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.

RUN FOR YOUR LIFE

This is the best news I've heard in a long time. And by long time, I mean since August 14, the day of my heart attack. It turns out that your body will, if you treat it properly, mount its own defense against heart disease and future heart attacks. It grows extra, natural bypass vessels where your heart needs them most.

It's hard to say what I love best about this diagram.

It might be the circled "best" and "worst."

This is truly life-changing. At my very first cardiologist appointment, almost two months ago now, my doctor drew me this diagram while he narrated my four potential futures.

Future 1: Nothing ever happens again and I live with a 30%-40% blocked LAD and minor deposits in my other arteries for the rest of my life. (The LAD is the one they call the "widowmaker" even though more women than men die each year from heart attacks. Oops, that's another subject.)

Future 2: My arteries continue to slowly clog up with cholesterol plaque until I become symptomatic (pain, pressure, fatigue etc.) and go in to be checked out. They do another angio, probably another stent, and I'm on my way back to rehab.

Future 3: Have another surprise heart attack due to a plaque deposit rupturing and my platelets trying like crazy to fix it and causing a clot to form. These kinds of heart attacks have no warning. I make it to the hospital, they intervene, and I live to repeat this whole experience.

Future 4: Have another heart attack and die.

At this point my eyes widened and he said, "well, you've already been through all this, we really don't need to sugar coat it" or something like that.

Well, maybe we could have. At least a spoonful.

It took me a few weeks and some antidepressants to pick myself off the floor from that pep talk, informative though it was. And then I started to see these headlines:

• "Back up system reduces heart disease deaths" University College London
• "Natural bypasses can save lives" American Heart Association
• "Do-it-yourself cardiac bypass surgery: All you need is walking shoes" Harvard Health Letter

I read and bookmarked them and tried to believe it was true. Really? There's something I can do about this? Some way I can affect my future and not just wait for one of Dr. Murad's four futures to play out? Be still my heart.

Here's how it works: Your heart is served by arteries that branch out into ever-smaller capillaries. Connecting this network are vessels called "collaterals" that are are essentially invisible until activated. When blood flow is increased, the inner layer of vessel cells sense the need for more blood and begin growing from capillaries into collateral vessels, creating an elegant back-up system, a natural bypass.

Hmm, when blood flow is increased. I wonder how you make that happen?

Let's see what Steffen Gloekler, MD and Christian Seiler, MD, who authored a study on coronary collateral arteries have discovered:

In response to endurance exercise training (such as running, bicycling, swimming, and hiking), blood flow is increased, which leads to a conversion from capillaries into collaterals.

And the Harvard Health Letter?

As . . . collateral vessels grow more muscular and interconnected, they begin to reroute some of the blood flow around the blockage. Scientists have been trying for years to nudge collateral blood vessels to develop and prosper, but without great success. However, you can do it at home without anything more high-tech than a comfortable pair of shoes.

It's really that simple, that easy, that obvious? Just exercise? Sign me up.

The heart on the left has lots of natural

bypasses, and less damage, than the right.

However, the oft-repeated and comforting recommendation that any little bit of exercise helps is not true in this case. You need to work out hard, for at least 30 minutes, almost every day. It needs to be aerobic and at a high enough intensity that your blood is moving fast.

Moving blood = more collateral vessels. Easy 11-minute mile jogs are not going to cut it.

But really, being lazy is not an option. Not only do individuals who have lots of natural bypass vessels have a 36 percent greater chance of living, they also sustain less damage to their heart muscle when they do have a heart attack.

So, the best news I've heard in a long time is this: Exercise will likely save my life. Running a fast 10K is hard, but heart attacks are harder.

If you're looking for me, I'm at the gym. 

P.S. I actually really love Dr. Murad. After he drew that diagram, he flipped it over and wrote down his cell phone. You will likely not be surprised that I wept with relief on the spot.

MY 12TH PILL

I now take 12 pills a day. Me, the self-righteous riot grrl who demanded to see the results of studies of this drug or that drug on women and then refused to take them when the doctor admitted there was no such thing. Me, the nervous first-time mother who wouldn't even take fish oil supplements while pregnant. Me, the healthy eating, marathon running, 37-year-old woman. Twelve. Per. Day.

There's the aspirin, metropolol, and birth control because I had a heart attack. Plavix because I have a stent. Zetia, Niacin, and Crestor for messed-up lipids. Synthroid for hypothyroidism and iron for anemia. And because of all that: Celexa.

Celexa is an antidepressant, in case you didn't recognize the name from TV commercials or four-page magazine ads. I waited four weeks to start it because my primary doctor wanted to see if I bounced back on my own first. No bouncing here, and I decided to cut myself some slack and insist on the drugs. I have enough going on without expecting to pull myself up from my bootstraps.

I'm told it takes up to four weeks to work, so it is hard to be patient. But then there's the placebo question: Am I feeling a little better because Celexa is doing its chemical job after just four days, or because I'm so happy to finally be taking it? Who cares. I feel better, and that's the point.

Depression is a common companion to heart disease and while that's unsurprising, it was unpleasant to discover that it is dangerous as well. Harvard Medical School reported that half of all heart attack survivors become depressed and the American Heart Association reports that women, and particularly younger women, are at an even higher risk. What's more, those who do become depressed are at a greater risk of another heart attack.

"Depression that occurs for the first time during recovery from a heart attack appears to be more dangerous than depression that started before the attack," the Harvard article states. "People with post–heart attack depression are two to three times more likely to have another heart attack or to die prematurely compared with survivors who don’t have depression."

And, it appears it might be all in my head - in my brain, that is. The journal Psychotherapy and Psychosomatics published a German study that found that persistent depression after a heart attack was associated with vascular changes in the brain, but that "more research is needed to determine whether depression causes these changes or vice versa."

But here's the thing: when I can't sleep or can't focus or can't formulate a plan more than an hour in advance, can't take care of my kids or can't return a phone call or follow through on dinner, or am somehow in greater danger of another attack, I don't care anymore about research studies or long-term effects or gender inequality. I just want it to stop.

So I take 12 pills a day. Gladly.


P.S. On to less, ahem, depressing subjects, here are the stats on two cheeses I forgot last time. Goat cheese earns 8 grams of total fat, 6 saturated, putting it in the "Not So Good" column. Fontina is 9 grams total, 5 saturated, placing it in "Pretty Bad for You." Drat.

THANKS, I NEEDED THAT

Her name was Ellen and she brought me dinner.

The parish nurse at our church has organized volunteers to bring over dinner a few times a week, and Ellen's day was Tuesday. She came to the door with a roast chicken, a salad from her garden, and a loaf of nine-grain bread. We chatted awhile, she asked how I was doing, and I replied that while my body felt fine, my head is another story. That we are all still in shock and I just don't feel like myself.

Ellen said she knew how I felt, having been diagnosed with diabetes in February. As we talked more about the challenges of special diets it hit me: Here's a woman (like me), with kids (like me), with a chronic health condition (like me), who, on a day she took off of work, is bringing me dinner.

Talk about humbling. But really, what good is a crisis without being taken down a peg or two?

When something bad or sad or scary or just hard happens to someone you love, or even someone you know just a little, the urge to help is strong. I know that this is true. I've been inundated with offers of help, and my own instinct when I hear of someone else's crisis is to start cooking, preferably pasta with some kind of cheese- or cream-based sauce. (Those were the days, but that's another post.) It's one of the best things about human beings, and no matter how cynical things may seem, it's alive and well. The better angels of our nature are with us still.

This isn't my first life crisis, and it probably won't be my last. Having learned a thing or two the first time around (the birth of my first baby nine weeks early by emergency c-section after I developed a life-threatening-for both of us-condition), I readily said yes to every offer of help I have received, and then asked for more. I've been clear about what we need, and what we don't. I've let friends see my house a mess. I've sat at my own kitchen table and watched someone else cook for my family. I've asked for favors I wouldn't dream of asking at any other time. And I haven't even sent my thank yous.

But I have noticed and I will remember. I was helped in innumerable ways then. I'm being helped now. I'll be helped again tomorrow. I can't do this alone, and I don't intend to try.

So, to Ellen and everyone who brought us dinner, took care of our children, provided transportation, bought groceries, supervised walks, hosted parties, cooked, cleaned, folded, shopped, played, emailed, wrote, and listened:

Thanks, I needed that.

HOW ARE YOU FEELING?

A simple question, really. But it has taken me three days to try to answer it.

The question came in a one-line email from a friend I haven't seen since I was a teenager. It also came at a time when I was feeling, well, miserable. So I didn't answer. (Sorry!)

Here's the weird thing: I really feel fine. Except for some psychosomatic pains, especially when I tell someone the story, my body feels just fine. But one day after getting home from the hospital, my mental and emotional state were . . . not.

I'm told the cardiologist who did the second angiogram spoke to me at length following the procedure. I retained nothing from that conversation since I can't even conjure up his face. Fortunately, he also talked to my husband, Scott.

Scott relayed to me that nearly the first thing out of the doctor's mouth was to watch for depression and that it was common in heart attack survivors. It's a funny thing about depression: just when I should feel happiest (I'm alive, I'm going to recover, my children are here, I'm not in the hospital), I'm the weepiest.

And the dingiest too (is that even a word?). I burned things in the oven. We didn't eat dinner til 8 p.m. or put the kids to bed til almost 10. Bought groceries one meal at a time. Went the wrong way repeatedly when driving to a store I've been going to for almost 20 years. (Scott insisted I be supervised on my walks and errands - thank you to Christine for coming along for the tour of Roseville.)

At first I thought it was shock, and it probably was. And then the crying started.

But here's the other thing about depression, at least for me. As soon as I said the word aloud, and started talking to Scott, Christine, and my mom about it, I started to feel better. And after one of my 30-minute walks on Saturday (on the treadmill, just a little faster this time, actually broke a sweat), I felt more like myself than I had in a week. And by Sunday I visited friends, worked on my almost-four-year-old's birthday party, indulged in a little retail therapy, researched heart disease online, and, with Scott's help, made a super-healthy lunch and dinner on time. I'm humbled and in awe of the body and soul's ability to recover and of the power of people, prayer, friendship, and love.

So, today I'm feeling just fine, thank you. I can't wait for rehab this afternoon. I have this little daydream that they let me break into a run. I think that's just what I need.