Listen To This
Some potentially life-saving heart-health stories plus run-saving podcasts
Last Wednesday, I hosted a Q&A for our paid subscriber Zoom with an ultrarunner I’ve long admired. Below, you’ll find an excerpt from our talk, which deals with heart health. If you’d like an invitation to the monthly online meetup and occasional bonus posts, please consider upgrading your subscription to the supporter level.
And don’t miss the second half of this post, where I’ll try to spark a recommendation/discussion thread in the style of the overflowing fertile threads on , where prompts recommendations and comments regarding books, TV, and myriad facets of life. I want to get a podcast-rec thread going, because podcasts greatly enhance my runs and drives.
Nailing a 100-miler, then an open-heart surgery
A while ago, while brainstorming runners to spotlight, I asked myself, “Who’s a great runner and cool person accomplishing impressive things who we don’t know about because they’re doing their own thing and not bragging on social media?” Monica sprang to mind.
Monica Ochs, 54, is a nurse, doula, and mom of two as well as a longtime ultrarunner from Anacortes, Washington. In addition to sharing the same age, we share a similar development as runners, but she always finishes ahead of me in results. When I PR’ed at the Napa Valley Marathon in 2009 with a 3:05, she finished the same race a couple of minutes ahead. When we both ran the Run Rabbit Run 100 last September, she finished a full two-and-a-half hours ahead and was the first female over-40 finisher in our “Tortoise” division (the elite “Hares” compete separately). She’s part of the old-school Seattle ultra scene that gave rise to her notable friends Krissy Moehl, Scott Jurek, and Ian Torrance. I loved getting to know her when we shared a rental during Jason Koop’s 2018 ultrarunning camp.
But then, last month, I found out that Monica was going in for open-heart surgery. What?! She had a life-threatening bulge in her aorta—an aneurysm—that had to be repaired. Two weeks post-op, she talked on our Zoom about the discovery of her aneurysm, what it was like to run the 100-miler last September with her condition, how the operation went, and some of the things we should know about heart risks as runners.
The word “aneurysm” triggers me because my adventurous mountain-climbing grandmother died at 49, a decade before my birth, after she collapsed from an aneurysm (but hers was a cerebral burst artery, at the base of her brain, not aortic like Monica’s). I grew up hearing my dad describe aneurysms as a “ticking time bomb.”
Monica had no symptoms—but symptoms for the condition, such as chest pain or shortness of breath, are uncommon. Most people don’t have symptoms and don’t know they have an aneurysm. She also didn’t have the risk factors of smoking or obesity.
“The only reason I found it is it was an incidental finding on a CT scan I had. I had high cholesterol genetically, so my doctor wanted to put me on statins, and I said, ‘Let me check my calcium score and see if my arteries are truly being clogged.’ So I went into [the scan] for that and had an incidental finding of an ascending aortic aneurysm.”
The tissue around the aorta (which is the main artery that carries oxygen-rich blood away from your heart to the rest of your body) was blowing up like a balloon, and the bigger it gets, the bigger the risk it will rupture. Hers was a moderate size where the risk of repairing it is about the same as the risk of the surgery. She decided to schedule an open-heart surgery to repair it about six months later, in December.
How did she feel running the Run Rabbit Run 100-miler last September, knowing she was stressing her heart by pushing herself for over 24 hours in the high altitude? She says, “scared, but stubborn. I wanted to get all that fun stuff done before surgery and get that Hardrock qualifier. I talked to the surgeon about it, and he was fine with it; he gave me confidence going into it.”
The eight-hour surgery was successful, but arduous and painful. Doctors cut her sternum and pulled out her heart and put her system on bypass during the repair. “The ascending aorta is behind the heart, so they have to move the heart out of the way to repair it,” she explains. Then they removed the bulging, thinning part of the aorta and created a new connection with a polyester sleeve-like tube. “The most awful part was waking up because I was still ventilated, with my hands restrained, and that was scary,” she says.
Recovery in the ICU for three days went well, thanks in large part to her good health going into the surgery, and she was up and moving by the next morning. “They told me that nine laps around the ICU equaled a mile, so that was my goal for Day 2.” Her Instagram post shows scenes and shares thoughts from her post-op recovery.
Two weeks later, Monica hiked 14 miles. But she refrained from running because, as is normal post-cardiac surgery, she has a temporary case of tachycardia (high heart rate) as her heart works to repair itself. She also has to be careful not to strain her healing sternum. She has no plans to race ultras this year but will come to Colorado in July to volunteer and pace/crew friends at the Hardrock 100 and High Lonesome 100.
She has two main takeaways from the experience of repairing her heart:
“It’s really important to pay attention to family history. I have grandparents who died of aortic ruptures. … If you have family members who have died that way, or you were told it was a sudden death and probably a heart attack but you don’t know for sure, then go get an ultrasound—an echocardiogram of your aorta. If you’ve had more than one relative [die that way], go get genetic testing.”
More philosophically, she shares that the aneurysm helped her more deeply appreciate her loved ones and health. “I was so full of gratitude for the support I got from friends and family,” she says. “Usually I don’t take that in so well. Maybe it’s the nurse in me—I want to be the one helping other people. But boy, it’s like when you hear people say a cancer diagnosis is the best thing that ever happened. I kind of feel that way about this, because it does make me really understand what’s important, and that’s the people I surround myself with. And to a large extent, it’s running and being out in nature, but it doesn’t have to be training for a race. It can just be walking in the woods. It’s helped me appreciate that I can do that—I can go walk in the woods for four hours, and how lucky am I.”
More thoughts on the runner’s heart
I wanted to know more about Monica’s cardiac surgery in part because I have an inflated fear about anything that prompts sudden death, especially heart conditions. My fear has prompted me to learn CPR/AED and to know where the AEDs around town are located. I keep baby aspirin in our bathroom to chew if my husband or I have signs of a heart attack.
Speaking of which, you should know the difference between a heart attack and sudden cardiac arrest, and their symptoms. A dumbed-down explanation is that a heart attack is a blockage, whereas sudden cardiac arrest is an electrical malfunction. With a heart attack, you have hours to get help; with sudden cardiac arrest, you have only a few minutes. My friend from high school collapsed last year with sudden cardiac arrest during an alumni event. She got lucky because another alumna who’s a cardiologist happened to be standing nearby, and an AED was in a building not far away. Both saved her life.
One other tragic reason that heart health is on my mind: A runner friend died nearly a year ago at 54 from an apparent but undetermined heart issue, and I’m heading to California soon to participate in a memorial run for him. He was super healthy and ran ultras for two decades. He became sick with covid in the final week of December 2022 and didn’t feel great the following month. Nonetheless, he ran a half marathon in early February and noticed—because he was a very precise, scientifically oriented athlete—that his heart rate was unusually low, and this low heart rate limited his speed. Two weeks later, he was found in bed having died from sudden cardiac arrest or from something else that made his heart stop. An autopsy found no underlying disease and concluded “enlarged heart—undetermined” for cause of death. But it’s normal for runners to have larger and thicker hearts. Perhaps covid was the culprit, as researchers are beginning to better understand how covid can either speed or slow heart rate and also increase risk of heart attack and stroke.
The thing that troubles me and many other older high-volume runners is the idea that we’ve potentially done more damage than good with our beloved habit of long-distance running. We’ve developed supersized hearts with a higher stroke volume (aka the athlete’s heart). On the one had, we’re told that our high cardiovascular fitness helps prevent disease and even helps prevent dementia, because what’s good for the heart is good for the brain (see this site and this book for more on that good news). But are we also damaging our heart by causing inflammation and scarring of it?
A book came out in 2017 that freaked out many endurance athletes with its scary subtitle: The Haywire Heart: How Too Much Exercise Can Kill You, and What You Can Do to Protect Your Heart. Followup studies pushed back against that book’s alarmist theory. I found this article about cyclists and this article about ultrarunners to be somewhat reassuring. Interestingly, that article for ultrarunners by Jason Koop points out that the stress of an ultramarathon may be deleterious given how big the ultramarathon overload is compared to day-to-day training, and we might be wise to avoid over-racing and consider spacing out our ultras to just a couple a year to ensure adequate recovery. I use “may” and “might” because the research is neither comprehensive nor conclusive.
Some additional takeaways:
Learn the signs of heart attack and stroke, and if you have any worrying symptoms, such as a feeling of chest pressure or irregular and rapid heart beat, get them checked out. Don’t feel bad if you find out your problem is something more mild or ordinary, such as indigestion or psychological stress. Better safe than sorry!
If you have a family history of aneurysm or heart disease, then get a scan to determine if you have that condition too. If you have access to preventative scans and screenings, get them done just in case. As described in the second half of this earlier post, I got a complex health screening that used ultrasounds and other devices to assess risk for stroke, aneurysm, and heart disease, plus it checked bone density. It didn’t cost too much out of pocket (about $180). The clean report showing that I’m very healthy and have minimal risk—and no aneurysm—calmed my fear.
Learn CPR/AED (and if you took a class years ago, take a refresher course) and know where AEDs (which stands for automatic external defibrillator) are located in your community.
I’ll end with a story by a reader of this newsletter, because it shows the importance of listening to your body and advocating for yourself in our delay-prone health care system. Karen Fennie, 64, has run some 70 ultras, including many 100-milers, over the past two decades. She gave me permission to share her anecdote:
Back in 2017 I did this thing called the Celtic Traverse, a six-day run across Ireland with various distances every day, the longest a 50K. When I got home and tried to run again, I struggled. And then I noticed all my clothes were tight. I thought, I didn't drink that much Guinness during the trip! Finally, a few weeks after the trip, I had another failed run and went to a walk-in clinic. My heart was in AFib [an irregular and rapid heart rhythm]. They sent me to the ER. Long story short, they put me on a blood thinner and diuretic and told me to set something up with a cardiologist. When I tried to do that, the soonest I could get in was a month or more away. I ended up calling my OBGYN who is most familiar with me and my running. He put me in touch with a cardiologist, and they got me right in. I had to be shocked back into normal rhythm. The doctor said it would likely happen again because I am a runner with "athletic heart syndrome." They monitored me for over a year but then said I no longer needed to come. I haven't gone into AFib since (that I know of). I think being a female athlete is a double-edged sword. Some docs seem to assume you're super healthy and might not look or test for things they should. And you really have to advocate for yourself (something that's hard for me). I am glad I did not accept waiting to get in to see a cardiologist.
Let’s talk podcasts
On a lighter topic, I’m sharing some podcast recommendations because I heard so many good ones recently. While I also listen to audiobooks, I find podcasts the most long-run-enhancing because of their variety. Please share a link or two to your favorite podcast(s) in the comments below.
I typically start a run without any audio enhancement because I like to get into the rhythm of the run by opening my senses to the surroundings. A half-hour or more into it, however, I let myself enjoy the distraction of a podcast if I’m doing a steady run. (For a speed workout with intervals, however, I prefer up-tempo music.)
Being conscious of safety—of the need to keep my ears open to hear cars, cyclists, large wild animals, and other people using the trail—I usually play the podcast on my phone’s speaker, which is in my hydration vest’s pocket, at a volume high enough to hear but not too high to block out other noises or to annoy other trail users. I’ve been spooked about using AirPods while trail running ever since I almost stepped on a rattlesnake. I heard its muffled rattling to warn me, but I mistakenly thought the noise was static from a malfunctioning AirPod. Having the sound of a conversation coming out of my pocket (rather than using AirPods in my ears) has the added benefit of alerting large animals of my approach when I’m on a remote trail in the woods, and hopefully scaring them off. However, when I’m on a traffic-free bike path or track desiring music, it feels safe enough to run with AirPods playing tunes.
Often I listen to non-running-oriented podcasts, one of my favorite being NPR’s Fresh Air. I loved the recent interviews with the writer and stars of Succession and the interview with the actor Sterling K. Brown, and this episode from last fall on women’s evolution and health. I also am a fan of Chicago Public Radio’s This American Life. (Their new episode is called “Embrace the Suck,” so I can’t wait to hear it.) I also like the podcast (and read the Substack)
that discusses the creative process.Of course, I follow numerous ultrarunning podcasts, which have exploded in number and variety over the past five-plus years. Here are five favorites. I know I’m leaving a lot out, and I’ll get criticized for the all-male-host list, but these really are my go-to’s, and I wanted to limit my list to five.
Singletrack: Host Finn Melanson does a great job interviewing top runners and analyzing the sport. He has a Terry Gross style of interviewing—asking direct, concise questions, and keeping the focus on the guest—unlike too many podcast hosts who excessively redirect the conversation back to themselves and indulge in their own stories. I really liked the recent talk with Zach Miller (and for bonus reading, don’t miss Zach’s essay in iRunFar finding similarities with running and writing after reading Anne Lamot’s Bird by Bird).
Side rant on interview style: It’s a mystery to me why Rich Roll is so popular. He was such a windbag talking about himself and his analysis, and repeatedly interrupting guest Tim Tollefson, in this important interview with Tim about male body dysmorphia. I get annoyed when podcast hosts get in the way of the guest’s story.
KoopCast: Jason Koop can get way into the weeds of sports science research, but his interviews are always enlightening. As mentioned in last week’s post, I admired this talk with Stephanie Howe about weight loss and nutrition. I also admire Koop’s podcast because it is unsponsored and therefore not pushing products in a way that can create a conflict of interest. I roll my eyes whenever my favorite podcast hosts break into their shows to promote Ketone-IQ or Athletic Greens or some other expensive and controversial supplement we don’t need. I get it—they need some income. I just wish they’d limit their sponsors to clothing or gear products and not include questionable nutrition/hydration products.
Between Two Pines: This relatively new satirical show started off more awkward than funny, but each episode gets better. The most recent episode offering predictions for 2024 and roasting Dylan Bowman made me bust out laughing, so much so that I had to pause running from being out of breath. Warning: this show is chock full of inside jokes. You have to be pretty up on longtime ultra trends, personalities, and news to fully appreciate it.
Crack a Brew with AJW: I started listening to Andy Jones-Wilkins’ show toward the end of last year and became a fan because his infectious goofball level of enthusiasm inevitably lifts my spirits mid-run. I also appreciate all the history of ultrarunning that he brings to his talks (although sometimes the name-dropping can get excessively insider-baseball-ish). This one with Ian Torrence and this one with Jamil Coury are two of my faves.
Ten Junk Miles: Every episode of this podcast by
runs really long and is best for extra-long runs. Scott has a gift for unfiltered conversation, and his unstructured talks that are about more than just running always hold my attention. I particularly liked this recent episode with . (Bonus reading: Katie’s Substack .)
For women-specific running podcasts, check out Cherie Turner’s Women’s Running Stories, which she always does a great job editing into a tight narrative arc (here, for example, is the one she did on me). I also occasionally listen to Trail Society because I’m a fan of Corrine Malcolm’s commentary (this is a good recent one).
Honorable mention: Mario Fraioli’s Morning Shakeout podcast. I’m less interested in his interviews with coaches and track/road runners, but I always enjoy his interviews with ultrarunners and his ask me anything episodes.
What are you listening to on your runs? Please share your recs below. And thanks for being here.
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Great piece on an important topic. It’s an important reminder not to assume our cardiovascular health is great just because we’re runners. Unlike Karen’s a-fib and our friend Keith’s apparently Covid-related heart condition, sounds like Monica’s aortic aneurysm didn’t affect her running one iota. So scary to think something that serious could be wrong but throw off no warning signs.
I listen to loads of podcasts, but my choices are probably largely too idiosyncratic for others. 😂 Mainly I listen to true crime (Dateline and Mr Ballen are faves). Some others outside that genre that I’d recommend are Malcolm Gladwell’s Revisionist History and a neat one on music called Strong Songs. I used to be really into This American Life and The Moth, and should probably return to them because they’re more nourishing than true crime. As for running podcasts, I also like the long form Ten Junk Miles podcast and, at the other end of the length spectrum, Between Two Pines cracks me up. Sally McRae’s Choose Strong can be hit or miss, but when she’s on I think it’s really good. I’m not really interested in news about and interviews with elites. Give me a good discussion about the mental barriers that hold us back, or how an average runner overcame challenges. Or the nitty gritty about a specific race I’m training for.
I so appreciate you bringing to light this important topic about heart health in athletes. It seems like the misconception that just by sheer nature of being an athlete, that we have a free pass to 100% good health, which isn’t always the case. Love all the podcast recommendations and agree with the criticisms on several you mention. I will add one more of my favorite running (but also, not about running) podcasts by females - Choose Strong with Sally McRae. Other non running podcast: You Are Not So Smart, Farewell (formerly, The Growth Equation) and We Can Do Hard Things.