Guilty

judge-gavel-1461291738X4gOne thing I noticed, after we discovered my coronary artery disease, was my need to tell people how unlikely it is that I should have it. Whenever I mentioned my diagnosis I was compelled to point out that I am 34, take care of my heath, and have no family history of heart disease. I wanted people to know that I am an anomaly.

Wanting people to know that your medical condition makes you a statistical outlier does not make for polite social exchange. Someone I barely knew would ask me about a bruise on my legs. I would begin by telling her that I’m on blood thinners and five minutes later I’d gratuitously detailed my past exercise regime, my commitment to cruciferous vegetables, and the non-heart diseases that killed my grandparents. And as the listener slowly backed away, sorry she asked, I would think to myself, “where did that come from?”

I realized that, for some reason, I felt guilty for having heart disease. I wanted people to believe that the disease wasn’t my fault – that I didn’t cause it by a bad lifestyle or by disregarding a strong genetic predisposition.

Upon first reflection I thought I was being silly, because I am visibly young and healthy – without saying a word, surely most people would assume I did not bring about heart disease by my own debauchery. Then I realized that this mindset was even more ridiculous, because (and I can’t believe I had to say this to myself) heart disease is an awful, potentially-fatal illness, and no one who has it deserves it, even if she has made unhealthy choices. And yet, I clearly felt the need to distinguish myself from others who had not taken good care of themselves or ignored their predisposition to the illness.

Maybe I felt guilty because at various points in my twenties I ate fast food or smoked socially. Maybe that’s why I wanted everyone to know that, despite some mistakes when I was younger, I am genuinely committed to my health.

But I don’t think that’s it.

I think the real reason I felt guilty was because, without ever realizing it, I had always blamed people for their own heart disease – and I’m pretty sure I’m not the only one. We live in a world that tells us over and over again that heart disease is caused by an unhealthy lifestyle. Sure, some people are genetically predisposed, but even they can prevent incidents by eating right, exercising, and listening to their doctors. When I heard that heart disease was the number one killer of Americans, I thought, “Well that makes sense, Americans are overweight, don’t exercise, eat crap, and have a lot of unmanaged stress.” So of course I thought I was immune to it, because I did yoga and avoided processed foods.  I was good so heart disease shouldn’t happen to me.

Do other people with heart disease experience this guilt? I wonder how it plays out for them. I also wonder if this attitude towards heart disease has an impact on the way we, as a culture, respond to it. Would we donate more money to research and treatment of heart disease if we were less judgmental of those who have it? Have more 5Ks? And this all raises a bigger question: How do we focus on prevention without placing blame on those who fail to prevent it?

Oh heart disease, once again you’ve given me a lot to think about. In the meantime, maybe I should start by making an effort to not give my full medical history to the person I’m sitting next to on the train.

Competitive Yoga – Pretty Sure I’m Doing It Wrong

Rebecca: Well, I took a class in New York, and, I mean, not surprisingly, I got an “A.”
Greg: They give grades in pole dancing?
Rebecca: They do if you ask.
(Crazy Ex-Girlfriend, ‘I’m Going to the Beach With Josh and His Friends!’)

Yoga is about being fully present in the experience. Doing yoga is the goal of doing yoga. I suck at yoga.

I learned early on that I cannot compare myself to others in the class. Some of these people can do amazing things with their bodies. So I watch them in awe and pray they’re not judging me.

But I am constantly judging myself. Today, during class, I got really angry with myself because I couldn’t get into wheel pose. Wheel pose and I have a tumultuous relationship. Sometimes I can do it. Sometimes I can’t. Sometimes I can do it once but I can’t do it when instructed to do it the second time. Sometimes I can do it but I get freaked out and collapse (which is probably not safe).

My frustration today was because I want to know where I stand with the pose. Can I do it or not? How do I categorize it? Where is it on my mental list: “poses I can do well” (mountain pose) – “poses I can barely do”(L pose) – “poses I hope to do soon” (crow pose) – “poses I hope to do within a year but probably won’t (handstand).”yoga-1240391-1279x853

And as I sat on my mat, contemplating my wheel pose plight, it occurred to me that comparing my current self to my past or my future self is very much NOT helping me be mindful and present.  That was when I realized just how much I suck at yoga. And the reason I suck at yoga isn’t because I can’t do a handstand. It’s because I think about yoga as something at which you can suck.

I have to find a way to let go of my goals in yoga class and try to just exist on my mat.  Then maybe I can finally win the Zen enjoy the present moment.

Cake Please – Memories of My Angioplasty

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Today is the 5-week anniversary of my intervention (another term for angioplasty). I realize my memories of the actual event are fuzzy, and will probably only get fuzzier. But there are a couple of key things I remember somewhat vividly, and they weren’t things that Google emphasized when I tried to learn about the procedure.

First of all – the room is really cold. You lay down on a special bed and they try to make the cold better with warmed blankets. These are nice for a few minutes – right up until they take off your gown, contort the blankets so that there’s a big gap of exposed skin around your groin (in case they have to cath you there), and then drape a heavy plastic sheet over you. It’s not very comfortable but the nurse and techs are extra nice.

I mentioned the “cath” – that’s the kind of cool shorthand medical lingo I use now – it’s short for catheterization which, up until this point, I thought was just for draining urine. But it’s not for urine here. Here, they insert a tube into you so they can shoot dye through your arteries and into your heart to show any blockages. In the past, they went in through the groin; now they can do it through the wrist. But they have to prepare the groin just in case.

So after they get you nice and cozy with your naked groin exposed under a plastic sheet in a freezing room – they tape your wrist down. This is also not particularly enjoyable, but at this point the nurse tells you she’s getting ready to give you the sedative.

After the sedative, things get blurry. I remember they shot something tingly into my arm, and then something warm. Or maybe it was the warm, then the tingly… I’m not sure. I think I asked for more sedative (you can do that).

The next thing I remember is an increase of people in the room looking at the computers. This was when I knew they found something. I think there may have been some general interest in my case. #MedicalAnomaly

The interventionist (the doctor who’s doing the procedure) walked over to me and said, “You have a very large, over 95% blockage in your left anterior descending artery. I think we can fix it with a stent, otherwise you can have bypass surgery. How would you like to proceed?”

Here’s what I thought: Wait. You can either do a minimally invasive, 15-minute procedure right now to fix this problem, or I can have major heart surgery? How is this even a question? Am I missing something? Are there perks to bypass surgery I don’t know about? What is going on?!?

Here’s what I said: Ummmm, I think I want the stent, but go check with my husband. (It’s nice to have a brilliant partner whom you can trust to make sure you’re not missing something while you’re on sedatives).

My husband agreed on the stent. In retrospect, this stent or surgery question brings to mind Eddie Izzard’s cake or death.

The last thing I remember is complaining that my wrist hurt and hearing the doctor say something about fentanyl. Twenty minutes later, I was in a recovery room with my husband and feeling pretty groovy.

Cardiac Rehab Is A Go – Stop Complaining

Dr. Cardiologist’s nurse called back. She said that Dr. Cardiologist would really prefer that I do the cardiac rehab – I may not need the entire 3-month program, but he’d like me to go for at least the first few weeks. He also said I can do my preferred exercise on the days I’m not doing cardiac rehab. iStock_82087951_XLARGE.jpg

I listen to the people who saved my life. Dr. Cardiologist says go to cardiac rehab – I’m going to cardiac rehab.

Frankly, I know this is reasonable, given the evidence that cardiac rehab is a good thing.

To quote the American Heart Foundation:

“Benefits of Cardiac Rehabilitation include:

  • A 20-30% reduction in all-cause mortality
  • Decreased mortality at up to 5 years post participation
  • Reduced symptoms (angina, dyspnea, fatigue)
  • Reduction in nonfatal recurrent myocardial infarction over median follow-up of 12 months
  • Improved adherence with preventive rates
  • Increased exercise performance
  • Improved health factors like lipids and blood pressure
  • Increased knowledge about cardiac disease and its management
  • Enhanced ability to perform activities of daily living
  • Improved health-related quality of life
  • Improved psychosocial symptoms
  • Reduced hospitalizations and use of medical resources”

For the most part, I want the stuff on that list. I mean, I’m not sure what “improved psychosocial symptoms” means. Also, I don’t exactly struggle with performing the activities of daily living (and that’s saying something, I live on the fourth floor of a walk-up). But I get the gist of it – cardiac rehab means more medical guidance in creating the ideal lifestyle for someone with heart disease and it is associated prevention of premature death. 

What I need is to have a good attitude about this. My doctor, whom I trust, wants me to do it. I have insurance that covers it. And it’s a great opportunity for education and support – I love education and support.

So, I am going to cardiac rehab, and dammit, I’m gonna like it!

Cardiac Rehab?

Cardiac rehab is a process by which many with coronary artery disease learn to exercise in a safe manner. It generally comes highly recommended – check out Heart Source’s post on what cardiac rehab is and why it was an important part of her recovery.

Now I know this may be controversial, but I’ll just say it: I don’t want to go to cardiac rehab, and I’m hoping my cardiologist will go for it. It’s true, skipping cardiac rehab is contrary to conventional treatment for those coming back from an angioplasty. But I am younger and had a much more active lifestyle pre-intervention than most others. In our last meeting, Dr. Cardiologist acknowledged that my heart could probably handle me going back to all exercise without a problem.

Before the angina slowly took hold of my life, I was doing an array of challenging activities and enjoying the pursuit of new fitness goals. Since my procedure, I’ve done every activity I’ve been cleared to do. At first, I was told walking was all I could do, so I walked anywhere from 3 to 8 miles a day. As soon my catheter wounds healed, I got back to yoga class. Now that I’ve been cleared for moderate intensity activities, I’ve been swimming and biking.

And while I am loving the freedom to move my body without that scary chest pressure, I really miss the fitness classes that really pushed me: my flywheel spin class, boxing class, and body combat. Cardiac rehab would mean that I’d be directed to do intense cardio in a gym – not in my beloved classes. And I can’t start cardiac rehab for two weeks due their limited availability. I don’t want to wait – I am anxious to start.

There are a lot of reasons I am eager to go back to my old activities. I’m supposed to lose ten pounds. I miss the community. But the most important reason I am dying to get back to these activates is this: I’ve had to make a lot of changes since we discovered my coronary artery disease. The pill regimen is daunting. Changing my diet is frustrating. But cardio, cardio I can do; cardio I want to do! 

When we met on Friday, Dr. Cardiologist and I agreed I would do cardiac rehab. At the time, I assumed I could do it quickly and then leap into spin class, or maybe train for a race while the weather is nice. But then I found out I have to wait to start, and the rehab program is supposed to be the only intense exercise I get for several months. That’s when I started reconsidering. When we discussed it, Dr. Cardiologist suggested that if cardiac rehab didn’t work out we could discuss my getting back to exercise on my own. I’m hoping that means my new impassioned plea to skip rehab and return to my old activities will be met with a “yes.”

I put in a call to his office and discussed my feelings with his nurse. Now I’m waiting to hear back with fingers crossed. But don’t worry – I’ll do whatever he says. I listen to the people who saved my life.

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More Pills

I resent the belief that our bodies are supposed to work perfectly without medicine. You know – this suggestion that we can achieve absolute health if only we live some ideally balanced lifestyle and blah blah blah. I think modern western medicine is great and many people are alive because of it. medication-14634705475Af

That said, when Dr. Cardiologist added an ACE inhibitor and a proton-pump inhibitor to my current regimen, all I could think was: “UUUGH, I am so over taking all these medications.” I was already taking baby aspirin, Effient (my anticoagulant, check out Bruises) and 80 mg of atorvastatin.

Do I really need these new meds? What do they do? What are the damned inevitable side effects? Why do you hate me?

Of course, Dr. Cardiologist kindly explained each of the meds.

ACE inhibitors are usually used in treatment of hypertension, which I don’t have (106/68, baby!). But, he said there is evidence that they also reduce the effects of coronary artery disease. Thus, taking it could be very helpful. But I have to go back every two weeks to have my potassium levels and blood pressure checked – because there is a risk my potassium could get too high and my blood pressure will get too low. So yes, we have to monitor for potential side effects – but it could help me not have another clogged artery. And yes, I need to try the ACE inhibitor and not be a cry-baby about it.

The protein-pump inhibitor, also known as omeprazole, is generally used to treat acid reflux, which I don’t really have. Dr. Cardiologist is less adamant about this one, but he highly recommends it for two reasons: first, it can reduce the possibility of stomach bleed (which I’m at higher risk of because of the Effient), and second, my stomach has been a little queasy since I started taking the baby aspirin. So yeah, I need to take this one too.

Lastly, I asked him about my statin (the atorvastatin). Statins are drugs given to reduce LDL (the bad cholesterol). My LDL was 72 before I even started on statins – that’s pretty good. But Dr. Cardiologist explained that statins have pleiotropic effects. That means (I think) that they reduce other problems of coronary artery disease unrelated to the treatment of high cholesterol.  Dr. Cardiologist has ordered a cholesterol panel on me in two weeks to see if my LDL is too low (but they aren’t sure if there’s such a thing as too low).

Verdict: Yes, I need to be on all the pills. There are far worse things than taking pills – like dying of a heart attack. I do, however, feel better since I asked. More importantly, I’m grateful to have a doctor that took the time to help me understand and health insurance that covers these medicines. I need to stop complaining and appreciate what I have.

 

Conflicting Mottos and Changing My Diet (Ugh)

All I want is to do everything perfectly on my first try and never have to change my method or approach.  Me – perfect – first try. I think this is reasonable.

A couple of years ago, after spending most of my life struggling with my diet, I finally found an approach to food that I thought was very healthyporterhouse-steak and supported my energetic lifestyle. It was a combination of clean eating with some paleo-esque undertones, shaped largely by the work of Gary Taubes and Nina Teicholz. I stopped eating sweets entirely, gave up processed foods, ate lots of fruits and veggies, minimized my refined carbs, ate a lot of animal protein, and consumed saturated fat fearlessly. I lost weight and felt amazing. I learned how to follow this diet year-round despite temptations and inconveniences. Feeling better than I had in my life, I thought: “This is great. I win nutrition and now I am done. All I have to do is this forever. I shall be a nutritionist and teach the world. You’re welcome world.”

My nutritional enlightenment was supposed to be finished. But no, I just had to get a stupid clogged artery. So now, I am advised that I need to make a few changes – not a lot of changes, but some. This conflicts with a motto I’ve formed in my vast 34 years on the planet: “change is always bad.”

I never meant to form that motto. It just kinda happened after years of rough transitions. The truth is, I’m not that interesting or adventurous and I like things to be the same most of the time. There, I said it.

Unfortunately, in this case, “change is always bad,” runs contrary with another motto I’ve formed recently: “listen to the people who saved your life.”

Dr. Cardiologist says saturated fat and red meat need to be cmcdc11_mediterranean_diet_guide-6colonsidered treats. Dr. Cardiologist says I need to follow the Mediterranean diet. Lastly, and most painfully, Dr. Cardiologist pointed out that when I stopped exercising (due to the angina) I gained 10 lbs which took my BMI from “healthy” to “overweight” – and this is also problematic for heart disease. 

So I’m cranky. I’m cranky that I have to give up foods I love. I’m cranky that I have to learn how to cook new foods. I’m cranky because I’m supposed to lose ten pounds while abandoning the approach that helped me maintain a healthy weight. And most of all – I’m cranky that I didn’t know everything and do it all perfectly the first time.

 

 

 

Meditation and the Chinese Finger Trap that Is My Mind

I can think of nothing so cruel as being told to clear my mind. The process generally goes like this:

“Ok. Clear my mind…clear my mind…clear my… Hey wait, I think I just did it… But now I’m thinking about it… Does it count if it only lasted a second, and then I think about it?…  I think it counts…nah, ‘cause niStock_000092111073_Fullow I’m thinking about it way longer than I actually did it… Ok, I am going to try again, but after I scratch my foot… Is it ok if I scratch my foot?… If my mind was clear, I probably wouldn’t need to scratch my foot… Ok, so I won’t scratch, I’ll just clear my mind…clear my… It really itches, I’m gonna scratch it so then I can clear my mind… Much better… I wonder if my yoga teacher saw me scratch it… She probably did and thinks I suck at savasana… No she doesn’t, yoga teachers aren’t like that. They only think nice thoughts… Probably ‘cause they can clear their minds… Which I can’t… What should I have for dinner?”

But I know, because everyone in the world says so, that mindfulness and meditation are key to good health and wellbeing. Just ask the American Heart Association, the New York Times, or Ellen.

So one of the things I’ve been trying to do is figure out how to turn off my mind and be truly present and mindful of my surroundings. My normal approach to developing a new skill is to work really hard at it – but that only seems to make it worse in this case.

For example, I’ve been reading The Power of Now by Eckhart Tolle. So far, it’s not helping. Tolle says I’m suppose to witness my mind at work, without judgment. But he also says it’s bad that my mind is always at work because it makes my Being (my real self) a slave to my mind. Presumably, my Being doesn’t want to be a slave to my mind. But how can I watch my mind work without judgment if I know that it’s bad that my mind is working? So then I’m judging myself, and I’m also judging myself for doing the judging, because I’m not suppose to judge. And before I know it, a simple exercise in mindfulness has become a quagmire of self-criticism and I’ve missed my train stop.

Maybe I’ll take a break from meditation and just focus on eating more vegetables. JK, I’m going to be zen goddamnit if it kills me!

Namaste.

Why Did I Wait?

I started experiencing chest pain in January, but I didn’t see my primary care physician until May.  Now I find myself asking: why did I wait?

My First Chest Pains

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This is the kind of thing I would pin. I bet that cheetah doesn’t even like pain and struggle. (Gymaholic)

It started in January. I was trying out a new HIIT class (Les Mills Grit Cardio) and about ten minutes into class I started to feel a pain in my chest. Thinking it was some sort of cramp or typical discomfort of an intense workout, I tried to push through it –  you know, because I had one of those stupid Pinterest boards full of quotes like, “pain is weakness leaving your body” and “your body can stand anything, don’t let your mind get in your way.” But the pain got worse. My chest felt really tight right around my heart. My breathing, though accelerated, seemed fine, but the tightness in my chest gave me this terrifying feeling that I wasn’t getting enough air. I had to stop.  Then had to sit. As I rested, the tightness slowly abated, and after 5 or 10 minutes I was able to rejoin the class.

It happened a week later in my regular spin class. The pain started ten minutes into class, with my heart rate monitor confirming I was getting my normal intense workout. Again, I tried to work though it, but it only got worse. I had to leave class. Again, the chest pain passed as soon as I stopped working out.

A week later it happened a third time, while I was trying a new running routine on a treadmill.

I assumed I was working out too hard. I was exercising 5 or 6 days a week, sometimes for up to two hours per day. That was definitely a lot. And I was taking a full-time course load of science classes at University of Illinois, Chicago. I needed to devote more time to my studies anyway. So I took a few weeks off cardio.

Seeking Help – In My Own Ineffective Way

When I decided to try spinning again in February, I experienced the same tightness, but by then I had learned not to try to push through it. I talked to some health care professional friends. A nurse friend of mine insisted I was having panic attacks. She even rolled her eyes when I told her the tightness was around my heart. “I’m telling you right now, Liz, it’s not your heart.” Another friend, a doctor, said it was probably tied to my lungs and I should probably see my doctor to discuss a chest infection or exercise induced asthma.

By March, after getting similarly non-urgent-sounding responses from other friends* and spending some quality time on google, I decided it was probably a chest infection. Thinking I was too busy to go see my beloved primary care physician (YOU FOOL!), I dropped into an urgent care facility on a Saturday morning. There, after describing my symptoms, I was diagnosed with exercise-induced asthma. “Just take two puffs of the inhaler before you work out, and you’ll be fine.”

But the inhaler didn’t help. And the tightness started being triggered by lower and lower intensity exercise. My friends told me I wasn’t using the inhaler right. By April, I couldn’t even get through a level 1 yoga class without having to stop.

 

*NOTE – My health care friends did all tell me to see my doctor. I chose to ignore that part and focus on their unconcerned tone (as I perceived it via text).  Also, these are the same people who were at my side when I was in the hospital: talking to doctors, updating my family, and making sure my husband and I understood everything. I point out their initial responses only to show just how easily I could have gone untreated, and to emphasize the prevalence of the belief that I couldn’t get heart disease.

Why did I wait?  The short answer.

  1. I thought chest pain was a natural consequence of intense exercise. (It isn’t.)
  2. Healthy 34-year-old women with no family history do not get heart disease. (They can.)

The Moral of the Story

Do: Have a good doctor and go see her when you have chest pain.

Do not: Self-diagnose via the internet, consult friends via text, pass GO and collect $200.

Young women can get heart disease.  Pass it on.

Questions for my Cardiologist

I’m meeting with my cardiologist tomorrow for the first time since my angioplasty on May 13th.  After my procedure I feel like I didn’t have any questions and now I can’t stop thinking of them.

  1. Cardio rehab.
  • Am I cleared to get started?
  • What can I expect?
  • How many visits?

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  1. Current heart condition.  I am walking and doing yoga.
  • What bout other low/medium intensity activities?
  • Can I swim?
  • Ride a bike?
  • What would happen if I get my heart rate up too high?
  1. Was there any long term damage done to my heart by the blockage?
  • Can it be repaired?
  • How long does it take?
  1. What does this mean for my future?
  • What kind of risk does this mean for my other coronary arteries?
  • How does this affect my life expectancy?
  1. Are there other normal activities I shouldn’t be doing?
  • Hot tubs?  Saunas?
  • Acupuncture?
  1. Bruises.
  • Is there anything we can do?
  • Switch meds?