Running after bypass

[RickP]

I am a 45-year old marathon runner.  I ran my last marathon about 2 years ago at an 8:30 pace. After 2 years of decreased performance (I was down to running 3 miles at a 9:30 pace and feeling exhausted--my HR was 176 at this pace) a heart cath detected blockages.  I had quadruple bypass in February.  I began jogging at 7 weeks and have been building back up for 4 weeks now.  My performance seems to be returning to the pre-operation level rather than showing any improvement (I ran 5 miles yesterday at a 10 min pace and my HR was 156.  A 9 min pace puts my HR over 170).  Do you have any data on runners that have undergone bypass or know where I can find some?  My hypothesis is that I should be able to regain some of my fitness of 2 years ago.  My concern is that perhaps some of the grafts didn't take.  Thanks

[tatakh]

A related discussion, Runner with no endurance was started.

[Getting Back]

Posting very very late (several years late) to this discussion for that person who, like I was, is desperate to find a reason for rapidly reduced run performance, exercise-induced symptoms, and then, again like me, is worried about quality-of-life - and quality of running (or physical exercise in general) after heart surgery.  I'm going to throw in some catch phrases for those Googling the heck out of the internet in search of some help.  Things like "heartburn and running", "intense heartburn while running", "acid reflux during exercise", and "running after bypass surgery" or "exercise after bypass".  I’m not a doctor and the diatribe you are about to read is really just the point of view of one guy who, for the longest time,  couldn’t figure out what was wrong.  You see, I was absolutely convinced I was suffering from acid reflux.  I had extremely intense symptoms during exertion.  It would move up my esophagus and then radiate into the soft areas where my neck and jaw meet.  My saliva would thicken.  It would fade pretty rapidly if I stopped.  And I could, with persistence, "run through” the symptoms and continue on with my workout (I'm a relatively young athletic guy....it's what we do, right?).  I tried TUMS, then the purple pill (Nexium), then more of the purple pill, then purple pill and TUMS together, then another pill that was slightly different from the purple pill.  Also tried several restrictive diets and a couple homeopathic/herbal cures (I was desperate).  I saw an ENT doc, then a G.I. doc.  Each visit would lead to some other test which, of course, couldn't be scheduled for another 3 or 4 weeks, then a follow-up visit 2 or 3 weeks after the test to get the results, then the next test (another month), and the next visit with the different specialist (another month)....starting to get the picture?  And everyone asks me why I went so long if my symptoms were so bad!!  Well, to make a long story short, it turns out I had a very significant blockage of my left anterior descending (LAD) cardiac artery.  Lesson one - cardiac symptoms aren't always like you see them in the movies.  I had no "chest pains" that felt like they had anything to do with my heart.  Neither did I have any pain, tingling, or numbness in my left arm.  It felt like stomach acid!  Lesson two - you don't have to be a fat, sedentary, smoking, old guy to have a heart problem.  I'm 41 and have been active my whole life.  I don't smoke, don't drink, and I generally watch what I eat.  I don’t have high cholesterol.  I didn’t have high blood pressure (that changed as symptoms increased – but has since gone away).  The docs can't explain why I ran into this problem other than to say it DOES happen - even to fit people....more than most folks realize.  Lesson three - the bad news is you are young and fit and have a heart problem…The good news is you are young and fit and have a heart problem.  Every room I got wheeled into at the hospital, both pre-Op and post-Op, it was the same thing, "Whoah, what are YOU doing here?”  I really felt embarrassed...like I'd failed some sort of man test...like doing push-ups.  The literature I was given, and the videos I was shown (both pre and post) were frightening to me - it was all focused on the most common cardiac patient the hospital saw - Mister older, fatter, sedentary, smoker guy – and slow recovery – and "cardiac rehab" with some physical therapist smiling patiently as she counts the number of times you can negotiate two stairs in the middle of a padded rehab facility.  Fortunately, and despite the well-meaning attempts to (re)educate me, I was smart enough to see the silver lining that none of the educational material contained.  Because I was relatively young and fit, I wasn't like anyone they were talking about.  My experience would be significantly different from anything they were describing.  Ultimately, I had single bypass surgery of the blockage in my LAD.  The docs did what is called a LIMA bypass - meaning they re-routed an artery from my chest to my heart to bypass the blockage (one graft location on the LAD) rather than cut a hunk of artery from my leg to do the bypass (two graft locations on the LAD).  The surgeon, who was very good, did it "off pump", meaning my heart was never stopped for the surgery...just slowed down enough for the doc to do his work.  "On pump" surgery is when they stop your heart, do the work while a machine pumps your blood, and then re-start your heart.  You can, and should, research on-pump and off-pump for yourself.....and EVERYBODYS SITUATION IS DIFFERENT....but....and recognizing I'm doing some serious generalizing here.....on-pump good, off-pump bad.   The idea of having my sternum sawed and cracked open was, without doubt, scary as heck.  Truth is though, they shoot the anesthetic in your IV, you go out, and in what seems like a split second to you, they are waking you up.  Might as well have been liposuction.  My sternum never really hurt.  Oh...there was some pain, but it was mostly connected to regaining control of bodily functions (getting the catheter out of my penis; doing number two after the anesthetic and pain meds had me good and clogged up for days; I vomited a couple times and that hurt; coughing hurt alot for a couple weeks (lesson four – use that silly looking plastic breathing exerciser they give you – it’s the ticket to feeling better faster); and now, months later, sneezing still hurts a bit.   But...I was on my feet and walking the halls of the hospital in about 24 hours.  I left the hospital 4 days after surgery.  I went to work half-days 21 days after surgery.  I started run-walk-running 24 days after surgery.  I went to work full time 28 days after surgery.  I did my first real run (2 miles) 32 days after surgery. The next three months consisted of lots of 2 and 3 mile runs.  They were pretty lackluster workouts with only marginal increases in speed and "feelgoodedness".  Much of the slowness was due to the beta-blocker drugs I was put on post-Op.  These bring down your heart rate and blood pressure and they make perfect sense during the immediate recovery period.  And it may be necessary to keep many people on these for the rest of their lives given individual risk factors.  But, if you are that odd case, like me, you should talk to your doctor about coming down in dosage...and maybe coming off the beta blockers (AGAIN, EVERYBODY IS DIFFERENT - talk to your doctor).  When on the drugs, I couldn't really get my heart rate above 138 beats per minute (max) during my runs and generally had to plod on at 125 bpm.  I was used to cruising in the 155 range, so it was about a 20-25 bpm deficit.   I'm off the beta-blockers now and feeling very good. I'm up to 25 miles a week and pushing fast toward 30.  Only thing holding me back now is the poor shape I’m in after feeling so bad for so long (before I even knew I had a heart problem).  I’m planning to do a marathon (my second) this winter.  Oh yeah, I recently underwent a CT scan to settle a debate that was going on between myself, my surgeon, and two cardiologists.  The question was whether I was a healthy 41 year old with a one-time, one-location, blockage who could now get on with his life...Or was I a healthy-looking 41 year old with no-kidding heart disease who should get on with his life as best he can considering he's got heart disease that's not going to just go away?  At least two of us thought the former was the case.  The others maintained that “common things being common”, patients with disease in one place will have it in others.  Regardless of the results of the scan – which I got – my lifestyle will not change a bit.  I’ll continue to eat healthy, exercise like I’m training for a marathon, and – last lesson here – if something feels wrong/different/unusual/etc ….go see a doctor!  Good luck.

[alaskamrb]

I have been reading the comments and need to say I am a 54 yr.old male and had double bypass 5 mo. ago.  Still having some problems with jogging and stay mostly to fast walking usually up some good hills.  trouble getting the heart rate up there before the legs give out.  got any other ideas about meds and what they can and cannot do.

alaska mrb

[RickP]

I asked the same question and they really don't have an answer.

[RickP]

I noticed the same problem before my surgery and was one of the reasons I went in.  Since my surgery I'm still feeling winded going up stairs as well as my decreased running performance.  My recent stress echo was fine and they told me to keep working at it.

[RickP]

No, not due to age.  You don't see a decrease in 1-2 min per mile pace in a 2-year period due to age when you're running practically every day.  Some of the faster runners in local races are the masters entries - over 40.

[BillC]

I'd like to compare notes / trade questions periodically WRT recovery and athletic performance.  Feel free to email me:
***@****

[BillC]

You too Rick...email me if you're interested in occasional email correspondence

[Fairport Brian]

Your comments caught my attention.  I'm a 43 year old male who underwent valve surgery in January at the Cleveland Clinic to repair a bicuspic aortic valve.  I've been a highly competitive athlete for a number of years and typically engage in half marathons, biking, aerobics, weightlifting.  My surgery ended up ok but my 3 month echo shows some slight leakage again.  On the running front, I'm working hard at getting my running back to pre op levels but am "stuck" at 10 minute mile pace.  It's only been 4 months from the surgery but I'd like to keep in touch and see if there are any breakthroughs you experience.

[BillC]

Rick - I'm having a similar experience - valve repair surgery in Jan 2002, trying to get back into bicycling and triathlon.  I was expecting a pickup in horsepower w/ repair of a severe valve leak...but I still can't perform as well as I could before the surgery.  But I've been keeping a log of my exercise and performance, and do appear to be making very gradual improvement, particularly over the last month.  I've found some Internet pen pals who are valve-job-marathoners, and all tell me that it takes several months to recondition the heart.  I'm keeping my fingers crossed...hope all we need is a little more patience ;-)

[Macevedo]

I asked the same question to my cardiologist in Worcester, MA. last week: why do I feel short of breath under sudden exertion? Well, he simply said it is a normal reaction anyone else would experience, that perhaps I am more aware and sensitive of my body reactions. But my personal opinion is that when we go running, we give our body more time to warm-up and therefore adequate time to our blood vessels to open-up, expand and increase the supply of oxygen to our bodies.

[barnyard]

I am 51, I had quint bypass 1 1/2 yrs ago. My cholesterol level was good, but doctors said it was genetic.  The problem I face , and I was wondering if others do, is that I can speed walk and jog for 45 minutes on a treadmill on a steady basis, but get pretty winded if I climb two flights of stairs. I do not understand this and was wondering if any one else has experienced the same problem.

[Terry Lee]

It certainly sounds as if you are doing everything possible to prevent CAD.  I really wish you well.  I had no idea I was so vulnerable or I would have tried to do more!

Take care.

Terry

[geosot]

I take a 100 mg aspirin, vitamic E (500 mgr.) and B1-B6-B12 complex. I do not eat red meat and I eat 4-5 times a week fish, and 10-20 gr. olive oil every day. (from my native country-Greece).

I have forgotten how cheese, cream and butter taste
and all dairy products that I consume are fat free (milk and yogourt  0% fat)

Aspirin, however, is ONLY a blood thinner and an anti-infammatory drug, does not stop the formation of plaque. Garlic must be consumed in vast quantities to work.

I do not think that I can lower my cholesterol bellow 160 without medication, but I will give a try to increase HDL to 60 or more with low intensity--long duration aerobic workouts and increase of omega3 omega6 consumption.

Regards

George

[Terry Lee]

With your family history, I would suggest that you take a baby aspirin a day, one garlic tablet (which is supposed to keep plaques from forming at all - latest study!) and perhaps one B12 and a folic acid.

All of these are supposed to be preventative.  Also make sure that your lipid numbers are REALLY good - I always had what I thought was low cholesterol (about 160) but my Doctor wants it between 120 - 140!

Good luck and hopefully you will never have any heart problems to deal with!

Terry

[geosot]

Not really,  but the family history (from father's side) is too bad. Father with MI at 56, triple by-pass at 57, but till today (69 years) he is OK.  
He was a heavy smoker 50-60 a day, with  high cholesterol more than 280 (from his 30s), high blood pressure 150/90 (from his 30s), overweight etc.
All his brothers and sisters with CAD and by-passes (one died from MI at 59).

I had some symptoms in the recent past, during a very stressful time of my life, but these symptoms did not involve chest pain or  agina during exercise or physical exertion, but palpitations, and a feeling of an embedding disaster, during mental stress. My MD thinks that was a form of panic attack, which disappeared since.
A did a series of tests, actually two stress tests and two ECHOs with normal findings. (LAFB, slightly oversized heart and slightly oversized  left ventricle and bradycardia  due to exercise).  

The only think that worries me is the LAFB, although my MD, and my cardiologist are quite sure that is normal variant in my case.
LABF puts me in a slightly greater risk for a pacemaker in the future.

Sorry for the lengthy answer.  Best Regards.

[Terry Lee]

My dad is the culprit.  He died of heart disease at age 58 but he was diabetic, smoked, was sedentary had bad lipid levels, etc. Only ate meat and potatoes, etc.  My Doc did not even think it was hereditary but I really can't think of any other explanation. I also read that all people are born with some "plaque" in the LAD - that seems to be the norm - but whether you develop the inflamation, etc. seems to be hereditary.  I only wish someone would have suggested a baby aspirin a day to me as they did my brother.

My lipid levels were very good.  In fact the day I returned home from my angioplasty, I had a card from my primary physician to let me know that my numbers were so good, the chance of any heart disease was minimal!

When my Doc did my angioplasty he was blown away.  He was on the phone checking all my tests.  My stress test was excellent as was my thallium scan.   The only thing that bothers me know is I can be monitored since I pass all the tests.

Have you had problems?

Terry

[geosot]

What about your family history, your blood lipid levels ?

It is unusual for young athletic females to develop CAD.

Certainly CAD is not a matter of lifestyle.

[No Bypass / No Stents]

Why take Atenolol if you don't have rhythm problems?  I think that it's mainly prescribed because it's off patent and is very cheap, it's effective at lowerig BP, and it's proven to reduce a second heart attack in the general population, which is mostly a bunch of couch potatoes.

My motto is no beta blockers, no blood thinners, no nitrates, if you are a physically active person.  All of these substances can help the couch potatoes live a little longer, but they are counterproductive to physically active people.

That depression of heart rate sounds like near syncope, which in my case, was caused by atenolol.  I have a low heart rate to start with and do daily physical exercise and weekend strenous exercise.

If you have a BP problem a better choice might be an ACE inhibitor.

You do have to taper off of a beta blocker, should you choose to dump it.

[TJMcD]

I am 42 and have been running 1 or 2 marathons a year for the past 10 years as well as getting lots of other aerobic exercise. The only risk factor for heart disease I have is that both parents also have it. 4 weeks ago I had bypass surgery. This isn't always due to lifestyle.

[Macevedo]

Not a marathoner, just 10K's. I am 69 years old and had a single bypass two years ago. I have continue running, although at a slow 10 to 12 minute mile pace. I had a stress test last month where the Dr. told me a max heart rate of 150 was OK for me. It is usually between 120-130 at a 12 minute pace and 130-140 at a 10 minute pace. But!!! I am also on 25mg of Atelonol which scares me often while running; if I suddenly increase my pace my heart beat takes a big dive into the 60-70's and spikes into 170's and back down to 70's before it settles back into my normal 120-130's. My thoughts are that I should not be taking Atelonol, since I am not a sedentary person. I have exercised all of my life. I also take Lipitor and my cholestorol level is 148. I have also been told the bypass should become as strong as a regular artery is. I also lift weights my chest has healed.
Lipitor has caused me a lot of muscle and joint pain, although my blood tests are OK.

Any thoughts?

[No Bypass / No Stents]

Unfortunately, it looks like the root cause of your decreased performance was not CAD, but something else.  That's one hell of a procedure to go through to find that out.  Of course grafts will never perform like your natural arteries, so perhaps that is the limiting factor.

Also could your decreased performance be simply due to age?  Isn't that why they have a different class for runners over 45?  Isn't that why professional athletes usually retire by 40?  It's hard to accept all of the mental and physical deterioration that we suffer as we age.

[Terry Lee]

This is something I would love to know.  I also was diagnosed with CAD after passing everytest in the book with flying colors.  I am a young female, thin with all the right stats who excercises regularly.  Not a meat eater, smoker, etc.

I began having chest pains on exercise and finally had a cath which revealed a 95%occlusion of my LAD.  After several re-stenosises, I seem to be doing OK but I get angry when I hear that heart disease is a "life-style" issue.  

Still wondering...

Terry

[geosot]

Congratulations for your decision to continue running after your surgery. I am not a MD, and I do not have any heart problem so far, but I am really interested in the answer of your cardiologist. Could you please keep me informed?  

I have, however, the following question. How an apparently healthy individual (a marathon runner) developed CAD in his 40