Guest Blogger – “Old Runner”

“Old Runner” is a seventy five year old well seasoned runner still running marathons with atrial fibrillation. I find him to be truly inspirational.

 

 

It was November, 2002, at the NYC marathon. I had previously run 15 marathons over a period of eighteen years, none slower than four and ½ hours.

This one was going to be five hours and 15 minutes!

I experienced shortness of breath while running to the side of the street and high-fiving the kids watching from the sidelines. I had to walk the bridge decks (the only change in elevation on an otherwise flat course.)

Suffering no ill effects from this race, I kept on running over the years, experiencing occasional periods during a training run where I had to slow to accommodate perceived extra effort without any change in actual pace. These episodes would pass after a few minutes and I could resume my normal pace again.

Then, in 2007 I passed out in the bathroom while urinating (the doctors have a word for this phenomena which I can’t recall). I went to the hospital for observation and after a stress test was diagnosed with right atrial fibrillation. An ablation procedure changed nothing.  Another doctor I visited said he would not have performed the procedure; when I asked why he stated, “too many trigger points”.

Today I’m seventy five years old, a veteran of 37 marathons. I haven’t run a marathon for a couple of years, my most recent half marathon was last year. I’m still running but most of my runs include some walking. My A-fib is on and off, meaning I go in and out of fibrillation, I have no idea when this occurs any more just that it does occur. A stroke is the biggest danger I face with this form of a-fib so my cardiologist prescribed “warfarin” a blood thinner.  At 75 years of age my pace is closer to twelve minutes a mile, which is a bit depressing, but it is what it is and I know moving is the most important thing I can do for my health – so I keep moving.

Signing out,

“Old Runner”

 

 

Advertisements

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.)

Pacific Crest Trail on Atrial Fibrillation?

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.

pctrun
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.

ringobrownmountain
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.

pcthikers
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.

pcthikerss
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?

pctr
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

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

vancusabefore
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).

vancusastart
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?

vancusacourse
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.

vancusa50states8
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?

vancusamedal
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.

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

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.

passllamas
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.

saxa1
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!

saxa2

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.

pass2
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.

OLYMPUS DIGITAL CAMERA
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.

pass1
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.”

sickhorse
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.

OLYMPUS DIGITAL CAMERA
Machu Picchu at Sunrise

On Being Slow – Running with Atrial Fibrillation

Being in persistent atrial fibrillation is sort of like being a pickup truck with a four speed manual transmission, but you can only use second and third gear.

If you’re going to continue distance running in persistent atrial fibrillation you’d better expect to be slower.

I was already slow to begin with – my quickest marathon was four hours and forty minutes and it took me an hour to run a 10K. I’ve always avoided 5Ks because people in 5Ks simply run too fast. Once I was a back of the middle of the pack runner, well, now I’m truly a back of the pack runner.

moikspraguert

Training Run

I’ve always been a larger runner, and that’s definitely a factor in being slow. I’ve done a dozen marathons at over 6′ 3” and about 235 pounds, and have often felt that people would “mark” me, use me sort of as a target. I’ve felt particularly self-conscious about those people, often found in the back of the pack in a marathon, who will run up and pass me and then start walking – over and over again. This can be really annoying. One guy did that for 14 miles! I finally told him, “please either keep running or keep walking.” I know that these people are simply followers of Jeff Galloway (there are a lot of them in the back of a marathon pack), but it’s still annoying and it happens every race.

But if I was moderately slow before, I’m silly slow now. In an effort to preserve my pace I have actually lost about 40 pounds – but I don’t think I’ve even broken even. I had previously ran ten minute miles in shorter training runs, but now twelve minute miles are more common. As stated previously I had a cardioversion and was in sinus rhythm for thirty-three days – and at my new weight I was delighted to be able to train, for shorter runs, at a nine minute mile if I wanted to – but alas after a quick five-mile run in the thirty-third day I went back into persistent atrial fibrillation. I could feel it immediately and knew what had happened.

I imagine that a lot of athletes who are reading this blog are people who have had episodes of atrial fibrillation, or who go in and out of atrial fibrillation. I think people with intermittent atrial fibrillation become much more symptomatic and have a lot more trouble with training. They might not be able to train at all. But with persistent atrial fibrillation, at least in my experience, I have found that I stabilized and am able to train (a slower pace). You just have to get used to it.

OLYMPUS DIGITAL CAMERA

Back of the Pack – Haulin Aspen Trail Marathon and 1/2 Marathon

There are a few major differences, however. Prior to atrial fibrillation, like most runners, I would start out a long run at a fairly quick pace and more or less degrade as far as my pace was concerned as the miles accumulated. But with atrial fibrillation I actually start out quite slow, and after a mile or two find that I have picked up the pace quite a bit. I generally don’t do much interval training, but I imagine that is out of the question at this point. I live and train in the mountains and I can still run hills, but not really very quickly. When bicycling I find I don’t stand up and charge up hills any longer, but remain seated and spin more.

Being in persistent atrial fibrillation is sort of like being a pickup truck with a four speed manual transmission, but you can only use second and third gear. You start out pathetically slow, and your top speed is greatly diminished – but she can still drive as far as you want.

OLYMPUS DIGITAL CAMERA

Big Slow Runner – Before A Fib

The most important thing, of course, is that I am still able to continue trail running and mountain biking, and I am still able to participate in marathons and even ultra marathons. I still get to experience the sheer joy of slogging through a long trail run through the forest. I was never going to win any prizes to begin with, so what’s the difference?

Actually, I was delighted to get a medal for second place in my age group at the 2012 Bizz Johnson 50K, which I ran while in persistent atrial fibrillation. That was the first year they had a 50K at that event and there weren’t very many participants. I’m pretty sure that there were only two people in my age group, but still!

8088969997_a13aa36c8c_z

Second Place (age group) Hell Yeah!!!!

One good thing about ultra running and marathon running, especially compared to 5Ks, for example, is that nobody really cares if you are slow. I was surprised that there were many people who finished behind me when I ran my first 50K in atrial fibrillation. Although it is kind of embarrassing to be so slow, you just have to change your mindset, and when you get involved with ultra sports, especially with atrial fibrillation, you need to simply enjoy yourself, enjoy the run, enjoy the trail, enjoy the people, and not worry about time.

If there are any other athletes reading this who are in persistent a fib, or intermittent a fib, I would love to hear about your experiences, and I encourage you to leave comments.

Running Alone

Even before I was in persistent atrial fibrillation I generally would like to run alone, although occasionally I run with my wife, Margo. Bike riding was different – I would often go for mountain bike or road rides with friends. At this point, however, I generally go alone so I can just keep my own slow pace.

Ninety-five percent of the running that I do is trail running, and almost all that is done with my dogs – so technically I don’t run alone. They don’t care how slow we go – they are simply glad to be out there.

OLYMPUS DIGITAL CAMERA

Ringo on Mount McLoughlin

Ringo is a blue healer, border collie cross and is a great trail dog. He behaves well off leash, never chases anything, and always stays with me. There are a couple of races around here that allow dogs and he always gets to go along for these events.

Our other dog, Sophie, is a husky/shepherd cross and pretty much needs to be on leash 100% of the time (otherwise she runs off after God knows what), which can be challenging for trail running. It pretty much completely eliminates Sophie as a mountain biking partner.

margosophie

Running at Lake of the Woods with Margo, Ringo, and Sophie

I often run in wilderness areas, or even remote trails near town, and sometimes worry about having a fall and getting hurt on the trail. I guess that just has to be an acceptable risk. I like to say I’d rather die in Sky Lakes Wilderness (our local wilderness) than at Sky Lakes Medical Center (our local hospital – where I am on the surgical staff) – but I feel sorry for they people who find me – imagine finding somebody on the trail . . . that big and that dead! As a precaution I always like to tell my wife where I’m going, and of course, I always have my cell phone with me. I usually take a bandanna along so I have something I can use for a tourniquet if necessary – don’t forget I am on a potent anticoagulant (Pradaxa).

I’d be interested in hearing from other runners and mountain bikers who are training while on anticoagulants and find out what type of precautions you take. Please feel free to leave a comment.