Dear PE’s:
Every now and then we get a nice, unexpected surprise. Five years ago, I was interviewed by Jennifer Pirtle (from England) for information regarding several cardiac issues associated with runners and running. I knew the information was to be used for an article, but I never heard anything else about it. Today, thanks to “Google” I came across the article, apparantly published in the NORTHERN EXPRESS, a Michigan newsweekly. I have reprinted it below, as it has some useful information regarding various cardiac problems which can cause problems for runners of all abilities. It is entitled The Heart of a Runner.
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The Heart of a Runner
Jennifer Pirtle
Peter Moore was used to pushing himself. An avid athlete, he’d run two marathons, climbed to the top of the Grand Tetons, and regularly biked for hours in the hills near his home. But in 2002, Moore was three miles into a 30-mile bike ride when something felt wrong. “I would try to crank up the speed, then become completely exhausted and have to slow down,” he says. “I’d go again, but it quickly became clear that I was fighting against something that wasn’t going to let me get through.” Moore, then 46, chalked up his fatigue to some kind of exercise-induced asthma. A few days later he visited a doctor, and found that one of the two arteries at the top of his heart was 99 percent blocked.
As Moore did, you probably assume that your heart is in pretty good shape. But that cardiac complacency could be your downfall: In 2004, about 1.2 million Americans discovered their heart problems when they had a heart attack — and 502,000 of those died. “Even though exercise reduces the risk of heart disease, it isn’t a panacea,” says Paul D. Thompson, M.D., a runner, cardiologist, and director of the Athlete’s Heart Program at Hartford Hospital in Connecticut.
KNOW YOUR NUMBERS
In fact, fitness should be just one aspect of your preventive health approach. “It’s also crucial to know your numbers and keep them at a healthy level,” says Tim Church, M.D., medical director of The Cooper Institute in Dallas. That means: blood pressure should be lower than 120/80; HDL (“good”) cholesterol above 50; LDL (“bad”) cholesterol lower than 100; triglycerides lower than 150; blood glucose level lower than 100; and waist circumference less than 35 inches for women and less than 40 inches for men. These factors plus your family history are key to understanding your overall cardiac picture.
Moore’s weight and cholesterol levels, for example, were right on target. But his father had suffered a fatal heart attack at age 52 while running, so his risk for heart disease was relatively high.
Prevention also means scheduling a checkup (including a blood test, blood pressure check, and a sounding of your heart) with your family doctor every year or so, to stave off any problems before they start.
And although runners are used to training through discomfort, ignoring any of the symptoms of heart trouble, such as tightness in your chest, dizziness or fainting, unusual shortness of breath, even heartburn, is inadvisable. As Dr. Thompson says: “He who has himself for a doctor has a fool for a patient. If you suspect something, get it checked out immediately.”
While atherosclerosis (narrowing of coronary arteries) is the problem that most people associate with heart disease, there are other cardiac conditions that athletes, par-ticularly those over 40, should be aware of.
Arrhythmia
An arrhythmia is a change in the sequence of the electrical impulses that cause your heart to beat. Four million Americans have the condition, according to the American Heart Association.
“Most arrhythmias aren’t serious,” says cardiologist John Randolph Backman, M.D. “It’s when you start stringing multiple beats together that you can get into trouble.”
These so-called sustained arrhythmias can make the heart beat too slow or too fast, or erratically, leading to stroke or heart attack. Though runners with atherosclerosis and high blood pressure are at greatest risk for sustained arrhythmias, even athletes with no discernible danger can be susceptible, especially during runs of 15 miles or more.
“On long runs you can become significantly dehydrated, leading to changes in the blood’s levels of potassium, magnesium, and calcium,” Dr. Backman says. “These chemicals play a vital role in starting and conducting electrical impulses in the heart.” Which makes the following hydration guidelines all the more important: Drink 16 ounces of sports drink two hours before a long run, eight ounces every 20 minutes during your run, and 16 ounces of sports drink afterward.
Myocarditis
Also known as inflammation of the heart, myocarditis is caused by a viral infection that damages the valves, the tiny “doors” that open and shut to allow blood to flow through the heart’s four chambers.
Although the condition isn’t very common, weekend atheletes still need to be careful if they’ve had any viral infection (including the flu) that makes muscles ache.
“Your heart is a muscle, so if your muscles are sore, your heart may be involved,” Dr. Thompson says. “Rest until your muscles aren’t aching. When you return to exercise, if you find that you just can’t run at the levels you used to run, see your doctor. You may have a persistent infection of the heart.”
Valve Conditions
Some valve conditions can be congenital; others become more likely as we age. A defective heart valve is one that fails to fully open or close.
“Leaky valve symptoms can be more insidious and develop more slowly than those of other heart conditions,” says J. Michael Smith, M.D., a cardiac surgeon at Good Samaritan Hospital in Cincinnati. “You’ll just feel a little bit more fatigued and gradually find your workouts more difficult.”
A good doctor can spot a defective heart valve by listening with a stethoscope for a heart murmur, the sound made by the blood circulating through the heart’s chambers.
“Some athletes, because they have such strong hearts and slow heart rates, throw a lot of blood out of their valve all at once,” says Dr. Backman, who recently ran his 100th marathon. “As a result, you’re likely to hear a bit of turbulence, called a flow murmur, which is not necessarily indicative of a problem. A doctor who understands the physiology of runners will recognize this.”
With the blessing of his doctors, Moore still runs regularly, and he’s added interval training and weight-training to his routine to give his heart a more varied workout.
He also no longer views six-mile runs as license to scarf doughnuts. “It’s wrong for people to think that their exercise program conveys some kind of protective bubble around them,” he says. “Running is great exercise, but there can be health-related things going on independently that can bring you down, as happened to my dad, and nearly to me.”
OTher Signals of Heart Hassles
Though cholesterol and blood pressure levels are among the clues doctors use to predict heart disease, they aren’t the only indications of a potential problem. Here are three of the newest additions to the doc’s diagnostic toolbox. A blood test can tell you where your levels stand.
Homocysteine
What it is: An amino acid in the blood.
Why it’s bad: Studies have linked high levels of homocysteine to an elevated risk of heart disease and stroke.
Treatment: Folic acid and vitamins B6 and B12 can break down homocysteine in the body.
C-reactive protein (CRP)
What it is: A naturally occurring chemical in the blood that is elevated when inflammation is present in the body.
Why it’s bad: Inflammation in arteries can make plaque rupture, causing a heart attack or stroke.
Treatment: Exercise can reduce CRP levels by helping restore the function of the inner lining of blood vessels.
Lipoprotein
What it is: A variation of LDL, the “bad” blood cholesterol Why it’s bad: Lipoprotein has been associated with an increased risk of stroke and cardiovascular disease.
Treatment: Diet, exercise, and cholesterol-lowering drugs can lower lipoprotein levels.
A version of this article originally ran in “Runner’s World.”
The reason I bring up this information now is that many of you have started training and racing recently. If you haven’t had a good cardiovascular evaluation recently and are not aware of your cholesterol, blood pressure (BP), HS-CRP, now might be a prudent time to contact your health care provider to make sure you are not putting yourself at undue risk.
Not everyone is satisfied with just a few marathons in a year or a lifetime. One of my patients gave me this article today from the Wall Street Journal which may be of interest to you, but I know it will be of great interest to our MarathonManiac members:
For ‘Mega Marathoners,’ the Race Is On — to Run More Races
At 73, Eugene DeFronzo Finishes His 402nd; He’s ‘a Nut Job’ and ‘a Marvel,’ Says Doctor
By NEIL KING JR.
KITTY HAWK, N.C. — Some compulsives collect shoes. Others obsess over video games. Eugene DeFronzo, 73 years old, runs marathons. He clocked his 402nd here on a recent Sunday, and has three more planned this year.
The Connecticut personal-injury lawyer cracked three vertebrae when he slipped during a race last December. He pulled a hamstring in Tampa two months later, and again in Mississippi a week after that. He nearly passed out in the parched hills of South Dakota in August, finishing last by two hours. In October, he got lost in the woods of Indiana when organizers cleared away the markers. “It’s an obsession,” he says. “No different than gambling, drinking or doing drugs.”
Mr. DeFronzo is part of a proud subculture of self-styled “mega marathoners,” people who run hundreds of the 26.2-mile races. Three Germans, a Finn and a Japanese woman are known to have clocked more than 1,000 marathons apiece — that is 26,200 miles, about 1,300 miles more than the circumference of the earth. The record holder, 74-year-old Horst Preisler, has run 1,636 marathons.
Norm Frank, 78, owner of a lawn-care company in Rochester, N.Y., was poised to be the first American to break that one-thousand mark before he suffered a stroke last November, a month after running his 965th marathon. He is now in a nursing home, forced to use a walker as he works to regain his strength and sense of balance. “I still have hopes,” Mr. Frank says.
Floridian Denny Fryman, 62, has only 192 to go. Shooting for 20 a year, the hotel concierge figures he can get to 1,000 before he turns 72. “Every time I cross the finish line, it’s the biggest natural high there is,” he says.
Scientists have studied compulsive running, not only in humans but in rats and mice. Some compare it to eating disorders like anorexia nervosa.
Michael Sachs, a professor at Temple University in Philadelphia who studies exercise addictions and usually runs 18 miles a week, says for most people, running multiple marathons is simply a passion, like skiing or surfing, and not a disorder. He says runners enter addiction territory only when they can’t control their urge to race. “If running marathons is at the top of your list of values above all else,” says Dr. Sachs, “that might be something to worry about.”
Marathon trackers say fixations usually hit in middle age, when men and women want to test their abilities before it’s too late. That’s also when people tend to have more free time and disposable income. The passion inspires odd fraternities. Have you run 100 marathons? There’s a club for that. Have you notched at least one marathon in all 50 states? There’s a club for that, too.
Larry Macon, a trial lawyer from San Antonio, completed his 105th marathon in 2008.
Bob Dolphin, who founded the 100 Marathon Club in 2001 with his nonrunner wife, Lenore, says he ran “seven marathons in seven consecutive weekends at age 77 in 2007.” Others have been known to do 50 races in 50 weeks the year they turn 50.
More than 435,000 runners crossed the finish line at the country’s 361 marathons last year, according to John Elliott, who runs the Marathon Guide Web site, which tracks nearly all U.S. marathons and records. Most of those were content with finishing just one race, but many were repeat runners, estimates Mr. Elliott.
One tally of mega marathoners, compiled by Japan’s 100 Marathon Club, counts 167 runners world-wide who have logged at least 300. Thirty-three are American.
Yes, there are the medals, and the bragging rights. Larry Macon, a 64-year-old lawyer at Akin Gump in San Antonio, Texas, says he does it mainly for the fresh air and camaraderie. He ran 105 last year, or more than two a week, and is about to break 600.
“The jerk percentage among marathoners is just so much lower than the jerk percentage among lawyers,” he says. This Thanksgiving he plans to run three marathons over three days, plus another four in December. (Obsession appears to run in the family. Mr. Macon’s wife, Jane, has a herd of 600 miniature horses.)
Born with a curved spine and diagnosed later with an enlarged heart, Mr. DeFronzo ran his first race, the 1991 New York Marathon, when he was 56. Not until 1994 did he run multiple races — six that year. He did 15 the next year, 20 the year after that, then 30 in 1997.
Mr. DeFronzo has achieved the 50-states feat six times and is 13 states shy of his seventh circuit. Every lap around the country, he figures, costs him $25,000 in travel costs and registration fees.
He ran past penguins in Antarctica. He had a near miss with lions in Kenya. He did a race in Death Valley, and crossed the tundra in Canada’s Nunavut Territory. He has run in Saginaw, Mich., four times.
The walls of Mr. DeFronzo’s law office in Cheshire, Conn., are hung with race medals, mounted and framed. A billboard outside bears a 12-foot-square photo of him finishing the 1994 Philadelphia Marathon, and the slogan: “I’ll go the extra mile for you.”
He can’t quite pin down why he does it. “It’s hard, and you don’t get anything at the end but a medal,” he says. “I guess overachievers just like to put obstacles in their way to conquer.”
His physician, Dr. Stephen Harris, calls Mr. DeFronzo both “a nut job” and “a marvel.” His vitals, Mr. Harris says, are those of a much younger man, while “his muscular and skeletal system is spectacular.”.
Even the cracked vertebrae last December and the pulled hamstring only slowed Mr. DeFranzo a bit. His recent trip to North Carolina’s Outer Banks marked his 15th marathon of the year. Last year, he ran a total of 35.
He arrived at Kitty Hawk a day early, as usual, to survey the route. He loaded his plate with rigatoni at the traditional pasta dinner the night before, but shunned the sauce because it could upset his stomach. “Too risky,” he said. He woke before dawn to stretch in his motel room, swallowed an aspirin and stuffed a spare shoelace in his pocket.
Jostled by runners near the starting line, he chugged a Red Bull, a caffeine-loaded drink whose motto is, “Gives You Wings.” He crammed two more cans in his back pocket and carried a fourth in a plastic bag. “My aim is to run this in finish time — whatever time it takes to finish,” he said. “I’m not looking for any hour or minute.”
He started strong, stride for stride with the horde, but soon slowed to his own pace. His shirt listed his 50-state accomplishments in bold on the back. A few first-timers jogged past him in awe. “You’re an inspiration,” one woman said. A guy in a red pick-up stuck his head out the window and yelled, “Way to go, buddy!”
“I don’t need crowd support,” he said, craning up a slope at the 11th mile. A mile later he chugged his second Red Bull. He navigated much of the course at a pace somewhere between a shuffle and a trot. A second wind, fueled in part by his last two Red Bulls, helped him overtake stragglers in the final miles. He finished 16 seconds shy of seven hours, and 14 runners ahead of last place. The winner beat him by four hours, 27 minutes.
“I’m glad that’s over with,” he said, before a woman draped him with another finisher’s medal. “It wasn’t that hard, but still, it’s 26 miles.”
Well, there you have it! I love these people. They all make me look sane!
Happy Trails,
JRB