I left the hospital armed with two lots of beta blockers and some blood thinners, albeit with a heart firing on all cylinders. The blood thinners were preventative - Atrial Fibrillation is in itself nothing to worry about, it is the clots that can build up in the heart because it is not beating properly, and then when the heart restarts normal rhythm the clots move and can cause strokes. Some people's symptoms are different - their AF makes them faint, or so weak as to not get out of bed. I was able to function almost as normal despite being in AF.
I was also told that AF has various triggers including alcohol, virus, stress, and coffee. I was told not to make my heart beat go too fast - all this makes sense when you consider that all the above increase the heart rate. I was told I could continue my sporting pursuits but to not make the heart beat too fast. We agreed on 130 ish as a very conservative approximate target.
To be honest I was gutted - I was in better than reasonable shape before my hospitalisation, having run the Paris marathon sub 4 hours and also run up the Col De Vence in 1hr 7 - not far off my all time best for that hill. I had put in a nice cycling base, and was starting to step up the swimming, although was woefully light on volume.
I evaluated my options.
I was entered for the Ironman and just missed the cut off to cancel and get most of my money back. In the meantime I started training again, but slowly and with very short distances. The first time I ran with Mrs R and the dogs, just 5km, but it was a huge relief. I was able to keep my HR below the target range, and felt like I hadn't even broken a sweat. The beta blocker / blood thinner mix definitelmade me feel sluggish, but at least I was out there doing something. I gradually increased my distances, and threw in a bit of cycling and swimming as well. I was very careful about sticking to my target HR, and at times I found this incredibly frustrating. I couldn't do any speedwork to improve my timings, but I thought if I could train on the distances the Ironman might still be achievable, if I targeted the cut offs.
In the meantime the responses I received from other people were very thought provoking. People cared, but to some it was almost like I was disabled, permanently ruined - the assumption that I had had something akin to a heart attack, possibly caused by endurance sports. And the drugs definitely made me feel terrible, just on a day to day basis. I was struggling to stay awake past 3pm in the afternoon some days.
Dr Google can be a curse in that anything can be proven and presented as fact with no come back. However it can be a wonderful thing. I found some forums and blogs of endurance athletes and triathletes (including a notable cardiac specialist cyclist) with people to whom sport was so important, but also suffered from AF. One cyclist was actually a cardiac doctor and specialist in heart rhythm issues (http://www.drjohnm.org/). Another was in permanent AF and still ran marathons (http://afibrunner.com/).
Three weeks before the IM I went for a 2km swim at 5am, and my HR was fine. I was slow, having only swum about 12km in total since December. But I was comfortable. I might not be a great swimmer (in fact that is probably a flattering statement) but I love the water and am very comfortable in it. I am quite happy to stop and take a break and tread water for a bit to reduce my HR, and I did so. I hopped out the pool and got on my bike with the express intention of cycling the major climb of the IM route. I had done this before, when I did the IM in 2012, and knew that I could do approximately 90km in a look taking in the Col de L'Ecre and cut through home. I was then planning on a 20km run.
Best laid plans and all that. I crested the Col De L'Ecre, pleased that I had managed the climb with a steady HR, sub 130 in the main, and was looking forward to a nice long descent to Greolieres. After 10km the road was closed due to a classic car hill climb. I turned around and made it home after 110km. As a result I was pretty tired when I started the run, and it was very hot. I cut the run after 6km and jog/walked home as my HR was constantly going above 130. Discretion was the better part of valour, as they say, no matter how personally disappointing.
A week later I managed a 30km run and 90km cycle in succession. I was growing in confidence, and feeling better every day. I also kept my training to myself, and smiled enigmatically when people commented how healthy I was looking. Must be due to the enforced reduction in training schedules, they said.
The following week I did a half ironman - on my own. It was slow, and I had to walk parts of the run, but the triumph was that I was off the drugs and without the beta blockers suppressing my HR I was still able to complete the distance but keep my HR below 130.
The Thursday before the race I had my appointment with the Cardiologist. I was hooked up to various machines and everything was fine, my heart was healthy beating strong and regularly. We chatted for quite a long time about the period in my life prior to the AF episode and since leaving CHPG, including sport and training. The Dr seemed impressed I had realised there was an issue with my heart and sought medical attention, purely due to my HR monitor I was wearing when I trained, and similarly that I had been able to control my HR when I ran.
She explained various things. I will definitely get AF again. It may be tomorrow or it may be in 10 years. But 100% I will have it within 10 years. The triggers remain the same - stress, alcohol, caffeine, racing heart, virus. Of course, just getting out of bed in the morning might send me into AF.
She went on to explain that there are three levels of treatment.
1/ No drugs, but drugs at home in case I go into AF, in which case I have to start - particularly the blood thinners, and to call her immediately. The aim is to avoid hospitalisation.
2/ Daily beta blockers and blood thinners. I am keen to avoid these as they made me feel so bad. Not just when I ran but the general malaise. Almost depressive.
3/ Ablation - an operation to rewire the heart.
I am currently on level 1 treatment. I have a blood thinner pill with me wherever I go. I am very low risk on the stroke scale due to youth and general fitness.
I was given the go ahead to resume my normal life as before, sport etc. But to be wary of the triggers and to keep from pushing the HR up too high when I train.
I discussed with Mrs R and made the final decision to take the start line of the IM. If I finished, it would be my second and last Ironman. The multi disciplined nature of the training meant I was a more rounded athlete but with far less time on my hands. I wasn't really interested in another one. I just needed to finish.
Number 1 and 2 had their end of year dance show the night before. At 4.20am on Sunday 28th June, after 3.5 hours sleep, my alarm went off. The dance show had gone on even later than normal due to technical issues and I had got home just before 1am. Not ideal.
I donned my wetsuit and went to the slowest swimming "box", conscious of my lack of training and wanting to avoid the punch up that is the beginning of the big races. Nevertheless, within three strokes my goggles had been dislodged by a stray foot / arm, I had swallowed enough water to make me choke and I was seriously considering turning around and going home. A few more strokes and I thought I would get into a rhythm, but then I got a handful of jellyfish. As I ducked my head under from taking a breath I could see the shredded pink blobs go by me. I felt the sting and, thoughts of my previous visit to CHPG after a mouthful of jellyfish in 2012 I started to hyper ventilate, on the verge of panic. I was not enjoying this one bit.
I gave myself a stiff talking to, and after treading water for a few seconds I was composed enough to carry on. The break had given me enough time to relax and also for people to pass me. With clear water I was able to get into a rhythm and actually swim, the rest of it a blur of trying to avoid people who don't seem to have learnt how to "sight" as they zig zagged all over the place, getting out of the melee from the intermediate exit and entry back into the water for the final 1.4km, and eventually finding a small group to draft off.
I finished the swim a minute quicker than 2012 and actually feeling pretty relaxed. A short transition, slather with sun lotion and some energy drink and I was off on the bike. If I didn't make the bike cut at least I had had a decent Sunday swim work out.
I chatted to various Brits on the climb from Nice to Vence but occasionally had to drop back when my HR climbed too high. I did have a moment on the Condamine - more than 10% gradient for 500m, where I had to get out the saddle and push hard on the "peddling air" gear. My HR went up but it was a very brief spike and when I crested the hill and hit the flatter section from Gattieres to Vence it went straight back down again. From then on it was a long grind up to the Col de L'Ecre, chatting to various English speakers - very strong first timers full of unnecessary nerves like Joe from Leeds and Ciaran from Dublin, some more experienced and less time sensitive participants such as Kim from California. I managed to keep within my prescribed HR limits the whole time despite the rising gradient and sun. Vicky, Ian's wife was cheering at the Chateauneuf de Grasse turning which was a nice boost going into another very steep section.
The downhill I love, and from Col de L'Ecre to Greolieres was a nice way to increase my average overall speed and keep ahead of the sweeper car. I took energy drinks when offered and avoided the Coke (no caffeine) which was a change to my race strategy and another thing to be aware of, but just kept on peddling.
Once I had done the out and back look to Col De Vence it was a nice, fast descent to St Laurent. I passed some bike litter - evidence of an earlier crash, and saw two people collide in slow motion at an aid station, but nothing like the air ambulance occupying the road of 2012. I even got a compliment from another rider on my descending before I left him in my wake.
As I was coming back into the transition area I saw a female cyclist collide with a pedestrian. Both were lying prostrate in the gutter as I went past, the crowd calling for an ambulance. I was glad to have got the bike leg over - I had been standing up over the saddle for the last 5km as my tri shorts gave minimal protection from my new go faster seat and undertrained back side.
The run started slow and got slower. The searing heat and fatigue had taken their toll, and I used the showers and every aid station to walk and bring down my heart rate. Blisters formed on my feet from my water logged and squelching trainers as I ground out the marathon. Mrs R and the kids were there at the first turnaround to cheer me on, with Jack to give me a lick. I was weary but giving up was not an option - I had given myself enough of a margin to walk most of the marathon if I needed to and still finish.
As I jogged it felt slow, deliberately so, but as the sun fell and it cooled slightly I couldn't speed up at all. The wheels properly fell off on lap 3, and my moratorium on Coke meant that my options were limited. I had a sit down and a couple of salted crackers with energy drink whilst a volunteer sprayed me with a hosepipe.
It was amazing - like a new lease of life. I trotted to pick up my third and last hair band (blue) - the marker for the completion of each lap, said hi to Mrs R and the kids, and continued to shuffle round. Cyclists were still coming in, surely too late to beat the cut off. The aid stations were already folding up trestle tables, concentrating their efforts with what they had left, as over half the competitors having finished.
As I reached the finish channel Mrs R and the kids were waiting, and #1 and #2 accompanied me for a hundred metres or so. #2 went ahead waving her arms, her bag and flip flops creating a hilarious image as people cheered her. They left me as I joined the red carpet and I somehow found the energy to airplane in, high fiving the still impressive turn out of supporters 3 deep for the final 100m.
I learnt something new beyond the usual "Anything is possible" cliches. Whenever I finish a race - 5k, 10k, marathon, whatever, there is always a discussion about how long it took, a sort of benchmarking about their own times or those of a friend. I have come to realise that I will never trouble the Kenyans at the front of the big city races but that in ultras or hilly village trail races I might do quite well. A lack of natural talent, family life, work and perhaps the unwillingness to sacrifice everything means that will always be the case. I now have something else to take into account in training and particpating, and I will make an extra mental note to applaud those people that try - even if they don't make the cuts. Who knows what demons they are fighting inside. They are not sitting on the couch, and that is what it is important to remember.
Two events will stick in my mind from the day, other than finishing and the pain of the saddle. Mrs R, the kids and I were discussing people we'd met - her spectating. I had chatted to a woman from California who's son was married and living in Paris, on top of the Col De L'Ecre. Mrs R spoke to her husband in the crowds! The second was that I came 1864th, and my dossard was 1863. Almost bang on from the organisers. I finished in 14hrs 03 mins and 59 seconds, over an hour slower than 2012 and Ian on the day. I'll take the finish.