heart health – Experience Has Made Me Rich

On the One Year Anniversary of my Heart Attack

So August 26th of this year marked the one year anniversary of my heart attack. I actually haven’t written a blog since the one I wrote about that day. That’s not as significant as it might sound – I have rough drafts for 3 different ones that I started but I’ve been busy with other things and haven’t devoted as much time to writing as I’d like (something I regret quite a bit). But for the anniversary of H-Day I thought it would be good to write an update on what has happened this past year. I don’t think a chronological narrative would make much sense, and besides, I don’t have that great a memory. So I’ll go with more of a stream of consciousness approach.

As you may know I am a high school math teacher. The heart attack happened exactly one week before the start of the 2014-2015 school year. Although many people couldn’t understand how or why I did it, I actually worked right from the first day of school. I certainly could have taken some more time to recover, but I didn’t feel I needed it that badly and the doctor said that if my job didn’t require heavy lifting and I felt okay there was no reason not to work. My reasoning for starting was that it was easier for everyone involved – students wouldn’t have to adjust to a new teacher twice, the school wouldn’t have to scramble to find someone to cover my classes and my colleagues wouldn’t have to worry about teaching more than their own course load. Now, almost a year later, I can say that the decision to start right away was neither good nor bad. If I had waited things would have been just as fine as if I had not. It’s funny how so many decisions in life seem important when they really are trivial. I took things easy at first and let my body tell me when I could ramp up, always erring on the side of caution. For example I took the elevator instead of the stairs for a couple of weeks, and kept my boardwork lower on the board (so as not to raise my right arm too high after the angio) for about a week.

One thing that I learned from my first follow-up with the cardiologist was that I have no “modifiable risk factors” for heart attack. Basically it’s good old genetics. I don’t drink or smoke. I have low cholesterol and low blood pressure. At the time of the heart attack I was overweight but by no means obese. I was keeping fit with heavy weights and regular though limited cardio. This was disturbing news – I mean it would be nice if I could just stop something I was doing and know I was preventing another heart attack, but as the cardiologist said, at least now I know. I had three partially and one fully blocked arteries, and except for one of the partials they were all stented. The one that was not stented is very small and doesn’t supply a large area, so that other arteries nearby can cover what it doesn’t manage. I am on a cholesterol medication that has been shown to prevent plaque buildup in arteries and even to slightly reduce existing plaque. I am hyper-aware of my heart so if anything does deteriorate I will be on it right away. In the meantime I decided to do everything I could do. As soon as I got the green light to resume exercising I began a cardio regimen of 45 minutes, 5 times per week. As of this moment, I have averaged exactly that. I say averaged because there were three weeks where I didn’t manage to get all 5 sessions in, but always compensated in succeeding weeks by adding sessions. Three different vacations didn’t keep me from my cardio. Some people tell me “Hey, you’re on vacation, give yourself a break.” My response is my heart doesn’t know I’m on vacation, there is no such thing as a break.

I also cleaned up my diet. Not that it was that terribly unclean to begin with. But I did eat a lot of red meat (3-4 times per week, sometimes more), and 2-3 times per week allowed myself cheat meals like KFC or Burger King, or just really decadent meals at restaurants. Now I eat only lean red meat, and only 1-2 times every month. I’d say over the past year I’ve probably had red meat about 15 times. My protein mainly comes from white meat chicken, fish, and some vegetarian sources like beans, quinoa, and nuts or nut butters. I eat very little fat, and almost no saturated fat. What fats I do eat come from the fish or chicken, or light salad dressing, which I use extremely sparingly. I don’t measure my food, but I never eat until I am stuffed. That’s also a change from before. For this entire year I have not felt stuffed even once. And I still eat a lot – probably 7-8 times each day. A lot of fruits, berries, vegetables and nuts fill out my diet.

So what the diet and cardio have done is resulted in fat loss. I spent my entire adult life struggling with fat loss – often successfully but not always. Each time the goal was fat loss. Now the goal is not that at all. The cardio and diet are to keep my heart healthy. The fat loss is a side effect, albeit a pleasant one. When I had the heart attack I weighed 225 lbs (down from an all time high of 245). Because I am a hobby bodybuilder that’s not as heavy as it sounds, but I was certainly carrying too much fat by an obvious margin. My weight this this morning was 189. I won’t lie and say that I’m ambivalent about that – I am overjoyed. But it wasn’t and isn’t the goal.

Speaking of exercise I also resumed lifting weights about 6 weeks after H-Day. This was with the doctor’s blessing. At first I kept things very light and let my body tell me when it was ok to go heavier, again always erring on the side of caution. I don’t remember the exact timeline but I’d say after about 3 months I was more or less back to pre-heart attack form. The weights and the fat loss are visually pleasing to me. Here are a few vanity photos of the impact this has had on my look.

I’d actually like to include a photo I took when I was 245 lbs but my computer is currently deciding I’m not allowed to look through old photos – thanks Windows 10.

The great news is that after the heart attack the cardiologist who saw me at the hospital said my heart was damaged (on a scale of 1 – 4 where 1 is the best, mine was a 2), but on my six-month follow up visit I had managed to return it to a level 1. The words of the cardiologist were “Except for the presence of the stents you have the heart of a healthy, athletic adult male with no sign of trauma.” And that, ladies and gentlemen, mattered profoundly more to me than how I look, although that is what people see.

Whenever you lose a lot of weight, or otherwise significantly change your look to something more aesthetic, people always want to know how you did it. The truth is I did it by having a heart attack. That flicked a switch in my mind that had never been flicked before. I no longer have a choice about eating well and exercising, which can read differently than I mean it. What I mean to say is that I know all to well what a struggle it is to have to make good decisions about healthy eating and exercise. To choose not to have a sundae and opt instead for the fruit salad. For me, now, the sundae is not a choice. Nobody is forcing me not to have it – it has been removed from the list of options by something outside my control. It’s actually pretty liberating. So my answer when people ask how I did it is to say “Well, step 1 is … you don’t want to do step 1.” Because Step 1 was have a heart attack. I didn’t decide to start looking better and then do something about it. I had a heart attack and this is how I am doing my best to prevent a repeat. I will say that I have had the odd dessert here and there. But each time I have done so it’s literally been a tiny forkful (as in just the tip of the fork) so I could taste it. The forkful concept would have seemed ridiculous to me a year ago. Now it is legitimately enough. I don’t have the forkful and then look longingly at the rest, wishing I could have more. The forkful does what I needed – it gives me the taste and that is enough. Once again this is not a choice I am making, or a philosophy I am forcing myself to embrace. It just is the way my brain works now – I didn’t deliberately activate it. If I did I would write a book about how. Another example is that there have been 4 times (no, I’m not counting I just remember them) when I have eaten one french fry at a meal. Because I wanted the taste.

Emotionally/psychologically it would be a lie to say I have not been affected. The day I had the heart attack one of the reasons I didn’t call an ambulance as soon as I should have is because I didn’t want to scare the kids. There’s no way around the fact that when your dad has a heart attack it’s scary. Same goes for my wife. The very last thing I want to do is scare them or have them worry. That said I am now hyper-aware of what is going on in my body, and especially my chest. And guess what? Chest pain happens, and it’s not generally a heart attack. Gas happens (especially because it is a side effect of some of the medication I am on). The pain can cause anxiety. Anxiety can cause chest pain. It’s a hilarity-filled ride. I can’t specifically recall how the heart attack itself felt – I just know it hurt but was not as intense as you’d think. I feel as though if it were happening again I would be sure. But I’m not sure if that’s true. So there are days when I find myself worrying. However with the cardio regimen I’m on I can always reassure myself that I wouldn’t be able to do 45 minutes of intense cardio without accompanying intense pain if I was actually having another heart attack.

On that note, when I started the cardio after the heart attack I was keeping my pulse rate in the 120’s, although my doctor did say I would be able to push it higher as I healed. As of today I usually use my elliptical machine (I have a gym in my basement although it has evolved since that blog about it), and the heart rate monitor I bought shows I’m keeping my heart rate in the 140-150 zone, which I made sure was ok with the cardiologist. Speaking of heart rate, I also take my blood pressure daily, and it stays in the 115/75 zone, with a resting heart rate of around 60 bpm.

One thing I have found recently (as in, the last 5 weeks or so) is that drawing is great therapy. It is extremely calming and does a great job of centering my thoughts. I highly recommend it. Another thing I’d have said if you’d asked me a year ago was that I can’t draw for beans. I never really believed I had any talent in that regard. But I have watched hours of YouTube tutorials and have been drawing every day. The therapeutic aspect can’t be overstated. It turns out when you practice something you also improve. Here is one of my earliest attempts at a portrait and one of my most recent ones. I’m no pro and may never be one, but the improvement is real and that’s only about a month. Therapeutic, fun, and inexpensive – I highly recommend it.

Wow. Ok this really has been stream of consciousness style. My writing is usually more organized than that. Ah well. This one wasn’t about writing, more about an anniversary summary. I admit I didn’t proofread that carefully either – forgive the errors. I am always happy to answer questions or offer assistance if I can. Leave me a comment and I will respond.

Thanks for reading,

Rich

So This Guy Has a Heart Attack

On Tuesday, August 26, 2014 I had a heart attack. I’m not the type of guy you would expect that to happen to. Shortly after it happened I wrote a long description of the events to share with friends. Some have told me that it may actually prove helpful for other people, so I am reposting it here on my blog.

First, as soon as it happened and as people found out, I received so many emails, texts, phone calls, and visits that I can’t even begin to count them. It’s like the support system of family, friends and colleagues is a big inflatable cushion that kind of hovers underneath as I move through life, inflating like an airbag in a crash when they are needed to carry me through. It’s overwhelming. Thank you.

I’ve gotten a lot of the same reaction from people when they find out.

“WTF? You’re so young and you exercise and eat right. How could this happen?” is a basic summary. Trust me, it summarizes my reaction as well. People have also asked more specific questions like how did I know it was happening and what did it feel like. I will answer with a narrative of events.

On Saturday August 23 I was doing cardio on the elliptical. Lately I’d been doing 45 minute sessions, 3 times a week. Towards the end of that session, I felt some pain in my chest which I thought was odd, but I chalked it up to asthma aggravated by the dust in the basement because we’ve had contractors in to finish the other side of the basement (my gym is the left side) for a couple of weeks. Once I got off the elliptical the pain went away, confirming my suspicion. It was not intense pain. Sunday, August 24 we went to Gravenhurst to spend the day at the cottage with my dad. It was a relaxing day where I didn’t do much, although my dad did buy a new barbecue and I carried it in from the car by myself, with no discomfort or trouble at all. The drive home took a lot longer than we thought because of traffic and I went straight to a rehearsal for the show I was supposed to be in. Rehearsal was fine and I went home and went to sleep. Monday, August 25 was the day I planned to start getting ready for the new school year. I had some boxes of vases from old parties and we are donating them to the school where I teach so I loaded them into the trunk of the car, along with a plastic bin full of empty binders. Got to school and brought the bin in and upstairs to the staff room. I was struggling quite a bit with it but attributed it to the heat. On my way up the stairs with the bin I had chest pains again and was sweating quite a bit, which I found very odd because the bin was not that heavy. At that point I was a little scared, but I sat down and recovered quickly. I went home, told my wife Marla what happened, and had a nap. Apparently Marla checked on me a few times during that nap to make sure I was breathing. I thought she was overreacting. Monday night we had rehearsal again and I went, and felt fine. Went home and went to sleep around 11, with slight pain in my chest but it felt a lot like heartburn, which I do suffer from regularly.

Tuesday morning I woke up at 4:00 and the chest pain was still there, only more intense. It still felt like heartburn and I wasn’t sure what to do. I was up for an hour, and Marla woke up around 4:45 or so asking if I was ok. I really wasn’t sure. I googled symptoms of heart attack and it’s a pretty wide range of things it can feel like actually, although chest pain that lasts for more than 5 minutes is not to be ignored. I also read that driving (or being driven) to the ER is not recommended, since if you call an ambulance you will be treated sooner (by the EMT’s) and also because the EMT’s can assess your condition and potentially take you to a different facility. At 5:00 am I decided to call 911. I was very upset at the thought of the kids waking up and finding emergency vehicles and people in the house. If the kids were not home I probably would have called earlier. I desperately didn’t want to scare them. It was bad enough I had already scared Marla. When you call an ambulance for chest pain they will also dispatch firefighters, because they can respond more quickly and are trained for first aid. While waiting I got dressed, brushed my teeth and sat down on the couch. The pain didn’t go away. Firefighters arrived and asked me a lot of questions about where the pain was and how intense. Shortly after that the EMT’s arrived and the firefighters filled them in as they hooked me up to an EKG monitor. The first readout showed something that concerned them a little, but two more readouts showed as normal. They asked me to rate the pain on a scale of 1-10, which I’ve always found odd since if I say 6 what does that mean to them? For all they know I would call a papercut a 10 (and now that I think about it I’ve had some pretty painful papercuts – every get one from cardboard? The worst). I said it was around a 3. They decided based on the first concerning readout not to take me to the closest hospital, which is Mackenzie Health, but to go a bit farther to Southlake, which is in Newmarket, because they have a cath lab there which is needed for angiograms and angioplasty. Score one for calling an ambulance instead of driving to the ER. We stopped at some point between my house and the hospital to meet another ambulance and a different EMT came in to attend to me. He’s the one who put the IV in and they gave me morphine for the pain (which was fluctuating between a 2 and a 7) and baby aspirin to thin my blood. At this point I still didn’t know if I was having a heart attack or they were just taking precautions. They called ahead to Southlake to have a team ready at the cath lab. We arrived and they wheeled me straight to the lab – do not pass Go, do not collect $200 – but there was no team there. Turns out they had accidentally called Sunnybrook, where there was certainly a team waiting for me, so they wheeled me to the cardiac care unit (CCU). This was around 6:30 am or so. The nurse in the CCU at Southlake called the team, which is always 20 minutes out. Meanwhile the cardiologist on duty came to see me. He looked at the EKG readout and was the first person to tell me with certainty that I was having a heart attack. In the meantime Marla had woken the kids and followed the ambulance up to the hospital, so they were already there. The kids were a little freaked out for sure, but I think the calm way everyone was dealing with it helped them a lot.

So anyway the cardiologist decided not to have the team come in since the morning shift was starting at 7 and they could do the procedure. He explained it to me and I had to sign some forms, and they wheeled me back in to the cath lab. They said the procedure would take about an hour. Nurses had shaved and washed my wrist and groin since those are the sites where they may insert the catheter. Once in the cath lab they must have put some good stuff into my IV because although I was conscious throughout the procedure it seemed to me to last about 15 minutes. It was actually an hour. The doctor decided to go through the wrist, and he explained everything as he did it. There was some pain from the freezing, and I could feel the catheter going up my arm. That sounds worse than it is – it’s really just a kind of pushing feeling. At one point my whole chest got warm. I said “My whole chest just got warm – is that you guys?” he said it was the dye the use for the angiogram. There’s a huge bank of screens that he watches as he does the procedure, and an x-ray device that moves back and forth over your chest as he works – it’s very cool. Kinda robotic. Anway I heard him asking the nurse for stents and I swear I could tell the moment he put them in because the chest pain went from about 5 to zero in an instant.

Once the procedure was done they wheeled me back to my room in CCU where Marla and the kids were waiting. There was a blue clamp bracelet on my wrist that was pretty damn tight (still bruised a month later) but otherwise I felt fine. My brother came and stayed for a while, then left and took the kids home. Marla stayed with me every second. The nurse came in often and was slowly releasing the clamp until he felt he could apply a pressure bandage instead, which he did. At that point I was overcome with nausea from the anesthetic and I vomited, which turned out to be bad for my wrist, which immediately swelled up and started bleeding (which it turns out is the reason I am still bruised). After applying pressure with his fingers for a while the nurse reapplied the blue clamp, leaving it on for much longer this time until he felt he could replace it with a pressure bandage.

In the meatime I was visitied by the cardiologist who performed the procedure. He told me I had one fully blocked artery and 3 partially blocked. He had stented the big one and two smaller ones but left one very small artery partially blocked and unstented, because it is very small and because it is not fully blocked and because too many stents at once is not the best thing for the body in any case. Additionally with a small artery like that one the body will create new arteries to replace it. I have before and after pictures of my arteries from the angiogram. They are spooky. That cardiologist also said that “most guys take at least a month of work” which shocked me as I felt ready to rock right then! I was also informed that I couldn’t stay at Southlake because I live closer to Mackenzie, and that as soon as there was a bed at Mackenzie I would be “repatriated”. Yes that is the word they used. I would have preferred extradited but it turns out there is no extradition treaty between Newmarket and Vaughan. A few hours later and they did have a bed at Mackenzie, so they called an ambulance to transport me there. I was sad to leave Southlake. It’s beautiful there, the nurses were superb, and I had a private room, but alas I am not a citizen of Newmarket.

At Mackenzie they wheeled me into a quad ward staffed with two dedicated nurses. The nurses there weren’t quite as attentive as the ones at Southlake, but then again I was somewhat out of the woods. They were very knowledgeable and answered all my questions patiently and thoroughly. Marla had followed the ambulance from Southlake to Mackenzie so she came right into the ward with me, and immediately got kicked out so that the nurses could apply about 763 new electrode pads to me (in addition to the 451 I already had), hook me up to a blood pressure cuff that automatically inflated every hour on the hour, and in general affix me to my bed with wires. Once that was done Marla came back in. She didn’t leave until long after visiting hours were over, and then only reluctantly. At Mackenzie I had a lot of visitors including my dad and his girlfriend, my two sisters, and my brother who came back.

Once everyone left and the night nurses settled in I tried to sleep but I had slept so much during the day that I could only drift in and out. Instead I answered texts and emails throughout the night. In the morning I saw the cardiologist at Mackenzie, who explained more specifically what had happened. I asked him what caused it. He said genetics – would have happened no matter what. He ordered some more tests, and left. The nurses told me that once he saw the results from the ECG I could most likely go home if I wanted to. ECG is an ultrasound on steroids, and shows the extent of damage caused by the heart attack. They wheeled me down to “nucular medicine” (I always laugh when people pronounce nuclear that way) and the lady there did the ECG. Marla was there too and got to watch. Said I might be pregnant. After that it was a short time before the cardiologist came back. He said that they rate hearts on a scale of 1-4, where 1 is a perfectly healthy heart and 4 is, well, not. Apparently there was damage done to the underside of my heart and I am at a 2. That’s good. He said that with a good rehab program getting to a 1 is possible, either by improving the damaged section or, if that’s not possible, by improving the parts that are not damaged to compensate. He put me on about 19 different drugs, gave me the prescription and sent me home. I didn’t have any clothes so Marla’s sister, who had driven in from out of town and was with the kids at our house, raided my wardrobe and brought some stuff for me. I was also visited by a good friend of ours who is a doctor – not my doctor but does rounds at Mackenzie – who was so nice to stop by and answer my stream of questions. Again the support from the community was overwhelming. I can’t even wrap my head around it.

When I saw the cardiologist again I asked him (I also our friend) if there was anything I did to bring this on. He said no. My blood cholesterol is normal, I have a low blood pressure, my heart rate is around 60 bpm, I am not diabetic, I exercise regularly, I don’t drink and I don’t smoke. He said it was hereditary. The good news to me is that arteries don’t block overnight so I imagine I’ll be feeling better than I have in a long time pretty soon. I am also on a drug regimen now that is designed to keep this from happening again. I certainly hope so! In retrospect it wasn’t that much fun.

If there’s a moral to this story, it is this:

DON’T IGNORE CHEST PAIN.

Follow up:

I have since been to a cardiac rehab orientation session that was chock full of information I already knew, have seen my family doctor and been to the cardiologist for follow-up. I’ve asked a lot of questions about why this happened. The answer is fully genetic. My arteries are bent a little too much in places. The bends cause turbulence as the blood flows awkwardly around them. The turbulence causes cholesterol to gather, which blocks the arteries. The stents prevent this from happening again, as does the regimen of drugs I am on now. The cardiologist did a cardiac stress test, which is basically a session on a treadmill where you are wired to machines that monitor your heart, and they slowly make the exercise more difficult. Since then I got the go ahead to resume exercise, so I have been lifting weights and doing cardio on the elliptical. I wasn’t significantly overweight before, but now that I am much more conscious of eating only heart-healthy meals I have lost about 12 lbs and am still losing fat. I am naturally concerned about a repeat episode, but the doctors assure me that with healthy living and the drugs, there is no reason to walk around worrying I might have another heart attack. So I do not.

Thanks for reading,

Rich