Heart on the Run

It’s my heart that’s on the run. Unfortunately, my heart is an overachiever when it comes to being fast, and that’s creating a problem.

I don’t know when my trek down tachycardia trail really started, but data-wise the first time I noted a high heart rate in my workout log was February 16, 2013, when I wrote off the much-higher-than-usual high heart rate I experienced in the last mile of the Flash 12K as a fluke.

Cardiac Issues

Though the ensuing episodes of high heart rate, the cardiologist visit (when I was initially cleared), the blog post about the 2014 Turkey Trot (after which Shannon Sullivan, Mary Jean Yon, and David Yon insisted I seek other answers), the electrophysiologist visit, the implantable loop recorder, the electrophysiology study, and the year of attempting to manage my symptoms with a beta blocker (because an ablation was contraindicated), I kept identifying myself as a runner, kept saying, “it’s a pain but as long as it’s confined to my running,” I just need to make adjustments.

It was when I was “just” walking a 5K on October 2 that I hit a physical and emotional wall on this trail, and I haven’t figured out a way around it.

Cardiac Issues

At the Stop the Violence 5K, BEFORE the race. Turns out Harper (the dog) and I each had our own struggles that day.

Besides the actual facts of what occurred over the hour which changed everything for me, my hesitancy to ask for help makes me want to kick myself in my OWN butt. I had not taken a beta blocker before the race because I’ve never needed one in a “walk” situation before. When my HR goes up precipitously, it does so with no warning. When it happened that day, I tried to stay calm, continuing to walk and do vagal maneuvers. I was passed by one couple who said “do you need help? And made some reference to one of them being qualified to help if I was having a problem.” Turned them down. I sat down on the curb (side note: I hate sitting down during races. I especially hate sitting down within sight of the finish line.)

I decided to walk back to the start area instead of trying to finish the 3.1 mile route. I walked past a man washing his car and made light conversation about his dog who was barking from the window rather than explaining I may be having a health issue. I was in a neighborhood where I know several people who probably would have come to help me if I had asked. During the attempt to walk back to the start area, my HR increased to an unhealthy rate again. I sat down on the curb, again. Throughout, I was texting my husband, explaining what was going on. I needed someone to be in the know.

I was participating in the race as part of a team, but I didn’t have anyone’s cell phone numbers I took my smartphone out and sent a message to the team’s event page on Facebook and one to our captain via PM. I explained that they should take their time (again, I might could have mentioned that I was possibly having a health crisis) but that I was going to need someone to pick me up. Eventually the race organizers sent a volunteer in a golf cart to come pick me up. Arriving at the finish line as a passenger in a golf cart rather than crossing it under my own power was so humbling (and, honestly, embarrassing).

Cardiac Issues

I didn’t share this publicly on 10/2, but this is the pic I sent my coach and team as I waited on my golf cart rescue chariot.

Here’s where things stand for me at this point:

This Is Not Just About Running Anymore

It was one thing to change my approach to running as the tachycardia issue got worse. Now that it’s affecting walking, the situation has gotten more serious as it impacts a proportionally larger part of my life. I’ve always had a sort of “I’m not fast but I can hang with pretty much anything endurance-wise” approach but now I find myself evaluating EVERY activity, not just the ones that are labeled as “exercise,” on its likelihood to be affected by my issue. When I was at a conference at Disney recently, my companions and I were running late to get to a dinner reservation in EPCOT because of some transportation changes (the Monorail to EPCOT was not running). We were under the gun to get to the restaurant before our reservation was cancelled and my credit card was charged. It’s a pretty long way from the admission gates of EPCOT to “Japan,” and I was praying I could keep up with their brisk pace, and popping a beta blocker hoping that would help me hang with them (it worked out fine).

I need to be able to walk a mile without stopping, both for exercise and because my life just involves a lot of “going.” 

Being Stubborn About Doing Things on My Own Can Be Dangerous

The double-pronged issue of a) loving doing things solo and b) being hesitant to ask for help is an issue that could just be classified as “that’s how I am” but now it impacts my health and survival. I’m grieving the limitations I feel now — I am not going to go out and spend an hour isolated on the Greenway — who would find me if I passed out? And although I would advise anyone in my circle to ask for help if they need it (and hopefully I would be the first to offer if they asked), I hate imposing. This is not an easy change to get used to.

We need each other. My biggest adversary here is myself, and I need to reach some detente with me.

The Exercise/Fatigue/Caffeine Cycle

Maybe none of this would be an issue if I had followed the cardiologist’s advice more than ten years ago and stopped caffeine altogether. I have tried a few runs without caffeine and still experienced problems, so I can’t say it’s the caffeine. But I am in a cycle (that I’ve almost always been in) of dealing with fatigue. I think some of it is low blood pressure — I’ve always struggled to stay awake … in meetings, singing in the choir (i.e., facing the congregation as a minister gives the message and dozing….THAT’S special). Lately I’ve had friends I’m conversing with say “you’re clearly tired” as I’m simply trying to stay with a conversation. Driving pretty much anywhere requires a cold brisk water, soda, or other beverage to keep me alert. One of the things I love about working from home is the ability to take a ten minute micronap when the fatigue hits — it makes all the difference and doing it in the privacy of my home doesn’t bring with it the indignity of getting drowsy in public.

If I don’t drink caffeine (or find some other way to not get drowsy/fatigued), my professional and personal life are impacted. I guess I should make a big summarizing point in this particular italicized sentence but: I love and need coffee and would find it almost impossible to break up with it. That is all!

The Gray Areas In Dealing With Cardiac Issues Are Vexing

It is irritating and a little humiliating to try to explain a health issue others can’t see. If I had a cast on my leg or some other outwardly obvious sign that I am working through something, that would be different, but as it is, many people start every conversation with “the usual”: “So when’s your next race?” “What are you training for?” Etc. Etc. Etc. My social  network is largely comprised of runners. My social media content is liberally filled with running. The first place I head when I walk into a store is the fitness/running section.

When Running Is Bad for Your Health

Although this post has been percolating in my head (I had lots of time to think about it sitting on that curb in Southwood waiting for the golf cart (sigh)), I hesitated because I do not want it to be a whining, “poor me” post. I guess in a way it’s an attempt to put down in words the fumbling around I do when conversing about this when the zillionth person says “when’s your next race?”

I feel more keenly aware of the fact that I’ve spent years throwing out platitudes to other injured/ill runner friends: “you’ll get back to it,” “every step matters,” “people understand.” I feel aware of the challenge my father in law must feel when he is feeling faint and I’m screaming at him “PUT YOUR WEIGHT ON YOUR LEGS” because honestly, there was a moment there at Southwood on October 2 when the 1 mile back to the start line might as well have been 10,000 miles. No amount of willpower on my part would overcome the fact that my heart was done. with. ambulating. for. that. hour. DONE.

It’s a pain when well-meaning relatives say things like “well now that you’re not running but eating like a runner, there’s a weight issue.” (Yes, there is. I weigh more now than I did at the max of either of my pregnancies and my food consumption, especially the stress eating, really needs to be separated out (by me) from my runner persona.) It’s a process.

The Finish Line

This is not a post with a nice neat ending.

I guess my best advice right now is …..if your health enables you to fully engage in what you love for exercise and an outlet, do it and don’t take it for granted. If someone in your circle drops off the radar, give them an opportunity to try to process it and know that they themselves may not really be capable of explaining it or responding to their personal challenges, but they do still need you.

Their heart may still be putting in the miles even if their race reports don’t show it.

Cardiac Issues

thoughtful-thursdays4

Why I Agreed to the “Human Microchip”

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:

HR Zones

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:

LINQ

 

(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.

Patient Assistant

Next Steps

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?

The Finish Line of 2014

This is my last post of 2014. This weekend’s experience participating in the Biggest Loser Run Walk Half Marathon in Panama City Beach encapsulated so much of my year.

2014 Review

I Got To Travel

I love traveling so much. Getting to take a quick road-trip to Panama City Beach in order to participate in this race fed a bite-sized morsel to the voracious travel lover in me. Packet pick-up was at the Edgewater Beach and Golf Resort, home of several memorable gymnastics experiences back in my Gym Mom days. Wow did that make me nostalgic.

2014 Review

Packet Pickup at The Edgewater Beach Resort and Meeting Danni Allen, Winner of Biggest Loser Season 14

I Got To Run

Running is so central to who I am. A trip that does not involve running is very likely not a trip I am on! It was so nice to enjoy the sound of the ocean waves as we traversed Front Beach Road throughout the half marathon course, to share my friend Tabitha’s first ever half marathon (yay!), and to experience just a little bit of relief from the stress that has hung over my races and runs since the Turkey Trot. (Note for anyone following the health part of the Turkey Trot post, I have an appointment with an electrophysiologist on January 6 and will hopefully get closer to having some answers.)

2014 Review

Tabitha (white visor), Robin (pink visor), Minnie Pinnie (pink and blue harness) and I mid-race!

I Got To Cuddle With A Dog

Okay, cuddling with a dog doesn’t represent a component of my year, but spending a half marathon with Minnie Pinnie was a SURPRISE! Oh how I love this 5-month-old, 4 pound bundle of awesomeness who did the entire 13.1 miles (carried for much of it) in a tutu that matched her mom’s. She made every single person who passed her smile (even the ones who mistook her for a chihuahua). She spent the ride back to Tallahassee curled up in my lap, fast asleep (admittedly, I did a little snoozing too). Takeaway for the year? Be open to new surprises. This “not a dog person” was won over in short order.

2014 Review

I Got To Support My Friends and Be Supported By Them

Ostensibly I was doing this race to support Tabitha as she ran her first half, but making the arrangements reminded me that it is okay to ask for help sometimes. Neither of our cars is really up to a long trip, and I was hoping to make it cost effective by sharing a hotel room, so I asked for help. All of that worked out, and moments along the way, such as this exchange with my dear friend Arlene, said “support” without saying a word:

2014 Review

I Got To Be Myself

As I wrote about in this post and this post, some of my struggles this year have been related to insecurity and lack of feeling accepted, with a dash of the feeling that I am more “myself,” and less inhibited on social media than I am with the people I spend time with in real life. The camaraderie, jokes, and shared moments of this weekend built rather than eroded; that was a plus.

2014 Review

Race eve dinner!

I Got To Write About It

This should be self-explanatory. The finish line of the last race of 2014 behind me, now I write. Although it’s true I will write about anything, but deeper truth is that I am inclined to write regarding just about everything. Look for that to continue in 2015.

Lastly, I Am Looking Ahead to Making The Finish Line Count

In thinking back through this weekend’s half marathon, I have noted how it captured many of the parts of 2014 I loved, including travel, running, friends, and writing. One of my main projects for 2015 will be participating in the 2015 New York City Half Marathon as part of Team SOAR which is running for the Leukemia and Lymphoma Society. What do you know? I get to travel to it, get to run at it, will be with friends old and new, and will inevitably write about it! It’ll have everything except the miniature pinscher! (I do have a commitment to fulfill in support of the Leukemia and Lymphoma Society in order to participate, though. Here’s my link if you feel inclined to donate — no amount is too small!). I just received my training shirt today, and it seems perfect as I start 2015:

2014 Review

 See you next year!

Turkey Trot Race Report 2014

I love the Tallahassee Turkey Trot. I mean, love, bolded, in RED, italicizedunderlined love the Turkey Trot. I love the Turkey Trot so much that when my husband suggested I go to New York for my 50th birthday (which fell the day after the Turkey Trot this year), I refused to even think about it (and trust me, me turning down any hint of going to New York is big!).

"Tuning Up" with the Cycling Turkey four days before the race!

“Tuning Up” with the Cycling Turkey four days before the race!

Before talking about Thursday’s 10K race, I have to add a caveat. I wrote this post about finding “ands” instead of “buts” in your running and am the most ardent of believers in the fact that every runner matters, and that the joy of running can be found at the front of the pack, the back of the back, and everywhere in between.

Post-Turkey Trot Questions

But Thursday was a day that shook me up a little bit, and it will most likely be a milestone in my running journey. Around the 5.5 mile mark, and right at the moment a runner came up to me and said, “your pace has been great; I have been trying to catch up to you to tell you that,” my pace immediately became a walk as this happened:

Turkey Trot HR Chart

“This” is my heart rate going a little bit wildly off the charts of what is normal for me. (My normal is 143-186 (with 143 being where I could converse with you while running and 186 being my “sprinting as if my life depended on it” pace). There’s a good basic explanation of heart rate training from Chris Russell of Run Run Live here.

I have been training by heart rate (under a coach’s supervision) since April 2012. As far back as February 2013, when I ran the Flash 12K race, I have had odd HR spikes. I remember the “angel” runner who ran through the finish line with me saying, “we’ll do this together.” The issue started cropping up again this summer, at the Pot Luck Bash and each of the summer trail series runs. I sort of chalked that up to the heat and race adrenaline. I had a racing HR issue during one training run this summer but again … Florida is hot in the summer (mild understatement).

I finally decided to discuss this (and a few other “small” issues) with my primary care physician. He did an in office EKG (fine) but decided to go ahead and refer me to our health plan’s staff cardiologist (props to the health plan for having a staff cardiologist). He had me do a stress test (thanks for the mile, doc!) (fine) and went ahead and had me to a cardiac echocardiogram (fine).

Feeling relieved, I thought “I can put all of this cardiac worry behind me since I checked out okay.”

When My Gut Said “WALK”

I arrived at the Boston Mini Marathon on October 25, my second half-marathon, feeling great. Although it was cold outside, the weather was perfect for running. I felt so good about my weight loss, my improved nutrition, and the cause I was running for (Miles 2 End Prostate Cancer). I felt confident that I would shatter my previous half marathon time and at least finish in less than three hours. I was well on target to do that until around mile 5 when my heart rate started going a little nuts. I kept running, thinking I could run through it. When it refused to settle down, I started walking. I kept moving forward, and turned around at the half way point of the out and back race. I decided to try running again, remembering the cardiologist asking me “does it just feel like your heart is racing or do you feel loss of power, like you’re going to pass out, etc.?” Since it had “just” felt like my heart was racing, I decided to run again. That’s when it felt “not right” (I know, not a medical term but ….). I spent the last six miles of the race run-walking. The good news about the run/walk approach is that my HR stayed down. The bad news it took longer to finish the Boston Mini-Marathon than it had taken to finish the Boston 13.1 in September 2012, when I was definitely in relatively inferior shape.

Between the Boston Mini Marathon and Thursday’s Turkey Trot, my training runs have been solid (no HR issues) and I had one of my best 5K times ever (sub 34:00) at the Vet Fest on November 11.

The Turkey Trot day dawned perfect from a weather perspective. I felt great (again). Well trained, nutrition dialed in, happy to be running the last race of my 40s with 6000+ of my favorite people.

When my HR spiked at around that 5.5 mile mark, I didn’t bargain with myself as long as I had at the Boston Mini. I stopped to walk (very disappointed but knowing intuitively that it was the best decision). Again, this was more than “feeling a racing sensation.” It wasn’t right.

When I saw my friend Gabrielle close to the finish line, she was so encouraging. I don’t know why I felt compelled to explain (except that I am me, and that is what I do), so I told her I was having HR issues. I did run through over the actual finish mat, and since my friend Adrea was finishing the 15K at the same time, had a chance to hug a friend and celebrate a bit.

THEN I texted my coach, and eventually I just called her because I couldn’t drive home to all the people dying to move on to Thanksgiving dinner and explain my complex feelings via text.

It was during that talk that I first floated the “maybe I need to move to a run-walk for the longer distances idea.”

The important point here is that although I have zero, none, nada issues with run walking, I have always said “it is not for me” (which is why my friends who saw me walking at Boston knew there was an issue). I love the feeling of continuous motion; I love the feeling of speed (even though I know I am a slow runner). Once I move to run/walk there’s one more piece of technology getting between me and my mental bliss.

(I am also hesitant to limit myself to running only when I can find others with whom to run. I love running with others but also love running alone; it’s the most peaceful part of my day.)

The morning I ran the Run for Andy Nichols 5K in Blountstown, October 11, I went into my DailyMile and revised my goal of running a sub 30 5K to something less specific:

dailymile

I know the likelihood of meeting the sub 30 goal is unlikely at this point. I also want to preserve my ability to run longer distances. Since these HR issues don’t seem to occur (yet) at the 5K distance, perhaps there is a middle ground for me in racing 5Ks and participating in 10s and halfs by run walking.

I have chidlren to raise and a second half century of life that just started; I don’t want to jeopardize it all just by being stubborn.

The Medical Part

It bears mentioning that I have done this drill before (in 2005). I was not actively running at the time, and after several EKGs and a nuclear stress test, I was told to drink less caffeine and given a clean bill of health. This time, the cardiologist has given me the same mini-cardiac lecture both times I visited him. He describes the heart’s anatomy and the little electrical bundle that coordinates the entire process. Ultimately, after three EKGs and an echocardiogram all were normal, he said I could wear a holter monitor for 24 hours but it’s really hard to wear a holter monitor and run (because the leads would get sweaty and fail to adhere). The other option is implanting a device that can track HR, and that invasiveness seems illogical in my situation. To his credit, he did refrain from suggesting I stop running until the very end of each conversation, and the gist of that part was, “if it only happens when you are running, you need to consider modifying your activity choices.”

I have asked myself if I am fretting for all the wrong reasons. With a congenital heart arrhythmia on Wayne’s side of the family that has led to the death of one member and life-changing modifications for many members, there’s been more than the usual chit chat about heart issues over the years and I always had the “luxury” of worrying about my kids but not myself (since they shared genetics with the affected person and I didn’t). My friend Lisa, one of the best athletes I know, had a massive heart attack while on a run and was saved because an RN was there. Another friend of a friend collapsed and died in the middle of a day on a regular training run.

I don’t know what the outcome of all this will be. I am going to focus on these four things and pray I’ve chosen the right four:

1) Continuing to work with Coach Kristie of KR Endurance to be the best (and healthiest) runner I can be

2) Knowing that each race is “mine” and no one else’s; I have only myself with whom to compete

3) Supporting causes I love through my activity, especially Charity Miles

4) Being grateful for all that running (and, ahem/sigh/okay I will say it) and run-walking has brought to my life and will continue to bring to my life.

Those four things deserve a big thumbs-up, in my opinion!

Photo Credit: Fred Deckert

Photo Credit: Fred Deckert