Runner’s High – a Gift?

Is distance running therapeutic? Is mountain biking addictive? Is there such thing as a good addiction? If my atrial fibrillation worsens and I could no longer do long runs or bike rides – how hard would it be to kick the habit?

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High Lakes Trail – Southern Oregon

Today in the hospital lounge, while I was eating some potato chips, somebody was telling me how bad potato chips are for me. Whatever – I have given up almost everything in the world that is bad for me. I haven’t drank alcohol in several years, haven’t smoked a cigarette in decades, gave up meat and eggs a couple of years ago, I’m almost dairy free, and I haven’t taken recreational drugs since high school in the seventies. Potato chips, which I feel are good enough to be “worth it,” are about it for me. Well, that and diet soda, which is also an unhealthy habit that I have.

But what about “runner’s high?” Is that my addiction?

And what exactly is runner’s high? Does it even exist? I’ve been hearing about it for a long time, even before I started running in the early 80s.

Allegedly the athlete’s brain is “flooded with endorphins, more powerful than any street drugs!”

Many distance runners claim to experience euphoria during or after running, and some claim they’ve never had it happen – not even once.

The endorphin theory is the oldest, but more recently I’ve read about how endocannabinoids (naturally occurring neurochemicals related, in a way, to the active ingredient in cannabis) might be the cause of runner’s high.

Another article I recently read attributes runner’s high to “dopamine, serotonin, and endorphins.”

Whatever the cause, it certainly appears to be real.

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Pacific Crest Trail via Brown Mountain Trail – Klamath County, Oregon

Ultrarunner Dean Karnazes describes the role that running has in his life: “Some seek the comfort of their therapist’s office, other head to the corner pub and dive into a pint, but I chose running as my therapy”

“I’m convinced that a lot of people run ultramarathons for the same reason they take mood-altering drugs. I don’t mean to minimize the gifts of friendship, achievement, and closeness to nature that I’ve received in my running carer. But the longer and farther I ran, the more I realized that what I was often chasing was a state of mind – a place where worries that seemed monumental melted away, where the beauty and timelessness of the universe, of the present moment, came into sharp focus.”
― Scott Jurek, Eat and Run: My Unlikely Journey to Ultramarathon Greatness

Actually, a recent New York Times article states that on good experimental evidence it has been finally determined that exercise does indeed produce a flood of endorphins in the brain. Lucky us!

Researchers in Germany, using advances in neuroscience, report in the current issue of the journal Cerebral Cortex that the folk belief is true: Running does elicit a flood of endorphins in the brain. The endorphins are associated with mood changes, and the more endorphins a runner’s body pumps out, the greater the effect.

I won’t review the article here, but please read it – an elegant experiment, and solid conclusions.

But irrespective of the cause, what is runner’s high and what does it mean to endurance athletes? Can a person become addicted to it?

Personally I feel that the term runner’s “high” is a misnomer. I would describe it better as an altered state of consciousness rather than a high. Maybe I’m splitting hairs but I have never felt intoxicated by endurance sports.

Euphoria might even be too strong of a term – but maybe not. There are times during and after running when everything appears exceptionally crisp and beautiful. That’s why I love trail running, in Oregon, in the wilderness – does that happen to people in health clubs running on treadmills?

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After an hour or so even carb gels seem remarkably delicious!

Also – music becomes intensely enjoyable. I do run with an iPod and sometimes I feel I am going back to the days back in high school when I smoked pot and would listen, chemically enhanced, to suddenly amazing music on headphones. Except now instead of sitting in a darkened basement I’m moving through the woods. It’s funny – a lot of the music that, for me, is most enjoyable on long runs, is the same type of music that I believe would be most enjoyable to a person who is stoned. Sometimes a song sounds so good I’ll repeat play a song two or three times.

But another reason I don’t like the title “runner’s high” is it isn’t all euphoria, beauty, and music joy. I think the exercise induced altered state of consciousness can involve a certain amount of emotional lability. Here’s an example: once I was on a twenty mile trail run, and at mile sixteen an old song I hadn’t heard in years, Careful With That Axe, Eugene, started playing in my random shuffle. This very early, nine minute long Pink Floyd song is sort of a novelty song; a one chord song that slowly builds on a rising and falling bass line with a mellow organ playing over it. At one point a whispering voice says, “Careful with that axe, Eu-zhene.” And then there is this horrific screaming and dissonant guitar, and finally it evolves back to the mellow bass and organ. Back when I was in high school, if we had somebody over who had never heard the song before, we’d put it on and turn down the lights, and of course when the screaming began it would scare the crap out of the first time listener, and we’d all have a good laugh.

Well I knew all about what was going to happen during that song and wondered if I would start laughing when the “axe” section came up. Imagine my surprise when I burst into blubbering tears when the screaming began. I should state that this was shortly after my ex-wife (with whom I was still friendly) and her family had died in a horrible house fire – but honestly I wasn’t even thinking about that until the screaming in the song. I know I wouldn’t have been anywhere near that emotional if I hadn’t just put in sixteen hilly trail miles.

Other times while running something will strike me as funny I will begin laughing giddily – out there all by myself, or in the back of the pack at a marathon. Or an angry song will play and I’ll feel, like, GRRRRRRR!, become angry – quite a catharsis.

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GRRRRRRRR!

So is exercise induced altered state of consciousness addictive? I’m thinking: yes.

A CAGE questionnaire is commonly used to assess alcoholism.

Try applying it to your running:

C – Have you ever felt you needed to cut down on your running?
A – Has anybody ever annoyed you or criticized your running?
G – Have you ever felt guilty about your running?
E – Have you ever felt you needed a run first thing in the morning (Eye-opener) to steady your nerves?

Well – I can honestly say I’ve never felt guilty about my running, but the rest of those questions, well . . . .

And I can state for the record that with my atrial fibrillation, and the likely progression of my a fib, including my upcoming need to be on a beta-blocker, I have been dreading the day when I am no longer able to run. Very depressing.

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Biking in A Fib – like riding through mud

Aside from that I have a theory. I think it is obvious that not everybody will experience anything like a runner’s high. Clearly many people hate the way running makes them feel, and they are the people who think distance runners are completely nuts. And why wouldn’t they? Based on the time they ran two miles and felt nothing but fatigue and pain, and interpolating that up to, say, thirty-one miles, their obvious conclusion would be “WTF?” to use the parlance of our times.

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Lyon’s Trail – Lava Beds National Monument

But as for myself, and I’m guessing most of the people who would be interested in this blog, the so-called runners high can be generally considered to be a gift.

Diversion: How to talk to your children about distance running:

Emergency Pack for Trail Running or Mountain Biking While on Anticoagulants (Coumadin, Xarelto, Pradaxa, Plavix)

This article is a work in progress and is only a description of my strategy for the time being. I hope to learn from readers of this blog about how to better plan for a trail debacle.

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Heading out for a trail run on the Pacific Crest Trail

What kinds of things should a person like me, who is dealing with atrial fibrillation and is taking an anticoagulant (I take Pradaxa), carry on a long run in the wilderness? Or during a long mountain bike ride in remote areas?

When the high country in our local wildernesses is not covered with snow, I will generally do runs, nearly every weekend, of anywhere between six to twenty miles. I almost always run alone (except for my trail buddy – Ringo).

Dangerous and a bad idea? Possibly. But this is what I enjoy in life so I don’t plan on stopping any time soon.

The most important piece of equipment is a phone. People complain that everybody is always on their smartphone, and they should NOT be talking on their phones on mountain summits when everybody else is trying to get all Zen-like and self-actualized, and whatever – that’s a different discussion. You certainly don’t even need to have your phone on; but you absolutely should take it with you, and it should be fully charged. The days of getting hopelessly lost and spelling out SOS with rocks hoping a search plane will find you are fading into the past. A smartphone is a GPS and a direct link to help.

I always carry my iPhone in a baggie with my ID and a sheet of paper towel (which I use for unrelated toilet purposes).

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Fully charged and protected from water

Even if there is poor cell phone coverage in your local high mountain or deep canyon wilderness, and a phone call isn’t always possible, I find that a text message can often still be sent. It might take a while but it eventually will be sent, especially if I am moving along a trail.

There is the standard emergency gear that most people take, often called the “ten essentials” which most people carry while in the wilderness. Of course there is truly no such thing as a standard ten essentials and the list of things you carry will vary depending on the season, your skill set, your location, and your past experience.

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My generic survival gear

I got out my little survival kit that I typically carry in the wilderness, and of course not everything is pictured here, and I might not even have all of this stuff with me on any given trip. Naturally I will also have other things like food, gels, electrolytes, a jacket, and plenty of water.

What I found in my default wilderness pack is:

Two knives – a mini-leatherman tool and a standard knife. I will only actually carry one of these.

Two lights – a headlamp and a tiny LED flashlight (one is plenty).

Fire starter – a cigarette lighter, birthday candles, a tampon, and hand sanitizer (which I discovered has completely evaporated).

A space blanket, a compass.

Repair gear (Shoe laces, tenacious tape, dental floss)

Pain pills: Vicoprofen samples – okay they expired in 2000 but I’m guessing they are still good (at least for a placebo effect). Missing: Benadryl for allergies or yellow jacket stings, and I probably should have some of my Pradaxa in case I end up unexpectedly staying out overnight. Also missing: small roll of duct tape, safety pins, and my whistle!

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Saint Christopher Medal

Oh, and there is a Saint Christopher medal. This one belonged to my grandfather. Well it probably won’t change anything, but it certainly couldn’t hurt. Feel free to substitute your own personal good luck charm.

But what about specific items for the runner on an anticoagulant? Is there anything else beyond the “ten essentials”?

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Other stuff: Map with reading glasses (if needed) and some rope

Obviously having a major bleed while running alone in the wilderness would be a disaster. Death is certainly a possibility. How can a trail runner prepare to increase the odds of a good outcome?

I always make sure to let somebody know (usually my wife) where I’m going and I also send her a text (I text “OOTW” short for “out of the woods”) when I get back to my vehicle.

I also wear a Road ID. This way if somebody finds me they will know I am on an anticoagulant. Maybe this won’t help, but it certainly is worth wearing. At least they will be able to figure out why I bled out so quickly (I know – not funny).

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My Road ID

Another item I always carry is a bandanna. This can be used for a number of purposes, such as making a field dressing; but I want to have it in case I need a tourniquet. Plus – I have an extra one because my trail dog always has one draped around his neck.

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Bandanna

My bandanna came in handy a week ago when my wife Margo (not on an anticoagulant) crashed her mountain bike and punctured her left thigh with her brake lever. I used it to make a compressive dressing before we road our bikes back to where we could get a ride to the hospital.

One item I do not currently have but definitely need to obtain is a Quickclot field dressing. Evidently these things really work and are routinely used in combat situations. It is a topical coagulant (an anti-anti-coagulant?) which helps clot blood and also serves as a physical barrier to bleeding. I’ve been meaning to obtain one of these for a long time. They are available online via amazon.com, and I just ordered one.

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Quickclot

Question: Will the Quickclot sponge even work on bleeding in an individual who is on a direct thrombin inhibitor like Pradaxa? Answer: I have no idea. I’ll let you know if I ever get a chance to find out.

In case of bleeding the most important first step is to apply direct pressure. As a surgeon I have a lot of experience with this. Usually sixty seconds of direct thumb pressure will stop or slow most bleeding, but of course if you take an anticoagulant it will take longer. Apply direct pressure as long as necessary. Elevate the wound if possible. Don’t try to clean out major wounds as this will restart bleeding – that can be done later at the hospital.

A tourniquet is a last resort, but the bandanna can be used as a compressive dressing if needed.

Please understand that an anticoagulant doesn’t completely stop clotting of blood, it just makes it take longer. Eventually bleeding will stop. Hopefully before all the blood leaves your body!

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Ringo always has a spare bandanna for me

Bonus – How to stop a nosebleed:

I have been plagued by frequent nosebleeds since I was a child but, oddly enough, I haven’t had a single nosebleed since I started Pradaxa a couple of years ago. The best method I have found is to pinch the nose, fairly tightly, just above the nostrils, and lean forward. Don’t lie with your head back – that doesn’t work. Hold for a full sixty seconds. Repeat as necessary.

If you are, like me, a trail runner or mountain biker on an anticoagulant, I would love to hear from you. Please leave comments and suggestions in the comments area below.

Thanks.

Atrial Fibrillation Stroke Calculator

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Atrial Fibrillation Stroke Calculator

I saw this link today on Facebook and thought I would share it – it is an AF Stroke Risk Calculator, and was posted by the Atrial Fibrillation Association – a great resource for people with atrial fibrillation. As you probably know one of the greatest risks of being afflicted with atrial fibrillation is that it can lead to you having a stroke. Blood clots can form in the malfunctioning atrium, break loose, travel to the brain and – BOOM!!!! – you’ve had a stroke. Prevention is the best approach.

This calculator is basically a clever automated version of the CHADS2 score. I was delighted to find my risk is 0%.

But if course my risk is definitely higher than zero percent – even if my CHADS2 score is zero.

My heart is abnormal in more ways than the atrial fibrillation. I have hypertrophy of my left ventricle (from running – not a risk factor) but I also have “severe hypertrophy” of my left atrium (the top chamber of the heart) which my cardiologist assures me is a risk factor for stroke and although my CHADS2 remains zero I am on an anticoagulant (Pradaxa).

My question has been: Why not include left atrial hypertrophy in the CHADS2 calculation?

Answer: I dunno.

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Lillian and Lolawanda ready for another trail run

My other question has been: What else can I do to reduce my risk of a stroke?

I understand my risk is NOT zero, regardless of what this calculator says.

Obviously one thing I know I can do is to remember to take my Pradaxa twice daily. Believe me, for somebody who is only taking one medication it isn’t as easy to remember as you might think. I have considered switching to Xarelto simply because of the once a day dosing.

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My Pradaxa

But other than that what else can I do? One more thing (I think) – stay well hydrated.

As a large, slow, long distance runner (who is often on the trail for several hours at a time) I sweat more than smaller runners, and I have to be very careful not to become dehydrated. I spoke with a friend of mine who is an Internists/hospitalist and he agreed – don’t become dehydrated. Being dehydrated can literally thicken the blood and increase the chance on a clot, and therefore increase the chance of a stroke.

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Be Careful Out There!

How much water should a person drink? I have no specific prescription but what I do is try to drink enough so that my urine is relatively clear once per day. Also there is such a thing as too much water and big, middle-aged distance runners are at relatively high risk of hyponatremia (too much water – not enough sodium) so be careful out there!

We talked about other risk factors are there? Risk factors for blood clots in the legs include being inactive, obesity, and smoking – probably less likely for the readers of this blog.

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Sedentary after a LONG RUN

What about alcohol? Does that increase the risk? He said probably not and in moderation might even decrease the risk – but remember – alcohol clearly increases your risk of atrial fibrillation – and if you drink enough alcohol you will become dehydrated – so there you go!

By the way – don’t expect this this risk calculator or this blog to advise you as to whether or not you should take your aspirin, your warfarin (Coumadin), your Xarelto, or your Pradaxa. It is important that you make this decision with your doctor.

Rejoice – Not All Runners in Atrial Fibrillation Are Slow

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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.

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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.

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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.

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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.

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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.

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

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

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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.

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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.

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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.

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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.
 
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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.

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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.

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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)

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The Fear of Going Too Hard – Atrial Fibrillation Running

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.

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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.

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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.

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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

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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.

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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.

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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.

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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).

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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.

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Almost Done

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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.

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.

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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).

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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?

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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.

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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?

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Large Man Crying At Finish Line

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

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

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

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

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

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Pre Race

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

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

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Along the course on the PCT

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

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

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Amber and Nathan after the 50K

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

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

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Along the Course

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

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Race Hang Out Headquarters

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

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

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

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

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

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Wearing my Road I.D. at a pizza parlor

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

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

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