride, the first seventy five miles or so, is on the OC&E Woods Line State Trail – a 100 mile long Rails to Trails project that is a long, narrow Oregon State Park.

OC&E Trail

I live near and use the OC&E trail a lot and have trained for about twenty (?) marathons on it, and frequently ride bikes on it as well.

I’ve logged thousands of miles on The OC&E – not really because of the scenery, but mostly because it is nearby, the ideal surface, the mile markers every 1/2 mile, and because it is a place where I can run with my well-trained dog off leash. Plus I’m totally used to it.

I have a ton of photos in my Flickr set.

The trail was originally a logging railroad, beginning in 1917, and was used by Weyerhaeuser to transport logs and lumber from Bly, Oregon (where they once had a sawmill) and areas East of Klamath Falls to their main mill and the main railways in Klamath Falls. As everybody know the logging industry isn’t what it used to be and the railroad was shut down and “rail banked” in 1992.

I can give a little background on the development of the trail – I was part of the original group that developed the trail back in 1992. There were about nine of us that were part of an organization supporting the trail and we had plenty of opposition. Most notably there was an opposing group consisting 150 well organized adjacent land-owners that fought the establishment of the trail. They gave a number of reasons for their opposition, including a lot of concerns for privacy, and worries about potential criminal activity on the trail; but I always felt the real reason was that if the land wasn’t rail-banked the adjacent land-owner would get all the land back for free – that’s a strip of land 100 feet wide and about a hundred miles long.

Ringo on the Roof

I never really thought the trail would happen. There were other groups opposing the trail including a group that wanted to leave the rails in place and build a recreational railway – train rides for tourists. We never even bothered opposing that idea because we knew that Weyerhaeuser had already sold the ties and the rails for the highest price ever to a salvage company – 4.5 million dollars (1992) and the excursion train people would have to buy them back from the salvage company. I don’t think they had anywhere near that kind of cash.

Probably the least pleasant group opposing the trail was the Nature Conservancy. They own a large portion of the Sycan Marsh where the Woods Line portion of the trail passes. This is the most remote and least used portion of the trail. The biologist’s concern was that the train tracks, which are on a raised ballast, divide the wetland into two distinct eco-systems with slightly different gene populations – certain creatures couldn’t cross from one side to the other. I never quite understood why that was a problem, but evidently it was. For some reason we thought the Nature Conservancy would be in favor of a recreational trail – after all they are a nature conservancy, and who doesn’t love nature, the great outdoors, hiking, etc. – but no – they wanted the entire rail ballast removed and NO TRAIL.

I have never actually been on the Woods Line section of the trail. To this day that section of the trail isn’t used as much as the sections near town.

When I saw the photos of the tour directors of the Oregon Outback wading through the water in the Sycan Marsh I immediately understood the purpose of those breaks in the trail – that must’ve been a compromise with the Nature Conservancy. Now the little creatures can frolic and canoodle with the little creatures from the other side of the tracks – brilliant!

Taking a Break

Anyway – given all the opposition to the trail I never really believed it would happen; but it turns out the trail became a reality in 1992. The way I see it the real powerful people in the world (like the railroads, the power company, telecommunication companies, etc.) liked preserving the right of way so they could rebuild railroads, or put up power lines, or communications cables, or whatever, without much problem. That’s the goal of rail banking – to preserve the right of way for projects like railroads, pipelines, telecommunications – and little community forums and debates are, I believe, just for show – big companies run the world. It makes sense – after seeing the level of opposition the adjacent landowners raised for the trail on existing right of way it would be unimaginably difficult to build, say, a pipeline through that property if they owned it – it would take years of lawsuits and expensive land purchases. One hold-out landowner could cancel an entire project. Rail banking makes it less complicated.

And in the case of rail banking outdoor enthusiasts benefit. And the community can benefit when folks like the Oregon Outback group or Cycle Oregon decide to use the trail.

I was fortunate enough to tour the trail via one of those trucks that rides on rails after the railroad was closed but before the rails and ties were salvaged. It was a wonderful day and a chance to see the entire route in one morning with a picnic lunch in Bly, Oregon to boot. Our group did a similar tour of the Woods line portion but for some reason I missed that one. I still want to get out there and see the large treacle that remains from the railway days.

Jan and Her Sister-in-law

The trail has quite of variety of personalities. The first one and one half mile is unpaved (last time I was there) and passes through an industrial area, including some switching yards and some transient camps. This area is infrequently used by joggers, etc.

From the 1.5 mile marker to the 8.5 mile marker the trail is paved and first passes through a commercial area of Klamath Falls and then the “South Suburban” area. This is the most densely used portion of the trail and local people walk their dogs, roller blade, ride bikes, jog, walk – you name it. On a nice day I’ll encounter dozens of people on this section; I frequently ride my road bike on this section but generally don’t run there because I prefer to run off pavement plus I like to run with my little cow dog, Ringo, off leash.

My favorite and (personally) most frequently used sections are the section from Reeder Road (6 mile marker) to about the 13 mile marker (past Olene,Oregon) and of course the Switchback Mountain section near Sprague River, OR.

Ten Mile Marker

Olene is a “town” that has about three or four houses and one store. There is a nice parking area there that I use as a headquarters for long runs (like the twenty mile runs that are part of a marathon training program). I will do a number of “out and backs” starting in Olene and use my truck as a resupply depot to refill my hydration pack after ten miles or so, and also restock things like carbohydrate gels and electrolyte supplements.

Horse riders often like to park their trailers here and start their trail rides in Olene, including people with tiny miniature horses they use to pull little carts.

Little Horses

Another good starting point is the picnic area at Switchback Mountain near Sprague River, Oregon. This is a unique section of rail trail – the train would do a “double Y” switchback in order to get over the mountain – as far as I know it was the only railroad in the United States that did so. This is the only hilly section of the trail and for that reason is a great place to train if a hilly race is in my future. Plus it is adjacent to “Devil’s Garden” which as one might imagine is an area of spooky lava rock formations – a fun place to explore. Switchback Mountain is thirty-five miles from Klamath Falls so it only works as a starting point if I have enough time to drive that far.

The actual quality of the trail surface is quite variable and runs the gamut from exquisitely paved to extremely overgrown and rocky. The highly used areas are generally very peasant to run on – but once the trail gets past Sprague River, Oregon there are a lot of hazards including large clunky chunks of ballast rocks, overgrown weeds and sagebrush, and of course cows.

I have been chased, once, by a young bull out there. Mostly I encounter herds of cattle that just stare and refuse to move, or else they follow me after I pass. In general they don’t mind me, but it’s my cow dog they could do without.

After Work Ride Near Olene

Other animals along the trail include the usual suspects for our area – jack rabbits, coyotes, badgers, deer, antelope, mountain lions, bears, turkeys – but primarily cows and horses.

A friend of mine recently ran (in sections) the entire OC&E including the Woods Line. It was an all Summer project for him. He said he met quite a few cows out there. I have ran or ridden most of the OC&E excluding the Woods Line.

I’m attracted to the Oregon Outback ride because I’m intrigued to keep going, to break past the limited area that I’ve been running and explore the entire state beyond the OC&E trail – all the way to the Washington border – wow. Sounds like a great adventure.

Race Report – Bizz Johnson Trail Marathon, October 13, 2013

Posted on October 16, 2013 by michaelpmccullough

Runners at the starting line 2013

This year, October 13, 2013, was my seventh time running the Bizz Johnson Trail Marathon. My first time was in 2007 and I have ran the event every year since then. Last year I ran the 50K (31 miles), but it is pretty much the same course, just 5 miles longer.

Has anybody reading this blog knows I have been in persistent atrial fibrillation for the last two years. For the 50K last year, and the marathon this year, I was in known atrial fibrillation. I am pretty sure that I went into atrial fibrillation about two thirds of the way through the 2011 marathon. At least (in retrospect) it felt that way, but that was before I knew I was afflicted with this dysrhythmia.

It took a long time to get to the finish line this year

The course of the Bizz Johnson Trail Marathon is well known to me and I enjoy it a great deal. The Bizz Johnson Trail is a rails to trails project, and is about 24 ½ miles long. For that reason the race begins with an out and back on a Forest Service fire road in order to make the marathon and official 26.2 mile run. Once the runners get on the actual rail trail the course is a gentle uphill until about the 6 mile marker at which point there is a 20 mile downhill section. This might sound like it’s easy, but remember, it’s a run not a bike ride. This is the only race where afterward I typically have a lot of quadriceps and heel pain from all the downhill.

Except for the portion where the trail crosses the Susan River Canyon the grade is very gradual. Trains evidently are unable to go up or down anything that is too steep, and the average grade is below 1%, and at its steepest probably about 2%. This is an estimate, I’m really not sure of the exact grade. One thing I can say, though, is that the steepest downhill is the last 6 miles down the Susan River Canyon. This is also where the course is the most scenic (including two tunnels) and often this section is quite warm.

This year the deciduous trees were changing and it was quite beautiful.

Along the course (No deciduous trees here – sorry)

Some people worry about the elevation at Bizz Johnson, but to me that isn’t even a factor. I live and train at the exact same elevation as the Bizz Johnson Trail. As a matter of fact I do almost all my training on mountain biking and hiking trails which are much steeper and more technical than the Bizz Johnson Trail.

I have to admit I had a bad time this year. I don’t think it had anything to do with the atrial fibrillation per se, I think I worked myself into a bad attitude, or bad mental state this year – ruminating over certain past events on the two and a half hour drive to Susanville the day before the race. Also I had trained for the 50K, but I really didn’t feel up to it and the day before the race I switched to the regular marathon. This probably was a good move, but I felt somehow depressed over that choice.

I’m not sure how many marathons I have ran, but it’s somewhere between seventeen and twenty races. There comes a time in every marathon where I start to feel poorly, but usually I don’t start to feel that way until somewhere around mile twenty-two or twenty-three. For some reason at this year’s Bizz Johnson I started to feel that way about mile six. “It’s going to be a long day,” I told myself.

Ultimately I completed it, I suffered like an animal, but I lived to fight another day. It’s interesting that I finished it at almost the same time that I finished the 50K last year, that is taking into consideration that the 50K starts an hour before the regular marathon. My recollection of the 50K last year is that I felt much better, surprisingly, throughout the entire race than I have during any previous marathons. Maybe I should stick with 50Ks.

My friend Stephen, who ran the race this year as well, said he suffered like an animal as well, and that “it seemed like every mile hurt.” But then again he finished several hours ahead of me, came in seventh place overall, and won his age group. It was probably worth it.

Sometimes I wonder – am I good at marathons? Maybe. Maybe not. I’m certainly not fast. Seems like I did a good job, the night before, sitting in a motel room watching sitcoms. Maybe I’m better at something like that. Well, I guess I’ll have to keep trying marathons until I get one right.

Finishing the 50K last year

Being a veteran trail runner who has to be self-reliant, except during a race, I carry my own water. I use an Ultimate Design WASP hydration vest, with NUUN tablets added for electrolytes. I refill it at the water stops if necessary. This year, for some reason, I figured I should probably drink some of the electrolyte drink that they offered at the water stops in addition to my own concoction. I should have known better. It was a pink drink that is evidently marketed by the Power Bar company. I have never tasted a urinal cookie before, but I imagine that this pink sports drink is pretty close. Every time I drank a Dixie cup of it at a water stop I had to walk a little bit and try to hold it down. In other words I was having a lot of nausea. Being nauseous will not prevent me from drinking because I figure I can always drink more water if I vomit, but it sure does keep me from eating, so I was a little deficient as far as carbo gels were concerned. I think I only had two all day (and had planned on five).

During last Sunday’s race I decided that the mile between mile marker twenty-three and mile marker twenty-four is definitely the cruelest mile. Suffering is maximized, and you’re close but not really close enough to the finish. If I tell myself, “it’s only three more miles!” I then start to think that three miles sounds like a terribly long distance.

I enjoy listening to music on my iPod shuffle while I run and when I arrived at the last quarter mile of the race a terrific song came on my iPod. It was Oh Comely by Neutral Milk Hotel. Unfortunately I was feeling remarkably emotionally labile at that point in time that I knew that if I listened to the song I would start crying. I already knew I was suffering and wasn’t going to appear well coming across the finish line, but I really didn’t want to finish crying like a little kid – so I fast forwarded it. I clicked until I found a song that was a little bit more emotionally bland.

When the finish line mercifully appeared I was glad to be done. I strolled over to the feed section and as usual there were a lot of great things to eat, but I was feeling so nauseous – there was not one thing there that I could’ve eaten. Claude, who also ran the race that day, was waiting for me and we took the shuttle back to the parking area. I had some food in my truck for post race meal, but as soon as I walked over there I became quite sick and expelled a large quantity of pink water. It must have just sat there in my stomach – there was a lot of it! I felt much better, changed into my dry clothes, and ate my post race meal. I started to wonder – emotionally labile, tearful, and nauseous – was I pregnant? (Ha ha)

The Fear of Going Too Hard – Atrial Fibrillation Running

Posted on October 10, 2013 by michaelpmccullough

One big difference between running in persistent atrial fibrillation and normal sinus rhythm is that, for me anyway, there is a lot of apprehension about over-doing it. The days of charging up a hill may be behind me at this point, and I haven’t done anything resembling a speed work-out in well over a year.

Prior to atrial fibrillation I used to do interval work-outs once in a while. For certain marathons where I had a specific personal time goal I would do a work-out known as “Yasso 800s.” Although some expert dispute that this is actually the most effective speed work-out for marathon training, nobody would dispute that this is a difficult work-out. I would do them on Wednesday nights at a local college track and I always felt they were my most difficult work-out of the week – probably more challenging than my languorous week-end long runs. Certainly this was the work-out where most feared injury.

To be honest I don’t miss Yasso 800s. I never have been a fast runner and never enjoyed short fast races like 5Ks.

But even during LSD (long slow distance) work-outs there usually comes a point where I will feel that the run is becoming difficult and I have to push through that. People often say “push through the pain,” but it isn’t really “pain” per se; but whatever it is it now makes me nervous!

But now that I am in persistent atrial fibrillation I think twice about pushing beyond any thresholds, however they are described. I have a fear in the back of my mind that I am going to make the atrial fibrillation worse, or pass out, or die, or . . . well who knows? This is all new territory for me.

I think this is why I “bonked out” of the second and third (out of seven planned) twenty mile runs I did during my build-up to this Sunday’s Bizz Johnson 50K. I just wasn’t willing to risk it. But if I’m unwilling to risk it it is obvious that I will only get slower and slower each year.

RINGO SAYS RELAX

I’d love to hear from other endurance athletes about this topic whether you are in a fib or not, and whether you are risk averse or not. Please feel free to leave a comment.

Next Event: Bizz Johnson 50K – October 13, 2013, Susanville, California

Posted on September 19, 2013 by michaelpmccullough

Race Director Wendel Doman gives pre-race instructions

My next event in the Bizz Johnson 50K – October 13, 2013 in Susanville, California – although at this point I am considering bagging it and just running one of the shorter events – maybe the marathon. Bizz Johnson has something for everybody – a 10K, two half marathons, a marathon, and a 50K.

As far as trail 50Ks in the West are concerned this is probably the easiest course. Bizz Johnson is organized by Coastal Trail Runs, an organization that is headquartered in the San Francisco Bay Area, and it takes place primarily on a rail trail (Rails to Trails). That’s why the course is easy – trains are, I think, unable to go up or down any more than a one or two percent grade. Plus the trail is as wide as the railroad tracks it once was, and as smooth as a dirt road. Most 50Ks in Oregon and far Northern California are on technical single track that go up and down mountains and canyons.

Along the course

This will be my seventh year running the Bizz Johnson – I’ve ran the marathon five times and the 50K just once – last year was the first year they even had a 50K. I even came in second place in my age group – but then again there were only two of us in that age group.

The entire rail trail is only about twenty-five miles so both the marathon and the 50K start with an appropriately measured “out and back” on an adjacent fire road to make the races end up being the proper distances. Last year this worked perfectly for me because the 50K started an hour before the marathon, so I ended up running into the back of the pack runners, who had just started. It was sort of like running a normal marathon . . . after going for a one hour morning jog.

Last Minute Preparation

The race begins with a six mile out and back (three miles up and three miles down) on a non-technical fire road; then it joins the Bizz Johnson Trail. The first couple of miles on the Bizz Johnson are uphill and then there are essentially twenty miles of gentle downhill running. The trail is smooth and a delight to run and goes through a pine forest at first with final six miles going down the Susan River canyon ending in Susanville.

There is one canyon crossing at about the twenty-five mile marker (the twenty mile marker for the marathon) that looks easy on the course map but is in reality quite brutal – probably my perception is based on the fact that this is the point where the course often becomes pretty warm (lower elevation in a deeper canyon).

Also there are two tunnels late in the race that are fun, but freak some people out – very dark and cold in the tunnels!

Sorry if I seem to be about to die – this tunnel is at 24 miles in the marathon (29 miles in the 50K)

The race is a small, well-organized point-to-point event with no expo, and bus transport from Susanville to the starting line. There are aid stations every two miles along the marathon course. For me the altitude in no problem (5600 ‘ to 4200’) because I live and train at the same altitude – some folks from sea level complain about it, however.

The cool thing, at least as far as last year was concerned, is the mile markers were all based on the marathon distance so psychologically it was easier. For example – when I pass the eighteen mile marker while running the 50K I am actually at about twenty-three miles – but psychologically it seems like I am only at eighteen. It might have something to do with my being so familiar with the course.

Twenty-three miles – but it only “seems like eighteen”

The race ends in a picnic area in a grove of tall pines and there is transport back where all the cars are parked.

The reason I am thinking about bagging it is that my training doesn’t seem as good this year as it was last year. I was in persistent atrial fibrillation last year, as I am this year – but my mileage was much higher last year. I was running fifty to sixty miles per week with one seventy-five mile week (my all time highest mileage week).

Age Group – Second Place in my first 50K – but only two runners in my age group.

This year I bonked out on my first two long runs (I’d planned on two twenties and ended up only running sixteen and thirteen – that was five and six weeks ago). Over the past three weeks I have completed three twenty or twenty-one mile trail runs in the Sky Lakes Wilderness.

The reason I bonked out on those long runs may not have anything to do with my atrial fibrillation – I think it is more related to my intolerance to heat. Both of those days were too hot, especially later in the runs. For the past few weeks I have moved my long runs to high altitude mountain trails that are actually much more technical and hilly than the course of my upcoming race – in other words much more difficult training runs than the ones I bonked on – but I am able to complete them because it is shady and cool up there. I have one more long run scheduled this weekend (twenty-four miles?) and then I start my three week taper prior to the race. It’s supposed to be cold and rainy this weekend so I will probably do fine.

Almost Done

Finish Line

My biggest problem occurs when it is hot on race day. I should clarify that for me temperatures in the seventies qualify as hot. I think this is what I am going to do: If my last long run goes well I will go to the race and check the weather report. If it looks like it is going to be cool I will run the 50K, but if it looks like hot weather I’ll run one of the shorter events – either the marathon or the half marathon.

My Bizz Johnson Photos (from the past several years) on Flickr 143 photos and two videos (including a tunnel video)

UPDATE: My final twenty went fine – I started getting sort of tired at mile thirteen but pushed through. I reviewed my training log and discovered that I had actually ran a twenty miler the week prior to the first of my failed twenties – so I have ran a total of five twenty mile training runs (three of which were more like twenty-one milers in the Sky Lakes Wilderness). I still haven’t decided whether to run the 50K or the 26.2. I’m going to see how I do during the taper (I always cheat and run too much) and also keep an eye on the race day weather.

Pacific Crest Trail on Atrial Fibrillation?

Posted on August 15, 2013 by michaelpmccullough

I live near the Pacific Crest Trail. The famous, fabled, fabulous PCT. Just about twenty-five miles away. You can look out our back window and stare lovingly at the mountains where it courses through the Sky Lakes Wilderness.

Heading out to run on the PCT

Although I come off in this blog as a marathoner, or an ultrarunner, what I really enjoy more than anything is trail running (and mountain biking – but mountain biking is forbidden on the PCT so forget about that). I simply love trail running and hiking, especially in the local Sky Lakes Wilderness and Mountain Lakes Wilderness; and the best part of being at my level of fitness and health is being able spend a weekend day doing a ten, fifteen, or even a twenty mile trail run. Although it is a slog now because of the atrial fibrillation I still love it – I love the movement through the wilderness and I love the trail itself.

Usually the only one who goes with me is my little trail dog – Ringo.

Ringo on the PCT at Brown Mountain

At this time of year – late Summer – all the thru-hikers, or I should say the small percentage that have made it this far, are coming through Southern Oregon. Most thru-hikers are traveling from South to North; they start at the Mexican border and hike through California, Oregon, and Washington with the goal of reaching the Canadian border. There are a lot of hazards along the way that can cause hikers to drop out and fail to finish – including blisters, running out of money, running out of time, deep snow, diarrhea, boredom, and forest fires.

I try to spend time on the PCT this time of year and will often photograph thru-hikers and post the photos on my flickr page.

PCT Thru-hikers

In addition to trail running on the PCT I am also an “armchair traveler,” meaning I’ve read a bunch of books about thru-hiking the PCT, including:

Cactus Eaters by Dan White – probably the best written PCT book and my most recent read.
Cascade Summer by Bob Welch – a middle aged Oregon newspaper writer hiked just the Oregon section. This might be more my speed.
Wild by Cheryl Strayed – the most well known and popular PCT book that will undoubtedly get more people on the trail. Also a well written and engaging read.
A Blistered Kind of Love by Angela Ballard – fascinating dual journal by a couple thru-hiking the PCT. It was interesting how the different genders report their trail experience. The male writes about where they went and what they did, and the woman writes about how she feels.
Skywalker – Highs and Lows on the Pacific Crest Trail by Bill Walker – the most endearing and charming PCT book ever.
Pacific Crest Trail Hiker’s Handbook by Ray Jardine – groundbreaking and controversial – Ray clearly changed the way people approach long distance hiking.
A Long Walk by Hap Vectorline – a whimsical journal of a partial through hike that started at the Canadian border and made it as far as Oregon.
In addition to the books I read various PCT blogs, and many of the youtube videos as well.

Hikers

My dream is to someday thru-hike the PCT – but I don’t think it will ever happen for a number of reasons. I’m certainly in good enough shape, and strong enough, but at 53 am I too old? I don’t think so – I’ve met plenty of thru-hikers that were middle-aged. They tell me they are slower and have to leave earlier and hike longer to keep up – but that would be no problem. I think hiking for that long on anticoagulants might be an issue. On Pradaxa falling just isn’t what it used to be! The main problem is, of course, finding the time. I work full time and just don’t have the resources to take six months off from work.

Maybe some day I could just thru-hike the Oregon section. Or maybe just the Sky Lakes Wilderness (fifty-one miles) – that could be done in a weekend. Why not?

Ringo Dingo

But I still love running in the Sky Lakes Wilderness. As far as falling out on the trail and bleeding out, or having a stroke out there, or being eaten by a bear, or whatever, I like to say that I’d rather die in the Sky Lakes Wilderness than in the Sky Lakes Medical Center.*

*Our local hospital, where I am on the surgical staff, is the Sky Lakes Medical Center. I like our hospital – I’m just saying that I’d prefer to die with my sneakers on, so to speak.

Running My First Marathon While In Persistent Atrial Fibrillation

Posted on August 7, 2013 by michaelpmccullough

Not my first marathon, of course, I think it was my fourteenth marathon, and maybe not even my first marathon in a fib.

Pre-Race

I should really re-title this as something about running my first marathon when I KNEW I was in atrial fibrillation. I recall one particular marathon, a couple of years ago, where I started out great and after twenty miles I totally fell to pieces. I would have quit if it hadn’t been a trail marathon with no easy way to DNF – I still had to get to the finish line. In retrospect I realize this was not “hitting the wall,” which I don’t generally tend to do, but I’m pretty sure I went into atrial fibrillation at that point. I don’t mind suffering but that was absurd. It was like eating your favorite food and inexplicably finding it tastes like $&!T.

That was before I even knew I was going into a fib, and I was probably still going in and out of a fib – but ever since May 12, 2012 I have been in persistent atrial fibrillation (meaning that I am always in a fib and have no expectation of NOT being in a fib).

Lining Up At The Back For This One

In May of 2012 I was actually training for my first 50K (31 mile) race (Bighorn Mountain Wild and Scenic Trail Run, Buffalo, Wyoming) and I had been doing a lot of long runs – looking at my training log I see that I had already done six twenty-milers during my training for that race.

I asked my electrophysiologist, who I hadn’t yet seen for my appointment, if I could run the 50K and he said I shouldn’t; so I was effectively grounded as far as the 50K was concerned.

But being the incorrigible distance runner that I am I rationalized, “Well I didn’t specifically ask about running a regular marathon. I‘ve been running 50-60 miles per week for a couple of months – I sure wouldn’t want to waste all that training, would I?”

I looked at the online marathon calendars and discovered that there was a regular marathon (26.2 miles) that same weekend, and only a five hour drive – the Vancouver USA Marathon in Vancouver, Washington – just across the river from Portland, Oregon.

I admit that I was scared – this was unknown territory – running a marathon while in atrial fibrillation. Would I be able to complete it? Would I drop dead? Would I suffer like an animal, I mean, would I suffer even more than running a regular marathon?

Along The Course

In a lot of ways the course for the Vancouver event was a lot safer than the Wyoming event. The Bighorn was up and down remote canyons in the Rocky Mountains whereas the Vancouver USA was a flat course through the suburbs of Portland. If I needed to drop out of the race, or if I needed medical assistance, that would be simple – go ring a doorbell.

But naturally I was still nervous when I started out. My plan was just to get through it. I decided not to try to beat anybody, to keep it slow and steady, and to walk up the few little hills that were part of the course.

Marathons In All 50 States – EIGHT TIMES!!!!!

As stated previously the experience of being in persistent atrial fibrillation is different than that of going in and out of a fib. Persistent a fib isn’t as bad. I’m slower but stable. People who suddenly go into a fib in the middle of a race often find themselves unable to continue – it can be devastating. I know – I think it has happened to me (see above).

At any rate – I started running with the eleven minute mile pace group and hung out with them for most of the race. Eventually I realized that running this race in atrial fibrillation wasn’t that much different than any other marathon that I have done – except for being a bit slower. When I was into the final miles I was surprised that I felt fine – clearly much better than the race described above. I think my plan of keeping it slow and walking the one or two hills worked out – I had very little suffering.

Crossing the finish line was an emotional experience and even though I was there all alone I broke out in sobbing tears. Tears of joy, I guess, because I had finished the marathon and I hadn’t died! It really was just about like normal and I started wondering – just how many of these things had I done in fib?

Large Man Crying At Finish Line

If you’re a runner in atrial fibrillation and you are reading this I want to make sure that you realize that I am NOT saying, “Go run a marathon in atrial fibrillation.” I am simply relating my personal experience. I am just one individual and, naturally, your experience is different. I stress that it is important that you agree with your cardiologist regarding running and atrial fibrillation. This blog is just my personal story – it isn’t peer reviewed and I am not a cardiologist.

By the way when I finally saw my electrophysiologist he cleared me to continue running and did go on to complete my first 50K four months after the Vancouver USA Marathon. At this point I am comfortable with distance running in atrial fibrillation and am not (too) afraid of dying out there – but that first marathon in (known) atrial fibrillation – well – that was huge.

My next event, incidentally, is the Bizz Johnson 50K in October.

Race Report – SOB Trail Run July 27, 2013 (Siskiyou Outback Trail Run)

Posted on July 27, 2013 by michaelpmccullough

The SOB Trail Run has been one of my favorite runs and I think I have five T-shirts from the past ten years.

Pre Race

Today was my first time running it in persistent atrial fibrillation.

I’ve always been impressed with how well organized the race is, the quality of the course, and the low price. The 15K is still only $25 (that includes a finisher medal but no T-shirt – a T-shirt is extra). There are three events – a 15K, a 50K, and 50 mile race. I’ve only ever done the 15K but several of my local running friends did either the 50K or 50 mile today. The 50 mile has 7000 feet (2133 meters) of elevation change – that’s crazy!

Along the course on the PCT

I think all the races start with the same nice 1/2 mile or so on a road that allows everybody to get sorted out as far as pace is concerned before getting on the narrow singletrack of the fabled Pacific Crest Trail. This is a good idea – races that start right off the bat on singletrack, like Haulin’ Aspen Marathon and 1/2 Marathon in Bend, Oregon – tend to develop bottlenecks because passing is so difficult. The truth is that passing is a problem on the SOB – I tend to be faster going uphill (as compared to the slow people I run with) and end up passing people who walk up the hills – but I’m relatively slower going downhill, especially on technical terrain like the PCT, and most of the people I passed going up want to pass me going down; and the 15K course is up / down / up / down.

After several miles of this the race transitions to a fire road and then re-enters the PCT for the last few miles.

Amber and Nathan after the 50K

The race is fairly high elevation – starting at 6500 feet and climbing to about 7000 feet (??). I don’t notice it much because I live at 4200 feet and regularly run at similar elevations, but people coming from coastal cities will definitely notice the rarefied air.

As far as running it in atrial fibrillation was concerned I had the typical slow start – it takes me a mile or two to warm up now, and then I felt my normal self again. I didn’t even look at my time and I didn’t wear my Garmin 305 – why? I walked only a few particularly steep sections and other wise (slow) ran the entire race.

Along the Course

As usual the start/finish line was great – nice people, good music, lots of post race food. I forgot to pick up my post-race swag bag so I don’t know what I missed there. I wish I would have checked the start time for today’s race because I ended up arriving about an hour and a half early – but I can’t think of a better place to hang out that Mount Ashland on race day.

Race Hang Out Headquarters

Running and Mountain Biking with Atrial Fibrillation? Get a Road I.D.

Posted on July 16, 2013 by michaelpmccullough

I used the see the Road I.D. commercials while watching the Tour de France and think, “Why would anybody buy a thing like that?” That was before I went into persistent atrial fibrillation and started taking a potent anticoagulant (Pradaxa).

Now something as ordinary and routine as falling down on a trail run or crashing on a mountain bike can become a big deal – maybe even a life and death situation.

My Road I.D. has my name, year of birth, hometown, my wife’s number and my sister’s number. Also it indicates that I am in Atrial Fibrillation, have no drug allergies, and am taking Pradaxa – an anticoagulant.

This way if I am found dead they know who I am and who to call to come pick up the bike and the body. If I’m still alive they will know about the atrial fibrillation and the anticoagulant. Pradaxa doesn’t have a reversal agent but any medical personnel will know to watch for bleeding and start an IV to push fluids. It certainly couldn’t hurt.

Wearing my Road I.D. at a pizza parlor

I wear mine whenever I ride or run, and also whenever I drive. I take it off at work.

I was half joking when I said “if I’m found dead” but somebody (I can’t recall who) recently noticed my Road I.D. and said he wished his friend (brother-in-law?) had had one. Evidently he had gone out for a run and died out there (for whatever reason) and had no identification. Nobody knew who he was so they put the body in the morgue for the weekend. I seem to recall that the wife was out of town and they had a hard time figuring out who he was. Eventually when they started to figure out who he was and one of his children had to come from out of town to identify the body. I wish I could remember the details more clearly – but at any rate a Road I.D. wristband would simplify a situation like that.

There’s nothing special or unique about a Road I.D. – any medical alert bracelet would be fine; but a Road I.D. just seems cooler. It’s durable, comes in cool colors, and is highly customizable, it cleans up well when worn in the post work out shower, and goes on and off easily.

Atrial Fibrillation at Altitude – High Elevation Hiking on the Lares Trek

Posted on June 30, 2013 by michaelpmccullough

We’ve just returned from a trip to Peru which included quite a bit of time at higher elevations – most notably hiking on the Lares Trail at 4600 meters (15,000 feet) above sea level. The highest thing we have around here is the conspicuous, glacier topped Mount Shasta (4,322 meters = 14,179 feet) and I’ve never even been up to the top of it. I’ve been up Mount McLoughlin (2,894 meters = 9,495 ft) sixteen times and even back when I was in sinus rhythm I would take one breath per step near the top.

Llamas Schlepping Our Gear

I have to admit I was worried prior to going on this trip.

I had no idea how the high elevation combined with my persistent atrial fibrillation would affect me. My wife Margo, who is a travel agent, arranged a terrific trip and we had a total of sixteen friends in our group. It was all bought and paid for and I was determined to go no matter what, so I didn’t even research how high elevation might effect my atrial fibrillation before leaving. That’s right – I didn’t even Google it!

I knew that our outfitter – G Adventures – had a mechanism by which people who had problems with altitude sickness could quickly return to Cusco – so I knew that I had an opportunity to bail out if need be.

Saksaywaman

We had two or three days in Cusco, Peru, which is 3,400 meters (11,200 ft) above sea level, so I was able to acclimatize. I felt no different in Cusco than I did at home in Klamath Falls, Oregon (4200 ft) and I even went for a run up to Saksaywaman (3701 meters = 12,142 ft) and it went well – although frankly, because of endless steep hills, it did involve a lot of walking!

The Lares Trek is a nice alternative to the extremely popular Inca Trail. It is shorter (only twenty-one miles) and higher elevation (4600 meters = 15,000 feet) but most importantly it was not nearly as crowded. There were sixteen in our group (plus porters and guides) and there was one other G Adventures group of ten who we would see once or twice per day – and that was it.

Ipasayqocha Pass

In contrast, the Inca Trail hikers we spoke to at Machu Picchu told us there were 200 people camped at a single, large camp outside Machu Picchu who all entered Machu Picchu before dawn on the same morning causing quite a line for the checking of tickets and passports at the small Inca Trail entrance to the site.

Machu Picchu at Sunrise

At any rate nobody in our group had serious trouble with the elevation, although everybody was gasping a bit. Margo was a little sick on the day we went up Ipasayqocha Pass but that was related to the usual traveler’s intestinal distress rather than altitude sickness. We were fortunate – the guides said that typically in a group our size they would expect three or four people to have trouble with some degree of altitude sickness.

Hiking Over the Ipasayqocha Pass

Our group was older but fit – but I have been told that being fit or being a couch potato has no bearing on predicting who will develop altitude sickness. Some people get it and others do not. Like I said we were lucky.

As for me I had the same atrial fibrillation symptoms I have at home, perhaps a little worse. I was out of breath when I started out but after several minutes I was in no distress. It takes me a while to warm up. Even in Lima, at sea level, I would huff and puff if I picked up a couple of backpacks and marched up the stairs to our room – that’s just the way it is for me now.

The first 200 meters of the Lares Trail is, I think, the toughest, because it goes up a long section of steep stairs. I was breathing so hard at first that I thought for a bit that I would be turning back – but ten minutes later I felt no different than a normal hike here in Oregon.

The porters had an extra horse in case anybody became sick during the trek they could ride that horse. Nobody rode it but during Margo’s bad day they put her daypack on the “sick horse.”

Margo’s Pack on the Extra Horse

So to sum it up my personal experience with hiking and running at significantly high elevation while in atrial fibrillation was unremarkable. Your experience may be different, of course. As far as I can tell nobody knows until they get there whether or not they will have issues with altitude sickness – so don’t get discouraged – give it a try.