I decided to share with you excerpts from a long email my wife sent out to friends and family regarding my heart condition.
Below is another chapter in Alan’s cardio-saga:
Yesterday’s activities began with a trip to the local cardiologist’s office to pick up pertinent records …
Along the way to Houston, I read the reports. … We found ourselves at the new cardiologist’s clinic, but were confused by its name: “Center for Advanced Heart Failure.” Not an optimistic greeting for someone seeking verification of a diagnosis (and who – only two years ago – was running half-marathons). All the other patients waiting for appointments had strap-on battery packs. One young girl even had a big ol’ backpack that probably wouldn’t meet FAA weight restrictions!
Sitting in that waiting room, Alan felt like a fraud. (When we return, perhaps he should wear a satchel hung by a shoulder strap.)
I was a bit more impressed by Dr. L (yesterday’s cardiologist) than I had expected. Before he saw Alan, he had examined the latest test (the “T.E.E.,” Trans-Esophogeal Echocardiogram), which we brought on DVD. That test (as was the previous Echo) had been interpreted by Dr. A, and his interpretation sounded much less “serious” than the “regular” (through-the-chest) Echo.
In the report of the T.E.E., the enlargement of the septum (the muscular dividing wall between the right and left sides of the heart) sounded much less serious than had the report from the previous Echo. … Because Alan’s main desire is to be physically active (run, work-out) and because of inconclusive data, Dr. L wants Alan to have a “treadmill nuclear stress test.”
The doc’s main objective for this test is to see what the heart does when it’s working under pressure … In the”treadmill nuclear stress test” … a radioactive is injected in a vein so that the coronary arteries (those “feeding” the heart) can be viewed… before, during, and after exercise (See https://www.cardiosmart.org/News-and-Events/2013/01/Video-Stress-Nuclear-Study).
According to Dr. L, tests seem to indicate that the partial blockage (from the left ventricle to the aorta) is less likely from a too-thick septal muscle than from floppy “heartstrings” (called “Chordae tendineae.” See the attached photo).
If too loose, these heartstrings won’t close the mitral valve completely (thus the “murmur”), and they get in the way of the blood on its way to the body. He did two experiments in the office, one of which caused the murmur to silence; the other, to increase. As I understand, the treadmill stress test … will show what happens when the heart is working… and whether Alan’s dyspnea (shortness-of-breath) is caused by coronary artery disease … or by floppy heartstrings. If the latter is the cause, Dr. L likely would prescribe a beta-blocker (or something similar) to slow down the heart (yes, even though it already is slow… as long as Alan didn’t feel bad with it slowed).
The “last resort” would be open-heart surgery to replace the mitral valve. And, I don’t see Alan going for that. If the problem appears to be caused by blockage to the coronary artery/arteries, well, that’s more testing, I guess.
This post is a blend of “talkie” and “pseudo-techie” because people with all sorts of understanding are receiving this. (I may have boogered-up the techie stuff, but I perhaps it’s “kinda-sorta” close). Thank you for your love, support, prayers, and info/consultation/ advice! ALL are most appreciated!
So now I wait for my treadmill test on Monday! Of course, I asked Dr.L if it was OK to run now. And of course he said “NO!” As you may imagine, I’m getting very frustrated …
Wish me luck!
In my previous post, I was so delighted to get back to running again. However, the euphoria didn’t last.
My doctor was concerned about my shortness of breath (dyspnea) and asked me to get an echo cardiogram. The test showed mitral regurgitation, the cause of a heart murmur I had experienced for years with no apparent effect. So my doctor referred me to the cardiologist, who decided on a transesophageal echo cardiogram (TEE) – shoving a tube down my gullet so he could get a better look at my ticker!
If all that sounds depressing, it’s only because it was. The worst thing was that the cardiologist told me I could not run, lift weights or do any other strenuous exercise for now. I guess the good news is it explained why I had not felt like running for a while, but the bad news is I was just starting to enjoy it again.
The TEE confirmed that I had HOCM – hypertrophic obstructive cardiomyopathy – caused by ASH (asymmetric septal hypertrophy). What this seems to mean is that the septum (the dividing wall down the middle of the heart) had thickened and was obstructing the mitral valve – that’s the one that opens and shuts to allow the oxygenated blood from the lungs to get to the rest of the body. When it regurgitates it means that it’s not shutting properly and so the fresh blood is held back and doesn’t get pumped out to the muscles.
When he saw my numbers, the cardiologist was amazed that I had been able to run at all: apparently this is a congenital problem that must have always been there but gets worse over the years. It’s actually the same thing that causes sudden death in young athletes: fortunately that’s not so common in older folks, but he still didn’t want me to take the risk. Bummer! I paid some attention to him, because he’s also a runner: he ran two marathons already this year!
The next step is to go to a serious heart man and see what he can do for me. That’s happening next week – I’m keeping my fingers crossed.
Does any runner out there have any suggestions for a superannuated plodder with HOCM?
I have to admit it. I’ve been off running again for a while.
Not from choice, mind you. Between traveling, health issues and the weather, I just haven’t been getting out like I used to
Talking of weather – has your weather been as weird as ours? A couple of weeks ago we had 37 degrees (F) – almost freezing – in May. More record lows this year than I can remember. Next week it will be in the 90s!
And rain – in Austin, which has had a three year drought, I heard that people drowned yesterday in floods.
All this is no excuse, really, for not running, but today – for the first time in a long while – I felt the urge to get outside again. Not to run, because I need to get back to it slowly, but at least to walk.
So I staggered around for a little over a mile and thought about my running shoes. They’re still in good shape, because I rotate through four pairs – a habit I got into when I was running every day. But I like to reward myself with a new pair whenever I do something really spectacular (like walking a mile when I’ve been out of action for a year!)
I’m a mild pronator, so I use a stability shoe, and I usually choose one that’s fairly light in the misguided belief that it will make me run faster. The only thing that’s likely to make me run faster is a tiger chasing me, and we don’t see too many of those here in East Texas. Even if we did, I’d be likely to give up after twenty yards or so and just say “OK – if you’re hungry you’d better just eat me.”
Plodders’ Running Shoes
As I tottered along the road I found myself pondering the problem of plodder’s shoes.
Nobody advertises running shoes for plodders. We see pictures of lean, healthy, young men and women smiling at us as they bound gracefully along in the latest neon footware, but never old, disgruntled overweight plodders scowling at the camera as they amble along in raggedy tennies.
Where can I find a pair of running shoes that will match my style (ha!) but still encourage me to try harder? Is this such a hard thing to ask for?
I’m thinking of starting a protest movement to goad the shoe manufacturers into doing something for the plodders – how about “Plodders of the world unite! You have nothing to lose but your bling!”
Is Your Running Form Causing Injuries?
I recently found an interesting article entitled “Does Foot Form Explain Running Injuries?”
Heel Striking or Forefoot Striking?
The author quotes a study carried out at Harvard University comparing injury rates between different types of runners. As you probably know, there has been a great deal of attention given recently to whether forefoot-striking is healthier for you than heel-striking. This question was the subject of the Harvard study.
In fact, as the author of the article mentions, most of us tend to vary in how our foot strikes the ground, depending on pace, terrain, shoes, how tired we are and probably other factors, too. We do, however, tend to have a predominant pattern, as did the 52 Harvard runners studied. About two-thirds of them were heel-strikers.
About two-thirds also were injured “seriously enough to each year to miss two or more training days.” The heel-strikers had about twice as many injuries as the forefoot-strikers.
Should You Change Your Foot Strike?
So, if you’re a heel-striker should you change your style and work on forefoot-striking? Should you switch to barefoot running? It’s hard to heel-strike when you’re running barefoot or with a minimalist shoe.
According to the author it might be a good idea, but not if you switch too fast. Like any other change you make, do it gradually, and listen to your body. The author tells that Mr. Daoud, one of the people conducting the study, broke a metatarsal while running his first marathon after transitioning too quickly from heel-striking to forefoot-striking.
How To Transition
Sudden changes in running form are a bad idea, but how do you transition slowly? Mr Daoud suggests that you try landing on the ball of your foot for five minutes at first at the end of your run. Work up to longer periods as your body adjusts, and only if you don’t find any continuing soreness.
Do you feel hungry after a workout?
Most people don’t.
Immediately after a workout, whether it be a long run, a speed training workout or a strength training workout, most people find they have no appetite for a while. About 30-45 minutes later, depending on the workout, the appetite returns.
These days, I alternate running with strength training. I have found that as I grow older my running gets slower and my need for strength training increases. Yesterday, I ran a short pace run and today I did a back and biceps workout.
After my workout today (which took just over ten minutes before breakfast) I was not hungry, but about 15 minutes later I was ready for breakfast. Following a strength workout, it’s important to take some protein within about 30 minutes, so I had a protein shake. It tasted great, and made the perfect prelude to a breakfast burrito!
(My wife is out of town at present, but she made me some sausage and egg burritos and left them in the freezer. One of those after a protein shake makes for a quick post-workout breakfast.)
Exercise May Affect Food Motivation
Science Daily carried a report this month entitled “Exercise May Affect Food Motivation”, detailing the results of studies carried out at BYU. The studies report that 45 minutes of moderate-to-vigorous exercise in the morning actually reduces a person’s appetite for food. This is great news for anyone who is trying to lose weight: you get the triple benefit of
- consuming calories while you exercise,
- raising your resting metabolic rate and
- desiring less food!
How Long Does It Last?
According to one of the researchers:
My own experience tells me that the diminished food motivation does persist with consistent long-term exercise. I know that, when running, dragging extra weight around gives a motivation to consume less junk food and focus more on energy-producing food. And strength training builds muscle and makes me more conscious of what I eat: my body demands protein to rebuild muscle fibers.
As a serious runner, you may find that you have no need to lose weight. In that case, I would suggest that you might need to add muscle mass through strength training: I found my upper body, especially, was wasting away during my half marathon training. Contrary to what many think, a weak upper body actually hinders long distance running.
Is it Better to Run a Fall or a Spring Half Marathon?
Most full and half marathons take place either in the spring or in the fall. One of the exceptions, of course, is the Antarctic Marathon, which next year includes a half marathon. Many runners dream of this run, but relatively few get to compete: it books up early.
If you run in the fall, you will need to train during the summer months. If you’re running this fall, you know that already! The problem with summer training, of course is the heat.
The past two summers have been exceptionally hot here. Last year, we had a drought, a heatwave and wildfires to contend with. For much of the summer, the smoke in the air made it unhealthy to run.
This year was not quite as hot, but the humidity was high enough to make up for it. I noticed today, too, how brown the grass is, and one of our trees appears to be dying. We have another drought: not as bad as last year, but still dry enough to kill off some of the vegetation and cause the lake levels to drop.
The general rule for running in heat is to take it easy and stay well hydrated. Early morning or late evening running is cooler than daytime running, but here in Texas it can be the time of maximum humidity. Taking it easy by running slower or running shorter distances is a sensible rule, but it interferes with training.
Keeping cool during summer running means wearing light synthetic running gear. Cotton does not work well in the heat: it gets wet and uncomfortable and is inclined to chafe. The modern “tech” tee shirts work well, and I like cool synthetic shorts and socks.
Top it off with a hat and sunglasses. A mesh synthetic cap with a big peak works best for me – it keeps my head cooler, provides shade and acts as a sweatband. Sunglasses will protect your eyes against UV damage and wind, dust and debris.
Winter training presents a different set of problems, the first being when to train.
If you are fortunate enough to be able to train during the day, say during a lunch break, then most of your problem is solved. Dress appropriately, run around noon, and save your long runs for the weekends.
Many of us, however, don’t have the luxury of running during the day, so we need to train in the early morning or late evening hours. Either way, this means running in the dark, which brings its own set of hazards. Reflective clothing is essential: you need to be clearly seen by drivers of oncoming vehicles.
If you’re running on a road, run against the traffic and try to keep an escape route open for the occasional driver who still won’t see you. (I make a point of waving to drivers when I’m running on roads: even if they didn’t see me before, the sudden movement can catch their eye and allow them to swerve in time to avoid me.)
Never run an unfamiliar route in the dark, and watch out for hazards on familiar routes. You should always carry a flashlight when running in the dark: you can use it to attract the attention of unwary drivers, but it’s also valuable for your own vision. (I sprained my ankle one dark morning when I hit a new pothole that had washed out overnight on a familiar stretch of road: limping home was no fun, and I couldn’t run for three weeks afterward.)
One difficulty I find about winter running is knowing what to wear. Most experts will tell you not to overdress, but I have found that wearing too little warm clothing can be even worse. When you get really chilled on a run there is no way to recover until you make it back home: if you wear too much, you can always remove a layer.
Which is Better?
It’s all a matter of preference, really. Both fall races and spring races present their own challenges. Depending on where you live, either can bring better or worse weather for training. If you generally run fall half marathons, why not try a spring one for a change, and vice versa?
Barefoot Running – Is it for You?
I just read an interesting article about barefoot running. The title is “Born to run barefoot? Some end up getting injured”, and it was written by Alicia Chang and syndicated by AP. Here is the link to the original article: http://www.msnbc.msn.com/id/47518383/ns/health-fitness/#.UCP_SqNmWFu.
It seems that, while some people can switch to barefoot running with no problem, for others it can cause serious running injuries. The trick, as you will probably know, is to switch over gradually. The catch is that running injuries may suddenly appear without warning and may stop you from running for an extended period.
The author describes ultramarathoner Ryan Carter’s attempt at running barefoot:
During a training run with a friend along a picturesque bike path near downtown Minneapolis, Carter suddenly stopped, unable to take another step. His right foot seared in pain.
“It was as though someone had taken a hammer and hit me with it,” he recalled.
Carter convinced his friend to run on without him. He hobbled home and rested his foot. When the throbbing became unbearable days later, he went to the doctor. The diagnosis: a stress fracture.
If you are thinking about switching to barefoot running, here are a few facts you should consider:
Barefoot running uses different muscles
Most shoed runners are heel strikers. Barefoot running encourages you to land more on the midfoot or forefoot, with a shorter stride than you use when wearing shoes. If you don’t manage this transition well, you will continue to land on your heel or else put too much pressure on your calf and foot muscles: either way leads to running injuries.
As the author says:
“Most just jumped in a little too enthusiastically,” said Langer, an experienced runner and triathlete who trains in his barefoot running shoes part of the week.
Bob Baravarian, chief of podiatry at the UCLA Medical Center in Santa Monica, Calif., said he’s seen “a fair number” of heel injuries and stress fractures among first-timers who are not used to the different forces of a forefoot strike.
“All of a sudden, the strain going through your foot is multiplied manifold” and problems occur when people don’t ease into it, he said.
If you’re going to try barefoot running, make the change a gradual one. Try one short walk a week to start with, then start jogging and increase your pace or distance slowly each week. Give your muscles at least one full week of recovery time in the initial stages: they need that time to repair the fibers and build strength. (This, by the way, is the same principle we use in the 7 minute workout to build strength without getting injured.)
You may want to try barefoot running shoes (oxymoron?), otherwise known as minimalist shoes. They help to avoid cuts and bruises from stones and other nasty objects on the running surface. Even better, transition through a pair of the new lower profile running shoes that come somewhere between a normal running shoe and a true minimalist shoe.
If you watched the Olympic track and field events, you will have noticed how many of the competitors were recovering from running injuries, sometimes necessitating surgery. As weekend warriors, we amateur runners are also prone to injuries, but ours usually come from trying to do too much too soon. Transitioning to barefoot running is like any of the other running tasks we accomplish: impatience is our biggest enemy!
Ryan Carter’s story
The article finishes Ryan Carter’s story as follows:
In April, he ran his fourth 100-mile race — with shoes. Meanwhile, his pair of barefoot running shoes is collecting dust in the closet.
Runner’s World On Half Marathons
Runner’s World issued a Half Marathon Special edition in August, 2012, packed with interesting information. They surveyed 8,719 readers and found out, for example, that 37% of runners considered the half marathon their favorite distance. This compared with 20% for the 5-K, 15% for the 10-K and 13% for the marathon.
I also found out there is a move to rename the half marathon the Pikermi. Somehow, I don’t think that will stick: unless you’re Greek you’ll have a problem with the pronunciation. Pikermi, apparently, was the half way point on the original run by Pheippides from Marathon to Athens.
If we’re going to rename the half, it seems to be that 21-K would be a better name. By my reckoning, the half marathon is actually about 44 yards short of 21 kilometers, but they refer to the marathon as a 42-K and the half as a 21-K in much of the world. The Pikermi name has the benefit of history, and was originally proposed by a Filipino living in South Korea (Eric Hidalgo), according to Runner’s World.
Half Marathon Statistics
Runner’s World has plenty more statistics – if you want them all, you’ll have to read their article. The most startling information for me was just how popular this race has become in the last few years: the number of half marathons increased from 400 in 1990 to 1,200 in 2010, while the number of finishers went from 303,000 to 1.3 million! Maybe they’ll add the half marathon to the Olympics in time for Rio in 2016. Meanwhile, we continue to debate whether the name should be changed. Some people feel that a half of anything sounds like you didn’t really try, while others are perfectly happy with the name. What do you think: should we change it, and if so what should we call it?
Runner’s World has plenty more statistics – if you want them all, you’ll have to read their article. The most startling information for me was just how popular this race has become in the last few years: the number of half marathons increased from 400 in 1990 to 1,200 in 2010, while the number of finishers went from 303,000 to 1.3 million! Maybe they’ll add the half marathon to the Olympics in time for Rio in 2016.
Meanwhile, we continue to debate whether the name should be changed. Some people feel that a half of anything sounds like you didn’t really try, while others are perfectly happy with the name. What do you think: should we change it, and if so what should we call it?
What Causes Running Injuries?
I was stretching after my run today and suddenly realized that I have had far fewer injuries recently than I used to. I found myself pondering why that should be, and decided to share my conclusions in this article. I believe there are three main causes of injury.
“Youth is a wonderful thing” said Bernard Shaw. “What a crime to waste it on children.”
Yes, youth is the most common cause of injuries. Young runners tend to be
What a lethal combination!
The inexperience means they have no idea of their limits: this can be a good thing, but it is also a leading cause of injuries.
Impatience causes them to ignore the usual precautions that we older runners take.
Aggressiveness leads to pushing too hard too soon.
As we grow older, we learn more about our bodies in three ways.
- Good experiences
- Bad experiences
Reading articles about running gives me new ideas and keeps me informed about the latest research. I also read articles on fitness, health and nutrition generally. The more we can learn about our bodies and how to take care of them, the better.
Good running experiences help us to test our limits safely. Running fast downhill without injury, using hill sprints to strengthen our lungs and legs, and finding that perfect long-run pace work together to teach us what our bodies are capable of without excessive strain. Good experiences help push our limits safely.
There are really no “bad” experiences – just learning experiences. Pushing past our limits to the point of injury helps teach us the value of patience during recovery, as well as how to cross-train. Through these learning experiences we discover how hard we can push ourselves without injury.
The single most common cause of injuries is overtraining. I have found over the years that three important rules will help keep me injury-free:
- The 10% rule
- Easy days
The 10% rule is just a guide: don’t increase any activity by more than 10% per week. Don’t increase your long run distance or time by more than 10%; don’t increase your weekly mileage by more than 10%; don’t increase your speedwork by more than 10%. It’s a good rough guide to avoiding injury.
When you do a hard workout, whether it’s a long run, intervals or hill sprints, your muscles need some recovery time. The idea behind easy days is to give the muscles a chance to recover and build strength before the next hard workout. Alternate hard days with easy days and hard weeks with easy weeks for injury prevention.
Running the same course every time in the same shoes at the same pace is a recipe for injury. Vary your course, if you can, use at least two different pairs of running shoes and alternate them, and vary your running pace. Mix up long runs, easy runs, speedwork and cross-training to avoid injury.
In this article, I mentioned cross-training. For many of us, cross-training is something we do when we’re injured and can’t run, but it has value in injury prevention. Running alone stresses the same muscles in every workout: cross-training helps to strengthen the other muscles we need to avoid injuries.
Most runners prefer to spend their exercise time running, rather than cross-training, so we tend to neglect this important aspect of remaining injury-free. My own experience has taught me that this is a mistake. Cross-training is an essential part of injury prevention.
If your time is limited, the single best form of cross-training for avoiding injuries is strength training. I have found this has given me more benefits than any of the recommendations I gave you so far. Ignore it at your peril.
Run strong, run happy!
People love to run.
So states Justin Levine in an article on Active.com titled Is Your Running Plan Appropriate for You?
The article concludes with the paragraph:
Random running without attention to progressions, strength development and smart tactics will lead to injury. You have to understand your body, pay attention to signs of overuse/overtraining symptoms and be willing to adjust the program accordingly. As an industry, let’s not bastardize running; let’s reward people for getting out there, pushing themselves and improving their health. The key is education. If you are a strength coach or running specific coach, hammer knowledge into the runners you train about smart training principles and get them to understand the complete picture. If you are a runner, be wise. Don’t just run without adding other elements to the program. Let’s remember, running is a sport that many people enjoy. Let’s encourage activity and promote smarter training so we can continue living healthy and taking advantage of every day!
I used to be a “random runner” until I started my own training plan, and I completely agree with Mr. Levine’s conclusion. Running should be fun, but too often it is not, due to setbacks caused by injuries. As Mr. Levine says, the secret is progression, strength training and smart tactics.
When I started running I had no intention of “racing”: for me, running was just a pleasant way of exercising and getting fit and healthy. A friend persuaded me to run my first 10K and I was hooked! After that I ran regularly without any plan and participated in 5K and 10K runs several times a year. I had frequent injuries, which took some of the enjoyment out of my running, but just believed they were a necessary part of the experience.
Training For A Half Marathon
It was not until I started running half marathons that I decided I needed a running program. In fact, I had already started mixing in some intervals, hill runs and fartlek with my routine runs, but had never really built a training plan. For the half marathon, though, I knew I needed more, so I researched several plans and developed a half marathon training schedule that worked for me.
As I was testing my plan, I recognized that different runners have different needs, depending on their starting point. That was the origin of the different schedules in my Half Training eBook, which contains various plans ranging from an easy beginner plan to an aggressive plan for experienced runners. Over the years, I have found little need to modify these plans.
As a runner, fitness counselor, and running adviser I have learned (sometimes the hard way) the truth behind Mr. Levine’s statements. If you are already a member of Half Training Schedule you will be receiving regular newsletters based on my own running experiences, in addition to the running advice on this website. Strength training was for me the final step in building the level of fitness I needed to enjoy my training schedule.
You will find no references to strength building in my training plans: I used to hate working out with weights. I now believe that strength training is an important part of overall fitness, whether or not you’re a runner. For runners, it’s vital as an aid to avoiding injuries.
Fortunately, strength training does not need to take nearly as long as running training. I now know that 20 minutes or so per week, provided you follow the correct plan, is sufficient.
Now that I can handle!