Lifestyle changes

by Doctor Science

Wednesday of the week before last, Mister Doctor Science started to have chest pains while he was at fencing. He was wondering if it was just acid reflux (again), but one of the other fencers insisted on driving him to the ER.

That friend is currently my favorite person in the whole world, because Mr Dr was in fact having a heart attack. His right coronary artery was completely blocked, so they did an angioplasty and put in a stent. (Actually, it was blocked in two places -- but in one of those places a natural bypass formed to take care of it.)

However, they also found a serious blockage in the left coronary artery, the one known as the Widow Maker. Yikes! So after going home from the hospital over the weekend, last Wednesday he went back in to a different hospital to have a minimally invasive, robotic bypass operation. This is very cool, super-advanced stuff: the sternum isn't split, they don't have to take the heart off-line, the incisions are small, and they use an artery from the chest wall to do the bypass, so there's no extra incision on the leg. He should be substantially recovered from the surgery in only 2-3 weeks.

Before this surgery, Mr Dr was still mostly in the "Denial" stage, but I'd moved on pretty quickly to "Anger". As you probably all know, the first thing they start talking to us about is a "Heart Healthy Diet" -- but we've been about 80% there for *decades*, without any particular medical orders. Mr Dr is very athletic (for a 60-year-old) and has, to a large degree, chosen his lifestyle with the goal of not having his father's medical history -- father died at 67 of inoperable heart disease (they'd already bypassed everything that could be bypassed), first heart attack in early 50's, severe Type II diabetes for several decades. So, for instance, when we first started living together (c. 1985) Mr Dr explained that he doesn't eat dessert regularly, drink soda, or keep cookies around -- because he figured he was at genetic risk for diabetes. And I, knowing I had a family history of high blood pressure in post-menopausal women (which happened to me, right on schedule) had already gone to a "lower sodium" diet. We really thought that, and exercise, would also be the key to dodging heart disease. And for many years his cholesterol levels were at "Eskimo" levels -- they've only recently edged into the "normal" range -- and he's always had very good blood pressure, blood sugar, triglycerides, all the mod cons. He also had an EKG and stress test and all that sort of thing about a year and a half ago, before his knee replacements.

But now this. I thought I had another 10 years or more before I'd have to start worrying about this! I want to *keep him alive*, because I sure plan on having a long run. The fact that both my parents are alive and in possession of all their marbles and other faculties at the age of 90 has possibly given me unrealistic expectations ... but I really want him to live longer. Like, a *lot* longer, decades longer.

Part of me feels as though I was sold a bill of goods about "avoiding heart disease", that the whole "Heart Healthy Diet" thing is no more than a cargo cult. Genetics holds the trump cards -- at least for Mr Dr Science's family. His sister says that she recently did a "23 and Me" genetic analysis, and what do you know, one of the "hits" was for an allele linked to heart disease.

Nonetheless, I'm looking up all this stuff about the "Heart Healthy f*cking lifestyle" -- almost all of which we've been doing! for years! -- and wondering which parts are really *important*. Or is the whole thing a scam, to make us feel guilty and/or in control?

Which things are most important to cut back, for people who already make almost all food at home: sodium, animal protein, animal fats, cheese, total calories? We do not consume significant amounts of: trans fats, refined sugars, desserts, "junk food", fast food.

In some ways the worst part is knowing I've passed into a different life stage, one where I really have to face how *frail* males are. Where I think of him as mortal.

I visited him on Wednesday after he was out of the surgery -- which went extremely well, "textbook" they said. As I was leaving the hospital I saw a woman we lived next to at our old house: my kids sometimes babysat her kids. She was there visiting *her* husband, age 64, who needs open-heart bypass surgery. We commiserated with each other, sharing our fears. I don't know how aware men partnered with women are of how much their frailty preys on our minds.

The Extraction of the Heart of St. Ignatius from the Altarpiece of St. Barnabas by Sandro Botticelli. I haven't been able to find out what event (or legend) this image depicts.

Comments

[wj]

Glad to hear Mr Dr is on to road to recovery.

I don't know how aware men partnered with women are of how much their frailty preys on our minds.

At a rough estimate: not aware at all. We all like to think that women are the frail ones. Makes us feel useful/important. In fact, taking care of (frail) women tends to be seen as our purpose in life. The reality of "taking care" has shifted some, from physical to economic, but the mindset is still there. (And that's part of why some men freak about women working outside the home. If they can support themselves financially, what other way is left for us to take care of them???)

If we actually stop and think about it, we are (reluctantly) aware that women have more stamina. That, after all, explains why you live longer. In spite of the fact that, especially if they weren't employed outside the home, women never do really retire. We retire from our jobs, and they just keep on doing the same things they have been doing all along. Forever.

But the idea that women actually think of men as "frail"? No, simply wouldn't occur to hardly any of us.

[byomtov]

I had a blockage in the LAD (the widowmaker) more than 20 years ago. Angioplasty - no stent - took care of it.

My diet has slipped considerably in healthfulness since, though it's not terrible. So there is no reason to think that Mr. Dr. S. can't keep ticking for a couple of decades or more.

One annoying after-effect is dread of chest pain. Yes, it's wise to go to the ER, but it's usually nothing cardiac-related. Unfortunately (or not) once the history is explained you are in for a couple of days of enzyme tests, a stress test with some sort of radioactive stuff injected in you, and a few other tortures. I do the routine every few years, though I have (unwisely?) identified a few things that no longer scare me.

Pro tip: Along with electronics, books, phone, etc. take a pair of pajama pants. Those gowns are undignified.

Good luck.

[CaseyL]

Oh, that's scary - very glad to hear Mr. Dr. Science went to the ER and is doing well! (And what a terrific friend that other fencer is!)

I think we're finding out that genetics really does trump just about everything else. It's a sobering thought for generations raised on the idea that if you do everything "right" regarding diet and exercise, you can outwit most systemic diseases.

I think the diet-and-exercise part is still important, because that keeps the biological machinery in better shape for things like recovering from surgery and getting the most out of physical therapy.

But thinking in terms of recovery rather than outright prevention might be a better model.

Best of luck to you and to Mr. Dr. S for a full and vigorous recovery!

[Hartmut]

Taking the heart out of people (after death) was quite common at least in the Middle Ages. The basic idea is that the true burial place is that of the heart not the body. If people wanted to be at a certain place but did not make it in life, they could ask their heart to be sent there. Most common example: wannabe crusaders that did not fulfill their vow to reach Jerusalem. If their hearts could be buried in the Holy City, they'd cop-out that way. Edward I. Longshanks is said to have done that.

If the image is not about Ignatius de Loyola but Ignatius of Antioch, then a different legend applies. He was martyred under the emperor Traian. Before his death he claimed that the name of Christ was in his heart. His tormentors opened his chest (after the wild beasts had killed him without any visible injury) and found the name of Christ on the martyr's heart written in golden letters.

[Marty]

I have slowly come to realize the fear associated with my frailty. I had a stent in 2004, quadruple bypass two years ago.

It is scary stuff, I feel for the whole family. It creates a realization of mortality of Dad in the kids also. In this case, maybe a first real sense. As I recovered I quit worrying about it, my wife seemed to be somewhat less worried, it seems to prey on the kids minds more.

[PaulB]

My wife was an oncologist, very well informed about risk factors, who made all the healthiest lifestyle choices. She died of cancer in her late forties.

You can reduce risk but you can't eliminate it. Stuff happens. She was very unlucky. Me, I was fortunate that the best woman in the world loved me and chose to have my children.

[Shirt]

Please make sure Dr. Science has nitroglycerine on hand. It's a damnably effective drug against angina and removes the question: is it my heart? If it's effective, yeah, you got a heart issue. Get thee to thy cardio-dude. I personally believe anyone over fuifty should be required to carry nitro tabs (they're really cheap) and the life the might save might be Dr. Science or perhaps even you or one of your friends.

Tomorrow is my follow-up nuclear stress test; I'm looking forward to it.

[Priest]

A very good friend of mine had this condition and procedure done about a year and a half ago. Another case of family history trumping lifestyle.

His friend Bill Torpy writes for the AJC, and did a good write-up about it. Unfortunately it's "premium" content, so not free, but it's a good read.

http://www.myajc.com/news/news/national-govt-politics/ocare-saved-a-life-heart-attack-city/njnRX/?icmp=ajc_internallink_invitationbox_apr2013_ajcstubtomyajcpremium

[Shirt]

fuifty? Fifty! sorry. One quick follow-up if the nitro doesn't work that DOES NOT MEAN you don't have cardio issues. I had cardio issues for years but it wasn't due to the LAD or RCA. It was due to the Circumflex artery --- The only artery to my heart. The chance of any one person having that condition is about 1:1000. It had blockages in three places. I also learned that bypasses do fail, probably in about 15 years but applying MTBF parameters to them is nuts. (If anybody has data that indicates otherwise, please share!)

[cleek]

PaulB, sorry to hear that.

[Turbulence]

I'm glad to hear Mr Dr is recovering well. On the 23 and me bit though, I'd advise caution. I have 23 and me, and for 95% of the disease linked alleles it flags, the results are basically worthless. The reason is that most of the studies are small, linked to a single ethnicity and are often contradictory. For lots of the disease risks it highlighted, when I looked at the details, there'd be 4 studies listed some of which indicate that I had a higher than average risk and some indicating a lower than average risk.

There are a few things that 23 and me is really really useful at, like the breast cancer BRCA genes, but most of the disease studies are just not robust enough to mean anything.

[Girl from the North Country]

So glad Mr Dr is doing well, but I am a bit puzzled by the omission of any mention of CT angiogram like one of these, which Mr GftNC's cardiologist insists on performing every 1 to 2 years. It is true that Mr GftNC, who is a true Yorkshireman, never had any tests until he met me, in his early 60s, but when he discovered he had high cholesterol and high blood pressure he was put on statins and bp meds promptly. The cardiologist when first visited some years later did all the ECG, Stress test etc, all of which were fine (Mr GftNC is very fit), but suggested the 256 slice CT for completeness sake, and sure enough it showed moderate blockage in a couple of arteries but not the widowmaker. So we've gone back every couple of years, had the CT and other tests again, and found that the blockage has worsened slightly each time, including in the widowmaker last time. So now the cardiologist (a very eminent guy) says we have to do this every year, and if it gets any worse it's stents. He seems to think that, when monitored in this way, disaster (at least of this sort) can be averted.

Very annoyingly, when we first saw him, I hoped he would discourage some of Mr GftNC's extraordinary but typically Northern dietary habits (eating all the fat on the lamb chops etc), but he said "He's on statins, he can eat what he wants and it won't do any harm". Re your lifestyle question, he said the most damaging behavioural choice was smoking (Mr GftNC had given up many years ago) and the best choice was a decent amount of moderate exercise e.g. a brisk walk every day.

[Morat20]

Glad to hear he's doing well. My father's 71, and we're doing a hefty specialist dance right now.

He was in the hospital two weeks ago because he decided to make a darn good go at bleeding to death internally. (Pro-tip: When they say blood thinners can 'interact' with other medications, they mean 'increase it's efficiency 5-fold'. OTOH, he's been on them 40 years and only twice had bleeding problems because of interactions. He was just REALLY serious this time).

Added pneumonia to the list (he had it going in), and he's having a slow time recovery. On the bright side, we have located the bleed -- an underlying condition (Crohn's, almost certainly. We're waiting on the 'prove it without a doubt' tests after one of those fun swallow a pill tests showed...a SI that looked like a nasty case of Crohn's) that hadn't been diagnosed.

Which explains a LOT about his health the last year, including his weight loss (doctor's kept searching for cancer), many problems with malabsorption of nutrients (thought to be a side effect of another medication), etc.

It's been sobering to see him so ill, and struggle to return to health so slowly. But the silver lining -- as with you finding out about that blockage -- is that it's uncovered other problems that can now be addressed.

In the end, he's likely to feel a LOT better, gain some muscle back (even if it takes a year), and switch to a blood thinner that's a lot less picky about other medications.

It would have been nice to figure it out without the 'nearly bleeding to death' bit.

[Han]

Regarding cholesterol, supposedly healthy eating, statins, and hearts, an engineering prof at MIT has done interesting research, provoked by her husband's health, not corporate sponsors, https://people.csail.mit.edu/seneff/

Being of Korean heritage, I can't help but noting that the French Paradox regarding diet is actually a paradox that involves almost all traditional diets versus the US healthy heart recommendations re low fat et al.

Did everyone see the official and very quiet retraction of the dietary cholesterol equals blood cholesterol,by the USG? Will try to remember to return with the link, but it's now quietly official.

Yes, the frailty of our male spouses weighs heavily as one ages. Do men not know of our worries?

[Morat20]

Did everyone see the official and very quiet retraction of the dietary cholesterol equals blood cholesterol,by the USG? Will try to remember to return with the link, but it's now quietly official.
And it's not always cholesterol. My father's has great cholesterol. What's clogging his arteries is a rarely checked for lipoprotein ( lipo(a) ). (It's level is, basically, genetically fixed. It doesn't change much at all over your lifespan).

It's still not routinely screened for without a family history of either high levels (which requires you to know it's a problem) or narrowing of your arteries without correspondingly high cholesterol levels.

[McKinneyTexas]

Doc, first sorry this has happened. Second, glad it got caught. No one likes being reminded of their mortality before it's time to check out. Mr. D is my age, more or less. He needs to watch the reflux carefully. That is nothing to sneeze at. Esophageal cancer is way harder to manage than a heart condition. As others have said, genetics is an issue. At least everyone is on alert and keeping an eye on things. Good luck.

[JanieM]

Regarding cholesterol, supposedly healthy eating, statins, and hearts, an engineering prof at MIT has done interesting research, provoked by her husband's health, not corporate sponsors, https://people.csail.mit.edu/seneff/

Seneff is a vocal anti-vaxxer. Just sayin'.

[JanieM]

P.S. More to the point, best wishes to the Doctor Science household for Mr. Doctor's speedy and uncomplicated recovery.

[byomtov]

Did everyone see the official and very quiet retraction of the dietary cholesterol equals blood cholesterol,by the USG? Will try to remember to return with the link, but it's now quietly official.

I didn't notice that, but my impression is that it's very old news. Back when I had my problems, 20+ years ago, I was told that the cholesterol villain was saturated fat, not dietary cholesterol.

[russell]

hey Doc S, so sorry you have this going on! good job on your husband's part getting it checked ASAP.

I have friends and family who have been through similar, and in general the prospects for recovery these days are pretty good. so, there is no reason to think Mr. Dr. S won't be around for quite a while.

it's true that it's kind of frustrating to do all the right stuff and still have stuff like this happen, but another way to think of it is that all of the good habits you have practiced make it way less likely that there will be any long-lasting ill effects from Mr. Dr's cardio incident.

All best wishes to him for a speedy recovery, and to you and yours for some peace of mind.

[ral]

"What russell [and JanieM and others] said", i.e., best wishes to you and Mr Dr [and others]

[Countme-In]

Best wishes for Mr. Doctor and Mrs. Doctor Science and all of the little Sciences in recovery and its fullness.

Although immature for my age and quite active with a pretty good diet, I've come around to the genetics-is-all perspective, especially after witnessing my Dad and a sister succumb to childhood diabetes, a fate that I and my other siblings have dodged.

But the boogeyman is out there hovering anonymously, I'm increasingly aware, despite trying to pledge a certain amount of now flagging allegiance to Nietszche's Amor Fati.

After witnessing my mother's ordeal with Alzheimer's (I've mentioned her here; I guess it's time to break the news that she passed away this past December; she was past ready to go), there's nothing to like about impending oblivion and whichever dreadful way we slide down the ramp.

Live for today. I play baseball starting April 14. Yes.

Regarding the reflux, I had a problem with that for several years so I finally, without medical intervention, took the bull by the horns and stopped ingesting all of the extras for a week -- alcohol, coffee, the low-dose Statin I take, and all but bland food -- and then added them back in one at a time.

Conclusion: coffee/caffeine was definitely the culprit and so I've been virtually free of the problem since. Also cut back on the alcohol because it is a secondary source.

Also, and I'm sure everyone is aware, adjust your sleep positions. Either prop up your upper body and/or avoid sleeping on your right side because of the angle by which the esophagus attaches to the stomach aggravates the reflux in that position.

A hiatal hernia could also be causing the problem. Basically, the valve at the base of the esophagus loses its vitality and doesn't do its job, thus letting acid go the wrong way.

Good luck.

[hairshirthedonist]

All the best Mr. DocSci. His story strikes terror in my pun-intended heart. I've always been a bit paranoid about heart disease because of my paternal family history.

The more kids I've had, it seems the worse my diet has gotten (more convenience-driven), though my exercise habits remain pretty good. Now that I'm getting closer to 50, the weight doesn't seem to come or stay off as easily, though, even though I can still do strenuous stuff without any trouble.

The one thing that keeps me from being overly nutty about my heart health is monitoring my heart-rate recovery after exercise. I prefer shorter, more vigorous exercise to longer, more moderate workouts, so my heart rate gets up to around 90% of its calculated maximum when I do cardio (which tells me my calculated maximum is probably lower than my actual maximum, otherwise I wouldn't be able to sustain my effort as long as I do).

I'm just curious if anyone else does this. I've heard too many stories about apparently very fit people dropping dead, usually during their workouts. My hope is that my heart-rate recovery would start to decrease before I had significant problems, giving me plenty of warning to get checked out prior to having a major event.

I measure my heart rate immediately upon stopping whatever exercise (let's say it's around 160 bpm then). After resting for 1 minute, I measure it again (let's say it's around 115 bpm). So my 1-minute heart-rate recovery would be about 45 bpm (a typical result - one I've been averaging and never too far from in a given measurement over a matter of several years).

The most interesting thing about heart-rate recovery is that it is a predictor of death, generally, and not just cardiac-related death. I'm most afraid of heart disease, so you could say that's what I'm most looking for, but I guess it's nice to know it might warn me about something else, too.

[cleek]

i'm a runner and i'm afraid to test my heart rate.

[Hartmut]

A hiatal hernia could also be causing the problem. Basically, the valve at the base of the esophagus loses its vitality and doesn't do its job, thus letting acid go the wrong way.

Yeah, that's what I have. It's going to be Omeprazol for the rest of my life. At least it's 100% covered.

[Nigel]

Coming to this rather late, and have little to add other than sincere best wishes.

As far as the male frailty thing goes, some of us secretly think that after a certain age we might just be fairly disposable...

[Slartibartfast]

My sympathies, Doc. It sounds like it's genetic. He's just going to have to be very careful.

My dad just tripped over his 80th birthday. He's been a smoker his entire life, and he eats whatever he pleases. Again: genes. His mother was much the same; smoked heavily and drank daily her whole adult life.

It hardly seems fair. Anyway: I'm glad they caught it before it was more severe. Are they going to implant a monitor, or do frequent checkups, or what?

[Stewart Dean]

Mr. Dr. might look into L-arginine, a simple amino acid that, how ridiculous, appears to clear up cardio-vascular obstruction...and do it gradually without breaking clots free and killing you in the process. My partner's father dropped dead at her age of a stroke caused by such. She had a ultra-sound scan of her cardiovascular system and was found with severe neck aertery obstruction....dead woman walking to follow her father. Six months later with L-arginine, she's clear. The treatment is simple and inexpensive and without any side effect. She uses this:
http://amazon.com/Health-L-Arginine-Supplement-5000mg-L-Citrulline-Cardiovascular-Health-Formulated/dp/B00J7UTCVC
Background info:
http://www.ncbi.nlm.nih.gov/pubmed/15849373
http://articles.mercola.com/sites/articles/archive/2010/08/12/new-study-shows-larginine-improves-blood-pressure-and-cardiovascular-risk-factors.aspx