‘Deep Medicine’ Paints Collaborative Future Between Doctors, Artificial Intelligence

Depending on your perspective, Artificial Intelligence (AI) either brings thoughts of a future enhanced by technology or strikes fear in your heart that robots will take over the world. Some of the brightest minds in technology (I’m talking about you Elon Musk) have warned humanity about the dangers on the horizon, yet it’s breathtaking to envision just how much AI can improve our lives. I for one welcome our new robot overlords.

In Deep Medicine, cardiologist Eric Topol takes readers on a fantastic journey to a not-too-distant future where AI works side-by-side with the medical community to improve all aspects of health care, from individualized medicine to improved productivity and lower costs to virtual personal wellness assistants (think Amazon Alexa on steroids). Topol’s research points to numerous advances either currently underway or in development and paints a picture of a true partnership that is already shaping the health care environment.

I choose to take an optimistic view of this future, perhaps because I admire science and what it has done and can do for humanity. When I bring up the future of medicine in conversations, I often see fear come across people’s faces rather than wonder. It happened today at a luncheon when the discussion turned to the future of health care and someone at the table brought up futurist Ray Kurzweil’s belief that in the coming years, we’ll all have nanobots injected into our bloodstream designed to hunt down and kill infections. A woman at the table looked downright mortified, and her look became even more uncomfortable when I followed by describing Kurzweil’s conviction that in the next couple of decades mankind will reach a singularity where man will essentially merge with machines. For some this concept means the end of homo sapiens, but for me and other cheerleaders for AI and machine learning it simply means the beginning of our next phase of evolution. Who’s to say evolution isn’t meant to include the merging of flesh and technology?

I understand why AI might frighten some people. And I agree mankind must move forward with a set of ethical guidelines to ensure we don’t end up in some dystopian brave new world. But I think a future with AI is brighter than a future without it. For me, science and technology represent progress. Just 100 years ago, human life expectancy was around 50 years. Today, thanks in large part to science and technology our life expectancy is around 80. Many experts believe that a person born in 2100 will have an average life expectancy of 100 meaning many of us will live well beyond the century mark. I can’t help you if you don’t want to live that long, but I’d suggest your worldview may be skewed by the fact that you equate old to unhealthy. Topol’s point is that AI and machine learning will improve not just our longevity but perhaps more importantly our quality of life.

The book, however, does not fail to alert readers to the potential pitfalls of a health care system reliant on AI. Perhaps the biggest issue for Topol, and rightfully so, is the concern over privacy. If bots and databases have access to our health information – including our genetic code – doesn’t that set up a scenario whereby our private health data can be stolen or even sold to the highest bidder? Or might we end up in a place where our employer, or the government, can deny certain rights or privileges because of our health? I’m no Pollyanna. I can imagine a situation where a person could be denied employment or insurance coverage because they have a health issue. However, Topol argues that we need to set up safeguards for just these kinds of things and if we do the pros will far outweigh the cons. And not for nothing, it’s not as if the American health care system is working now. Even though America pays thousands more per capita for its citizen’s healthcare we rank at or near the bottom of most global ratings systems in terms of measures like quality and efficiency. We can only go up from here, and technology will play a key role.

Topol also raises concerns over where technology will reside within the healthcare system. By that he means if we let AI replace doctors, we may gain some efficiencies and diagnosis improvements, but we will lose the patient/doctor connection or “presence” that he and others believe is paramount to quality care. Rather, he argues that the best future sees AI working alongside medical practitioners in order to free them up to focus on patient care. Doctors today spend more time entering data into electronic health records via keyboard or recorder and less time listening to and examining patients. If AI is able to manage the routine parts of healthcare and assist doctors with diagnosis using machine learning and big data that will give doctors more time to interact with patients, something all medical professionals agree equates to better results. If you’ve ever sat in a doctor’s office while he or she typed notes into a tablet or laptop instead of looking you in the eyes you know what I’m talking about. These days it’s not unusual for a doctor to spend less than 10 minutes with a patient!

“The greatest opportunity offered by AI is not reducing errors or workloads, or even curing cancer: it is the opportunity to restore the precious and time-honored connection and trust—the human touch—between patients and doctors,” Topol writes in Deep Medicine.

That said, there are so many areas of medicine where AI can help us make giant leaps in diagnosis and treatment. AI has remarkable advancement opportunities in areas like pathology and radiology where machines can look at millions or billions of inputs to see patterns that the human eyes could never see. It can identify correlations that might never be noticed by human researchers. It can scan through billions of pages of studies and articles and identify a diagnosis in a fraction of a second, where humans could never consume or recall the vast knowledge base that medicine relies upon. It can compare billions of patient records and uncover connections that can lead to new, more effective, treatment protocols. It can compare genetic data with pharmaceutical data and recommend the exact right drug to treat an individual’s specific medical issue.

One area that I found fascinating (and really exciting) is the potential for virtual medical assistants that can work with patients in the clinic or at home to diagnose and suggest treatment. If you have a digital assistant at home (like an Amazon Alexa or Google Home) or a smart watch or smart phone you’ve already seen how this works. By 2018, more than 60 million Americans were using these AI-powered devices and that number will grow. It’s projected that by 2020, 75 percent of American homes will have at least one voice-activated personal assistant. Indeed, we have a Google Home device in every room of our home and access Google Assistant on our smartphones multiple times per day. And while medical applications for these devices today are pretty much limited to counting steps or providing information from WebMD, many people (including myself) now have a smart device that can check one’s pulse rate and some even check blood pressure. The medical applications for these devices are increasing rapidly.

“Offering a glimpse at how wearable technology may help flag potential health problems, the Apple Watch was able to detect atrial fibrillation (AFib) in a small group of people who had received an alert of an irregular heartbeat, said researchers presenting results from the Apple Heart Study.” – American College of Cardiology, 2019

The future will include glucose monitoring for diabetics, gut biome assessment, sleep improvement, stress reduction, and more. Topol lays out a host of amazing ideas, some that are already in development. He offers several potential scenarios where an individual can begin a dialogue with a home-based AI that can results in immediate diagnosis via voice input and/or device input (one even includes a scenario where the person is asked to place his phone up against his stomach where he is having pain and the device uses ultrasound or some mechanism to determine that the patient has gallstones and should see his doctor for treatment). The future is only limited by the imagination of data scientists and inventors who can design and build all kinds of input devices.

Again, Topol is in no way suggesting AI should replace doctor care. But if AI can diagnose many common and treatable issues at home the time and cost savings will be dramatic. I’ve already had a doctor diagnose an infection by looking down my throat via video conference on my mobile phone – it’s a simple step to having that same diagnosis come from a machine without the need for human interaction.

Frankly, all of this excites me and makes me hopeful for the future. And Topol didn’t even get in to other medical advancements in this book, such as precision medicine, 3D printed spare organs, or CRISPR gene editing. I admit that part of the reason for my interest in these areas is because I have a damaged heart from a heart attack I experienced in 2011. The idea that my heart can be returned to normal through new medicines, gene editing or stem cells is, well, heartwarming. This technology came too late to keep me from having the heart attack in the first place, but it’s not too late to both improve my life and perhaps extend my life. And while I’m not exactly holding out for the singularity, I wouldn’t mind living a long and healthy rest of my life.

The Time My Family Acted FAST and Saved My Life (again)

When celebrities die, the world seems to suddenly become more aware of the many maladies that kill humans. I think that’s probably a good thing, because we need the occasional reminder of our mortality to keep us centered, but also because following the death of a famous person we get a series of reminders of what we need to look out for regarding our own health. Famous deaths, in a strange way, have a secondary effect of making us healthier.

Actor Luke Perry, who died on March 4 following a stroke.

While we don’t know yet exactly what killed actor Luke Perry, we do know it was due to complications from a stroke. The buzz around his death is that most people think stroke is a disease that old people get, but unfortunately that’s just not true. There was a good article in the New York Times this week about how stroke effects younger people.

In my work I meet a lot of young stroke survivors including some in their 20s and 30s. While it’s not too common, it does happen. The article calls out undetected birth defects, blood clots, and aneurysm as reasons for stroke in young people, and there have also been some high profile drug interaction causes like in the case of the oral contraceptives Yaz, Yasmin, and Ocella which were not found to cause stroke but which were taken off the market because of side effects that may have led to stroke in some women.

And then there is the dreaded spontaneous arterial dissection, something that I learned far more than I would have liked when in 2017 at age 50 I suffered a stroke as a result of a dissection of my carotid artery. Because you probably have no idea what a dissection is, here’s a definition:

“An arterial dissection is a tear in the lining of an artery. When a tear occurs in a major artery in the head and neck — the carotid or vertebral arteries — that transmit blood to the brain, this is called a cerebral arterial dissection.”

— University of California San Francisco

In layman’s terms, for various reasons an artery can tear without warning and as a result blood flow can be cutoff to the brain or a clot can travel to the brain causing a stroke. Fun, huh?

In my case, I was in Tucson helping my parents move on a lovely April day and unbeknownst to me I began slurring my words. When I say unbeknownst to me that’s because I honestly have no recollection of it. I continued to move items from the truck into the apartment, and apparently my niece thought I was joking around and slurring my words on purpose in an attempt to make fun of someone. Unfortunately, that wouldn’t be abnormal behavior for me. A few minutes later, back at the truck, my brother in law responded much more dramatically. He noticed that the entire left side of my face had dropped, and he yelled for my wife.

Moments later I do remember being back in the apartment and telling my wife I was fine. In fact, I insisted I was fine. But my wife was by my side six years earlier when I had a heart attack and tried to play it off so she was having none of it. She also knew about FAST.

  • Face Drooping
  • Arm Weakness
  • Speech
  • Time to Call 9-1-1

I had the F and the S covered, and she took care of the T. Within minutes, the paramedics arrived and while my symptoms had gone I got a ride to the hospital to be safe (I was a heart patient after all). Because the stroke was short-lived, doctors figured it was a Transient Ischemic Attack (TIA), often called a mini-stroke. These are fairly innocuous, but could be a warning sign of something worse to come. But tests confirmed I had a full-on stroke, and nobody could tell me why.

I don’t want to minimize my stroke, but I got lucky. Unlike Perry, my stroke was small, came and went quickly, and in the end I have had no noticeable deficits. My face and speech returned to normal, I experienced no arm or leg weakness — hell I didn’t even have a headache. In 2011 I had a nearly 100 percent blocked widow maker artery and my heart has pretty much bounced back. I had a stroke and have had no lasting effects. I am clearly a lucky dude.

Perry, however, was not so lucky. As we learn more about his stroke I suspect the reason for its size and devastation will become more clear. For my part, it took five days in the hospital, three specialist followups back home in Phoenix, and multiple invasive tests to diagnose with some certainty (not complete certainty) that my stroke was a result of a dissected carotid artery.

Honestly, we still don’t know exactly. The hospital doctors couldn’t determine why following the stroke my carotid artery was 100 percent blocked. Neither could my cardiologist. She sent me to an electrophysiologist to see if it was due to a clot from atrial fibrillation (AFib) or another heart rhythm issue. He ran some tests and those came back normal. I then went to a vascular surgeon, who said that because of the shape of the blockage in my carotid artery it was likely a dissection, but he couldn’t be sure. Oh, he also said there was no way to fix my carotid artery because it was too dangerous to try to open the blockage so I would simply have to live the rest of my life relying on the other arteries delivering enough blood to my brain. (This is cool, but apparently the body learns to compensate and even creates new arteries to get around the blockage).

Because of my heart history, the biggest worry for me was that the carotid blockage was caused by the same thing that caused my heart attack — calcium buildup from fat and cholesterol in my blood. This was infuriating to me, and really scary, because since my heart attack I had changed my lifestyle and been working hard to maintain good cholesterol. If my efforts had been fruitless I may have been fighting a losing battle all these years.

Strangely, the possibility that the stroke was due to plaque buildup put me into a major funk. I had beat the heart attack in 2011, but if I could still drop dead any second from a stroke or another heart attack despite all that I had done to negate this possibility, I was a lost cause. After my heart attack I was oddly calm. I got lucky, and I moved on. I really didn’t overthink how close I came to dying. But the stroke knocked me for a loop.

I started to dwell on death. I began researching cemeteries because I wanted all those details to be taken care of before I croaked so my wife and family wouldn’t have to worry about it all. I went as far as to research various alternatives to burial like burial at sea and natural or green burial. I found out I could be cremated and planted with a tree, or turned into a diamond (although asking one’s spouse to wear your dead ashes around their neck after your gone is a bit selfish). I even dragged my wife to visit a few cemeteries in the area, but in the end the cemeteries in Arizona were depressing as hell and I eventually changed my mind altogether and decided I wanted to be cremated and have my ashes spread at Powerhouse Park in Del Mar, Calif. (my favorite spot on earth). So I got that going for me.

The possibility of the stroke being caused by more plaque buildup led to me having an angiogram to check inside my heart and arteries. So it was back to the hospital to have a camera inserted through my groin and up into my cardiovascular system, and the good news was that my arteries were all very clear. All the work I had been doing to keep my cholesterol down had been working.

That was sweet relief, but it didn’t provide an explanation for the stroke. Next stop was a neurologist, and more scans, and then something really odd happened. The new scans, taken just a few months following my stroke, showed that my once fully blocked carotid artery was now flowing nicely. It had spontaneously cleared on it own. This phenomena all but convinced my neurologist that I did indeed suffer a dissection, since many dissections spontaneously heal on their own. The body once again outsmarted medicine.

This all leaves me with no clear answer as to what caused the dissection, as I did not experience any trauma like an accident or a roller coaster snapping my neck too forcefully. And while I ended up having a good outcome (just like I did with my heart attack), it still left me a little uneasy about how delicate our bodies can be. But hey, what can you do?

These days I don’t think about the stroke much. When I meet stroke survivors who have been left with deficiencies, I feel a little guilty in the same way I feel guilty when I meet heart attack survivors who had to get cracked open for a bypass. And, as this blog post might suggest, I am always taken back to that day in April 2017 when someone famous has a stroke.

The bottom line here is that I am probably still alive thanks to luck, and the quick thinking and persistence of a smart spouse. So I suppose the lesson is to know the signs of stroke and heart attacks and be vigilant. If you suspect you are having a stroke or heart attack, get thee to a hospital post haste even if you aren’t sure. The life you save just might be your own.

And RIP Dylan McKay!

American Stroke Association

New Data Suggests Half of Americans Have Heart Disease — Here’s How to Tell if You’re One of Them

Last week new data was released that indicates about half of all Americans have some form of cardiovascular disease, representing more than 120 million of us. And while the number crept up in part because of new guidelines regarding blood pressure, it’s nevertheless a staggering number.

The Centers for Disease Control reports that about 610,000 people die of heart disease in the United States every year – that’s 1 in every 4 deaths. Heart disease is the leading cause of death for both men and women. While the media and our elected officials spend their time focused on manufactured or even downright false threats to Americans like caravans of Mexicans and Islamic terrorists, the true threat is staring us in the face and we’ve hardly noticed. For comparison’s sake, in 2016 the number of people in America who died due to terrorism was 68. Cardiovascular disease is the number one threat to the well being of all Americans regardless of political ideology.

Like many concerns, a solution begins with the admission that you have a problem. Well, Houston…and Minneapolis…and Charlotte…we have a problem.

The factors that were used to determine if you have cardiovascular disease includes both behavior and health measures. And not surprisingly, there are no surprises here. It is simple to find out if you are one of the 120 million Americans who have some form of cardiovascular disease. There’s even a handy dandy free checklist online here.

Here are the seven factors:

  1. High blood pressure. Anything 130/80 or above is bad. Seriously, it takes one minute at any drug store to find a kiosk and check your blood pressure.
  2. Cholesterol. Generally speaking, adults should have total cholesterol of less than 200. Your LDL (bad cholesterol) should be under 100 and your HDL (good cholesterol) should be 40 or higher for men and 50 or higher for women. Triglycerides should be less than 149.
  3. Blood sugar. A fasting blood sugar level less than 100 is normal.
  4. Be active. Sitting on the sofa is going to kill you. Get up and move. You don’t need to run a marathon, just move your ass at least 150 minutes per week at a moderate pace. That’s like 20 minutes a day of walking.
  5. Eat better. This one is also easier than you think. Lay off the carbs and added sugars and eat a well-balanced diet that consists of mostly vegetables, fruits, whole grains, and healthy fats. This is not rocket science people.
  6. Lose weight. If you do the above two things (eat better and be active) you don’t have to do anything more to reach this goal.
  7. Stop smoking. Vaping too. Knock it off.

So are you one of the 50 percent of Americans who have some form of cardiovascular disease? The answer is yes if you have high blood pressure, high cholesterol, high blood sugar, or if you smoke, eat like crap, don’t exercise, or carry around some extra weight. Frankly, it’s surprising to me that it’s not more than 50 percent of us.

All this is to say what I’ve said before on this blog — heart disease is 80 percent preventable so dying from heart disease is essentially optional. It’s time to pay attention to your risks and do something about them. There’s no excuse anymore for not knowing your risks. If you are a functioning adult you should be able to rattle off your blood pressure numbers, and your cholesterol and blood sugar levels. If you don’t know your numbers, see your doctor right away and find out. Your life literally depends on it.

Not All Bread is Created Equal

“Give us this day our daily bread”

Matthew 6.11

Whole grains. Refined grains. Ancient grains. We’ve come to a place in history where even something as simple as bread has become a cacophony of choices. It’s one of those things that drives some people crazy because change is hard, and while I understand the desire for wanting things to remain the same when it comes to health I prefer to listen to the science. And the science is becoming quite clear when it comes to bread. You may have grown up on white bread but eating refined grain bread like Wonder Bread is akin to downing straight sugar — and sugar is going to be the death of you.

This week I read a great article that did a nice job of making the case for whole grain bread. Whole grain means the bran, the germ, and the endosperm of the grain kernel have all been left intact, meaning the bread is rich in fiber, vitamins, and minerals. Whole grain bread can include wheat, but can also include other grains like barley, rice, oats, and others. You may see it marketed as 9 grain, or 12 grain, or even 21 grain.

Regardless of how many types of grain are in the bread, the key thing is that the grains are not processed down to flour which removes the nutrients and when digested pretty much leads to excess sugar in your bloodstream which in turn is stored in the body as fat. This is why so many doctors, nutritionists, and other health professionals say cutting out bread can help you lose weight. Refined flour can also lead to insulin resistance and eventually diabetes and heart disease.

“Bread made with whole grains = good. Highly processed bread (e.g., white bread) that adds calories and sugar but not much else = not so good.”

— Health & Fitness Cheat Sheet

Hence you’ve probably heard me say bread equals death of some variation of the bread will kill you trope. You’ve probably also heard me say I eat a low carb diet, which is true — but note that I never say I eat a “no carb” diet.

I avoid all refined-grain bread and bread products, including bagels, pizza, crackers, pretzels, etc. I will almost always pass the bread basket at a restaurant because those rolls are more than likely made from refined grain. Yes, it’s hard. That shit is addictive. If you try to cut it out cold turkey you’ll go into withdrawal. I read that heroin-addicted rats once given sugar water will choose the sugar over the heroin.

But I do eat bread on occasion. In fact, whole grain bread is an important part of a healthy diet. I may have two slices as part of a sandwich a few times a week, or eat a slice of toast with eggs for breakfast. But I eat whole grain, high fiber, low sugar bread. And no, it doesn’t taste like cardboard. In fact, I think whole grain bread has much more taste and texture than refined flour bread.

Unfortunately, the labeling and marketing of bread are confusing. Wheat bread may be whole grain or not. Multigrain may be whole grain or not. You need to look for the words “100 percent whole grain.” Here’s a good explanation.

But I’ll make it even more simple for you. Our favorite bread is Dave’s Killer Bread Powerseed. It is ridiculously delicious and loaded with fiber, protein, and whole grains. We also enjoy Ezekiel Bread, which is made from sprouted wheat. Nature’s Own is also very good.

The trick is to eat good bread, in moderation, and to avoid bread of unknown content which means most bread served in restaurants and sub shops. You can sometimes find whole grain bread at specialty restaurants, but as a rule, you’re much better off avoiding bread when eating out.

Yes, I know, it’s hard. But your health depends on it.

Why I’m Doubling Down on Low Carb, Intermittent Fasting in 2019

I’m not much of a New Years resolution guy, but it’s hard not to think about the year ahead as the new year approaches. When it comes to my diet plans for 2019, I feel the need to echo the late George Herbert Walker Bush during the 1988 presidential campaign — stay the course.

All of my reading and research last year led to my full adoption of a low carbohydrate lifestyle, and nothing has changed that would lead me to rethink this approach. I’m not a doctor, but I’m fully confident that my cardiovascular health improved over the course of 2018. A year-end visit to my cardiologist confirmed my own analysis. In December I had an echocardiogram, a nuclear stress test, and a blood workup and all of these diagnostics returned very positive results.

The biggest danger for a heart attack survivor like me is to have a second cardiovascular event. In the first few years following my near fatal event, my heart performance was stable and improved a bit. My blood work was better, if not perfect, and all the other tests showed incremental improvement. Most importantly, my ejection fraction (my heart’s ability to pump blood out to my body) went up each year.

At the time of my heart attack, my ejection fraction (EF) was measured at around 30-35 percent. An EF of less than 40 percent may be evidence of heart failure or cardiomyopathy. For me, this was the scariest aspect of my event. It was also what has been driving me to make changes to my lifestyle.

Improving my EF has provided positive reinforcement for the things I’ve been doing to improve my cardiovascular health. I know that lifestyle led to my heart attack, and therefore lifestyle could keep me from having another one. This is why I’ve spent the past seven years exercising more, taking my prescribed medications, seeing my cardiologist regularly, and eating right.

Honestly, the only aspect of the above lifestyle changes that have provided any complications for me over the years since my heart attack has been eating right. I truly believe the medical establishment either doesn’t know or doesn’t want to suggest how to eat appropriately for cardiovascular health (I think they don’t want to provide advice because it is not so clear cut and if they are wrong they may be worried about liability). All the proof you need that the medical establishment doesn’t know the best way to eat is to Google diet advice — you’ll go down a rabbit hole from which you may never surface.

After my heart attack, my first cardiologist told me to avoid sodium because high blood pressure can lead to heart failure and/or cardiomyopathy. In that first year I avoided sodium like it was poison. Do you have any idea how hard it is to limit sodium intake to less than 1,500 mg a day?

But sodium didn’t cause my heart attack, so I spent a lot of time researching the latest medical advice on diet. I was really frustrated with what I found. I read about the China Study and Dr. Caldwell Esselstyn and thought perhaps meat was the cause of heart disease. I became a pescatarian, eliminating all meat except for fish. Then research started to point to the Mediterranean Diet as the best overall diet and that seemed reasonable so I went down that path. My blood work was better, but still not where I needed it to be.

I watched every movie about diet from Forks Over Knives to Fed Up to Fat, Sick and Nearly Dead and all I got was more frustrated and confused. But as time went on, I started to notice a trend — there was more and more information out there about the dangers of carbs and sugar. I really honed in on this trend, reading everything I could get my hands on. At the same time, I started working with a new primary care doctor who also believed that carbs and sugar were the real culprits of diseases like diabetes, metabolic syndrome, and heart disease.

I jumped in to the low carb movement under doctor care and with regular blood work checkups to assess how I was doing. And for me, the results have been compelling. My blood work is enviable by any standard, and my weight is in a good range. Best of all, my EF has continued to rise and last month was measured at between 60-65 percent — the best it has been since before my heart attack and within the normal range.

As of today, I have above average blood work and a normal EF. That’s all I could have asked for seven years post heart attack. I may cheat here and there (I do enjoy a beer now and again), and my sugars are not as low as I’d like them (that’s where the intermittent fasting is hopefully going to help), but basically, I am in great cardiovascular health. And I’m enjoying how I eat, which is to say I get to eat a wide range of foods including meat, eggs, and a little whole grain bread.

So here I am in January 2019 with probably the best cardiovascular health I’ve had since I was a teen. I attribute this to exercising more, taking my prescribed medications, seeing my cardiologist regularly, and eating right — that is to say, a low carb, low added sugar diet. I definitely need to exercise a bit more, but for the first time in a long time, I am confident I am eating healthy.

Dying From Heart Disease is Pretty Much Optional

Punk rock legend Pete Shelley died on Thursday from an apparent heart attack at age 63, and once again my reaction was anger. Every time someone famous has a heart attack, I get in a fight with my inner voice. How did he not know he was at risk? Why didn’t he take care of himself? When are people going to start paying attention?

I know this might seem a touch disingenuous given I had a surprise heart attack when I was 45, but what I’ve learned about heart disease in the past seven years is enough to make me want to scream from the rooftops — you don’t have to go out this way! Heart disease is optional!

I’m not mad at these people, rather I’m mad at the situation. Nearly 18 million people die each year from cardiovascular disease (according to the World Health Organization) and 85 percent of those deaths are from heart attacks and strokes. 

Heart attacks and strokes are 80 percent preventable!

Yes, that’s right. The vast majority of these deaths can be attributed to preventable factors like obesity, poor physical activity, heavy drinking, eating unhealthy foods and not keeping your blood pressure and cholesterol under control. The CDC also found that about six in ten preventable heart deaths occur in people younger than 65 years old.

So why do people keep dropping dead from heart attacks? Do we not know how to prevent heart disease? Do we not care about getting heart disease? Are we too busy to worry about it? WTF people.

See, I get mad. It’s my issue, I know. Every time a famous person under…say…75, has a heart attack I am reminded of my own mistakes and my own mortality. I immediately go back to stage two of the five stages of grief. I’m serious. I get angry, then I get depressed (which is stage three).

Coach Mike Ditka had another heart attack recently. Alan Thicke. Garry Shandling. Carrie Fisher. Bill Paxton. It doesn’t make a difference who it is. Each time it happens I take it personally.

I wonder why I’ve become so passionate about heart disease prevention. Plenty of people have a health issue and keep to themselves. You don’t see Mike Ditka tweeting about heart disease. I think maybe there’s something in my personality that makes me want to stand up on a milk crate on the corner and preach the gospel of heart health. Is that a personality flaw or strength? I guess it depends on how obnoxious I am about it!

So, if you’re going to get anything valuable out of this post I probably ought to tell you how to prevent a heart attack so you don’t become one of the 14.4 million people who die each year from a preventable disease.

It’s pretty simple actually. I can tell you how to NOT have a heart attack in six words: Eat healthy. Move more. Don’t smoke.

Not smoking is the most obvious one. People who smoke are two to four times more likely to get heart disease. The risk is even greater for women who smoke and also take birth control pills. Seriously, don’t smoke.

Moving more is actually pretty easy as well. The American Heart Association recommends adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week. What does moderate-intensity aerobic exercise look like? 

  • brisk walking (at least 2.5 miles per hour)
  • water aerobics
  • dancing (ballroom or social)
  • gardening
  • tennis
  • biking slower than 10 miles per hour

Seriously, all you have to do is walk for 30 minutes, five days a week. Nobody is suggesting you have to run a marathon or swim 50 laps a day.

Lastly, eat healthy. Well, this one may be a little more complicated. Note that I said complicated, not difficult. Most experts suggest you simply eat a diet that focuses on a variety of fruits and vegetables, whole grains, low-fat dairy, skinless poultry and fish, etc. 

There are some that argue a “Mediterranean Diet” is best. Some argue you should be fully plant-based. Others argue keto is the healthiest way to eat. Paleo? Pegan? You can spend the rest of your life trying to figure out the “best” way to eat and never figure it out. So pick one of the above because in truth, all of them are healthy enough for the average person to avoid heart disease in combination with moving more and not smoking.

I have written about this extensively, and I’m convinced from my own health and indicators that it’s working. I eat a low carb, very low sugar, high healthy fat diet. I’m also doing a little intermittent fasting and I’m doing great by any standard. 

Want to know how you’re doing? I recommend you sign up for Life’s Simple 7 and take the survey. It’s free and you can go back again and again as your numbers change. It’s not perfect, but it’s an easy way to see how you’re doing.

Yes, heart disease is voluntary. I wish I knew that prior to Oct. 11, 2011 and that someone had shared these tips with me. Then again, had I not had a heart attack maybe I wouldn’t be on the Interwebs sharing these tips with you.

Getting ‘Poked and Prodded’ is My New Normal

Tomorrow I head to my cardiologist’s office for another in a seemingly endless series of tests. I know my life changed on Oct. 15, 2011 when I had a heart attack and that things will never be the same, but I had no idea how often I’d be subjected to diagnostic tests. I feel like the proverbial guinea pig.

Since it has been seven years since my cardiac event, I only have to see my cardiologist a couple of times a year now. But between those exams, I am required to have a blood test regularly (keeping an eye on my cholesterol, triglycerides, blood sugars and more) and then regular stress tests and echocardiograms. Tomorrow I get the double whammy — a nuclear stress test and an echocardiogram.

A nuclear stress test is a type of stress test that uses radioactive dye and an imaging machine to create pictures showing the blood flow to your heart. This is more involved than a standard stress test in which the victim (er, patient) is simply hooked up to an electrocardiogram (ECG) and blood pressure cuff to measure your heart’s reaction to exercise. For the nuclear stress test, you are also hooked up to an IV for the dye injection.

During the same visit, I’ll be subjected to an echocardiogram which is basically an ultrasound of your heart (it’s just like the ultrasound a pregnant woman receives to check on the status of her baby except instead of finding out the sex of the baby you find out the strength of your heart). The echo is a simple test, but I’ll never get used to the cold goo.

To be more precise, an echocardiogram takes images of the size and shape of your heart and also show how well your heart’s chambers and valves are working. This is pretty critical for me since at the time of my heart attack I had permanent damage to my heart muscle and it’s important to keep track of any changes in the amount of blood my heart pumps (known as ejection fraction). A normal heart’s ejection fraction is somewhere between 50 and 70 percent, while anything below 40 means you are in heart failure. At the time of my heart attack my ejection fraction was between 30-40 depending on who you believe, but with medication, exercise and time it has bounced back to around 60 at last check. For me, my ejection fraction is how I keep score of how I’m doing and so far, I feel like I’m winning.

The stress test, on the other hand, basically tries to determine if any of the coronary arteries that supply blood to and from your heart and blocked. A typical stress test is not foolproof, but a nuclear stress test is a much better way to determine if you have any blockages. Frankly, neither test is perfect and to be sure the best way to check for blockages is to insert a camera into your arteries but that’s pretty invasive and only done if the stress test or other indicators (like actually having a heart attack) suggest you might have a blockage. Basically, if I “fail” the stress test they’re going to go in and check and if I have blockages they can blast them with a balloon (angioplasty) and/or insert coronary artery stents to prop open the narrowed pathway. I had three stents inserted at the time of my heart attack, but the angiogram showed no other significant blockages so…I have that going for me.

All this is to ensure I have not gotten any worse since my heart attack, and thankfully, so far, I have not. In fact, I’ve gotten better. Still, these tests have become part of my routine and will likely continue to be part of my routine until such time as medical science comes up with a better way to see if your heart and arteries are doing what they are supposed to do.

I know these tests are helping me live longer, but I still feel like I’m at the doctor or a testing center all the time. It’s a pain in the ass. I know I should feel fortunate that I live during a time when we have all these diagnostic tests, and on top of that I have darn good medical insurance to pay for all these tests. But it’s still a pain in the ass.

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.

It’s Time to Quit the Lonely Heart’s Club

I was struck by a report yesterday in the Daily Mail about a new study that says lonely people are twice as likely to die from heart problems. You can read the report for yourself, but the study found, among other things, that:

  • Lack of social support may cause people to not take medication correctly
  • Loneliness increases people’s risk of anxiety and depression by three times
  • Approximately 42.6 million adults over 45 in the U.S. report being lonely
  • In the U.K., 3.9 million people say the television is their main source of company

Loneliness is a strong emotion and I’m not surprised it can cause health issues, but being lonely makes you twice as likely to die from heart problems? I guess you really can die of a broken heart.

“Loneliness is a strong predictor of premature death, worse mental health, and lower quality of life in patients with cardiovascular disease, and a much stronger predictor than living alone, in both men and women.” – Study author Anne Vinggaard Christensen, Copenhagen University

The caveat here is that the study looked at patients with existing cardiovascular disease, and I can tell you from experience that having a friend or partner to talk to when you have a health issue is critical. But this also speaks to finding a support network when you have a heart attack or frankly any health crisis.

Following my heart attack at age 45, I couldn’t find anyone to talk to that shared the same experience with me. There were support groups, but the most prominent one was full of patients much older than me. During cardiac rehab, I was the youngest patient by 20 years. I felt alone, which is what led me to start my own support group specifically for young heart attack survivors. The group started small, but today the Under 55 Heart Attack Survivors Group on Facebook has grown to more than 3,300 members from all over the world. The American Heart Association also has a support network.

Loneliness is a tricky thing. I can’t imagine how I’d have gotten through my health issues without the love and support of my wife and son and my extended family. I know survivors who don’t have a significant other and that fact alone can make things so much worse. There’s nobody to go with you to doctor appointments. Nobody to celebrate with when you reach a milestone. Nobody to lean on when things don’t go as planned. Being a heart attack survivor is something I deal with every day — I’m so fortunate I don’t have to deal with it alone.

That said, I probably don’t do as good a job as I should simply getting out of the house to meet with friends. Men have a harder time making close friends than women, I think. There’s something very offputting about calling up a guy you don’t know that well and asking him to join you for a ballgame or a movie. Most men, and probably a lot of women, only have a handful of really close friends. I mean, lots of people checked in on me in the days and months following my heart attack, but after a while that petered out and now I often can’t find a guy to go to a concert with or have a drink with.

It’s definitely a two-way street though. If you want friends you have to be willing to take the first step. Excuses are easy to find. Maybe he or she has young kids and you don’t. Or maybe you live just a bit too far away for it to be convenient. Or maybe you like country music and she prefers hip hop. Or maybe I’m just overthinking it!

Recently I’ve tried to push myself on this front. In the past few months, I initiated lunch with a guy I didn’t know that well. I invited a newer friend to a concert I wanted to attend. I launched a monthly book club. I’m trying.

A 2017 New York Times piece says bocce ball is the secret to living a long life

I think a lot of the difficulty stems from our busy lives in general. But I’m now at a point where I don’t have a young child in the home and I have a job that doesn’t keep me up working at all hours of the night. I do think, though, that there’s something of a societal issue going on. One-quarter of the U.S. population lives alone. And we’re working more. And if we’ve got kids we’re running them around to karate and soccer and swim practice. There’s also been a decline in civic activity in general.

In 2000 author Robert Putnam wrote Bowling Alone: The Collapse and Revival of American Community. In the book, Putnam reported that “we’ve become increasingly disconnected from family, friends, neighbors, and our democratic structures.” By this, he means we’ve stopped joining clubs and social groups. In fact, in the 25 years prior to the book coming out, Americans had a 58% drop in attending clubs, a 43% drop in family dinners and a 35% drop in having friends over. I don’t know too many people my age who are involved in Kiwanis or the Jaycees, or who participate in sports leagues or bridge clubs.

I do think there’s a growing trend in these activities among millennials and generation Z. I have some young friends at work who are in a kickball league (how very millennial). And maybe some of you are doing things and I’m just not aware. I have at least one friend who goes lawn bowling (and yes, he’s under the age of 80). I have another friend who is very active in Rotary. But in general, I think the trends outlined by Putnam haven’t changed much since 2000.

All this is to say, there’s a cure for loneliness and all it requires is for us to step out from behind the computer and go outside. And lest you think loneliness is not a health concern, this study surely proves otherwise. And for me, I just have to think about that “buzz” I have when I come home from dinner with friends or a concert with a buddy. Those are endorphins and increasing them releases stress and is good for your heart.

I enjoy alone time as much as the next guy — maybe even a little more than the next guy. But I can also tell when I’ve been hanging out by myself too much. I actually get sad and mopey. I need to remind myself to make time to engage with others in the real world.

What do you do to ensure you spend quality time with other human beings? Are you good at being the one who initiates a dinner or a coffee meetup? I’m going to keep looking for new ways to get out there and now I can say I’m doing it for my heart.

Anyone up for bocce ball?

Heart Attack Survivors Should Embrace Prescription Drug Therapy

colors colours health medicine

It’s amazing to me how many people I’ve met in my life who complain about prescription drugs. They treat headaches with meditation, muscle pain with acupuncture and guzzle herbal tea for everything from indigestion to toe fungus. In America, measles is making a comeback because uninformed parents refuse to inoculate their kids because some quack on the Internet referenced a flawed study in a phoney medical journal. Yes, some “alternative” treatments have therapeutic value. But you’ve had a heart attack — it’s time to put your big boy pants on and take your meds. Former heavyweight boxing champion Mike Tyson famously said “everyone has a plan until they get hit.” That’s how I feel about people who refuse to take the life-saving drugs available today. Think about how lucky we are to live in a time when researchers have developed extraordinary medicines to keep us alive. There’s a reason why your grandfather died after a heart attack when he was 45 — all he had to treat his diseased heart was aspirin and Alka-Seltzer.

If you are one of those lucky people that has gotten through life having barely having to take even a simple Tylenol for a headache, congratulations. But if you’ve had a heart attack, that part of your life is over. The sooner you get over the fact that you have to buy one of those pill cases with the days of the week on them to keep track of all your medications the better. Seriously, what’s the big deal? Take your medicine.

Current treatment methodologies for heart attack patients have drastically reduced the risk of death from 30% in the 1960s to approximately 3–4% today. Part of this is due to medical advancements like angioplasty and stents, and part of it is due to the discovery of new medications. Historically speaking, it wasn’t that long ago that first-line treatment for heart disease included bloodletting or mercury.

In truth, it’s a glorious time to be alive. Medical advancements in the 20th century have had a significant impact on the health of humans and one need only look at life expectancy to see just how significant we’re talking about. At the start of the 20th century, according to the World Health Organization the average global life expectancy was 31. 100 years later, it is 65.6 and in some countries it is as high as 80. The reason for this dramatic improvement is multifold, but some of the key reasons include the eradication of infectious diseases like smallpox, polio and leprosy and the decline in deaths from diseases like measles. In fact, in just the past century science introduced vaccines against the six most deadly childhood killers (polio, diphtheria, measles, mumps, rubella, and chickenpox). Advances in childbirth safety made a huge impact too. Other important advancements included the use of randomized clinical trials, vitamin supplements, insulin treatment for diabetics, chemotherapy, x-rays, and of course the introduction of antibiotics. In the heart diseases realm, the past 100 years have seen the introduction of bypass surgery, heart transplants, and pacemakers to name a few. And in terms of noninvasive treatment, we’ve seen the development of numerous drugs to treat all aspects of heart disease.

All this is to say, depending on your specific condition, today’s medical professionals have a huge arsenal from which to choose to treat your heart disease. And yes, with many medications there are side effects, but the side effects are far outweighed by the success of these drug treatments. To be sure, some of us will experience a side effect that is too severe to live with, but even then there are both mainstream and alternative treatments.

I am now nearly six years post heart attack, and my heart is doing great; in fact, I suspect it’s in better shape today than it was before my heart attack. I attribute this to following a good diet, exercising, and taking my meds. Yeah, I had to buy two pill boxes to keep track of everything I’m taking (one for the morning and one for the evening) but what’s the alternative? I’ll tell you what the alternative is — dying.