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.

Heart Disease, Depression Strongly Linked

anthony-bourdain-dead-6The suicides this week of Kate Spade and Anthony Bourdain have left many of us wondering how in the world such successful people can feel so helpless as to end their own lives. For sure, depression is a dark passenger that is tough to shake.

Depression is also decidedly linked to heart disease. Heart disease can cause depression, and in fact, does in a large percentage of those who suffer a heart attack or similar major cardiac event. Up to 15 percent of patients with cardiovascular disease and up to 20 percent of patients who have undergone coronary artery bypass graft (CABG) surgery experience major depression (American Heart Journal).

On the flip side, depression can actually cause heart disease. Studies have shown that depression and stress has a negative effect on the heart and can lead to high blood pressure, irregular heartbeat, and even increased inflammatory markers like C-reactive protein which is a risk factor for cardiovascular disease.

I bring this up to remind us all that depression is a serious matter that can destroy a life in many different ways, not just through suicide. So much of what we read about how to prevent heart disease focuses on diet, exercise and risk factors like smoking. But not much is written about the cardiovascular effects of poor mental health.

That said, a focus on total health that includes mental health is the first line of defense against heart disease. Any medical professional worth their weight in education should prescribe mental health therapy as part of any approach to overall wellness. Mind and body are inexorably linked.

The good news is that many of the things prescribed for overall health work to balance mental health and stress as well. Eating well, sleeping well and regular exercise positively affects the body and the mind. Activities like yoga, meditation and mindfulness also have powerful ramifications for both physical and mental wellbeing.

I have to admit I’m not a big fan of exercise and while I’ve tried yoga and meditation I can’t seem to get inspired to make either of them part of my daily routine. I know I should, but since I don’t enjoy it I always find excuses. But every time, without fail, I feel better mentally after exercise.

I’ll try to find more inspiration to exercise, not only for my physical health but for my mental wellbeing. As a heart attack survivor, it’s even more important for me to exercise. The American Heart Association recommends at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity). That doesn’t seem so hard.

Just a few days ago a new study was published that suggested just 30 minutes of exercise four to five times per week is enough to keep your heart young.

“Exercising four to five times a week appears to be a sweet spot for overall artery health.” — Study author Dr. Benjamin Levine, a professor of internal medicine at UT Southwestern Medical Center

As for depression, don’t let it get the best of you. It’s bad for your heart and it can easily spiral out of control. If you’re experiencing depression, seek help immediately. There’s no stigma associated with getting help for mental health. And there are so many ways to treat depression, from the aforementioned exercise to therapy to medication.

If you have any suicidal thoughts, reach out right away to the The National Suicide Prevention Lifeline, a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. The number to call is:

1-800-273-8255

Given how Anthony Bourdain lived — eating everything and anything, drinking, smoking, and taking drugs, it’s amazing he didn’t die from a heart attack. In fact, when I first saw the headline this morning that’s exactly what I thought happened. But no, it was depression. It’s ironic and sad that a guy who lived life on the edge was taken by his mind not his body. Perhaps there’s a lesson there for us all.

 

Regrowing Damaged Organs no Longer Stuff of Science Fiction

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

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

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

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

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

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

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

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

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

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

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

I ♥ science!

Don’t Be Fooled by Your Total Cholesterol Number

We all know that elevated cholesterol is an indicator of heart disease risk, but the truth is most of us have no idea what our cholesterol data tells us. Even if you’ve been a good steward of your heart health and have your cholesterol checked regularly, most doctors only tell you the basic results of your blood tests — and that doesn’t tell the whole picture.

You probably know your total cholesterol level, and perhaps you even know that the Centers for Disease Control and other medical experts suggest your total cholesterol should be less than 200 mg/dL. This common wisdom also suggests that your LDL (“bad” cholesterol) should be less than 100 mg/dL, your HDL (“good” cholesterol) should be 40 mg/dL or higher and your triglycerides should be less than 150 mg/dL.

Too often we look at our total cholesterol number and if it’s under 200 we figure we’re fine. Unfortunately, I can tell you hundreds of stories about seemingly “healthy” people who had cholesterol levels under 200 and still had a heart attack. Myself included.

So if these numbers don’t tell the whole picture, what’s a better indicator of your cholesterol-related health? Well, a study published in the American Heart Association journal Circulation found that those people with the highest triglyceride-to-HDL cholesterol ratios had a sixteen times greater risk of heart disease than those with the lowest ratios.LDL-cholesteral-particle-size-matters

Why? It turns out not all LDL cholesterol is the same, so just knowing your LDL number doesn’t tell you much. In fact, LDL particle size is a much better predictor of heart disease. Some LDLs are large and fluffy while other LDLs are small and sticky. The small sticky cholesterol plays a more critical role in determining your cardiovascular health and it turns out a higher triglyceride to HDL ratio is more indicative of small sticky LDL.

The triglyceride to HDL ratio also indirectly measures insulin resistance, and that is a predictor of diabetes — and diabetes is also a major risk factor for heart disease.

Ideally, you want no more than a 2:1 ratio of triglycerides to HDL cholesterol. So, if your triglycerides are 100 mg/dl, your HDL cholesterol should be 50 mg/dl. — Dr. Stephen Sinatra, cardiologist

It turns out a better strategy for lowering your risk for heart disease is to lower your triglycerides and/or raise your HDL. Ironically, the first line of defense for elevated cholesterol recommended by most cardiologists is a statin to lower your LDL. But statins don’t affect your triglycerides to HDL ratio.

It’s also possible to get a newer type of blood test that measures particle size. The Vertical Auto Profile (VAP) test or a similar test is available at most labs and can give you a sense of whether you are one of the unlucky ones who create small sticky (known as pattern B) cholesterol. Here’s a pretty good explanation of why VAP is better. The site suggests the standard cholesterol test fails to identify as many as 60% of people who are at risk for cardiovascular disease.

Cholesterol is much more complicated than a single number. Don’t let that total cholesterol number fool you into complacency. If you have other risk factors (like diabetes, high blood pressure, elevated blood sugar, family history of heart disease) you shouldn’t assume your total cholesterol number or even your LDL number means you’re safe. Check out your triglycerides to HDL ratio and ask your doctor for an advanced cholesterol test.

Oh, and as I’ve mentioned before, if you have these risk factors you might consider having a coronary artery scan as well.

 

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

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.

To Infiniti…and Beyond!

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

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

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

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

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