Saturday 9 June 2012

My Iron Lady, The Comrades Ultra Marathon & Supraventricular tachycardia (SVT)

My Iron Lady, The Comrades Ultra Marathon & Supraventricular tachycardia (SVT)

I was recently reading a dissertation titled: Shakespeare’s Women: The Weaker Vessel or Stronger Sex? In this dissertation I came upon an interesting homily.  A homily is a commentary that follows a reading of scripture. In many Churches, a homily is usually given during Mass. Many people consider it synonymous with a sermon.

I read the following : “St Peter gives his precept saying: you husbands deal with your wives according to knowledge, giving honor to the wife as unto the weaker vessel, and as unto them that are heirs also of the grace of life, that your prayers be not hindered (1 Peter 3). … For the woman is a weak creature, not endued with like strength and constancy of mind, therefore they be the sooner disquieted, and they be the more prone to all weak affections and dispositions of the mind, more than men be, and lighter they be, and more vain in their fancies and opinions.”             

(An Homily of the State of Matrimony, 1562, from Aughterson, 1995, 23.)

I have also read some abstracts from the Indian scriptures of Manu, which dominated the Hindu mind for thousands of years.  They were filled with similar garbage.  He too was convinced that women were inferior to men and needed to be dependent, first on their parents, then on their husbands and later on in life on their husbands and their children. 
It seems obvious that these guys were suffering from massive emotional and mental problems; besides they didn’t get to meet some of the women I know.

Road to Comrades 2012: A story of Heartbreaks, Plantar Fasciitis and Backaches.

The road to Comrades starts, in all earnest, for Neepa and me with the Standard Chartered Mumbai Marathon.  We ran that race in January 2012 as sub 5 pacers and then planned a second marathon in February. 
On the 6th of February 2012, Neepa and I had planned a 12k run in the Borivalli National Park.  It is an out and back run. We first run a rolling 5k and then climb a 1k hill and then return to the start.   
We started running together around 5:30 am. At 5k, we reached the bottom of the hill and as I started running up, Neepa just fell back and started walking.  I continued running up and reached the top of the hill and then waited for her.  Almost 4 minutes elapsed before I saw her walking up.  When asked what had happened, she used our mutual running jargon and replied, “I just lost it”.  It meant that she had suddenly tired out.  She explained that she just lost her breath.  But then, she turned around and started running back down.  I passed her quickly and reached the bottom of the hill and again had to wait for her.  When she reached down she said that she was unwell, that something was not right, that breathing had become a problem and that her heart for racing. 

The National Park at this early hour in the morning is a car free zone.  Our car was parked about 5k away, outside the main entrance gate.  Neepa said that she will run/walk towards the gate and asked me to run ahead and complete my training run.  I told her that I was going nowhere leaving her alone.  As we walked slowly, we discussed that it was now time to do another ‘physical’ with our cardiologist.  It had been a little over a year since we had done a stress test.  After a few minutes of walking she started running again and I followed.  She kept telling me to run ahead but I refused.  With about 4 k to go, she said she was again feeling very uneasy.  I told her that she should just sit on a bench and that I will go and get the car in.  I sprinted towards the park gate.  I ran up to my car parked outside the gates and by this time the park was opened to cars. I paid the entry tax and drove towards Neepa.  By the time I got to her, she had walked another km.  She got into the car and said, “Let me drive behind you while you finish your run”.  I told her, “Let’s just go and get a cardiogram done right now”. 
Within a few minutes, Neepa started hyperventilating.  She shouted that we must get out of there and to a hospital. She started gasping for air. The noise coming out of her throat made me think that no air was going in.    

I raced the car towards the entrance and then onto the highway.  The closest hospital was about 20 minutes away (Nanavati or Ambani).  Neepa was sitting slumped against the window and gasping more and more loudly for each breath.  It seemed that no air was going in.  I drove as fast as I could on a Mumbai road.  I called one of my brothers-in-law, Dr. Amrish, who is a pathologist and told him what was happening.  Neepa’s side of the family (paternal and maternal) has a history of heart attacks and I was sure she was having a cardiac attack. I noticed that even as she gasped for air, she kept talking and thinking coherently. She said she wanted to go only to the Hinduja hospital which was a bit further away. Her decision probably had to do with the fact that  my nephew, Purujeet, a young doctor is currently working in the Casualty department of the Hinduja Hospital and that my other brother-in-law, Dr. Jnanesh, is a heart and lung transplant surgeon also attached to Hinduja hospital. 

I drove as fast as I could.  The family converged towards the hospital in their own cars.  All the time, Neepa gasped desperately for air and told me that her heart was pounding and racing and that she was feeling dizzy and near fainting.   I thought I was going to lose her.  I couldn’t believe that this was happening.

We zoomed into the entrance of the hospital, towards the casualty dept. My brother-in-law had phoned in and they were expecting us.  Neepa was put into a stretcher and they rushed her in. 
She moaned and gasped and I stood looking helplessly. They tore off her running vest and wired her up.  The monitor showed 200 heart beats a minute.  I walked outside and dialled my father-in-law who was at that time 4 hours drive away from Mumbai.  I told him that Neepa was having a cardiac event and that he should start towards the hospital.

A few minutes later they gave Neepa a shot of Adenosine. And then within a few seconds her heart beats returned to normal. She suffered excruciating pain in those few seconds when her heart “rebooted”. The family arrived and although nobody said a word, I knew that they were blaming running as a cause for all this. 

As I stood near Neepa’s bed, she smiled and said, “I am totally ok now.  I can run back home.  Let us get out of here.”
Of course, the doctors of my family were not going to let her move out of there until they did every possible test on her. 

4 hours later as we sat in the car we reflected on what we had been told at the hospital. Neepa had suffered from an attack of SVT.  It was an attack caused when her heart’s electrical system did not work right, causing it to beat very fast. 

Neepa and I had been scared out of our wits.  We had both thought that she was suffering from a heart attack.  The cardiologist on duty at the emergency had told us that her running days were over and that from now she had to be on some pills for the rest of her life. 
Although we drove home in silence, I knew that those words weighed heavily on her mind as they did on mine.  We were losing a part of our daily life which brings us so much joy.
We reached home and went to sleep.  We were physically and mentally wiped out.
We woke up in the evening, had dinner and went back to sleep.  The next morning when I woke up at 5:00 am, Neepa was already on the internet and Googling: “SVT and Running”, “SVT and Sports”.
By 7am she had concluded that she intended to continue running.
Over the next week we met with several cardiologists who specialize in treating SVT.  The best cardiologists in Mumbai informed us that the SVT attack was not caused by running or because we were running a difficult race like Comrades.  We were told that a SVT attack may or may not occur at anytime, to any person. It could occur while one was running or it could occur while one was at home lying in bed and watching TV. 

We were informed that SVT can be treated by either a cardiac ablation procedure or by drugs or as by some people who just learn to live with it and do nothing.  There were certain simple procedures like coughing, gagging, or putting ice-cold water on ones face or rubbing one’s eyes (called vagal procedures) or taking calaptin tablets SOS which can be used to deal with the attack in its early stages.  We also learnt that an SVT attack is not life threatening.        

Neepa refused to undertake a surgical procedure based on one SVT attack or go on life-long medication based on one SVT attack.  She concluded that she will continue running and just watch what happens.  She felt that she now knew what to expect and how to react in case she got another attack while she ran.  
Of the many possible causes of SVT, one of the major possible cause is caffeine or energy drinks/supplements (like caffeine strips) with a high caffeine content and Neepa usually drank 4-5 cups of strong black coffee each day.  She decided to give up coffee. She concluded that she will run with the calaptin tablets in her pocket and that she intended to run Comrades in 2012.

Three days later we stepped out again for a 5k, ten days later she ran a 42k.  I was away running the 3 Cranes Challenge in Africa and so she ran the 42 k without me.  We had decided that she would run a route in the vicinity of the Hinduja Hospital (with Neepa’s brother-in-law Sanjay Dalal and sister Mona running alongside her and my faithful friend Khwaja driving the car as her support team).

Over the next 3 months we kept running, always making sure that we carried the SOS tablets in our pouches.  There was not a single day when I ran with her without being worried about SVT.  We never spoke about it but the thought and fear was always there with us. Sometimes I would want to remind her to carry her tablets but would hesitate bring up the dreaded topic. 

She kept training for Comrades and then we went off to the United States in May for a month long vacation.  During that time, we ran a brutally hard 50k Ultra in the Nevada desert in 100 F heat.  She breezed through it.  We then ran a really hard Marathon in Pittsburg.  The SVT problem did not leave my mind for a minute during those races.

For 27 days in the United States we, like all tourists, walked and walked as we should to show that wonderful country to our children.  We walked for perhaps an average of 6 to 7 hours a day.  And for the first time in her life, Neepa picked up an injury from walking too much: Planter Fasciitis !!
With less than a month to go for Comrades, she started aggressively undergoing physiotherapy and kept icing her foot.  

Normally she never does such stuff for herself and to watch her religiously go to the physio and ice her foot meant that it was really bad.  I kept getting more and more worried.
The day before we left for Africa, we did our last Yoga session. Neepa strained her back during the session.  I could feel a cloud of gloom descend on us. All the pre-race signals were ominous.  

3rd June 2012  : 89 km, Comrades Ultra Marathon

As we left India, my dad called Neepa inside his room and told her, “Look after Amit, bring him into the finish.”

The start line of Comrades touches the deepest part of a runner’s heart! It sends a chill down a runner’s spine and inspires him/her to greatness, no matter how many times he/she has already been there. 
This was Neepa’s 3rd start and my 4th.  She will always enjoy the honour and distinction of being the first woman of Indian Nationality to have run Comrades.  She had run her first “down run” in 11 hours 50 minutes and her first “up run” in 11 hours and 56 minutes.   

Starting in the H pen we reached the start line after 8 minutes and 20 seconds.  Our watches showed that we had run/walked 800 meters to reach the start line.  Less than 1 km from the start we hit a small hill and a few seconds later, Neepa fell back! I felt sick in my stomach when I realized that she was not next to me.  After a few minutes I stopped running and waited for her.  She caught up and I asked her what had happened?  She explained that she had walked the hill.  And so, on and on we went, very often she would fall a bit behind and I would wait for her to catch up. 
Every time I asked her how she was feeling, she replied, “Fine”.  Now from long experience, I know that Neepa believes that when she says ‘Fine’, she soon starts feeling ‘Fine’ even if she is feeling terrible at that time.  So I kept wondering if her ‘fine’ was a real ‘fine’ or a self-hypnosis ‘fine’.

But by 40 k, the bottom of Inchanga (a massive hill), she started getting faster.  She wanted to run up Inchanga and I had to hold her back. Then she wanted to run down Inchanga and I followed her down.  She then wanted to run up from Drummond (half way) up to the top of Botha’s hill (the hardest part of the route).  I told her she was crazy and that I would be finished if I ran up Botha’s (45k to 52k, I normally have to walk up 70% of Botha’s).  She said that she wanted to finish in 11 hours 45 minutes and was easily possible.  I told her that my legs were very sore.  She told me that her planter was killing her since 15k and she felt so much pain that she wondered if the foot would fall off and that she was trying hard not to cry but she said that she had decided in her mind to run and that her body would follow her.
My mind, on the other hand, was following my body which was slowly getting more and more tired.

With 18km to go, I was incredibly fatigued.  We had 2 hours 34 minutes to run the 18k but my quads were killing me.  I could not run.  Neepa asked me if I was cramping and I said, “No”.  “Ok then”, she said, “It’s just pain.  Just run through it.  I am running through this planter pain. I feel like my foot is about to fall off. But I can run and so can you. Just Run!”

The truth is that I have never run through pain. I always stay in a certain comfort zone and what she was asking me was to run beyond that zone.  It was new territory. I had never travelled through it.

With 13k to go it was fast becoming crunch time.  Enough time to finish if I ran, but not if I was walking.  And I was walking. 
Neepa screamed, “If you Love me, Run”.  I ran..for the next 6k.. and then my love ran out...I started walking again...
With 7k to go we had only 57 minutes and 21 seconds left.  It was now or never. I realized that unless I win the battle with my mind at this point, I might as well stop giving motivational talks to people.
Our friend Peter, who was seconding us, came and gave me a drink.

She pleaded with me again. “Run for the kids”...I ran...but with 5k to go, I hit the cat-eye in the middle of the road and fell flat on my face, landing on my chin.  Both my palms started bleeding, so did both my knees and both my elbows.  But the pain I felt in my right calf made all the other pain seem irrelevant.  It felt as though the ligaments in my calf had just been ripped apart.  I knew it was all over.  I was close to tears.  Neepa who was a 100 meters ahead of me, sprinted back.  The spectators reached me first and lifted me up.  I wondered if I could possibly take another step.  I tried, I could.  A dozen spectators broke into applause.  I stated to walk. 

Neepa poured water on my hands to wash off the blood.  She reminded me that she had also fallen in 2010.
She asked, “Are you ok?” “Yes,” I answered, “Let’s go then”, she said, “let’s get this done and over with.”
“Neepa, I can’t run anymore,” I said, “You go ahead and finish. I will keep walking.”
“I am not finishing without you. We both need to finish”.
“I don’t want to finish,” I said, “My legs are tired”.
“It’s not about your body, it’s about your mind.” she said.  
At this she stopped walking and stood behind me.  “You run and we both finish or we both don’t finish.”

I searched my mind for a few choice bad words, but what came to mind was the story of Roma.  Plutarch writes that after Troy fell, some of its people escaped, found sailing vessels, were driven by storms upon the coast of Tuscany, and came to anchor in the river Tiber.  The men and women went ashore and wondered if they should explore the land.  The greatest and most intelligent of the Trojan women was Roma. She figured that the men would never settle down and will keep roaming and wandering over the seas unless they were forced to stay on the land. So she proposed to the other women that they should burn the ships and consequently they would be forced to settle down. And that is what they did.  Having no way left to return to the sea, the men were forced to settle down in the country. They prospered and then they named the city in her honor: “Rome”!

By standing behind me and refusing to run, Neepa had burned my Ship.  
I had no option left.  I would have been happy for her to finish and go home with her medal but now there was no option but to run.
And run we did!  I ran the last kms under 6:30/km.  I realized that the pain in my quads did not stop me from running fast. The bleeding palms, knees and elbows were just a mild irritant. I realized that I had pushed back my pain threshold. I had achieved a new personal break-through inside my mind.  

We ran into the stadium and Neepa took the Indian Tri-Colour from our brother and host Dr Sid Reddy. And so once again, just as in 2010, we ran into the finish, holding the Tri-colour....

The men of Troy were really upset when they found out that their wives had burnt their ships.  They felt that they were now forced to settle in an unknown land.  As they walked towards their women filled with wrath, the women decided to salute their kinsmen and husbands with kisses as a way of supplicating them and to appease their wrath.  From that day on, it became customary for the women to salute their men with a kiss.

Consequently, I feel that Neepa too, owes me a kiss just like the men of Troy did from their wives who had burnt their ships. (Although I got a finishers medal due to Neepa just as they got a whole new country due to their wives).

So Tonight is the Night!!

I shall request my wife, to appease me with a kiss and then...we shall go a step further...we shall do much more...we shall sit with our log books and plot our way to the start line of Comrades 2013...........

 Some Explanatory Notes:

(A) In ‘The History of the Peloponnesian Wars’, Thucydides declares that, the best woman is she about whom there is the least talk among persons outside regarding either censure or commendation, feeling that the name of good women, like her person, ought to shut up indoors and never go out.
I disagree totally. The best women lead men with their examples and those examples should be made public.
Neepa agreed to make public a personal health issue as she felt that, just as she had googled ‘svt and sports’ and taken inspiration from athletes with SVT who participated in the Tour de France, triathlons and ultra-marathons, perhaps, some runner someday will take heart from the fact that she could keep up with her running after her episode.
(B) Neepa was given a go-ahead to run Comrades by two of the best Cardiologists in the city.
(C) Since that episode in Feb 2012, Neepa has not suffered any more events.
(D) She now drinks just one cup of coffee with her breakfast.
(E) Shakespeare’s Women: The Weaker Vessel or Stronger Sex? In real life, let there be no doubt about who is the stronger sex!