Guest Blogger – UK AFib Runner Mike Munson

This is an amazing story from a British AFib Runner, Mike Munson. This guy is truly hard-core and persistent. Non-runners who read this will be shocked, but I think most endurance athletes with atrial fibrillation will “get it.” Mike has been a gifted athlete over the years – his times when he was having to walk and jog because of an AFib attack are probably faster than my PR times! He initially dealt with attacks of atrial fibrillation, and eventually had to deal with (probably unrelated) cardiac arrest and coronary artery disease. Please feel free to comment. Thanks for sharing your story, Mike!

 

I had run regularly since about 1964 when I won my local district schools 1 mile in 5m 4secs (aged eleven) on a grass track, bare footed (the school did provide spikes but they hurt my feet). I joined my local Athletic club at twelve, running Track & Field in the summer, Cross Country in the Winter at County & National level. After University I worked in Africa but ran hard most days and started running slightly longer distances in hot climates in Central Africa (ie 10km & 10 Miles). I didn’t race much but did my first 10k in Lagos, Nigeria.

On returning to the UK in my mid 30’s and just starting a family I eased up on the intensity of my training but still ran most days and competed regularly for my local Running Club. As a club we had an internal “Grand Prix” where we competed against clubmates of similar ability.

In late 2000 (aged 50) I was taking part in the last 10km of the year, a relatively easy course that would normally have taken me about 40 mins to compete. I was a very consistent runner and usually started slower and ran negative splits. On this occasion I found myself collapsing for no apparent reason within a few hundred metres of the start. As it was the last run of the series (& I am not one to give up anyway), I picked myself up and initially started walking then broke into a jog, but very quickly had to stop again. I had no idea what was happening but by stopping and walking and jogging very slowly I eventually got round but really collapsed at the finish in around 60min . I went to see my GP the following morning and she sent me straight to Hospital. On doing a test on the treadmill they noted I had an irregular heartbeat, but didn’t do anything about it.

Over the next few years the attacks increased from every few months to every few weeks and seemed to be quite random, although I tried to work out if by running at a particular pace or warming up longer would help. If an attack occurred in a race I tended to stop  and walk to the finish as I was coaching youngsters and didn’t want them waiting around too long for me  if I ran to collapse .

In 2006 I moved to Suffolk and introduced myself to my new GP who happened to be a runner. He immediately referred me to a Cardiologist at the local Hospital who had me tested immediately and then transferred me to Papworth (Our Regional Cardiac Centre). They carried out an ablation which unfortunately didn’t work and I still have AFib. However I was given medication (Flecainide ), this had side effects of dizzy spells and blackouts which became very regular. Some of my friends found me a bit blasé about my collapsing and I was often heard to say to a fellow runner who might have stopped to help me, “Oh it’s no problem, I just have a heart problem.” Sometime they would be very shocked but would still try to encourage me to get up quickly and run fast to the finish but all I ever wanted was to get to the finish at my speed, which sometimes could be quite fast and sometimes I would be walking through the line. I became incredibly inconsistent. Over the past 25 years I have been in clubs that had 5km handicap championships each summer. Previously they would very by under a minute over the season but latterly on a good day (prior to going on beta blockers) I could vary from 22 to 31mins, depending how many times I collapsed.

All this time my pace was getting slower as I was unable to train properly (ie more than I would have expected due to my getting older), although one time I spoke to my GP about it an she said “don’t you realise you are getting older” to which I replied yes but I am slowing down too much!

 Therefore I turned to trail running with self navigating. This became very enjoyable and I particularly enjoyed the refreshments at check points, however by 2013 I was getting concerned about my ability to compete longer events and started collapsing and feeling sick if I tried pushing the pace at all. I spoke to my GP who arranged a 24 hour monitor. During this period we had our club 5km championship so I was happy to test myself with the monitor on. Please bear in mind I had been assured that  Afib wouldn’t kill me by my GP.  About 400m from the finish I had a black out  and I went down. A friend was just behind me, checked on me, I had come to and told him I was OK and would walk to the finish. He informed the next official who advised him I was now just behind him. In fact I recovered so quickly I actually overtook him before collapsing again near the finish. I returned the monitor to the Hospital the following day and soon after getting home a Consultant called me to come in immediately but I shouldn’t drive. I was kept in for tests, but in the end they changed my medication to a Beta blocker, which did stop the dizzy spells and blackout, however, my pace in training immediately slowed further from around 8 minute mile to 10 minute mile.

I was then doing more Trail Marathons as it didn’t seem to matter what pace I ran and was good fun, whilst still a challenge and hopefully keeping me fit. 2016 & early 2017 I found when doing easy Trail Marathons increasingly I was struggling over the last few miles, even contemplating taking short cuts, not wanting to cheat but just to finish. I did actually collapse twice at the finish and on one occasion the paramedic suggested going to A&E but I felt I would be OK in the morning (and of course I was).

Then 4th June 2017 I was in the 25th mile of the Stour Valley Trail Marathon (a fairly tough race with several long hills which was my 7th Marathon of the year) on one of the warmest days of 2017 in England, when I collapsed with an SCA (sudden cardiac arrest). Apparently this may be nothing to do with my Afib.

I had an ICD fitted and it has triggered twice since (during runs/ long walks as I am supposed to be taking it easy) and I have now had a double bypass as 2 arteries were narrowed. I am now doing Cardiac Rehab and hope to get back running soon, but will be patient (especially after dying last year for 25 minutes). However the Afib is still with me and I am still on 3.75 mg Bisoprolol.

 However now my wife carefully vets anyone giving me a lift. The guy who gave me the lift on that fateful day is still not allowed to drive me.

The local running community have been great. As I lost my driving licence friends have driven me around. As I could run last winter the local Cross Country League have let me walk the ladies distance. Unfortunately my last collapse meant I missed the penultimate race as I was in Hospital, so as race Director I was busy sending messages out to get the race on. At the Presentation night I was given a special award which was very humbling. I was the first recipient of this award named after a regular runner who had passed away in the previous season.

This summer as I have not been allowed to run I have been raising money for local cardiac charities by organising 21 Trail runs in my County on Wednesday evenings, starting at a Village Pub and using Public Footpaths. It is a simple concept whereby we sell an instruction sheet for £2 and runners self navigate round one of 2 routes either short (maybe 3-4 miles) or longer 6 + miles and then finish at the Pub. We sometimes put on additional things, like one night we tested people for AFib before they set off. This was well received and 120 people turned up; however I was the only person testing positive for A Fib! It created a fair amount of awareness and we managed an article in our Regional Daily.

Is this the sort of thing you wanted to see?  My family have been very supportive of me as they saw me in Hospital with tubes in me etc and where told that maybe I wouldn’t survive the induced coma and if I did as I was out for 25 minutes I might have brain damage but I seem to be very lucky!

Best Regards Mike Munson (aged 65)

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Atrial Fibrillation Podcasts?

 

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

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

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

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

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

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

All of these recommendations are unrelated to atrial fibrillation

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

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

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

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

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

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

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

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

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

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

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

Rich Roll Podcasting

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

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

I miss my Bianchi San Jose.

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

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

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

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

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

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

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

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

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

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

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

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

Please feel free to share your comments.

Cycling and AF Blog

John’s Bike

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

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

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

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

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

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

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

This is me, in AF, riding around Crater Lake

Endurance Sports and Atrial Fibrillation – WHY?

Endurance Sports and Atrial Fibrillation – WHY?

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

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

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

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

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

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

Moderate exercise may actually protect against AF.

Ringo after a long run – Fremont Trail

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

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

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

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

Interestingly the AF rarely occurs during running:

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

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

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

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

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

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

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

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

 

 

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

Re A-Fib: 5 Things I’ve Learned in 10 years… A Guest Post by David Grayson Lees

runmoorepark

I’m a 64 year-old road/trail runner, marathoner and weight lifter diagnosed with atrial fibrillation more than a decade ago. I’ve had three ablations and as many cardioversions, plus I’ve swallowed the usual assortment of prescription meds. Now my a-fib has become paroxysmal atrial flutter—about one episode every two weeks or so, usually lasting a few hours—and while my running days seem to be over, I still regularly make it to the gym and I’m discovering the joys of walking and hiking.

Through trial and error—plenty of each, actually—as well as a fair amount of research, I’ve come to a handful of conclusions that may be useful. While I believe them to be true, keep in mind that my observations are true for me; your experience may well be different. Finally, since I’m not a physician, nothing here is intended as medical advice.

And now: 5 things I’ve learned in 10 years of dealing with the always-entertaining world of cardiac arrhythmia.

A-Fib won’t kill you…even though a diagnosis of a-fib—and its symptoms—can be very scary, barring underlying cardiac disease, a-fib is not inherently life-threatening. And so if you have just been diagnosed, relax as best you can.

…but a stroke could. Pay rigorous attention to your anti-coagulation regimen. Even if your CHAD score is zero, at least take a low-dose aspirin every day. Personally, I find Coumadin to be a true pain, what with blood monitoring, dietary restrictions and the like. I much prefer the newer meds, especially Xarelto. It acts quickly, and as an added bonus you don’t have to be continuously concerned with your INR numbers.

martinmiro

Your EP isn’t interested in prevention. Typically, EP’s are all about fixing stuff rather than prevention. Which is weird, because unless you’re on the younger side of 40 and/or your a-fib has been freshly discovered, one ablation usually won’t do the trick. Of course, I’m grateful to my two EP’s, one rated among the best in California and the other acknowledged as one of the best in the world. It’s just that neither one has ever expressed any interest in the contours of my life, including what my exercise habits happen to be, what sorts of supplements I take, or what my days are like. Now, I’m not looking for a new best friend, but it’s clear that for them I’m a unique problem to be solved rather than a unique human being. I’m not angry about it; after all, these docs chose a field in which their major interaction with patients occurs when the patient is unconscious.

Still, I believe the implication is clear: you are pretty much on your own when it comes to figuring out how to modify your life style, exploring vitamin/mineral supplementation, and gathering the latest non-nutsy information.

(BTW, in terms of info, two websites I recommend are Dr. John Madrola and The A-Fib Report. Dr. John is a younger EP who always has a thought provoking take on new developments in a-f treatment and research and The A-Fib Report is a readable compendium of international a-f research, written in lay language. It requires a nominal membership fee that’s well worth it.)

ringobrownmtn

Supplementation could work for you. I haven’t thrown out my beta blocker (Sotalol AF, not regular Sotalol) but along the way I have had excellent results in controlling the frequency and duration of my atrial flutter episodes by supplementing with 200 mg of magnesium citrate in a pill taken at lunch and ¼ teaspoon of potassium citrate dissolved in water taken in the morning and again at dinnertime (Please note: ingesting too much potassium involves some quite severe health risks, so be careful.)

Life is good. But first, the bad news: as near as I can tell, nobody knows what causes atrial flutter. The gang of suspects spans endurance sports (!) to mysterious biochemical mechanisms that somehow encourage the formation of tissue substrates that make the electrical system of the heart go haywire. Researchers—and your EP, too–are just guessing, leaning on statistical correlations rather than employing demonstrable causal connections. Maybe cutting out caffeine will help you; maybe it won’t. Maybe abstaining from demon rum will prove to be the answer; maybe not. Obviously, if you are over-drinking, over stressing (like many of us who are into enduro sports) under sleeping or happen to be engaged in other deleterious deeds, changing your behavior is simply a good idea, a-fib or no a-fib. Just don’t expect that any one thing will be the answer.

The good news is, you can have a great life even with a-fib and a-flutter. No, I don’t love my a-flutter episodes; they are annoying and sometimes, even after a decade, still frightening. I don’t run anymore, but a long walk or a moderate—I know, I know, not my favorite word, either—hike turns out to be a lot of fun. No, I can’t put the same hemodynamic load on my heart that I used to, but I can still work up a nice funky sweat underneath the weight machines at the gym.

sob2

Besides, working out is only a part of life. My friendships, relationship with my son, work, and my love life (I’m getting married again, and I’m stoked!) are just as satisfying as ever.

Maybe more so.

Those of us with a-fib or a-flutter aren’t sick, not truly. Nor do we need to afraid.

So—live!

(Thanks to Linda for the inspiration. Thanks to you for reading.)