Major Bleakness

I know it's stupid, but I stored all of my exercise data on my work laptop, mainly because it has a COM port which I can use to download the data (my personal computer needs a USB-Serial adaptor). So I had ALL the data that I've gathered since being in Pretoria on that PC! Which is really sad, because it's quite interesting information that I can't get back!

Oh, did I say that my laptop was stolen from my office at work this past weekend? My window was pried open and my laptop taken from my desk :( I guess it serves me right for leaving my blinds open. The saw it in the window, but we are supposed to have a really good security system, state industrial secrets and all!

Sometimes, just sometimes, I hate my country.

On the bright side, I did start this blog, to store an outline of the data, and I also have my old fashioned logbook...still

Week 32 - Sortof back into it (3-9Aug)

What incredibly frustrating about being me is that I work really hard to get to a level of fitness, for months at a time, and all of that seems to vanish in a few moments when I get sick. That not only makes going for a run less fun, but also destroys my motivation! So I went for a walk on Sunday 3 Aug, did what I assume was about 5km in 50mins, which was fine. It was when I went for my first run on Monday evening that I realised my fitness was seriously compromised.

The route was Spiral which is 5.5km and it took a dismal 51 mins to complete, because I simply couldn't run, there was nothing there when I tried to turn it on :( . The running club was doing a VO2 Max test on Wednesday, so I skipped that and went for another 60min walk, which I assume was about 6km. Friday was a little better, I did 4km in 33min, but still far off the pace of the 15km I'd done 3 weeks before.

There is a possible added reason for my feeling a bit flat. I was taking some supplements, Co-Enzyme Q10, which I haven't actually run past my doctor...so don't tell him :P. But when I got some symptoms that my INR was too high, bruising etc, I stopped taking them and went for a long overdue blood test...yes I hate them! My blood was pretty much fine, but I don't really want to start taking them again and have them change my INR. Next time I see my Cardiologist I will ask him about Co-Q10, I've done a little research and there seems to be some strong indications that this stuff may be of some help. If coming off it has contributed to my feeling less fit then thats a clear indication in my book... however, the eternal skeptic says, it could also just be psychosomatic!

Anyway, whats the moral of the story? Firstly, don't over do it Mark! Duh! And second, don't try things without talking to a doctor (in my defence I started on a very small dose)

Week 31 - Straight after Walk the Talk

To say that 30km was over doing it is an understatement I guess. I was finished! I think that probably contributed wit what happened later in the week. I got to work on Wednesday and all was fine, however by about 10am my hands were really cold. I got a cup of coffee and put my hands under the hot tap, when I got back to my office I put the aircon on hot, which I very seldom do (energy use, carbon footprint etc). Nothing worked and half an hour later I was shivering like I was outside in subzero temperatures in my undies.

Needless to say I went home, which was interesting considering I ride a motorcycle (energy use, carbon footprint, financially sensible). I got home and went to bed. I then sent SA Doc what must have been a really annoying sms, but considering my other close doc friend was in SCOTLAND at the time, she was my only option. She told me my symptoms were pretty broad and that, considering my condition, I should see a doctor. I knew she would say that, so I went to the doctor, because at this stage I was pretty alarmed.

The doctor was unimpressed by my "alarming" symptoms and sent me home with a letter booking me off till the weekend. He said I had "viremia", which is short for "I have no idea what you have but you will live", and told me it would pass in 48 hours, which it did! I had fever and a headache all of Wednesday night, read a book most of Thursday, slept like a log on Thursday night and went back to work on Friday.

Needless to say the only exercise I did was 2.8 VERY slow km's on monday.

Ok ok!! I know I must be more consistent!

So I haven't posted for more than a month, terrible I know, but in all honesty I have been REALLY busy. I try to blog on weekends and I honestly haven't managed to get to a PC on the weekend for ages!

The good news is that I have been pretty consistent with my running. Except for a week in the Western Cape when I went to visit my sister and her new baby... oh and a week where I did the cycle ride mentioned in my previous post... IT WAS TORTURE by the way... otherwise I have been consistently exercising three times a week, recently more.

So here's what I've been up to in brief:
Cardiologist visit
I actually wrote a post which I must put up later this week. But the jist was that my echo indicated a significant improvement in Ejection Fraction. I'm always a little sceptical because I know that you can have errors in measurement, but it was good news.

Great Mpumalanga bike ride
Scenery: Fantastic!
People: Awesome!
Route: Hell
The route advertised and mentioned in my last post was SO not the route followed! Because there were so few entrants the organisers had to use smaller venues and so the route had to change. I wish they had told me because I probably would not have gone. I completed day 1, 6 and 7, for the rest I took the sag wagon at some point as the hills and the distance were just too great. My body was saying "dude, you're pushing too hard" by the last day I had a bit of a cold and I decided not to ride.

Do I regret going? No.
Would I do the same route again? No.
Would I go on another cycling holiday? Very likely yes.

Western Cape visit
Managed to get in one 15km ride and a 2,5hr hike up table mountain. It's always cool to come back and appreciate what you've left behind. But I should have done more and I felt it for a week or two when I got back.

Since then
Somewhere along the line I realised that I have less than a year left to get to my goal of a 21km, so I kindof decided I need to commit to some longer runs than just doing a 5km 3 times a week. So I've decided with my training partner that we will do atleast 1 10km run a month, and as those get easier or quicker we will start to do some slightly longer runs aswell.

I also decided that I would like to lose a bit of my belly so I'm following a mild weight training regime. So far I am down to my long time minimum weight of 74kg's I hope to get to about 70, I'll be happy with that.

So we did the first 10km yesterday and I thought I wasn't ready for it. It seemed like an easy route and as I got to the finish I realised I had lots left over. I completed it in 1hr16 which is fine for me although under 70mins would be much better, but I'm not looking for a time, my first priority is always just to finish. Time will look after itself.

I feel like perhaps the extra strength in my legs... and perhaps the rest of my body... helped me out yesterday, so I'm going to continue with the weights as long as it's helping me to do so.

I also looked online for info about "alternative" treatments for heart conditions. I've seen Carnitine and Co-Enzyme Q10 mentioned regularly so I will try a small dose of this for the next two months. Hopefully I feel more energetic and these items will help my heart get stronger aswell.

Summary
Basically if you thought I had gotten lazy you are wrong, I've been working hard, sometimes feeling like I'm getting nowhere, but whether I'm going through an optimistic or pessimistic phase (I know I do!! LOTS) I'm still keeping active and getting slowly closer to my goal. Watch this space :)

Cycling is still easier... I think.

Because I'm going to do this big cycle ride I've been riding twice a week, more to get my butt used to the saddle more than anything else. But what has become quite clear to me again is that I find cycling a lot easier than running. I don't know why but I suspect that it's because while running you are continually lifting your body of the ground, energy that is expended which doesn't move you forward. Perhaps I run badly. With cycling all your effort goes into forward motion, so perhaps thats why it seems easier to me.

About the Great Mpumalanga Bike Ride that I'm doing early next month, I thought I'd give an over view for those of you who think I'm mad. I know the ride will be quite hilly, but considering we have an entire day to get to the next camp site, I hope I can take it slow enough not to be entirely exhausted at the end of every day. I'm sure the scenery will make up for the effort required to get from site to site. I'm going to try to keep a diary, which I might post when I get back.

The route is as follows:
Day 1 Saturday 5 April - Nelspruit to Sabie 45km
Day 2 Sunday - Sabie to Lydenberg 43km
Day 3 Monday - Lydenberg to Brandraai 62km
Day 4 Tuesday - Brandraai to Pilgrems Rest 77km
Day 5 Wednesday - Rest day at Pilgrims Rest, I think I might need this day!!
Day 6 Thursday - Pilgrims Rest to Hazy View 47km
Day 7 Friday - Hazy View to White River 38km
Day 8 Saturday - White River to Nelspruit 20km

Ok so now that I put it down like that and look at it... and look at it again I'm a bit scared!! But I think I'm pretty fit, if anything I'll just fall into bed every evening and sleep like I've never slept before. Oh and it's a camping trip so no terribly comfy bed... I think I'm going to invest in one of those expensive self inflatinf airmattresses.

I would have liked to take a GPS to record this, alas my GPS willl run out of juice after the first day. Perhaps I can rig up some kind of charger so I can record the route... and especially the contour!!

I'm sure this won't be my last post about this, I'm getting quite excited.

Probably the pain killers

Refering to my last post "Palpatations...again?" according to SA Doc of All Scrubbed Up fame there are some references to the pain killer, Lentogesic, which I took on Friday night having some interactions with Atenelol. Most medications also have an effect on INR, which is controlled with Warfarin but I'm not really worried about those.

Her advice about the Lentogesic was "if you start getting palpetations, stop the lentogesic" which is exactly what I did anyway. So i think I'll delay the cardiologist visit till March when I am supposed to go anyway. Especially considering I walked 6km on Sunday, and run/walked 5 yesterday and felt fine...relatively speaking.

Palpitations...again?

Like I said in Week 4's exercise log, I slept very badly this past Friday(25th Jan) night. I told the people I was to run with that I couldn't come and went back to bed. My domestic arrived a few hours later, and I went about a normal Saturday morning. I was plagued by an intermittent headache, but put it down to dehydration. I went for lunch with some friends and when I got home I took down some laundry off the line and was standing in my kitchen when I suddenly felt VERY faint. It felt like when you suddenly get up out of bed and all the blood drains from your head. I sat down quickly and started to feel palpitations. It feels a bit like someone is shaking your body, but no-one is touching you. I broke out in a cold sweat, went to lie on my bed. It took 2-3mins to pass.

What's really worrying about this is that I don't remember having a bout like this since when I was rediagnosed. However there are a number a of explanations. I could put it down to being dehydrated, or to a reaction to the local anaesthetic that was administered for a minor surgical procedure. I was prescribed an antibiotic (Levofloxacin) and a pain killer (Lentogesic). I specifically told the pharmacist that I had a heart condition and asked if these drugs were appropriate. She seemed to think so. I will find out if they have any side effects.

However, for those of you who may be concerned, I don't think you should be too alarmed. I went for a 6km walk this afternoon and felt fine, but I think to be on the safe side I will also make an appointment to see the cardiologist as soon as possible.

What the cardiologist said

I had an appointment with a new cardiologist last Friday (the 12th). Why a new one? Because the old one is in Cape Town, and plane tickets aren't covered by my medical aid. It was a bit strange, the procedure was completely different to what I'm used to. I was first asked to get undressed and put on some boxers that were supplied.

Then I sat in a second waiting room, for the semi dressed people. When the ECG lady was ready for me she asked me to stand on a scale, 75kg. Then she asked me to stand in front of her while she stuck conductive electrodes all over my chest. Once she had wired me up to the ECG machine she asked me to sit, instead of lie on the bed, which is what usually happens. It showed my heart rate as 57bpm, which is lower than I expected.

Having removed mercifully little chest hair, I was sent back to the waiting room to wait for the doctor. He then asked me the usual questions: Do you smoke? Drink? Family history of heart conditions? When were you first diagnosed... blah blah blah. I'm not sure I gave him the full picture as I'm so over all that, and he didn't seem to ask all the correct leading questions, hopefully he requests my file from my previous doc.

Once he had got enough history he asked me to lie on a bed while he recorded what he remembered me saying with a dictaphone, presumably for later typing by a secretary. He then listened to my heart, took my BP, checked my ankles for swelling and then listened to my lungs. We then went to the echo machine and he did an echocardiogram. Checking the size of my left ventricle and my ejection fraction.

The good news is that there are marginal improvements in both these measures of cardiac function. That could be due to measurement error, or an actual improvement in my cardiac function. I have some recollection that the last time I went to my Cape Town cardiologist, he said the same thing, that there was a marginal improvement but it is difficult to say whether it is a real improvement because it is such a small change. It's unfortunate that my appointments are so far apart and that I have no personal records. But if my recollection is correct then 2 small improvements make 1 bigger improvement, so maybe I am seeing some real improvements in my condition. My ejection fraction is currently 36%.

The doctor also asked for me to have some blood tests to check some chemical markers that are indicators of heart failure. What they are exactly I'm not sure. I also got myself sorted again for monitoring my INR, that's the thickness of my blood. I have had a pretty constant dosage and have been really lazy about having blood tests lately. Not because I don't like having them, but because, firstly there are no fixed dates for the tests, and secondly because the nurses at the clinic where I last had a blood test seemed really disagreeable.

The problem, which I am very aware of, but have been shoving to the back of my mind, is two fold. If my blood is too thick then a clot could possibly form, getting stuck anywhere in my body, including my brain, which could cause a stroke. So it's a good thing that I'm having it monitored correctly once more. It does mean that there are numerous regular blood tests that I need to have in the near future.

I asked what the doctor thought of me running regularly. He said as long as I wasn't racing it should all be good. As soon as you start competing with people you stop listening to your body and can do some serious damage.

He also said that I may need to consider having an ICD installed. ICD - Internal Cardioverter Defibrillator. I will write an article about what that is soon. He says that they are indicated (that means suggested or necessary) for patients with ejection fractions under 35% so I am very much on the cusp. Because it is invasive and visible, and because I am young, he said we will avoid it for as long as possible. Personally I don't think I need one, but perhaps as time goes on I will.

All said the news and prognosis is good and I should live healthily at least until my next appointment in 6 months time.

Running in the rain

While most people were running scared to the shelter of their homes yesterday, I was running around Pretoria getting rained on and nearly struck by lightening. It was awesome!! But I am finding this weather rather annoying, it's interfering with my running dammit. I missed Friday's run and now most of yesterday's run. I only did one 2km loop before we decided that it was looking really ominous, 30 seconds later it started hailing, so we were right.

I don't mean to sound ungrateful, because we need the rain, but could it just rain at more convenient times please!

Hill training and cardiologists!

I was less than delighted yesterday when the coach/manager suggested that we do hill training. The Boys High route has a nice hill half way through the route, with 0,100 and 200m market out. So we were expected to do this hill 4 times. I had some serious shin splints on the way out and was not a happy camper. We just continued as we would, running when my watch beeped, walking when it beeped again, not caring if it was uphill or down.

Inevitably there was one running interval that started at the bottom of the hill... I ran the whole 200m hill! I was so surprised, I just went, there was no ragged breathing, no faintness, no burning legs. The ladies started walking one after the other, but I just ran, it was the most awesome feeling!! The simple things in life.

There's no doubt that I'm getting a lot fitter. I remember struggling to walk up 2 flights of stairs! Well I hope to keep that a thing of the past. I'm going to see a cardiologist next week, not because there is anything wrong. It's just time, I think it's been almost a year since my last visit, and the paranoid dude inside me says that this can't be right, something must be going wrong. So hopefully he puts me on a treadmill, wires me up and then tells me I'm nuts, but my heart is fine (well within limits). Actually chances are that he will just do an ECG and an echocardiogram.

I'm actually a little nervous, I've done this a hundred times before, been poked and prodded by cold hands. Had what little chest hair I have ripped off by those super sticky electrical pads, oh and a lot more of my less sparse leg hair! I've even had shock therapy :P ... no not for the madness... read the article about the various procedures I've had in particular cardioversions.

So why am I nervous? What if he tells me to take it easy, or to stop running? I'm enjoying this so much! That would seriously suck! Wish me luck. 

Heart Transplant? Pacemaker?

A while ago I asked my cardiologist alternatives to all the medication and the lack of exercise tolerance. We talked briefly about a heart transplant, but this was almost immediately discounted. Firstly to be eligible for a heart transplant I would need to be in advanced heart failure, clearly this is not the case at the moment. If it was (hypothetically) done anyway there could be an improvement in some parts of my quality of life, but I would be trading some known, and well managed, problems for others. As I understand it, transplant patients need to be on anti organ rejection drugs (immunosuppressants), pretty much for the rest of their lives. These can make feel pretty grotty, and susceptible to other infections. So if I were to go into heart failure again, this might be a consideration, but I will try my best to stay healthy and avoid this.

We also discussed the possibility of a pacemaker, my heart rhythm is not normal. This most easily noticed by feeling my pulse, it will be regular for some time and then suddenly speed up for a few beats and then slow down again. If I remember correctly that's not really the problem though. Before I get into the pacemaker story, I'll try explain, again I think, how the heart works, but this time with a little more emphasis on nerve impulses (I'm not a doctor, so I could be getting this all wrong).

The heart has four chambers, two atria and two ventricles. Blood is pulled into the (smaller) atria at the top of the heart and then pumped into the (bigger) ventricles at the bottom of the heart. The ventricles then contract to pump blood all the way around the body. The timing of all these contractions is controlled by a set of nerve pathways around the heart. The heartbeat is generated by a special group of cells, the sinoatrial (SA) node, in the right atrium, this group sends an electrical signal out that contracts the heart muscles, starting with the atria. The signal is passed through nerve pathways down the atrium to the atrioventricular (AV) node, this node passes the signal on to the ventricles. Here comes the clever bit, for the best operation, the atria should be empty before the ventricles contract, so this AV node has a special property. It delays the signal for about 0.1 seconds, this ensures that the atria have contracted and primed the ventricles before they, in turn, beat. 

So what about my heart? Well my atria are beating way too fast, so I guess something went pear-shaped and my SA node is now going ballistic. I have atypical atrial flutter, so according to what I have read my atria could beat at above 340bpm. It is caused by a self sustaining circular neural pathway passing a signal around the heart. My atria are "tired" they don't actually contract anymore (well that is unless they have somehow fixed themselves since my last ECG). Of course a  whole heart beating at that speed would be pretty scary and probably not good for you and would also get "tired", unless you are a humming bird. The AV node fixes this, it only allows a certain number of these beats through every minute. This maximum is where you get your maximum heart rate from (roughly 220 minus your age).  Still my heart beating at 190 bpm all day would still be really uncomfortable, I don't think it ever did actually get to that pace even when I was sick, but I might be wrong. Anyway I have medication (beta blockers) which brings this max down even further, it seems my max heart rate is about 150 bpm. I have no idea why my resting heart rate is about 65.

Anyway, this arrhythmia bothered my cardiologist and we discussed options to fix it. I think I have mentioned my numerous cardioversions and the attempted cardioablation, so I won't say more about those here, except that both treatments failed. So if this rhythm problem becomes dangerous to my health, the only other option is to (if I remember correctly) destroy my AV node (burn it away) and implant a pacemaker which would only stimulate my ventricles. I'm not sure what that will mean for exercise etc, but I assume there is someway for the pacemaker to realise that you need greater cardiac output and speed up the heart rate. So far it's been decided that my heart is still good enough, with my current medication, not to do anything that drastic, so I don't need to worry about running out of battery power just yet, hehehe 

Damn that salt!

I've been thinking of more things I can write about to keep this blog interesting and this one doesn't seem to be that interesting, but I'm going to put it up anyway, just so that there isn't an exercise log at the top of my blog.

So what kind of things do I have to consider? I was talking to someone about this a few days ago, he had a heart attack a while back, and I was quite surprised when he said he can't eat ice cream!! I was a little puzzled, but when I thought a little harder it occurred to me that it was probably cholesterol that was ultimately the cause of his heart attack and to prevent further incidents he had been advised to stay away from fatty foods.

That's good advice, no matter how healthy you are. In my case however fatty foods aren't my major concern. I do watch my diet and the amount, and type of fat I eat. I'm less worried about eating a handful of peanuts, or some olive oil on my salad, than I am about the cream in a delicious pasta or the fat on that a juicy lamb chop.

So what do I need to consider when it comes to my particular condition? I've made passing comments about salt and water already, but here is the full story. I remember clearly the day when my doctor suggested the type of things I should steer clear of... and it hurt. I've never been much of a sweet tooth, so if he had said ice cream, or Bar Ones I would have been happy. But he told me to stay away from salt and the biggest sources of salt in ones diet are those delectable snacks that we all consume with such vigor at get-togethers of any sort... CHIPS and BILTONG!! I could have cried. To say that I don't eat them would be an outright lie... I love them and I'm human. So every now and then I indulge myself with a packet of Salt and Vinegar, or sample the latest addition to the Simba range. Biltong, when offered, is never refused, I just keep on walking whenever I go passed a biltong shop in a mall. It's always the little things....

So I've talked about salt but perhaps I should explain the reason. As I understand it, when your heart doesn't perform at full strength it has trouble processing fluids, so slowly as you drink water, fluid will build up in your body. This tends to pool in your lungs, I'm not sure why. Salt helps your body retain water, that's why all these energy drinks talk about replacing electrolytes. When you sweat you loose salts with that, and an energy drink replaces those salts, helping you re-hydrate better. In my case however if I have too much salt I put on weight...quickly... and start coughing, as the fluid irritates my lungs.This also puts more strain on my heart to get rid of the fluid. Whether I've explained it properly or not is beside the point, all that is really important is that I must avoid salt. 

Limiting salt consumption goes hand in hand with limiting the amount of fluids I drink. Even without too much salt, too much fluid in my body is still a strain for my heart. So I am advised to only drink about a litre of water a day. In the week, while at work this is no problem, I have a cup of coffee in the morning, and two or three more cups of whatever I feel like for the rest of the day, and maybe something more when I get back from my run or after supper. In the week there is no problem. Come social events, it gets much more difficult, that's where nursing a glass of appletiser or coke becomes an invaluable skill which I haven't yet mastered!

What's next? Probably a blog about all the other stuff I can't eat. I'm away next weekend, so the chances are that I won't be able to put up anything next weekend. The challenge is really going to be to go for 2 runs while on a weekend away. I won't be around from my Friday or Monday sessions... Self discipline will have to prevail... oh and the wrath and/or disappointment of the friends who read this blog regularly :)