Whatever Happened to AFIB Ultrarunner?

Posted on April 18, 2018 by michaelpmccullough

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!

Endurance Sports and Atrial Fibrillation – WHY?

Posted on March 14, 2018 by michaelpmccullough

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!”

Afibrunner: Patient Perspectives: Long-Distance Running and Mountain Biking in Permanent Atrial Fibrillation / EP Lab Digest

Posted on December 7, 2014 by michaelpmccullough

Patient Perspectives: Long-Distance Running and Mountain Biking in Permanent Atrial Fibrillation / EP Lab Digest

I am honored to have had an article published in the December 2014 issue of EP Lab Digest, a monthly journal for electrophysiologists and allied health professionals who work in electrophysiology labs.

The managing editor, Jodie Elrod, had approached me about writing a “patient perspective” article as she was familiar with my afibrunner blog. The article is basically a synthesis of material already presented in this blog, particularly my article called Atrial Fibrillation – A Visit to the Electrophysiologist.

I am delighted to have this opportunity to communicate with the EP community and promote my plea for empathy with respect to the endurance athletes afflicted with atrial fibrillation.

Thanks EP Lab Digest!

Also interesting – my cousin Chuckie, (an electrophysiologist – I’m sure they don’t call him “Chuckie” at work), who I mention in my article, had an article published in the November 2014 issue of EP Lab Digest.

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

Posted on August 13, 2014 by michaelpmccullough

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.

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.

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.

http://youtu.be/Vd4jeeu90Rk
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.

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.”

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.

Too Much Water? Not Enough Salt? Hyponatremia in Marathon Runners

Posted on February 21, 2014 by michaelpmccullough

Hyponatremia (low sodium, or “water intoxication”) is a risk for runners with atrial fibrillation. It is certainly a risk for me and I believe I have experienced it a number of times in the past. Personally, I am much bigger than most marathoners (6’3” 205 lbs), and because of that and the atrial fibrillation, much slower – so I’m out there twice as long and sweating twice as much. Plus – over the years it has been drilled into all of us to make sure we drink enough water.

Ironman athletes, ultrarunners, and bigger runners are all at increased risk because we are simply out there for much longer periods of time. Women athletes tend to be at higher risk for hyponatremia – it has been found that women hydrate more during a race.

Drinking enough water is a good idea – but it needs to be accompanied by increasing salt intake.

Normal levels of sodium are about 135-145 mEq/L. Symptoms are likely to begin at 130 or lower and if you get below 120 the condition may become fatal. While there are a number of medical causes for hyponatremia marathon runners fall into the category of consuming too much water and not enough sodium, and sweating out valuable sodium. Think of the white dried salt on your temple or on your hydration pack straps after a long run.

Symptoms include bloating, headache, swelling (check to see if your ring or wristwatch seems to be getting tight), nausea, vomiting and eventually weakness, restlessness, confusion, and well . . . it just gets worse from there. It is particularly problematic for runners because some of the symptoms (headache, nausea, cramps, and dizziness) are the same symptoms for dehydration so the impulse is to drink more water – which of course makes it worse.

There is currently an ongoing study at the Houston Marathon involving volunteers who are followed closely, weighed, fluid intake measured, lab studies obtained, etc. The study found that runners with lowered sodium levels drank more water, retained more water than normal volunteers, and they lost more total sodium and had saltier sweat.

Runners who were dehydrated but not hyponatremic had higher heart and respiratory rates, felt worse, and had lower blood pressure than hyponatremic runners. The hyponatremic runners felt better, but had more nausea and bloating.

What can be done?

Drinking less water is sometimes recommended but it is difficult to do when you are used to drinking a lot of water while running. I’ve tried drinking less water during a marathon and frankly I think it made things worse. Also some runners can become hyponatremic without over-doing the water consumption.

Weighing yourself frequently along the course and looking for weight gain (water retention) has been recommended – YEAH RIGHT! How is this going to happen?

Personally I try to drink water with sodium supplemented (NUUN, GU Brew), and try grabbing some little pretzels at aid stations (if available); but some research suggests this might not always be helpful.

“Watch out for feelings of confusion, nausea, fatigue, and particularly vomiting and swollen hands and feet. If you experience these, seek medical help.”

Fatigue? Really? Fatigue during a marathon – you don’t say? Isn’t that generally a part of the experience?

I don’t have a good answer. I know I’ve had problems with this – I’m clearly in the high risk category for hyponatremia. I also generally have particularly poor races if it is a warm day.

My interventions include

1.) Drinking enough water
2.) Electrolyte supplements in my water (NUUN, Gu Brew)
3.) Additional electrolyte supplementation (SaltStick caps, Endurolytes caps, little pretzels)
4.) Making sure I have a salty snack or meal after a race or long run
5.) Trying to dress so I’m a little cool rather than a little warm

I’d love to read your suggestions – please leave a comment if you have any experience with hyponatremia and suggestions as to how to avoid it.

Update (March 13, 2014):

I found this terrific article posted on Twitter by Dr. Larry Creswell. The key points are quoted below.

KEY POINTS

Most medical scientific organizations recommend low or moderate sodium diets to the general population in order to reduce the risk of high
blood pressure (hypertension).

Regular physical activity reduces the risk of hypertension.

Athletes lose sodium in sweat during exercise. The amount of sodium that is lost during endurance exercise depends on the sweating rate and
the concentration of sodium in the sweat. In turn, sodium loss during exercise depends on individual factors, such as genetics, fitness and heat
acclimatization, as well as the type, intensity and duration of exercise and the external environment.

Sodium ingestion by endurance athletes does not typically increase blood pressure, so low sodium diets are not recommended for individuals
who participate in long-term aerobic exercise.

Sodium ingestion during or following endurance exercise will help to stimulate thirst and drinking as well as stimulate fluid retention by the kidney.

No athletes are immune to hypertension, so athletes should monitor their blood pressure as they do their general health. This is particularly
important for older athletes, athletes with a genetic predisposition to hypertension, stroke or other cardiovascular disease.

Run, Smile, Drink Water and Don’t Die – A Guest Post by JoAnna Brogdon

Posted on January 5, 2014 by michaelpmccullough

Once upon a time there was a girl that loved to run just for the fun of it. She woke up early one morning on a cold and rainy March morning, excited to run the Rock Creek River Gorge Trail Run at Prentice-Cooper State Forest, just outside Chattanooga, Tennessee. She had run this race before and was wowed by the gorgeous gorge views and challenging single track trails.

She signed up for the 10.2 mile run but wasn’t feeling exactly right that morning. She couldn’t put her finger on it. She was just a little off but that wasn’t going to stop her! She bounced out of bed and decided to do the 6.5 mile option instead of the 10.2—a decision that turned out to be one of the best she ever made.

The start was a little fast. Everyone was ready to get moving on the chilly and very wet morning. Soon the 158 runners headed into the woods and formed a single line, slowing the pace which was a good thing. The trails were incredibly slippery with tons of thick mud after much rain that winter. One runner took a face plant when crossing the creek and came up with a big gash on his forehead and blood dripping down his face.

“Are you OK said the girl?”

“Yes, I am just happy to be out here,” he responded.

“Me, too!” she replied. There were smiles on everyone’s faces as they headed up steep hills and carefully focused on the each step.

At the half way mark, she was feeling OK but a little more tired than usual. No problem she said to herself, just having an off day. It was time to focus on other things, talk to people, make some jokes and carry on. She found a guy wearing a shirt that said, “Idiot Runner’s Club – Run, Smile, Drink Water and Don’t Die.” This sounds like my kind of runner thought the girl! They chatted and laughed about how slow they were going but how happy they were to be there instead of sitting on a couch or still sleeping in bed. The mud was so thick that their shoes nearly got sucked off but happily they went up yet another hill.

Even though she wasn’t moving very quickly, her heart was starting to race quite fast. She slowed down and was walking more than running. She put her hands in the air a few times feeling like it was getting a little hard to breathe. Just focus on the gorgeous trails and it will be over soon, she told herself.

There is that Idiot Runner again. He caught up and they were passing each other back and forth. It was time for more chatting and laughter. Only a few more hills and it will be time to relax and enjoy the day. One final push, climbing up through the narrow Indian Rockhouse and the race is almost over.

It is only 6.5 miles, she thought why does this feel so hard? She had run 50Ks and didn’t feel this bad. There goes a female racer. She will have to see if she can catch her but just felt so tired and ready to stop. Then she heard the crowd and knew that the end was near. She pushed as hard as she could one final time to make it to the finish line—she did it! And then she decided to sit down for a minute, she really didn’t feel so good … and then there was darkness …

…what is that noise?

She was waking up and heard a loud noise – it was her heart pounding at an incredible rate and a bright light in the distance. Someone was saying something to her, if she could only get to the light. She woke and found herself inside the medic tent with two physicians by her side. Her legs were cramping with the worst pain she had ever felt. Where was she? What had just happened? What was her name? Which hospital did she want to go to? So many questions…

She was being placed in an ambulance and sent to the local hospital. She was in rapid rate Atrial Fibrillation and needed a Cardizem drip to get her rate down. They admitted her to the hospital and the nurse came by to explain what A Fib meant. She drew a nice picture for the girl.

She learned that A fib occurs when one or both of the upper chambers of the heart – called the atria – don’t beat the way they should. This can cause blood to pool in the left atrium, where a blood clot can form. If that clot breaks away, it can travel to the brain, where it can cause a type of stroke called an ischemic stroke.

Two and half days in the hospital she waited for the meds to convert her heart back to normal sinus rhythm. They placed a band on her wrist that said “fall risk” – they had no idea.

The doctor decided the only way to get her heart back to normal rhythm was to cardioconvert using an electric shock. She was wheeled down to the operating area and what a surprise– she saw the two doctors that were at the race. One was a cardiologist and the other was an anesthesiologist for cardiology. They were chatting and laughing and encouraging her that it was all going to be OK. Her cardiologist was running late and it delayed the procedure. He was known for this as he always took time with his patients. Right as the doctor arrived; the nurse looked at the monitor and said wait—she converted on her own! We don’t need to shock her heart. The girl was happy and believed that it was actually going to be OK— maybe not happily ever after but OK. She smiled as she remembered the new friend she had just met on the trail…

“Run, Smile, Drink Water and Don’t Die.” Now those were words to live by.

The End.

JoAnna Brogdon, forty-three years old, went into a fib several times since the race and was hospitalized twice. She has no underlying chronic conditions and the doctors are unable to tell her why she has had a fib. She believes the worst part of the condition was the emotional stress and not being able to exercise as she had in the past. She underwent a cardiac ablation recently and her heart has been beating normally since. She is hopeful that she has put a fib behind her at least for now and looks forward to running, traveling and feeling normal again. JoAnna wants to support those that struggle with a fib and may be contacted at joannabrogdon@hotmail.com.

Rejoice – Not All Runners in Atrial Fibrillation Are Slow

Posted on December 27, 2013 by michaelpmccullough

Moore Mountain 1/2 Marathon

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)

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.

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A Fib Runner – Distance Running and Mountain Biking With Atrial Fibrillation

A blog about atrial fibrillation and trail running, ultra running, mountain biking, and other endurance sports.

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