I have Atrial Fibrillation (AF or AFib). Paroxysmal AF, which means it comes in bursts and rectifies itself eventually. In my case it comes on spontaneously and generally reverts in a matter of hours. No identifiable cause. It can come on simply bending over to tie my shoelaces. Walking the dogs. Running. Sitting on the couch. For me it is not life threatening but it is definitely life altering. There is mild danger of developing a clot in your heart which flies off and causes a stroke. Given my otherwise good health this is a fairly low risk but I am on blood thinners just in case. But the symptoms are very distressing when it does occurs and the faulty and rapid beating causes reduced circulation and resultant fatigue and sometimes breathlessness. The more you are in AF the harder it is to revert and stay out of it.
As runners we work hard to build up our endurance, our strength, our speed. We strive to make ourselves fitter. At the core of all that physiology we want our heart to be strong and efficient. It is our primary muscle. It is our engine room. As athletes of whatever calibre it is the common denominator at the centre of all our fitness: a healthily functioning heart. When it fails you have big problems. You feel betrayed. You feel vulnerable. You feel weak. You feel frustrated because you can no longer do the things you take for granted, like running. You feel cheated. It is not like an achilles or a hamstring or an itb. You can rest, rub and stretch those. And you know they will come good, eventually. This breakdown perplexes and defies explanation. Even the experts don’t really know why it happens. And it gets worse with age so it is hard to see light at the end of the tunnel.
About a month ago I was lying in the emergency department looking at the world through the distorted plastic of an oxygen mask. I knew I had a big problem. I was probably as fit as I could have been. Ironically that was likely the cause of my problem. The blood pressure cuff inflated spontaneously squeezing my upper arm before releasing and beeping away on the large monitor above me. My heart-beat zigzagged all over the screen like a drunken spider dragging it’s legs through a pot of ink. My pulse was racing at 140 despite me lying flat on my back. I didn’t need the monitor to tell me something was wrong. I could feel my heart pounding in my throat. It felt like it was trying to break out of my chest. At the same time I was short of breath. I was low on oxygen and my circulation was compromised.
I was in Atrial Fibrillation. Or AF as it is more commonly known. And apparently it is common. But usually in older people. At 47 and very fit I was a curiosity to the Emergency staff. But I am not alone in the sporting world. The association of AF with male over 40 endurance athletes is becoming all too common. It recently featured as an article in the American Trail Runner magazine. I initially ignored it when I picked up my copy. But later read it searching for answers that seemed lacking in the conventional texts.
When I finally got to see a Cardiologist about 3 weeks after the first big attack, he told me I was the third athlete in two days he had seen with AF. Little consolation. And very few answers. And missing the most important one: a quick cure. My expectations were always going to be unrealistic. But he knew his stuff and had a sensible and conciliatory approach that I could live with. For now.
I was already on beta-blockers to try to regulate my heart rate. And aspirin to help reduce the chance of a stroke. The beta-blockers are worse than the disease. Not only is my heart rate suppressed but so am I. Most of my days are spent in bed or asleep on the couch. I try to run but it feels like I am dragging bags of concrete behind me. But I still try. As hard and uncomfortable as it is, I need to maintain that connection with who I really am.
The cardiologist’s other prescription was less exercise. Both volume and intensity. I was supposed to be going to the US to run the Hardrock in 6 weeks. He wanted me to try new medication and come back and see him in 6 weeks. There goes Hardrock. After the 20minute consultation the only thing I could remember was his comment about being out in a bunch ride the other day with a mate who had had an ablation and he (the cardiologist) had trouble hanging onto this guys wheel. That’s what I want: an ablation, where they go in with catheters and burn the rogue electrodes.
As an ultrarunner I have developed a personal fitness rating that tells me where I’m at. Generally, with base fitness I can roll out of bed on a weekend and go run a marathon. If I am fit, I can roll out of bed and go run 100km. When I am in really good shape I can get up and go run 200km. On the beta-blockers I am lucky to get out of bed, period. Running 10km in an hour and a half on flat pavement is like running up a mountain on day two of a hundred miler. And it even comes with the same nausea. It is just plain awful. And I get home and collapse on the floor for another hour to recover. And still the flutters and racing heart occur. I barely run at all and have lowered the intensity by necessity and design. Yet I can see no improvement. Where is that light at the end of the tunnel?
I am still running, but it is no longer a pleasure, far from it. As a rule I love to run. And there are so many great trails out there that I still want to run. So many great races I still want to run. I crave to feel that freedom that only comes from long hours out on the trail. It is what I love to do. It defines me. But for now, all my goals have been swept away. I treat this disease like another ultramarathon, I keep putting one foot in front of the other and hope that eventually things will get better again. Ironic how running ultras has trained me for coping with life with AF but having AF means I can no longer train for ultras.