My Love/Hate Relationship With Breakfast

Today is National Cereal Day, and it comes at a time when I have been having a crisis of confidence regarding my breakfast choices. I’m not talking about whether to eat Lucky Charms or Cheerios (you might as well be pouring your milk over a bowl of cookies), rather my Sophie’s Choice involves grain in general. Because the more I look into it, even oatmeal or whole grain toast spikes your blood sugar which leads to diabetes and heart disease. Sorry Wilford Brimley, but oatmeal is actually NOT the right thing to do.

For years I’ve been eating plain steel cut oats with some berries or a banana and some sliced almonds for breakfast thinking this was a smart choice. It turns out this has been a better choice than cereal, pancakes or waffles but still inflammatory and a bad way to start the day.

“The major problem with oatmeal is the same problem with every other grain: It spikes your blood sugar and makes you hungrier.” — Dr. Mark Hyman, author of Food: What the Heck Should I Eat?

So if cereal is bad, and oatmeal is bad, what the heck should I eat for breakfast? That, my friends, is the question of the day.

In America, breakfast has really just become an excuse to pour sugar down your gullet. Breakfast has always been my favorite meal of the day. But as I’ve gotten older, and after having a heart attack, I’ve been obsessed with food and nutrition. I’ve talked to my doctors, read all the studies and looked into all the diets (Mediterranean, paleo, Engine 2, juicing, etc.) All the “expert advice” on the Interwebs is enough to drive you to drink. The web is a cacophony of conflicting advice. Who are we supposed to trust?

I’ve written about this before, but the best person to trust is yourself. My blood work has improved tremendously as I’ve eliminated grains and added sugar. My weight is down as well, though I’ve always been relatively thin by American standards. Late last year, six years post heart attack, I had another coronary catheterization and my arteries are clear. Whatever I’m doing seems to be working. So why change anything?

The biggest improvement in my blood work came after I started reading the advice of Dr. Mark Hyman. Yes, I’m skeptical of any “celebrity” doctor and I certainly don’t agree with everything he says — but he always links to research and that research is peer-reviewed and published in legitimate journals. When I started incorporating his paleo-vegan or “pegan” style of eating into my life, that’s when my blood work went from good to great.

After a year or so of eating a mostly pegan diet (I admit I didn’t always follow the rules, morning oatmeal being a perfect example. A little too much beer being another.) I was feeling pretty good about myself.

So recently when my wife picked up his new book Food: What the Heck Should I Eat?, I opened it first and started to read. And it reinforced what I’d been doing. And then starting on Sunday I doubled down on eating pegan. But then I woke up on Monday morning and with oatmeal off the table as it were I had no idea what to eat for breakfast! So I scrambled a couple of eggs with onions, avocado, and tomatoes using avocado oil in the pan and ate it with a serving of fresh blueberries. Then on Tuesday morning I fried a couple of eggs and ate them over a bed of sauteed spinach. And then this morning I woke up and couldn’t imagine eating eggs once again so I turned to the web to see what Dr. Hyman has for breakfast and basically it boils down to some kind of eggs with veggies or a smoothie.

So I poured some almond milk into the blender, added a half cup of frozen berries and a half cup of frozen mango, a tablespoon of ground flax seeds, two tablespoons of almond butter, half an avocado, and a tablespoon of coconut oil. And it was tasty. And it filled me up (in fact, as I write this it has been four hours since I drank my smoothie and I have not been hungry at all).

Still, there has to be more than eggs and smoothies, so I’ll continue to research. But it isn’t lost on me that what I’ve been eating for breakfast the past few days flies in the face of conventional wisdom about breakfast in America.

After all the controversy last year about saturated fat and in particular coconut oil, I’ve done more research. I think the medical establishment is wrong on fat and Dr. Hyman has helped to convince me. But I’m not just taking his word for it, I’m looking at the studies and ultimately my own body.

I’ll be getting some new blood work done soon so I’ll report out the results. In the meantime, just say no to National Cereal Day today and every day.

The One Thing You Should Do Today if You’re at Risk for a Heart Attack

1_lp5iquleQM96kgSkir-iegAs a heart attack survivor, I’ve had the opportunity to speak to hundreds of people about my experience. Whether I’m sharing the story over dinner with friends or blogging about the day of my cardiac event, one particular question always seems to pop up: what can I do to make sure this doesn’t happen to me?

People have preconceived notions about who is at risk for a heart attack and unfortunately these assumptions are usually very wrong. Most of us think heart attacks only happen to overweight people, or sedentary people, or smokers. People look at me and see themselves and it freaks them out. True, I didn’t have any outwardly apparent risks for heart disease, but below the surface I was a ticking time bomb. My triglycerides were significantly elevated. My high-density lipoprotein (HDL or good cholesterol) was low. My blood sugar was borderline high. My family history was chock-full of heart disease. I had what is commonly known as Metabolic Syndrome or Syndrome X — a cluster of conditions that increase the risk of heart disease, stroke, and diabetes.

Metabolic syndrome occurs when a person has three or more of the following measurements:

  • Abdominal obesity (Waist circumference of greater than 40 inches in men, and greater than 35 inches in women)
  • Triglyceride level of 150 milligrams per deciliter of blood (mg/dL) or greater
  • HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women
  • Systolic blood pressure (top number) of 130 millimeters of mercury (mm Hg) or greater, or diastolic blood pressure (bottom number) of 85 mm Hg or greater
  • Fasting glucose of 100 mg/dL or greater

I had three of the above symptoms, all hidden below the surface. And I knew about it. And I tried to fix it on and off for years by adjusting my diet and exercising more. But I still had a heart attack at 45.

What could I have done to avoid having a heart attack?

When people ask me that question (and they always do), I say the same thing: if you have three or more of the signs of Metabolic Syndrome, or a family history of heart disease, and are over the age of 40 — go get a coronary artery calcium (CAC) scan.

Right now you’re probably thinking how come you’ve never heard of this test. Is this something new? It’s not new, and has been around since the early 90s, but for a long time it has been seen by many cardiologists as not reliable enough to recommend for their patients. But that is changing, as discussed in a newly published article by Harvard Health Publishing, and as evidenced by the growing number of hospitals and diagnostic labs that offer the test.

“CAC results can help identify a person’s possible risk for heart attack or stroke, even if that person doesn’t have the obvious risk factors or symptoms,” says Dr. Jorge Plutzky, director of preventive cardiology at Harvard-affiliated Brigham and Women’s Hospital. “It can be a way for some people to get the necessary treatment early and hopefully head off a serious cardiac event.”

If I’d had a CAC at a local hospital prior to having a heart attack on Oct. 15, 2011 it’s very likely the test would have shown that I had a severe blockage in my left anterior descending artery. Instead of having the heart attack that nearly killed me and permanently damaged my heart, the test results would have tipped off doctors that I was in danger and they could have gone in and stented the artery before the damage was done.

I’m not saying everyone should run out and get a CAC. But if you are at risk for heart disease it’s a valuable tool in the arsenal and it just might save your life. And while insurance companies aren’t yet sold on its value (and since when have insurance companies cared about your health), it’s a relatively inexpensive test and in most places you don’t even need a referral from a doctor. That’s right, you can use Google to find a test location near you, make an appointment, and plop down less than $100 for a 15 minute non-invasive test that might save your life.

That seems like a small price to pay for peace of mind.

National Wear Red Day® is Friday, Feb. 2, 2018

Heart disease is the №1 killer of women, causing 1 in 3 deaths each year. That’s approximately one woman every minute!

To spread awareness about heart disease in women, the American Heart Association invites you to wear red on Friday, Feb. 2 and share pictures on social media using the hashtag #WearRedDay

Learn more about women and heart disease on the Go Red For Women website.

GoRedVideo

The Best Post Heart Attack Diet and How it Can Also Prevent a First Heart Attack

I can say with no uncertainty that the fastest way to get into an argument with a bunch of heart attack survivors is to discuss diet. Seriously, you’re better off discussing politics or religion. I think the reason for this is quite simple — nobody really knows the best way to eat to prevent heart disease, the number one cause of death in the world.

Well, that’s not entirely true. I don’t think anyone would argue that a truly healthy diet is mostly focused on fruits (providing you are not diabetic) and vegetables. And while we can argue about the merits of measuring glycemic load vs glycemic index, or whether juicing fruit removes too many of its healthy properties, fruit is healthy for most people and it is part of a balanced diet.

But that’s where the agreement ends and zealotry begins. For every diet “expert” on the Internet that claims fat will kill you there are an equal number who tell you fat is our friend. Should we eat meat? Just white meat? Just fish? And what about carbs? Simple or complex? Gluten or gluten-free? And just what the hell is a FODMAP?

For each style of eating there’s a diet out there that helps you meet these typically strict requirements. U.S. News and World Report recently published its 2018 ranking of diets, and they looked at no less than 40 popular diets. Some you’ve likely heard about, like the Mediterranean Diet, Weight Watchers, and the Zone Diet. Others sound flat out made up, such as the Nutritarian Diet, the Volumetrics Diet, and the Flexitarian Diet. And of course there are the “hot new trend” diets like the Whole30 Diet, the Engine 2 Diet, and the suddenly everywhere Keto Diet.

But back to my fellow heart attack survivors. I run a support group for heart attack survivors on Facebook and whenever diet comes up the same thing happens — everyone chimes in that their diet is best and if you don’t eat this way you’ll die. And they usually point to legitimate studies to support their view. And that’s the real problem. Many of these diets will improve your overall health, but in some cases the diets themselves contradict each other.

For example, one popular diet among the heart attack crowd is the Esselstyn Diet, which purports to prevent and reverse heart disease. Holy crap, shouldn’t we all be on this diet? Dr. Esselstyn argues that a plant-based, oil-free diet can not only prevent and stop the progression of heart disease, but also reverse its effects. On his diet, you’ll also need to eliminate nuts/nut butters and saturated fat, but you can increase whole grains. Hot dog buns yes, hot dogs no? And beware of the vegan police!

Then there’s the Keto diet, which argues you can have all the meat you want, plenty of high fat dairy, nuts and other fats but stay away from grains, fruits and sugar. Lamb chops yes, apples no?

Which diet is right? Can they both be right? Well, that’s a tough question. Both diets will undoubtedly lead to weight loss, but I’m interested in heart disease prevention. Which is it, bread or no bread? Fat or no fat? Apples or no apples? Trying to figure this out is enough to cause a heart attack!

For what it’s worth, U.S. News and World Report ranked the Keto Diet 35th out of 40 for best heart-healthy diet and dead last in overall diets, for the most part because it’s hard to follow and the data is not in yet on this relatively new diet (although it sounds an awful lot like the old Atkins Diet to me).

U.S. News selected the DASH Diet tops overall and for heart health. This diet focuses on lowering blood pressure, emphasizes fruits, veggies, whole grains, lean protein and low-fat dairy, and suggests you avoid foods high in saturated fat such as fatty meats, full-fat dairy foods and tropical oils, and sugar-sweetened beverages and sweets. Hmmm. This sounds familiar — eat your fruits and veggies and lay off the fat and sugar. A little lean protein and dairy is okay.

Here’s my take — as long as the jury is still out scientifically on “fad” diets like Keto or ultra-specific diets like Essylstyn and its little brother the Engine 2 Diet, I’m going to stick to the basics. I try to eat a Mediterranean Diet, which has been proven to lower the risk for heart disease. It’s also easy to stick to and gives you flexibility. And it aligns nicely with the mantra espoused by writer and journalist Michael Pollan, who famously wrote about his seven word diet: eat food, not too much, mostly plants.

Am I eating in the best way possible for my heart? I don’t know and I don’t think the medical community knows. But my post heart attack health speaks for itself. I had a recent angiogram that showed very little plaque buildup in my arteries and my blood work would make a healthy person jealous. Cholesterol is under 100. Triglycerides at 85.

I eat a diet rich in fruits and veggies, lean poultry, fish, healthy fats (think avocado and olive oil) and small amounts of whole grains. I avoid added sugar as much as possible. Wonder Bread no, Ezekiel Bread yes. It seems to be working for me. Is this a Mediterranean Diet, or the DASH Diet, or the Michael Pollan Diet, or the “Pegan” Diet?

Yes.

I Was the Last to Know I Was Having a Stroke

Last spring I had a stroke. It feels weird writing these words, because truth be told I haven’t really shared this with too many people. When I had a heart attack in 2011 I shouted the news from the virtual mountaintop that is social media, but for some reason I’ve kept the stroke news closer to the vest. I think maybe I’ve been reluctant to share the stroke story because I’m still in denial about it and frankly it scared me more than I’d like to admit. More than the heart attack. I’ll tell you why.

My stroke occurred more than five years post heart attack, and in those five years I’d been doing everything in my power to take good care of my cardiovascular system. I had been eating right, taking my medications, exercising regularly, and keeping my cholesterol in check. I’d been going to the cardiologist every six months and having all the appropriate tests — stress tests, echo-cardiograms, blood work. I was in as good a condition as any heart attack survivor could expect. I let my guard down. So the last thing I expected last April 30 was a stroke.

I was helping my parents move into a new apartment in Tucson when it happened, but I didn’t know anything was wrong. I was moving boxes and clothes between the rental truck and the apartment when apparently I began slurring my words. My niece said later she thought I was being silly. My mother said she thought I was making fun of someone. My brother-in-law, however, was the first to notice something was not right. He was handing me a box from the back of the truck and evidently he yelled for my wife to come quickly.

My wife took one look at me and called 9–1–1. I was telling her to relax and that I was fine while she was on the phone with the 9–1–1 operator telling her that I was slurring my word and that the entire left side of my face had fallen. I assured her I was fine. The look on her face was of pure terror. She told me to sit down and be quiet.

The paramedics arrived within minutes and I guess by then the symptoms had already gone away. I listened to my family tell them what had happened and I honestly thought they were nuts. I was fine. They took my blood pressure and asked a few more questions, then let me know they’d be taking me to the hospital to be safe. I then got my second ambulance ride in the past five years.

At the hospital they ran some more tests and surmised I’d had what’s called a transient ischemic attack, or TIA. Basically a TIA is a temporary blockage of blood flow to the brain. A TIA is like a stroke, producing similar symptoms, but it usually lasts only a few minutes and causes no permanent damage. Unfortunately, after a few more tests, including an MRI of my brain, the truth was I did indeed suffer a stroke. A small stroke, but a stroke nonetheless. Additionally, one of my carotid arteries was 100 percent blocked. And despite my insistence that I was fine and more than well enough to fly to London in two days for a long-planned European vacation, I would not be going home for a few days and I would not be seeing Big Ben anytime soon.

Without going into too much detail, the next several weeks included more tests, a visit to my cardiologist back home in Phoenix, a visit to a vascular surgeon to confirm the carotid artery blockage, a visit to an electrophysiologist to rule out that the stroke was caused by a clot as a result of atrial fibrillation (AFib), and a trip to the cath lab to see if I had any other new blocked arteries.

None of these doctors could fully explain why I’d had a stroke. The vascular surgeon thought the stroke was likely caused by a spontaneous dissection of my carotid artery, meaning the blockage was the result of a random tear in my artery. The electrical guy pretty much ruled out AFib. The cardiologist who did my cath said my heart and surrounding arteries were clear and it was unlikely that the stroke was caused by a clot emanating from my heart.

All of this was good news actually, because the biggest concern for me was that despite all the work I’d been doing to keep my arteries clear (i.e. diet, exercise, medications) I was still producing sticky artery-blocking plaque. I was terrified that all my hard work was to be for naught, and in fact that fact alone caused me to fall into a pretty serious funk in the weeks following the stroke. I was sure my body was a plaque-making machine and that I was doomed to die an early death. I’m not typically a doom and gloom guy, but I actually started looking into burial plans so in case I kicked the bucket my wife wouldn’t have to worry about the details. Morbid I know, but that’s where my head was. And by the way, when you reach a certain age it’s actually a good idea to discuss your death wishes with your loved one, but that’s a story for another blog post.

The last specialist I saw was a neurologist, and his assessment was that the vascular guy was probably right — I’d had a dissection. And a few weeks later when another MRI showed that my carotid artery was no longer fully blocked but in fact mostly open, we all agreed that I did indeed have a dissection. In layman’s terms, this means I had a stroke because for some unknown reason my carotid artery decided to tear and as a result a small clot traveled to my brain and cut off the blood supply long enough to cause slurred speech and face droop. Yep, it was a freak accident and probably had nothing to do with my heart disease history aside from the possibility that my carotid artery may have been a little weaker due to plaque build up. Basically, there was nothing I could have done to prevent it, but it wasn’t likely to ever happen again.

Boy did I feel…lucky? I’d cheated death for the second time in five years. Let’s hope the third time is not the charm.

So why share this now, after nine months? Well, this week many of the best medical minds in the world are gathering in Los Angeles for the International Stroke Conference, the world’s largest meeting dedicated to the science and treatment of cerebrovascular disease. Yet I bet you had no idea stroke is the fifth leading cause of death in America.

I don’t think many of us think about stroke, or even really know what a stroke is. There are various kinds of strokes with different causes, and you can learn a lot on the American Stroke Association website. But really what I’d like to get across is that 80 percent of strokes are preventable through diet and exercise as well as by keeping an eye on the warning signs like high blood pressure, elevated cholesterol, obesity, diabetes and more.

I’d also like to spread the word about the warning signs of stroke — the things my wife and family noticed about me that lead them to call 9–1–1. The warning signs of stroke are: face drooping, arm weakness, and speech difficulty. One or all of these symptoms means it’s time to call 9–1–1. Knowing these signs can save a life.

Boo-Yah! I’m Happy to be Alive

espn_sscott_01_600x600.jpgWhen the news broke yesterday morning that ESPN commentator Stuart Scott had lost his battle with cancer I once again found myself in a funk. The news hit me hard, but only partly because I was a huge fan. Yes, he brought us the classic home run call of “boo-yah” and when a guy like M.J. drained a game winning shot he’d remind us all that the player was “cooler than the other side of the pillow.” These calls stuck with us as sports fans and became part of the sports vernacular.

But while I was sad about his death because he was a great television reporter, I was even more upset that he died at such a young age — around my age. Stuart Scott and I are less than a year apart in age and while it’s always sad when someone dies young since my own brush with death a few years ago these deaths seem to hit me harder. I don’t know Stuart Scott and he didn’t have a heart attack, but I feel a closeness to him and other people who die young. And not just celebrities. I have the same reaction whenever I hear about someone my age dying.

I get really sad when people my age die; in fact, yesterday I was depressed for most of the day. I thought about his two girls and how they’ve been left without a dad. I thought about all the friends he had at ESPN and around the world. Man, 49 years is not enough time on this planet.

I’m sure everyone who knew Stuart Scott or who was a fan of Stuart Scott felt the loss yesterday, and I’m not suggesting I feel it more because of my own experiences. Plenty of people have survived devastating diseases and believe me many of them have had it far worse than me. I think it’s just that each time someone like Stuart Scott doesn’t make it I am reminded that I almost didn’t make it and that starts me off on the “woe is me” stuff. I know I have been extremely positive about my heart attack publicly, and for the most part I have remained positive in my personal life as well, but that doesn’t mean I don’t have freak out moments about almost dying and it seems to be more prevalent at times when someone my age dies. If my wife is reading this right now I know exactly what she’s thinking: shut up and quit whining. You want to change places with someone who is actually suffering? There are millions of people who’d trade places with you.

There’s a great quote from Woody Allen in Annie Hall:

“I feel that life is divided into the horrible and the miserable. That’s the two categories. The horrible are like, I don’t know, terminal cases, you know, and blind people, crippled. I don’t know how they get through life. It’s amazing to me. And the miserable is everyone else. So you should be thankful that you’re miserable, because that’s very lucky, to be miserable.”

I need to remember that line whenever I’m feeling bad about my circumstances. Intellectually I get it, but sometimes it’s tough. The good news is, the sadness usually only lasts a short while. Which brings me back to Stuart Scott. He was one of those horrible cases. He suffered through seven years with cancer, including multiple surgeries and chemotherapy. I chose to share the old photo of Stuart in this blog post because that’s how I will always remember him, not as the frail man he became over the past few years as he battled the disease.

But more important than his physical stature, Stuart Scott exemplified what I think we all should strive for when the chips are down. The guy could barely move last year when he arrived at the Espy Awards to receive the Jimmy V Perseverance Award yet he was as cool as the other side of the pillow. For him staying positive mentally was far more important than being physically fit (though he did manage to take up MMA fighting while he was recovering from chemo). The line we’ll all remember from that speech at the Espy’s, and the one that is getting a lot of airtime over the past 24 hours, is this one:

“When you die, it does not mean that you lose to cancer. You beat cancer by how you live, why you live, and in the manner in which you live.”

So while my initial reaction to Scott’s passing was sadness, today I woke up with a renewed spirit to live my life to the fullest. Not all of us get a second chance.

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