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.

NOW YOU KNOW

Heart disease is the number one killer of women in this country. Number. One. It kills more women than the next four diseases combined, including all forms of cancer.

But it didn’t kill me. At age 37 and in training for a marathon, I had a heart attack. With no risk factors save a family history of high cholesterol, I thought I knew enough to stay safe. I didn’t, but you should.

February is American Heart Month and I really want you to take it seriously. Not for me, because I survived and I’m healthy and thriving. But for the 500,000 other mothers, daughters, sisters, nieces, wives, lovers, and friends who will have a heart attack this year, and the 300,000 who will die from it.

Did you know that:

• 8 million American women are living with heart disease; 35,000 are under 65.
• The biggest risk factors are high cholesterol, high blood pressure, obesity, diabetes, smoking, and family history.
• Women’s hearts respond better than men’s to healthy lifestyle changes.
• 80 percent of cardiac events could have been prevented through healthier choices.

And if you knew the dangers and knew your risks, would you make the changes necessary to protect your heart? Would you:

• Talk to your doctor and get a lipid profile to check your cholesterol levels.
• Know your Body Mass Index and lose weight if you need to.
• Know if your blood pressure is high and take steps to improve it.
• Stop smoking.
• Make sure your doctor knows if you have a family history of heart disease or high cholesterol.

I knew that I had a family history of heart disease. I knew I had high cholesterol. I knew that women often explain away their symptoms: "I must have lifted something funny, hurt myself in yoga, maybe its heartburn," all excuses I used for days as the pain steadily grew worse for two days beforeI went to the hospital. And I knew that women's heart attacks present differently than men’s and seem somehow, inexplicably, hard for doctors to spot. I knew all that and I still never imagined this could happen to me.

But it can, it could, and it did, and it could happen to you or someone you love. And now you know.

FIND OUT MORE

The Heart Truth is the National Heart, Lung, and Blood Institute’s women’s awareness campaign, and the original Red Dress campaign. Check it out for videos, prevention tips, warning signs, and information about how you can participate in and promote national Wear Red Day in February. www.hearttruth.gov.

Check out Go Red for Women, a program of the American Heart Association, for its great nutritional center, free risk assessment tool, and a social tool “Tell 5 to Save Lives.” Go Red for Women also produced the Elizabeth Banks short video “Just a Little Heart Attack.” www.goredforwomen.org

Sources: American Heart Association, National Institutes of Health, Women’s Heart Foundation.

NO EXCUSES

I like this phrase from this public service announcement: "Don't make excuses, make the call."

My symptoms were pain in back, shoulders, and arms, and fatigue. I made lots of excuses for my symptoms. You shouldn't.

Please take 60 seconds to watch, and then pass it on.

WHY WAIT?

"I think there's something wrong with me. In case I don't get back in time, you'd better stay here and take Owen to camp."

I said something like this to my husband around 8:30 a.m. on a Sunday morning, after I'd spent the whole night awake, whimpering in pain and popping Advil four at a time. Once I finally told him how I was feeling and we decided I had "better get checked out," I didn't call 911 or rush to the ER.

Nope. I ate breakfast, helped pack for camp, took a shower, styled my hair, supervised a pre-schooler potty break, and put on makeup. For my date. With a heart attack.

Why do people who suspect they are sick or in danger delay seeking help to attend to family, work, pets, or in my case, my hair? That is the question that a group of researchers at Yale University are trying to answer through the Yale Heart Study.

I took the study myself about a month ago. Funded by the National Institutes of Health, it is a simple online survey designed to understand why people wait, on average, four hours to go to the hospital when having heart attack symptoms. If you are a member of the heart disease awareness community (I am now, of course, card-carrying), you know that "time is muscle." Every minute counts.

The problem is, heart attacks can be sneaky, particularly in women, and it is not unusual for people to mistake heart attack symptoms for indigestion, heartburn (my excuse of choice), anxiety disorders, fatigue, or asthma. Add to that our tendency to put everything and everyone else first.

Here's how the study's primary investigator, Dr. Angelo A. Alonzo, describes it:

We are so embedded and invested in our daily lives that we are very, very reluctant to just drop everything and seek medical care. We have to be certain it is a real problem, we have to finish the task at hand, we need to make arrangements if we are hospitalized, we have to cancel appointments, our work activities are important to our identity, and we are too strongly tied to our social obligations to just leave them. . . only when the signs and symptoms become so overwhelming do we willingly go.

This is indeed exactly what happened to me, and the denial didn't stop in the parking ramp (yes, I drove myself). I called home to make sure rain gear was packed for camp. I called again from the ICU to give instructions on what to pack for my younger son's trip to my brother's house while I was in the hospital. I emailed work colleagues after my first surgery. It took nearly 24 hours in the hospital before I gave in and let go.

The idea behind the study is to understand why individuals like me make the decisions they do. With this knowledge, an effective intervention strategy can be devised to get people to the hospital faster. Says Dr. Alonzo: "The irony is that one gets the most therapeutic benefit if one is in the hospital within the first hour of acute symptoms onset."

The study has reached about 15 percent of its goal of 2,300 participants. They are seeking survivors of all ages, men and women, willing to share their experiences to help others. It takes about 30 minutes to an hour to complete (you can save and return to the survey if you are short on time). It is also completely anonymous.

If you or someone you know has had a heart attack, please encourage them to take the study. It may save someone else time and muscle, or quite possibly, their life.

For more information, visit https://heartstudy.yale.edu/hacs/ or email heart.study@yale.edu.

STRESS RELIEF

I got the results of my first post-heart attack stress test today, and the news is good. Very good.

My total cholesterol went from 230 to . . . (drumroll) . . . 106!
My LDL (bad) cholesterol went from 180 to . . . 58!!
My HDL (good) cholesterol also dropped a little, from 39 to 35, which is not the greatest news but expected, since my overall number is so low.

And even better news than that, my heart itself is in great shape. It has enough blood flow at rest and at peak exercise. It is not damaged or compromised from my heart attack. I wish you could have heard the nurse's voice on the phone when she said "and there's not even a scar!" with that little lilt of incredulity, like she didn't really believe what she was seeing.

I didn't expect this much progress either. True, I've been eating like a model heart patient, exercising 4-5 times a week, learning all I can, and taking all my bitter pills, with or without a spoonful of sugar. And though I expected some results (dammit), I didn't think it would be this dramatic. I really thought my DNA would have been more determinate.

So when you see articles and TV talk shows and PSAs where the doctors say "heart disease is largely preventable," that's really true. While I will always have it, if you know your numbers and commit to the necessary changes, you won't. Because all this stuff -- diet, exercise, and medication and focus and sacrifice and love and prayer -- actually works.

JENNY

If you are one of the millions like me named Jennifer, you know the Jenny song. You know, "Jenny, I got your number. I'm gonna make you mine. Jenny, don't change your number . . . 867-5309 ee i en." That one.

(Once at a work/social event for my husband, the band asked if anyone was named Jenny. To my mortification, Scott's hand shot up as he shouted "My wife!!" And that's how I ended up on stage in front of all his co-workers and bosses and a bunch of strangers. Not cool.)

But this is pretty cool. Plenty campy, but nonetheless fun. "Jenny please know your numbers, blood pressure, lipids, and BMI ee i ee." I had to share it.



Mayo Clinic is using this video to promote its free Facebook app that makes it easy to know your numbers and your potential. Check it out.

Love,
Jen(ny)

ALL IN THE FAMILY

I can't begin to imagine what it is like to be a person close to me. I don't know what it's like to watch someone you love or care about have a heart attack, and I hope I never do. There's something about being the person who's in crisis, the subject of the drama, that feels, well, kinda normal. Even in the ER, the ICU, in rehab -- all along I'm thinking, feeling, acting, living. I'm just . . . me.

But what is it like to be the man driving a kid to camp, knowing only that I'm in the ER and that they gave me nitrogen? The man who sat in the waiting room through three surgeries. The man who had to go back to work and back to school, and then could do nothing more than watch and worry and wish for normalcy.

What is it like to be my friend? The one thousands of miles away but close enough to have nightmares about me. The one up at 3 a.m. with her newborn and reading my text from the ICU alone in the dark. The ones who fed me and pampered me and made me laugh, but who look in the mirror and wonder if they are in danger. I will never know.

My brother Mike and me, after
the 2009 Twin Cities Marathon.

What is it like to be my parents? This is one to which I can at least relate; I've stood by my child's hospital beside before. If you are a parent in that place, you think the world should simply stop moving until your child is safe. And you're bewildered when faced with evidence that it doesn't.

How about my brother and sister, who share not only memories of our treehouse and summers at the lake, but also my DNA? Are they scared for me? Are they scared for themselves? Well I should hope so. I was still in the ICU when I suggested, in the bossy way only big sisters can, that their doctors might be interested in the fact that I just had a heart attack and they'd better give him or her a call.

They did and they were. Both had consultations, blood work, and more testing. My brother had a stress test and my sister a calcium CT scan. I'm happy to report that both tests were normal, though Mike's cholesterol is sky-high. My sister's cholesterol numbers are actually the same as mine: higher than normal but not outrageous, especially by our family's standards. Both are now on medication, and their families already eat healthy and exercise plenty.

My dad (red hat) and sister, Anna, (holding my son Noah), with
our brother Dylan (left), my nieces Lydia and Alayna, nephew
Isaiah, my sister-in-law Kimi, and my son Owen at one of his
baseball games this summer.

But knowing that my brother, my sister, and I are the Three Musketeers of Shared DNA makes me want to know more about how familial hypercholesterolemia is inherited. Between us, my siblings and I have 10 children. I've already had my older son's lipid profile checked (he's 10 years old; it was normal), but I'm worried about all of them. Will they all get it? When should we start checking? What changes should we make in their lives now?

So here's our family history: My father has high cholesterol and heart disease. He's had two angioplasties but never an actual heart attack. He's super-fit and exercises every day and has been managing his disease for 20 years. His father, my grandfather, has high cholesterol, but no angioplasties or any blockage that we're aware of; he's also very fit and has watched his diet for 47 years and counting.

My mom and me.

My dad's mother, my grandmother, had angioplasty and a stent to clear a 90 percent blockage five years ago (she made it to the hospital in time to avoid a heart attack). She's never been other than super-fit and healthy. My dad's grandfather died at age 45 of heart disease.

My mother does not have high cholesterol or heart disease and neither did her mother. Her father had three heart attacks, all in his 50s and 60s, but he died at 79 of Parkinson's disease.

So you see, I come by this condition very honestly.

Familial hypercholesterolemia is inherited in an autosomal dominant manner, meaning you only need one copy of this gene to get it. It is caused by a mutation on gene 19 (in case the super-detail-oriented among you are wondering) and can be passed from one parent to some or all his or her children. Each child of a parent with familial hypercholesterolemia has a 50% chance of inheriting the disease.

That does not mean that five of our 10 will have it.It could mean two of them, all of them, or none of them will. But since I had no other risk factor for heart attack besides family history, it definitely means vigilance starts now.

According to Scott Kahan, MD, MPH, a preventive medicine specialist at the George Washington University Weight Management Program, many adult diseases begin in childhood,often early childhood.



Running cousins after the
Twin Cities Marathon family races.

“Heart disease, in particular, has been shown to begin quite early in life in many cases," he states in an article on WebMD. "Many children have blood pressures and cholesterol levels high enough to warrant treatment with adult medications."

The American Association of Pediatrics recommends screening for children with a history of high cholesterol or blood fats, or a family history of premature heart disease (age 55 or younger for men, age 65 or younger for women). The first screen should be after age 2 but before age 10; if it is normal, it should be repeated every 3-5 years.



Treatment and prevention, of course, is about as common sense as it gets: feed your children well and make sure they exercise. Set a good example with what you eat and how active you are. Don't smoke so they don't start. And with our genetic history, lipid screening starting at a young age.

These are the wonderful children who share my DNA. Being Aunt Jenny is one of my favorite identities, and I love my nieces and nephews second only to my own sons. I'm so grateful to share in their lives.

All 10 awesome kids, ages 17 to one month. This was taken in May 2010.

I'm also grateful that my sister's family, my brother's family, and mine have years of practice raising healthy families; these changes would be so much harder if we didn't. My brother and I started running in 2008 and my sister recently treated her family to "a month from scratch" cooking. Everyone has farm shares or gardens and cooks from whole foods. The cousins run races together, play sports, ride bikes, and play at the park. They eat their fruit, veggies, and grains, eagerly tucking into things like black beans, pumpkin pancakes, quinoa, and plain yogurt, all of which I'm positive I would not have touched as a child. Of course they like their candy and Doritos and video games too, and I've had to cut out my son's favorite salami and nearly all red meat. But the foundation is in place for healthy eating now, and in the future.

While I don't really want these kids to know enough about what happened to me to worry, I do want them to know. I want them to tell their doctors, when they are young men and women and on their own, that they have a family history of heart disease. That their mother or aunt had a heart attack. I want them to know their cholesterol numbers. I want them to know the risk factors and symptoms.

I want them to know. So their brothers and sisters and parents and friends never have to.

GET IT. GOT IT. GOOD.

Alright ladies, listen closely. If you haven't ever had your cholesterol checked, do it now. If you know you have high numbers, start working on it. If you have a family history, get yourself a cardiologist and have a full workup. Know your body and know your risks. Now.

As if you need a reason other than living past 40, consider this one: do you want kids? If you have kids, do you want more?

I have two sons and they are the center of my universe and my reason for living. And now I know they are even greater miracles and blessings, because yesterday I learned there will be no more babies. Ever. Apparently being a heart attack survivor and being pregnant are incompatible.

"You would be extremely high risk."

I figured.

"The increased blood volume is too much for your heart."

Okay.

"You already have children who need you to live."

Okay!!

"Furthermore, all the drugs you are on are not safe for pregnancy and it's not safe for you to go off them."

Okay, okay, I got it!

And to ice the cake: "But, you can't have any hormone-based birth control, and oh, when you get to menopause, you can't have hormone therapy then too."

Sweet.

I'm not really as bitter as this sounds, it's more like bittersweet. I'm even more grateful that I was able to have my two boys, and we had pretty much decided that we did not plan to have more children. It's just so weird when something so close to my definition of myself -- a woman, a mother -- is suddenly no longer my decision or even an option. I guess that's part of living with heart disease (or any disease for that matter). I can't decide that I don't like the idea of medications. I can't decide I'll just work off the extra calories if I want to eat that dulce de leche or mac and cheese. I can't decide, when my youngest turns eight or so, that I really did want one more baby.

But you can decide to be proactive and protect yourself as much as possible. What could you do to avoid this not-surprising-yet-life-changing side effect? Don't have a heart attack, if you can avoid it. Do everything you can to make yourself as safe as you can. If you know what you need to do, do it. If you don't, find out, and then do it.

Get it? Good.