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)

UPDATE: The product reviewed here is no longer in production, and I believe the company is out of business. I leave the following as it was written, as I think it has some informative thoughts even though at least one of the options is no longer available.

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.

Wednesday, July 2, 2014

Recovery Day 17-ish: Recovery, Envy, and Mortality

I continue to work my way back from the heart attack I suffered during a trail race about 17 days ago. Okay, I confess, I've been trying to write this damn post for almost 3 days, and keep getting side-tracked!

I could whine about this whole rehab and recovery thing being no fun - which is true - but I choose instead to look forward instead of backward, to focus on improving and enjoying every breath instead of feeling sorry for myself or wallowing in frustration. After all, I have much to live for, such as my three wonderful sons

and of course my fabulous wife

So I'm planning on sticking around for awhile, and in fact not just being there but also on being vital and active during the time that I am around. One step at a time, one day at a time, but with the road clearly mapped - thanks in large part to many dedicated doctors and nurses. IMHO, it's always good to have a plan.

I am now alternating my daily "workouts" between (a) visits to the cardiac rehab facility or (b) working up a mild sweat on my own.

At the cardiac rehab facility I experience something that is at once both humbling and surreal. The facility at Park Nicollet Methodist Hospital is really very nice, and the staff have been terrifically friendly and helpful. But for me it's really odd to be attending sessions where I exercise alongside folks who are clearly decades older than I am and who have more than likely lived very different sorts of lives. I overhear discussions about diabetes, smoking cessation, dietary changes, and other very important topics for people who have not really taken care of themselves for decades (probably). I don't mean that be insulting or judgmental, and anyone who knows me also knows that I believe in the "to each his own" (or to each her own, I'm not sexist) approach to life: as long as what you are doing doesn't harm another person, then by all means feel free to continue. What's so weird for me is that I am surrounded by people who've experienced a serious cardiac issue just like me, but who are so significantly NOT LIKE me that it's as if I'm in the wrong place! At some level I know that's stupid and possibly narcissistic, because in truth all of us there are more alike than we are different, and everybody is trying to get better. We are a sort of club, or cohort. In fact, when one of us is finished with the rehab, the nurses jokingly refer to it as "graduation day". So we all strive together, and look forward to that symbolic diploma.

The facility is sort of like a mix between a semi-posh health club and mission control.

Actually, it's not either of those things exactly, but instead it's a series of concentric rings: in the center are the cardiac nurses who are manning banks of computers that monitor all of us via portable EKG devices; the next ring is made up of nurses and physical therapists who work directly with us, helping, measuring, encouraging; the next ring is an array of workout equipment ranging from fairly standard treadmills and stationary bikes to modified equipment that is very low impact and more appropriate for those who are less fit or possibly in fragile physical condition; finally the outer ring is a sort of track that encircles the entire encampment, used by patients to take monitored walks and to be tested on a timed six-minute walk (either as a pre-test or as a final measurement of improvement at graduation day). It all works like a well-oiled machine, and I'm there with my crew thumping away on the treadmill at 3.8 mph for all of 15 paltry minutes - wishing I could go faster and longer. Patience, patience, patience - not my strength I guess.

Conversely, when I'm exercising on my own, I've been focusing on cycling - gently - which enables me to open up my lungs, re-train my heart muscles, and to be OUTSIDE again. You never realize how much you miss the fresh air until you have it pulled away from you. Just feeling the wind on my face (and the occasional bug in my mouth) is bringing me such basic joy!

Of course, I'm only toodling along, and I'm being passed by EVERYONE: commuters with bulging messenger bags, mothers pulling kids in bike trailers, old ladies on their therapeutic tricycles, etc. Well, maybe I'm exaggerating just a bit there, but I do admit that I'm sitting in my seat, spinning a low gear, barely maintaining 14 mph and there are definitely people passing me left and right who would not have done so just three weeks ago (even on my easiest day). Well, I suppose the right attitude for me to take is "good for you, go for it". But I'm human, and mostly I just feel envy and frustration. Darn.

That time on the bike, going easy, sometimes zoning out, has given me some time to confront my mixed up feelings about this whole messy chapter in my life. Aside from dealing with anger/annoyance/frustration, feeling impatient, feeling somewhat emasculated, and whining about it all (those are the minor irritants, when you boil it down), what does bring me to my proverbial knees emotionally is confronting the reality of my own mortality.

In his seminal book The Denial of Death author Ernest Becker lays out a fascinating treatise that builds on the works of Soren Kierkegaard, Sigmund Freud, and Otto Rank. Becker's basic premise is the we humans embark on a sort of "immortality project", wherein we can overcome the dilemma of knowing we will die by a pursuit of becoming part of something that feels eternal. Yeah, I know, it's not simple or obvious, and frankly you'll need to read the book because I am admittedly no expert here. My totally amateur interpretation is that we need to create meaning and a sense of permanence, or else we'd all be in a psychological state of paralysis brought on by thinking something like this: "I'm going to die and disappear anyway, so why bother?" From that perspective, all that we strive for, find joy in, love/desire/lose, and all other personal experiences are enabled only because we can deny our own impermanence.

Thus, when that shield of denial is pierced by, oh say perhaps having a totally unexpected heart attack, it creates a great deal of inner emotional turmoil and chaos.

Perhaps the true measure of a person is how they then cope with that disruption.

I'm also no expert on Freud, but in reading ALL of his books (yes, I went to grad school), I think I was able to glean at least a surface understanding. If anything, Freud was recommending that all of us open our eyes to ourselves, confront our defenses, admit that life is rife with conflicts and disappointments, but then just get on with it anyway! His work showed that denial and other defenses could be -when taken too far - maladjustments to life, leading to all kinds of dysfunctional mental, emotional, and even physical states.

Interesting, right? But am I just intellectualizing here? And, really, this is a blog post, so enough already! All I'm really trying to say is that it's hard, at times, just readjusting to what amounts to a sort of new life. I'm getting my feet back on the ground, moving forward, but I'm not fully recovered yet - and that means not just my injured heart but also my tumultuous psyche. I remain confident that I'll emerge from this eventually, and I wish it would be NOW, but time is an essential part of the healing process, isn't it?

If you are healing from any difficulties in your life, know that you aren't alone and that we all have to face our own demons now and then. Let's all try to be patient - but let's also admit that our task is not simply waiting for time to pass. Instead, we have to work actively at getting better, and not just physically.

In closing this all-too-long post, I just want to re-thank everyone who has been on my side and wishing me well. Every single thought matters and helps. Thank you!

Wednesday, June 25, 2014

Recovery Day 11: Cardiac Rehab

It's now been 1.5 weeks, more or less, since I was hit with a heart attack during a trail half-marathon. I'm still trying to explain - to myself, to doctors and nurses, to friends and colleagues - why this could have happened to me. I'm supposed to be the guy who's more fit than everyone else, the guy who seems so much younger than 52 years. Sigh.

After all, I had basically NONE of the common risk factors that are under one's control:
1. Smoking tobacco - I've never smoked a cigarette, not even one, honestly
2. High cholesterol - only once in all of my life did I have a number above 200, and my HDL ratio is usually good
3. High blood pressure - never
4. Physical inactivity - please! I've done some sort of exercise, on average, 350 days per year for over 3 decades
5. Obesity - nope
6. Diabetes - never
(By the way, if you have any of these risk factors then PLEASE start working with your physician to reduce them as quickly and as permanently as you can. Not only will you reduce your risk of heart attack, but you'll have a higher quality life too.)

There are also three "uncontrollable" risk factors, but even they fit my case only a little:
1. Increasing age - but not yet hitting 65, which seems to be the magical number for heart attack
2. Being male - can't do much about that, I suppose
3. Heredity - my father has had bypass surgery, but the rest of the family has no real heart issues

I guess whatever factors were involved, even though technically minor compared to the overall statistical average, ended up being enough to trigger a heart attack for me. Darn.

Anyway, I had my first session of cardiac rehab, and I think it went pretty well. After checking in and providing all of the information (again), I took a short quiz to test my knowledge about my condition. I did okay, but didn't nail it. I wasn't sure what the appropriate level of exercise should be, and (embarrassingly) I was a bit unsure on some questions about heart attack v. cardiac arrest v. cardiovascular disease. Not a bad approach to start with a quiz, getting things "wrong" helps me to focus on learning what's right.

The American Heart Association has a ton of great information on their website. I highly recommend you spend some time there, and especially a good idea to do an honest self assessment of your risk.

After a chat with the nurse, they hooked me up to a portable EKG unit and had me do a six minute walk test while they monitored all of the readouts. I circled the perimeter of the indoor facility and ended up passing with flying colors, I guess. They said I was moving at about 3.5 miles an hour and that my heart rate never exceeded 85 beats per minute.

Next up was the treadmill. Just walking, but gradually increased from 3.2 mph up to 3.8 mph without too much strain. They asked me to keep my RPE within 11-13, and really I was probably around 10 or 11 most of the time (about 15 minutes in total).

Having succeeded at that (heart rate, blood pressure, and cardiac rhythm all fine), we next moved to a stationary bike. The nurse set me up to maintain first 90, and then 100 watts of output. That put me at about 80 rpm and maybe 12-13 mph. Pretty comfortable. This was the first time that I started to just barely break a sweat, so I think my RPE went up to 12. Again, no major alarms went off, so after 15 minutes of spinning I walked a little to "cool down", and then scheduled up about a dozen more appointments for the coming weeks. The goal: to try a short jog at the rehab clinic while hooked up to the EKG by the end of July! Fingers crossed on that one.

They encouraged me to repeat a similar effort on my own daily, between appointments. I will admit to some trepidation - I don't want to experience another heart attack! The nurse assured me by putting it like this: two weeks ago, I was basically a ticking bomb waiting to go off, clueless and unconcerned. Now, not only is the blockage in my right coronary artery opened up, but I'm also on medications and being monitored regularly, so it's actually SAFER for me to exercise now than it was two weeks ago!

Hmm. I'll ponder on that one.

In the meantime, I'll overcome my anxiety and get about 30-60 minutes of light aerobic exercise daily (probably by walking briskly or cycling at an easy spin) to see how it goes. This is all in the service of healing and re-invigorating my damaged heart muscle tissue. 

Taking it day-by-day, inch-by-inch. I'm a runner at heart and by experience, so I just need to convert this process into the familiar pattern of a "build-up" in training - adding just a little bit at a time, slowly increasing the workload until it becomes easy, then adding a little bit more, in a carefully choreographed cycle. 

I assume many of you have had to work your way back from one injury or another, or a major life setback or two ... maybe even multiple times. If you are doing so right now, at the same time as me, then let's be kindred spirits and tackle the physical, emotional, and psychological challenges together. Best of luck to us all!

Friday, June 20, 2014

A Very Bad Day - or - Lucky to be Alive?

Last weekend started off like a lot of weekends for me: an early alarm, a quick bite and cup of coffee, then a drive to a nearby trail race. In this case, I'd be running the Sour Grapes Trail Half-marathon for the third year in a row. The race was part of the 2014 UMTR Trail Race Grand Prix Series, a competition that I did well in last year but for which I had a lot of catching up to do this year.

I arrived in plenty of time, found a decent parking spot, picked up my number, and went about a typical warm up: a bit of walking, a mile or so of easy running, a few basic stretches, and heading for the start. Nothing out of the ordinary, in fact I was feeling pretty good.

The organizers got us lined up and sent us off. As usual, the faster-younger-more talented types rocketed off the line, leaving me and the rest of the pack to follow. I was probably sitting in about 15th place, more or less, about where I'd expect to be. With 13.1 miles to go, no need to push the pace early.

We rounded a couple of corners, and hit the first tiny little hill. We weren't even half a mile into the race at this point, but "something" happened to me right there. I felt a kind of flutter in my heart, and started breathing a bit heavier than I'd expect to be. Hmm. No pain. So I slowed down, thinking maybe I'd overdone the caffeine that morning, just needed to get my breathing under control and I'd be fine.

About a mile later I felt some tightness across my chest muscles. What the hell? Could I be having a heart attack? No way, I'm still running, only a few people have passed me, this is just a bad day. Maybe I was tense on the steering wheel during the drive, so I shook out my arms, slowed a bit more, tried to control my breathing.

Boy, did it feel like a bad day. For the next 3 or 4 miles I was forced to slow down to about 8:25 pace, well off what I thought I'd be able to do. But I was able to keep running, so I ignored my sensations and plugged on.

In fact, I plugged on all the way to the finish, which was a disappointing 20th place in about 1:47:00. Results. Compare that to last year's second place in 1:32, and you can see it was a bad day.

It was about to get so much worse.

I really felt crappy after the race. Super-tired, nauseated. and a bit woozy. Maybe I was bonking? I grabbed a banana, had some electrolyte replacement drink, toweled off, changed into dry clothes, and hit the road home. Still felt awful.

About 20 minutes into the drive, I finally admitted to myself that something was really not right. Stubborn fool. I pulled off the road, called my wife. She said, "Get to a hospital". She was right. I asked Siri to find me the nearest one, she obliged and I pulled into the parking lot of St. Gabriel's Hospital in Little Falls, MN.

I strolled in, sweating profusely and feeling light-headed. I told the receptionist that I might be having a hard attack. Within a couple of minutes I was on a bed and chewing children's aspirin, as the staff ran preliminary tests. It wasn't long before the doctor told me that I was indeed having a heart attack.

Okay, let me just pause here for one second. I was having a heart attack, one which had started almost 2 hours before, in fact I just ran something like 12.5 miles on trails WHILE HAVING A HEART ATTACK. Clearly, my capacity for denial is pathological, and my pig-headedness about finishing races had now put my life in danger.

I was so scared, it's hard to describe. Alone, and informed that I'd now have a wild ride in an ambulance for about 30 miles to get to St. Cloud Hospital, where they had specialists in cardiac catheterization waiting to help me ... I put my life in the hands of the professionals. I guess the fact that I'm writing this proves that it was the right thing to do.

The next few hours were a surreal and painful and frightening blur. I recall moments, like banging through the hospital corridors on a gurney, having my pants pulled off fast, receiving anesthesia, feeling almost out of my body, being told that I'd had a significant heart attack, and that I'd had an angioplasty and a stent implanted in my right coronary artery.

Then, I was in a recovery room. My typical, beloved type of trail race weekend had begun so normally, and now here I was.

My heart, shocked by this whole thing, couldn't seem to find a rhythm. After a couple of hours of my EKG bouncing all around, they sent me back to the Cath Lab so that they could insert a temporary pace maker for the night. I spent the wee hours in and out of a restless sleep, my heart pounding out a faster-than-normal and heavy-feeling beat, while intense thunderstorms pounded outside of my window. Like something out of a bad movie.

Eventually, I began to bounce back a little. On Sunday morning they turned off the pace maker, and my heart hung in there (mostly, still some funny beats now and then, they told me that was to be expected). I finally got a bite to eat. They came to my room Sunday evening to remove the catheters from my femoral artery (painful, very painful). By Monday morning I was able to take a few tentative steps out of bed, and by Monday evening I was able to be moved to a step down unit called Telemetry, which I always thought had something to do with launching satellites into orbit but apparently is basically a way to monitor things from a distance.

By Tuesday afternoon I could head home. Still scared, and now with a body filled with new and probably-long term chemicals (medicines) to help keep me alive: blood thinners, beta blockers, ACE inhibitors, and statins.

I had almost zero of the risk factors, and had just had my annual physical about 5 weeks ago - passing with flying colors. I do have a father who's had bypass surgery, but he smoked for years, didn't really exercise, and loved his eggs and bacon. Still, those darn genetics are just enough to get you. A heart attack? Me? Never!

Well, wrong!

I've now got a long road ahead, to work on recovery. The cardiologists said that my overall heath and fitness will not only help me make a "complete recovery" (well I hope so), but that in fact without it I would have suffered this episode earlier in my life and might not have survived it. So there's that.

I start cardiac rehab next, and if all goes well I'll be back running in several weeks. Not sure about any of this right now, of course, because I'm still wobbling around in a mixed up emotional and physical fog caused by fear, dread, anger, indignation, embarrassment, and drug-induced side effects. I know I've got to give it some time and work through everything. Of course I wish it had never happened in the first place.

I want to thank my loving wife for being strong and taking care of so many things through this crisis. And for someone who hates driving on the highways, she managed to come see me every day even through blinding rain storms and terrible traffic. Of course I'm also very grateful to the nurses, doctors, and everyone else at St. Gabriel's and the St. Cloud Hospital. The latter really was a top-notch experience.

As the weeks unfold now, I'll try to be more diligent about sharing here what I experience and what happens to me on this next leg of my life journey. I've got to get back up off the ground, dust myself off, and move forward again. I'm a pretty determined fellow, so I am confident that this hurdle can be overcome. But I'm damn glad to have help along the way, and I'm lucky to be alive.

Take care of yourselves, our time is so short and so precious.

Hope to see you out on the trails in a few weeks time, fate willing.

Monday, April 7, 2014

Stumbling Into Spring

Photo credit: Andy, Creative Commons Attribution 3.0 License
"Little darling, it's been a long, cold, lonely winter
Little darling, it feels like years since it's been here ...
Little darling, I feel the ice is slowly melting
Little darling, it seems like years since it's been clear ..."
From The Beatles "Here Comes the Sun" written by George Harrison
(my favorite version is by Richie Havens)

Finally, after an interminable winter, small signs of spring have begun to arrive. Yesterday in our garden, the first tiny points of spring flowers began to push through the dirt, and I think I even spotted an ant or two scurrying about.
Photo credit: Bre LaRow
I've had a rough winter running season, with very little mileage and non-stop struggles with my left hip - another case of piriformis syndrome. I will likely write a post on this common runners' injury soon, but for now I'm getting myself fired up about an upcoming race, my first one of the year: The Zumbro 17 mile trail race, first stop on the UMTR 2014 Grand Prix Trail Run Series.
In 2013, I managed to put together a consistent trail running season and pull off what I'd consider a bit of a miracle by winning that series. However, I came into last year with a solid base of training mileage and no nagging injuries. Ah, yes, good times. This year is very, very different.

I know in my heart that I'm not ready to compete at the 17 mile distance. I would probably be okay at half that mileage, but 17 is going to be tough. I'll need to run cautiously and under control the entire way, and focus more on myself than on any kind of competition. And pack in some calories, because I'm imagining that I'll be out on that course for quite some time. I'll leave the competition part to my wife Monika, who is coming off a strong training cycle and I think will be a force to be reckoned with during the 2014 series. We did a 10.5 mile trail run just over a week ago on snow-covered trails at Lebanon Hills Regional Park, and she was just floating along. I'd like to run with her next weekend, but I suspect she'll drop me early and simply run away. And I'll be the proud husband wobbling in, well-behind!

I hope your winter miles have come more easily these past few months. Good luck to all as you tackle spring 2014. I'll be back with a race report on the Zumbro 17 after the weekend. A brief search just now couldn't turn up any detailed race reports from the past two years, so if you know of any please post a link in the comments below.

Wednesday, January 29, 2014

Is Hibernation an Option?

It's winter in Minnesota. That sounds rather mundane, I suppose. But in Minnesota winter should always be written as WINTER, or perhaps WINTER-IN-YER-FACE.
Must. Find. Front. Door.
Earlier this week, I returned from a short family vacation in southern Florida. I took off from Fort Lauderdale, mildly sweaty in the 82 degree Fahrenheit temperature. I stepped out of the airport terminal in Minneapolis about 4 hours later into 15 degrees below zero F - for those of you who are counting, that's 97 degrees colder. 97. Did I mention NINETY-SEVEN?!

I did a couple of short runs in Florida, but I'm keeping my running miles to a bare minimum right now. That's partly because my left hip is continuing to bother me (I'm sure it's my old friend piriformis syndrome, but that's worth another post on another day). And partly because, well, it's WINTER-IN-YER-FACE in Minnesota. I heard on the radio today that people were ecstatic because the temperatures would be above zero today. Ecstatic + above zero should probably not occur in the same sentence.

So, I keep wondering if hibernation might actually be an option.
Or perhaps technology can offer a solution, so that our winter training program looks something like this:
Minnesota Runners Ideal Winter Training Regimen
How do you cope with cold weather running? I'm usually not that intimidated by cold snaps, but when the temps are below zero for weeks-on-end, I slowly lose motivation. Thank goodness I've got one of these torture devices in the basement. My cat looks at me funny when I'm whirling away on the thing, but it keeps me in shape (and possibly gives her something to cat-laugh about).

No, that's not really me, but that IS really my cat. She's convinced that I'm a complete idiot. 
Here are a few tips for running outdoors in the "polar vortex" winter weather:

1. Layers. This is old advice, but it's truly effective. Wicking layers against your skin, wind-stopping layers on the outside. You don't need to spend thousands of dollars on fancy stuff, but you do need to avoid cotton at all costs. And get some nylon shell mittens to put on over your running gloves.

2. Screw shoes. Don't read that incorrectly, it means "put hex head sheet metal screws into the soles of your running shoes". These really, really work. I ran a winter trail race once that was just sheer ice, and I beat at least a dozen younger, faster runners who were simply sliding all over the place. All I did was chug along with my screw shoes providing a firm grip. Here's an good post about how to do screw shoes.

3. Petroleum jelly. I lather this stuff on my lips, nostrils, eye lashes, eye lids, and any exposed skin. It protects against cold and wind burn, and it prevents your eyelashes from freezing together when you blink. Yes, that happens. Did I mention WINTER-IN-YER-FACE?

4. Lights. Winter running often means running in the dark. A headlamp is a must. I like the Petzl Tikka - fairly light, durable, and bright enough. I combine mine with rechargeable batteries and I'm good to go all winter long.

You probably have your own advice to share, go ahead and comment below. Good luck out there, stay warm and stay safe.