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.

bocci
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?

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.

 

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.

So It’s the Kind of Protein in Red Meat, not the Saturated Fat that Kills us?

steakI have been thinking about reintroducing red meat into my diet after a decade or so of avoiding the stuff. In the ongoing saga that is my diet, I feel like I’ve finally settled into some themes about how to eat healthy — I call how I eat a modified Mediterranean diet but it has also been called Pegan. Basically, I’m all in on eliminating all processed carbs like bread as well as all added sugars while increasing my intake of healthy fats from sources like avocado and nuts/seeds. As for meat, I’ve been sticking with fish, chicken and turkey. We have the meats!

The more I eat this way, the better I feel and the better my blood test results. My triglycerides are very low (under 100 at last check) and my LDL cholesterol is well below the 70 mark recommended for heart disease patients. The “experts” I’ve been following such as Dr. Mark HymanDr. Stephen Sinatra, and Gary Taubes to name a few all suggest sugar, not fat, is the demon that causes heart disease and frankly the data is compelling. The common theme among these low carb/high fat evangelists is that red meat (and the saturated fat that comes with it) is fine.

There are good scientific and health-minded reasons to eat high-quality, organic, grass-fed, sustainably raised meat as part of an overall healthy diet. — Dr. Mark Hyman

Yes, everyone agrees plants are better for you and that they should make up the largest part of your diet, but if saturated fat isn’t bad then grass-fed red meat should be back on the plate in modest portions.

Not so fast.

new study found that eating meat regularly is associated with a 60 percent increase in the risk of heart disease, while plant-based proteins have been found to benefit the organ.

But the study doesn’t point to saturated fat as the culprit, rather it suggests there’s something troubling about the protein in meat versus the protein in plants, nuts and seeds.

“Our results suggest that healthy choices can be advocated based on protein sources, specifically preferring diets low in meat intake and with a higher intake of plant proteins from nuts and seeds,” the authors said.

This research doesn’t vindicate the anti-meat people because the argument against meat has long been about saturated fat. If true, and protein is the issue, then they have been right all along but not for the reasons they believe.

The saturated fat debate is far from over. Both sides make compelling arguments based on real research. Personally, I’m not willing to risk it by introducing saturated fat to my diet when I haven’t been eating it for years. No butter, no red meat, no coconut oil.

But I was, as I mentioned above, considering adding back in a little grass-fed beef to mix things up. Hey, I haven’t had a good burger since the George W. Bush administration.

Thanks for nothing Loma Linda University School of Public Health, AgroParisTech, and the Institut National de la Recherche Agronomique!

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.

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.

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.

Take this With a Grain of Salt

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

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

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

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

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

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

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