This article was originally published in the March 2024 issue of UltraRunning Magazine. Subscribe today for similar features on ultra training, racing and more.
If you know what a widowmaker is, the above title certainly caught your attention. Unfortunately, I had never heard of the term until three months ago when it happened to me.
I have been an accomplished endurance athlete for 55 years, with countless joint and ligament problems. I’ve worked through them all while always assuming the engine—my heart—was incredibly strong and healthy. But I was only half right.
In early October, after returning from the World Masters Mountain Running Championships in Madeira, I was suddenly besieged with a cacophony of complaints: dental surgery, Shingrix vaccine and Rhinovirus, plus shortness of breath and constriction in my chest during exercise.
That last symptom was alarming, so on October 17 I requested a chest CT scan which showed three cracked ribs (from a fall on my e-foil). My doctors said, “This will be fine in a month. Go away, come back then.”
I’ve had cracked ribs before and this didn’t feel the same, so I demanded another CT scan, this time with contrast: turns out I had a pulmonary embolism. These are not good. I was given an anticoagulant drug and told, “This will be fine in three months. Go away, come back then.”
Meanwhile, a running friend in Utah who is a doctor was becoming irate. He kept emailing me detailed reasons why all my docs were wrong. I agreed—something didn’t feel right.
I kept pressing and got my PCP (primary care physician) to provide referrals to a pulmonologist and cardiologist. Both said, “You have a pulmonary embolism. It will be fine in three months. Go away, come back then.”
The pulmonologist categorically refused any further testing. The cardiologist, when pressed, agreed to do an echocardiogram (ultrasound), which came out fine, so he refused to do a stress EKG.
I remained calm and patient. I was hiking and cycling 50+ miles a week, and aside from being unable to do anything above zone 2, was enjoying myself and having a good time. All blood tests looked okay, multiple ECGs came back fine, even the echocardiogram showed my heart was healthy and I had no conventional risk factors. But my doctor friend in Utah called one morning after becoming so worried about me he couldn’t sleep. His concern came not from the data from these complex tests, but simply from looking at my Strava feed.
Finally, on December 13, with strong insistence from my wife, I reluctantly shifted tactics. I walked into the emergency room of the local hospital.
They sprang into action. Within hours I had another chest CT scan which showed the pulmonary embolism was gone (as I suspected). The next step was a coronary angiogram with contrast, which they performed within the hour.
The cardiologist on duty walked in and said, “You’re not leaving the hospital. You have a 95% blockage of the left anterior descending artery (LAD). I’ll do a coronary angioplasty with stent tomorrow.”
Yikes—I didn’t see that coming.
I thought I had the healthiest heart in the world. The LAD is called the “Widowmaker” because it supplies blood to the heart. Another 5% of blockage and I’d be gone in minutes.
Photo courtesy the author.
COULD IT HAPPEN TO YOU?
Yes, heart disease can happen to you and indeed, it has already started. Here’s what I learned, and you should know.
Plaque starts building on our artery walls when we’re teenagers. It’s an unfortunate genetic human trait. According to the National Institutes of Health, half of Americans over age 45 have significant levels of plaque buildup, or atherosclerosis, and don’t know it.
It keeps building our whole lives and one in four adult males die from it.
Heart disease is not like the flu—this is not a pathogen. It’s simply the term applied when the buildup passes the numerical threshold of 70%. Everyone reading this is now at some point on this spectrum.
Exercise, diet and other factors are very important, within our control and should definitely be practiced. They enable a long and healthy life, but do not eliminate heart disease.
A heart-healthy diet will significantly reduce your risk, and you must start that diet now—again, heart disease is cumulative over a lifetime, so that means you shouldn’t wait to notice a problem because it is likewise very hard to reverse.
Exercising in nature has been proven to be the best thing anyone can do for physical, mental and emotional health. But do not think for a minute that vigorous exercise gives you a free pass on your eating habits. If your coach tells you it’s okay to eat anything as long as you get enough calories, that may be fine over the next few years, but it is terrible advice for many decades to follow. Being a great endurance athlete grants you no immunity from heart disease. A strong cardio-pulmonary system means we are better equipped to survive problems, but it does little to prevent them.
I think high-end athletes have always had an intuitive sense that “more is not always better.” Hopefully most of us realize running a hard 100-miler will in no way improve our health. There’s probably the usual bell curve, whereby minimal exercise provides huge health benefits, which gradually level off at some point of exercise intensity unique to each individual, then may even decline when engaging in extreme activities.(1)
The authors of a British study wrote, “The demands of modern ultrarunning, both in training and competition, are far more extreme than the persistence hunting or scavenging our ancestors might have done. We should not view ultra-endurance running as the ultimate expression of our evolved physical nature…”(2)
The results of this study surprised me: In 2014, 50 males who had run a marathon every year for at least 25 years were matched with sedentary males of similar weight and other statistics. The runners had 58% more plaque buildup than the non-runners. (“Conclusion: Long-term male marathon runners may have paradoxically increased coronary artery plaque volume.”) (3) This startling data is offset by the athletes having arteries that may be twice the diameter of normal, resulting in less clotting tendency and thus, no higher mortality rates (and the tendency to pass most screening tests for heart disease).
More American men die of heart disease every year than the total number of Americans who died of COVID during the height of the pandemic.
Regardless of fitness and athletic achievements, paying attention to cardio health is imperative for all athletes. Starting now.
Photo courtesy the author.
THIS IS HOW IT GOES
While our healthcare system is poor at actually taking care of our health—we need to do that ourselves—it is incredibly good at “disease care.” If you get run over by a truck—or would rather not die almost as quickly from a cardiac infarction—the US is a great place to be.
After my shocking diagnosis, a restless night was spent in the hospital hooked up with all kinds of wires and tubes. In the morning, the cardiologist performed what is called a primary percutaneous coronary intervention. They snaked a catheter up an artery from my wrist, used a ‘balloon’ to expand the constricted spot in the LAD, then inserted a stent—which is a semi-flexible tube of mesh—to keep it open. An hour later, I got up and walked out. Surprisingly, there is no general anesthesia for this dramatic procedure. Using intravenous therapy (IV), a patient is sedated with the infamous Fentanyl and a drug called Versed, but stays conscious with memory, thinking and perception greatly reduced. Then, an hour later, it wears off with no side effects (I see how people get addicted to Fentanyl).
This procedure was less traumatic than dental work, in my opinion (provided you don’t look at the big needles). I could have walked the 4 miles home afterward and would have done so except it would have traumatized the nurses.
Post-procedure, I’m probably fine. I’m back to hiking, cycling and starting to mix in a little running (and didn’t stop dancing, of course). I have 30-40% blockage in my other three arteries, and have always been a complete non-drug person, whether legal and prescribed or recreational. Now, I’m taking a powerful anticoagulant, blood thinner and a cholesterol-reducing medicine, which are definitely not performance-enhancing, energizing, psychoactive or fun, in any way.
Photo courtesy the author.
IF IT DOES HAPPEN TO YOU
Everything that happened to me was very surprising. Here are more details so you won’t be as surprised as I was.
All my blood tests showed I was fine. So did the vaunted EKGs, the whole point of which is to test your heart. Even the echocardiogram stated, “Normal left ventricular size and function.” All three types of tests failed at achieving a correct diagnosis.
If you have serious concerns, you need a coronary CT angiography with contrast or a stress EKG (A coronary artery calcium scan is cheaper but provides a less targeted diagnosis).
Your doctor probably won’t order this test. My cardiologist said, “That’s our medical system. That test costs more, so unless we see a big problem to justify it, insurance won’t pay for it.”
You’re an athlete, so you need your doctor to re-calibrate for who you are. Three days before my dramatic angiogram, I biked 53 miles, because at 95% blockage I could still do more than most other 72-year-old people who can’t make it up the stairs to the doctor’s office. Our healthy appearance can deceive doctors who then tell us to get out of their office to make room for someone who is actually sick.
I loathed the thought of an emergency room, but if you have a problem, just do it because they will jump on it. As a friend said, “From our three visits to the ER this year, upon arrival, the assumption is this person might die. It doesn’t take long to get a full team involved and all of those medical diagnostic tools are right there—it is not the usual long, linear progression to figure out what is going on.”
I had a serious arterial blockage for nine weeks and received no treatment. After a lot of pushing, I finally received excellent care. You do not want to wait nine weeks.
WHAT NOW
All my friends are promptly returning my calls and happy to see me and meet up. Near-death experiences have some positive side effects. It’s like a prelude to the eulogies at your funeral: you may have been a total jerk your whole life, but now everyone will say what a great person you were.
I also received many emails thanking me for sharing my story. My best friend, Peter Bakwin, who has a PhD in physics from Harvard, sent a typical email response: “Thank you for taking the time to research and compose this story. You are literally going to save someone’s life. Maybe mine! My mother’s father died of it in his 50s, and my mother had a heart attack at age 75.”
At present, I am not fit and my athletic future is unclear, but I am feeling good and energized. You know that famous question, “If you had only one year to live, what would you do with it?” That question doesn’t feel rhetorical anymore—it’s real. Whatever your authentic self is, now is the time to manifest it. Definitely take really good care of yourself, and if there’s something you’ve always wanted to do, now would be a very good time.
THE FITTEST PERSON IN THE MORGUE
Do you remember Jim Fixx? You should. His 1977 book, The Complete Book of Running spent 11 weeks on the New York Times’bestseller list and sold over a million copies. He appeared on countless talk shows extolling the health benefits of running, becoming a major spokesperson for the first running boom. Seven years later, he died at age 52 of a heart attack while on his daily run. “The fittest person in the morgue” had a 95% blockage of the LAD (same as me). One should also note, he didn’t start running until age 35 while weighing 214 pounds, after which he had a great life—running definitely works. But it did not erase his unhealthy habits nor grant immunity from heart disease. Do any of you have “Jim Fixx Syndrome”?
References
(1) “When the CAC score in marathon runners was compared with that in males from the general population with a similar risk factor profile, marathon runners had an even higher CAC (Coronary Artery Calcium) score.”
“Risk Stratification for Coronary Artery Disease in Marathon Runners”
https://www.ecrjournal.com/articles/risk-stratification-coronary-artery-disease-marathon-runners
(2) Quoted in Outside Magazine, “The Limits of Ultrarunning” (original paper for purchase only)
https://www.outsideonline.com/health/training-performance/limits-of-ultrarunning-research/
(3) “ Increased Coronary Artery Plaque Volume Among Male Marathon Runners”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179497/