The Long Run

The Long Run Heartbeat

By Tamekia Reece

On September 11, 2011, Derek Fitzgerald walked slowly down the middle of the street. He was exhausted, breathing hard. His heart was pounding. He had just crossed the finish line of the Travis Manion 9/11 Heroes Run. Many others crossed the finish line that day, but none shared Derek’s remarkable story.

Just eight months earlier, running was impossible. Derek laid in a hospital bed with end-stage heart failure, hoping a donor heart would become available in time to keep him alive.

That is why crossing this finish line meant so much. “It was such a feeling of accomplishment,” recalls the now 44-year-old of Doylestown, Pennsylvania. “It felt amazing to be out in the sun, running, being active, doing something I never thought I’d be able to do,” he says.

A Tough Year Gets Tougher

Derek’s heart problems started with cancer. He was diagnosed with non-Hodgkin’s Lymphoma at age 30 when doctors found a grapefruit-sized tumor in his small intestines. After several rounds of chemotherapy, his cancer was declared in remission in May 2004.

A few months later, he started having breathing problems. He thought it was due to being deconditioned after the cancer, but one day, as he sat on a hill gasping for air, he knew it was something more. Derek had climbed the hill between that parking lot and his workplace hundreds of times. On this day, though, he got halfway up and had to stop. “My breathing sounded like a saliva suction tube at the dentist’s office,” he says. “It was gurgling, it was popcorn-y, and I had to find a bench nearby to catch my breath.”

Over the next few months, he went to the emergency room several times. Despite many diagnoses that included pneumonia and pleurisy, his breathing troubles continued. It wasn’t until a cardiologist sat at his bedside that he finally knew what was wrong. Fitzgerald recalls, “He said, ‘Derek, I know you’ve had a tough year, but I’m afraid I have more bad news. You’ve got heart failure.’”

It turns out, one of the drugs in his chemotherapy regimen, Adriamycin (Doxorubicin), can cause heart damage in some patients. In Derek’s case, it caused dilated cardiomyopathy (DCM), a condition in which the heart muscle becomes so stretched and weakened that the heart’s ability to pump blood to the rest of the body is decreased. This can lead to heart failure.

DCM can be inherited from parents or caused by a number of factors, including heart disease, poorly controlled hypertension, alcohol or cocaine abuse, exposure to certain heavy metals and as in Derek’s case, two medications used to treat cancer.

Although his heart was failing, he was not immediately put on the heart transplant list. He was prescribed medication and advised to exercise and clean up his diet. Treatment options for DCM are limited to treating the cause of the heart failure, if possible, managing symptoms and stopping the disease from getting worse.

“Barring a heart transplant, there was no cure for my condition, and in order to get that transplant, I would need to be in end-stage heart failure,” Derek says. Endstage heart failure occurs when other treatments no longer work and the only remaining options are an implanted heart assist device or heart transplant.

Derek’s heart failure worsened and he began getting a feeling he describes as just having been knocked out in the 12th round of a heavyweight fight but still being on his feet. “The world would start spinning. It felt like I had two 5-pound weights hanging from each lung. My hands would get heavy and fall to my sides. My chin would get heavy and fall to my chest, and I would have to find a place to sit while the world spun around me,” he says.

The episodes initially lasted for only 30 seconds, but over time, the spells grew longer. By mid-2010, he was experiencing symptoms 23 to 24 hours a day. He had reached end-stage heart failure and was placed on the heart transplant list, nearly seven years after his diagnosis. Four months later, Derek was in the hospital in bad condition. He was unable to stand or walk, and though he spent most of his time sleeping, he couldn’t lie down. “I had to be propped up because my heart wasn’t strong enough to pump the fluids out of my lungs, so if I laid down flat, I would have drowned in my own bodily fluids,” he recalls. Without a heart transplant, he wasn’t expected to make it much longer.

Then, on January 3, 2011, the transplant coordinator came into his room to tell him they had found his new heart.

A Walk Becomes a Run

Eight months later, Derek stood at the finish line of his first 5k. After his transplant, he attended cardiac rehab. He started with a shuffle, worked his way up to a walk then graduated to a slow jog. During one of those jogs, he experienced runner’s high.

“All these feelings and memories of what it felt like to be healthy came flooding back into my memory because I had forgotten what it felt like,” he says. “At that moment, I knew I wanted to do everything I could to honor my donor and to feel more of what I had just felt.”

Becoming a runner was a lofty goal; Derek wasn’t exactly athletic. He’d been active in his younger years but stopped working out once he entered college and the working world. Before his cancer diagnosis, Derek was overweight and out of shape. As he tried to gain traction, his biggest challenge was physical. His cardiovascular endurance and the strength in his limbs weren’t strong enough, and as they improved, they didn’t progress at the same rate.

“Certain days, I felt like my heart and lungs could have gone for miles and miles, but my body wasn’t strong enough to keep up with that,” he says. “Other days, it was reversed, and I thought my legs, arms and core felt great, but cardiovascularly, I just wasn’t there.” It took patience and persistence, but he kept pushing until, at last, he crossed that first finish line.

That was just the start. Since his transplant, Derek has participated in more than 80 endurance events, including marathons, triathlons, a 4,400-mile bike ride across the country and several half and full-distance Ironman triathlons.

In 2013, he became the first (and only) American heart transplant recipient and cancer survivor to complete an Ironman — a 2.4-mile swim, 112-mile bike ride and 26.2-mile run. “As I entered the Olympic oval [near the end of the race] and heard the crowd, it was just overwhelming to know I had been able to carry my donor’s heart for 140.6 miles,” he remembers.

Making Strides

There’s some debate in the medical community about whether distance running is a good option for heart patients. Paul D. Thompson, M.D., Chief of Cardiology and Director of the Athletes’ Heart Program at Hartford Hospital in Connecticut, says the ideal exercise is the one the person will do, whether it’s running short distances, long distances or doing something else altogether.

“My routine advice to heart patients is that they get near-maximum benefit, from a heart and survival point of view, out of 75 minutes of running a week,” he says. “However, if it makes their life more complete to run marathons, I allow them to do that [if they’re healthy enough to do so].”

Would-be runners should always get approval from their doctors and make sure to train safely. Derek’s cardiology team was always aware of his physical activity. Early in his training, he signed up with Team in Training, an endurance training program that raises funds for The Leukemia & Lymphoma Society. The coaches made sure his training wasn’t too strenuous. Most importantly, when Derek is out on a run, he doesn’t overdo it. “I’m not a fast athlete. I’m a completer, not a competer,” he says.

That’s a good attitude for heart patients to have, Dr. Thompson says. “Even though exercise lowers your risk of having a heart attack or sudden death over the long-term, when you’re actually engaged in the exercise, your risk goes up because your heart is working harder during that time,” he explains.

Runners with heart issues should pay attention to their bodies and not push themselves too hard. “Any shortness of breath that is more than you expect, discomfort in the chest or anywhere from your teeth to your belly button, or discomfort that comes on with exercise and subsides when you slow down should be discussed with your doctor,” says Dr. Thompson.

Although it’s scary to think that exercise could increase your risk of having another heart event, that doesn’t mean people with heart disease shouldn’t work out. Usually, the benefits outweigh the risks. People who participate in a structured exercise program like cardiac rehab after a heart event have about a 20% reduction in subsequent cardiovascular events, according to Dr. Thompson. And those who were physically active before their heart issues have even better odds and tend to have easier recoveries, he adds.

For Derek, exercise, running specifically, is now a way of life. He trains seven days a week, keeping himself in shape for the many events on his calendar — whether it’s a 5k run for personal enjoyment, a marathon to raise money for charity or a triathlon to increase awareness about heart disease or lymphoma. In addition, he’s helping others reap the benefits of physical activity. The Recycled Man Foundation, an organization he founded in 2012, works to help people who have had significant health challenges improve their quality of life through exercise.

When asked why he does it, Derek says the real question is how could he not. “There isn’t a day that I don’t wake up and thank my donor, whoever that person was, for having the courage, the generosity and the compassion to save the life of a complete stranger,” he says. “I made it a mission to do everything I possibly could to honor my donor and be the best host body for the gift he or she left behind.” Running is one of the many ways he does that.

 

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