Training Log Archive: Frostbite

Adel Crag. Trying quite hard but the legs were complaining all the way. Very very wet - it has been raining for two days non-stop.

Bentley Woods, British Night Champs. A few mistakes, mostly going wayward on route rather than missing controls. I haven't done night O for 4 years I think and it showed. I was a bit cautious with some routes, and at other times just got bogged down in grot when nicer running was a few yards away - not a problem in daylight. Never felt comfortable with the running, struggled on the few hills, and very tired at the finish. I blame Dickie's spare room, the wind, the rain and the Trans-Pennine Express for a disturbed night's sleep.

5th place, 6 minutes behind Rich Barrett.

Got called out by work last night - working from 9 until 11 and then fretting about it until 2am. Didn't feel at all like running when I got home from work today.

Oxley, first 10 minutes slow, 2nd 10 minutes fast. A bit wet.

Warm up via Grove Lane. Jog home via Tannery.

8 x Sunset Road. A little bit quicker than last week at the start and much quicker at the end. Better all round. 1:28, 1:28, 1:29, 1:29, 1:34, 1:34, 1:31, 1:32. Had a bit of a wobble at the top of the 4th and then again on the 5th, but ok.

Back in December 2006 I was lucky to scrape into the England team for the Senior Home International when lots of Sheffield based runners had to make themselves unavailable. I did ok without doing great on both days, and after the weekend I was absolutely knackered. On the Monday following the event I was having a sneaky look at the split times on the internet at work when I felt my heart start to beat at an abnormally fast rate. I could feel it beating in my chest but there wasn’t much of a pulse to measure at my wrist. It didn’t even calm down when I stopped looking at split times and got back to doing some proper work.

After half an hour or so with my heart pounding away I was beginning to feel slightly unwell – a bit light headed but mostly just uncomfortable – and took the rest of the day off. I got myself home (by bus and on foot), then thought about seeing my GP. As soon as I mentioned heart rhythm problems they got the doctor to phone me straight back and he told me to get to the surgery sharpish. With a heart rate of about 190 the doctor thought it was probably best if I went directly to A&E. I got the full works - blue flashing lights, siren, speeding back into town at about 10 times the speed of the bus I had got in the other direction an hour or so earlier.

At the hospital I was rushed to the front of the queue because I had what is called a Ventricular Tachycardia (VT), or rapid beating of the lower part of the heart – the bit that does all the pumping. Apparently this is very dangerous, and the priority was to do whatever it takes to get it to stop. Usually people have fainted, or worse, by the time they get to hospital but I was still feeling much the same – a bit light headed and a bit uncomfortable but nothing worse. They got me to blow very hard into a syringe, which they didn’t think would work but they thought was worth a try. They have lots of syringes after all. Next they tried a drug that made me feel like I was burning all over and I think was supposed to suppress the electrical connections between the upper and lower parts of the heart. When everything settled down I was still pumping away at 180+. Next they tried Amioderone, a drug which slows the heart rate down but which can have some nasty side-effects. After a while the rate began to creep down – 170, 160, 150. It was now about 8 hours after the VT started and they were beginning to consider the final option in their armoury – electrical shock treatment with a defibrillator – clear, zap, bam just like on the telly. The thought of that was enough to get me back to normal and the rate jumped down from 140 to 50 in a few seconds. Ahhh that feels better. My next problem was persuading them that a heart rate in the mid-40s was normal for me and I was feeling absolutely fine.

I felt mostly ok throughout the whole thing, although after 8 hours of my heart beating at that sort of rate I was just a bit done for and apparently looking a bit pale. However the doctors were clearly far more agitated than I was, and once my heart rate was back to normal one of them explained that it is one of the scariest things they deal with in A&E, with bad results as often as good ones. I think he may have been less euphemistic about it.

They kept me in the Cardiac Care ward for a week while they prodded and poked me and kept an eye on me to make sure it wasn’t going to happen again. After a week I was told that I probably had ARVC – arrhythmogenic right ventricular cardiomyopathy. This is a congenital condition which causes the bonds between cells in the heart muscle to be weakened. The resulting damage to the heart muscle can cause electrical instability, which can result in the VT that I had suffered. It is thought that quite a significant proportion of the population have the genetic abnormality that can cause the damage, but for the vast majority of them it never advances far enough to cause them any symptoms. I was told that people who indulge in endurance sports, and specifically those who have spent years doing high-volume training for endurance sports, tend to be more likely to develop the symptoms. I think this was the consultant’s experience rather than an established statistic.

Note that I said I probably had ARVC. I have never been told definitively. I definitely had a VT, I definitely had an area of damaged heart muscle in the right sort of area. The only established explanation is ARVC. Stating it as a proven fact is problematic. On the day I came out of hospital I noticed a story in the paper about a Hinckley Town footballer who had collapsed and died during a game, and according to the post-mortem he had probably had ARVC.

There had been warning signs – I had been having bouts of rapid heart rate going back over the previous two years, all noted in my training diary. There were just a handful of them, each lasting only a minute or so. Each time I would have to stop and walk for a minute, the heart rate would revert to normal, then I would be off running again. I had thought about seeing a doctor about it, but once it stops there is nothing for the doctor to observe.

Following my first trip to hospital, I was told to stop running and to take beta-blockers. These are drugs which block the production of adrenaline and slow the heart rate down. About a month later I ended up back in A&E with the same thing when carting piles of controls and stakes around set me off. I wasn’t running. The second time the doctors went straight for the Amioderone and it only took 3 hours to get the rate down.

After that they decided to try catheter ablation. This is a relatively unobtrusive operation where they put a catheter into your thigh and then push it up along your artery and into your heart. The catheter has a couple of leads which provide electrical pulses to stimulate the heart into pumping, and a tiny microwave lead which zaps the heart muscle in order to kill parts of it off. They could identify the problem area reasonably easily and gave it a few zaps, but by stimulating the heart with the electrical pulses they could still trigger the VT so it was apparent the ablation hadn’t worked. They could have done a few more zaps and hoped for the best but the problem with this sort of ablation is the danger of burning a hole right the way through the muscle. We decided it was best to stop. (I was awake throughout. Feeling an electrical lead being pushed up your artery and snagging on all the junctions is mostly weird. Having the inside of your heart microwaved mostly hurts).

Next I tried another ablation at the Freeman Hospital in Newcastle. They were using the same catheter method but had some clever computer mapping software for the inside of the heart so they could see more clearly which areas had been zapped and which hadn’t. I had to wait a couple of weeks before I was tested again back in Leeds, and they could still trigger the VT. It had changed, however, and was more difficult to get going. I did an exercise test on a treadmill where there were no signs of any problems, so we decided to leave it at that and stick with the beta-blockers for a while.

That was in February 2007. At the end of March the doctor said I could try jogging again, but to stop if there were any problems. My main problem was the beta-blockers which restricted my heart rate to below 150. I continued like that without any problems for a while, even doing the occasional race, but by September I was beginning to get a bit ahead of myself and trying to go a bit too quick. I felt the heart rate beginning to go a couple of times and then one day it went while I was out running at lunchtime. It stopped by itself after about an hour, but by then I was in A&E and discussing my options with the consultant.

He had decided that the original ablation had not worked because the damaged area of heart muscle was closer to the outside than the inside, and the only way to get at it would be an external ablation using a cryo-probe. This would freeze the muscle rather than burning it, which is much safer because you can kill off a much bigger area without risking making a hole. It is also possible to freeze it a bit, test the heart electrically to see what difference you have made, then unfreeze it if you want. This sounded like a good option, except for the fact it was a major operation which would involve slitting my chest open, breaking my breastbone, and putting me in a rack to bend my shoulders back and open up my chest, which all sounded quite painful.

The operation was scheduled for April 2008 in Newcastle. I was back to not running again after the September problems, but by December I was feeling completely stable again. I tried a bit of jogging, then got a bit quicker and a bit quicker without any problems. I figured I could aim to do the JK a couple of weeks before the operation since I didn’t know what would happen afterwards. I was very pleased to get 3rd place.

The operation was on April 10th. The surgeon said they had killed off about 20% of my right ventricle, but that I probably wouldn’t notice. The cardiologist said that when they got through to the heart they could see the damage on the surface, so they knew they had got the right spot. Everything had gone as well as it could have. I was in agony. They give you a morphine pump where all you have to do is press a button and it gives you a shot, but it knows how much you’ve had so you can’t overdose. I had my finger pushed down the whole time. Unfortunately morphine makes me throw up, so after I had done quite a lot of throwing up they took the morphine off me and I had to make do with codeine instead.

After about 2 days I got my bladder drain removed. Next day I got the chest drain removed and I could walk about. I got as far as the shower, struggled to wash myself, then struggled back. I was still hurting a lot. I could only breathe lightly and any cough or sneeze was agony. Laughing would probably have been agony too but I wasn’t doing much laughing. In the night I slept only fitfully and all there was to think about was my heart rate jerking about. One night I could feel it speeding up until it was sustained at about 150 bpm. I felt bad anyway, but it seemed worse because I assumed that the problem we were supposed to be getting rid of had come straight back. I persuaded the on call doctor to do an ECG even though it was the middle of the night and he wasn’t happy about it. The VT hadn’t come back. This was a new problem, Atrial Fibrillation. Apparently open heart surgery can quite often lead to AF. It isn’t as dangerous as VT, because the atria are only responsible for priming the ventricles with blood. If they are mistimed then your heart will be working less efficiently but there is not much risk that you will be pumping no blood at all which can happen with VT. I was reassured that it would settle down, and put on Warfarin to guard against the possibility of blood clots.

For the next 3 months I improved gradually and the AF more or less stopped. I would feel it occasionally but it wasn’t causing me any problems, and I was taken off Warfarin. I went to see the surgeon at the beginning of June and he gave me the ok to start running again and, unfortunately, to go back to work. I ran, slowly, at the O-ringen – which I had entered before the operation had been finalised – and by the beginning of September I was beginning to run reasonably well again. To my surprise I was selected for the VHI in Northern Ireland at the beginning of October (mainly on the basis of my JK result), so I gave myself a couple of chances to prove my fitness to myself. As it turned out I ran really well at Ilkley Moor and beat anybody that would have gone as reserve so I thought I might as well give it a go. I’m glad I did – I did ok, and it might be my last chance to run for England. My first home international was the JHI in 1982.

After October things got worse again with the AF coming back more frequently, although not frequently enough for it ever to be going when I saw a doctor. Three days before Christmas I got home from work and was sat at home when I felt the fingers of my left hand go numb. The numbness crept up my arm and I felt like the left side of my face was drooping and I could only speak slowly and with conscious effort to control my mouth. It lasted 5 minutes, maybe, but by then the ambulance was on its way. This time I was diagnosed with a probable Transient Ischaemic Attack, or TIA, which is basically a stroke that doesn’t last very long and has no permanent effects. It is caused by a tiny blood clot on the brain which dissipates before it can do too much damage. The doctors thought that the clot was probably the result of AF, but at the time I did not have AF and it hadn’t been seen on an ECG since I was operated on in April. They tried putting me on a 24-hour heart monitor but it still failed to capture it so all they had to go on was me saying that my heart went a bit funny sometimes. Without an ECG it could be AF or VT or all sorts of other things or nothing at all. They put me on Aspirin rather than Warfarin which caused me all sorts of bother.

At the end of March (we’re into 2009 now) the AF started while I was out for a fairly gentle run. It came and went for the next 2 days making me feel quite uncomfortable and occasionally giving me very sharp pains in the heart where it felt under strain. I went to A&E so they could at least get an ECG of it, and this confirmed the AF had come back and I was put back on the Warfarin. Since then I have had lots of intermittent problems with AF – a few weeks with no problems, followed by a few weeks without being able to run properly, then back to being ok. Training is very frustrating because every few weeks I have to go back to the beginning again. It does seem to be getting better, and I have learnt some strategies to cope with it and what my limits are.

Apart from the AF I still have to deal with the original problem. If I have ARVC it is not cured, and may still cause more damage to the heart muscle. However the consultant is now inclined to think that I do not have ARVC, and that the damage to my heart was caused by something else. The consultant has a theory that the cause of my problems (and those of other athletes) could be simply due to stress on the heart causing ARVC-like damage without it actually being ARVC – in other words I have pulled my heart muscle.

I have been through the initial preparations for genetics testing, basically a long chat with the geneticist, and we decided between us that I had nothing to gain from being tested. There are so many issues.

It’s been interesting, anyway. I have had to get used to competing at a much lower level, but I deploy my excuses as and when I need them, and I will get better.

C • AF, etc 6