Friday, June 8, 2012

A Decade Lost, and a New Life Found

I began running in late 1974 or early 1975, at the age of 12.  For the next 25 years, I enjoyed good health, both in terms of running injuries and more generally.  Starting in about 2000, however, I experienced a decade in which I was plagued by a series of health issues that, while not life-threatening, seemed certain to end my competitive running days, and quite likely to end my running life altogether.  This is the story of that lost decade, and my improbable recovery.

From time to time throughout my running career, I had had days when I just couldn't perform.   I'd try to run a hard workout or race, but just couldn't do it.  I'd get out of breath, nothing extraordinary about that, except that it would happen far too early and with far too little exertion.  Those days were rare, and when they occurred I chalked them up to some sort of minor and intermittent asthma.  I can't even recall the first time it happened, but it did happen every so often.

As of February 5, 2000, according to a note in my running chart, I believed I had "reactive airways syndrome," a form of asthma brought on by irritants in the air.   I was just getting back into training at that time, although I did just manage to break three hours -- barely -- at the Napa Marathon on March 5, 2000.  For the next 18 or so months, I continued to get back into shape, although I continued to experience these asthma episodes a bit more frequently.

My performances began to grow increasingly uneven.  On February 17, 2002, I ran 2:43:10 at the Austin Marathon.  On September 22, 2002, I ran a 10k in 34:54.  On December 14, 2002, however, I ran the same distance in 38:10.  At or around that time, I was officially diagnosed with "exercise induced asthma."  A notation in my running chart on July 9, 2003, for example, blames a bad workout on asthma brought on by stress.  Notations of "asthma" begin appearing more and more frequently at about that time.  Nevertheless, on days when I didn't have an attack, I was still running well, including a PR of 1:12:59 at Mt. Baldy, finishing 5th overall on September 1, 2003.

It all came to a head in January of 2004.  I was just finishing up training for the Austin Marathon, scheduled for February 15, 2004.  My goal was to break 2:40 for the first time.  On January 25, 2004, I ran my last key workout, a 14 mile run on the bike path in Marina Del Ray in 1:21:47, about 5:50 per mile, with Clyde, who was injured at the time, riding along side me on his bike.  I distinctly remember standing in the parking lot after that run, feeling warm but not fully exhausted, thinking that I had beaten this asthma thing and was ready to run under 2:40 in three weeks' time.   Five days later, however, everything changed.

On January 29, 2004,  I went for my annual physical exam.  My GP, Dr. David Grossman, does a very thorough job.  Among  other things, he takes an EKG, and on that day he found that I was in atrial fibrillation, meaning that the top two chambers of my heart where not beating normally but instead fibrillating or fluttering wildly.  Dr. Grossman explained -- correctly -- that I was probably going in and out of A-fib on a regular basis, and that what we all thought were asthma attacks was really an arrhythmia.   My heart wasn't performing properly, and I started to breath harder.  The doctors had never seen one of these episodes before, and therefore had no reliable way to know exactly what was going on.

Within about two hours of that EKG, I was sitting in the office of a cardiologist who was telling me that I shouldn't walk up stairs for six weeks, let alone consider running a marathon.  Moreover, I was scheduled for all sorts of tests to see what else, if anything, was wrong with my heart.  An ultra sound, a CT scan and a nuclear stress test -- and probably several other tests I have since forgotten -- confirmed  the diagnosis of A-fib, but also that my heart had other detectible defects.  Four days before the Austin marathon, the six week ban on running was lifted and I was cleared to compete, with the proviso that I was to drop out if I had an A-fib incident.

I'd been running long enough to know that I still had a chance to break 2:40 at Austin.  I'd completed my last hard workout before the diagnosis, and the week or so of forced rest was unlikely to harm my conditioning.  It was probably a good thing.  And, I felt better knowing what had been causing my poor performances.  I'd never felt completely sure that I had asthma, and part of me wondered if it wasn't all psychological.

Paul paced me through the first half of the marathon, and we came through exactly where I wanted to be, just about 6:03 per mile.  I felt great.  At mile 16 or so, however, I began to feel a tightness in my left hip and was forced to drop out around 17 miles.  It turned out to be a stress fracture, and I was out for six weeks.  On March 27, 2004, I jogged a single mile, and felt very sore and weak.  I ran ten miles for the first time on May 25, 2004.

Although my hip healed in an orderly fashion, my heart did not.  Instead, it got worse and worse.  On July 4, 2004, I ran a 36:13 on the tough Palisades Will Rogers course, but a week later I ran 52:10 for the same distance on the flat Keep LA Running course.  I'd never run over 40 minutes in a race before, let alone over 50.

I tried a variety of medications for A-fib, some of which seemed to work for a little while, but none of which lasted for long.  I had my first catheter ablation on February 24, 2005.  The doctor uses the arteries in the leg to gain access to the heart, then uses a laser to ablate -- or burn -- a portion of the surface of the heart.  The goal is either to kill or isolate the cells that give off the signals causing A-fib.  The procedure is not nearly as bad as it sounds; I missed just a few days of running.

The first procedure -- much like the mediations -- worked for a while but then the A-fib came back.  And, on August 14, 2005, it became clear that my left knee wasn't doing so well either.  I'd torn a meniscus, and had arthroscopic surgery on August 30, 2005.  The surgery did little or nothing, and my knee was sore off and on through most of 2006.  Then, starting in March or April, 2007, the A-fib began coming back more regularly.

From 2007 through 2009 I was fighting both heart and knee problems.   I tried various medications for my heart, and for my knee, but nothing worked well or for long.  I tried two more ablation procedures, but the same temporary and unsatisfactory results.

On June 18, 2008, I decided to go to the UCLA emergency room when I felt like I might pass out at dinner with Wayne and Jack, after a 12 mile run near Camp Josepho.  On September 12, 2008, I went into A-fib while on the treadmill at the cardiologist's office.  On October 5, 2008, I was forced to drop out of the Loch Ness Marathon at the 11 mile mark when I went into A-fib.  On April 19, 2008, I tried to run the Nagano Marathon, but the night before I woke up and felt my heart beginning to flutter.  I took a beta-blocker at 4am or so, then tried to run the marathon in the morning, with predictable results.  I couldn't get my heart rate up high enough to run, and I crashed.  My running was a complete mess.

In retrospect, the turning point finally came on July 15, 2009, when I had my fourth ablation, but I certainly did not see it that way at the time.  That fourth ablation immediately and completely wiped out my A-fib, apparently for good -- it has been almost three years now.  But, that procedure had serious short term side effects.  For about five months, my heart rate would not come up above about 120 beats per minute no matter how hard I ran.  I couldn't run faster than a jog, and even that hurt.  I was completely miserable.

Earlier that year, I made plans to run the Victoria Marathon with Jack.  By race weekend, however, it was clear that I shouldn't attempt it.  Nevertheless, I decided to go on the trip.  Nothing wrong with that!  At the last minute, however, I made the foolish -- and, if you know me, completely predictable -- decision to run the marathon.  I ran 3:26:37, my worst time ever by nearly 20 minutes.  And, my knee was now shot.  At that point, it seemed like I would never run again.  My knee certainly would not allow it.

But, my heart rate slowly began to recover.  I know this from riding the exercise bike.  In fact, by early 2010, it seemed that my heart was working just fine.  Yet, my knee still would not allow me to run at all, and it resisted all the usual cortisone and Synvisc shots.  I began looking for an orthopedist who could suggest a way to get back to running.  Instead, I was told over and over that I'd never run again and, in fact, was a good candidate for a knee replacement, and everyone agrees you cannot run on an artificial knee.

Finally, Dr. William Hohl referred me to Dr. William Bugbee in San Diego.  Dr. Bugbee's initial opinion was that everyone else was correct and that I would never run again.  He explained that my knee joint was out of kilter, and had been for some time.  Ideally, the knee joint is level, so that the weight is spread out over the tibial plateau.  My knee was uneven, with all the pressure on the medial side, and as a result I had lost substantial cartilege both above and below the joint, and I had edemas (or small stress fractures) as well.   He suggested that I take up swimming.

I told Dr. Bugbee that the only thing I wanted was to run, that I wanted him to do whatever he could to make that happen and that I did not care if the chances of success were low.  After a few minutes of discussion regarding my lack of common sense and good judgement,  Dr. Bugbee suggested a procedure known as a high tibial osteotomy, or HTO, as the only chance I had of running again.

The concept of the HTO is simple.  The doctor breaks the tibia all the way through, takes a piece of bone from the hip, makes a wedge from that bone and inserts it into the tibia.  This is something like when a table is uneven, and we place a napkin under one leg as a sort of wedge.  But instead of placing something under the leg, an HTO is more like breaking the leg and inserting the wedge in the middle.  The x-ray at the bottom of the blog shows what my knee looks like now.

Dr. Bugbee performed the HTO on June 24, 2010, at Scripps in San Diego.  I was on crutches for eight weeks, and on a cane for three weeks after that.  I worked hard in rehab, but that did not change the fact that I had been off my feet for so long.  On January 1, 2011, I ran my first two miles, dead slow.  It was very, very difficult.  I was weak and, even worse, uncoordinated.

But from there on out my recovery was nothing short of miraculous.   I was ecstatic when I was able to run five miles comfortably, but soon enough I was running 10.  In fact, by July 31, 2010, I ran a 1:20:12 half marathon in San Francisco.  Just a few months before that, I thought I'd never run 13 miles again, let alone at anything like that pace.

It is now June 8, 2012, and my knee doesn't hurt at all.  My heart works just fine.  I haven't missed a day of running because of injury or illness in nearly 18 months.  In short order, I ran my first 50k, 50 mile and 100k.  I ran across the Grand Canyon, the run known as Rim to Rim to Rim.  I've had more fun than I can possibly describe, and enjoyed running more in the last 18 months than I did in the first 25 years of running combined.  If it doesn't last another day, or if I die tomorrow, I still count myself as incredibly lucky.

I have four people to thank for my recovery and return to running:

Dr. Shephal Doshi performed my fourth ablation, which finally cured my A-fib.  That procedure lasted longer than even the slowest marathon, as Dr. Doshi had to track down and ablate misbehaving cells in various areas of my heart.  Dr. Doshi also implanted a pacemaker in a friend of mine, who went on to win at least one age group national championship in the middle distances.  So, he saved my running life and my friend's as well.

Dr. William Bugbee at the Scripps Institute performed the HTO that miraculously cured my knee and, so far, has given me 18 months of pain free and virtually unlimited running.  You can see his handiwork at the bottom of this blog.

My physical therapist, Kelly Oneil, worked with me from just a few days after my surgery until I was back to running again.  The first day I met her in mid-2010, she asked me my goal.  I told her I wanted to break 3:00 at the Loch Ness Marathon in fall of 2012.  She must have thought I was mad, but she was very nice about it.

Finally, my training partner, Jack Rosenfeld, drove me home after my knee surgery in San Diego, visited me when I couldn't walk, walked with me when I couldn't run, jogged slowly with me when that was all I could do and ran with me as I became stronger.  I will never be able to re-pay him for his kindness.

No comments:

Post a Comment