Ultrarunner fighting Atrial Fibrilation (AF)

This blog has pretty much always been about running ultras, mostly Hardrock. It still is but now it is also about running with AF. I was forced to miss Hardrock in 2011 due to my AF but my long term goal was to get back to a level where I could enter the lottery for 2012. And hopefully help any other runners with AF who stumble upon this site. I never made it into Hardrock in 2012, or 2013, or 2014. I didn't have a qual for 2015. I ran Fatdog in Canada instead. That was tough. Now back to Hardrock.

The heart problems all started back on May 25: http://howmanysleeps.blogspot.com/2011/05/out-of-hardrock.html

Saturday, July 23, 2011

Perspective

this was the run
note the flat terrain 
but high heartrate through 
the middle section


There has been heaps of complaining on the Hardrock yahoo email list. It happens periodically but the latest burst has been unusually venomous. It all revolves around the lottery process and entry criteria. All good races suffer from popularity pressure these days. But as a race director it wears a little thin. It smacks of selfishness. You can please some of the people some of the time. But in lotteries those that miss out will often find fault. Me, I have been lucky with the lottery. I would love to have been there this year but things happen. There are people dying of famine, drought, flood, disease and violent causes all over the world. Hardrock, all said and done, is just a race. If you miss the lottery move on.

I have been driving my mother-in-law to the rehab hospital the last few weeks while I have been off work. She had her leg amputated nearly 2 years ago and they are trying to fit her with a prosthetic leg. It is a huge effort trying to learn to walk again, especially given her age and that it is an above knee amputation. Other amputees come and go from the gym while I wait. They are not all old people, far from it. It is a salient reminder of how lucky we are to be able to run.

I ran today. On my favourite trail. It was slow but magical. I felt OK for a change, well relatively speaking. Perhaps it was just the place. I love it down there. I have plans organised for a race on this course but that is on hold until I have the energy to deal with it. I am ever optimistic that I will get over this problem. The tide was coming in but we still made it along the beach with some rock scrambling around the exposed headland. There has been a heap of track maintenance and the surface was great. Several times I felt like opening up on the downhills but know better. But despite taking it very easily my heartrate continued to spike. Even on the long flat beach section. Rapid unexplainable accelerations. And then dropping back just as fast.

On the drive home I was in full-on AF with my heartrate hitting 236bpm at rest. And rather uncomfortable as you might imagine. It continued for some time at home and I was tempted to take a flecainide but eventually it settled. The weirdest sensation after these events is that my heart actually feels relaxed and genuinely tired. Is that physically possible? Almost the same contented tiredness you feel after a solid run. Seems my heart is running it's own race. I just can't keep up with it. One day we will be back in synch. I hope.
this was my heartrate after the run

Saturday, July 16, 2011

First visit to Electrophysiologist

Finally the visit I have been waiting for pretty much since I established I needed an ablation. My new cardiologist comes highly recommended in his area of expertise. That is what I want. And he was a very calm and concise man in person, inspiring the sort of confidence you want when your future is depending on him. He discussed in detail the procedure: Radiofrequency Ablation. On a printed fact sheet he drew and described the path of the catheter that gets fed in through a vein in my groin up into my heart. And an oesophageal ultrasound probe was passed down my throat and provided images helping direct the catheters. A fluoroscopic x-ray machine is also used to help guide the catheters into the appropriate chambers of my heart. And because they run a truck load of fluid into me during the procedure, they will stick a catheter into my bladder while I am out of it. Keeps getting better all the time.

Once in the right side of my heart he will poke the catheter through the thin wall between the upper chambers to get to the left side. Here he will use the electrode on the end of the catheter to burn areas around the base of the pulmonary veins that pass blood from the lungs back into the heart. This is where the extra beats originate to cause the fibrillation. The whole job can take 4-6 hours.

I will wake with a sore throat, sore groin and likely a little chest pain, oh and the catheter in my bladder of course. 6 hours flat on my back. 2 nights in hospital. 2 weeks off work. No mention of running. The first catch he mentioned was that best results are achieved after repeating the ablation again in 4-6 months. The next catch: he has a waiting period of 6-8 months! He recognised my desperation and the impact the events and drugs were having on my quality of life and put me on the urgent wait list. If a cancellation occurs I will be in. Could still be 3-4 months.

The success rate is 85%. There is a 2% risk of heart attack or stroke during the ablation. There is a tiny risk of needing to have open heart surgery if something goes wrong. And there is a 1 in 1000 chance of death. I can live with those odds. Or die by them I guess. They are pretty good odds from where I am sitting. The decision was easy and never in doubt. I am waiting for that phone call.

Monday, July 11, 2011

Hardrock horror stories

I followed Hardrock intently all weekend. Online checkpoint times for runners and tweets from runners and crew out on the course. But you never get the full story. And you never get a real feel for what it is like out there. I received part of Joe Prusaitis' report just now and although I haven't had a chance to check with him if he is happy for me to post it, I feel it compelling enough that it has to be shared. Joe is an extremely experienced ultrarunner with bags of Hardrock finishes including a HR/Badwater double. He doesn't need to embellish so read what follows and remember this was all at night. Deb Pero told me she experienced the same but she was coming last and alone out there. Helps explain the high drop out rate just for starters.


"Thunderheads lined up one behind the other, with clear patches of stars between each. Sleet and hail hurled sideways into us with enough force to lift anything loose and soak what was underneath. Had we been at 10000-ft it would have been a nasty storm, but near the summit of 14000-ft handies Peak… it was much more than that. This was stupid crazy. We had to summit quickly before the lightning started or retreat back to Burrows Park. My gloves were soaked through and my hands were numb and stinging. I knew that I had to climb the next few pitches very fast, but I couldn't breath and was reduced to a crawl, barely moving. Marty was right behind me, Jim just in front. Jim was moving well, so he was quickly over the top and gone. Inching upwards carefully through a field of frozen snow, we reach the ridge just below the summit, where we both stop to catch our wind. The next face is all rock and very steep. Just below the summit, I see then hear the first
flash of lightning. I stop and lay low for a few minutes, taking the time to put away my trekking poles. Marty is just below me, when I reach the summit. Another flash and boom, so I lay as low as possible. I yell back down to Marty but he can't hear me. A few moments of calm and I'm up and running as fast as I can go at 14000-ft. I reach the highest point, looking back to see Marty following, then turn and sprint down towards American Basin. There is nowhere to hide, no cover… and fear drives me faster. On the naked ridge hanging over Boulder Gulch, 1000 ft down, I stop and lay down facing back up the mountain… looking for Marty. He's nowhere in sight. I wonder where he is... what's happened to him. I don't know what to do. I lay there on the ground with the thunderheads roiling overhead and being pelted by the hail… searching the barren face for Marty. What the hell is he doing? I can't go back up! I have to go down… but I wait. 5 minutes feel like 3
0. I'm not sure how long, and then a light and another... Marty with somebody else. Its too loud to talk so its impossible to answer my questions. I get up and start running again… another 4 or 5 switchbacks, then I turn and look back again. Both of them are way back. I'm either moving very fast or they're moving very slow, but this is killing me. I wait again, and while I wait, I search my pack to see if there's anything else I can use to stay warm. I find the cheap rubber garden gloves Joyce put in for the snow. I remove my soaking wet gloves and put the garden gloves on. My hands are frozen and wet so its awkward, but I finally get them on. When Marty and the other guy get to me, I get up and start running again. Down to the snow field, I stop and wait again.  A few minutes or more, they get closer, but I go before they get close. I cross the snow field, which is turning to ice. The hail and sleet are constant, but my hands seem to be warming in the runner gloves. I
keep moving now, no longer content to wait. I need to escape the storm before I go hypothermic. The combination of altitude and cold is clouding my thinking. I feel fuzzy and numb. My frozen popsicle feet are soaking wet from the snow melt marsh we passed through just before summit. One thought persists in my muddy mind… 'keep moving', so I start running again. From flag to flag, down into the American Basin. I turn now and again to see if Marty follows and I can see that his light is higher as I drop further. The tracks through the snow sometimes lead to a flag but mostly I just head towards the high ridge which I think is the pass that leads over into Grouse Gulch. The snow is mostly ice, turning to slushy mud. When we marked this route last week, the entire basin was snow, so we chose a route across the snow by guessing where the trail was underneath. Now, it's a patchwork of snow and rock, such that sometimes the route we marked is on trail but mostly its 10 to 20 f
eet offset. The current snow track is not aligned directly with the rock trail. I go along for 50 yards of snow, then have to climb 20 feet of rock up to the trail for 50 yards, then drop back down to the next snow track, and repeat. Over a shallow hump of snow, I glissade down into a mess of slush and running water, then hop a larger flow, and crawl up a muddy bank. Over and again I check back to see if anyone follows. A series of lights dot from the top of Handies down into the basin and I'm surprised how many people there are. The storm seems to fade for a bit and I can hear my own ragged breathing, but I can't stop. The route seems to go on for such a long time. In the darkness, Its impossible to tell how far I've gone and how far remains. Hail starts coming down hard and fast again, and that's when I realize I'm standing just under the exit ridge. I push across the saddle and drop quickly. It a messy sopping wet marsh of snow melt, tundra, and rock and then into Grouse G
ulch. I slip on the edge of the track and start sliding down and realize I'm off trail. I look back to see a flag above and off to the right and another directly underneath. Instead of trying to climb back up, I simply keep sliding down through the switchback into another snow field towards the next flag. Reaching the flag, the snow track goes right and back onto a muddy dirt trail. I have escaped the worst of it. It's an easy track from here, heading directly down and out.

And that was just the first set of storms..."

I am not sure exactly how many Hardrocks Joe has done but it's a lot. He missed last year after developing pulmonary oedema in the lead-up to the race. The year before he finished after the final cut-off, but finished nevertheless. So this year he was looking for some redemption and told me before the race he was feeling good. He is possibly the most experienced ultrarunner I know and was the inspiration behind me starting Trailrunningcompany with his race directing and coaching business Tejas Trails. When he found out about my heart problem and that I was out of Hardrock he asked if there was anything he could do for me. I asked if he could put an extra rock on the Joel Zucker memorial cairn on Grant-Swamp pass for me as is the tradition (Hardrock100/Joel). I never met Joel but his death in 1998 soon after finishing his 3rd Hardrock always resonates with me. More so now I have this affliction. Following the results online over the weekend I was bitterly disappointed to see Joe drop out at Ouray. Having read his account above I now have a better understanding of why. So Joe never made it as far as Grant-Swamp this year in the counter-clockwise direction. I hope I get a chance to put an extra rock on that cairn next year with him.

Thursday, July 07, 2011

Perhaps this is as good as it will get

todays heartrate


When time came for me to head out for a run today I simply couldn't face it and chose to curl up in front of the heater with the dogs for a sleep. I woke feeling drugged. How appropriate. The irony wasn't overlooked. I was already dressed for a run so dragged myself out the door. As is now the routine I walked for the first 10minutes to slowly warm my heart up. Then it is a slow jog of around 7 minutes per kilometre to ensure my heartrate stays below 130bpm. I have chosen that as my upper limit. Go above that and I walk until it drops significantly and start again. This is the pattern of my runs. Add to that the ever present feeling of dragging a tyre or 2 behind me. And the lack of blood getting to my legs makes them feel like I am wearing compression tights that are 2 sizes too small. The big muscles starved of adequate oxygenated blood start to complain even at a slow jog.

Some days once I start to run, regardless of how slow I go, my heartrate spikes and I can feel the pressure. It can jump from 110 to 170bpm in the space of a few paces for no reason. And then drop as rapidly. Today this began after nearly 20minutes when I thought my heartrate was nice and stable. The spikes can be seen clearly on the trace above. It didn't get too high as I kept stopping. Eventually it stopped with only minor accelerations. But the frustration, the interruption to momentum, the disappointment was still there. Walking home slowly up the hill I looked back at the sun setting behind the clouds across the Moorabool valley. The sky was grey, orange and black. The wind was cold and the rain was stinging even through my tights. It was coming in horizontal and hitting me in the face under the brim of my cap. Normally I would complain about such horrible weather. Tonight I embraced it, realising this was probably as good as it was going to get. And what is the alternative?

Sunday, July 03, 2011

Bad days and bad days


I seem to be stringing together more bad days than good days. I have been free of AF for about 3 weeks now so that is definitely a positive. But I have also been off work pretty much the past 4 or 5 weeks continuously. And not doing much else besides lying on the couch. I have eliminated all obvious stimulants: no alcohol, no tea or coffee and even turned to decaf green tea. I was finding that if I ate too much my heart would go beserk for the rest of the night so I have cut down my portions. Seems to have helped. I try to avoid lying on my left side, sounds bizarre but it tends to give me arrhythmia. It was so bad one event that I actually started to pass out. And still the incredible lethargy. And frustration. That never ends.

Tomorrow is 4th July celebrations at Hardrock. Americans celebrate Independence Day like you wouldn't believe. Silverton holds a festive parade and the Hardrockers 'march' behind the start/finish banner. It is a fun day out culminating in the Rhubarb Pie Fair in the park and then the local fire brigades have a 'hose-off' where they try to kill each other with their high pressure hoses. How they don't take out an eye or rupture an ear drum beats me. But it is quite the scene, especially when they finally turn the hoses on the crowds. I will miss not being a part of all that.

Photos are filtering though from the Hardrock course marking. The snow is simply amazing. Way more than in 2008 when I was worried it would be cancelled because it exceeded the allowable depth in the lead-up. But it does melt out fast. Though there will be some scary sections. None worse than climbing the pitches up Virginius. A lot of runners will go through there in the night and early morning when the snow is turned to treacherous ice. I remember hauling myself up the fixed rope in 2009 and being shit scared of slipping. I also remember getting to the top and claiming that 'there ain't nothing like that at Badwater!'

Back home the You Yangs Trail Races are fast approaching and a few of us spent some time clearing trails today. The park has been closed for 6 months after flood damage and the trails are largely covered in leaves, bark and sticks. We raked, scraped and blew the trails clean. Well the guys did, I was worn out by the end of the morning and went home to sleep on the couch. But it was great to get out in the bush for a while. I appear to have suffered as a result, on my run tonight my heartrate went out of control towards the end of a very slow and easy 8km. It hasn't done that at the end before so I was disappointed. And totally trashed when I finally got home.




Friday, July 01, 2011

Good days and bad days

There are good days and bad days. Today was a bad day for running. After some stable runs over the last week I thought I was starting to adjust to the medication. Adjust is a misleading description. By adjust I mean not having my heartrate spike erratically. I have still been struggling to go much faster than 8min/km pace. But I had a '1/2 tyre' run the other night which was really refreshing. And led me to believe maybe I was acclimatising just like my friends are currently doing at Silverton.

After not running yesterday and feeling pretty crappy I was keen to get out for a run and clear the head. From the start my heartrate get accelerating disproportionally to the effort. We would slow to a walk and it would drop below 100. I would ease into a shuffle and it would climb to 140. At 8+min/km. And I could feel it. Every step was a struggle. My breath was short and shallow no matter how much I tried to slow and lengthen it. There was no rhythm. There was no respite. Eventually we walked back to the car for a very ordinary 4.5km. I was thoroughly dejected, realising I was still totally at the mercy of this disorder and the medication.

Entries open tomorrow morning for the Kepler in New Zealand this December. They sell out in minutes. I had planned to chance the rush and see if I could get in. Not this year. I look at the spring season of ultras rapidly approaching and realise that realistically I am likely going to miss the lot. Except GNW. I will not miss GNW. That is not an option. Let's just hope it falls on a good day.