Stress Free: Tick-Tock Sur­viv­ing and thriv­ing af­ter a heart at­tack at 42

Never too young? How I sur­vived a heart at­tack at 42 and lived to write about it

ZOOMER Magazine - - CONTENTS - By Jim Slotek

IT OB­VI­OUSLY SHOCKED his fans when 47-year-old film di­rec­tor Kevin Smith was stricken by a ma­jor heart at­tack in Fe­bru­ary while per­form­ing on­stage for a com­edy spe­cial. But it shook other peo­ple more. It shook peo­ple who know what it’s like to have a coro­nary episode in their 40s. Peo­ple like me.

(For one thing, I can pretty much guar­an­tee Smith’s friends are ask­ing him ques­tions like, “Were there any symp­toms be­fore­hand, and were they at all like the ones I’ve been hav­ing?”)

I was 42 when I had mine on Nov. 25, 2000. I was play­ing squash. And I vividly re­mem­ber I was win­ning. But a pain that be­gan in my arm had spread (text­book) to my ch­est. I called the game, show­ered and started walk­ing, as I’d planned, to­ward the of­fice.

Things got worse, and the pain verged to­ward ex­cru­ci­at­ing. I can­celled the of­fice plan and de­cided to go home, driv­ing while hav­ing a heart at­tack. Once there, I fig­ured I would get my wife to drive me to the hospi­tal. She wasn’t there.

I called 911, then no­ticed I’d parked the car part­way up the curb. So, in a daze as I waited, I went out to straighten it. The paramedics ar­rived as I was get­ting out of the car, hollered at me and fairly threw me into the am­bu­lance. I re­mem­ber one of them on the ra­dio say­ing, “Direct to nee­dle!”

I didn’t know it at the time, but I’d suf­fered what had eu­phemisti­cally come to be known as a Hockey Heart At­tack – wherein peo­ple in their 40s and 50s, with no reg­u­lar ex­er­cise rou­tine, go all out once a week (with, maybe, chicken wings and beer af­ter). At Toronto Re­hab’s sto­ried Rum­sey Cen­tre (more on that in a bit), I met two guys my age who’d both had their my­ocar­dial in­farc­tions as they skated, ashen, to the bench.

Co­in­ci­den­tally, a few months later, the ac­tress Sharon Stone, who is four months older than me, would suf­fer a stroke while train­ing for a 5K race.

My an­giogram did not show ex­ces­sive block­age – 30 per cent in one artery, 40 per cent in an­other – “about av­er­age for a 40-some­thing North Amer­i­can male,” a car­di­ol­o­gist told me. This sounds like a lot, but Kevin Smith had a 100 per cent block­age of his LAD artery. Typ­i­cally, when you hear about block­ages and heart at­tacks, they’re above 90 per cent. Doc­tors be­came aware of the pro­gres­sion in the gen­eral pub­lic dur­ing the Viet­nam War when, trag­i­cally, they had an un­usual sur­feit of young adult ca­dav­ers on which to per­form au­top­sies. They dis­cov­ered ev­i­dence of ath­er­o­scle­ro­sis al­ready in young adult males barely out of their teens. Plaque may not be nat­u­ral, but we all have it, in North Amer­ica at least (and in places with a North Amer­i­can diet) and in chil­dren as young as three. In my case, the like­li­est scenario was that a piece of plaque had bro­ken off, clogged an artery, but was sub­se­quently dis­solved by the clot-busters I re­ceived im­me­di­ately upon ad­mit­tance.

“Of course ex­er­cise isn’t a bad thing,” says Dr. Paul Oh, di­rec­tor of the Rum­sey Cen­tre. “But peo­ple can de­velop vul­ner­a­ble plaque spots in their ar­ter­ies, and then some kind of stress can tip it over. Fatty streaks grow up over time, and stress can make that plaque rup­ture.

“It’s kind of like a vol­cano that erupts. It’s quiet, and ev­ery­thing looks okay un­til a point where some­thing hap­pens. In ge­ol­ogy, it’s when that tec­tonic plate shifts. For hu­mans, it could be an acute stres­sor, like that shift in a hockey game, that squash game. It might be shov­el­ling snow. It might be smok­ing a cig­a­rette or it might be men­tal stress.

“If you’ve in­creased your lung ca­pac­ity, say, im­proved your fit­ness and low­ered your blood pres­sure and heart rate, the plaque can be more sta­ble, even if it’s the same size.”

Oh works at the place that saved my life, the Rum­sey Cen­tre, a rev­o­lu­tion­ary fa­cil­ity in Toronto’s Leaside neigh­bour­hood that shocked the med­i­cal world when it be­gan in 1968, by get­ting heart pa­tients walk­ing and then run­ning. Af­ter com­plet­ing its pro­gram, I would end up jog­ging 10,000 miles over the next 10 years, with a lower body mass in­dex and nearly a litre more lung ca­pac­ity.

But it started at that 50-year-old cen­tre that is so un­changed my re­visit felt like I was hav­ing a flash­back. On the in­door track, about a dozen peo­ple were walk­ing pur­pose­fully, some wear­ing ch­est mon­i­tors, while staff watched from the side­lines. Same as it ever was.

For decades from 1973 on­ward, the founder Dr. Terry Ka­vanagh, a run­ner him­self, took teams of pa­tients to marathons – a ven­ture that reached its apex in 1985, when he put a heart trans­plant pa­tient in the Bos­ton Marathon. Brian Price was 44 when he re­ceived his trans­plant and ran the marathon 15 months later. Price died in his na­tive Wales this year on Jan. 14 at age 77, two weeks short of the 34th an­niver­sary of his heart trans­plant.

The Rum­sey Cen­tre was like heart school. And the most im­por­tant thing I learned was that ev­ery­thing we used to know was wrong. I also learned that, in car­diac treat­ment, there is no such thing as the good old days. The “nee­dle” that awaited me at the end of the am­bu­lance ride was a dose of clot-busters – throm­bolytic ther­apy – that serves to dis­solve block­age (a treat­ment so ef­fec­tive, they didn’t let me shave for a few days, lest I bleed out).

Widely in­tro­duced in the late ’80s, it raised the sur­vival rate from 50 per cent to more than 90 per cent al­most overnight. “Ba­si­cally, in the old days,” one doc­tor told me by way of prais­ing throm­bolyt­ics, “the way we treated a heart at­tack was to give you mor­phine and wait for you to fin­ish hav­ing a heart at­tack.”

In the 17-plus years since my ex­pe­ri­ence, there’ve been other re­fine­ments. “In the past 15 years, it’s be­come com­mon to go right to the an­gio­plasty room and open the artery up right away with a stent, which was very rev­o­lu­tion­ary,” Oh says.

But it was the “lie-in-bed-re­cov­er­ing” mind­set that re­ally had to be over­turned. “What Dr. Ka­vanagh did was quite provoca­tive,” Oh says. “There’s this ar­ti­cle I quote from 1965, a jour­nal called Cir­cu­la­tion, one of the pre­em­i­nent car­diac jour­nals. It’s about the man­age­ment of the di­lated heart – and in it, it says, ‘You should rest in bed for sev­eral months.’ That’s the quote.”

Sev­eral months af­ter my heart episode, I’d al­ready run a 10K.

God knows how many peo­ple were killed by that well-in­ten­tioned ad­vice to stay in bed. But the re­verse pre­scrip­tion clearly saved many. The Car­diac Health Foun­da­tion of Canada, the char­ity that orig­i­nally funded the Rum­sey Cen­tre, works with 30 other car­diac pro­grams in Ka­vanagh’s model to spon­sor Walk of Life fundrais­ers across Canada.

It’s sim­ple and rel­a­tively cheap, which doesn’t save it from health­sys­tem cut­backs. John Saw­don, pub­lic ed­u­ca­tion di­rec­tor of the Car­diac Health Foun­da­tion, tells us that sim­i­lar car­diac re­hab pro­grams have closed re­cently – in­clud­ing those at North York Gen­eral Hospi­tal’s Bran­son Hospi­tal and at the Lon­don Health Sciences Cen­tre.

Hey, peo­ple can ex­er­cise at home, right? Why waste tax­pay­ers’ money on life-sav­ing ad­vice and su­per­vi­sion?

For Oh, a youth­ful-look­ing 53 and a mid­dle-dis­tance run­ner him­self, the pro­gram has been some­thing of a spir­i­tual up­lift.

“It’s been very re­ward­ing work­ing with the teams and pa­tients here. I spent the first 12 years of my life in in­ter­nal medicine at an acute care hospi­tal, help­ing peo­ple with re­ally acute med­i­cal events like heart at­tack, stroke, in­fec­tion, kind of just patch­ing peo­ple up.

“Here, I found my­self work­ing with peo­ple over the course of months or years, work­ing on life­style things, see­ing peo­ple re­gain their health. That’s very ex­cit­ing.”

Ir­re­spec­tive of ex­er­cise, the ac­tiv­ity ac­tivists have a new tar­get – seden­tary work­places. As you’re prob­a­bly aware, sit­ting is the new smok­ing. And it’s only taken 65 years for that mes­sage to spread.

In 1953, a study was pub­lished in the med­i­cal jour­nal The Lancet of Bri­tish dou­ble-decker bus driv­ers and con­duc­tors. The con­duc­tors spent all day on their feet, tak­ing tick­ets up and down the bus. The driv­ers sat and drove. They had three times the rate of heart at­tacks. “It was a very nicely con­trolled ex­per­i­ment,” Oh says, “be­cause they were guys from the same neigh­bour­hood and jobs, you can as­sume they all had the same life­style, ate the same things, drank in pubs, smoked. The main dif­fer­ence af­fect­ing health was the non-seden­tary be­hav­iour.”

As for me, my world­wide run (I’d found run­ning trails all over the U.S., in Lon­don, Paris, Thai­land and Tur­key) ended af­ter three knee surg­eries, to be re­placed by a home el­lip­ti­cal ma­chine. I’m no an­gel, diet-wise, my blood pres­sure and choles­terol need mon­i­tor­ing, but I have kept off the weight. (Granted, the once obese Smith had dropped 65 pounds. Ap­par­ently, you can be over­weight or un­der­weight and still be at risk).

And as a free­lancer these days, I’m no longer tied to a desk, which means I can break up my work by get­ting up and walk­ing the dog or do­ing a bit of laun­dry. (For those still go­ing to the of­fice, I have one friend who just had his first day at a “stand­ing desk.” Ap­par­ently, it will take some get­ting used to.)

“I guess I’m in the Zoomer vin­tage,” Oh says. “And I’ve taken up the healthy liv­ing chal­lenge. There’s a car­di­ol­o­gist, Dr. Lloyd Jones, who talks about what hap­pens to you af­ter age 50. At that age, your risk of a heart at­tack or stroke could be as high as 50 or 60 per cent – or as low as five per cent – depend­ing on what you choose to do in terms of your health be­hav­iours. Eat well, don’t smoke, be ac­tive, mod­er­ate your al­co­hol in­take. “My mes­sage is you can choose your des­tiny.”

And mine is: keep mov­ing.

“EV­ERY­THING WE USED TO KNOW WAS WRONG”

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