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.

GUEST POST: HOW TO GET MOVING

My friend Breanne has been my running inspiration for years. When I first started running to lose weight after my second son, she cheered my first 5K like I'd just finished the Boston Marathon. When I decided to try for my first marathon, she became my coach. She helped me create a training program, provided critical advice (Body Glide: get some!), and listened to my running stories with amazing patience though she'd been there dozens of times before. (I really can talk about a long run for upwards of an hour.)

So naturally she was the first person I thought of who could give us the best advice about how to start exercising and how to keep going day after day, year after year, until it adds more to your life than just fitting into your skinny jeans or finishing your first 5K.

My brother and me after our first marathon. Breanne coached my brother too,
since everything she told me I passed on to him. Eventually he started sending
me emails that started "Could you ask Breanne ____."

Here's Breanne's take on how to get moving.

Six years ago my husband ran his first marathon. I was really impressed, and later vowed that if he ran the same marathon next year, I'd run the 10 mile race that went with it. A few days later I forced myself to run and had a miserable time. It was about 80 degrees out, I had no water, and I was going way too fast. "I hate running!" I thought. "I hate it! It's just not my thing."

I went on to run that 10 mile race and 13 marathons after that.

I discovered a few thing about myself and exercising along the way. When we want to start exercising I think many of us make the same mistakes and end up quitting. For example, we do an activity we think we should do, whether or not we enjoy it. If it hurts we take it as a sign that we can't do it or that the activity should hurt. We chose some heroic time of day to exercise that we hate.

If you'd like to start exercising and want long-term success, consider these things before getting started:

1. What time of day suits you best? I consider myself a morning person but that is not my best time for exercise. Neither is after work -- I'm too tired and hungry. While I occasionally do work out at those times my sweet spot is midday (over my lunch hour at work or midmorning or afternoon).
2. Do you prefer social activities or solo? What got me through my 10 mile training was realizing that I hated running alone. I joined a group training for the race and made friends and got advice and support.
3. What does your gut tell you that you enjoy the most? Does biking always feel great? Does yoga really fulfill something in your life? While it's fun try new things, you can't make yourself consistently do something you don't like. Don't second guess whether it's the "right" activity -- if your body is better for it, than it's worth doing.

A few other things that help make sure you'll keep at it:

1. The first few times (or weeks) you do your new activity, do it half as slow or easy as you think you should. We all do this -- we go out too hard at first. We're insecure, we think it's going to be hard so we make it so, and we cover up the fact that we don't know what we're doing by trying twice as hard. Most of the people who think they can't run really can -- they just need to slow way down and then build up over time.
2. Choose a goal, one that you admit to at least a few other people. A race, a distance, a yoga pose, a number of laps. When you reach that goal, celebrate! and then make a new one.
3. Figure out what motivates you. Does signing up for a class with set meeting times and a group to be responsible to appeal to you? Or would you rather draw up your own schedule and do it and not tell anyone? If you can have your exercise do double duty in your life (walking your dog, pushing the kids to the playground, biking to work) it'll be even easier to make it a habit.
4. Invest in some decent clothes to exercise in. Any kind of technical/wicking/dryfit clothes will do -- they are all fine. They should feel comfortable while you're exercising and keep you relatively cool. You should also like how you look in them. Target's C9 brand is fairly inexpensive and decent of quality.
5. Choose an activity that has an instructor (a class, group leader, or coach) or identify a mentor from your personal life. Having someone you can ask questions of helps keep you from feeling frustrated. And don't be afraid to ask questions -- who doesn't love to help someone else?

A few secrets to motivate you:

1. Once it's a regular part of your life, exercising really does give you energy and make you feel great.
2. The mental benefits of exercise are as amazing as the physical benefits. Nothing calms me down after a tough day like exercise. It also gives you a ton of confidence. 

Breanne is an amazing marathon mama and the best coach a girl could have. Read more about her life and her passions at her blog, Borealis.

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.

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.

AMAZING RACE

This weekend was Twin Cities Marathon weekend - the race I was training for this summer and was planning to run with my brother, Mike.

Life, as we know, intervened. So a few weeks ago I asked my rehab physiologist (aka boss-of-me) if she thought I could run the TC5K instead. I got permission from her, and my cardiologist, with a few provisios: I was not to let my heart rate exceed 150. I could run 10 consecutive minutes, if broken up by two-minute walk breaks. I was not to race it or try for time, and I could sprint for only the last 30 seconds. And be sure to cool down completely. Other than that, no problem! Sure! That's a great idea!



So I registered for the 5K and my sweet husband rallied friends and family to dress in red and cheer me on. My boys were bright, bright red and even wearing their Red Dress pins without fuss. Aunts and uncles, parents, cousins, siblings, and friends traveled to see me. My cousin ran the 10K that morning, my boys and nieces and nephew ran in the kids' races, and we all hung out in the beautiful sun all day. I was genuinely and honestly completely happy and I'm more proud of that 5K than any race of any distance I've ever done. (My time was not too shabby either - 31.12 with four minutes of mandatory walking!)

My brother and I started running in 2008. Our first race was a 5K and I remember how hard it was (it also remains, to this day, my best 5K time). A few 5Ks and 10Ks later we ran the Twin Cities Marathon in 2009. A couple more 10Ks and half-marathons later (and a full marathon for Mike, so now's he's got three medals and I only have one), we decided we wanted to run the Twin Cities again this year.

We went to packet pickup on Friday and among all the chaos of registering children and picking up about 6 packets, bibs, and t-shirts, I noticed Mike also had a 5K shirt. My sweet brother had surprised me by registering for the 5K, reasoning that while I couldn't run with him, he could run with me. It was just the perfect thing to do, and yes, I started crying. I had way more fun running with him than I would have alone. Thanks Mikey. I love you!

We kept the fun going with a pasta party at our house Saturday (featuring tasty, heart-healthy sauces, find the recipes here), watching my brother run the marathon, and Sunday night celebrating. I volunteered at the finish line, which turned out to be a great way to be there for the marathon but simultaneously and completely distract myself. The whole weekend was fun and positive. My doctor had said I should be doing things that "feed my soul." This weekend I was very well-fed. 

My cardiologist says I have to wait three months post heart attack to train or race any harder, so I can't quite make the Monster Dash, but racing is as fun as it ever was and I'll be back at the start line just as soon as I can. But I'll have to step up my game -- I can't ever get a worse time than what I got just six weeks after a heart attack!

Thank you to my husband, Scott, for all you did to make the weekend meaningful and easy for me, and to my boys for being sweet good sports. Thank you Mike and Beth and your wonderful kids Oliver, Natalie, Jenna, and Lauren for all the fun you bring. Thanks to my dad, stepmom Sherry, brother Dylan, my cousin Janna, Uncle Scott and Aunt Laurie, Aunt Deb, parents-in-law Jim and Carolyn, and friends Christine (and her girls Maddie and Nora) and Kelly for coming to see me run. You all made the race an amazing experience!

Love,
Jen(ny)