In 1970 Dad died. He was 74. I was 40. I, an only child, worshipped him. He was everything that I could ever hope to be, my Alpha and Omega.
I crashed. I couldn't think, eat, sleep, work. I was clinically depressed. Somehow I was still smart enough to know that exercise is a fabulous treatment for depression.
I put on my running shoes, cut off some jeans, and started to wobble around the neighborhood. As a Walter Mitty type, in 1971 I ran the Boston Marathon, slowly. I was captured, and probably addicted. That was the first of 43 consecutive annual marathons I ran all over the world, New York, London, San Francisco, Big Sur, my favorite, Limerick, Athens, Australia, Beijing. I was on Heartbreak Hill in Boston, mile 21, for the infamous 2013 bomb punctured event. Four years ago I was in Oxford on a visit so I was keen to run on the track where in 1951 Roger Bannister broke the four-minute mile barrier. It took me 13 minutes to do my mile. He could have lapped me four times, but who cares how fast? My friend, great middle distance runner Ron Clarke from Melbourne observed that "the race of life goes not to the runner who starts out first but to the one who slows down last." Running became my religion. I was and am on the editorial board of Runner's World. I preached fitness to my friends and patients with probably excess fervor. Not that I have any outstanding credentials as a runner. I am slow and awkward, often the last one in.
My decades of long distance running not only lifted my temporary depression, but also has served to consider myself immunized against life's problems, protected by a suit of armor which is a metaphor that I have used as a blog. Exercise is the universal treatment for every ailment, body or mind, cheap, effective universally available, and safe. I am an exercise zealot.
But then three weeks ago while idling I sensed a funny flutter in my chest. I had started to fibrillate. Instead of my heart beating in its usual synchronous pattern the top chambers, the atria, became chaotic. Then the ventricles beneath which are the main pumping chambers and derive their signaling from the atria developed their own intrinsic chaotic beat around 60 per minute, but irregular. No pain.
I continue to run regularly, three miles per trip, up and down.
I turned myself into my friendly cardiologist colleagues who are appropriately conservative in their advisories. I may have a cardioversion in my future, to see if the normal rhythm can be jumped back to normal.
I don't like it. I can't stand anything being wrong with me. I deny any frailty, but cannot neglect the reality in this case my heart simply doesn't pump as it should rendering me too easily breathless. The tumbles in my chest are not pleasant.
My theory presumes that my decades of endurance running has stretched the walls of the atria of my heart, and thereby tented the nervous conduction fibers that regulate the rhythm. My echocardiogram shows this stretch.
All of this bruises my ego. I like myself better when I am super fit, but now the reality must be faced.
There was a fine summary article in the New Yorker, July 15 2014 by Dr. Lisa Rosenbaum, a cardiologist herself. Her article is titled "Extreme Exercise and the Heart." (1) She summarizes what we know and don't know. Previously the Greek dogma was "everything in moderation." Dr. Rosenbaum seconds this advice. She quotes Dr. James O'Keefe of Kansas City who says that extra exertion can be harmful to the heart. We do know that endurance exercise features a higher incidence of fibrillation. Beyond the known cardioprotective benefits of exercise lurks the possibility that more need not necessarily be better.
How much is enough? How much is too much? for how long? What is the threshold of value?
At age 85 and fibrillating I don't back down on the benefits that have accrued to my life and continue to do so. I just don't like myself with a bruise on my heart. It is not broken, but bumpy. I conclude that exercise is still the best treatment, but maybe I ran too much.
Rosenbaum, L. Extreme Exercise and the Heart / The New Yorker, July 15, 2014.
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