SURVIVOR IN TRAINING

It's on.

I've been stress-tested, blood-tested, and pressure-tested. I've been examined, reviewed, and notated. Poked, prodded, and medicated.

And all the tests and medical professionals have come to the same conclusion: There's nothing really wrong with you, except for that heart attack thing. So yes, go ahead and train for that marathon. Go ahead and live your life.

Oh, I will, and oh, it's on.

It isn't quite that simple, of course, but that's the (ahem) heart of the matter. There are a few rules to follow now that I'm a survivor. But I like it that way.

My first post-heart attack stress test was last November, and I passed it with ease. The test showed perfect heart function and no scarring, and while there is blockage in other arteries (that may either build up slowly or rupture spontaneously someday), it wasn't restricting blood flow. Dr. Murad, my cardiologist, said then: "It's like [the heart attack] didn't happen. But you know it did, and I know it did. We were there."

I was given the green light to resume vigorous exercise (which my trainers have taken extremely literally), and told I could probably try a marathon again. "But let's check again in May."

So last week we checked again. And by checked, I mean I had nuclear isotopes injected into an IV and then a 3D scan of my heart done in a kind of MRI machine. Then I ran on a treadmill at an ever-increasing incline while wired to an EKG machine and having my blood pressure taken every minute. When you are about to collapse -- like you really can't go another step -- you cry uncle and then they shoot you full of isotopes again and you have to keep going for one more minute. When you are done, it's back in the MRI machine to see what your heart is doing under  . . . well, stress.

Again I passed this one with ease, if being injected with stuff that comes in a locked, lead box is easy. My heart shows "excellent exercise tolerance" and "completely normal blood flow." And after obtaining sign offs on my training plan from Dr. Murad ("In my opinion, you can train for your marathon"), my trainers ("I'm gonna want to see your training plan. Are you resting enough?"), my old friends in cardiac rehab ("Cut back on the mileage in the later weeks; it is better to under-train than over-train. And take some vitamin D."), my primary doctor ("Do I think it is okay, yes. Do I think it is wise, no."), and even my ob/gyn (though that was just scheduling coincidence), I'm allowed to train for the Twin Cities Marathon.

But . . .

I'd better actually do the training. Because if they suspect I am not fully prepared, or that I'm pushing through something or forcing or sagging and lagging like I was last summer when I was training while getting ever sicker, they are going to pull the plug on their approval, like my trainer just did for the half marathon I was going to do June 2. (Having missed two long runs she doesn't think I can make up the training and just powering through is not allowed.)

Here are my rules:

• I'm not to over-train.
• I'm required to stop if something feels wrong, not just assume I must be some kind of wimp and keep going.
• I can't run if it is too hot.
• No anti-inflammatories. (That's Advil. Marathon training with no Advil.)

Basically, don't mess around, because you did have a heart attack, whether you feel sick or not. To quote Dr. Murad: "As we discussed, listen to your body, know your limits, and train within yourself. Be safe."

And really, this is the best thing they could have done for me or said to me. Because I do better with training when the rules are clear, the consequences are obvious, and someone's looking over my shoulder. I can't skip a work out because if I do I might ending up missing the whole thing. And I really don't want to miss it again. This year, I've got something to prove.

It's so on.

REPORTING IN

I love a good infographic. What a fun trend and great way to present information in our ever-more-visual, data-saturated media age.

So of course I'm going to love a heart-health infographic, and this one from the Wall Street Journal does not disappoint. (Click on it to see larger.) It accompanied an article called "The Guide to Beating a Heart Attack." Outlined in seven simple steps, it tells the same story I've been trying to communicate here: most heart disease and heart attacks are preventable. You, however, must make the right choices.

It's been eight months since my heart attack and I've been committed to doing all the right things. So let's review my report card and see how I measure up to the seven steps to beating heart disease.

KNOW YOUR NUMBERS

The Wall Street Journal calls this "the basics," and I love this quote: "Knowing your cholesterol and blood pressure numbers is as fundamental to heart health as knowing the alphabet is to reading." Yet about one-third of people with high-risk levels don't know it.

According to WSJ, the optimal LDL, or bad cholesterol, is under 100; HDL, or good cholesterol, is over 60; and blood pressure is less than 120/80.

A++ for me. My LDL is 62, my HDL is 34, (yes, it is less than 60, but since my LDL is so low the ratio that my cardiologist cares about is fine) and my blood pressure is 100/60. Take that, heart disease! 

NO DUH: DON'T SMOKE

Not a problem, haven't smoked since college. And even then I was a "social" smoker, until one day my senior year it was the first thing I did when I woke up. Gross. Quit cold turkey that minute and haven't had one since.

My grade: A- (for having ever smoked at all)

EXERCISE

I've earned an A+ on this one, mostly because I like working out so much. But here's the good news for those who do not like it so much, do not have the time for marathon training, or don't have access to personal training.

Guidelines urge three hours a week of brisk exercise to maintain heart health, but many people who can't find the time to work up a sweat for 30 minutes most days don't bother. "It's the all or nothing phenomenon," says Martha Grogan, a cardiologist at Mayo Clinic.

But how about 10 minutes a day? While the 30-minute target is associated with a 70% reduction in heart-attack risk over a year, Mayo researchers analyzed the data and noticed that a brisk 10-minute walk a day results in a nearly 50% reduction compared with people who get hardly any exercise.

KEEP MOVING

This one is interesting. Even if you are active, and get your three recommended hours of exercise a week, too much sitting can negate that positive effect.

A study from Australian researchers published two years ago found that spending more than four hours a day in front of a computer or television was associated with a doubling of serious heart problems, even among people who exercised regularly.
Prolonged sitting was associated with higher levels of inflammatory markers in the blood, higher body weight and lower levels of HDL, or good cholesterol, indicating that sedentary behavior has its own bad biology apart from whether you're physically active.

Thank goodness I'm home with my 4-year-old and hardly sit at all, so I get a passing grade of B on this one. For those who must sit for work, the article recommends getting up every 30 minutes or getting a stand-up desk for computer work. Taking walk breaks instead of coffee or snack breaks, taking the stairs, and parking far away will also help.

BE HAPPY

Easier said than done, of course, but stress -- and the stress of being unhappy or worried -- takes its toll on your heart. As my doctor said to me last fall: feed your soul. Make yourself a priority. (And if you need to, like me, get help, professional and/or pharmaceutical.)

I get at least a B+ on this. Though I went through some pretty difficult depression the first few months post-heart attack, feeding my soul, exercising my body, focusing on my family, and taking my antidepressant have made a huge difference. I am happy.

EAT YOUR VEGGIES

Eat healthy. Yeah, I'm all over that. I have to give myself a B+, though, because to earn an A+ I'd really have to go vegan.

B+ to me means I hardly eat any dairy (save fat-free yogurt and milk), only lean protein (chicken, turkey, tofu, beans, and fish), two eggs a week, the right oils, and lots of fruit, veggies, and whole grains.

GET ENOUGH SLEEP

Here's my worst grade of all: C- I regularly don't go to bed until midnight and then I don't fall asleep until 1 a.m. or later. Some of this is due to the medications I take; timed just wrong and I'll lay awake for hours.

Here's what the article has to say about sleep: 

Sleep's role in protecting the heart is underestimated, says Mayo's Dr. Grogan. "If you get one less hour of sleep than you need each night, you've basically pulled an all-nighter a week," she says. Chronic sleep deprivation can lead to high blood pressure, weight gain and increase your risk of diabetes, she says.

So sleeping is good for you! If only my kids understood that and let mommy sleep in.

This is my report card after having had a heart attack. Earn better grades than me and maybe you'll never have one.

IT'S BEEN A WHILE

Once last fall, in the midst of battling the worst of my post-heart-attack depression, I told a friend to be worried if I didn't blog for a while. That writing was something positive I was doing, and if I couldn't summon the energy to write, something must be wrong.

So, unsurprisingly, she was a little worried when there was only one post in March, and that was about how much I love nuts.

But it wasn't depression this time, it was just my regular life taking over, and I think that's a good sign. We went on vacation in early March, and when we returned, I had a lot of volunteer work to get done, chairing my sons' school PTA auction fundraiser. With only a few limited work hours available when my little Emperor Palpatine wants me to help catch Clone Troopers hiding in the dining room, I was just, well, busy.

So it's been a while.

It's also been a while since my heart attack, at least in the cardiac-care world I live in. Eight months tomorrow, to be exact. Not that I'm counting.

Oh wait, yes I am. Did you know that 42% of women who've had heart attacks die within the first year? Most of the time I feel safe and healthy and happy, and eagerly plan my summer of strenuous races and tennis lessons and yoga and training. And then I realize how lucky I am that I'm training for a marathon within a year of my heart attack. That I get to work out as hard as I want. That I can play baseball for hours with my family on Easter. That I'm here at all.

Sometimes I can't wait until August 14 and I pass my one-year anniversary. Will I then be safe from that statistic? It's been a while. But not long enough.

NUTS TO YOU

I have a new love of my life: these spicy and sweet curried nuts. I can’t get enough of them. I made them first for my heart party (um, I mean wine-tasting party) and I’ve made five batches since. I’ve finally given in and started doubling the batch.

Although I can’t stop eating them, I comfort myself that I’m at least getting loads of heart-healthy antioxidants with my zillions of calories. And, I learned from the keynote address at the heart health event I spoke at last month, that eating nuts - along with not smoking, being the right weight, exercising, eating right, and all those other good habits - is actually an indicator of longevity. So by eating these, I'm adding to my life. As long as I don't add too much to my waistline.

But, seriously, I challenge you to stop eating at just 1/3 cup (the serving size). I think you'll end up as addicted as I am. You are warned.

SPICED MIXED NUTS
Adapted from Ellie Krieger’s cookbook The Food You Crave 

1 cup whole, unsalted, raw almonds
1/3 cup unsalted raw cashews
1/3 cup unsalted raw pistachios
1/3 cup unsalted raw pumpkin seeds
1 tbsp. maple syrup
1/2 tsp. curry powder
1/4 tsp. cayenne
1/2 tsp. dried rosemary
1/4 tsp. salt

Preheat oven to 325 degrees F. Combine nuts and seeds. Add the maple syrup and spices and salt and toss to combine. Line a cooking sheet with parchment paper and bake 15 to 20 minutes until nuts are fragrant and lightly toasted.

You can adjust the quantity and types of nuts to suit your preference – the total should be 2 cups nuts. I love the cashews, so sometimes I skip the pumpkin seeds in favor of more cashews. The original recipe calls for walnuts too, and I’m sure that’s equally yummy, and they are better for your heart than cashews.