Last Sunday I ran the King’s Runner 10k, a prep race for the Hapalua Half Marathon. Both races are put on by the same great folks who produce the Honolulu Marathon. I had two goals, 1) to see how hard I could push myself, and 2) to trigger a heart event that so far has eluded detection. I was successful in both.
The first goal was a mental skills challenge. In his book Endure Alex Hutchinson presents many views on mind over body, how the brain regulates endurance performance. That is not to say that we can exert free will over all aspects of our performance. The jury is still out, but it appears that some of what limits us are thought patterns we do have control over, and some are part of our autonomic nervous system and as such beyond our control. For example, the discomfort we experience as pain or fatigue can lead us to decide to slow down or stop, but we can choose not to. The athlete might be thinking, “I don’t feel like doing this.” An example of a possible autonomic action is when messages received by the brain that indicate low glycogen reserves can result in our brain selecting muscle activation patterns that recruit fewer muscle fibers, forcing us to slow down in a way we cannot overcome. In that case the athlete might be thinking, “Why am I slowing down?” I wanted to know to what extent my historically poor performance is simply a matter of surrendering too easily to fatigue.
My 2019 Honolulu Marathon was when I finally realized there was something wrong with my heart. I saw my GP, got a referral to a cardiologist, waited the requisite six weeks to get an appointment, and made it in just before the spring 2020 Covid lockdown. Dr. Cogan (whom I highly recommend) asked me to purchase a Kardia portable EKG (https://www.kardia.com/) , carry it and my phone on every run and bike ride, record an EKG (a strip, in doc speak) whenever the symptoms occurred, and email it to him. For almost two years I carried my little Kardia, did a few test strips, but never had the kind of experience I had at the marathon. That October I even did a full Ironman, part of the VR series. I even got a finishers medal and t-shirt, two of my prized possessions. No heart issues.
Last year I placed all of my focus on running a good marathon. We were not even sure it would be live, I just wanted to be ready in case it happened. My training went really well. The only setback I had was a nagging pain in my left ankle that turned out to be a poor match between my funky running form and the newest Hoka One One Ironman Edition shoes. I did PT and switched to Bondis, and all was well. I was really looking forward to that race. I thought I might even set a new PE, that’s how confident I felt.
My fuel plan called for a combination of carbohydrate from my Precision Hydration sports drink and a fistfull of Hammer gels. My fuel belt was jammed full and I had to carry my phone to let my wife know how I was doing. I had not needed the Kardia for two years, so it was left behind.
My pacing plan was a bit like this race except the intensity was lower. I have gotten really good at running slow, a cornerstone of the 80/20 philosophy. I believed that I was capable of running faster than my easy pace and did a series of tests to find what I could sustain. I followed that plan, but right after I started running I felt something was wrong. I have been running by power (Stryd) and was right where I wanted to be. Finally I checked my heart rate and was shocked to see it way higher than it should have been. My old friend was back, and no way to record it.
I spent the next five miles trying to get my heart rate under control. At mile six, at the park, I felt terrible and decided I did not want to walk the next twenty miles. I decided to take a DNF and get started finding an answer. I was dizzy walking through Waikiki and for the next couple hours.
This year’s Great Aloha Run (roughly a 10k, for those unfamiliar) in February was virtual. I ran it more as an extra long training run. No heart issues. Hmm.
Meanwhile my cardiologist ordered more tests and put me back on medication to suppress my heart condition. I decided Sunday’s 10k was a perfect opportunity to push myself and see if I could trigger an event. If the meds were working I should be fine.
My race plan was very simple. Warm up at the park before the race so that I could start running as soon as we crossed the start line. Hold zone 2 for fifteen minutes, then move up to low-mid zone 3, and after halfway just go by feel but push hard, no holding back. I visualized a cross country ski racer collapsing onto the snow as soon as they crossed the finish line. My “perfect race” estimated time was 1:45. I told my wife Pattie I would be happy with anything under two hours.
Unlike the marathon, I felt great running right out of the shoot. I actually had to hold myself back. I got up into zone 3 and felt fine.
I was watching my heart rate like a hawk. About a mile from the halfway point I noticed it creeping up into zone 4. I started to try to hold it down, then decided that since my goal was to push hard I should let it go and see what happens. Slowley it went from 145 bps to 150, much higher than I usually see in a run (132), but my legs were going fine. It plateaued at 152 for a long time. At that pace my breathing became full and deep, appropriate for a 5k or even a 10k. Then it went to 155. I was genuinely surprised I had not keeled over. 157. 158. Breathing hard but going strong.
Let me pause here to point out that despite working really hard at this point my pace was still miserably slow. I was still running with people walking, 17:00 - 17:30 min/mile. Try to understand how strange this must appear, an old guy running along panting like a proper 10k runner but running alongside people who were walking.
My max heart rate for the day came around here, 163. Yes! I had no idea I could run above 155. I have my TrainingPeaks maximum running heart rate set to 158! I was holding onto (barely) what should have been Friel zone 5C. Crazy. Right after the race, TrainingPeaks sent me a message that my threshold heart rate had gone up, from 145 to 151! Normally that would be something to celebrate.
I began to notice that sometimes when I got above 155 bps I felt a little pain from my heart. Or was it an unhappy gut? I burped and felt better. Slow down a little, then push again and see what happens. I didn’t die, no puke, so all good.
I thought about stopping and taking an EKG strip, but, silly me, I did not want my time to go over two hours. I was sure that whatever was happening would still be there at the finish. I was so tired after running up Atkinson, roughly the last mile, that after we turned onto King Street I just had to walk a bit, but I made sure to run that last hundred yards and wave cheerfully to the cameras.
As soon as I crossed the line I dug out my Kardia and took a strip. The app provides an assessment. Mine have always been “Normal Sinus Rhythm.” This time it read “Possible Atrial Fibrillation.”
This may sound strange, but at that point I was actually happy. I finally had useful data on what was going on. Two years, and at last I had something more than a hunch.
I was so impressed with this app that I went over and showed it to the doc at the medical tent. He had me sit at let his crew of young apprentices examine me, all the while explaining to them how unusual this was and what questions to ask the victim. Er, patient. I was pleased to be able to provide a rare diagnostic opportunity for these kids.
My time? 1:55:49. Not as fast as I hoped for, but under two hours. I said I was slow, didn’t I? That earned me 2468th place out of 2623, 25/26 in my age group. Winning time, not that it matters, was 32:50. Whoosh! Best in my age group was 52:12. I actually beat Steve Davidson, by a whole two minutes, but he walked the whole thing due to a nagging knee injury.
Since this race and my truncated marathon were roughly the same distance I was curious to see how some stats compared. In making this table I was surprised to see how high my heart rate got in the marathon. Back then I was still a Stryd true believer, meaning heart rate was worthless. And while we’re at it, let’s include last month’s virtual Great Aloha Run, which I ran conservatively.
Date
Dist.
Dur.
Avg. Pace
Avg. HR
Max. HR
12/12/21
6.19
2:00:40
19:30
146
162
2/20/22
8.16
2:32:32
18:41
129
147
3/6/22
6.34
1:55:34
18:14
147
163
You can see a dramatic difference in heart rate. What I suspect is happening here is that when my heart is working correctly and I am at my easy pace my heart rate is fine, but when I push the pace, even just a tiny bit, the arrhythmia kicks in and I’m cooked. Now back to our story.
I had stashed a carton of chocolate milk in my post-race bag, along with a bottle of high strength Precision Hydration drink, which is high in electrolytes. As I sat guzzling those I ran another strip. This one said “Unclassified.” Probably not holding my thumbs correctly. I was exhausted, almost like those alpine skiers but still standing. I began to feel dizzy - not uncommon after a race like that – and went off in search of something to eat. It was then that I ran into Steve Davidson, and while standing out in the sun catching up I not only felt dizzy, everything looked too bright. I got my packet of cookies, which is all they had (what, no bananas?) and still felt dizzy walking back to the car, so when I got to the car I took another strip. This one gave “Possible Atrial Fibrillation” even though my heart rate was much lower. At the finish my HR was 151 bps, thirty minutes later it was down to 107. My eyes were dilated all the way home.
After that I was wrecked until around 4:00PM. I sent Dr. Cogan my three strips. I felt fine at dinner but the honey barbeque chicken was a bit too much for my stomach and kept me up until midnight. Fortunately I was not in the kind of upset I have been after a marathon. My Garmin says I only got four hours sleep. Oh well. I ran hard, and that was what mattered.
As my brain came back to life I began to process the results. If the app was correct and I have A-Fib, I might just as well retire. I was already taking meds for it. The next step is a surgical procedure called ablation, which involves carefully killing little pieces of heart muscle to get the electrical signals flowing smoothly. It’s not always a one-and-done deal. Sometimes it never works. Sometimes the cure is temporary. I’m not a pro. At my age was there any justification for going through all that? I knew I should wait until I had a proper diagnosis and treatment options, but the little doctor in my head had already decided that my racing days were over. I was bummed.
First thing Monday morning I got a reply from Dr. Cogan. His opinion, not A-Fib. All he sees are a bunch of PACs - Premature Atrial Contractions. Like a good doctor he asked me to come in and take a real EKG, then we met and talked about the results. In the end he encouraged me to keep on doing what I do, just understand that I need to run slowly. I felt so much better!
There are as many types of arrhythmias as there are varieties of apples. They can be classified in three levels, annoying, potentially dangerous, and life threatening. Ventricular fibrillation can trigger cardiac arrest, which is deadly unless there is an AED handy to give you a shock. Atrial fibrillation has the potential of causing a stroke, by way of blood clots forming in the heart and migrating to the brain. PACs are misfires. They feel weird, and reduce the volume of blood the heart can pump, but they are harmless.
I think that last part, about the heart not pumping smoothly, has a lot to do with why I struggle sometimes. You can see this in the above table. Another good example (I have more!) comes from my first time at Honu, when I had to swim as hard as possible to beat the cutoff time – and just barely made it. When I started my ride I was shocked to see my heart rate up in zone five, and I felt like I could barely lift my bike. My HR stayed crazy like that for the rest of the ride. I could not believe how weak I felt climbing up to Hawi. I just thought I needed to work more on my swim. Well, I did, but this is a common reaction that athletes have to heart arrhythmias. They make you feel weak, and the obvious solution is to train harder.
I never have PACs when I train. My long rides and runs are low intensity, and my high intensity work is always done with work intervals too short to trigger them. My intent for last year’s marathon and last Sunday’s race was to push myself to run faster than my training pace, to get deep into the discomfort zone. That taught me that in my case going too hard has a seriously negative impact on performance.
What I need to do between now and June is look for a pace I can sustain without triggering PACs. I have no idea if that is even possible, but I’ll do my best.