Heart Health: Healing a 'broken' heart
After suffering a heart attack while running in the prestigious Boston Marathon nearly two years ago, Nancy Richards set about regaining her health and returning to the sport of running.
In December, she completed more than three-fourths of a marathon in California. Next weekend, Richards plans to run in the Heart Breaker Half Marathon in Hillsboro. You might say that she's back.
"Nancy's determination and discipline have taken her across the finish line so many times before," said Dr. James Beckerman, the Portland-based cardiologist who has been treating Richards. "I really respect how she approached her recovery with the same goal-oriented attitude that she has brought to her training."
Richards, who farms with her husband, Martin, and son, Kevin, at Fox Hollow Ranch, in Madras, came late to the sport of running.
"I started running in early 2007, at the age of 49," she said. "It took me three months to prepare for my first 5K."
A graduate of Sandy High School, Richards had played sports in high school — volleyball and shotput for track — but had never been a runner.
After operating a small farm in Sandy, the Richards bought a 350-acre farm on Dover Lane in 1989, and moved their young family to Madras.
"We farmed and raised kids," she said, noting that their oldest son, Gary, 39, an electrician, built a house on their farm, their daughter, Katie, 37, lives in Prineville, and their youngest son, Kevin, 34, now also lives on the farm.
In 2007, Richards went iceskating on their irrigation pond and was surprised at how sore she felt afterward. "I decided that if I didn't make some lifestyle changes, I wouldn't be able to enjoy my grandchildren as they grew up," she recalled.
For Richards, who now has three granddaughters, ages 8, 10 and 12, and two grandsons, ages 2 and 4, the thought of those grandchildren made all the difference as she prepared for her first race.
"I ran one 5K and I was hooked," she said, noting that she gradually increased the distances she ran until she ran her first marathon in late 2009.
"In November of 2013, in my third marathon, I ran a Boston-qualifying time in Hamilton, Ontario (4:04:01 at a 9:18/mile pace)," she said.
Nearly a year and a half later, she and her daughter, Katie, traveled to Boston in April 2015 for the big race, as well as all the pre-race activities.
The day of the race was cold and windy, but Richards prefers those conditions, so she wasn't concerned.
The race started well for Richards, who, at the halfway point, was on pace to finish the race in 4 hours and 10 minutes, a pace of 9 minutes and 30 seconds per mile.
"I was running well and enjoying the crowds and other runners," she said. "It was everything I had imagined."
But that runner's high didn't last. "I started to struggle in the Newton Hills and by the time I reached Heartbreak Hill, my pace had slowed considerably," she said. "I had some tightness in my chest; my shoulder hurt a little bit. I had an upset stomach and was struggling to take the liquids and nutrition I needed."
Richards didn't understand why she seemed to be having more problems than usual, but passed it off as the normal "marathon pain."
"By mile 23, my pace had slowed to 18 (minutes) per mile," said Richards, who doesn't remember much about the last three miles. Five hours and 20 seconds into the race, she crossed the finish line, where her expression caught the attention of a volunteer, who grabbed her, helped her into a wheelchair and moved her to the medical tent.
"My body temperature was very low, but when they warmed me up, I got worse," she said. "An EKG revealed that I was having an acute ST segment elevation myocardial infarction (acute STEMI) … a heart attack."
Richards was immediately transported to the Massachusetts General Hospital, where a coronary angiogram, thrombectomy, and angioplasty of her left anterior descending artery were performed.
"In other words, they removed a blood clot from an artery of my heart," she said. "My artery was too large for a standard heart stent. They did a second coronary angiogram two days later and decided that I was healing well and they chose not to put a stent in."
Fortunately for Richards, the volunteers in the medical tent had been trained by Dr. Aaron Baggish, the associate director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center.
"They recognized my symptoms quickly," she said. "Dr. Baggish was actually in the medical tent that day, and was my doctor during my stay in Boston."
Baggish explained that a blood clot had formed in her artery after a vulnerable plaque ruptured. "The blood flow gradually became more restricted, but it remained partially open while I was running; the artery blocked completely when I stopped. He said that running could have been a factor in the timing of the rupture, but that it could have happened while sitting in my chair watching TV."
Baggish also told her that her level of fitness may have helped save her life and reduced the damage to her heart.
Advising that it would be in her best interest to remain active, Baggish recommended a colleague — Dr. Beckerman — and assured her that the doctor would help her safely return to running.
While her heart healed, she took the prescribed antiplatelet, beta blocker, statin, and aspirin to help prevent another cardiac event.
"For several weeks, I attended cardiac rehabilitation sessions in Bend," said Richards. "Under strict supervision, they allowed me to gradually increase my activity level while monitoring my heart's response. I eventually returned to running, swimming and biking without supervision, but I did start carrying my cell phone and I wear medical ID."
Within a few months, Richards was cleared to walk in the Todd Beamer 5K on July 4, 2015, and then the MAC Dash on Sept. 12, 2015 — provided she didn't race. The latter event, which Richards had individually competed in every year since its inception, includes swimming, biking and running.
After additional testing in March 2016, Beckerman allowed Richards to increase her activity level, stop taking the antiplatelet medication and even said she could begin training for another marathon.
"I was comfortable swimming, as I knew a lifeguard was present," said Richards, who considered running a struggle at that point. "I don't know how much of my problem was from fear of having another cardiac event and how much was from loss of fitness, heart damage, and medication; I just know it was frustrating."
For a change of pace, Richards decided to train for the 100-mile Strawberry Century bike ride in Lebanon in June 2016. "I didn't race, but I finished and I enjoyed it," she said.
In the meantime, Richards kept running, and entered the MAC Dash in September 2016. By fall, her running had improved and she felt confident that she was ready to compete in a marathon — the California International Marathon in Sacramento on Dec. 4, 2016.
"My family decided to go with me," said Richards, whose son, Gary, also entered to compete in his first marathon. "Kevin, Katie, and daughters-in-law, Natalie and Shannon, entered the relay."
"On race day, the weather was perfect, my pacing was good and I was feeling good until about mile 18," she said. "As they say, the wheels just fell off at that point. I don't know how much was physical and how much was mental, but I got scared and pulled out of the race at mile 20."
"I was bitterly disappointed and discouraged," said Richards, who has managed to regain perspective on the race, and plans to try again. "I don't know if I'll successfully complete another marathon; what I do know is that I'm enjoying running, swimming, and biking. Other than taking my medication, wearing my medical ID, and carrying my cell phone life is back to normal. I feel good."
Despite some permanent heart damage, Richards said that her heart has adapted and is functioning at a normal level. "I was lucky that I was diagnosed and treated quickly."
Before her heart attack, Richards did not have any risk factors and had a calcium screening in 2008 that did not show plaque build-up or narrowing of the arteries.
"I urge everyone to stay active and do what you can to reduce any risk factors you have," said Richards, who lost 15-20 pounds when she began running.
"I also urge you to learn to recognize the signs of a heart attack and not to ignore them. Women have different symptoms that are sometimes hard to recognize," she cautioned. "Seek medical help if you're not sure!"
Symptoms of a heart attack include: chest pain or discomfort, which might not be on the left side for women; pain in one or both arms, the back, neck or jaw that may come and go; stomach pain which could be mistaken for heartburn; shortness of breath, lightheadedness, or nausea; a nervous, cold sweat; and fatigue. If you have one or more symptoms, call 911 immediately.
To regain your health after a heart attack, said Beckerman, "Exercise is a key part of recovery. In fact, we recommend cardiac rehabilitation to all of our patients."
"Cardiac rehabilitation is a structured, supervised exercise program that also includes an educational component (nutrition, stress reduction, smoking cessation, etc.), said Beckerman, who wrote the book, "Heart to Start: The Eight-Week Exercise Prescription to Live Longer, Beat Heart Disease, and Run Your Best Race."
"People who participate in cardiac rehabilitation have a lower future risk of heart attack and death from heart disease," he added.
"I also believe strongly in goal-setting," Beckerman continued. "Once someone has recovered, if they are able to participate in an event — like a 5K, or a special hike they have always wanted to do — it can be inspiring to them and validates their recovery."
Secondly, he recommends "a whole foods, more plants, Mediterranean style diet. Avoid processed food, too much sodium or preservatives, and simple sugars."
Finally, he advises that people get at least 30 minutes of moderate activity most days of the week, which can include walking, cycling, swimming, or other activities. "Some is good, more is better, and everything counts!" he said.
On Saturday, Feb. 12, Richards will participate in Beckerman's event, the Heart Breaker Half, in Hillsboro, a fundraiser for and the final event for his Heart to Start program.
"This will be my first time running this event," said Richards, noting that her doctor is encouraging her run for the experience, rather than the competition. "The weather has made training difficult, so I'm not very well prepared, but I want to support his event so I'll just run it slowly."
Beckerman praised Richards' work ethic and determination, adding, "She started small and worked her way back. I have so much admiration for her!"