I have been doing heart rate-based (HRT) training since April 2012. HRT focuses on the athlete training to certain heart rate zones rather than focusing on pace, speed, distance, or perceived effort. Read this post from RunRunLive for a great basic explanation.
Setting your heart rate zones involves a max HR test and threshold testing (at least the way I have done it). Mine have been revised since I started, but they currently are:
Signs of an Issue
From April 2012 through February 2013, my HRT was going just fine. The first sign of any issue was the Flash 12K on February 16, 2013, when my Max HR was 229, well above my aerobic capacity of 186. I sort of wrote that incident off as a fluke.
I became less able to call my HR issues a fluke during the Summer Trail series of 2014. Granted, running in Tallahassee in the middle of the summer is an invite to strenuous running, but it did not feel right. I had to stop and walk several times to allow my HR to come down when it climbed above 200.
As I wrote in my Turkey Trot 2014 Race Report, the HR issues became more pronounced and more frequent, especially at the Boston Mini Marathon and the Turkey Trot (then at the Swamp Forest Race on January 3, 2015).
The Process of Finding an Answer
Right before the Boston Mini Marathon, I had been cleared by a cardiologist after a ten-minute stress test and a cardiac echocardiogram. After the Boston Mini Marathon, I called him back and asked to reassess. That is when he referred me to an electrophysiologist.
Twice (at least) the first cardiologist said “at some point you may have to get a loop recorder.” Twice (at least) I said “oh if it comes to that I won’t go as far as to have something implanted under my skin.”
When I met with the Dr. Silberman, the electrophysiologist, he reminded me that “you can still stay fit without running.” (I know, all you runners out there ……. I hear you laughing at the screen!). To his credit, he also recognized that running is quite possibly saving my sanity. (Also, I contend that as a runner I avoid so many health problems that would make me costly to CHP: diabetes, blood pressure issues, problems brought on by unhealthy BMI, etc.)
He explained that the implantable loop recorder really is the best option to help him gather information. One likely diagnosis is Atrial Fibrillation (which is described here).
Since the incidents occur sporadically, some diagnostic procedures will not yield the data he needs. Therefore, I agreed to what my teammates and I have come to fondly refer to as “my human microchip.” It looks like this:
(And if you want to see exactly where it is, click this link. I am not a fan of subjecting people to “wounds” or other TMI pictures on social media but by the same token if it helps with education, I don’t mind. (This picture was taken the day after implantation; it is a tiny little scar now.)
So Much Waiting
And now I wait. I wait while my microchip records (and transmits data to my electrophysiologist’s office nightly). I wait for an incident to happen so I can use my handheld “patient assistant” to mark the incident.
After sufficient data is collected to give the Dr. Silberman the data he needs, I have a couple of choices:
- An ablation, in which the short-circuit is corrected via radiofrequency energy
- Plan B (ps – I don’t know what Plan B is…)
Medication is not an option because my blood pressure is already on the low side, and most medications would exacerbate that. I assume Plan B would involve life style changes, such as less caffeine and less racing. I really don’t know right now.
Putting It All Together
This title may be mislabeled because this situation does not feel “together” yet. I can tell you the questions/concerns swirling through my mind:
- It is strange when people describe the various heart rhythm disturbances by saying “one kills you instantly and one only heightens your stroke risk.” I simply don’t see the value of that “only” before “heightens your stroke risk.”
- I have stopped drinking caffeine prior to my runs. In 2005, during a previous set of cardiac evaluations, Dr. Batchelor advised me to stop drinking caffeine. About a thousand gallons of Diet Coke (before I stopped in January 2013) and coffee later, I have to admit that he may not have been making a passing suggestion.
- I am so grateful for the people who look out for me and who share their stories. For Shannon Sullivan, who was basically going to put me under house arrest until I asked the cardiologist who had just cleared me to refer me on to Dr. Silberman, for Mary Jean Yon, who has been so helpful by sharing her story (and telling me to not be so conservative that I don’t get data!), and to David Yon who is the best, most supportive researcher you could possibly want on your side. All of them have encouraged me to a) stay healthy and b) not throw the towel in on running.
- All of the technology involved in this process is simultaneously reassuring and question-raising. When I had my loop recorder implanted, the Medtronic representative was present. When I had my first in-office visit, he was present. What happens if Medtronic changes hands? (I know there will be contingency plans but I have seen a few awkward situations among my relatives who have pacemaker/defibrillators and can’t resist questioning.)
- I miss running free of worry. I know I am fortunate compared to the challenges many runners face. It is simply not a relaxing or release-filled time for me in my running life.
- I have to “let go” of so many concerns about what others think. Dr. Silberman advised if I am having an episode to lie down and get in a sit-up position to break the cycle of whatever is going on electrically for me. That just sounds like an attention-getter (but if it saves my life, who cares?). I feel self-conscious about the fact that I represent my incredible team, KR Endurance, but with the fact that my times are getting slower, not faster, what kind of example am I of the incredible work our coaches do?
I love running and the running community. Now that I have shared my situation with runner friends, people are coming out of the woodwork to discuss their own experiences. I am not alone in having a health challenge, and I know wherever this process takes me, I am fortunate to have the support of many people.
Now that I have a microchip, anyone want to put a leash on me and take me for a run?