Heart's Delight

Remembering what is important.

This post has little to do with sailing or boats or marine science.  This one's from Damon.  It's personal.

Ten years ago last week, on March 14, 2013, I had a heart attack. I'd felt increasing pain and fatigue for five days, but I did nothing about it. Despite the fact that I have a deep family history with heart disease, and knew what was happening, I was in denial. I did the dumbest thing possible: waiting until I was having a full-blown heart attack before taking any action. I was 44 years old and an avid runner who lived a pretty healthy lifestyle. My story is not that unusual, but it contains some useful lessons. Surviving a heart attack has been a liberating experience; it has actually been one of the best things to happen to me. Here is some of what I learned over the past decade:

1. Your risk of having a heart attack is influenced by 3 things: Your heredity, diet, and lifestyle. A junk food junky who leads the most sedentary life can have a healthy heart if they have "good genes." Conversely, you can lead the healthiest life and still have a heart attack if you have "bad genes."

2. Physical fitness is crucial. So why should you bother to exercise and eat well if it's all about your genetics? The important point is that genes are not the only factor. It's not just a game of chance. Nothing is entirely in your control but you do have a large influence on your health. Someone who is genetically predisposed to coronary artery disease can delay that heart attack by years simply by taking good care of themself. Someone with just "moderately bad genes," may be able to prevent that heart attack entirely. But here is the important thing: heart attack sufferers who were physically fit prior to the attack are more likely to survive and are more likely to return to a normal life than are those who were sedentary and/or overweight.

"Use it or lose it" is the perfect description of your health and fitness. People don't stop exercising because they get old, they get old because they stop exercising. You don't have to be a runner or competitive athlete to have a healthy heart. Anything that increases your activity level helps. Just use your car and your couch a little less.

Snowshoe racing is a thing.  Racing at Bradbury Mountain in Maine, 2016.

3. Don't ignore the symptoms. I suffered from a combination of being embarrased to find out that I may just be having acid reflux, of being in denial, and of being just plain stubborn. This almost killed me. The ER doctor told me that if I had waited another couple of hours to come into the hospital, I probably would have died. My symptoms started out as mild fatigue and an achy back. At first, I thought I was just coming down with the flu. Then it progressed to pain in my throat and jaw, before developing into the classic symptoms of pain in the chest and left arm. I remember these sensations very clearly because the ER doctor looked me straight in the eye and said:

"Remember all the symptoms that you've been feeling. Burn them into your memory. If you ever feel them again, call an ambulance. Don't wait five days to do something because you'll probably end up dead. You were very, very lucky this time."

Her speech should have concluded with "You idiot." Being the professional that she is, she left that part unsaid. But the message was clear. The only reason I survived my foolish delay in treatment was that my heart was very strong. If you feel these types of symptoms and they get worse during or after mild exertion, get someone to drive you to the hospital or call 911 immediately. Don't be that idiot.

4. A heart attack doesn't have to be the end of your world. Of all the life-threatening diseases to have, cardiovascular disease is actually one of the best! The ultimate cause is genetic and biochemical. That stuff is really complicated and researchers are still trying to figure out how it all works. But the result of all that biochemistry is a plumbing problem. Just like a drain pipe, your coronary arteries can get clogged. And just like plumbers, cardiologists can pinpoint the problem and open up that clog. In most cases now, the procedure is pretty simple: angioplasty and stenting. In fact, I was awake for the entire procedure. The surgical team knew that I was a biologist so they turned the video monitor so I could see my heart and the catheter being fished up into my coronary arteries, as well as the view from the catheter inside my arteries. It was so cool; I just wished I didn't have to pay the price of admission for this movie. As I watched the doctor put the stent in place in my heart, I felt better instantly.

As a kid growing up in the '70s and '80s, I had known people with advanced heart disease. Back then, it seemed like people either died suddenly of a heart attack or they slowly withered away. The diagnosis back then was a death sentence. But that is certainly not the case today. Fifty years of medical science has made huge advances in treating this disease. About 8 weeks after my heart attack, I ran a 5k race. I didn't run fast, but it felt so good, so normal, to be out running with people. With approval and guidance from my cardiologist, I was able to resume running and racing all-out. I have competed in half marathons, trail races, mountain races, and snowshoe races. In 2015, I won my age group in the U.S. National Snowshoe Championships and qualified for the National Snowshoe Team (Unfortunately, I wasn't able to compete in the world championships because of a calf injury).

5. Having the right doctor for you matters. When I was in the hospital, I saw a lot of different doctors, usually for very short visits. They'd prescribe something and then I wouldn't see them again. By the time I was released I had a bag full of prescription meds. In the first couple of weeks after being released, I continued to be very fatigued, to the point where I'd fall asleep at all times of the day, even at work. Something wasn't right, so I started wearing my heart monitor all the time (which I normally wore during running workouts). What I found was that my resting heart rate was dropping below 30 beats per minute (the monitor stops recording at 30 bpm, so I'm not sure how low my pulse actually got). When I went to see my new cardiologist about a week or two after my heart attack, he took the time to get to know me and recognized that I wasn't the typical cardiac patient. One of the drugs that I was given suppresses the heart rate. It is a common medicine prescribed to heart attack survivors that allows their heart to rest. Given that my resting pulse was naturally in the 40s, I didn't need that drug. So he told me to stop taking it and I immediately felt "normal" again.

After lots of tests (EKGs, ultrasounds, stress echo tests, etc.), my cardiologist told me that other than the blockage that had been re-opened, I had a healthy, strong heart. And he encouraged me, under his close supervision, to slowly build back up to the level of running that I was at prior to the heart attack.

Racing at the 2015 Granite State Snowshoe Championships (a 10k race that featured 1,500' feet of elevation gain).  I won the masters' division of the Granite State Snowshoe Series that year.

6. Having role models is important. One of the things that buoyed my spirits and inspired me to get back out there and live a full life was the realization that there are lots of people leading active lives with conditions similar to mine. Having grown up in Massachusetts and being a runner, one of the highlights of the year was watching the Boston Marathon. Ever since I can remember, Team Hoyt, consisting of father Dick and son Rick Hoyt, competed in the marathon. Rick has cerebral palsy and is a quadriplegic. Dick would push his son in a wheel chair for the entire 26.2 miles. But it wasn't just the Boston Marathon; they competed in over 1,100 endurance events including 72 marathons (32 Bostons) and 257 triathlons (6 Ironmans). At the age of 50, Dick ran the Marine Corps Marathon in 2:40 while pushing Rick in his wheelchair, which was the fastest time posted by any runner in the over 50 age group. In 2003, at the age of 63, Dick had a heart attack. Following his recovery, he and Rick returned to competition, running their last marathon together in Boston in 2014.

I have other role models who are much closer to me. My older brother, Bill, has a similar condition. He had his first experience with cardiac care several years before me and he returned to his normal, active life, which includes playing ice hockey a couple of times per week. My father-in-law had bypass surgery in the 1990's, a much more invasive procedure than stenting. He, too, returned to an active life. Now at age 91, he is in better shape than most 60 year-olds.

Following a cardiac crisis, your prognosis is largely up to you. You can decide to withdraw and lead a sedentary life, which will be the beginning of the end. Or you can decide to be active, which will help maintain your heart's strength and health. Looking at the health outcomes for people who chose the latter helped inspire me to do the same.

Janet and I with her dad, Charlie, 26 years after his bypass surgery.

7. Insurance matters. Luckily, my employer had an excellent health care plan. The total cost of my care for the heart attack was approximately $50,000. We paid less than $1,000 in copays and deductibles. Because of this good quality insurance, we never had to make any difficult decisions regarding the cost of treatment. If it wasn't for our insurance plan, this health crisis could have triggered a financial crisis. Healthcare is the #1 reason why individuals have to declare bankruptcy. We are very fortunate. Not everyone is as lucky.

The souvenir I got for my experience, a wallet card with the model number of the stent and information on where it was implanted. 

8. Cardiac rehabilitation is important. I had been an athlete for my entire life. I really thought that my body was indestructible. The heart attack caused a profound loss of confidence in my body. It's difficult to regain that confidence, but it's vitally important to do so. Remember that bit about using or losing your fitness? You have to get back out there and be active.

Cardiac rehabilitation is what restored my confidence and allowed me to regain my fitness. It is essentially like going to a gym to workout, except that you do it while being hooked up to EKG and blood oxygen monitors, and exercise physiologists and medical technicians watch the monitors as they guide you through individually-tailored exercise sessions. In this way, you can safely increase your fitness, regardless of your initial fitness level. And you can prove to yourself that your body is still capable of exercising. Cardiac rehab is especially useful when combined with the results of a stress-echo test. Immediately after my heart attack, I was hyper-vigilant about any new pain or sensation. I was paranoid. But after a few weeks of cardiac rehab, my confidence grew and I simply stopped thinking about my heart. Over the past decade, I have spent much more time worrying about my achilles tendons than I have about my heart.

"Healthy" doesn't have to be boring.

9. Having a heart attack was one of the best things to happen to me. It sounds trite but life threatening experiences can be liberating and a source of motivation. It makes you realize what's really important. For years, Janet and I had been talking about getting a bluewater sailboat and cruising for a couple of years. Up to that point, it was all talk. As soon as it became clear that I was going to make a full recovery, we got serious about those plans. We realized that we shouldn't wait until our 60s or 70s; life is too unpredictable. If it hadn't been for my heart attack, we wouldn't be out cruising today.

I don't actually recommend that you go out and have a heart attack, or any other life-threatening condition. Just take my word for it; life is short, live it while you can.

Janet posted in her An Ocean Lover in Maine blog about this back in 2014. It's interesting to read her perspective, one year after my heart attack.