PAY ATTENTION NOW

I think the most important message I can send is that heart disease can happen to anyone. It is not a disease of old age; it is not a men's disease; you can be healthy and active and still be affected. So naturally I want to share this American Heart Association infographic on myths vs. realities.

Pay attention to your body and your risk factors. Heart disease is the #1 killer of women, more than all forms of cancer combined. Pay attention, and spread the word.

Click image to enlarge.

HEALTH RISK

So it's finally happened to me. My health insurance company has refused.

I've always considered myself and my family blessed to have good insurance. We've had our share of medical emergencies and long-term issues and with a little hard work and a lot of time on hold, we've gotten good coverage through the years.

So this is my first outright rejection. They don't want to pay for Crestor anymore, because my cholesterol no longer needs to be reduced more than 40 percent. So precisely because it worked -- dropping my LDL from 180 to 58 -- I no longer need it. Sure, that makes perfect sense.

They'll reconsider if I "try and fail" the generic brands, so lucky me, I get to start testing new medications and dealing with new reactions, interactions, and side effects. I'm especially looking forward to the muscle pain I hear comes with Lipitor; despite the mega-dose of Crestor I was on, I had managed to escape that. Muscle pain + marathon training = good times.

And then there's the anxiety of new drugs. I don't especially love that I'm on 14 pills a day, but at least I'm used to them all and I know what they do to me. Spending the next year trying and failing sounds like a new roller coaster ride of emotions and stress.

The most frustrating thing about this is that it seems that insurance would rather pay for another heart attack than keep refilling Crestor for the next 50 years (I'm optimistic, even when mad). They must have fed my data into their algorithms and concluded I was a low risk and therefore worth the extra cash in hand today. They feel comfortable with the risk; too bad I don't.

I know that this is a minor setback and that for millions of others, denied coverage is a much, much bigger issue -- one of life and death, not of anxiety and inconvenience. It happens. To many.

It shouldn't.

MYTH BUSTING

My new Road ID for running. In case I'm miles from home, alone,
it would be good for EMTs to know I've had a heart attack.

This post is inspired by a helpful American Heart Association article "Top 10 Myths About Cardiovascular Disease," which warns of the dangers of making false assumptions about your risk for heart disease.

I'm not the only one who made false assumptions about my heart; it took ER doctors and even cardiologists hours to believe I was really having a heart attack. But now I know the real truth and I want you to do the same.

Here are some of the myths the article describes and my own take on busting them. Read up, take your heart seriously, and pass it on.

I'm too young for heart disease.
Ha. I think we know how false this one is. I was 37 when I had my heart attack, and over the course of my eight weeks in rehab I saw at least two survivors much younger than me. In fact, 62% of people living with heart disease are under age 65.

I'll know I'm having a heart attack because I'll have chest pain.
Again, ha. No chest pain whatsoever. Sharp, stabbing back pain, yes. Arms, hands, and even palms aching to the point of tears, yes. Cold sweat, yes. Chest pain, not a bit. Especially for women, the symptoms of a heart attack can be as subtle as nausea. If something doesn't feel right, get checked. Don't assume it's heartburn, headache, muscle strain, or any of the zillions of excuses women make for their symptoms.

Genetics are destiny. Since heart disease runs in my family, there's nothing I can do about it anyway.
I fell victim to this one a little bit. I knew I had high cholesterol but so did most people in my family and they hadn't had heart attacks. I was off-and-on medication but it didn't really improve that much. I was off-and-on my low-fat diet, figuring all the exercise I was getting balanced that out.

Well, it didn't. With family history of high cholesterol my only risk factor, I had a heart attack anyway.

But here's the thing. After my heart attack, aggressive medication, diet management, rehab, and continuous exercise have brought my cholesterol way down, from a "bad" level of 180 to 58, and total from 230 to 106.

There is something you can do about it. So do it.

I don't need to start worrying about heart health until middle age.
Again, do I need to remind you that I was 37? (I guess that might be middle age - yikes!) Maybe it is, but if I'd been paying attention before that (I knew about my cholesterol levels in my early 20s), I might have avoided my trips to the cath lab and cardiac rehab.

The American Heart Association recommends you start getting your cholesterol checked at age 20 and to start even earlier if your family has a history of heart disease. Children with a family history can have high cholesterol levels, putting them at increased risk for developing heart disease as adults. My brother tested in the 300s when he was 13; I had my older son checked at age 10. So far, so good.

I should avoid exercise after having a heart attack.
Really? Someone actually thinks this? It might be hard. It might be scary. But if you want to live, get out there. I loved cardiac rehab and I recommend a formal, supervised re-entry into exercise. I felt so much safer, stronger, and more confident, and the structure it provided kept me accountable. Make sure your doctor approves and then get moving. I'm running a marathon this fall, but really, I'm running for my life.

The American Heart Association recommends at least two and a half hours of moderate intensity physical activity each week. There are 168 hours in a week; can you spare 22 minutes a day?

These are just half of the top 10 myths. Check out the AHA article for more!

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.

YOGA POWER

I heart yoga.

I started about 18 months ago, shortly after leaving my full-time job. It had been on my I-really-should-but-don't-have-time list for years, and I finally screwed up my courage and took a beginner's class at a studio down the street from me. I had the best teacher who seemed to read my mind (she could always tell if I stopped focusing on my breathing and let my frantic thoughts take over) and who taught us very slowly and carefully. In that stressful transition period between ending my career and starting my new life as an at-home mom, yoga was the perfect partner. Where had it been all my life?

After a few beginners sessions and then continuing classes, I started heading out on my own to different drop-in classes, like the one on Wednesdays at a community center close to our house. The instructor is very good and has a devout following at the various classes she teaches around the city.

So I asked her one day (again, screwing up my courage) if she would consider having a Go Red for Women day at her classes. Her response was an enthusiastic "I love this idea!" I told her about my heart attack (I had just stopped coming to class and then appeared again weeks later with no explanation, and she didn't ask) and suggested we could wear red and I'd get some materials from the American Heart Association. She included my story and an article I wrote about women and heart disease in her email newsletter for three weeks, reaching 275 women.

Our Go Red for Women Yoga class was today and it was so empowering. I got a little choked up seeing all the people in red, and I shared a bit of my story. What struck me, though, watching everyone's reactions, was how little people know about women's risk of heart disease and heart attacks. They really don't know that it is the number one killer of women.

I said what I really wanted them to take away was knowledge of the risk factors for heart disease, and the knowledge that 80 percent of cardiac events were preventable through healthy choices. But I also wanted them to know that if they did everything right and still had a heart attack, then they needed to know the symptoms and to toss aside women's typical "don't be a bother" behavior and get themselves to the hospital, pronto.

The only man at class that day raised his hand. He is a paramedic, he said, and he wanted to tell us more about the signs and symptoms. Don't smoke, he reminded (I'd forgotten that one), and told us that for women, unexplained shortness of breath can mean a heart attack. I confessed I drove myself instead of calling 911 and he covered his face with his hands with frustration. I'm so glad he was there; I think his message really made an impact.

Yoga always makes me feel calm and strong and powerful, and it was even more so today. There's power in knowledge, power in community, and power in women. I felt it today and it felt amazing.

Namaste.

Yoga in my backyard with my nieces.

30 MINUTES A DAY

This very cool video is worth the watch. It makes it crystal clear why moving your body is the best medicine.

ACTIVE INVESTMENT

My brother started running a few months after I did,
and ever since we've been race buddies. He slows down
to run with me.

I have been a pretty active mama since my second son was born in August 2007. Staring down a bridesmaid's dress and a Hawaii destination wedding within five months of his birthday, I had ample motivation to get going. I started walking, then running, and the baby fat melted off. The next spring I ran my first 5K and was hooked on racing. I was on my way.

So it was more than a little surprising that I had a heart attack anyway, four years, one marathon, one half-marathon, and at least a dozen shorter races and hundreds of training miles later. And while I had a good base of fitness, I didn't have the whole thing mastered, especially post-heart attack. For that, I needed help.

I started cardiac rehab about five days after I was discharged from the hospital, and I discovered I loved being told what to do, how fast to do it, and for how long. I worked as hard as I could (or the staff would allow), and left cardiac rehab dripping with sweat, which from what I could see was a fairly rare phenomenon. I loved it, but I couldn't stay forever.

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.

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.

MY 15 SECONDS

At the risk of completely embarrassing myself, I'm sharing this video/commercial. You might recognize the representative heart attack survivor.

Seeing and hearing yourself on camera is never a girl's favorite thing, but the Allina staff did a nice job with the messages on this prevention-oriented video. I'm very glad I got to say things about considering myself healthy, having no idea this was coming, and that my symptoms were not typical. I really think that message needs to get out in as many ways as possible.

This was aired during an hour-long program on cardiac health on Kare 11, our local NBC station. (You can see that program online if you are interested; I do think the segment on women is very good.)

Allina was one of the sponsors and thus had this longer promotional commercial placement. Apparently someone from cardiac rehab gave the marketing staff my name and voila, my 15 seconds of fame!