Archive for March, 2010

Heart Attack Reflections – One Year

On March 12th of 2009, my family and I were visiting my brother in Florida, over 1100 miles away from our home in Pennsylvania, and I had a heart attack.  Ten days shy of my 41st birthday, I had a heart attack.

Backstory

The best place to start is probably 2006.  I had been to the doctor for a regular check up and the doctor ordered blood work as a routine measure. The results were surprising.  My cholesterol was outstanding.  My HDL was 72, my LDL was 73, and my triglycerides were 51.  My thyroid, however, was off, indicating hypothyroidism, and I was very anemic.

I started thyroid medication and an iron supplement, and on I went, not happy that I would have to take a pill for the rest of my life.

To treat the anemia, my doctor suggested a birth control pill. It made me feel awful.  I stayed on it for 6 months, tolerating depression and generally feeling bad the whole time.

Near the end of my time on the pill, I started having chest achiness and palpitations like I’ve never had before.   In December I went to a cardiologist for a stress test.  Everything looked fine.  I was happy.

The Heart Attack

In March of 2009 for spring break, my husband, two daughters, and I headed to Tampa to visit my brother and his family in Florida.  Thursday of that week was our last full day there.  We were set to leave the following morning–early.  That would get us back to PA Friday night and we’d have the rest of the weekend to recuperate so the girls would be ready for school, and Don and I, for work.  Besides that, Emily, our older daughter, was supposed to go to New York on Tuesday with her journalism class and she would need to do laundry and repack.

And so, we were making the best of our last few hours in Florida.  About 3:30pm I joined my kids in my brother’s cold pool (it was only March, afterall) and began doing the breaststroke.  Suddenly, I felt a pain in the center of my chest.  It stopped me in my tracks.  Immediately, I thought I pulled a muscle, but quickly decided that wasn’t the case.  Then I felt sick.

I got out of the pool and sat in a chair, sure that it (whatever it was) would pass.  But I continued to feel sick, so went inside and changed into my clothes.  I sat down in the living room and then the tunnel vision set in.  I felt nauseous, put my head between my knees, hoping it would help.  I decided to head to the bedroom to lie down.  It was at this point that I decided I might not be able to ignore the possibility that I was having a heart attack.  But the idea of a hospital, of hurting our chances of leaving the next morning, of being wrong and embarrassed, kept me from doing anything.

Then my left arm started to feel really heavy and my elbow began to ache.  I decided to call my insurance company’s nurse on call (she was terrific).  I described my symptoms.  She said that although it seemed unlikely, my symptoms all pointed to heart attack and she encouraged me to get checked.

By now, about an hour and a half had passed.  I finally told my husband what was going on.  My sister-in-law gave me some aspirin, and off Don and I went to an urgent care facility.  (I still wasn’t completely convinced that it was a heart attack and didn’t want to spend hours in an ER for nothing.)

In the car, the pain in my chest seemed to lessen and my back began to hurt right in the center, between my shoulder blades.  My arm was still heavy, though not as much.  I suggested to Don that maybe whatever it was was over and probably not a big deal.  He made an executive decision and we continued to the urgent care facility.

I got right in.  The EKG came up normal.  The doctor on duty came in to talk to me.  The EKG result seemed to give me some options.  He said that if I were a family member, he’d suggest I go to the hospital to get checked out more thoroughly, but that since the EKG was okay, I could simply go home.  Then he listened with his stethoscope.  My heart started jumping around.  He hurried the EKG machine back in and it showed that something funky was going on.

At this point, it seemed I didn’t have a choice.  He called the EMTs and with what felt like a major production, I was off to the hospital in an ambulance with Don following behind.

Immediately, blood was taken.  I was given nitro.  The headache set in and I started getting tunnel vision and feeling nauseous.  Don found his way to my room just before the doctor came to tell us that I did have a heart attack, though mild.  I would have to stay the night and have a heart catheterization in the morning.  I was upset.  I cried.  So much for getting on the road.

I was taken to intensive care.  The room was awful, but my nurse was nice. I was wired and tubed and tied to all kinds of bags and machines.  And the toilet was in a cupboard.  Literally.

The Heart Catheterization

The next morning, I was taken down for the heart cath (for info see: http://my.clevelandclinic.org/heart/services/tests/invasive/ccath.asp). Again, the nurses were lovely.  They made me a little loopy (which, if I’m being honest, I very much enjoyed) with some meds.  I was able to watch the video screen as the doctor pumped dye through my arteries.  Everything was clear except for a very tiny posterior descending artery that was 90% blocked, but too small to stint.

Following a cath, you’re not allowed to do anything but lie there.  There’s a risk with a cath because the doctor is puncturing and entering a major artery.

I stayed in ICU for another night with my toilet in the cupboard.

Diagnosis – Why a great doctor is important

I was a conundrum.  First, I was a young woman and my estrogen was supposed to protect me.  Second, my cholesterol at the time of the heart attack was 165, which is high for me, but pretty good for most others. Finally, only one tiny little artery all the way down at the bottom of the heart was blocked and everything else was completely clear.

Upon my return home, I went to a highly regarded cardiologist who, I later found out, didn’t even look at the video of my heart cath.  He was patronizing and condescending and when I asked a question about the statin (cholesterol lowering medication) he wanted to prescribe, he replied sarcastically that I clearly wasn’t listening to his explanation just before. Add to that that he never actually wrote a prescription and when I asked the nurses about it on my way out, they seemed afraid to ask him about it; I left completely confused.  Accolades and recommendations or not, I decided to find someone else.

The next doctor I went to came into my appointment well preparead and openly recognized that my case didn’t make sense.  He was curious and asked me questions and watched the cath video.  He ordered a Transesophageal Echo – TEE (see: http://www.asecho.org/i4a/pages/index.cfm?pageid=3327) to see if there might be a hole in my heart.  He ordered blood tests to search for the possibility that I might have a clotting disorder.

Thanks to his efforts, a picture began to come clear.  I have a genetic mutation (MTHFR) that puts me at greater risk of clotting and early atherosclerosis.  I’m also borderline for Antiphospholipid Syndrome (APS), also a condition that can cause clotting.  I have to have blood work on a regular basis to check homocysteine and cardiolipin levels.

In the end, he was sure that my heart attack was not an athero event (not related to cholesterol/plaque build up), but a thrombotic event (the result of a clot).  We can’t be exactly sure about the trigger—was it the MTHFR?  the birth control pill?  a combination?

My Efforts

I never took a statin.  I wanted to manage what I could on my own and have been very successful doing it.  My cholesterol is 143 (HDL – 63 and LDL – 70).  I attribute these numbers to three factors:  regular exercise, a vegan diet, and soy.

I have taken up running on a regular basis.  And while I don’t run for long distances, my 2 to 3 miles 5 times a week has done wonders for me.  I also do strength-building exercises at least 5 times a week.

The vegan diet is the only way to go as far as I can see.  The purposeful ingestion of cholesterol seems entirely counterintuitive, and that’s what you do when you eat animal products.

Finally, soy has been proven to lower cholesterol and I’ve seen it first hand.

Medication

For the past year, I’ve taken the following everyday:

75mg Plavix

81mg aspirin

25mg metoprolol tartrate (this was cut to 12.5 mg in October of 2009)

Multivitamin, Calcium plus D, Folic Acid, B12

(and levothyroxine for my hypothyroidism)

Following my one-year follow-up appointment, I was taken off Plavix and am now taking 162mg aspirin.  The new concern is that my chance of another incident is elevated.  Studies show that when patients stop taking Plavix, risk of heart attack or stroke increases as the platelets adjust. The extra aspirin is intended to make up for this absence, but the risk of stomach and brain bleeding elevate as the dose of aspirin increases.

These things are worries for me.

Emotional and Intellectual Adjustment

Following the heart attack, I was almost constantly worried that I would have another.  Every palpitation and flutter made me stop and think and “listen” closely to any clues my body might be giving me.  Additionally (and I’m not proud of this), I was angry at people who didn’t take care of themselves.  I felt myself to be the victim of an enormous injustice.  I took care of myself.  I ate properly, was the proper weight, and was still 40!

I also thought a lot about my likelihood of living a long, full life.  I want to see my kids grow up and live their adult lives.  That I have a strike against me is upsetting.

A year later, I still worry.  In the end, though, this heart attack was something of a gift.  It was mild, did no real damage, and made me aware of the issues that I have thus enabling me to be as pro-active as possible. Additionally, I’m more appreciative of all that I have and I like the direction my life has taken.

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St. Patty’s Day – Brown Apple Cake

The Irish make great brown breads and cakes.  Here’s a traditional apple cake…. Vegan style.

1 1/2 cups whole wheat flour

5 tsp cornstarch

2 1/4 tsp baking soda

3/4 tsp salt

1/4 tsp cinnamon

1/8 tsp ground cloves

1/4 cup Earth Balance (butter substitute)

1/4 cup canola oil

4 medium Gala apples, peeled and diced

3/4 cup packed light brown sugar

Egg Replacer for 2 eggs

2 Tbsp soy milk

2 tsp sugar

Preheat oven to 375 degrees.  Spray 9″ springform pan with cooking spray.

Mix flour, cornstarch, soda, salt, cinnamon, cloves together in large bowl.  Rub in Earth Balance until mixture is crumbly. Mix in canola oil.  Add apples and brown sugar and mix well.  Whisk together egg replacer mixture and soy milk.  Stir into flour/apple mixture.  It will be heavy and thick.  Mix until everything is moist.

Spread batter evenly in pan.  Sprinkle top with sugar.  Bake for 35 minutes. When slightly cooled, run knife around rim and release sides of pan. Top with powdered sugar.  Serve with favorite vegan ice cream.

Some of My Favorite Things

As I thought about what I most wanted for a snack earlier today, I thought about how much I loved Stonyfield Soy Blueberry Yogurt.  I scooped it into a big bowl, poured a pile of grape nuts over it and happily devoured it.  Little things like this make me grateful for all the little things–and some big ones–that make me happy.  I thought I’d share  some of them….

Food

Stonyfield Blueberry Soy Yogurt – I can’t even describe how delicious it is.  THE BEST yogurt I’ve had.  EVER!

Wegman’s all natural organic peanut butter on homemade whole wheat bread

Green Mountain Coffee with Blue Diamond Almond Milk (the unsweetened 40 calorie variety)

Naked Juice – though it’s expensive enough to constitute a luxury, I like to have it once or twice a month

Soy Chai Latte – Irvings Bagels in State College, PA and Donkey Coffee in Athens, OH make the best I’ve ever had; they easily beat Starbucks–hands down.

Vegan Red Curry at Cozy Thai in State College, PA

Whole wheat pizza loaded with red peppers, garlic, spinach, shitake mushrooms and pineapple

A marinated tofu sandwich ala Vegan Yum Yum loaded with vegan mayo, tomatoes, and spinach

Vegan pancakes and waffles of all kinds with maple syrup – the real kind

Broccoli rabe parboiled then sauteed in olive oil with garlic, topped with a pinch of kosher salt and pepper; I usually eat an entire bunch myself in one sitting

Drinking red wine when I cook

Working Out

The first 50+ degree day after winter so I can run outside (otherwise I’m on my glorious treadmill–I’m a wimp, I know)

Coldplay’s “Yellow” on my ipod when I run–it’s the perfect running pace for me

Walking with my very best friends

Going an extra mile because I feel pretty good at the moment when I normally stop

Adding an extra pushup every couple of days

My 10 lb. dumbbells–I’ve had them for at least 15 years.

My balance ball

Good running shoes

Social Responsibility

Seeing most people at the grocery store with reusable bags

Having lots of food choices–farmers markets, CSAs, good grocery stores

My Toms Shoes burlap shoes – I just bought my second pair of this kind; so cute

Nicholas Kristof and everything he writes

Nicholas Kristof and Sheryl DuWunn’s Half the Sky

Kevin Salwen and Hannah Salwen’s The Power of Half

Food Inc.

Penn State’s THON

Low-flow shower heads, front-load washers

Composting

Gardening

Please add yours.  I love checking out and trying new things!



“Better” is better – Ethical Consumption

People love cheap stuff–especially when it comes to the stuff you have to have.  And who doesn’t look for a bargain and how can you blame them?

The problem, however, is that more often than not, we are sacrificing something bigger to have the cheap stuff.  The other problem is that many people can’t afford but to buy the cheap stuff.

Every purchase we make is a vote of support for the way a company operates and a vote against the way another does. Buying coffee?  The cheapest route would support a major corporation like Procter and Gamble, the largest multinational in the world, who uses its power to drive down prices and pay farmers far less than what has been deemed fair.  The more expensive fair-trade coffee ensures that farmers are paid a living wage and that the conditions under which the coffee beans are grown are environmentally sustainable.

Shopping at Wal-mart indicates your support for their abuse of workers around the world.  They have received an “F” grade for their record on workers’ rights (http://www.greenamericatoday.org/proGrams/sweatshops/scorecard.cfm). Target isn’t much better with its “D+.”

At the grocery store, we can support factory farms that put the population at risk with their practices, or we can support farmers that work to create sustainability and provide nutritious food that doesn’t contaminate our environment or our bodies with chemicals and pesticides.  Did you know, for example, that factory-farmed ground beef is washed with ammonia to kill e-coli that only occurs because cows are fed corn and not grass?  A terrific option for produce and meat is local farmers markets or buying into a CSA (Community Supported Agriculture).  With these choices, you not only get the freshest products, but you also know exactly where your food comes from and you support your local economy.

Are these choices more expensive?  Mostly, yes (though my membership in our local CSA will ultimately cost less than all my purchases of similar items from the grocery store).  But in the end, our own ethical choices can serve as votes for the people who are doing it right and, in turn, are making the world a better place.

So maybe we don’t buy a bunch of new clothes from Wal-mart.  Maybe, instead, we shop at a second-hand store or only buy a couple quality  items from a fair-trade or union supplier.  Maybe we don’t drink 4 cups of coffee a day, but drink what we can afford because we’ve made a choice to buy fair-trade.  And maybe we don’t eat meat every day of the week, but instead only 2 or 3 because we’re buying from farmers who live their beliefs.

The more those us who can make these choices do make these choices, the more these ethical practices will be adopted by bigger players.  In turn, prices will come down and the options will be more accessible to those who struggle financially.

A good guiding principle  might be:  “More” is not better.  “Better” is better.

For additional information on companies that are doing it right, see:  http://www.newdream.org/marketplace/conscience_guide.html