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I Am Dying to Run. But Am I Willing to Die Running?

Faced with heart damage and debilitating long-haul COVID-19, the author asks himself hard questions, and keeps dreaming.


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What would you do if you found out you had a 10% chance of dying within the next year unless you stopped running? Would you run anyway? How about if you learned there was a three-in-five chance that continuing to run would make you seriously ill? Would you find a new hobby?

For me, these questions are not some idle thought experiment. Within the past year I’ve been diagnosed with two separate medical conditions, one of which may increase my chances of dying as I run, while the other leaves me virtually immobilized a few days after I run. All runners are willing to bear some cost to do what they love. I happen to be in a position that forces me to decide what cost is too great.

The Heart of the Matter

The condition that puts me at risk of pulling a Jim Fixx is the same one Jim Fixx had — atherosclerosis. Unlike him, though, I do not have a family history of heart disease, nor have I ever smoked or been sedentary, as Fixx did and was before he discovered running. Instead, my coronary artery plaques appear to have been caused by running (and swimming, and cycling, and elliptical biking) — years and years of stressing my poor ticker to the max.

I know what you’re thinking: ‘I thought running was good for my heart!’ And it is! But for reasons that aren’t well understood, doing large amounts of intense running over long periods of time leaves a mark on some individuals, including me. According to the results of a recent angiogram, my calcium score is 363, which, based on my age and gender, means I have a 5% chance of suffering a heart attack within the next 10 years. But here’s the fine print: Studies suggest that all calcium scores are not equal, and that the risk of cardiac events is not as high for someone like me, who earned his 363 by running instead of by smoking and eating bacon.

A short time ago I sought the advice of Amy Fiedler, MD, an assistant professor of cardiac surgery at the University of Wisconsin-Madison, and also an ultrarunner and triathlete. My own cardiologist is okay, but she’s not an athlete and she doesn’t treat a lot of athletes, and I wanted the perspective of an expert who’s able to see things as I do. After bringing her up to speed on my situation, I asked Dr. Fielder what she recommended I do as a next step toward assessing my risk of running myself into an early grave. Without hesitation, she told me I should get a coronary catheterization, which she described as a mildly invasive procedure that can determine the severity of any blockages I might have. “Depending on the outcome,” she said, “you’ll come away with either peace of mind or a basis for pursuing further treatments.”

“Let’s say I do that and there are no blockages,” I said. “If I understand you correctly, that tells me it’s safe run now. But if running caused my plaques, won’t more running just keep making them worse until I do have a blockage?”

“That’s a good question,” Dr. Fiedler said, “and I don’t know the answer to it. And I don’t think anyone does.”

To summarize: A simple, expensive procedure will give me a much better sense of how risky it is for me to run today. But what I can’t know is how this risk might change with continued running. I feel like Hamlet, minus the despair: ‘Do I roll the dice, or play it safe?’ Lucky for me, I’m under no immediate pressure to answer this question. Less lucky for me, my heart condition isn’t all that’s wrong with my body.

Matt Fitzgerald The author, watching others run.
The author, watching others run. (Photo: courtesy Matt Fitzgerald)

Going Long

There’s a lot of confusion surrounding long Covid, so let me try to clear it up. Long Covid is not the acute illness people experience after being infected with the COVID-19 virus. Nor is it the normal, sometimes protracted, process of recovering from the virus. It is a separate, chronic condition that somehow gets triggered by the virus in a percentage (estimates range from 10 to 30%) of those who survive the acute illness.

My symptoms include fatigue, shortness of breath, paresthesia, insomnia, and cognitive impairment. Another common symptom of long Covid that I have in spades is post-exertional malaise, which is a fancy name for not being able to get out of bed after exercising.

The last time I ran was August 8, about four weeks ago as I write. I felt ready. For the first time in more than ten months I had no symptoms (unless you count some minor numbness in my left lower leg and foot). Having learned from past disasters that it’s impossible to be too conservative, I ran for 15 minutes at a very slow pace, quitting while I was ahead. Or so I thought.

Three days later, I woke up feeling as if I’d been dragged behind a horse. Only now am I getting back to a point where gentle walking doesn’t set me back even further. Fair to say, running isn’t an option for me at the moment, and for all I know it might never be. There’s a part of me that’s okay with this possibility. I had 40 good years as a runner. I ran in Kenya and Bulgaria, with Kara Goucher and Haile Gebrselassie, through blizzards and desert heat. Running changed my life for the better and made me the man I am today. I have no unfinished business as a runner.

Or do I?

Don’t Stop Believing

Lately I’ve been thinking a lot about Charles Barkley. The “Round Mound of Rebound” was 36 years old and playing his last season of professional basketball when he ruptured his left quadriceps tendon on December 8, 1999, during a game between his Houston Rockets and the Philadelphia 76ers. Soon after being carried off the court, the always unfiltered Barkley conceded that the injury was probably career-ending.

A part of him was okay with this possibility. After all, he’d already made the decision to retire. But a bigger part wasn’t okay. And so, six months later, on the final day of the 1999-2000 season, a less-than 100% recovered Sir Charles entered a game against the Vancouver Grizzlies during the second quarter and played (badly) for seven and a half minutes. And then he retired.

“I can’t explain what tonight meant,” Barkley said at the post-game press conference. “I did it for me. I’ve won and lost a lot of games, but the last memory I had was being carried off the court. I couldn’t get over the mental block of being carried off the court. It was important psychologically to walk off the court on my own.”

You see where I’m going here. Charles Barkley couldn’t bear the thought of leaving a sport that had given him so much on a note of defeat, and I guess I feel the same way about running. My last official race was the 2020 Way to Cool 50K, which I quit at 8 miles because I was sick. With Covid. It sure would be nice if just one more time I could feel what it’s like to be fit and fast and confident, to finish strong.

One thing that I always noticed but never could explain about running was the way in which my racing ambitions caused everything in my life to line up behind them. When I had an important event in front of me, I was happier, nicer, more productive, an all-around better, saner person. Running has been mostly taken from me, but the one part of the experience I can still claim, if I so choose, is the dreaming part.

The dream of running again now substitutes for my prior dreams of running faster, farther, and better than ever before. I freely confess that this new goal doesn’t make me quite as happy, nice, or productive as chasing PR’s once did, but that’s only because I feel like crap all day every day. The dream of crossing one last finish line does, however, make me a saner, better person than I’d be if I just gave up, and that’s what matters. I’d even go as far as to say it probably doesn’t matter if I never achieve my goal, as long as hope doesn’t die before I do.