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

Four Heartfelt Takeaways From Running

Then, somehow, from a place beyond sense or strategy, she breaks forward, unpinned from her body’s flaws and marvels. It’s only courage that takes her the final distance. Only grit. ~Paula McLain 

As I was struggling through a 4-mile run last week, I was listening to Circling the Sun by Paula McLain. Horse racing is one of the main topics of the book, and the protagonist, a rare female trainer in the 1920s, needed her horse to win. The horse had started out strong, but was not in the lead as the end of the race approached. The passage above describes how the horse found her reserves and transcended what she was physically capable of in order to win. She became unpinned from her body’s flaws and marvels, buoyed by courage and grit.

My body’s flaws are winning over courage and grit, and I am trying to figure out how to get them all to make peace with each other.

Since April 2015, when I had an electrophysiology study after which my physician decided he could not do an ablation, the plan to deal with my multifocal atrial tachycardia has been to take a beta blocker a half hour before each run.

After having my procedure on April 6, 2015, I went on my first mile run on April 14. It took 14:06 to run 1.06 miles (13:17 pace). My average heart rate was 143 and my max heart rate was 153. On June 4, 2016, about 14 months later, it took 57:42 to run 3.16 miles (18:16 pace). My average heart rate was 138 and my max heart rate was 197. Both times (all times between now and then), I had taken my beta blocker a half hour before starting the run.

Although there have been a few brief visits to the sub-13:00 per mile speed over the past 14 months, it has been far more typical for my average pace to be in the 14’s, 15’s, or 16’s. For me, running on beta blockers is like running through mud.

I suppose my hope after the electrophysiology study, once I knew there had been no ablation and the ongoing plan involved medication before every run, that I could reach some consistent “status quo.” It has taken me the whole 14 months to begin to let go of my years-old goal of running a sub-30 5K, but as time passes the question becomes “where does running fit for me at all?”.

Is running still good for me physically?

Although I am fortunate to have an electrophysiologist with a great way of explaining things and a respect for the sport of running, he also says, “you know it’s not necessary to get your HR up to 160 (or whatever…) for it to be a workout,” right?

He’s right – I can get a good workout in a multitude of ways that don’t escalate my heart rate like running does.

But they are not running!

Nothing I have read online, no doctor I have spoken to, no one I know who has tried to combine running with an arrhythmia situation really has the clear answer.

Probably the best summary is: running while experiencing tachycardia is not generally as dangerous as it sometimes feels. BUT given that my EP thinks mine is likely to convert into atrial fibrillation (which increases stroke risk) over time, and the fact that I usually run alone, and the fact that I have to err on the conservative side because I want to be around to see my kids grow up, I think I have to assume that running to the point of abnormally high heart rate is not necessarily the healthiest choice for me. (Ironically, if it DOES turn into AF, I will be a candidate for an ablation again, and it is likely to work, but I can’t engineer that situation into being.)

What do people think?

If I had a dime for every time I have said, in all sincerity, to another runner or prospective runner, “you’re only competing against yourself,” “every mile matters,” or “you’re lapping the person on the couch,” I would be wealthy.

However, I would be totally lying if I didn’t say these are the thoughts that have dogged me over the past few months. At first, after the EP study, I thought I would reach that comfortable status quo, and just blend into the scenery at races, just log my usual refreshing and energizing training miles, just keep doing something good for my body (and mind) out on the roads and trails.

But that little “how can you still call yourself a runner?” voice in the back of my head will not stop its incessant pestering.

  • When I post my times to DailyMile and people see it took me 18 minutes to run a mile.
  • When I stop right before the finish line as I did at Gate to Gate and walk little circles off to the side while doing a Vagal maneuver to try to get my HR down from 197 so I am not running the risk of passing out in public as finish line adrenaline kicks in.
  • As I tell people “really, no, don’t wait for me. I’m going to take FOREVER.”
  • As I participate in races, trying to keep my feet running without my heart noticing they are while my head tries to mediate between the two
  • As I stopped logging my food and gained back 25 pounds I lost while training for a half marathon (and obviously my cookies-every-day habit has nothing to do with my tachycardia except for the fact that I know my mindset and my eating choices are inextricably intertwined right now).

You Can’t Trust Technology Blindly Without Listening to Your Body Too

Even when you have the best technology, you still have to pay attention to your body. Back in November-December of 2015, I was seeing “high” readings on my Garmin. These readings, for example, led me to run/walk the Turkey Trot rather than solely running it at a moderate pace. I decided maybe the batch of metoprolol I had recently been given was “bad.” I called the Publix pharmacy which had dispensed it, which said it was fine. I called my EP’s office, which confirmed the readings from my loop recorder were fine. It turns out my receiver on my Garmin chest strap was bad (oops!). I ordered a new one and the problem was solved. Now I follow the care instructions for my chest strap to the letter (it has to be cleaned often to prevent salt buildup).

How do I still contribute to the running community?

Running pervades every single aspect of my life. If I’m not dressed up, I’m almost always in a race shirt. If I am packing for a trip, the running shoes go in first. If it’s a weekend, my review of possible activities always involves which races are being run. I am a running groupie, and running people are my favorite people.

I have commitments as a Fitfluential Ambassador, a Charity Miles All-Star, and as a runner for Gareth through I Run for Michael. I know Gareth’s family “gets it” because he also has an invisible condition (a mitochondrial disorder). I know Charity Miles has my back – I can walk/bike and/or keep running 18 minute miles and #everymilematters still applies because the causes we love benefit. Fitfluential is a bit more challenging. I can only hope that my choices during this frustrating interim period help someone else who is struggling know they are not at all alone and you can have a love of fitness without looking like a fitness magazine model.

Running Cardiac Issues

While I suppose it would be an easier thing to discuss if I had a cast on my leg or some other outward physical sign of a health challenge, an invisible condition like a cardiac arrhythmia with questionable impact plays a different role in the multi-act play that is my running life.

I suppose I am at the intermission and the second act of this play has not been written nor rehearsed yet.

Running Cardiac Issues