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Lifestyle
 
My Heart Messed With My Head
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I’D always hoped I had my mother’s heart. She died a few years ago, at 92, in good physical shape almost to the end.
On my father’s side, hearts were weak. Dad had his first heart attack in his mid-50s, and died from his third, at 65. Dad’s older brother, Ben, died of a heart attack at 50; his younger brother, Carl, had open heart surgery in his mid-50s.
Through my 40s I gave little thought to my mortality. With four young children, our house was full of life. I was in good shape and had lots of energy; my only medical procedure — arthroscopic knee surgery — was a result of being overactive.
About the time I hit 50, my primary care physician, a cardiologist, noted I had elevated cholesterol: a little over 200, nothing terrible. When six months of trying to eat better made no difference, he suggested a statin, which lowered my cholesterol to good levels.
This was the first indication that I might not have Mom’s heart, and that played with my head. I started reading the obituaries more closely, particularly ones about men in their 50s dropping dead. The worst were about men who dropped dead while running or biking. For years, I’ve jogged four miles regularly, and reading the obits quickly dispelled any notion this would save me.
For about a year, I was nutty about this. I thought too much about my chest. Any twinge, any pain, I wondered, “A symptom?” As a boy, the only time I remember seeing my father cry was when he told me his brother Ben, a doctor, was dead.
I was now older than Uncle Ben.
A few times in that year of living nuttily, if I felt chest discomfort, I stopped by my doctor’s office to check my blood pressure.
It was fine, they said.
During a summer vacation trip to Michigan, I was out early, climbing sand dunes with the kids, and felt a heaviness in my chest. Soon after, I experienced persistent nausea, lightheadedness and a cold sweat. By then I was well versed in symptoms. I went to a nearby emergency room.
I was fine, they said.
When I got home I told all this to my cardiologist. He suggested, given the recurring symptoms, that maybe it was time for a coronary angiogram, which is done at a hospital. A thin tube is inserted through a blood vessel from the arm or groin area up to the heart, allowing a dye to be injected so a complete picture can be taken of the coronary arteries.
The angiogram showed some plaque buildup, but no blockages.
And that ended my year of living nuttily. I came to understand that my body was middle-aged, and I had to listen to it differently than I had as a younger man. If the first mile of my jog felt uncomfortable, I accepted this as normal and waited for adrenaline to kick in. I remembered something the E.R. doctor in Michigan had said (undoubtedly aware I was a nut case): If you run, it’s like giving yourself a daily stress test; if there’s a problem, you’ll feel pain.
I decided my family history might not be so ominous. My father and uncles did not have the benefits of today’s public health campaigns. They had smoked two packs a day for 20 years, and I have never smoked. While I don’t eat perfectly, my father was part of the pastrami generation — he was considerably overweight and didn’t exercise until after his first heart attack.
Over the next five years, I saw my cardiologist regularly and, except for adding a blood pressure pill two years ago, all was good. I had lots of energy, exercised daily, felt great.
About a month ago, my cardiologist, Dr. Michael Chesner, suggested a stress test. My vitals were all good, but it had been five years since the last one.
I didn’t want to do it. I repeated the quote from the Michigan doctor; I explained that my family history was probably misleading.
A precaution, he said.
The stress test was easy. I had no trouble keeping up with the treadmill, and felt the same at the end as at the start.
He called the next day, and right away I could tell something was up. The nuclear scan indicated less blood flow to the inner lining of the heart after exercise. “You’re not having symptoms?” he asked.
“Not really,” I said.
“Not really?”
“No.”
Was I?
Instead of another coronary angiogram he suggested a less intrusive diagnostic tool, a CT angiogram, which could rule out a blockage. Until then, he said, walking might be better than jogging.
The day before the test, the obituaries page featured Michael Martin, the graffiti artist, and Billy Mays, the TV pitchman, both dead of apparent heart attacks at 50.
The morning after the test, my cellphone rang a little before 8. I was finishing a brisk four-mile walk on the beach. The scan showed three possible blockages, though a coronary angiogram might still show none were significant.
Several days later, the coronary angiogram showed two were nothing, but a third was an 80 percent blockage in the circumflex artery, which the doctor cleared, before implanting a medicated stent.
It has been a little over two weeks, and I feel great. Of course, I felt great before. I’m also confused. I’ve had so many advantages my father’s generation did not — medication, diet, exercise, not smoking — and yet, my first heart episode came at almost the same age as Dad’s.
I asked Dr. Alice Jacobs, a professor of medicine at Boston University, the director of cardiac catheterization at Boston Medical Center and a past president of the American Heart Association, why I hadn’t done better.
“You’re ahead,” Dr. Jacobs said. “You haven’t had a heart attack,” which does irreversible damage to the heart.
Innovations that boomers like me have benefited from — cholesterol drugs (20 years); blood pressure medication (25 years); stress test/nuclear scan (25 years); stents (15 years); medicated stents (5 years) — have all most likely contributed to improved mortality rates, Dr. Jacobs said.
In 1950, according to the Centers for Disease Control and Prevention, 587 Americans per 100,000 died of heart disease; by 2006, the number was 200.
In contrast, the mortality rate for cancer is little improved, from 194 per 100,000 in 1950 to 181 in 2006.
But on the micro level, individual by individual, it’s more fuzzy. “You can modify the major risk factors, but you can’t modify family history,” Dr. Jacobs said. The presence of coronary disease in a close relative younger than 55 for men increases heart disease risk.
The fact that I had no symptoms? A minority of people don’t, she said. Or possibly I missed them.
More than a million Americans a year get stents. Will mine prolong my life? Unclear. For stable patients like me, studies comparing mortality rates over a five-year period with a single stent and taking medication, versus treatment with medication alone like blood thinners and a statin, show no difference in outcome.
The science gets better, but life remains inscrutable.
With my doctor’s permission, the weekend after the procedure I drove my daughter to a softball tournament three hours away in the Poconos. A few days later, we flew to Michigan, where I sent her off to band camp.
About a week ago, over a breakfast of low-fat yogurt, fruit and granola, I read the obituary of Christopher Hipp, a groundbreaking computer designer who collapsed and died at 47, while biking.
Then, my wife and I and two of our sons walked up to the beach.
It was a perfect summer day, the water was warm, the waves strong. I took my first swim since the stent, and though it was never spoken, I think Sam and Ben, both lifeguards, stayed with me just to keep an eye out. In an hour of bodysurfing, I caught a couple dozen great rides. As I walked back to my towel, the water dripping off me, the sun warm on my back, I couldn’t help thinking it was wonderful to be alive.