I RUNNING
I’d just turned 65 and decided to get a heart checkup. The biggest predictor of heart disease is advancing years, my grandfather had a heart attack in his 50s and I’d started reading those articles arguing that high-mileage running could permanently damage the heart. A runner for 50+ years, I’ve completed 75 marathons and 110,000 lifetime miles.
I aced my EKG and echocardiogram, but then came the shiny, black image of my coronary artery calcium (CAC). ‘See the white spots around your heart?’ my cardiologist said. ‘That’s calcium in your arteries.’
That calcium was cholesterol plaque turned solid and meant I had atherosclerosis (or coronary artery disease). If I also had softer cholesterol plaques lining my arteries, they could rupture and cause a heart attack.
Since I had no symptoms – shortness of breath, high blood cholesterol – I was told not to panic. And since I had no angina pain, I could still run. I was prescribed statins to further lower my blood cholesterol, and aspirin to prevent blood clotting.
I left 10 minutes later feeling lightheaded, dizzy. Scouring the web proved less than reassuring: my calcium score meant an up to seven times higher cardiac event risk. A million questions buzzed through my brain. Should I stop running? What should I tell my wife and children? I felt paralysed.
In the following days, I took my pulse morning, noon, night and especially after running. When I detected several skipped beats, I insisted on a test for heart rhythm
issues. I wore the scanner for 36 hours. The results were completely unremarkable. My heart seemed OK, but my mind was still a wreck. I lived, and ran, in a cesspool of scary ruminations.
MONTHS LATER, I visited Dr Paul Thompson, a world-renowned cardiologist (and 28time Boston Marathon finisher) who has been studying running’s risks and benefits for half a century. I begged for more tests. I wanted data that would answer my ultimate questions: should I keep running? Would I live longer if I stopped?
Thompson answered patiently: ‘ You’re doing fine and more tests aren’t likely to tell us anything important.’ He also told me about seven-time Boston Marathon winner Clarence Demar, the first lifelong runner to have his heart autopsied ( he died, aged 70, from bowel cancer). Demar had some coronary artery blockage, but his arteries were two to three times larger than average, leaving plenty of room for healthy blood flow. Thompson said my ‘ hoses’ probably had a similar ability to expand. Exercise trains arteries to dilate when more blood is needed, so even with some plaque blockage, blood can still easily pass through.
Then we talked more philosophically: Why do I run? What does it add to my life? ‘Telling you not to run would take me off the hook,’ Thompson observed. ‘But 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.’
Since receiving my CAC results, I’ve finished four Boston Marathons and run 20- 30 miles every week. I’ve also absorbed much from Thompson from the psychological-emotional realm. ‘Medical knowledge has made incredible progress,’ he said, ‘but there’s still so much that we don’t know. Doctors and patients 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 or gain a greater appreciation for the greatest miracle of all – our own existence. I now draw strength from aphorisms that 50 years ago I disdained. I’d rather wear out than rust. I don’t want to be one of the ‘cold and timid souls who know neither victory nor defeat,’ as US president Theodore Roosevelt so pithily put it.
My runs are 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, which I hate, but I accept that I can’t change the trajectory of my life. And I know this for sure: every run is a new adventure, and every mile is a gift.