Thursday, June 25, 2015

Recovery at One Year: A Part-time Runner

It's been one year since I found myself in an ambulance, speeding down the interstate, on the way to St. Cloud Hospital for emergency life-saving surgery due to a heart attack.

One year.
Image source:
That year has been spent well, I think. I've followed doctors' orders, I've made tweaks to my diet (really eliminating saturated fats and especially animal fats), stayed consistent with exercise, and tried hard to adapt to my cocktail of medications.

Overall, I'm just damn glad to be around to complain about all of the above!

One of the bigger changes in my life I suppose is that I'm really just a part-time runner now. I spent so many years - decades actually - running nearly every day. I was never quite able to be one of those so-called "streakers" (people who literally run every single day for years and years), usually due to some illness or injury or more-important life event. I did once have a streak of 1805 consecutive days running (that's 4 years, 11 months and 9 days - for those who are counting). That streak came to a stop because of a bad case of the flu that put me in bed for a few days. During that streak, I ran 15,372 miles for an average of 8.5 miles per day. Seems impossible to me now! Last thing about that streak: it was a rather long time ago, ending in 1986, the last year (I think, but correct me if I'm wrong) that gas prices in the US dipped below $1 per gallon. Ah, yes, 1986.

Fast forward to today: By part-time runner, I mean that I'm able to run a bit, but just not every day - and not by a long shot. I get too sore, I get too tired. Typically, I can get out 2 or 3 times in any given week. I am able to go 6-8 miles each time, so I'm not a non-runner by that measure. My other days are focused on cycling or sweating it out on the elliptical. I have been able to exercise almost every day so far in 2015, hopefully that will continue.

But I confess that I do miss running every day. It had a kind of consistent rhythm that grounded me in so many ways. Somehow alternative exercises just don't quite hit the same notes for me, psychologically.

But you know what? I'll take it!

At least I can still get out there and put in a few miles. And deep in my heart I'm not giving up just yet. Perhaps modern medicine will find ways to keep my cardiac issues at bay and allow me to slowly rebuild without all of the side effects holding me back. Time will tell. Hey, maybe arterial plaque-eating nanobots!
Image source:
Lesson: Never take for granted your days of running. Revel in the feeling, appreciate the opportunity you have to be completely alive and testing yourself physically in such a natural way. Every run is a kind of mini-miracle, try not to forget that.

Wednesday, February 4, 2015

Reality, Nostalgia, the Space Between, and the Wisdom of Sheehan

(not me) Image source:

  • old
  • slow
  • heart attack survivor
  • plodding along this morning
  • in the fluffy snow
  • at 12 degrees F
  • huffing and puffing to maintain 8:30 per mile pace
  • keeping heart rate under 130 bpm
  • BUT ... wearing probably the nicest high-performance, all-weather gear I've ever owned
  • and still loving the simple act of motion
George Sheehan: "Like most runners, I always want to do better. I am constantly after myself for eating too much and training too little. I know if I weighed a few pounds less and trained a few hours more, my times would improve. But I find the rewards not quite worth the effort...I am forced, therefore to do the best with what I've got."

  • reading through running logs from almost 30 years ago
  • young
  • fast
  • yearning, striving, working hard, concentrating
  • arrogant?
  • complaining - even though now I look back and see that it all came so much easier then
  • limits? what limits?
  • possibilities and long time lines
  • how could I have been so damn excited about a new pair of shoes ... so many times?
  • gear? what gear? I just need some socks and shorts and an old t-shirt
George Sheehan: "Sweat cleanses from the inside. It comes from places a shower will never reach."

The Space Between:
  • balance
  • acceptance
  • an honest self-deprecating sense of humor
  • embracing what is possible, not what once seemed possible
  • intrinsic
  • in the moment
  • alive
  • happy is as happy as you can be, and that's just right
  • doesn't hurt to have nice gear!
George Sheehan: "Success rests in having the courage and endurance, and above all, the will to become the person you are"

Thursday, October 9, 2014

Recovery - Month Four: Strides

It's an interesting irony to feel, at the same second, that time flies and yet every moment is savored. Perhaps that a common notion for anyone who's had some kind of very real brush with death? Then again, who am I to generalize from my personal experience to the wider world?

I suppose it's very lucky that I really don't have much to report! I've been plugging away. Hey, we're runners, that's what we do. We plug away, we log our miles, we improve little-by-little through effort and perseverance. I suppose all athletes who enjoy endurance sports fall under that formula. We're not home run hitters, but instead we are the faithful and the dedicated, always out there, always working hard, and hoping for the best.

I've been back to exercising nearly every day for many weeks now. It's not quite what it used to be, probably because of the medications I'm taking and the fact that my heart muscle is permanently damaged. In addition to those variables, I'd add the ingredient of fear - I'm hesitant, holding back, worried, a little tense. I typically alternate workouts, running one day, cycling the next, repeat. Here in Minnesota the cold weather has begun, so soon those cycling days will become elliptical days, but that's par for the course. Some factors that now put constraints around my workouts include:

  1. I'm short of breath: maybe due to the meds lowering my blood pressure, maybe due to lower heart rate, maybe due to reduced blood output of my heart, or some combination of the above. At any rate, I breathe more heavily than I used to, especially during the first 10-15 minutes.
  2. I keep my heart rate under 125 bpm. Compared to what I used to do in training, this seems rather pedestrian. But when I'm hitting 125 I feel (subjectively) like I'm working pretty hard.
  3. My fastest mile on any run since my heart attack took place this morning. On the third mile of my 8 mile run, I clocked a 7:33. Certainly nothing to brag about, but these days any mile at or a little under 8:00 is a raging success. I'll take it. On my bad days, I run about 8:45 pace, and on my good days (like today) I can average just under 8:00. Again, I'll take it.
  4. I bring drugs with me on every workout. It's just Nitro, but should I have another heart attack it could save my life. 
  5. I wear a couple of ID tags on every workout. Just in case.
  6. I appreciate the sunrise like never before, and yesterday I had the chance to see the "blood moon" on an early morning ride. Beautiful.
I hope to keep plugging away, following doctor's orders, and maybe someday be able to lace up for a (medium-length) trail race on a cool, clear morning, deep in a canopied wood. Please.

Good running everyone!

Sunday, August 31, 2014

Product Review: GuardianCall (This could save your life)

Readers of this blog already know that I suffered a near-fatal medical issue in the recent past. Part of the fall-out of that incident is that I take much more seriously the need to carry identification with me whenever I'm out there doing my thing, whether that's running, cycling, hiking, swimming, paddling ... well, you get the picture.

My recommendation: You should always have clear identification with you, including emergency contact information, and if possible a mobile phone. It's common sense, and you just never know when it might save your life.

With that in mind, I've been using a relatively new product/service called GuardianCall

GuardianCall has been impressive in a number of ways. I'll get to that soon, but first let's set the context with comparisons to competing products.

Most athletes already know about RoadID, if only because of the company's omnipresent advertising (in athletics magazines and often found on bib numbers at running races).  I like RoadID, I own one, I use it. In fact I've had one for a few years, well before I had to put any "significant medical history" information on it. But it's not a perfect solution. Read on.

I reviewed a competing product about one year ago called Go ID. It's a nifty idea because you make your own ID tags at home on your laser printer, and then attach them to your gear. Convenient, and relatively flexible. I had questions about durability, and when I added one of the tags to my already rather bulky Garmin GPS watch, it was a bit uncomfortable. For more details, please read my complete review.

Both the RoadID and Go ID have notable weaknesses in that the amount of information they can display is extremely limited, and frankly that display might be a worry for some folks who might not want their spouses's name and number along with a list of their current medications readily available for all to see. For example, perhaps some of you have had this experience: you are sitting at a table in a coffee house, reading and enjoying a warm mug of fresh-brewed java, and out of the corner of your eye you see the person next to you squinting at your wrist - you've forgotten to remove your RoadID, and they are trying to read your contact and medical details. Creepy.

I would be remiss, of course, if I did not mention Medic Alert, probably the oldest product of the bunch. You likely recall seeing late-night ads for this product, a piece of questionably-styled jewelry with your basic info and medical needs etched onto it. My mother has one, because she has a unique medical condition that's hard to diagnose quickly. She wears it 24/7, which is good for her. But a jangling metal chain on my wrist or flopping around my neck while running is just not for me, and the cost of the jewelry plus membership fees seems like the most-expensive option of all. Hmm.

All three of those options have one important thing in common: once the information is etched or written, it cannot be updated without creating a new item - that means either buying more pieces of jewelry, ordering updated replacement parts, or editing and printing new information. Now, I suppose that is not too much of a worry for folks who have no remarkable medical history, but for people like me this could add up to money and annoyances rather fast, and (except for Go ID) it could also mean waiting several days (or up to a few weeks) to have accurate information on hand.

Into this mix comes GuardianCall, with a unique twist on the solving the problem. In essence, you use a website to build out a detailed profile of your medical issues, emergency contact information, doctors, medications, etc. Then you receive from GuardianCall a set of tags and stickers that display a toll-free number and unique code that medical personnel can use to get whatever information they need, and fast. You add the tags to your shoes or watch band, and you put stickers on all of your usual portable possessions - your mobile phone, your wallet, your key ring, and whatever else you might usually have with you. In any situation in which you need assistance, emergency responders have access to detailed data via a toll-free phone call.  Pretty nifty. And any changes to my medications or condition can be updated immediately on my web profile - no need to re-order or re-print anything.

I signed up for the service a few weeks ago. It's easy to do, you pick a plan and away you go. By the way, you can sign up for 1, 2 or even a 4 person plan - so you can cover your family in one handy place. You can pay with credit card or even PayPal. Convenient.

GuardianCall sends you an email with instructions on how to proceed, then you build out a complete profile online. The interface was straightforward, and the sheer amount of information that you can enter is broad and pretty comprehensive. Not just one, but multiple emergency contacts, and they are all validated by GuardianCall to make sure that they agree to the role (take it from me: make sure to let your chosen contacts know it's coming, or they may think it's some kind of scam). I will admit that I got a little confused about how to access and add details to my wife's profile (we signed up for a 2 person account), and I suggest they add instructions for that to the FAQs on their website.

A few days later I received a packet of tags and stickers in the mail. I now have them affixed to everything I listed above, and more. Because I'm a heart attack risk, I feel much more confident leaving the house now, because should anything happen to me, emergency personnel would be able to figure out who I am, what they should do, and whom to call very quickly.

A few more thoughts about the GuardianCall approach:
  • Good for modern families, who are often scattered around different cities
  • Good for families with active parents and kids
  • Great for people who have medical conditions and take medications regularly, especially if there is any chance that those details can change over time
  • The ID tags are free, GuardianCall is in the service business, not the trinket business
  • No one gets access to your information without calling into the 24/7 service center, and being validated as a legitimate responder
  • Better than a tattoo! (certainly easier to edit)
So you've got a decision to make. Which product/service is best for you? Let's do a side-by-side comparison on some features and costs, then I'll offer my suggestions.

Hmm, that's quite a bit to digest, isn't it? Choices, choices! Isn't capitalism grand?

By the way, I put in the Contingencies line to illustrate some differences when it comes to elements of change over time - you may choose to skip those lines and just focus on the subtotal line in yellow.

Here are my suggestions - please take them or leave them, after all I'm just some random blogger - you should make up your own mind of course and get what works best for you.

1. If you are bargain-hunting, have no big medical issues, and you like the DIY approach, choose Go ID.
2. If you are concerned about yourself or your elderly and/or sickly relatives who are not very active, get a bracelet to wear 24/7. Choose based on price if you like (if you think facts could change or the bracelet could get lost, use GuardianCall). If you or your relative really, really want a metal piece of "jewelry", go for MedicAlert.
3. If you are active and healthy and always remember to wear your bracelet, plus you never lose anything and the facts of your identity and medical needs don't change, RoadID is a good choice.
4. If you are concerned about privacy and confidentiality, want the comfort of a 24/7 service center and family notification, and/or if your facts tend to change over time (whether that's address, medications, conditions, doctors, etc.) then GuardianCall is your best best.

Of course, you could be like me and have several of the above choices, using them all as the situation warrants!

The bottom line from me to you: get yourself some kind of ID and wear it while on your adventures. It could very well save your life, and that's a worthwhile investment regardless of the product you choose.

Be well.

Full disclosures: GuardianCall provided me with a free account in order to use and evaluate the service. In return I agreed to write a review, but stated that my review would be my own honest opinion, and would include both pros and cons. I will not receive any other services or goods from the company. I had similar terms with Go ID. I have received nothing from RoadID nor MedicAlert. My evaluation and recommendations are mine alone, and by their very nature amateur. Still, I do my best!

Wednesday, August 20, 2014

Recovery Week Nine: 4 Reasons to be Happy

One of my favorite authors is Bill Bryson. One might consider him a memoirist and/or humorist, but I just find his writing engaging and he makes me chuckle. In his book Notes from a Small Island (1995), he shares a list of  three reasons never to be unhappy. Please read the book (especially if you are an American who's spent any significant time in the UK) to flesh these out, but his list boils down to:
  1. " ... you were born. This was in itself a remarkable achievement."
  2. " ... you are alive. For the tiniest moment in the span of eternity you have the miraculous privilege to exist."
  3. " ... you have plenty to eat. You live in a time of peace."
One could take issue with any of these, of course. And I am especially aware that number three is simply not true for a significant portion of our human population. I think that Mr. Bryson was addressing primarily his readers (through himself, in a way) and not trying to expound universal truths. I think it's probably also relatively safe to say that if you are actually reading this, you're probably doing okay in terms of daily caloric intake and lack of gun fire in your immediate vicinity. That is not meant in any way to down play the horrors of any past, current, or future violence anywhere on the planet. Actually, it's meant to emphasize how lucky many of us are that we can write and read online blog posts instead of worrying about basic safety and shelter and water and food. We should never take that privilege for granted, and we should use that realization to increase our general sense of happiness.

I'd like to add a fourth item of my own. I don't think it's profound or even particularly impressive. But it's the kind of thing that helps me remain positive, happy, and optimistic about my tomorrows. Maybe you too.

   4. You are connected to other people.

I can't really define "connected" very well here. I am using it to cover a range of things, from deep and devoted love, through distant relatives, to business-only associates - and just about everything in between. But life is happier, richer, and more satisfying when you have a sense of the intricate web of relationships that is woven all around you. People need people. We are social animals, we are happiest in our herd.

My herd has nearly always been "runners". Now, as I adapt to a new normal, my familiar herd is out-pacing me and I fear I'm falling behind. But what's amazing is that all I really need to do is to open my eyes to the complete herd in its full range - not just those few who are prancing away like gazelles, but also all of those who find joy and meaning in simple movement, pace-per-mile be damned. Being a runner is a self-defined identity, and our herd has always accepted any member who says "I'm in". Yet another thing to love about our sport.

I'll be what competitive cyclists call "pack fodder" now, just a face in the crowd - no longer aiming to win, place, or show in any races. Considering the alternative, I'll definitely take it. One step at a time.

Tuesday, July 29, 2014

Recovery Week 6: The Stress Test

It's been about six weeks since I suffered a heart attack during a trail race.

Even when I was still in the hospital, the cardiologists told me that six weeks was a key moment in time. Why? Here's what I recall being told:

  • For most people, any post-attack healing of the heart muscle is completed in six weeks
  • Cardiac rehab will be useful until about six weeks, when I would probably be totally bored with it and ready to exercise on my own (please note: it was made clear to me that this was based on my 35+ years of steady exercise, my relatively young age, and my overall health - cardiac rehab for others who have different circumstances might last for a few months - please don't generalize to your situation, talk to your doctor).
  • A cardiac stress test would likely be scheduled at six weeks to assess how I was doing, and to help chart the course for the next several months or even for the next few years. 
It would seem that the predictions were coming true. I was certainly bored with cardiac rehab - that's no knock on the facility or the staff, but flopping around on an exercise bike or elliptical machine at well below my usual physical intensity level for 20 minutes wasn't really engaging me, and I was rather tired of the 20 min. drive each way as well. 

Plus, the stress test was scheduled!

I looked forward to that test and dreaded it all at once. I didn't know exactly what to expect, but secretly I hoped I'd be a total outlier, passing with flying colors (they told me that I'd be on the machine between 6 and 15 minutes - I planned on at least 20 because, as I've noted before, I'm a stubborn mule). But to be honest I was also worried and anxious:
  • What if something bad happened in this first instance of really testing my heart? Another heart attack? Having my druthers, I'd rather not go through that again.
  • What if what they found was that I'd not healed at all? 
  • Worse yet, what if the blockage in my left main - called the Widow Maker - had gotten more severe and I needed immediate surgery? Yikes!
  • What if I turned out to be a total wimp and couldn't even put forth a minimal six minute effort?
Well, whatever was going to happen was, I guess, going to happen. Wait, is that some kind of tao concept? Hmm.

So, I reported to the cardiac clinic early yesterday morning and got hooked up. They placed me on a cold table and taped at least 8 electrical leads to my chest, and plugged in an IV for injecting me with "image enhancer" (which sounded like some kind of miracle cure for public relations disasters, but was actually just a sort of milky looking dye that apparently would make it easier for the ultrasound technician to get a clear picture of what was going on with my heart).
Then they strapped me into some pedals, took some baseline measures, and got the thing whirring. Here is a photo taken during my stress test:
Well, maybe not exactly, but that's more or less what the darned thing was. In fact, there were no handles to grab (that would have helped), and the machine I was hooked up to had big, strappy pedals on it, but it did involve lying down and trying to exercise in a similar position. There was one really odd thing about it too: the pedal spindles on the machine were located closer to my heels than to the balls of my feet, which meant I'd be pedaling without any real way to engage my calf muscles. For the first couple of minutes, I kept making the machine go CLUNK-CLUNK because I would naturally use my calf muscles and thus jerk the pedals around wildly. I kept apologizing. Yeesh.

I don't recall where they started me exactly, but in essence I was instructed to pedal at 65 rpm (that's much slower than I'm used to with my cycling, which is typically 90-100 rpm) and they would add resistance every two minutes in increments that increased my effort by 25 watts until I hit the target heart rate (over 142 but under 168) or felt too fatigued. The first level I recall clearly was when it hit 175 watts, which I think was at 10 minutes. Before that, it all felt relatively easy - if extremely clumsy. I was just pedaling easily and chatting with the nurse about his upcoming 10 mile race. But when the machine hit 175 watts I started having to push pretty hard (with the weird spindle position, I was really only using my quadriceps so I could not spin in full circles, just stomp down hard on each down-stroke, which was a really unnatural movement). I started sweating. A lot. They turned on a fan. Full blast. Didn't help much. 

At 200 watts I was breathing harder, and starting to watch the clock a bit more closely, although my heart rate was still only about 115 beats per minute. At the 14 minute mark the machine hit 225 watts, and that's when I finally felt the burn for the first time in a long time, at least since before my heart attack. I was huffing and puffing like the big bad wolf, and sweating like a maniac. The nurse was pumping me with the dye and the technician was sliding the ultrasound wand all over my chest and snapping digital photos. It was a flurry of activity. Meanwhile, I was going anaerobic fast, and breathlessly told them so. I didn't think I could handle 250 watts, and it became clear I was correct as my rpm slowly dipped from 65 to 63 to 59 to 57 ... and then as my legs locked up they shut me down at 16 minutes. My max heart rate had been only 136.

I partly felt like a failure for not hitting my 20 minute goal and for being unable to get my heart rate up any higher. Yeah, I know that's stupid, but those old competitive fires don't go out easily. 
Source =
It took me about two-three minutes to get my breathing back down and my heart rate back to 66 - until then my chest was really thumping away. But otherwise I felt pretty good, burning quad muscles aside. They gave me some water and a towel, and sent me away. I met up with my wife in the waiting area, and we realized that we had an hour before I would see the cardiologist to go over the results. It was a nice day, so we went outside and walked together for about 35 minutes, just chatting. I was probably chatting too much, because I felt the flush of a hard effort (yay!) but also the anxiety of finding out the results (gulp!).

The results: We ambled into the cardiologist's examining room and sat in eager silence. The doctor entered moments later, and was all smiles. He went over the results. While it was true that part of my heart muscle had been damaged by the attack, the overall measurements of my heart were within the normal range. My ejection fraction was 55%, and it increased with effort during the test, a very good sign. The overall flow through my coronary arteries was good, and my cholesterol levels had dropped considerably due to the medications. Things were looking good - at least I thought so.

Then the doctor said words that I'd been longing to hear, such as "this is looking good" and "it's time to resume your active lifestyle". Of course there were also words that I knew were coming but did not enjoy hearing, such as "don't even think about running a marathon" and "don't do anything crazy, like racing hard". Like I said, I knew that would be the instructions, but of course I wish it were different. Still, I'll keep saying that I'm just glad to be around to complain about all of this.

And I don't have to go to cardiac rehab anymore!

So I've got the green light start jogging a bit, and work up to an hour (or even a little more) of gentle effort aerobic exercise. I will probably never race all-out again, competing is now a thing of my past. Sigh.

Still, I'll definitely take it. I have to celebrate the good things, and look forward instead of backward. I have a lot to live for. Hell, we all do, if we just take the time to realize it. 

Happy running, whatever your pace. I just ask that you be kind when you pass me, or frankly when you pass any other runner/jogger/walker out there. We're all in this together, right?

Tuesday, July 8, 2014

Recovery Day 24: Scared Shirtless

Well, maybe "shirtless" wasn't exactly the word I was looking for. But I wanted to maintain my PG rating.
As an aside: what on earth are " ... some thematic elements"? Well, it turns out that there is actually a Motion Picture Association of America definition of Thematic Elements

Anyway ...

Late last week, I had a negative and scary follow-up visit with a specialist cardiologist. He went over all of my recent medical records, and especially the report from my catheterization procedure of June 14. What I understand is that the doctor who implanted the stent in my right coronary artery also basically took a look around the other arteries of my heart while he was in there via angiogram. Apparently he saw and noted several more blockages in my coronary arteries, which is in itself depressing. But worst of all, he noted that one of those blockages (estimated at 40%) gives me a terrifying double-whammy: it's located in a spot that can't be fixed with a stent (main coronary artery), and if a clot forms there I'm a goner within minutes - because it's the main artery that feeds most of my heart. They call this a Widow Maker. Insert intense and loud curse words here.

He told me that I will need open heart surgery and at least a double bypass surgery "soon". I will be getting a second opinion of course, but I suspect that this is simply my reality now.

From his perspective, I might be able to run again, but only at low intensity and for short periods of time. He also said I'd probably never run a race again. I will confess that looking forward to specific races has been an integral part of what I've relied on to feel happy for over three decades. Thus, I need to re-configure my life quite a bit now, especially to come up with other things to look forward to, which seems so easy to type here but at the same time feels so challenging. Should that embarrass me? Perhaps. Running has been such a steady companion through all of the ups and downs of my adult life, maybe I came to rely on it too much. My challenge will be to reformulate my coping strategies and keep moving forward.
I'm a bit depressed. I would imagine plenty of you are familiar with that feeling. I think ever since I reached age 40 I've been joking with my peers about how it sucks to get old, but now it's not really much of a joke anymore is it? What matters most now is sticking around awhile to be here for my wife, my children, my family. Certainly that's more important than even the most-awesome race in the universe.

Meanwhile, I continue to do cardiac rehab 2-3 times per week and some easy cycling in between. I'm getting outside and feeling the air on my face. For example, I managed to get out on my road bike this morning for about 12 miles at a fairly easy cadence, keeping my heart rate down under 110 bpm. What's hard for me is the inevitable comparison to what I used to be able to do. Psychologically, I need to move away from "I used to be so much faster" to "man, am I glad to be here and to be able to smell the damn roses".

If you are facing challenges in your life (and really who doesn't face challenges?), I hope you will join me in determination to defeat defeatism.