It is my lifelong passion. But a diagnosis of heart disease threatened to take it away.
Don’t be a dope, I told myself. Get your heart checked out.
I had just passed my 65th birthday and figured I ought to get a thorough heart checkup. After all, the biggest predictor of heart disease is advancing years. Plus, both of my parents died in their early 50s, though not from heart disease, and my grandfather had his first heart attack in his 50s. Even more worrisome: the first “excessive endurance exercise” articles had begun to appear in medical journals. The authors weren’t just noting the exercise paradox – the fact that risk of sudden death rises during vigorous exercise even as regular exercise lowers your overall mortality risk. These docs were arguing that high-mileage running could permanently damage the heart. As a runner for 50-plus years, I’ve completed 75 marathons and 176,000 lifetime kilometres.
I found an excellent sports cardiologist, Matthew Martinez; he took a lengthy history and ordered three tests: an EKG, an echocardiogram and a coronary artery calcium (CAC) scan. I aced the first two, and expected the same from the third.
I won’t soon forget the morning Martinez gave me my CAC results in the form of a shiny, black medical image. It looked like an X-ray. “I think we found something here,” he said. I felt my pulse jump, and noticed an instant dampness across my forehead. It’s amazing how fast the body can react. “See the white spots around your heart?” he continued. “That’s calcium in your arteries. You have a score of 946, which is worse than 90 per cent of men your age.”
Sure, I could see some white spots. But what the hell did they mean? Martinez explained: The calcium in my heart arteries was basically cholesterol plaque turned solid.
Most of us have been measured for “blood cholesterol”, which consists of little bundles of fat floating around in our blood. “Cholesterol plaque” is in our arteries, and consists of cholesterol and other stuff that sticks to artery walls.
My sky-high calcium score meant I had atherosclerosis, or coronary artery disease, exactly as predicted by some of the alarming papers. If I also had softer cholesterol plaques lining my arteries (which can be determined only through invasive measures), such plaques could rupture at any time and cause a heart attack.
But since I had no symptoms – no shortness of breath, no high blood cholesterol – Martinez told me not to panic. And since I had no angina pain (chest and/or shoulder-arm pain), he said I could still run. He prescribed a statin to drive my blood cholesterol even lower, and a daily aspirin to prevent blood clotting.
Driving to the Runner’s World office 10 minutes later, I felt lightheaded, dizzy. My palms left a damp smear on the steering wheel. At work, I scoured the web. This wasn’t reassuring. Studies showed that men with a score in the 900s had a cardiac event risk up to seven times higher than men with lower scores.
A million questions buzzed through my brain like bees in a hive. Should I stop running? What should I tell my wife and two (grown) children? Did I need a second opinion? I felt paralysed.
During the days that followed, I couldn’t stop obsessing. I took my pulse morning, noon, and night, and especially after every workout, something I hadn’t done in decades. When I detected several skipped beats, I called Dr. Martinez and insisted on a Holter monitor test to determine if I was missing beats or exhibiting other heart rhythm issues like atrial fibrillation. I wore the portable scanner for 36 hours straight. Results: completely unremarkable.
My ticker seemed to be doing fine. My brain, on the other hand, was a wreck. I lived, and ran, in a cesspool of scary ruminations.
Several months later, I retired and moved to my home state. There I enlisted Paul Thompson as my cardiologist. Thompson is a world-renowned expert who has been studying the risks and benefits of running for almost a half century. Along the way, he finished 28 Boston Marathons.
On my first visit, I practically begged him for more tests. I wanted data – Big Data – that would yield a Yes/No answer to my ultimate questions: Should I keep running? Would I live longer if I stopped?
Thompson answered patiently. “You look good and you’re doing fine,” he said. “But more tests aren’t likely to tell us anything important, and they are somewhat invasive, so they carry risks that I don’t think are justified in your case.”
Thompson recounted the story of seven-time Boston Marathon winner Clarence DeMar, the first lifelong runner to have his heart autopsied (after his death at age 70 from bowel cancer). DeMar was found to have some coronary artery blockage, but his arteries were two to three times larger than most, leaving plenty of room for healthy bloodflow. Thompson said my “hoses” were probably similar in their ability to expand. That’s what exercise does – it trains arteries to dilate when more blood is needed. So even if there is some plaque blockage, blood can still easily pass through. Exercise also increases the number and size of coronary capillaries, the small, secondary blood delivery systems in the heart.
Ultimately, we talked more about what could only be called my “philosophy of life”. Why do I run? What does it add to my life? What would be subtracted if I stopped?
“It would be much easier for me to tell you not to run,” Thompson has observed several times. “That would take me off the hook. But it wouldn’t be treating the whole person. As a physician, I don’t want to remove anything that adds joy to your life.
“It’s my job to tell you I don’t think the risk that you’ll have a heart attack while running is very great. It’s your job to evaluate the benefits.”
It helps that there is evolving, though speculative, data that elevated CAC scores in runners might not be as dangerous as in nonexercisers. Also, while protecting medical privacy, Thompson has told me he works with a “fair number” of other patients who are lifelong runners with high CAC scores. To date, none have keeled over on the run.
Since receiving my CAC score of 946, I’ve finished the last four Boston Marathons more or less comfortably, and continued my streak of 53 consecutive Thanksgiving Day races. Most weeks I run 32 to 48 kilometres, a little more and slower in winter, when I’m building up for Boston, a little less and faster in summer, when I enter 5K fun runs. I log another five or six hours a week of relaxed recumbent bicycling at home, and have completed three years of regular strength-training, not that anyone can see a difference.
I’ve absorbed a lot from Thompson, whom I’ve seen annually for the last three years, from the psychological-emotional realm. “Medical knowledge has made incredible progress in my lifetime,” he says, “but there’s still so much we don’t know. Doctors and patients both need a tolerance for ambiguity.”
In other words, there are no guarantees. Stuff happens. When we run, we run risks. We could sprain an ankle, get hit by a bus, or die from a heart attack. We might also form a world-changing idea, witness a miracle or gain a greater appreciation for the greatest miracle of them all – our own existence.
I now draw strength from favourite aphorisms. Fifty years ago, I disdained all these as pabulum. Today, they strike me as timeless wisdom. I’d rather wear out than rust. I don’t want to be one of Teddy Roosevelt’s “cold and timid souls who know neither victory nor defeat”. I embrace Dr. Walter Bortz’s exercise dictum: “It’s never too late to start, and it’s always too soon to stop.”
I doubt that I’ll set any longevity records, but my runs have turned relaxing again. I don’t focus on my heartbeat and don’t take my pulse afterward. I just run. I’m getting older and slower every day, which I hate, but – God grant me the serenity – I accept that I can’t change the trajectory of my life.