Round 2: Life After a Heart Attack

Heart Attack + 2 years: Blood Profile Update

2011-09-26T08:37:00.000-07:00

It's been 6 months since my last blood work. I've been doing pretty good with the meds and exercise, and OK on diet. Here are the updates:

Here are my March 2010 values (first ones after the heart attack):

cholesterol, total 173 mg/dl <200 (GOOD!)
HDL cholesterol 37 mg/dl >39 (CLOSE!)
cholesterol/hdl ratio 4.68 <5.00 (GOOD!)
LDL cholesterol, calculated (can not be calculated when the triglyceride exceeds 400 mg/dl).
triglyceride 712 mg/dl <150 (BAD!)

Here are my September 2010 Values:
cholesterol, total 153 mg/dl <200 (20 pts improvement)
HDL cholesterol 50 mg/dl >39 (13 pts improvement)
cholesterol/hdl ratio 3.06 <5.00 (50% improvement)
LDL cholesterol, calculated 76 <100 (good)
triglyceride 133 mg/dl <150 (nearly 600 pt redux)

Here are mySeptember 2011 Values:
cholesterol, total 143 mg/dl <200 (10 pts improvement)
HDL cholesterol 47 mg/dl >39 (3 pts drop)
cholesterol/hdl ratio 3.04 <5.00 (good)
LDL cholesterol, calculated 49 <100 (good)
triglyceride 234 mg/dl <150 (creeping up!)

My LDL's are continuing to go down, so I assume the Statins are doing their job. The Triglycerides are creeping up! I'm on Tricor for that, but it's not keeping up. I see my PCP this week, and we'll see what he says.

On the fundraising front, we just finished the Heart Walk in Erie, and we had a great turnout and raised quite a bit of money for the American Heart Association.

Have you been to see your doctor lately? Have you had blood work done in the last year? If not, ask yourself why. Also think about what the world would be like if you were to die tomorrow of a heart attack, just because you didn't think it was important enough to get checked out.

Remember, I was running 20 miles a week when I had my heart attack in 2009. Don't confuse feeling good for being well. Get checked out!

Still Ticking - and Walking!

2011-09-01T08:19:00.000-07:00

I'm approaching 2 years since my heart attack, and I'm feeling pretty good. I'll have another round of lipid profiles to review soon, but I'm sticking to the medicine regimen and am getting some good exercise.

Walking is a great low impact way to exercise. I am lucky to work in a place that has some great paved walking trails as well as unpaved hiking paths. I get out 3 or more times each week for an hour, and sweat a bit. It feels pretty good!

I'm also coordinating walkers, and walking in the Heart Walk. If you would like to walk with me, or sponsor me, you can click here.

The details :

Heart Walk – September 17

Location: Liberty Park (Erie bayfront)

Distance: 3 miles

Time: 9AM Register/Photo, 10AM Walk

It's a great way to get healthier, and support the American Heart Association!

Plavix Boy Hates Shaving - And Scores of Interns!

2011-06-24T06:34:00.000-07:00

I have concluded that a regimen including Aspirin, fish oil and Plavix is not conducive to shaving with a razor.

It's not like I bleed profusely, but it takes forever to stop. I'm not really complaining. Worse things have happened to me!

One upside to my heart attack story is that I connected with an executive at GE who has asked me to champion the GE Heart Walk team here in Erie. I'm currently working with a group of energized interns who are doing all kinds of things to raise funds for AHA. They are holding their own cookout, canning (hanging out with a donation box/can), doing a restaurant fund raiser, and holding their own mini-walk. I expect around 200 interns for the walk. These young people are really doing an excelent job in pulling together, being creative, and donating their time and money for this great cause!

Incidentally, to join my Heart Walk team, or to sponsor me, click here.

The Lipid Profile - 1 year after meds

2011-05-07T07:24:00.000-07:00

I have my lipids tested every 6 months now. Here are the last three together. You can see a marked improvement in all of the key indicators over the 12 months. The HDL is higher, the LDL is lower, the the Triglycerides are way down from the original. That's the Tricor doing its stuff.

It looks like I still need to work on the Tri's, and my weight is creeping up. Much of that is diet related - I don't watch what I eat and drink as much as I should.

Here are my March 2010 values:

Lipid panel:                         Value                Good:    Comments
   cholesterol, total               173  mg/dl         <200    (GOOD!)
   HDL cholesterol               37  mg/dl            >39    (CLOSE!)
   cholesterol/hdl ratio           4.68                 <5.00 (GOOD!)
   LDL cholesterol, calculated   (can not be calculated when the
triglyceride exceeds 400 mg/dl).
   triglyceride                        712  mg/dl         <150 (BAD!)

Here are my September 2010 Values:

Lipid panel:
   cholesterol, total               153  mg/dl         <200    (20 pts improvement)
   HDL cholesterol                 50  mg/dl            >39    (13 pts improvement)
   cholesterol/hdl ratio           3.06                 <5.00    (50% improvement)
   LDL cholesterol, calculated   76                   <100     (good)

   triglyceride                        133  mg/dl         <150    (nearly 600 pt redux)

Here are my March 2011 Values:
Lipid panel:
   cholesterol, total               132  mg/dl         <200    (21 pts improvement)
   HDL cholesterol                 46  mg/dl            >39    (4 pts drop)
   cholesterol/hdl ratio           2.87                 <5.00    (Still lower)
   LDL cholesterol, calculated   52                   <100     (good)
   triglyceride                        168  mg/dl         <150    (Just over the limit)

I think if I had shown the first lipid panel to a PCP, they would have instituted a

change that may have reduced the risk or prevented my heart attack.

My sister tells me that her Tri's are also high, so there may be some

genetic contribution.

So if I were you, I would schedule a PCP visit at least once a year, and insist

on a lipid panel. It will tell you a lot about your heart health!

New eBook published!

2011-01-23T12:12:00.000-08:00

I recently published an eBook version of the story of my heart attack and recovery. Based on my blog and with some changes, it's now available online, at the low low price of $2.99!

Update: It's now available in Amazon's Kindle Bookstore and Barnes and Noble's Nookstore,

Here is the cover:

14 months after: progress report

2010-12-20T19:40:00.000-08:00

Last week, I had my 1 year checkup with my cardiologist, following an echocardiogram and stress test. The stress test was interesting, and I got to really work my heart while they took EKG, blood pressure, and imaged my heart before and after to see where muscles were strong and weak. I have the reports here and made sure I knew what they meant.

The good news is good:

My heart is in great shape
I can work out at pretty high intensities, and am OK'd to go for it
My cholesterol has really turned around in the last year
The Doc has no major concerns

The bad news is not that bad:

I have to stay on all of my meds, including the beta blocker Atenolol. This has some interesting side effects, including lowering my max heart rate, and encouraging weight gain.
The lowered heart rate limits my max exertion in the gym, but I'm adapting to it.
My weight is up, about 15 pounds since I started the beta blockers. I'm not the picture of post-cardiac health that I wanted to be.

So I know what I need to do this year:

Keep it up at the gym - high aerobic and anaerobic workouts to burn fat and built muscle
Cut back on the calories and start to reign in the waistline.

Before the cardiologist appointment, I studied up on all of the medications. It felt like cramming for an exam, but I really understood his discussion and I knew why he kept me on the medications.

Here's my Christmas wish: Everyone should get the present of being present with their loved ones. I saw two people close to my age both die suddenly of heart failure this fall. It literally can happen to anyone with little warning. So do these things:

Get checked up. Cholesterol, stress and other conditions can be managed to lower your risk.
Love the ones you're with. Sad to say, but you or they could be taken tomorrow.
Be prepared. Have a will. Know the warning signs. Don't be Superman (/woman).

Sorry to be a downer, but I have to use my Round 2 for good. Make a resolution to get checked up, and hit the gym for some heart-healthy stress-busting sweat-generating fun!

Happy Holidays!

John

Happy Birthday to Me!

2010-10-17T19:18:00.000-07:00

I turned 1 today...not a birthday but a rebirth day. One year ago I got rebooted 3 times, received stents in my artery, and started life over again. I haven't missed a dose of meds yet, my cholesterol is good, and last week I ran 19 miles, including 2 high-intensity sprint workouts. Yes, I need to drop 20 lbs and be better with food and drink...but I'm doing much better than a year ago.

So I made it out of the tough part. You...reader...have you held up your side? Do you know your cholesterol? Do you get out of the car/couch often enough, and get your heart rate up? It is not hard once you start. Do it!

Heart Health: 6 months after medicine

2010-09-14T19:35:00.000-07:00

I just got my blood work back from my September labs.

Here is the March values:

Lipid panel:
   cholesterol, total               173  mg/dl         <200    (GOOD!)
   HDL cholesterol               37  mg/dl            >39    (CLOSE!)
   cholesterol/hdl ratio           4.68                 <5.00 (GOOD!)
   LDL cholesterol, calculated   (can not be calculated when the
triglyceride exceeds 400 mg/dl).
   triglyceride                        712  mg/dl         <150>(BAD!)

Here is my September Values:

Lipid panel:
   cholesterol, total               153  mg/dl         <200    (20 pts improvement)
   HDL cholesterol                 50  mg/dl            >39    (13 pts improvement)
   cholesterol/hdl ratio           3.06                 <5.00    (50% improvement)
   LDL cholesterol, calculated   76                   <100     (good)

   triglyceride                        133  mg/dl         <150    (nearly 600 pt reduction!)

Clearly, the cholesterol meds, Omega 3/6 and food/exercise have worked!

The reduction in triglycerides is amazing.

So, thanks to medicine (mostly) and lifestyle (somewhat),

I have some really good lipids.

The Tricor, Simvastatin and Atenolol were a bit tough to get in balance,

but they worked out fine in the end.

The bad news is that my Glucose is 96 for a healthy range of 65-99,

and my Hemoglobin A1C, a longer term measure of glucose levels, is 5.7,

right at the boundary of healthy and risk.

So I need to continue the weight loss and exercise to keep that in check.

There's hope for me.

Now, get your butt out there and get a lipid profile.

It takes 5 minutes at a lab.  Do It!

Still, Stayin' Alive

2010-07-27T21:21:00.000-07:00

It's been a bit since I posted on the heart blog. I've been crazy busy at work and with my photography business.

I have been staying on my medicine and extras (Omega 3 and 6 supplements). We'll see how my September blood work turns out.

I have hit the gym 2-3 days per week all year. It's a bit lighter now, but hopefully I can keep it up. I really need to burn some more calories or cut back on the intake to lower the body weight.

So dear readers, try to eat right, get a lot of exercise, and keep taking your medicine. And if you haven't been in for a checkup in the last year, you owe it to your family to go! Yes it will be uncomfortable. Yes it will be something you don't want to face. Yes they will find something odd, and you will have to go for more tests. But it's better than the alternative!

And speaking of that, make sure you have good term life insurance if you have a family. And get a will.

And, have a nice day.

Stayin' Alive

2010-06-13T12:27:00.000-07:00

A very busy spring so far, with my youngest graduating from high school (with tons of honors and awards - congrats Jen!). Also I played in the pit for GMHS' production of Grease, and we had a crazy busy second quarter at work. I'm also getting into Wedding and Senior photography season in Erie.

My challenge 8 months into this, is keeping the healthy aspects of my post MCI life going strong. I'm 100% compliant with the medicine and trying to keep up with the fitness, but some fatigue still remains from my Tricor/Simvastatin inner battle. I'm hoping it works itself out.

Diet-wise, I'm still getting a lot of fiber and flora. I do occasionally have a bit of fried food or a steak, but I'm doing pretty good there. We joined a farm cooperative - Wild Winds Farm out in the Harborcreek area, and we are already starting to receive lots of organic produce, which will continue each week into the fall. They include some recipe ideas, which will help us use the new items creatively. We also put in some peas, cukes and green peppers in our tiny 32' garden.

I'm also thinking of getting a road bike and riding to work when I don't have events after work. That will be exciting, and keep my fitness going.

So no news is good news I guess. I haven't made it back to my Cardiologist but my PCP is working with me on medications and such.

A reminder to all you dads out there: Next weekend is Father's Day. Schedule a checkup so you will be around for many more of them!

Starting Tricor

2010-04-25T06:57:00.000-07:00

I have been on Tricor for a week now, and am doing fine. I have not seen any of the complications of Tricor's interaction with Zocor, the Simvastatin that I'm taking.

I have to say that Tricor and Plavix, the anticoagulation drug I take, are very expensive. The new insurance where I work is marginal at best, as it requires me to pay out of pocket at pretty much list price for medications until I hit a very high deductible (thousands). My Plavix and Tricor are over $200 each month.

I suppose the alternative is worse, but I bothers me that our new medical plan is supposed to encourage good health practices. I'm paying out of pocket for my follow up PCP visits and most everything else.

On the positive side, I had a couple of milestones this week: a 29 mile week running, and a 9 miler on Friday morning. I'm getting back into that running rhythm. I've also been taking Omega 3,6,9 supplements - one of fish oil and two of flax seed oil. Still no chicken wings or fries!

6 Months After Flatline

2010-04-17T15:42:00.000-07:00

"The reports of my death are greatly exaggerated."
  -- Mark Twain

It's 6 months since the amazing crew at Affinity Hospital in
Massillon Ohio put life back into me.

It seems like regular life came back pretty quickly,
and the time has just zipped by.

Have I changed my lifestyle?  I can say yes:
- I take all my meds every day
- I'm eating better - no chicken wings and very little fried food. 
  Lots of flora.
- I see my doctors on a regular basis
- I'm getting a lot of exercise

This week marked my first week of more than 20 miles running.
I'm hitting the gym 3-4 times each week on average, and mixing
aerobic and weight training.

Tomorrow I start on Tricor, a medication designed to
reduce triglycerides.  It has some interaction with the
Simvastatin (Zocor), so I have to be careful.

We'll let you know how that goes.

I can still do better.  My weight is a bit high. 
But I hope that I can continue to reduce my cholesterol
and improve my fitness and health.

I'm glad that I'm still around.  I want to see my youngest
graduate this year, and I have a TON of photography work
lined up this summer.

If feels good to be 6 months old!

TRI, TRI Again

2010-03-23T19:03:00.000-07:00

My PCP says my Triglycerides are too high. I expected that and would have whacked him had he said anything else, given the evidence. I read about the two main drugs to treat it, Tricor and Lopid, and was not surprised when he prescribed Tricor, which I'm trying to set up through mail order.

We'll see how that drug works out for me. It does have some interactions with my other drugs, meaning I will have to take it in the AM and watch out for complications such as muscle pain.

He also was a bit concerned about my blood glucose at 106. All told, my vitals put me in the category of having Metabolic Syndrome, a precursor to all kinds of disease including heart disease and diabetes. I'll be getting a Hemoglobin A1C test next time around to check my long term blood glucose readings. Perhaps I'll cover Metabolic Syndrome later, as many of my contemporaries doubtless have this condition.

I'm continuing 4-5 days at the Gym in the early AM, alternating between heavy aerobics on the treadmill and weight lifting. I did get to run outside last week, which was lovely.

I'm taking care of myself to the best of my capabilities. How about you?

Johnny's Report Card

2010-03-13T07:19:00.000-08:00

Well my lab results of my Lipid Profile are back. Here's what they say:

Lipid panel:
   cholesterol, total               173  mg/dl         <200    (GOOD!)
   HDL cholesterol               37  mg/dl            >39    (CLOSE!)
   cholesterol/hdl ratio           4.68                 <5.00 (GOOD!)
   LDL cholesterol, calculated   (can not be calculated when the
triglyceride exceeds 400 mg/dl).
   triglyceride                        712  mg/dl         <150>(BAD!)

So, my overall cholesterol is well within the recommended limits. My "good" HDL is close to the recommended minimum of 39, but my Triglycerides are very high.

The National Cholesterol Education Program guidelines for triglycerides are:

Normal Less than 150 mg/dL
Borderline-high 150 to 199 mg/dL
High 200 to 499 mg/dL
Very high 500 mg/dL or higher
These are based on fasting plasma triglyceride levels (I was fasting for 12 hrs).

Current recommendations are to keep the triglycerides well below
500mg/dL, and low enough to reduce your VLDL to safe levels. Your VLDL
level is considered safe if it plus your LDL level are no higher
together than 130mg/dL. Doctors do not routinely measure VLDL, but if
you subtract your HDL cholesterol from your total cholesterol, you can
get the LDL plus VLDL sum.

So in my case, total cholesterol less HDL is (173-37) or 136. So I'm close on total VLDL+LDL, but the Tri's are way out of the safe range.

Triglyceride levels are very sensitive to diet, exercise, and health habits. It is common to have high triglycerides if you are overweight, if you are physically inactive, if you drink alcohol or smoke, or if you consume a high-fat and high-carbohydrate diet, particularly if your carbohydrates are not whole-grain foods. Triglycerides are also elevated in people with diabetes, kidney disease, thyroid disease, and certain inherited cholesterol problems. High triglycerides are one sign of the metabolic syndrome, a collection of health risks that indicate a very high risk of heart disease. It is important for you to be tested for diabetes and to have your blood pressure evaluated, because these are other features of the metabolic syndrome.

It is possible to substantially improve triglycerides by increasing your exercise and sharply cutting the amount of saturated fat and rapidly absorbed carbohydrates (processed flours or simple sugars, including milk sugar) in the diet. You should substitute whole grain foods, fruits and vegetables, skim milk and reduced-fat foods wherever possible. Medications are also available to lower triglycerides, including statins, gemfibrozil (Lopid), fenofibrate (Tricor), niacin, and omega-3 fatty acids.

In the last post I mentioned the recommendations for lowering Triglycerides.

In my case, I'm eating pretty well, getting 3-5 intense workouts each week, taking Omega-3 fish oil caplets (yuk), and tearing up the produce department. So I think I have two causes left:

1. I have a hereditary disposition to high Triglycerides
2. I need to cut back or eliminate alcohol

I have an appointment with my PCP this week. We'll see what he says about all of this.

Demon Rum - How Alcohol Affects Heart Disease

2010-03-06T17:26:00.000-08:00

Last post we talked about Triglycerides, the Very Low Density Lipoproteins. Too much of them is bad. We mentioned that alcohol and carbohydrates increase triglycerides, while Omega-3 and Omega-6 oils and exercise reduce levels.

Alcohol's impact on Triglycerides

Alcohol are a source of excess calories which are being turned into fat - usually, triglycerides, so the fat levels in your blood go up. But that’s only part of the story. Researchers have found that apart from adding calories to the diet, alcohol also prevents the burning of fat. According to a Swiss study reported in the Journal of the American Medical Association, alcohol in the bloodstream can slow down fat metabolism more than 30 percent.

When alcohol is present in the blood, the liver prioritizes removing alcohol from the blood over other metabolic processes. The liver can detoxify about one ounce of alcohol per hour, which is about one serving of an alcoholic beverage - equivalent to 12 ounces of beer or 4 ounces of wine. In the meantime, however, any sugars present in the drink will also be further processed into triglycerides which raises their blood levels. Additionally, alcohol reduces the amount of the enzyme that breaks down triglycerides and spurs the liver to make more triglycerides. Some people have increased susceptibility to developing raised triglycerides in response to alcohol. So if you do not require insulin, or are not diabetic, and consume alcohol regularly, you may be able to lower your elevated triglycerides just by avoiding alcohol.

By taxing the liver and reducing the ability to detoxify blood, alcohol causes more harm to blood vessels. When the liver is busy processing alcohol, it is less able to process cholesterol. As a result, LDL-"bad" cholesterol levels go up. In addition, alcohol will potentiate the toxicity of cholesterol-lowering medications much more than the drugs would do alone. Actually, this is the major problem with the statins. By drinking alcohol daily, you may increase your chances of serious statin side effects, especially liver problems. Therefore, to protect your liver, you should go easy on alcohol or avoid it completely while taking a statin.

Lowering Triglycerides

Changes in lifestyle habits are the main therapy for high triglyericdes. These are the changes you need to make:
* If you're overweight, cut down on calories to reach your ideal body weight. This includes all sources of calories, from fats, proteins, carbohydrates and alcohol.
* Reduce the saturated fat, trans fat and cholesterol content of your diet.
* Reduce your intake of alcohol considerably. Even small amounts of alcohol can lead to large changes in plasma triglyceride levels.
* Eat fruits, vegetables and nonfat or low-fat dairy products most often.
* Get at least 30 minutes of moderate-intensity physical activity on five or more days each week.
* Substitute monounsaturated and polyunsaturated fats —such as those found in canola oil, olive oil or liquid margarine — for saturated fats.
* Substituting carbohydrates for fats may raise triglyceride levels and may decrease HDL ("good") cholesterol in some people.
* Substitute fish high in omega-3 fatty acids instead of meats high in saturated fat like hamburger. Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in omega-3 fatty acids.

The National Cholesterol Education Program guidelines for triglycerides are:
Normal Less than 150 mg/dL
Borderline-high 150 to 199 mg/dL
High 200 to 499 mg/dL
Very high 500 mg/dL or higher
These are based on fasting plasma triglyceride levels.

I get my blood lipid tested next week. I'll report on my cholesterol numbers once I have the results back!

Lipids and Heart Disease

2010-02-20T06:13:00.000-08:00

We've been learning about atheroma (artery disease) and what causes it. A major driver is the cholesterols that go zooming through your blood stream. HDL = "High Density Lipoprotein" (eg the Good kind); LDL = "Low Density Lipoprotein". Lipoproteins are fatty acids, or giant molecules that move cholesterol throughout the body. Also present are Very Low Density Lipoproteins, also called Triglycerides, and they are perhaps more bad than LDLs. The key is trying to get the body to produce more HDL, and less LDL and VLDL.

Here's a bit more research on Lipids, mostly from Wikipedia.

Because LDLs transport cholesterol to the arteries and can be retained there and can start the formation of plaques, increased levels of LDLs are associated with atherosclerosis, and thus heart attack, stroke, and peripheral vascular disease. For this reason, cholesterol inside LDL lipoproteins is often called bad cholesterol. This is a misnomer. The cholesterol transported on LDL is the same as cholesterol transported on other lipoprotein particles. The cholesterol itself is not bad; rather, it is how and where the cholesterol is being transported, and in what amounts over time, that causes adverse effects.

Increasing evidence has revealed that the concentration and size of the LDL particles more powerfully relates to the degree of atherosclerosis progression than the concentration of cholesterol contained within all the LDL particles. The healthiest pattern, though relatively rare, is to have small numbers of large LDL particles and no small particles. Having small LDL particles, though common, is an unhealthy pattern; high concentrations of small LDL particles (even though potentially carrying the same total cholesterol content as a low concentration of large particles) correlates with much faster growth of atheroma, progression of atherosclerosis and earlier and more severe cardiovascular disease events and death.

A 4 minute animation of the atherosclerosis process, entitled "Pathogenesis of Acute MI", commissioned by Paul M. Ridker, MD, MPH, FACC, FAHA, at the Harvard Medical School, can be viewed at pri-med.com By Clicking Here.

Lowering LDL
The use of statins (eg Lipitor, or in my case, Zocor), is effective against high levels of LDL cholesterol. Statins inhibit the enzyme HMG-CoA reductase in the liver, the rate-limiting step of cholesterol synthesis. To compensate for the decreased cholesterol availability, synthesis of LDL receptors is increased , resulting in an increased clearance of LDL from the blood. In other words, these drugs force the liver to create larger Lipid particles which is better for your heart health.

Clofibrate is effective at lowering cholesterol levels, but has been associated with significantly increased cancer and stroke mortality, despite lowered cholesterol levels.

Niacin (B3), lowers LDL by selectively inhibiting hepatic diacyglycerol acyltransferase 2, reducing triglyceride synthesis and VLDL secretion through a receptor HM74 and HM74A or GPR109A. Yeah, what he said. Just know that it works.

Tocotrienols, also called Vitamin E, have been shown to be effective nutritional agents to treat high cholesterol in vitro in recent research programs. They suppress the production of a specific enzyme which results in less cholesterol being manufactured by liver cells. This decrease in hepatic (liver) LDL levels causes hepatic LDL receptor up-regulation, further decreasing plasma LDL levels as it is taken in by the liver.

Dietary
Insulin, driven by the ingestion of carbohydrates, stimulates the production of cholesterols, while glucagon, driven by ingestion of protein, reduces the production of cholestrols. Glucagon levels are very low when insulin levels are high. A ketogenic diet (eg Adkins diet) may have similar response to taking niacin (lowered LDL and increased HDL).

Lowering the blood lipid concentration of triglycerides helps lower the amount of LDL, because Triglycerides (also called "Very Low Density Lipoproteins" or VLDL) gets converted in the bloodstream into LDL.

Fructose, a component of sucrose as well as high-fructose corn syrup, increases LDL synthesis.

Dietary Fiber
The main action of dietary fiber is to change the nature of the contents of the gastrointestinal tract, and to change how other nutrients and chemicals are absorbed. Soluble fiber binds to bile acids in the small intestine, making them less likely to enter the body; this in turn lowers cholesterol levels in the blood. Soluble fiber also reduces the absorption of sugar, reduces sugar response after eating, normalizes blood lipid levels and, once fermented in the colon, produces short-chain fatty acids as byproducts with wide-ranging physiological activities. Although insoluble fiber is associated with reduced diabetes risk, the mechanism by which this occurs is unknown. Not yet formally proposed as an essential macronutrient, dietary fiber is nevertheless regarded as important for the diet, with regulatory authorities in many developed countries recommending increases in fiber intake.

Importance of antioxidants
Because LDL appears to be harmless until oxidized by free radicals, it is postulated that ingesting antioxidants and minimizing free radical exposure may reduce LDL's contribution to atherosclerosis, though results are not conclusive.

Triglycerides
Triglycerides are formed from a single molecule of glycerol, combined with three fatty acids on each of the OH groups, and make up most of fats digested by humans.
Triglycerides, as major components of very low density lipoprotein (VLDL) play an important role in metabolism as energy sources and transporters of dietary fat. They contain more than twice as much energy (9 kcal/g) as carbohydrates and proteins.

Fat and liver cells can synthesize and store triglycerides. When the body requires fatty acids as an energy source, the hormone glucagon signals the breakdown of the triglycerides to release free fatty acids. As the brain cannot utilize fatty acids as an energy source (unless converted to a ketone), the glycerol component of triglycerides can be converted into glucose , via gluconeogenesis, for brain fuel when it is broken down. Fat cells may also be broken down for that reason, if the brain's needs ever outweigh the body's.

The American Heart Association notes that diets high in carbohydrates, with carbohydrates accounting for more than 60% of the total caloric intake, can increase triglyceride levels.

Increased exercise and reduced carbohydrate consumption ameliorate one potential cause of insulin overproduction to help maintain sensible triglyceride levels. Triglyceride levels are also reduced by omega-3 fatty acids from fish, flax seed oil and other sources. Recommendation in the U.S. is that one ingest up to 3 grams a day of such oils. In Europe the recommendation is for up to 2 grams. However, omega-3 consumption should be balanced with omega-6 fatty acids, ideally in a ratio between 1:1 and 4:1 (i.e., no more than four grams omega-6 for every one of omega-3).

Daily ingestion of omega-6 fatty acids, more than 1 gram of niacin (i.e., a mega-dose of vitamin B-3) and statins may also help improve triglyceride levels. It has been found that residents in Western countries do not ingest sufficient quantity of food with omega-3. The ideal ratio is almost never met, and the ratio is often too high, about 12 in France, up to 80 among whites in the U.S. and Canada. Omaga-6 fatty acids can be found in many grain oils such as sunflower, safflower and flax seeds.

Unused saturated or monounsaturated fatty acids accumulate in the body in the form of triglycerides that do not participate in the metabolism of the body.
In some cases, fibrates have been used to bring down triglycerides substantially.

Alcohol abuse can elevate triglycerides levels. (More on that in the next post). Just one drink can increase triglycerides in susceptible people. If you have elevated triglycerides and consume alcohol - a reduced intake or not drinking alcohol at all is strongly advised.

So, let me summarize:

Not all Lipids are bad.
HDL's are best.
LDL's and Triglycerides (VLDL) are worse in terms of heart disease.
You can minimize LDL/VLDL with:

Drugs (statins)
Suppliments (Niacin/B3, Vitamin E, and Omega-3 (fish oils) and Omega-6 (grain oils) fatty acids.
Fiber (lots of sources)
Exercise lowers insulin levels which lowers the LDL/VLDL production.
Diet (lowering carbohydrates) will have a similar effect.

Next up: Demon Rum!

I Heart You!

2010-02-14T13:08:00.000-08:00

Today is the "Heartiest" day of the year! Happy Valentine's Day to everyone I care about!

And a shout out to President Bill Clinton, who had his own heart issues addressed this week.

I'm nearly into month 5 of my “second round” of life after my heart attack. I have been reading a lot about heart disease and what may have caused my problem, not just to reduce my chances of another "big one", but to understand how others may reduce their risk of this kind of event.

What follows is some research I did online, mostly from Wikipedia (I love that place!)

Ather-what?

Technically, my heart attack was caused by a blockage of the Left Anterior Descending artery which provides about 50% of the fresh blood to the Left Ventricle of the heart. It was most likely caused by an atheroma, which is an accumulation and swelling in artery walls that is made up of cells or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue. It is an unhealthy condition, but is found in most humans. The overall result of the disease process is termed atherosclerosis or "hardening of the arteries."

In developed countries, with improved public health, infection control and increasing life spans, atheroma processes (artery hardening) have become an increasingly important problem and burden for society. Atheroma continue to be the number one underlying basis for disability and death, despite a trend for gradual improvement since the early 1960s (adjusted for patient age). Thus, increasing efforts towards better understanding, treating and preventing the problem are continuing to evolve.

According to United States data, 2004, for about 65% of men and 47% of women, the first symptom of cardiovascular disease is heart attack or sudden death (death within one hour of symptom onset.) Read that one again, slowly.

Most artery flow disrupting events occur at locations with less than 50% lumen narrowing (they were not totally blocked before the attack). From clinical studies published in the late 1990s to IVUS (in-the-artery-ultrasound) to visualize disease status, the typical heart attack occurs at locations with about 20% stenosis (narrowing), prior to sudden lumen closure and resulting heart attack. Cardiac stress testing, traditionally the most commonly performed non-invasive testing method for blood flow limitations generally only detects lumen narrowing of ~75% or greater, although some physicians advocate that nuclear stress methods can sometimes detect as little as 50%.

My translation

Most/all people have some atheroma, which begins at a young age. The conditions for a heart attack are difficult to discover before it happens. Most people will have their first indication of heart problems by having a heart attack or dying from it. Our culture lets people live longer, but the lifestyle is conducive to athersclerosis.

Well.

That's not very encouraging.

I mean, if I had been screened, even including a cardiac stress test, they probably would not have found any reason for alarm. I was reasonably healthy. I ran 20 miles each week but was a bit overweight, with a BMI of 29.4, which is the top of Overweight category. Incidentally, to make it into the "normal" weight category, I'll have to lose 30 pounds. I'm shooting for more like 20, given that I do have more muscle from running. Last time I was that skinny, I was, well, pretty skinny.

Back to the whole prevention thing: My diet was pretty high in fats, particularly those from the chicken wing and burger/fries sections of the food pyramid. I also drink wine and beer which we will see in a couple posts drives triglycerides high...but I'm jumping ahead.

Had I been able to get a PCP checkup before the attack, I don't know if they would have seen this one coming. Other than telling me to lose weight, drink less and eat better, I'm not sure I would have received the kind of medical attention or medications that I'm currently taking, or that it would have prevented the heart attack I had in October 2009.

How to lower risk?

I kept digging. Given that you can't necessarily tell if you are likely to have a heart attack, it's best to follow a path of prevention.

Many approaches have been promoted as methods to reduce atheroma progression:
(a) food choices (like eating fish and fish derived omega-3 containing fats),
(b) abdominal fat reduction (which has a significant effect on cholesterol behavior)
(c) aerobic exercise (burns fat, lowers blood glucose, gives you that nice buzz),
(d) inhibitors of cholesterol synthesis (known as statins, like Lipitor),
(e) low normal blood glucose levels HbA1c below 5.0 (Avoid Type 2 Diabetes onset)
(f) micronutrient (multivitamin and magnesium) supplements

It was mentioned that cholesterol is not the villain that causes atherosclerosis. From clinical treatment trials, changing lipoprotein physiology (good/bad mix), and lowering blood sugar levels have proven to have the most dramatic impacts on reducing cardiovascular events and death rate from atherosclerotic disease.

Summary:

- It could happen to anyone
- Not a lot of warning signs in many cases
- Staying thin, exercising and eating the right stuff lowers risk

In the next posting, I'll get into the dirty details about Lipids (eg cholesterol) and factors that influence the mix of so-called “good” and “bad” cholesterol.

6-dang AM

2010-01-21T18:16:00.000-08:00

I have a new job at GE, and am pretty busy. I wanted to get back in shape and knew I couldn't get in the lunch workout or the after work workout. So I started going in early.

Many of you know I'm not a morning person. But I'm trying to get into the AM workout. The good thing is that GE gym is pretty much empty before 8AM.

I'm getting up around 6, heading straight to the gym in my jammies, and hitting the treadmill. I'm showered and ready for work before 8, and burn several hundred calories each day. I am averaging 4+ miles per day on the treadmill followed by some light lifting. Yah, I will PUMP YOU UP.

I can get into the 130's for pulse on a workout. That's Cardio range for a 40-50 yr old, so I consider that good, particularly since the Atenolol is lowering max heart rate and BP.

Sticking to the high fiber diet and meds. So far so good. I think I'm lined up for a stress test in March, so we'll see how I do.

Overall, I feel pretty dang good 3 months after the REBOOT.

Get a checkup.

New Year, New Habits

2010-01-03T09:46:00.000-08:00

Finally, past the holidays. I slipped a bit on my diet regimen, but didn't totally go off the wagon. I avoided the prime rib and other really fatty foods, and tried to still get some fiber and vegetables. I didn't miss a single pill and was reasonably active.

Finally, on Jan 2, I hopped back on the treadmill and did a couple miles running. It felt pretty good for a treadmill run. I hate those things, but it's better than not working out.

I'd like to use the gym at work but I know it will be crazy with the "Resolutionaries" for the next 4 weeks. By Valentine's day it usually drops back to the normal levels. Perhaps the roads will thaw and it will warm up a bit so I can get back to running outdoors.

So now it's back to getting 100% of my daily fiber and increasing those vegetable and fruit servings. Works for me...I love the flora.

For all of you who haven't made a decent resolution this year, do this: Commit to getting a good physical and blood lipid profile this year. You don't want to follow in my footsteps. Remember that it was pure circumstance that I was able to receive treatment as quickly as I did last October.

I just received notice that this blog was highlighted as a top 20 Heart blog by MRI Technical Training. Makes me want to post more useful stuff!

Oh, and here is a self-portrait in BW before I got rid of the "Christmas Beard".

John 1, Treadmill 0

2009-12-02T19:31:00.001-08:00

I had a nice 30 minute workout on the treadmill tonight. Pulse up to 120 and felt good. Let's see if I can keep up with this and make my goal of a run on Christmas Day.

My minor surgical operation is healing up nicely and I get stitches out 12/11. Looking forward to that as well.

I'm not falling off the food wagon but maybe hanging off the side. I'm still getting lots of fiber but have slipped on the 5+ fruits over the last few days.

I shall try to do better!

More Heart Fun

2009-11-30T13:34:00.000-08:00

On "Bad Friday", I had some plastic surgery to remove a couple of questionable skin blemishes - one on my forehead and one inside my ear. I don't know at this point if they were bad or not - I'll find out in a week or so.

During the prep for the surgery, the standard instruction was to lay off the Plavix, as it can lead to more bleeding during and after surgery. Given that I have stents, I couldn't do that. So I stayed on aspirin and Plavix.

The first couple of days after the surgery were a bit tough, but I'm getting back on my feet. I do have a couple of nasty looking scars that will scare the children for a few weeks.

I've also adapted to the change from Coreg to Atenolol, and I am happy to say I have most of my energy back. I have been getting some armchair exercise from our new Wii, but I intend to hit the treadmill soon to start working on getting some aerobic fitness back. I'd like to give myself a nice run outside for Christmas.

I Heart These Things

2009-11-26T20:47:00.000-08:00

I am thankful for many things:

- Bruce, my guardian angel, who saved my sorry ass 6 weeks ago
- The EMT's and ER people who did their jobs very well
- The Cardiac specialists who also did their jobs well
- My family for their incredible support
- My friends and co-workers who provided great support during my recovery
- My church family who continually remind me that prayer is good for us
- My new PCP, cardiologist and others in the medical community who keep my sorry ass healthy
- The members of the HCHS Marching band family who offered their support during my recovery
- And for me just being here this fall. It might not have turned out that way had any one thing been different.

I have a bit of non-cardiac surgery tomorrow...should be even better after that.

Cheers,

John

Heart Doctor

2009-11-18T16:43:00.000-08:00

This past Monday I had my first visit with my cardiologist. They took another EKG which still showed some residual damage from the heart attack. The cardiologist mentioned that the damage may reduce over time, but there may be some permanent damage. It will be more obvious in 3 or more months.

I also described my fatigue and he indicated the Coreg may be causing that. I'll be changing from that to Atenolol, another Beta Blocker, this week.

And, the cardiologist released me to start walking, and phasing into running again. I'll start with brisk walking once I can get my energy level back.

I'm staying pretty close to the diet, but I did travel this week and had some trouble getting completely healthy food whilst eating out. I did manage to have more salads than other food, and avoided the fried stuff.

So, recovery is under way and hopefully I'll be my normal bubbly self before too long!

Smoothie Operator

2009-11-04T18:53:00.000-08:00

I got pretty "anal" on my last post about fiber (har). It's one of the key parameters I'm trying to balance in my new diet: Fiber, salt, fat. The rest will fall into place.

There are lots of good bread options loaded with fiber. Sandwich rounds are great. I'm staying away from plain pasta or white bread. The whole grain stuff has lots more flavor.

I'm also going heavy on the fruit, and decided to try out fruit smoothies. I never got into them because I thought the name was stupid. But they are a great way to get calcium and fruit.

I make them like this: Toss about a cup and a half of fresh and/or frozen fruit in the blender. If fresh, add some ice cubes. Add about a cup of skim milk and 1/4 cup or so of fat free vanilla yogurt.

Blend like hell for a minute or so and pour into a cup. Tastes really good. You get a lot of fiber and vitamins from the fruit and some calcium to boot.

Doctor Update!

I have an appointment tomorrow with my Primary Care Physician and a Cardiologist appointment on the 16th of November. Thanks to all for helping me get these under way!

Eat This - Heart Healthy Food Decisions

2009-10-29T19:10:00.000-07:00

I promised a treatise on healthy eating. I have been reading a lot about this recently. There are great guides available, but a lot of confusion over the "truth". I'll show you some items that I think are pretty solid as they pertain to your cardiac health.

My discharge instructions told me to eat a high-fiber, low-fat, low-sodium diet. I'll do that to the extent that it's good to eat...beyond that, I know I'll fall off the wagon. So I'm all about health "with flavor"...I had some pretty bland crap in the hospital and I'm not looking to reproduce that experience again.

We like to cook, and eat. So I'm looking for ways to expand my culinary experience, getting healthier while tasting new and great stuff. I don't want to be bored and cheating with McNuggets in 6 months.

Much of this information is from the National Institute of Health Cookbook (and good guide to nutrition). This is a great online resource which includes basic nutritional guidance as well as a bunch of great recipes that I will be trying.

Calories and Basic Nutrition Requirements
1,600 calories—For young children (ages 2-6), women, and some older adults
2,200 calories—For older children, teenage girls, active women, and most men
2,800 calories—For teenage boys and active men
This puts me in the 2500 calorie per day range...kind of active and a man.

Basic Nutritional Intake Guidelines:
● Total fat .............No more than 30 percent of daily calories
● Saturated fat ......Less than 10 percent of daily calories
● Cholesterol .........Less than 300 milligrams per day
● Fiber ....................25–30 grams per day
● Protein ...............10–35 percent of daily calories
● Carbohydrates....45–65 percent of daily calories
● Sodium ...............No more than 2,400 milligrams per day

FIBER - Get Things Moving

I have spent a lot of time trying to get more fiber, from natural sources. The best sources for me are fresh fruits, vegetables, oatmeal and beans. I'm shying away from processed stuff like granola. I eat "sandwich rounds" which have 5g of fiber in each round. They are like a pita, but a bit more palatable.

There are two main types of fiber—soluble (also called “viscous”) and insoluble. While both have health benefits, only soluble fiber reduces the risk of heart disease. The difference between the types is how they go through the digestive tract.

Soluble fiber mixes with liquid and binds to fatty substances to help remove them from the body. Soluble fiber thus helps to lower cholesterol levels—thereby reducing the risk of heart disease. Good sources of soluble fiber are whole oats, barley, fruits, vegetables, and legumes (which include beans, peas, and lentils).

Insoluble fiber goes through the digestive tract largely undissolved. Also called “roughage,” insoluble fiber helps the colon function properly. Good sources of insoluble fiber are whole-grain
foods (such as wheat and corn bran), fruits (such as apples and pears with the skins), vegetables (such as green beans, cauliflower, and potatoes with the skins), and legumes.

As a rule, fruits have more soluble fiber and vegetables more insoluble fiber. You should try to eat 25–30 grams of total fiber each day. That should include at least 5–10 grams daily of soluble fiber.

I have found that not much processed American food has much fiber. You have to go looking for the stuff, unless you get your RDA of fruits and vegetables and beans.

FATS - Tasty but Oh So Bad?

I am OK without fried food. I like meat, but really like salads, vegetables and seafood, so I think I can do well in fat land. Here's what the book has to say:

Saturated fat. This fat is usually solid at room and refrigerator temperatures. It is found in greatest amounts in foods from animals, and increases cholesterol in the blood more than anything else in the diet. Keep your intake of saturated fat low.

Unsaturated fat. This fat is usually liquid at room and refrigerator temperatures. Unsaturated fats occur in vegetable oils, most nuts, olives, avocados, and fatty fish, such as salmon. There are types of unsaturated fat—monounsaturated and polyunsaturated. When used instead of saturated fat, monounsaturated and polyunsaturated fats help lower blood cholesterol levels.

Trans fatty acids. Foods high in trans fatty acids tend to raise blood cholesterol. These foods include those high in partially hydrogenated vegetable oils, such as many hard margarines and
shortenings.

My New Food Mission

So what does this mean? I'll put it in terms that I understand.

EAT MORE OF:
Oatmeal and high fiber breakfast cereals
Beans (yeah, look out!)
Fruits and Vegetables
Whole Grains - in Breads and Pastas
Oils - EVOO and its brethren
Seafood and lean meats
Vinegarette type dressings

GO LIGHT ON
Cheese and other dairy
Salty stuff, particularly snacks and any prepared side dish (rice, etc)

EAT LESS OF:
Fatty Meats...including chicken wings...damn!
Fried foods
Things made with butter, margarine
Refined starches (bread, plain pasta, sugary stuff)
Creamy dressings

The Food Pyramid

One area I have been noticing is the focus in the US on Meat and Dairy. The USDA Food Pyramid relies heavily on meat and dairy in the daily diet. This is largely owing to the heavy lobbies of the meat and dairy industries. Other cultures (and vegetarians in our country) have shown us that it's very healthy to avoid one or both of these categories and still be quite fit and get your nutrition. For example, I encourage you to check out the Mediterranean food pyramid - which deals very well with the types of food common in that area, and features very little dairy and meat. On average, other cultures may have no meat or dairy, other than a smattering of seafood, in the daily diet. Incidentally, the level of health is high in that area of the world. And a glass of wine is encouraged (well...not discouraged) with dinner!

I'll close with a quote from Michael Pollan, which summarizes his philosophy. 7 words to boil down your choices for healthy eating:

Eat Food. Not Too Much. Mostly Plants.

Other Links: New York Times article.

Getting Closer

2009-10-29T17:22:00.000-07:00

A quick, non-ranting update:

I'm recovering well and keeping up with my medications. I have good stamina, although I am sleeping a good 8-9 hrs/night (and loving it). I called back one family practice and am confirmed for December start up. I have a lead on another and may get in there faster than the first.

I have had a couple of calls from friends who are in the health care industry in Erie who are sympathetic to my cause, and have provided great leads on speeding up the new patient process, and getting hooked up with a good cardiologist.

I'm staying on a good low-fat, high-fiber diet (with a little red wine in there), and feel pretty good at this. We're still pretty busy with band and some other stuff, but it's calming down starting next week. A later post, when I have time, will get into the whole food pyramid and America's love affair with meat and dairy.

Many thanks to those who sent good wishes and goodies. I really appreciate it!

One good outcome of this was that I was able to corral all of the ladies in my family and set up some outdoor photos this last weekend. This is the first outdoor set we have ever formally done...from my front yard!

Thanks ladies. I even smiled nice!

The Sargasso Sea of Medical Care

2009-10-23T04:37:00.000-07:00

Warning: this is a Rant Post.

One of the first steps when we got back from the hospital was for me to schedule an appointment with a PCP and a Cardiac Specialist. One would THINK that would be a pretty easy process.

I thought I had a primary care physician. Years ago I had a checkup and follow-up exam at the PCP listed on my insurance card. The kids go there regularly. I had not personally gone in years. So I call this summer to get a checkup and they tell me that I have been away too long so they took me off of their list of active patients.

I was a bit confused, but I asked to get back ON the list. They'd have to talk to their people about that. They'll get back to me.

Two or three weeks later I call again...thinking simple administrative oversight. Same runaround. The say they will call back and never call. They don't want my business, or are simply incompetent in the area of patient retention.

So I pick another place to start up as a PCP, a new facility 2 miles from me, affiliated with a major local hospital. They will consider me as a new patient, but they need my medical records from old people. I call old people. "We destroyed your records".

Now I'm stuck in a hard place. Old guys not competent and won't take me anyway. New guys stubborn on medical records which don't exist.

So I call a NEW, new place. They need to ask the physician if they will take me, even though they say they are accepting new patients. Once more in a holding pattern...this one can take a week they say. I started the timer on Wednesday 10/21.

Meanwhile I call the leading cardiology practice in Erie to get set up with them...'cause I KNOW I have some issues there. They won't take me unless I get a referral from my PCP. Which I don't have, and don't exactly know when I will have.

So I am in medical limbo. No PCP, no specialist, no idea when I'll get either...and specific discharge instructions from the hospital to see both asap.

In reality, the only medical care I can get right now is to go to the ER. At least if I complain of chest pain they'll move me up the waiting line.

I know much of it is my own fault for not going for years...but this process of changing a PCP should not be this hard or time consuming.

Putting my Six Sigma hat on from my Black Belt days, I see a repeated breakdown in the practice's "transactional process" of new patient screening and acceptance. I don't know what their process requirements are (Critial To Quality characteristics, or CTQs). Usually it's cycle time, accuracy and maybe volume or capacity, and of course, customer satisfaction. If a business doesn't think about the process CTQs, they end up with a home grown process that optimizes some other parameter, such as the workload or satisfaction of the new patient administrator. As a customer/user of their process (regardless of whether they accept me, I'm input to the process), I am obviously not aware of their process CTQs, nor do I feel that the "normal" CTQs are being measured or considered.

I realize that the main processes in a practice are: Scheduling, Appointment/Care Delivery, Billing, Prescriptions, and Emergency, but Patient Onboarding is a key process as well. You miss this one and your practice will get a bad rep from those alienated or rejected, and your patient volume could come down.

I predict that the practice I find that can screen and accept me immediately is the one in town that actually has a support staff that is competent, and has a set of "onboarding" processes that were thought out with the intention of minimizing the waste associated with starting new patients.

Here's my advice to medical practices in Erie: Know your customer base, both those you have accepted and those who apply. Spend a bit of time to define the common processes and what should be important to the customer during those processes. Little things like telling them how long it may take for screening, and regular updates will go a long way to improving your reputation and making the processes better from the customers' eyes. And gather some data during the process - how many inquiries per week, how many turn into applications, how long each application took through various stages of the process, how many you accept, how long until first appointment. Basic stuff that you can collect and analyze with little effort. Having a standard process with standard measurements will let you know how you are doing.

And here's my advice to medical consumers: Know your PCP. Make sure they think you're still alive and haven't shredded your medical records. Give them feedback on which processes work well and which don't.

Oh, and don't try to live with a heart attack if you live in Erie. Better to do that in a small town in Ohio, where they still know how to care for you.

Hills of Pills

2009-10-22T06:21:00.000-07:00

I took no medication before the Heart Attack. Once in a blue moon I'd take Ibuprofin but that was it. I took a daily multivitamin for guys my age. I took pills a lot as a kid and since college, was never on a prescription.

Well, now I get to take lots of pills. I figured I'd write them down here so I don't forget, and so people have some idea of the mechanism behind cardiac medications.

In no particular order, we have:

Carvedilol (brand name Coreg).
Dosage prescribed: One pill twice daily. Dose 6.25mg
Carvedilol is a nonselective β-adrenergic blocking agent with α1-blocking activity. That means that it is a beta blocker with alpha blocking abilities as well.

Beta blockers counteract the stimulatory effects of adrenaline (epinephrine) on beta receptors, found in many tissues of the body including the nervous system and heart. When beta receptors are stimulated, the heart beats faster and harder and the blood vessels constrict, resulting in an elevation of blood pressure. If the coronary arteries are narrowed by atherosclerosis, the increased burden on the heart can cause inadequate oxygen delivery to the heart muscle, leading to the chest pain and other symptoms like I had on Saturday.

Beta blockers act by suppressing these impulses and lead to a slowing of the pulse rate and a reduction in blood pressure. They are prescribed as treatments for high blood pressure and have been shown to improve survival when administered following a heart attack.

The most common side effects are drowsiness and fatigue, along with dizziness and weakness. Dryness of the mouth, eyes, and skin may occur, and those taking beta blockers may develop cold hands and feet. Sleep disturbances and a decreased sex drive are less common but possible side effects of beta blockers. Wheezing is also a less common but potentially significant side effect of beta blockers, and for this reason, they are often not prescribed for people with asthma. Other serious side effects are rare.

Simvastatin (brand name Zocor)
Dosage prescribed: 40mg, once per day
Zocor is a lipid-lowering agent. They lower cholesterol by inhibiting the enzyme HMG-CoA reductase, which is the rate-limiting enzyme of the mevalonate pathway of cholesterol synthesis. Inhibition of this enzyme in the liver results in decreased cholesterol synthesis as well as increased synthesis of LDL receptors, resulting in an increased clearance of low-density lipoprotein (LDL) from the bloodstream. The first results can be seen after one week of use and the effect is maximal after four to six weeks.

These drugs are made from by products of the fermentation of a fungus.

Statins are generally well-tolerated and have only two major side effects that occur relatively rarely: raised liver enzymes and skeletal muscle pain and/or damage.

Clopidogrel (brand name Plavix)
75mg 2/day initially, then 1/day after 2 weeks
Clopidogrel is an oral antiplatelet agent to inhibit blood clots. It works by irreversibly inhibiting a receptor called P2Y₁₂. It inhibits platelet aggregation (clumping).

I was told that this is the most important drug for those with stents, as the body will try to stick things on the stent and this drug will reduce the impact of that activity.

Some interesting commercial information on this drug: It's nearly $6/pill as it is in exclusive north american production by the patent owner, Bristol-Myers Squibb. It is sold in nearly 110 countries, with sales of US$5.9 billion in 2005.

In 2006, generic clopidogrel was briefly marketed by a Canadian generic pharmaceutical company before a court order halted further production. The court ruled that Bristol-Myers Squibb's patent was valid and provided protection until November 2011.

Generic clopidogrel is also produced by several pharmaceutical companies in India at significantly lower retail prices, up to 1/30th of the price. Counterfeit Plavix is in circulation, as with many popular medicines.

So, this is a medication that is highly useful and expensive, so there's lots of shady and illegal duplication going on. At least in late 2011 the drug price will go down as legal generic manufacture may be permitted.

Adverse effects include hemorrhage.

Aspirin
Dosage prescribed: 325mg, once per day

Aspirin also known as acetylsalicylic acid, is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. Aspirin also has an antiplatelet effect by inhibiting the production of thromboxane, which under normal circumstances binds platelet molecules together to repair damaged blood vessels. This is why aspirin is used in long-term, low doses to prevent heart attacks, strokes, and blood clot formation in people at high risk for developing blood clots. It has also been established that low doses of aspirin may be given immediately after a heart attack to reduce the risk of another heart attack or of the death of cardiac tissue.

The main undesirable side effects of aspirin are gastrointestinal ulcers, stomach bleeding, and tinnitus, especially in higher doses.

Today, aspirin is one of the most widely used medications in the world, with an estimated 40,000 tonnes of it being consumed each year.

Glyceryl trinitrate (brand name Nitrostat)
Dosage prescribed: One tablet only as needed for chest pain

Glyceryl trinitrate (GTN) is an alternate name for the chemical nitroglycerine, which has been used to treat angina and heart failure since at least 1870. Despite this, the mechanism of nitric oxide (NO) generation from GTN and the metabolic consequences of this bioactivation are still not entirely understood. In medical circles it is often referred to as "nitro."

This is the same substance as the explosive, but in very tiny quantities. I had a couple of these on Saturday - one in the ambulance, and another sometime during the ER or Cath Lab adventure.

So...now I take a cholesterol reducer, two anti-clotting drugs, and a beta blocker, and I have my "emergency pills". I'm still not sure how I feel about all of this, but if these reduce the potential for a recurrent of the symptoms, I will gladly take them!

What, pray tell, is a Stent?

2009-10-21T10:32:00.000-07:00

Here's a nice, boring description of the procedure that brought me home.

Not long after my second "reboot" in the ER, the Cardiac Surgeon was explaining treatment options to my wife and daughter. The Left Anterior Descending artery (LAD) was blocked and needed to be opened up. He discussed that there is a nonzero chance of complications, but that the procedure was important to start quickly. We all agreed that the current situation was not desirable, and told them to proceed.

So they prepped me in the ER (shaving - youch!) and sent me to the Cath Lab, which is where they perform Angioplasty and insert the stents.

They enter the artery at the groin and thread a tube inside the artery to reach the right spot near the heart. They insert dye into the tube to make the contrast stand out more on the screen (GE Medical Systems equipment). I could turn my head and watch the video of the tube moving and various things, but I didn't really know what they were doing. It took a team of three to make it all happen - one on the "steering wheel", another supporting him (operating the air line and dye I think), and a third to grab the needed parts.

Reboot number three happened in the lab. I don't know why, but it was before the procedure had been completed. Probably because the pipe was still clogged.

I did some reading on the whole procedure, called Coronary Angioplasty. Here's a great explanation of the procedure. Basically after the tube reaches the destination, they inflate a balloon which pushes against the arterial walls and opens up a passage through the plaque or other blockage. Once that's done, they insert a stent (a metal matrix), which is expanded by the balloon and, once in place, holds the arterial walls open.

I got three stents installed during my session. Here's a photo of a stent very similar to those inserted into my artery last Saturday:
You can see that it is a hollow matrix or scaffold made of stainless steel, and once inflated by the balloon, holds its shape. This one is also coated with a specific drug that is used to discourage rejection. It's called a "drug-eluting stent". For the first 120 days, it will secrete a drug to keep from accumulating stuff on its surface. Mine are brand name Promus, made by Boston Scientific. Hmm, I wonder if I can get a "Powered by Promus" T-shirt? Not many people would get it - it would be considered an inside joke - pun intended.

This whole session from arrival in the lab to leaving, seemed like maybe an hour. Once they removed the tube, they had to put a pressure dressing on the insertion site to keep from bleeding. I had that on for several hours and was instructed to not move my leg for about 12 hours after the procedure. Bleeding risks are increased after a heart attack, because I had lots of clot-reduction drugs in my system.

The Heart Attack occurred around 5:30 on Saturday. By 7:30 PM I was recovering from the Cath Lab procedure and was actually on my feet standing on Sunday morning.

I now carry a card that describes the location and nature of the stents. They will be there forever. The card describes what medical people should do in the event that they need to do an MRI, as the stents are metal and might be impacted by the strong magnetic fields of an MRI.

So, here's to the medical and scientific community that can put a man's heart back in order in 2 hours, and have him walking a day later!

There was no white light

2009-10-20T14:31:00.000-07:00

It's still crystal clear. We were at a marching band competition in Massillon Ohio, nearly 3 hours from our house. I was hanging out on the top of a hill, waiting for band awards to end and the marching band to come over for dinner. We had pizza, soda, fruit and other snacks for the kids and support team, and I was the guy guarding the chow and the picnic grove.

As I walked down the hill toward the car, it came over me. Right in the middle of my chest. It wasn't bone-crushing hurt, but enough that I couldn't think of anything else. Panic and troubled breathing. I tried to sit down, lay down, nothing worked. I thought it was maybe a bad case of heartburn from our lunch, but something told me this was more serious.

I popped open the cell and called Bruce. He's another band helper (Pit Dad) and we had just traded numbers not 2 hours earlier. He answered and I told him I was having chest pains and could he get over to the picnic area. Not 30 seconds later I see him barreling down the hill like a fullback. He took one look and called 911. He found a couple aspirin which I took, and set me beside a tree.

It could not have been more than 2 minutes until the first responders arrived. They quickly put a portable EKG on my chest, and started the interview process. Maybe 3 minutes later the ambulance arrived and off we went to the local Affinity hospital ER. On the way, the guys gave me a Nitro tablet and started the IV. By the time the ambulance pulled up at the hospital, much of the pain had gone away.

Once we hit the ER, things moved very quickly. A hundred questions: No, I didn't take cocaine. No, I don't smoke. Another IV started in the right arm. The specialists were pointing at the first remote EKG strip, and they could tell exactly where the problem was. Something about an artery.

Lots of noise and confusion. Then: nothing.

Absolutely nothing.

Like someone turned off all the lights, sound and sensation.

No white lights, no out of body, just nothing.

Then: all the switches came back on at once: hearing, vision, sensation. I had no idea where I was for a bit, not accustomed to seeing ceiling tiles and faces. Then it came back to me and I realized where I was...but not what had happened. I thought I had passed out.

It was a bit more than that. I am told I flatlined twice in the ER, within about 5 minutes of each other. That team knew exactly what to do, and to my great gratitude, did it well. I still have some tender spots from the paddles, but I'm really not complaining.

I don't know why it happened to me. I'm 46. I'm pretty healthy, slightly overweight, and I run 10 miles a week. I'm a blood donor and have strong vitals. I don't have a strong family history of heart disease. But my artery plugged up and the result was a heart attack and 3 cardiac arrests in one day.

This is obviously a significant life event. Other than the three "reboots" and the discomfort of the treatment and recovery, I don't feel all that different. But that by itself is the miracle. How a heart can be restarted and the body and brain picks up and can keep going is truly amazing. It is possible because I was in a place and with people who could treat me as soon as it happened. Had I not been in the hospital when my heart stopped, it would have been much worse. My brain and heart did not suffer for lack of Oxygen for very long, so I had even my short term memory after I came back.

But I know things will change. I have an injured heart. I will have limits where there were none before. I have to back off on some of the stuff I do. I have to get my affairs in order: a will and more. Time to grow up I guess.

I'm home. I can't thank enough the medical professionals, close friends, family, clergy and co-workers who offered support and concern for my family. It was a very rough few days, more I think for my wife and daughters and family than for me. Believe me, I thank each of you for caring.

I don't know where this blog will go. It's more for my own good to document my thoughts and journey into cardiac recovery than for any other purpose. If you find it to be useful, or if it persuades you to get a checkup or change a lifestyle, then it will be good for more than my personal therapy.

Here's a photo that I asked my wife to take of me today, as I was released from the hospital. Note the Halloween decorations in the yard off to the right. That wasn't intentional, but I'm real glad to be standing in front of the fake graveyard at this point.