Yawn

Got up at 7:30am. Woken by my phone reminder alarm. The sun so bright and hot now at 7:58am. Not gonna do any run now. Besides I'm so sleepy after returning home at 1:35am from Segamat, Johor attending a wedding of an ex-colleague. Hopefully, this evening can run a bit. But my hamstring does feel a little tight when I woke and even now :(

Aiyoh, guess what. My phone reminder was that SCSM 08 is 1 week from 7:30am, 7 December 2008.

The Lab Says Heart Attack, but the Patient Is Fine

November 27, 2008
Personal Best
The Lab Says Heart Attack, but the Patient Is Fine
By GINA KOLATA

THE man was 40 years old and seemed perfectly healthy — he had just run a 10-kilometer race. But he fainted after the race and was rushed to a hospital. There, in the emergency room, his blood was tested. His levels of a heart protein, troponin, were sky-high. It looked as if he was having a heart attack.

The runner ended up in the coronary intensive care unit at Hadassah-Hebrew University Medical Center in Jerusalem. He was in the hospital for four days, undergoing test after test. Yet nothing appeared to be wrong, his doctors — Lior Tolkin, Beth Goldstein and David Rott — report in a recent issue of Cardiology. He had no other symptoms of a heart attack; every test of his heart’s function was normal. And his soaring troponin levels, which can be an indicator of heart muscle damage, went down to normal.

A false alarm or a heart attack averted or maybe a lab error? Researchers say the most likely explanation is that the man had been caught up in a poorly understood but surprisingly common phenomenon: blood tested shortly after a long or strenuous bout of exercise is likely to show abnormalities, maybe even indicators of a heart attack or liver failure. But usually the patient is not in danger. Instead, those results are normal and are not a reason for concern.

While it is unusual to find such effects after a race as short as 10 kilometers, researchers say they are well aware of the general problem.

“I can tell you several stories like that,” said Dr. Fred Apple, a professor of laboratory medicine and pathology at the University of Minnesota School of Medicine.

In one, in fact, he is the center of the story.

Dr. Apple likes to experiment on himself, so one day, when he was a medical resident at Washington University in St. Louis, he drew his own blood and sent it to the hospital lab for routine tests.

The next thing he knew, he was being paged and escorted to the coronary intensive care unit. His blood test results were terrifying, with levels of an enzyme, creatine kinase MB, 10 times higher than normal. Like the runner in Israel, it looked as if Dr. Apple was having a heart attack.
His heart was fine. But Dr. Apple had just gone for a long run (he was running 50 to 60 miles a week in those days).

That experience, in the 1980s, made Dr. Apple curious about lab tests after strenuous exercise, and led him to systematically study the problem, documenting the exercise effect.
“I’d say that 5 percent of people who stress their bodies with exercise could bump up some of these levels above the level that signals a heart attack,” Dr. Apple said.

To avoid false alarms, he suggests that patients avoid lab tests within 24 hours of exercise. If not, he said, “you are asking for abnormalities to be detected.”

Dr. Malissa Wood, a cardiologist at the Massachusetts General Hospital who is a marathon runner, goes further. “I think it’s a really bad idea to have blood work unless something is wrong,” she said.

Dr. Wood and her colleagues have studied runners in the Boston Marathon, testing their blood before and after the race for proteins that can indicate a stroke risk or a heart attack.

“Almost everything we looked at went up,” she said.

And it may not take hours of exercise to do it.
Rob Shave and his colleagues at Brunel University in England recently reported in the Journal of the American College of Cardiology on nine young men who ran a marathon distance on a treadmill. The researchers took blood samples from the men every 30 minutes while they ran and periodically for 24 hours afterward. All had marked increases in troponin within one to two hours after they started running. Everyone’s troponin levels fell within an hour after the run, but in eight of the runners the protein’s levels rose again over the next hours, and five runners had elevated levels 24 hours later.

Yet, Dr. Wood noted, this study involved healthy people. They were not having heart attacks. “Their hearts were fine,” she said.

It is not known for sure why exercise can elicit such strange lab results, researchers say. But part of the explanation is thought to be immune system responses involving inflammation, and part is thought to be effects of temporary skeletal muscle injury.

For example, some studies biopsied the muscles of runners before and after marathons. After the race, muscle fibers were broken and dying. But skeletal muscle is very different from heart muscle. When heart muscle dies in a heart attack, it never regenerates. Skeletal muscle does. Within four days, those runners had repaired their skeletal muscle, growing new muscle fibers to replace the ones that had died.

An echocardiogram also might be misleading. Vigorous exercise can bring on transient abnormalities in the functioning of the left ventricle.

Further complicating the picture is the huge variation from person to person.

“Everyone responds differently,” Dr. Apple said. “Each person is their own little experiment.”
Enzyme levels also soar in people with larger muscles, men as compared with women, blacks as compared with whites. Enzyme levels in a black man after a marathon can be twice as high as those in a white woman, Dr. Apple said.

“I’ll often get a call from a clinic,” asking about lab test results for a black man who recently raced, Dr. Apple said. “I’ll say, ‘That’s normal for a black man.’ ”

Dr. Wood said that athletes and doctors should be wary of blood tests that seem at odds with clinical findings. All too often athletes end up in emergency rooms after races because they are breathing hard or they fainted or their chests hurt (typically because their stomachs are upset). Often, she added, those athletes are just fine.

“We recognize that after a long-distance endurance event the body is going through some sort of adjustment,” Dr. Wood said. “Most of it is a blip on the radar screen.”

Some SC BKK 2008 photos

42km, 10.5km and 5km finishers' medals

The Standard Chartered Bangkok Marathon 2008 event tee

(New Balance Lightning Dry)


Water points - all plain ice water from Pepsi and served by army boys (no 100Plus)

Me in front of the Grand Palance and in front of the start line.

Every finisher collected a medal and then given 2 MacDonald's burgers (2 fish fillets)

Shouting from BKK

It's 11:44am Spore time but 10:44 BKK time.

Run is over. Completed the 10.5km in 1:18:26 my watch time. The gun time was 48secs later at 1:19:06. Pretty good time but injuries all over both legs. Ha ha ha.

Pre-race, I noticed that people bring their dogs - and each dog got their own bib with number. Wah...ha...ha...ha. Won't see that happening in Singapore since the rules usually forbid it. Quite a number of expatriates working in BKK, Asians and Europeans were also at the start line for the 10.5km. One 'farang' guy even had a camel-bak for the 10.5km - serious stuff.

Ran up and down highways and bridges, some were quite steep. Saw a mobile toilet (where the piss came through the floorboards of the bus) onto the road. So spoilt in Singapore with energy drinks. The route had 4-5 water points and it's just ice water by Pepsi. End of race had MacDonalds 2 burgers from choice of 3 (pepper chicken/ beef hamburger which many locals rejected and fish fillet), iced (thick but very sweet) ovaltine and more ice water courtesy of Pepsi.

Saw quite a lot of Singaporeans just from the way they speak English, SCSM 06 vest, GE Women 10k 2008 red vest, Spore Nike Runaholics, Sundown Marathon and even Saucony PAssion Run 08 green vest. Am surprised so many Singaporeans ran 10km in BKK.

Not many photos and I wished I knew where I ran so I can mapped but I think with all the twists and turns, that's quite an impossible task.

Now waiting for my 150BHT 1 hr bus ride to airport at 11:10am Thai time. Will pass the internet session to my room mate slow_runner.

BKK here I come

Leaving for BK today. 3:30pm flight via AirAsia.

Short prep run

Did a quick 4km today. 4.15km actually using MapMyRun. Ran too fast over the last click. Finished in 30mins:10secs (Avg pace of 7mins/16secs per km).

Tough run

Yeh. Woke up late. Was 7am. I drank water. Splashed sunblock cause the sun's usually up at 7:20am.

Set off at around 7:30am. Surprising, it wasn't rally sunny at all as the sky was overcast.

What a tough run. Was breathless at 4km mark. My sniffles came around before the 3km mark and I've always found breathing through the mouth a thirsty and more tiring affair than breathing through the nose. I brought a running cap but no tissue (!!). Might be unbelievable but at around 5km under Rumbia LRT, I saw a plastic bag with empty MacDonald's fries pack + a tissue. I scooped it and blew my nose clear. It helped but little. I was already breathless. Stopped and walked quite a few times during this run. It was tough. I really was thristy. During the last km, my saliva tasted acidic, like the phelgm in my throat or the acid from the stomack creeped up my throat into my mouth. Yukky.

At the end, I walked 3/4 of the last km. More than I wanted. Completed the 8km in 1 hour, 4 mins and 45 secs (Avg pace of 8mins 6 secs per km). My knees were okay but my right ankle felt slight discomfort. The stretching does not seem to help. I target doing a 5km next Wednesday night before the Sunday 10km run, if possible.

Ran but it drizzled...

2 weeks with flu and rains causing havoc. Not sure what is my fitness like now and there's a 10km race in 1 wk+ followed by another 10km race on 7 December.

Tonight reached home it was cloudy, as in very dark clouds. I was hoping that it would not rain or will only rain later int he night. Around 6:45pm I set off. Wanted to do a 4km or 5km loop. Not sure which. Finished my 1st km in 8min 14 secs. Real slow. But it was okay.

Before 2km mark, light rain started dropping. Sigh. I was already on the 5km loop. Was thinking where to cut short since I was still having my flu/sniffles. Before 3km mark, my nose started a little drip and had to breathe through the mouth/throad which I don't like cause it makes my throad dry very quickly and there was no water station unlike during a race. Anyway, I turned off and completed 4.26km. {Click the MayMyRun button link below}.



I completed 4.26km in 33mins. Quite a good average pace of 7mins 45secs. Short distance but it meant I started going at a faster pace after my 1st km. But was glad to get out of the rain as my nose was wet. Was thinking just now that hopefully Sunday morning I can clock 7km. See how.

12 November 2008

I didn't see doctor today. Day started quite well though by lunchtime the thick mucus in nose returned and it was yellowish. :(

Almost whole day I told myself I want to run 5km, whether the flu gets better or not. I think God decided I should not kill myself and send heavy rain + lightning in the afternoon which is still drizzling now. :)

Quite unwell

For those who noticed I've not run for 2 weeks. I got runny nose (sinus) since 1 November which has developed into thick mucus, blocked nose + phelgm high up the back of my throat. The mucus was yellowish since 2 days ago and turned greenish today. I went to company's Raffles Medical clinic last Thursday and they didn't have a few medicines like Zyrtec-D and Piriton to clear my runny nose. So, get gave me generic Delcogen.

Now I have little choice. Will have to go back there tomorrow morning. Sianz.....