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.

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!

THIS PATIENT'S STORY

With Kris, the manager of cardiac rehab and Exercare
at United Hospital, and the emcee of the event.

I was asked to speak at a United Hospital Foundation event celebrating American Heart Month and to share my "patient story." The annual event, "Celebrating the Hearts of Women" focuses on women's heart health and prevention, and was held February 22. I was nervous, but it went well, and I made it through without crying (too much). 

I thought you might like to read my speech, so I've pasted it below. If you have read along with me on this blog these last few months, some of it will sound familiar.

Today I'd like to start with a story about Mary Jean. Mary Jean leaned over to talk to me as I waited for my first cardiac rehab orientation on a sunny Monday last August.

"Will you be joining us?" she said.

"Yes," I said. "I had a heart attack last Sunday, and I left the hospital on Wednesday."

"Oh," she said, and paused. I didn't wait for her to ask what I guessed was coming.

"I'm 37."

She didn't say I was too young to have a heart attack, or even act that shocked or surprised. She told me that she was 86, had had bypass surgery and now had a new valve and a pacemaker. And then she said, "You'll like it here. The people are very nice."

They were nice, and I did like it. The effort was lighter than I was used to, since I'd been training all summer for the Twin Cities Marathon and two duathlons. 

But it was exercise and movement and it felt good. I was supervised, monitored, checked, and scored. Someone told me what to do, when, for how long, and at what intensity. After the shock and upheaval I'd just been through, it was perfect.

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.

ARE YOU GOING RED?

My family and I, wearing red!

I'm very excited about my "very first" National Wear Red Day on Friday, February 3 - first post heart attack, that is. It's a simple way to show women that raising awareness about women's risk is important.

But, having left my job last year to stay at home with my boys, I'm without a natural group to Go Red with. I will wear red that day - but I'll mostly be at home, dropping kids off at school, or at the gym. My boys will wear red, and maybe my husband will finally wear that tie I bought him with the red dress symbol on it. (I promise, it's not girly.) But I won't have a group photo to post or submit to the American Heart Association just for the fun of it.

So I wonder if you will help me. Will you wear red on Friday, February 3, and get your family, colleagues, or classmates to join you? Snap a photo on your phone and email it to me? (jen (at) mylifeinred (dot) net). I'll put the photos I get on this blog and we'll have a virtual Go Red community.

I am working on some extra posts and features to commemorate American Heart Month in February, and I look forward to sharing what I've learned. Heart disease is number one killer of American women, taking more mothers, sisters, wives, daughters, and friends than all forms of cancer, combined.

Find out more about the Go Red For Women campaign and plan to wear red February 3!

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.

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.

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 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!

 

SUPERFOODS, PART I

While writing this I ate three pieces of cherry Laffy Taffy from the Halloween basket (and if the basket wasn't downstairs, it would have been more) so I'm not exactly a nutritional saint, even now.

But, in the last few days I have made some very tasty, very righteous recipes featuring the nutritional powerhouses walnuts, barley, and kale. I wanted to share them with you because they are really good, really good for you, and quick and simple to make. Nutritional virtue was never so easy.

First, a few words about our healthy-living sponsors: walnuts, barley, and kale.

WALNUTS

Walnuts are energy-dense (that's code for high in calories; 185 in just one ounce) but worth it, especially for heart health. They are high in omega-3 fatty acids (as in 90% of your daily recommended amount in just one ounce), vitamins like E and B6, niacin, thiamin, riboflavin, and folic acid, as well as minerals like potassium, calcium, iron, and more. (Niacin, omega-3s, and fiber are like the trifecta of cholesterol improvement.) Walnuts also pack a fiber and protein punch, and oh yeah, they taste good.

BARLEY

I really love barley. It has a superb texture, nutty flavor, and an inexplicable ability to make whatever it is cooked with taste rich, decadent, and smooth, almost buttery. All that from a humble little seed.

Barley is a low-glycemic grain (good, because my carb intake is really too high right now), and high in both soluble and insoluble fiber. Soluble fiber helps the body metabolize fats, cholesterol, and carbohydrates, and lowers blood cholesterol levels. It is also a good source of niacin, vitamin E, and antioxidant lignans (also found in the super-food flax).

KALE

Not just a pretty leaf, kale is one of the healthiest foods you can eat. One cup of kale contains only 36 calories, but five grams of fiber, along with 15% of your daily calcium and vitamin B6, 180% of your vitamin A, 100% of your vitamin C, and and 1,020% of your vitamin K, along with 40% of the magnesium you need, plus iron, potassium, and copper, and the antioxidants carotenoids and flavonoids. The fiber makes it especially heart-healthy, but it is also good for your eyes and has numerous anti-cancer benefits.

In case you are thinking that ingredients this healthy cannot taste delicious and decadent (and no way will my kids eat it!), stay with me. These recipes are my-kitchen-tested and even kid-approved (and of course, ultra low in saturated fat), so try one and savor the feeling of delicious nutritional virtue.


RECIPE: MUSHROOM AND BARLEY SOUP WITH KALE
RECIPE: KALE RED PEPPER PESTO
RECIPE: KALE PUTTANESCA

TRANSITION

I've been transitioned. After six weeks and 1 day at rehab, I've graduated to "Level III: Transition" care and won't be returning to outpatient rehab at the hospital (at least, I have no intention of having to return there!).

This is my report card, er, "outpatient discharge summary."  It has a sort of kindergarten-report-card vibe to it -- I don't get a grade, or even "exceeds expectations," on the required tasks. It's just "Met".

Some of the best lines:

"Verbalizes understanding of normal anatomy" Met
"Verbalizes understanding of pathological disease" Met
"Verbalizes cardiac signs and symptoms and knows appropriate actions" Met
"Demonstrates compliance toward personal risk factor modification" Met

The last one is my favorite. Beautiful sentence structure, outstanding word choice, and ultimately, kinda funny. Yes, I am modified. Yes, it's personal. Yes, I'm complying and meeting expectations. I'd be an idiot not to.

The next phase in my personal risk factor modification is to keep up the exercise. On Wednesday I start at Exercare, a gym across the street from the heart hospital staffed with nurses and sports physiologists. I get six sessions during the transition phase, after which I can join if I choose to. At this point, that seems like a good idea, until I really know and understand what is a safe and effective exercise plan for me. That's the part of my behavior modification I don't feel I've mastered.

I will miss rehab. I liked the predictability of Monday-Wednesday-Friday at 3 p.m., I liked the company, and I liked having a prescribed plan. I was able to work out longer, faster, and harder each day and I could feel progress being made. Here's proof: according to my report card, my average beginning Met level was 4.7. My average on discharge was 7.2. Whatever that means. It's clear I need to go back to school.

Exercare, here I come.

PARTY HEART-Y

I don't think I'll ever get tired of heart-related puns. If you continue to read this blog, consider yourself warned.

Last weekend my family and I had a ton of fun while running. To fuel those workouts, we had a pasta party at our house Saturday night. Pasta is a safe bet: crowd pleasing, healthy, easy. But crowd-appealing sauces that are also low in fat and saturated fat? A little bit harder. Foodie-worthy too? Bring it on.

I scoured my cookbooks and websites and came up with several options, four of which I tested on my husband and his parents. Three made the cut: Turkey Meatballs with Spicy Marinara, Mushroom and Red Wine Sauce, and a light and healthy Spinach Pesto. There were many compliments Saturday night (my high school senior cousin liked the mushroom sauce best - impressive!) and I waited until people commented before revealing how good it was for them too.

Before you doubt that turkey meatballs are good (because I did, owing to a turkey meatloaf disaster a couple years ago), trust me that these are tender, juicy, tasty, and heart-y. (Hee hee.) One of my uncles was three-quarters done with his plate when someone told him they were turkey; he didn't believe them.

I found the recipe in Ellie Krieger's book, The Food You Crave, which I highly recommend. You can also find her recipes on Food Network. I barely modified the recipe, but I couldn't help making a couple changes. It takes some time, so save it for a weekend or make a double batch and freeze some meatballs and sauce (but freeze them separately, after the baking step but before simmering in the sauce).

RECIPE: TURKEY MEATBALLS WITH SPICY MARINARA

Pesto purists might turn up their noses at a pesto with so little cheese and oil, but I liked it alot. Spinach provides nutrients and makes up for that grassy flavor that a lot of good olive oil would impart. The small amount of cheese means it doesn't get sticky when heated and actually holds and reheats - something you just can't do with regular pesto. I served it in a crock pot on warm and it was ladle-able (is that a word?) on top of the noodle of choice. Again, not your typical pesto behavior.

This pesto has a light flavor and sharp garlic bite (add as much or as little fresh garlic as you want). It balanced the other two sauces perfectly. You could also add cooked chicken or shrimp to make it a complete dinner, or top with some diced fresh tomatoes. I like red pepper flakes on it too.

This recipe came from the American Heart Association Cookbook. I had been thinking of going all Julie & Julia on that book and cooking everything in it, but the first thing I tried bombed so I nixed that idea. But, this recipe has redeemed the book and I will try more recipes.

RECIPE: LIGHT AND TASTY PESTO

Last but not least, a delicious sauce for mushroom lovers. (If you hate them, stop reading now and make pesto instead.) I found this one in Joy of Cooking, and modified just a bit, as in I left out the pancetta.

This one is easy, but it takes patience. You just slice some porcinis, baby portobellos, and button mushrooms and cook them a long time with lemon, sage, garlic, and red wine until they take on a dark, rich glaze. Sauce up with a little stock, toss with some papparadelle, grate the best parmigiano reggiano you can get over the top, and marvel at how good fungi can taste. Earthy, meaty, rich, and only 1 gram of saturated fat.

RECIPE: MUSHROOM AND RED WINE SAUCE

If you try these please let me know what you think, or share your favorite sauce recipe. Happy, healthy carb-loading!

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)

COMFORT FOOD

First day of 5th grade!

It might be the cold, rainy fall days, the start of school for my boys, or the fact that I just could use a little comforting these days, but I've been making some serious comfort food this week - mac and cheese, tomato soup, chicken fingers, pumpkin bread. And before you start worrying, I used heart-appropriate recipes or safe substitutions for these comfort faves and came up with a few winners I deem good enough to share with you.

Bundle up and enjoy!

RECIPE: LIGHTER MAC & CHEESE

Sounds weird, is good. Trust me. The sweet nuttiness of the squash combines with the salty, tangy cheeses to create a great approximation of cheddar Bechamel, but with only 6 grams of saturated fat for a really generous serving (vs. 36 grams for the real stuff). I've had other squash mac-and-cheese dishes and this one is the best one I've tasted so far.

First day of Pre-K!

RECIPE: PUMPKIN BREAD

Ooo this one is so good! It has a great, silky texture and is spicy and pumpkin-y and delicious. It is not sweet, so I served it with maple butter (to my brunch guests), though I loved it plain or, gulp, with my Smart Balance margarine (I really can't believe I'm saying that). Total fat per slice: 3.75 grams, 0.25 saturated.

RECIPE: ROASTED RED PEPPER AND TOMATO SOUP
The way your house smells when the veggies are roasting is the best part of this soup, but it tastes only slightly less amazing. Super easy and super healthy -- did you know tomatoes are a heart-health super food? If you use fat-free Greek yogurt you're looking at about 2 grams of fat per serving, 0 saturated.

RECIPE: CHICKEN FINGERS WITH RASPBERRY SAUCE
I bought this little American Heart Association kids cookbook because Owen likes to cook with me. We made the chicken fingers and I probably loved them more than either Owen or Noah did. I guess they are just one of those kid foods I never outgrew. But, Scott liked them too, so you can confidently embrace your inner child and enjoy, for only 3 grams (and 1 gram of saturated fat) per serving.

A TOTALLY NORMAL DAY

I hope everyone has seen this funny and really, far too realistic video, produced by Go Red for Women, the American Heart Association's women's heart health campaign.

The day of my heart attack started as a totally normal day, and I expected normalcy to resume at any moment (hmm, still waiting). I called Scott from the ER to make sure Owen's rain gear was packed for camp. I called again from the ICU to give instructions on what to pack for Noah's trip to my brother's house while I was in the hospital. I emailed work colleagues after surgery. At the time it didn't seem real. My head seemed to be the last thing to catch on.

Please watch and share this video, then check out the warning signs of a heart attack. It's not always what you think.

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.

NO SUBSTITUTIONS

It's a rare recipe that turns out well when you substitute a low-fat or fat-free version of something, especially dairy. And don't even get me started on margarine. For some ingredients, there really are no subsitutions.


See that walnut on the left? That's
good for me. The rest, not so much.

Since I plan to live and therefore must eat this way for decades, I'm determined that my food be foodie-worthy, not just fat-conscious fuel. Therefore, I embarked on a mission to learn everything there is to know about the fat levels in my favorite cooking cheeses. My hope was that at least a few of the best ones made the cut. (Julia Child maintained that there are only three worthy cheeses: cheddar, Swiss, and Parmesan; I hate to differ with Julia, but there have to be at least a couple others!)

The American Heart Association Nutrition Center, while appearing useful in other ways, was not helpful regarding cooking with dairy. Here is the extent of the information I could locate:

• Select fat-free (skim) or low-fat (1%) milk. Avoid milk that contains added flavorings such as vanilla, chocolate or strawberry. They usually have added sugars and calories.
• Choose fat-free, low-fat or reduced-fat cheeses.
• Use egg whites or egg substitutes instead of egg yolks. (Substitute two egg whites for each egg yolk in recipes that call for eggs.)
• Choose soft margarines that contain “0 grams trans fat” instead of buying butter. (These margarines usually come in tubs.)
• Don’t buy a lot of butter, cream and ice cream. Save those for special occasions and, even then, limit how much you eat. These foods have more saturated fat than whole milk.

Choosing fat-free, low-fat, or reduced-fat cheese is precisely what I'm trying to avoid. I can't makethat delicious couscous-edamame-feta salad? What about Cooking Light's recommendation to subsitute cream cheese to make low-fat mac and cheese? Caprese salad? That has to be okay, right? I don't need to pile on the creamy, gooey, salty, tangy, sweet, nutty goodness at every meal, but fat-free cheddar? Give me a break.

The USDA nutrition website was similarly unhelpful. Where was the index of cheeses by name with nutritional information? And where's the list of "good" cheeses that are approved for the heart attack survivor to eat? Am I the first to ask this question? Or, is it unavailable because I really, truly shouldn't eat cheese at all?

My daily total fat grams target (including the good-for-me kind) is 50 grams and my daily limit of saturated fat is 20. The nutritionist at the hospital told me to look a 2-to-1 ratio of total to saturated (e.g. 8 grams of total fat should have no more than 4 grams of saturated fat). Almost none of the cheeses I looked up meet that criteria, so any use would require careful fat-gram budgeting. I think that's what they mean by "use sparingly."

So, here's what I know, for better or worse (mostly worse). That vegan thing is looking better all the time.

All data below is for just 1 ounce, or about the size of a matchbox!

BETTER

Part-skim ricotta
Total fat = 2.25
Saturated = 1.4

Cottage cheese (1%)
Total fat = 2.5
Saturated = 1.5

Part-skim mozzarella
Total fat = 4.5
Saturated = 3

Fresh mozzarella
Total fat = 5
Saturated = 3

Cream cheese
Total fat = 5
Saturated = 3

Feta
Total fat = 6
Saturated = 4.5

NOT SO GOOD

American Cheese
Total fat = 7
Saturated = 4

Parmesan
Total fat = 7
Saturated = 5

Provolone
Total fat = 7.5
Saturated = 5

Swiss
Total fat = 8
Saturated = 5

Brie
Total fat =8
Saturated =5

Blue
Total fat = 8
Saturated = 5.3

Monterey Jack
Total fat = 8.5
Saturated fat = 5.5

PRETTY BAD FOR YOU

Cheddar
Total fat = 9
Saturated = 6

Gruyere
Total fat = 9
Saturated = 5

Havarti
Total fat = 10
Saturated = 7

This is just a sampling, not definitive information (see above, USDA). Some of this came from brand names so check your labels!

FAT FREE FOODIE

Those who know me know that I'm a serious cook and a serious eater. I love food and everything about it: the farmer's market, pretty linens, cookbooks, dutch ovens, china, my gourmet grocery store, aprons, my dining room, and people, always the people. Food is a language of comfort, of companionship, of caring, of fun. Food is my language of love.

Our first day of school celebratory dinner: shrimp, of course. It's Owen's favorite. The big bowl of raspberries on the table. ("I got those for you," I say as Scott's eyes light up. "I know," he replies.) A gorgeous bridal shower buffet. Baked mac and cheese that treats sadness and celebrates new babies. A birthday cake that looks like a back hoe.

I do love a cooking challenge and I'm determined that life as a fat-free foodie not be an oxymoron. Sure, the velvety bechamel I've perfected and the baked brie for which I am famous are a thing of the past, and probably that delectable beef ragu that once rendered me speechless is too. But really, it won't be so bad eating (saturated) fat free.

Here's the good news: I should eat all the vegetables, fruit, and nuts I want. Grains too (after years of dieting, I'm giddy that I'm actually supposed to eat them, especially oats, barley, and flax). I should eat more soy protein and seafood because I need those omega-3s even more now.

How about avocados? Yep. Mayo? Yep. Sushi? Uh huh. Oh, and I almost forgot, red wine.

Yummy. See how I suffer?

And here's what not to eat: Any animal that lives on land. Foods made from animal products. Anything artificial. Added salt.

Duh.

Okay, it's not quite that simple and the rules are not that draconian, but if I wanted to eat the most heart-healthy diet possible it would have to be vegan. I'm starting out with lots of vegetables, grains, seafood, and some turkey and chicken once in a while. I'm eating very little dairy other than skim milk and fat free yogurt, and that is a true cooking challenge. I've also had to give up Diet Coke, which is honestly harder to live without than butter.

I've just begun my fat free foodie education and my plan is to share Jen- and family-approved recipes on this blog, along with my experience integrating my heart-healthy diet into a busy family life (as well as onto my party table). I'm really more interested in talking about food than myself anyway.

So I'll start today with some good info for your nutritional inspiration, and one good recipe from this weekend.

• "Four Foods That Lower Your Cholesterol" an article in Time Magazine. 
• (Brace yourselves, Diet Coke lovers) "Daily Diet Soda Linked to Higher Risk of Stroke and Heart Attack"  on MSNBC and other sources
• "From Omnivore to Vegan: The Dietary Education of Bill Clinton" on CNN
• "Time to Revive Home Ec" from the New York Times (I loved home ec!)

ROASTED TOMATO SPAGHETTI
Serves 4 hearty eaters, with a bit left for you for lunch the next day
Adapted from Real Simple magazine

3 tablespoons olive oil
1 cup chopped red onion
1 tsp crushed garlic (from a jar)
1/3 cup pitted kalamata olives (about 12)
1 teaspoon anchovy paste
1/2 teaspoon crushed red pepper
1 teaspoon dried oregano
28-ounce can Italian plum tomatoes with juice
kosher salt and black pepper
1 pound spaghetti (I use Barilla Pasta Plus, for more protein and omega-3s.)
2 tablespoons chopped parsley

Heat oven to 450° F. 2. In a large ovenproof skillet or baking pan over low heat, combine the oil, onion, garlic, olives, anchovy paste, crushed red pepper, and oregano.

Bring to a simmer and cook, stirring, for two minutes. Remove from heat, pour the tomatoes over the top, and season with ½ teaspoon salt and ¼ teaspoon pepper. 

Transfer to oven and roast for 20 minutes until the sauce is hot and bubbly and the onions are soft. Meanwhile, cook the spaghetti according to the package directions.

Transfer the roasted tomato mixture to a food processor or blender and pulse once or twice to your desired consistency.Toss with the spaghetti and parsley.

Variation I'm going to try: This robust sauce, similar to puttanesca, would stand up well to tuna. I'm going to add some next time to get in another fish serving and up the omega-3s even more.

Nutritional Information
Calories   639 ;   Calories From Fat   141 ;   Fat   16g ;   Sat Fat   2g ;   Cholesterol   0mg ;   Sodium   853mg ;   Protein   19g ;   Carbohydrate   105g ;   Sugar   15g ;   Fiber   8g ;   Iron   5mg ;   Calcium   114mg

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.

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.