Running with PFO
Last year, I confirmed I had PFO: Patent Foramen Ovale. That's a hole between the left and right atria in the heart that can allow for deoxygenated blood to go back into your bloodstream. It's actually quite common with 20-25% of the population having it beyond childbirth. Usually it closes up at childbirth, as it only serves the purpose of having your mother's pulmonary system doing all the lung work oxygenating you while you are still in the womb. In some cases of adults with PFO, it can allow blood clots through and cause a stroke. It is also dangerous for scuba divers. For them, it can lead to the bends. I believe one day research will increasingly recommend against PFO people from doing too much at high altitude. Unless one has a stroke because of it, my personal experience is that heart surgeons will unlikely close it up since there isn't enough of a risk of stroke in the general PFO population. The 3% or so risk of atrial fibrillation resulting from the procedure is a factor surgeons do not want to introduce to otherwise healthy PFO patients.
PFO may be a problem numerous ultrarunners have. My story begins at Crested Butte 55k in Sept. 2018, a race that is between 9000 - 11500 feet above sea level. Like many other similar distance runs I've had at high altitude, I felt pretty good for the first 25 miles, but the last 10 miles, especially the last 5 miles, became a scary experience of barely maintaining consciousness and feeling extremely nauseous. I had little power to move forward, especially up any hills. Essentially, symptoms not too far off from high altitude pulmonary edema (HAPE). As I walked like a zombie into the finish line, I was blue colored and I was therefore heralded straight to the medical tent. Eventually, the medical staff gave me oxygen when they saw my blood oxygen levels were in the upper 80s. Not catastrophic, but not great either. They gave me supplemental oxygen. Within 10 minutes, I felt heavenly, and honestly could have run another 10 miles. Long story short, that event led to some medical testing over the following year. I believe having a top-notch physician who was willing to explore every possibility (and eventually send me to a cardiologist), along with me being proactive, led to the discovery. What it means: Because I get the same symptoms at high altitude on runs longer than 25-30 miles or so (depending on the vertical gain and average elevation), and sometimes the symptoms even start as early as 17 miles, I cannot do ultras at high altitude (at least runs of 50 miles or longer). Incidentally, I believe downhill running sends more deoxygenated blood through across the atria wall by disturbing the PFO. At least, that's my working hypothesis since I can run up and down the 14er of Pikes Peak (24-miles round trip) and feel great, but if I ran the same distance at similar altitude, and same vertical gain, but with downhills more intermixed, I seem to perform much worse. There may be a cardiologist or heart surgeon out there who would do a closure procedure for me, but so far, I've found resistance from the ones who saw me. First world problems, right? But now that I'm aware of this, I'm thinking there's a whole world of discovery about ultra runners who have PFO. There is some literature on the topic, and it seems to confirm that PFO folks have troubles at altitude (along with hints that PFO folks suffer more in the heat), but it's still a budding research area. Hopefully I can become involved one way or another.
Figure. "Not dead yet". Me goofing around when I started to feel better at Crested Butte 55k. The first step in a journey of determining PFO is a detriment to high-altitude ultrarunning for me. Photo by my friend Jake. I was fortunate to have a good group of friends tend to me at the medical tent and keep my spirits up.
At any rate, I will go about running my longer ultras at lower elevation; hence, Superior 100. At the elevation of Superior, I am sure PFO still is detrimental to my performance (likely decreasing my VO2 max and longer endurance/heat acclimation in unknown ways), but I have more of a fighting chance and it won't be life threatening like it very well could be at the same distance at altitude (HAPE is no joke).
Exercise today: 31 minutes of indoor biking for 10 miles (level 10). Unfortunately, I experienced patella soreness in both left and right knees, but esp. the left (problem) knee.
Also, I walked a mile during a break at work. The knee had some weird sensations that are difficult to put into words, but I wouldn't call it pain.
PFO may be a problem numerous ultrarunners have. My story begins at Crested Butte 55k in Sept. 2018, a race that is between 9000 - 11500 feet above sea level. Like many other similar distance runs I've had at high altitude, I felt pretty good for the first 25 miles, but the last 10 miles, especially the last 5 miles, became a scary experience of barely maintaining consciousness and feeling extremely nauseous. I had little power to move forward, especially up any hills. Essentially, symptoms not too far off from high altitude pulmonary edema (HAPE). As I walked like a zombie into the finish line, I was blue colored and I was therefore heralded straight to the medical tent. Eventually, the medical staff gave me oxygen when they saw my blood oxygen levels were in the upper 80s. Not catastrophic, but not great either. They gave me supplemental oxygen. Within 10 minutes, I felt heavenly, and honestly could have run another 10 miles. Long story short, that event led to some medical testing over the following year. I believe having a top-notch physician who was willing to explore every possibility (and eventually send me to a cardiologist), along with me being proactive, led to the discovery. What it means: Because I get the same symptoms at high altitude on runs longer than 25-30 miles or so (depending on the vertical gain and average elevation), and sometimes the symptoms even start as early as 17 miles, I cannot do ultras at high altitude (at least runs of 50 miles or longer). Incidentally, I believe downhill running sends more deoxygenated blood through across the atria wall by disturbing the PFO. At least, that's my working hypothesis since I can run up and down the 14er of Pikes Peak (24-miles round trip) and feel great, but if I ran the same distance at similar altitude, and same vertical gain, but with downhills more intermixed, I seem to perform much worse. There may be a cardiologist or heart surgeon out there who would do a closure procedure for me, but so far, I've found resistance from the ones who saw me. First world problems, right? But now that I'm aware of this, I'm thinking there's a whole world of discovery about ultra runners who have PFO. There is some literature on the topic, and it seems to confirm that PFO folks have troubles at altitude (along with hints that PFO folks suffer more in the heat), but it's still a budding research area. Hopefully I can become involved one way or another.
At any rate, I will go about running my longer ultras at lower elevation; hence, Superior 100. At the elevation of Superior, I am sure PFO still is detrimental to my performance (likely decreasing my VO2 max and longer endurance/heat acclimation in unknown ways), but I have more of a fighting chance and it won't be life threatening like it very well could be at the same distance at altitude (HAPE is no joke).
Exercise today: 31 minutes of indoor biking for 10 miles (level 10). Unfortunately, I experienced patella soreness in both left and right knees, but esp. the left (problem) knee.
Also, I walked a mile during a break at work. The knee had some weird sensations that are difficult to put into words, but I wouldn't call it pain.
Nutrition: 1799 cal, 87 g protein, 32 g
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