52 Things I’m Thankful for on My 52nd Birthday

52-highsOne thing about nearly dying is that it makes you appreciate life more. It may sound cliche, but there was a time not too long ago when I wasn’t sure I’d make it to 52. And even though it’s not a nice round number like 50 or 55, I still feel like celebrating simply waking up for another birthday. Happy 52nd birthday to me.

Even for those who did not have a near-death experience, the world sure seems to be coming apart at the seams. Things feel pretty dire. We have a lunatic in the White House. The world looks to Germany for moral authority. The climate is changing so rapidly that huge chunks of the polar caps are falling off and melting into the sea. The American wage gap is getting wider. Americans are getting wider. Kids keep getting gunned down at schools. The U.S. Men’s National Team didn’t make the World Cup!

Yet even still, perhaps because I have been consciously trying to pay less attention to politics and the news, I feel like I have a lot for which to be thankful (including knowing how not to end a sentence with a preposition).

I’m not really going to tick off 52 things I’m thankful for as I turn 52 (not because I can’t come up with 52, but because I don’t think you’d read through a list that long). I am, however, going to hit some high notes.

  • First and foremost, my heart is strong and while it will never be fully recovered it is pumping within the normal range (ejection fraction at 55). My arteries are clear. I recovered completely from the little stroke I had last year with no permanent deficiencies. Aside from a few normal age-related aches and pains, I’m in pretty good health given my history.
  • I have a loving wife/best friend who treats me like a king despite my often whiny personality. In a few months, we’ll be celebrating our 25th wedding anniversary.
  • We have raised a remarkable son who at 20 is wise beyond his years. He may still be trying to find himself, but he’ll never be lost.
  • I live in a wonderful town in a perfect townhouse in a great neighborhood.
  • For the first time in my life, I can truly say I love my job. I had a great year raising money for the American Heart Association and I am honored to be able to do this work for a living. Strange way to find a calling, but I’ll take it.
  • Despite some ups and down this year, my mom, dad, and sister are doing well (as well as can be expected given they all live in Tucson now).
  • We’re doing well enough financially to afford to travel more and are starting to tick off our bucket list one by one.
  • I have great friends both online and in real life.
  • The heart attack support network I founded on Facebook has grown from a handful of survivors in Phoenix to nearly 3,500 across the globe.
  • I serve my community as a board member of a great nonprofit that unites, strengthens and advances the state’s nonprofit sector.
  • The Suns have the first pick in the NBA Draft tonight and will finally land the “big man” they’ve always needed. The Padres are not winning, but they are on the right track with a great young core and some special players almost ready for the big leagues. The Cardinals drafted a QB of the future. No team I’ve ever rooted for has ever won a world championship — but that will change in the next few years. Go Cardinals. Go Padres. Go Suns.
  • I have found a new passion in soccer and have become a rabid fan. Seriously, I wake up early every weekend during the season to watch Arsenal play.

All this is to say that I’m living a great life. It’s nothing like the life I imagined I’d be living in my 50s, but it’s great nonetheless. And despite world events, my own life is really good. And I’m grateful. And I need to remind myself to share that fact more often, and certainly not just on my birthday.

I’m a heart attack and stroke survivor and I’m grateful for everything I have in this world.

Regrowing Damaged Organs no Longer Stuff of Science Fiction

timeismuscleI have only one regret from my heart attack experience in 2011, and that is that I waited two days from the onset of symptoms to seek treatment. Aside from the fact that I very likely could have died during those 48 hours, the time I waited very likely caused more damage to my heart than if I had gone to the hospital right away. In the heart attack business, time is muscle.

It’s a sobering experience to hear your cardiologist say that part of your heart is dead, but that’s exactly what happens to your heart when oxygen is cut off. In my case, I lost about 15 percent of my heart muscle in the area at the lower left ventricle known as the apex. Because of this dead muscle, I have what the doctor calls left ventricular hypokinesis. Basically, it means my heart doesn’t contract as much as most people’s hearts resulting in a lower ejection fraction.

This means my heart doesn’t pump out as much blood as a normal heart, which is no big deal until it gets too low (an ejection fraction of 50 percent or lower is considered reduced) and if it gets down below 40 or so it means you are in heart failure. At the time of my heart attack my ejection fraction was around 35-40, but today it’s in the 55-60 range which is at the low end of normal. Lucky me.

Every cardiologist I’ve seen, and everything I’ve read, says heart muscle damage is permanent. But as college football broadcaster Lee Corso says — not so fast my friends!

Medical science is progressing at a breakneck speed. Just think about coronary stents for example. It seems like they’ve been around forever, but the first one was inserted into a human in 1986 (just 32 years ago). If I had the very same heart attack in 1985 I’d be walking around with a 90 percent blocked left anterior (LAD) descending artery (also known as the widowmaker) instead of having three stents. Or more than likely I’d be dead.

Which brings me to that dead heart muscle. This week in the magazine Nature I read about a new procedure that will be done on three patients in Japan. Doctors at Osaka University will take thin sheets of tissue derived from cells and graft them onto diseased human hearts. The team expects that the tissue sheets can help to regenerate the organ’s muscle when it becomes damaged.

If this works as it has in lab animals, these doctors will in effect reverse thousands of years of medical orthodoxy. Time may be muscle, but science is more powerful than current knowledge.

This experiment is part of a field known as regenerative medicine. Rejuvenating or regrowing human tissue has limitless possibilities for medical science, and while the field is in its infancy it feels like every day we hear about a new breakthrough. Just a few years ago scientists grew a complete human bladder outside the body, and we’re not very far from the ability to grow more complex organs to use for transplantation. How long before scientists can grow a human heart that can be used to replace failing ones? The stuff of “science fiction” is no longer outside the realm of possibility.

I recently read Never Let Me Go by Nobel Prize winner Kazou Ishiguro. Spoiler alert: it’s about clones who are created to harvest replacement organs. But given the direction of real science, the dystopian world laid out by Ishiguro will not be needed!

This is a long way of stating that I am grateful for medical science. In fact, science is the closest thing I have to a religion. I put my faith in regenerative medicine, CRISPR, biotechnology, immunology, and everything else that involves the scientific method. My heroes are scientists, doctors, and inventors. They bring me peace of mind and hope for the future.

My heart damage is probably not severe enough to warrant stem cell therapy or regenerative cell sheets. But it’s nice to know if things get worse for me, or as science continues to progress, my heart could easily be fixed. Permanently.

I ♥ science!

You Are What You Eat

fatsickandnearlydeadLong before I suffered a heart attack I had been thinking a lot about food and its relationship to health. I had good reason to learn more about food as my cholesterol, triglycerides and blood sugar were elevated due to a combination of genetics, inconsistent activity levels and an undying love of pizza. So I started doing research on how to naturally lower these signs of impending crisis and each time the path led back to the same place — food.

Flash forward to last night and here I am again watching a documentary about food and health, this time at a special screening of Fat, Sick and Nearly Dead at a local restaurant called Pomegranate Cafe. And just like all the others, the premise involves eating fruits and veggies. Hmm. Maybe it’s true that 50 million Elvis fans can’t be wrong.

Here are just some of the films I’ve seen and books I’ve read over the past few years that preach the gospel of healthy eating:

I’m sure you can find tons more, but these are some of the popular ones. The thing is, so much research (both scientific and anecdotal) points to the plain fact that food can make us sick and conversely food can heal. You don’t have to believe it, or even care, but that doesn’t make it not true. What would it take for you to change the way you eat?

What of you had a heart attack? Would you change the way you eat, or would you continue the unhealthy lifestyle that made you susceptible to heart disease in the first place? It’s not an easy answer. In the months since my heart attack I have run into all types of survivors — those who don’t change because they either don’t care about living or they think it’s too hard to those, like me, who are willing to make a radical change in hopes of not only living longer but being healthy enough to enjoy that longevity. For me it’s a no brainer, but I understand the other side.

Changing my diet was really hard at first, and not just because I missed regularly having a couple of slices at NYPD Pizza. The hardest part has been eating at restaurants. I’ll tell you what’s not hard — eliminating most animal products. I have been mostly vegetarian for years (I continue to enjoy seafood) and truthfully I don’t miss the meat. Yes, every once in a while I dream about a Double Double, but it passes and those cravings happen less and less. I’m even thinking being vegan or raw wouldn’t be too hard since I’m almost there already. Limiting fat and cholesterol is simple, especially if you eat mostly vegetarian anyway.

Unfortunately for me, my heart was damaged by my heart attack and if I want to take care of it — permanently — I need to severely limit sodium. This has been the hardest thing for me, and not because I crave the taste. It’s hard because sodium is everywhere and often in places you least expect it. I won’t go into detail on why sodium is so bad for heart patients, but suffice it to say sodium makes you retain water and retaining water makes your heart pump harder. When your heart pumps harder, it will naturally enlarge and that would exacerbate my damage and inevitably lead to heart failure. How much sodium are we supposed to eat? The recommended daily allowance for a healthy person is 2500 mg. For someone like me, I need to stay under 1500 mg. I am currently eating between 1000-1500 mg per day. To give you an idea of what that means, a single teaspoon of table salt? There is around 2500 mg in a teaspoon of salt. A typical slice of pizza? 700 mg. How about a “healthy” meal at a “healthy” restaurant? A small Greek salad at Pita Jungle has 940 mg of sodium.

So you can see eating at restaurants is a challenge for me. But it’s worth the hassle given my condition. If you don’t have a heart condition, changing your diet is a breeze. But even keeping to the RDA is tough for a healthy person. A single portion of lasagna classico at Olive Garden contains 2830 mg of sodium. Holy salt lick Batman!

Why wouldn’t you change your diet? It’s so easy and the evidence is so clear. I know, you love a good steak. Enjoy, but why not consider making small steps in the right direction? Michael Pollen says it best. When asked how to dig through all the hype and misinformation he says, simply:

Eat food. Not too much. Mostly plants. 

In case you’re confused, by suggesting we “eat food” he’s basically saying to eliminate anything processed, chemical, manufactured, toxic, etc. Broccoli is food.  Methylchloroisothiazolinone is not.

A Bitter Pill to Swallow

pill_box_with_pillsOne result of my heart attack is that I now have a crapload of pills to take each day. There are two ways to look at this: on one hand, I am very lucky I live in a time when science has brought us so many amazing medicines, and on the other hand I am a little freaked out by how many foreign substances I am putting into my system each day. On top of that, during my recovery, I have done some reading and watched some documentaries that not only question the use of drugs but provide scientific evidence for natural ways to bring about the same positive results. What to do, what to do?

Here’s a little taste of what I swallow each day just for my heart:

  • Plavix — Keeps the platelets in your blood from clotting to prevent blood clots after a recent heart attack or stroke.
  • Carvedilol — Used to treat people whose hearts cannot pump blood well as a result of a heart attack. Carvedilol is a beta-blocker that works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.
  • Lipitor —  Used together with diet and exercise to reduce blood levels of low-density lipoprotein (LDL) cholesterol (”bad cholesterol”).
  • Altace —  Used to reduce the risk of heart attack and to improve survival in patients with heart failure after a heart attack. Altace is an angiotensin-converting enzyme (ACE) inhibitor that works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.
  • Aspirin —  Used to prevent heart attacks in people who have had a heart attack in the past or who have angina. Also used to reduce the risk of death in people who are experiencing or who have recently experienced a heart attack.
  • Warfarin — Used to prevent blood clots from forming or growing larger in your blood and blood vessels. Warfarin is also used to treat or prevent swelling and blood clot in a vein and it works by decreasing the clotting ability of the blood.

Last night I finished watching a documentary about Ray Kurzweil called Transcendent Man. Ray is the proponent of something called The Singularity, which he thinks will take place within the next 30 years. The Singularity is “a proposed advancement that will occur sometime in the 21st century when progress in genetics, nanotechnology, and robotics will result in the creation of a human-machine civilization.” Until this time, Ray is trying desperately to keep his biological body alive and as part of this process the man swallows more than 150 supplements per day. That seems like a lot of effort, but if you honestly thought it would extend your life wouldn’t you at least consider it? That’s sort of my conundrum with all the pills I’m taking. I definitely believe in science and my cardiologist is highly trained and has seen results with pharmaceutical treatment. I’d be stupid not to do what he says. I know there are some of you out there who think taking drugs is a scam and all the hype is just a way for big pharma to make money, but that’s easy to think until you are faced with a life or death situation. Mike Tyson used to say “everyone has a plan until they get hit.” That’s how I feel.

I will say this — I have made a pretty solid recovery in the seven months since my heart attack and I have to believe the reason for this is because I did the three things my cardiologist asked of me. I did cardiac rehab and continue to exercise regularly, I drastically lowered my intake of cholesterol, fat and sodium, and I’ve taken my meds. As much as it freaks me out to take all these drugs, it appears to have made an impact. Of course, if I follow this logic I will be on tons of drugs for the rest of my life. But at least I’ll have a rest of my life.

Heart Attack? That Was So Six Months Ago

Today is the six-month anniversary of my heart attack. Milestones seem like a good time to reflect a little, so here are some random thoughts:

  • Thinking back to the early days of my recovery, it feels like I have traveled a “life marathon” since then. So much has happened, both physically and emotionally. Truth is the emotional has been more difficult.
  • Health wise I have made tremendous progress. Without getting too technical, my ejection fraction has gone from “about 30-35” in the days following my heart attack to “about 45” six months later. This measurement means my heart is working much more efficiently than it was at the time of my M.I. and is now pretty close to the normal range of “50-75.” My cholesterol is way down (much lower than yours I bet!) thanks to diet and medication. I have had no medical issues since my heart attack and in fact I’m probably stronger now than I was prior to the attack thanks to stronger blood flow through the three stents in my left anterior descending (LAD) artery. In other words, I feel great physically.
  • I am exercising without any issues 5-6 times per week.
  • The mental rehabilitation has been more complicated. Most days I feel great. Happy to be alive and feeling like I have the whole world in front of me. Some days I freak out that I had a heart attack and worry that I’m going to drop dead at any moment even though that is extremely unlikely. My cardiologist said he had a higher chance of having a heart than I do now. Still, it’s hard not to think about how close I came to death and how scary it would be to leave my family behind.
  • Some days I wake up feeling anxious even though there may be no apparent reason for the anxiety. It’s a nasty thing anxiety. If you’ve ever struggled with it you know it can manifest itself in physical ways including chest tightness, the inability to concentrate and even heart racing or palpitations. The anxiety comes less often now but it can strike at any time. If I seem short with you one day maybe I’m having one of those days. 😉
  • Some of my friends and co-workers seem to be worried that I have to avoid stress or I’m going to have another heart attack. To them I say thank you for your concern, but stress didn’t cause my heart attack and stress is not a big issue for me these days. Like everyone I have some days that are more stressful than others, but don’t baby me — I’m not going to drop dead from stress.
  • The biggest (and in some ways only significant) change in my life has been food. If you believe as I do that food can kill you and food can heal you then it seems like an obvious thing — eat well and you’ll be well. But it’s not that easy. There are three things I have to look out for — saturated fat, cholesterol and the biggest one, sodium. Lowering fat and cholesterol is really quite simple. I stay away from red meat and fatty foods. Simple. Sodium on the other hand is a bitch. Why is sodium so important? Well, sodium makes you retain water and that forces your heart to work harder and your blood pressure increases. You don’t want that, as a heart patient or as a normal person. It’s one of the biggest reasons why heart disease is the number one killer of men and women in America. The average American gets as much as 10 times the daily recommended allowance of 2,500 mg per day. As a heart patient, I’m supposed to keep my intake to around 1,200-1,500 mg per day. It’s not so much the added salt that troubles me (I don’t use any), but it’s the sodium in foods that you may not know about. Cooking at home makes things easier, but eating out is no fun. Do yourself a favor (and I won’t preach anymore) and check out the nutritional charts online for some of your favorite restaurants. It will scare the shit out of you. Before my heart attack one of my favorite places to eat was Rubios, where I’d typically have a shrimp burrito. The burrito has 2,200 mg of sodium, nearly double my daily allowance. Nowadays I still go to Rubios but I have the salmon or mahi mahi tacos on corn tortillas (190 mg of sodium per taco).
  • Eating out has become a social occasion for me rather than an eating event. For instance, tonight I am going to a concert with friends and we’re meeting beforehand for a meal. I checked out the online menu of the place we’re going and there’s really nothing I can eat, mostly because they don’t list their nutritional values on their site. I’m going to eat something at home beforehand and enjoy my time with my friends over a beer. This is, as my lovely wife likes to say, my new normal. I nearly lost my life because of food and I’m not about to give it a second chance to kill me. Most people who have heart attacks have more than one — I am never going to have another one because I am willing to sacrifice being a foodie for being alive. Yes, it’s a tough sacrifice, but I feel like I don’t have a choice. Not everyone who has suffered a heart attack makes this choice (some don’t even stop smoking), but I have too much to live for to let a little thing like food stop me from enjoying my life. I will miss you NYPD pizza and Rubios shrimp burritos…have fun killing someone else!
  • Lately I have thought about becoming a vegan. It is clear to me that a vegan diet is healthier for humans, and the research I’ve seen (including the film Forks Over Knives) makes a pretty compelling case. I was a pescaterian prior to my heart attack, meaning the only meat I ate was fish, but I ate a crap load of dairy and dairy is loaded with bad fat. From the way I’m eating now it’s not a stretch to get to veganism. Maybe if I make the decision it will take some of the stress away from worrying about meal preparation and eating out. It would certainly simplify it. I’m willing to listen to my vegan friends out there. Sell me.
  • I need a hobby. I love to read and watch films, but I need something more active. Any suggestions? Golf is fun but it’s expensive and it’s about to get hot in Phoenix. I’d love to go fishing if anyone out there enjoys it and wants to bring me along. I have a rod. Bowling maybe? At least it’s indoors which is a bonus here in Phoenix. I don’t really have an active hobby and frankly I’m a little bored in the evenings and on weekends. I certainly don’t want to work more!
  • I have been trying to be more active with my volunteering. I’ve always volunteered and done pro bono work, but these days it’s calling me. I’ve started to do some work with the Heart Association, helping them with PR and social media. I’m also looking into ways to be more involved with what my company has to offer in terms of corporate social responsibility. Apollo Group does a nice job in the community and I’ve already reached out to some folks in our external affairs department for ideas. I’m looking for something more in-depth than just doling out food or cleaning up trails — I’m thinking board level or committee chair. Send me your ideas. When I have been an active volunteer in the past it has come with many rewards.
  • I’m going to do more travelling with Leslie and Connor. I lost all of my vacation and sick time when I was on disability, so we haven’t done much travelling in the past six months. We did spend a wonderful weekend in Coronado at New Years and we’re planning something small for Memorial Day weekend. In July we’re going to go to Chicago to meet family and see some sites, and then after my vacation gets refreshed in August I think we’re going to plan something special for fall break. We’d also like to do something spectacular next summer — perhaps Europe. Having future things to look forward to makes life worth living.

Well, that’s about it for now. Consider this my therapy blog post! Six months post heart attack and frankly I think I’m doing great. People tell me I look great, which makes me wonder how I looked before October 15, 2011. I have lost about 20 pounds as a result of my healthy diet and I am exercising a ton so maybe I do look good! Oh, and methinks the goatee has outlived its usefulness so I think it’s coming off today to mark the anniversary. Hearing Josh Brolin make fun of goatees as “so 90s” last night on SNL was the clincher.

Thanks for reading.

The Heart of the Matter

leslieValentine’s Day is a silly made up Hallmark holiday designed to con men into buying flowers and candy, not to mention a corny greeting card inscribed with someone else’s sentiment. When you’ve been married for nearly 18 years, it’s hard to take Valentine’s Day too seriously. I can never figure out what to do for my wife on Valentine’s Day. She doesn’t eat candy and flowers seem so cliché. Jewelry is out of the question because she isn’t a big jewelry person and what she does wear belonged to her dead mother so how can I compete with that? This year I can’t even really take her out to dinner because I can’t eat much of anything on my post heart attack diet. I’ve been thinking about it for a few days now, and what I’ve decided to do this year is give her a gift from my heart — hell, it is my heart.

Dear Leslie,

Tomorrow is the four-month anniversary of my heart attack and I have made so much progress it is remarkable. But what is even more remarkable is how much you have been there for me. I always thought wedding vows were just a formality, but I have a new appreciation for “in sickness and in health.” It’s one thing to stand by your partner in tough times, but there are degrees of being there — not everyone is capable of giving as much as you have given to me over these past few months. From the moment Dr. Kerr called you from her office and told you I was headed to the emergency room you changed your entire life for me. Hell, you beat the ambulance to the ER and was waiting for me when I arrived! At that moment I put my faith in you to make decisions about my health because I knew after 17 years of marriage I could trust you more than anyone with life and death decisions. I never once felt scared because I knew you were there for me, which is why I seemed to be so cavalier about the whole experience. I was scared inside, but I also had a tremendous peace about things because I knew you were going to take care of me.

In the days and weeks that followed you took the bull by the horns and made my care your top priority. You didn’t just sit by my side, you owned this crisis and became an overnight expert on heart health. You researched all of my medicines and asked a million questions of my healthcare team, all so you’d know how best to take care of me. And then there was the food! I don’t think people understand how critical food is in the first six months post heart attack, but you do. Reading labels is only the start…but you went so far above and beyond the call of duty its astounding. I don’t think I had to cook a single meal in the first few weeks, and even today you make my eating life so much more amazing than it would have been had I been in charge. I don’t think there’s any doubt had I been alone on this journey I would be eating peanut butter and jelly sandwiches for every meal. In the past few months you have made — from scratch — a variety of meals fit for a heart-healthy king. Pizza. Lasagna. Sweet and Sour Chicken. Chili. Soups. Fish. Casseroles. Grilled cheese. Even hamburgers this week! All low fat and low sodium. This is no small task and I want you to know how much I appreciate it. And have I mentioned the bread. I had no idea that when you bought a bread machine I’d be eating every kind of low sodium bread under the sun. Rye. Pumpernickel. Wheat. Sourdough. Homemade bagels and buns! You are not normal and I am so damn lucky.

Not every wife would have come with me to all my doctors appointments, or reminded me to take my pills (and there are so many of them!). When I started cardiac rehab you came three days a week with me until I settled in and got comfortable. You are one of the only spouses who regularly attends the learning sessions so you can have even more knowledge to take care of me. But it’s so much more than my physical health that you’ve taken care of these past four months. You’ve managed to do all of this while still making me laugh, and going on walks with me, and taking me out to restaurants and parties and friends houses. You planned my first post heart attack “vacation” with an incredible weekend for all of us in Coronado over New Years and while it could have been so stressful it was instead a new beginning and it shed the light on our future together. We can travel and eat out and enjoy the life we were meant to share together. You even encouraged me to buy the expensive impractical car and you haven’t complained yet about my new (is it permanent?) facial hair!

It hasn’t always been easy. But I really haven’t had too many down periods since all of this shit hit the fan. On the rare occasions when I’ve felt overwhelmed, you’ve simply been there for me to talk to or to hug. You have been so strong through all of this, and though I know you’ve had your moments as well, they have been few and far between. You are such a strong person…I could only hope to be as strong as you someday.

Through sickness and in health. We have been together for 20 years and it hasn’t always been easy. Relationships are hard work, and there is a reason why most marriages don’t make it. But through it all, you have been there for me. This may have been the biggest crisis we’ve had as a couple, but there were plenty of smaller ones. The common theme though is that you always rise to the occasion. Whether it was Connor’s health issues or our ill-fated move to Georgia or my career fiascos, it never mattered to you — you simply did what comes natural to you and took charge. I think you are the most remarkable woman on the planet and I don’t know what I did to deserve you. You are the most beautiful, intelligent, funny, caring, sexy, amazing woman in the world and you’re my Valentine. And I’m your Valentine. I wouldn’t want to be with any other woman in the world…ever.

I love you and Happy Valentine’s Day.

Lenny

Take this With a Grain of Salt

cutting-back-on-salt-01-afI promised I wouldn’t be preachy about heart disease awareness, so take this post for what it is — a cautionary tale. I have been on a very strict diet since October as I try to ensure my heart has the best chance it can to remodel itself following the damage of my heart attack. As you can probably guess, I’m seriously watching my cholesterol and fat intake. You may also know that there is a pretty clear link between salt (sodium) and heart disease, but I bet you didn’t know how clear.

Excess sodium can increase blood pressure which increases the risk of both heart disease and stroke. My cardiologist and the American Heart Association recommend heart patients limit daily sodium intake to less than 1,500 mg per day. One teaspoon of salt equals 2,300 milligrams of sodium. One Original Rubios fish taco has 450 mg of salt. A Big Mac has 1,040 mg of salt. A six-inch Subway Spicy Italian sandwich has 1,520. Get the idea?

Yesterday I made what I thought was a pretty healthy decision at lunch. I had mahi mahi tacos with nothing on them from my company cafeteria. A few hours later I went to cardiac rehab and my resting heart rate was elevated — with medications these days it’s usually around 60 bpm and it was close to 80. What caused the jump? The friggin tortillas! Two small flour tortillas together probably had about 700 mg of sodium and there was probably some seasoning on the fish I wasn’t aware of. I’ve been doing a really great job of sticking to around 1,000 mg per day so my lunch was way out of line — and it instantly affected my heart. That salt is some scary shit.

Ironically, yesterday was also the day that the CDC came out with a new report that most Americans were getting far too much salt in their diets. You can read the article online, but here’s a fact:

Americans eat on average about 3,300 mg of sodium a day. The U.S. Dietary Guidelines recommend limiting sodium to less than 2,300 mg a day, and about 6 out of 10 adults should further limit sodium to 1,500 mg a day.

I can tell you from experience that limiting salt is a pain in the ass. Eating out is nearly impossible and so many food items you bring home from the grocery store are also overloaded with it (ever looked at the nutritional values on a typical “healthy” frozen lunch?) This has become the hardest part of my post heart attack lifestyle. Salad bars are even dangerous. Leslie has done an amazing job of cooking for me and is even baking sodium-free bread from scratch. It’s still tough to stay on target.

It’s not that I miss the salt or the taste…it’s just so hard to find true low-sodium foods.

Three Months and Still Ticking

coronary_arteriesYesterday marked the 90-day anniversary of my heart attack which occurred on Oct. 15, 2011. I figured this is as good a time as any to give everyone an update on my condition, especially since I went to the cardiologist today. Here’s the latest:

  • I feel great. I am back to work full time, attending cardiac rehab twice per week, walking briskly 3-4 additional days per week, eating amazingly well (thanks in no small part to Leslie’s wonderful skills in the kitchen) and doing pretty well emotionally too.
  • At the time of my heart attack there were two main concerns — I developed a clot in the lower portion of my heart and there was muscle wall damage there as well. The good news from the cardiologist appointment today was that both of these have improved. The clot has shrunk considerably (the echocardiogram tech couldn’t even see it) and my heart function has improved as well.
  • Clots are common with heart attacks. The goal is to eliminate it, and to do that they put me on a series of drugs to thin my blood and lower my heart rate and blood pressure. The doc says another few months on the drugs and the clot should dissipate or be absorbed into the heart wall.
  • Heart function is measured by what is called an ejection fraction (EF). Basically it is the percentage of blood that’s pumped out of a filled ventricle with each heartbeat. A normal ejection fraction is anywhere from about 55 to 70. At the time of my heart attack the cardiologist estimated my EF to be around 35 and today it is closer to 45! An EF under 40 can be life threatening and may be a sign of heart failure, so the fact that mine went up so dramatically in just three months is a great sign. This improvement can be attributed to taking my meds, exercising and eating a low fat, low sodium diet.

So, what’s next? In mid-February I will be taking a stress test to see how my heart performs when my heart rate goes up. Since I have no other blockages and my stents have fixed the one I did have, I should be able to exercise vigorously going forward without any trouble and this test will show my doctor how my heart performs under duress. Even though I am exercising now with no trouble, my heart rate has remained low because of the drug therapy. I’d like to start increasing the intensity of my workouts so this will tell the doctor if that is ok. In March I have another appointment with my cardiologist to check my blood work (my cholesterol was around 70 in December…yes, 70, not 170!) and then a few weeks after that I’ll get another echo to see if the clot is gone and if my EF has gone up any more. I can have a very normal life with my EF at 45 but of course the closer to normal the better.

Physically I feel great. Psychologically I am doing good, but I still have bouts of anxiety although these are fewer and further between. The big mental part is wondering what the future holds and whether or not I will be able to do all the things I want to in life. Intellectually I know I will, but the anxiety can still get to me. It’s weird, but it hits at strange times like when I see a commercial on TV where someone is talking about retirement or when someone is working out really strenuously (damn you Gatorade!). I’m sure this will all get better over time, although I am seriously considering starting a local Meetup group for young heart attack victims to have some people to share stories with. It’s hard when all the patients in cardiac rehab are 20-30 years older than me! If you know anyone who might be interested in this kind of meetup group send them my way…

That’s it for now. Take care and thanks for listening!

To Infiniti…and Beyond!

What do you get when you take one 45-year-old man and add in a heart attack? A serious mid-life crisis! Surviving a heart attack last month really fucked with my concept of the future and now I truly understand what people mean when they say life is short. Shit, life can end in the blink of an eye. So why put off until tomorrow what you can do today?

For me, that means getting the car of my dreams. I have always wanted a convertible but old “practical” Len kept buying the Honda Accords and the Nissan Altimas. Hey, there’s nothing wrong with being practical and those cars served me well. But this life-altering event called for something really, really impractical! Why not, right? We have the Murano for long trips and hauling stuff around town, so today I got the flippin’ convertible!

Len Gutman would like to introduce the newest member of the family — the fully loaded 2011 Infiniti G37 convertible:

This is a car show image, but this is the car I leased today…black obsidian with wheat leather interior. Rear-wheel drive. V6. 330 horses. Retractable hard-top roof. Wicked sound system with Bose speakers built into the headrests. Navigation with real-time traffic. Heated and cooling seats.

I’m kinda diggin’ this whole Len 2.0 thing. You know you’re jealous! 😉

Are You a Heart Attack Waiting to Happen?

calciumThe most common question I’ve received so far from friends and relatives regarding my heart attack is how in the world did this happen to me? It’s true, on the surface I seem like the least likely person to have a heart attack. But the truth is, I was a ticking time bomb and had no idea. This much is true — I am thin, I run three miles three times per week, I do not eat meat with the exception of some fish, I have a relatively stress-free job and I see my doctor regularly. So why did I have a heart attack at 45?

I’m not sure we’ll ever fully know the answer to that question, but here are some other facts:

  • I have had high cholesterol and triglycerides  for more than a decade. I have been monitoring this, however, and have been on a baby aspirin and a statin (Lipitor) for many years and every six months I get my blood tested and my cholesterol numbers have been good. Last check my overall cholesterol was around 175.
  • I have a terrible family history of heart disease. My grandmother and grandfather on my dad’s side both died relatively young from heart related illness. My father had a heart attack in his early 60s, had both carotid arteries blocked and had quadruple bypass surgery. He has high blood pressure and diabetes.
  • I grew up in a household where both parents smoked and I ate a shitload of red meat and fatty foods well into my late 20s. I had a 80-90 percent blockage in one artery and it probably started long before I began to take care of myself.
  • What I’ve learned in the past few weeks is that with my family history I should have done more to keep my cholesterol down even lower.

So what could I have done differently? What can you do if you have concerns about your own heart health? The first step is to see your primary care physician and get a blood workup. After that, make an appointment to see a cardiologist to get a baseline of your heart health. They’ll do an EKG and maybe even a stress test. I saw a cardiologist about 8 years ago right after my dad had his bypass. I was 38 and the doctor told me to take a baby aspirin every day, stay active, eat right and come back and see him in five years. I did not, and looking back he may have done a stress test at that time and found the blockage before I had my heart attack.

But there’s a new test that is available now that anyone can take and it can determine your likelihood to have a heart attack well in advance and it is non-invasive. It’s called a Calcium Score Test and it’s a simple CT scan that can show whether or not you have any blockages. Had I had one of these tests they would have seen my blockage and been able to go in and clear it out before I had a heart attack and before any long-term damage was done to my heart. Wow.

The test is available at many places around the Valley. Because it’s new, it is not covered by most insurance companies (why does that not surprise me? ) but it’s really inexpensive. You can get the test for under $100 at Abrazo and Chandler Regional for example:

Get smart for your heart!