What am I doing here?
It's 8:30 a.m. on a Tuesday morning, January 8, 2002, when I would normally be strapped to my workstation, a slightly frantic, 54-year-old editor putting the finishing touches on a newspaper that absolutely positively has to go the printer at 1 p.m.
Instead I am strapped to a long slab in a cold room at the Mercer campus of Capital Health System in Trenton, watching passively as a cardiologist, Dr. Sunder Venkatesulu of the Mercer Bucks Cardiology Group, and two technicians prepare to insert a catheter into an artery in my groin and snake it up into my heart. Overhead a bank of fluorescent screens and video monitors loom ominously.
As the cardiologist punctures a tiny hole through the skin -- numbed with lidocaine -- and into the artery and installs a six-inch long sheath into the artery to guide the catheter as it begins its intravenous journey, the technicians review my chart: "Blood pressure 110 over 70, total cholesterol under 150," they observe, citing the figures that suggest I am not an obvious risk for heart disease. "What are you doing here anyway?" they ask, in a tone that suggests this might be another one of those big false alarms.
As the cardiologist prepares to inject an iodine dye through the catheter into the heart, I explain that I have had some vague feelings of chest discomfort. Moreover there was an area of uncertainty on a thallium stress test I had two months earlier. At that point the cardiologist injects the dye. The squirt goes in, the images emerge on the screens overhead.
"There it is," says Venkatesulu matter of factly. He points to what I later learn is the left anterior descending artery -- the LAD or, as some wags have described it, "the widow-maker." Leading out of the heart the artery on the screen looks like a fountain pen. Then it abruptly turns into a piece of fishing line. In typesetting terms it's as if an eight-point rule suddenly turns into a one-point rule:
-- -- -- ________ ______
"It's 90 percent blocked," says the cardiologist. "That's why he's here."
As my thoughts plunge into a black hole of despair, the team in the catheter lab turns salubrious. "Congratulations," they say. "We're sending you over to St. Mary for an angioplasty and a stent." Someone suggests it will be a slam dunk. I have watched too many sports contests to be assured by that analogy, and I keep free falling into the black hole. But eventually I realize what they are saying: Good for me to be where I am. In the alternative, I imagine, I would be back at the desk, blissfully ignorant, strapped to that work station until the magic moment occurs when some glob of fat in the blood -- a glob no bigger than one of those bacon bits from the Caesar salad or a fleck of butter from that bagel -- flowed up to that artery and wedged into that last little open channel. It would be a capstone to my career. Capstone, rhymes with tombstone.
While coronary heart disease is the number one killer in America, exceeding the fatality rates of cancer and AIDS together, for example, it has never been the disease lurking in the back of my mind. For as long as anyone as ever measured it, I have had low cholesterol and normal blood pressure. My weight crept up from my high school level of about 155 pounds to as high as 165 pounds. But that was over a 30-year period and I'm 5-foot-10 -- hardly fat.
My father and my three uncles all have had coronary heart disease of some sort, but not until they were in their 70s. When doctors ask about family history of heart disease they are referring to the early onset of the disease. My father is living happily at the age of 83 with a quadruple bypass, performed at the age of 80. Of the four brothers the two who also smoked are dead. That was another positive note in my CHD dossier: I have never smoked.
Still, CHD is a big killer, and the doctors I have had since the age of 40 have all raised the specter of it during my physical exams. When I was about 45, a young internist named Mark Schaeffer with the Princeton Rheumatology Group suggested that I start walking 20 to 30 minutes a day, four or five times a week.
I remember asking Schaeffer what good that would do. Would the mere act of blood passing more rapidly through the arteries keep blockages from occurring? If so, I was thinking, how could a guy like Jim Fixx, the first guru of jogging and author of the best-selling book, die of a heart attack?
Schaeffer's response was intriguing: Maybe it helps, maybe it doesn't, he answered. But the physical activity might reveal a problem sooner rather than later. In the alternative, I remember him saying, you could just be sitting at your desk, and discover it all at once, when it would be too late.
That made a lot of sense, and I thought about walking. But let's remember: Combined cholesterol total well under 200, blood pressure normal, not overweight, never a smoker, and no family history of "early" heart trouble. So I never did go walking. Not even once.
A few years later Prudential, the medical insurance carrier we had at the time, had skyjacked its rates for small businesses through the roof. So our company went with good old "Blue," Blue Cross-Blue Shield, and I caught a doctor named Harold Gever. At that time he practiced out of the Blue Cross clinic on Quakerbridge Road -- that's right a clinic, with all the trappings that one might associate with socialized medicine. But, like Schaeffer, Gever also seemed to listen to what you had to say and he even seemed to encourage you to talk about your health.
These are not traits that come automatically with your MD degree. As I was getting comfortable with Gever, through various minor ailments and more or less annual physicals, my father was going through his quadruple bypass. That procedure propelled him through dozens of appointments with various medical practitioners. After a while, my father began a little time and motion study. Instead of keeping track of how long he waited for each appointment (that was plenty long, as you can imagine), he began tracking the amount of time each doctor spent with him during the appointment. Would you guess five minutes? My father's informal survey revealed an average patient-doctor interchange of about 90 seconds.
Gever might have given him 5 or even 10 minutes. The son of a pharmacist in Philadelphia, Gever got interested in medicine as a child. In 1971 he was admitted to Brown in a pre-med program and after seven years later took a residency at Temple, "where residents ran the show." One of his first jobs was with a public health program. Seeing all kinds of people with all kinds of diseases, he learned the value of listening. "To me one of the pleasures of the profession is meeting and talking with people, and it's served me well in a diagnostic role," he says. But, he adds, in the managed care environment, "it's not in the interest of the physician to probe a lot. It's my background to cover as many bases as we can, but unfortunately that's not as common today."
In the spring of 2001 I first began noticing some discomfort in my chest: Not all the time, and not for very long. Later -- much later -- I would discover that my feelings were virtually identical to the symptoms of heartburn. Sometimes the discomfort visited me shortly after I jumped into the car and headed off for home or the office. Often I experienced it at moments of emotional turmoil or anger. There were plenty of those moments. Putting out a newspaper once a week brings a little stress with it. Being a manager of people (that's an oxymoron) is another stressor. And at this same time I was enduring the legal necessities needed to terminate my ill-fated marriage.
During one of those proceedings, my adversary's attorney asked me if I were in good health, asking the question in such a way that the expected answer would be yes. I was under oath at the time, and I surprised myself by my answer:
"I'm not sure that I am."
The attorney of course moved on immediately to other subjects. But afterward I began asking myself what I meant by that answer. That chest discomfort, I decided, must be with me more than I realized. A few days later I called Gever's office to schedule an annual physical. It was June, 2001, but the first opening they had was not until September. I debated playing the chest discomfort card to see if I could get in earlier, but decided it wasn't that serious.
Come September I am at Gever's office, now a private practice on Mercerville-Whitehorse Road but still honoring Blue Cross Blue Shield. All the blood work seemed normal, but Gever -- true to form -- is willing to listen. I talk about the chest discomfort, framing it -- as many patients must do -- in an apologetic, I'm-sorry-if-I'm-overreacting tone. Gever doesn't see it that way.
"Here we take any report of chest pain very seriously," he says. The doctor explains that I am at the age where a precautionary stress test is probably a good idea. And the only kind of stress test worth doing, he says, is a thallium stress test, "the gold standard," which involves a trip to the hospital, the injection of radioactive dye into the bloodstream, and X-rays taken before and after a cardiologist-supervised session on a tread mill. It would take a full morning at the hospital and the insurance company allows about $5,000 for it. Gever's office puts the paper work into motion immediately.
That was Monday, September 10, 2001. If the appointment had been one day later I probably never would have mentioned the chest discomfort (if you wanted to hear about discomfort, I would have said, talk to the families of the World Trade Center victims). And I certainly would have put off the thallium stress test.
The stress is scheduled for October 24 at Mercer in Trenton. It's a hurry up and wait procedure -- hurry to get there on time, get some radioactive fluid injected into your arteries, wait for an set of chest X-rays that are taken in something almost as enclosed as a CAT-Scan machine, and then wait for a brisk walk on a treadmill under the supervision of a cardiologist. After the exertion, you get a second round of X-rays, all enhanced by that radioactive dye. If your numbers on the treadmill are suspect, you can bet that the cardiologist is going to study the X-rays that much more intently.
I am not expecting great results on the treadmill. I used to walk a lot in my life, and I always enjoyed walking briskly, but the days of walking from the Time-Life Building down to Penn Station -- a pretty good cardiovascular workout -- were long gone. By the fall of 2001 my big walks are from parking lot to the liquor store, and I am not even making that pilgrimage as often as I had in my youth.
The cardiologist who picks up my case that day is Dr. Abraham George, director of the medical staff at Capital Health Center who also maintains a private cardiology practice just across the parking lot from the Mercer center.
"Have you ever been on treadmill before?" he asks me before we begin the trek.
"No," I reply.
"Well, don't be nervous," he said. "It's just like the one at the gym."
"No, doctor," I explain. "When I say I've never been on a treadmill, I mean never, not anywhere."
George is unfazed and conducts the rest of the test as if I were old pro on the treadmill. When it's all over he tells me he will review the X-rays and get back to me with the results.
A week passes, then another. I began to figure that this one, like most every other medical test I have ever taken, will prove to be negative -- another false alarm. What was I ever doing, worrying about a little chest discomfort? I will be truly sorry now for wasting the time of Gever and George and all the technicians and nurses who were involved.
On election day, Tuesday, November 6, I have an appointment with Rose Palma, the manager of the HQ shared office center at Forrestal Village. Palma, I realize, is a name I have seen in press releases from the American Heart Association. Michael Palma died of heart failure in April, 2000, at the age of 41, while working out at a gym. His widow, Mary Palma, has become a spokesperson for the American Heart Association's campaign to equip gyms and fitness centers with automatic defibrillators that might make the difference between life and death to someone with serious heart disease. I make a mental note to ask Rose if she is related.
As I close out one issue of U.S. 1 and am racing toward the door to meet Palma at Forrestal Village, I pause to take a phone call. It's Dr. Gever's office. "Mr. Rein. Your stress test has come back positive. You need to see the cardiologist. We have a referral for you to pick up."
Positive? I literally have to remind myself that positive is negative in this case. I head off to my appointment, and I still ask Palma if there is a connection. Yes, Michael Palma is her brother. But I am less enthusiastic about hearing all the details. Where is all this leading?
Within a few days I meet with Dr. George, the cardiologist. George is from the state of Kerala in India. His father was an engineer but his extended family includes several medical doctors. "I just fit into the mold," he says of his decision to become a doctor. "And I had reasonable good grades." He studied at Vellore, the medical school in India, and then came to the United States in 1976, finishing his cardiology training at the University of Louisville, Kentucky.
Gever likes George. "He's a conservative guy and he knows his stuff," the internist says. And he does not rush to judgment. "He's probably a pretty good poker player," Gever adds.
At our follow-up appointment George says he's not hiding any cards, he just can't be sure of what they are. The X-rays from the stress test, he explains, shows a "shadow of doubt" in terms of blood flow. Unfortunately the shadow falls in the one area of the heart where false positives often occur. He too is aware of the low cholesterol, the normal blood pressure, and the lack of family history at an early age.
But we should take no chances, George says. The only way now to get a definitive answer is with an angiogram, the procedure that will send the catheter through the artery and into the heart.
I interject what little I know about coronary heart disease. Wouldn't it be possible to treat something like this with medication or exercise or diet, I wonder aloud. "It would be pointless to speculate," George responds. "We need better information and that's what we will get with the angiogram."
Thinking back to the length of time it took to get an annual physical scheduled, I begin to think that the angiogram might take place in late winter or spring. The scheduler at the cardiology practice gets me on the phone. They can take me in three days. Three days? I explain why that's no good. So let's do it early next week, they suggest. Next week is also impossible. In fact, the entire month of December is no good, because of the demands of the annual U.S. 1 Calendar, which I still desktop publish single-handedly and other year-end duties that make this a very trying time of year for me.
How about early in January, I ask. Okay, is the response, but only if your cardiologist approves. George agrees, but only if I do not experience any further symptoms.
So we pick Tuesday, January 8. That gives me all day Monday to wrap up most of the details for the January 9 issue. I finish up in the office that night at around 11 p.m. I'm asleep shortly after midnight, awake at 5:30, and riding down to Trenton at 6 a.m. thanks to my next-door neighbor. I take nothing with me other than my insurance ID card -- I am expecting to have someone from the office pick me up at 2 p.m. or so. Still, this is a lot of work for a little bit of chest discomfort. What am I doing here, anyway?
In the days before the angiogram I had received all sorts of anecdotal information and well intentioned recommendations from friends and acquaintances. Some nurses at a New Year's Eve party cheerfully told me that I might not even need the procedure and that I should get another opinion -- people die during angiograms.
Another said that the most painful part of the procedure was the five or six hours of pressure that had to be applied to the groin to staunch the bleeding of that femoral artery. But, I was told, doctors had an alternative to the pressure treatment -- it was a plug that could be installed and allow you to be immobile immediately. But you had to insist on it, these knowing nurses told me, doctors make more money prescribing the pressure treatment.
And another friend, himself a veteran of a heart bypass operation, counseled that I have someone with me at the hospital. "You may not be thinking clearly and you will need someone to help weigh all the options."
That friend turns out to be half right. I am not thinking clearly. In fact, as the cath lab crowd offers their congratulations on my relatively early discovery of a problem, I am falling into that black hole of despair. I no longer have a hint of coronary heart disease, I have coronary heart disease. I am being transferred to St. Mary for the "slam dunk," but in the meantime I will wait in the intensive cardiac care unit at Mercer.
Intensive care. The cath lab people explain that that is strictly a procedural technicality -- because they are hoping to do the angioplasty and stent installation later that same day at St. Mary, they will leave the sheath inside the groin so that I will not have to go through the long process of healing one puncture hole and then starting another. But anyone with an open wound in a major artery has to stay in intensive care.
To me it is all the same: After 17 years of working my heart out at this newspaper what I have to show for it now is heart disease. And in recent years, thanks to those divorce proceedings, my business has been picked over by the lawyers and accountants as if it were a Hallmark card shop -- it has so much cash flow, it can be projected to have such and such return over the next eight years, all you have to do is plug in the numbers and clip the coupons. But I know that in comparison to a card shop or lots of other less artistic endeavors, a newspaper -- especially this one -- is driven by the heart and soul of its founding editor and publisher. And at this moment the heart is lying damaged in an intensive care unit in Trenton.
Despair is not an uncommon visitor to the cardiac care wards. When my father came up for air after his quadruple bypass, he said enough was enough -- and promptly began pulling wires from his body in preparation for an escape. He was restrained, of course, and now those dark days are a distant memory.
Arnold Ropeik, the longtime columnist for the Trenton Times, wrote a column on May 24, reflecting on his recent bypass operation: "The second day into recovery, my mind, weathered slightly by 80-some years and having fought off the enemies of anxiety before, let me down slightly and I could see all kinds of patterns and figures and lines and flashes and dashes and mishes and mashees and snakes and dark roads and sinister faces. I felt people were hovering over me to do me ill. I had my own list of terrorists to deal with."
Even after getting home, Ropeik reported, "I don't feel a part of the scene yet. . . I am so very tired now. . . This is wintertime, lifewise, anyway. This is my life."
My life is passing before me in the cardiac intensive care ward. I cannot answer a simple question without choking up. A nurse named Elena visits with me and literally just holds my hand. Two of her children are boys about the same ages as mine -- talk about our boys is about all I can manage.
So much for thinking clearly. But as for options, there are none presented, and I am in no mood to discuss them if there were. The only course of action is to go immediately to the medical center in Middletown, just outside Newtown. St. Mary has not one but two open heart surgery suites -- and the doctors won't do an angioplasty unless a surgery suite is open, just in case.
Twice the ambulance ride to St. Mary is postponed. Elsewhere in the intensive care unit another patient is having a heart attack. Alarms sound. From my prone position I catch glimpses of nurses and doctors scrambling in response. That patient gets moved ahead of me and into the ambulance. Finally, after about six hours of lying flat on my back I am carted off to Pennsylvania.
I am reminded that whatever else happens, I should not attempt to sit up or move my leg. That six-inch sheath is still nestled in my right femoral artery -- a potential lethal weapon if it gets moved out of place. In the ambulance I'm strapped in tight on the stretcher. After 20 minutes or so we are parked at St. Mary, and I am moved to the asphalt. As the crew closes the doors on the ambulance, the unattended stretcher begins rolling down a slight grade. I look to my right and see a car heading toward my path. "That's it," my depressed brain announces matter-of-factly. "I've got coronary heart disease but it doesn't matter because I'm going to die right here -- hit by an f-ing car."
At that point one of the crew reaches out and casually grabs the rolling stretcher.
St. Mary turns out to be just what the doctor ordered, even though the promise of a same day angioplasty falls through. Finally settled into a room (still unable to move from my flat-on-my-back position), I am told that this has been a very busy day in the cardiac unit. At the moment not one but two catheterizations apparently have gone awry -- both patients are now undergoing open heart surgery. Since I am at rock bottom emotionally, this news does not bother me. After all, I had just looked death in the eye in the parking lot.
At around 6 p.m. the doctor who will do the angioplasty and stent installation shows up in the room. Dr. David Drucker is young (37, I later find out) and enthusiastic and straightforward. He explains the reason for the delay -- the two simultaneous catheterization emergencies that have tied up both open heart surgery suites. While my procedure doesn't have any chance of reaching that level (I recall the "slam dunk" analogy from the morning), Drucker explains that he just won't do it without an operating room available. "It's the safety net," he explains. "But you are first on the list for the morning."
At that point I expect Drucker to bolt out to see another patient, but he surprises me by hanging around and talking more about the big picture of CHD. While my procedure may be a slam dunk, he says, in effect, I should nevertheless now realize that I am at high risk for another arterial blockage, possibly leading to a heart attack or stroke. The good news is that some of the factors contributing to the disease are matters of choice: Smoking, consuming the all-American diet, and enduring the stress of modern life.
I am impressed by Drucker's bedside manner -- a combination of youthful enthusiasm and cautionary wisdom. Later I discover that Drucker determined that he would go into medicine when he was just 13 years old and experiencing the medical system as it treated his father during a prolonged battle with terminal cancer. "I was an angry 13-year-old," he says, unfavorably impressed with the communication skills of some of the physicians on his father's case. "My feeling was that I could do things better."
Drucker's path took him from Duke to Washington University in St. Louis for medical school to a residency in cardiology at Yale to the University of Chicago. He is now considered a cardiovascular specialist. "I use catheters to fix everything," he says, "coronary arteries to arteries in the neck, the legs, and the kidneys." He has been doing catheterizations for the last five years, and does anywhere from 500 to 1,000 in a year. When he finds out I am an editor, he lights up. "I worked your counterpart at the Trenton Times, Arnie Ropeik." Sure enough, a column by Ropeik describing some stent work performed by Drucker is on the bulletin board in the hospital hallway.
I am now looking forward to a new day.
Just like the morning before in Trenton, the sheath and catheter are somehow inserted into my groin without so much as a pin-prick of pain. I expect this procedure to be a little more complicated than the day before and I am looking at the monitors above to see if I can observe the procedure, if I can see what happens when that catheter roots into that blockage. After 10 minutes or so I haven't seen a thing, and I think about asking Drucker where we stand. That's when he announces cheerfully that we are finished. Finished!
Later I get a copy of his report:
"This is a middle-aged male with chest pain and a positive stress test. Cardiac catheterization done at an outside hospital revealed a critical LAD lesion. He is now referred for angioplasty.
"After informed consent was obtained, the patient was brought to the cardiac catheterization laboratory and a A#7 French short sheath was placed into the right femoral artery. ReoPro therapy, as well as heparin therapy, was given, and a #7 French JL4 guiding catheter from Cordis was used to engage the left main coronary ostium.
"Diagnostic catheter revealed a 99 percent mid-LAD lesion, and angioplasty was performed. The lesion was crossed with a BMW wire hydrocoated wire, and a 3.5 x 18 Penta stent was inflated to 10 atmospheres. The final results showed the LAD lesion to go from 99-0 percent. There were no complications. The sheaths were removed at the end of the case."
But for the last sentence, the report might have taken almost as long to write as it did to actually do the procedure. Removing that sheath, however, is another matter. Two or more nurses participate in the procedure, which involves removing the six-inch plastic guide and then immediately clamping down on the hole in the artery so that it gradually knits itself back together. Until recently they loaded sandbags on your groin for four or five hours. Now at St. Mary they used a plastic collar that goes around your waist, with a clamp that presses a device the size of a baseball onto the exact point of entry. Now you feel a little pain.
The nurses turn up the screws on you, so to speak, and check your foot to make sure that a little blood is getting through. For the next four or five hours you lie very still and are watched very carefully. Finally the collar is removed, but you are still not allowed to move. After another hour or so you can move the left leg. After another hour you can move the right one. Finally you can get up. While I am lying flat I do some calculations: My first sheath went in at around 8 a.m. Tuesday. It was pulled at 7 p.m. The pulling process was complete at around 4 a.m. I received my second sheath at around 7 a.m. Wednesday. By the time I am able to get up and walk around it is 8 p.m. That's 36 hours, 33 of which have been lying flat on my back.
It's not pretty, but it's educational. I watch and listen as other heart patients are admitted. In the interview the first question is not about diet or stress or cholesterol. It's always about smoking. One man, returning to the bed next to me after a successful angioplasty, tells the woman taking his history that, yes, he does smoke, but only one in the morning with his coffee, another after he mows the lawn or works outside, and perhaps one or two more after dinner.
She interrupts this elaborate answer. "It really doesn't matter how many or how few you smoke," she tells him. "Because starting now we don't want you to smoke any. Not even one."
When my checkout time finally arrives late on Thursday morning, the discharge instructions are to go on a low-fat, low-cholesterol, low-sodium diet; to begin an exercise program -- walking is the one that is mentioned; and take a combination of drugs and get my blood tested for two things I had never heard of until then: lipoprotein (a) and homocystein.
Just being overweight puts you at risk for heart disease, but no one had ever accused me of being overweight. Still, over the years my weight had gradually moved upward and most of that weight seemed to be in the form of a beer belly, which also turns out to be an indicator for possible heart trouble.
I had already cut back on my beer consumption. Several years ago I stopped stocking the beverage in the office refrigerator, a substantial change given that I have been known to spend 16 or 17 hours a day there, several days in a row. Then, on September 10, 2001, Dr. Geever and I discussed my lifestyle and he recommended cutting back even more. Good idea, I thought to myself, I will make it my New Year's resolution this year. For sure. The next day, one of the most painful 18-hour days in my life, I got home around midnight to watch a replay of the Twin Towers disintegrating. I immediately decided to stop drinking my favorite beverage at home, as well -- a small tribute to the thousands lost that day, including the husband of U.S. 1's Brenda Fallon.
It turned out to be no great sacrifice. So now after a long day at work, I would come home and unwind with a liter of club soda. I still would have a drink or two when I was out socially, but that would happen once every couple of weeks, certainly not once a day with my schedule. I sat back and waited for the pounds to evaporate. Needless to say they never did. After years of privately scoffing at people who were trying to lose weight but claimed it was difficult, I changed my mind.
Now this medically prescribed diet, I think, will be no more difficult than cutting back on beer. I am already eating mostly pasta and chicken rather than red meat and buttered potatoes. My boys and I actually eat broccoli (steamed, with no butter) and carrots (raw). I drink my coffee black and for the past decade, at least, I eat toast with no butter. I hardly consume any milk at all and I usually skip dessert. For as long as I can remember I have never added any salt to anything.
Still I go to one of those diet websites and check out the inverted food pyramid -- the one that tells you to chow down on carbohydrates at every opportunity. I'm surprised to find dairy products near the foundation of the pyramid. What's more, the recommendation is that people in their 50s consume more dairy than younger people.
I start eating non-fat yogurt and sour cream, and I start reading those nutrition labels on food packages. I look for zero grams of fat, cholesterol, and sodium. The carrots and broccoli are supplemented by tomatoes and squash and onions. The chicken breasts give way to low-fat cuts of turkey and fish. Fish -- I hate fish. But suddenly it becomes pretty tasty.
Less than a month after the angioplasty a good-hearted friend invites this somewhat weak-hearted editor to join her at a charity ball. I try on the tuxedo that I haven't worn in nearly 10 years -- amazingly I can now squeeze into it. Progress. And getting out with adults and talking about something other than my medical problems is icing on the cake (which I don't eat anymore).
With the exercise program prescribed in the discharge papers, I immediately think about walking -- about the only form of exercise I have ever engaged in since high school soccer and cross country. Dr. George offers some simple advice: Don't start with 30 minutes, start with 10 minutes. And build up in five-minute increments. George recommends that I not just saunter around the block but that I move fast enough to cover 2 miles in 30 minutes -- that's the common pace that the experts say will raise your heart beat enough to promote cardiovascular fitness.
Just to make the program interesting I go for 2.5 miles in 30 minutes -- that's five miles an hour and enough to get me breathing pretty hard. I devise a few walking courses. From work I stroll up Roszel Road to the Carnegie Center, through the greenway to the 500 cluster of buildings, the one with the clock tower, around the new pavilion there, and then back, with an extra turn in our parking lot to help fill it out to 2.5 miles.
My in-town course begins on Nassau Street at Sovereign Bank. I head up Nassau Street to Bayard Lane and eventually back to Wiggins and up the Linden Lane hill and back to my starting point. Brenda Fallon loans me the Polar heart rate monitor that her husband, Bill, had used for his marathon training. Using the standard chart I set my target rate: 220 minus age (55 in my case) equals maximum heart rate (165). Then, for a moderate intensity workout, the desired heart rate should be 140 to 150 beats per minute.
For most of my in-town walk I stay in the range. Up the Linden Lane hill, however, the alarm starts sounding -- it's a minute or so of heavy breathing in the 150s. I refer to it as "Heartbreak Hill."
As a newbie exerciser I get some good advice from veterans:
Forget the old high school notion of "no pain, no gain." At my age, if you hurt you should back off or at least ease up. One day my toe starts hurting. I skip two days until it's better.
Get good running shoes -- New Balance 991s are the answer for me.
On either of these courses, before I get to the two-mile mark I am sweating like a pig. Sure enough the pounds are also dripping away. Maybe weight loss is a lot harder than it seems, but -- like other things in life -- it might also take more effort than we at first assume. My 160 gives way to my old high school weight, 154, and then 150.
People wonder if I am eating right. I check the scale again and it's in the 140s. I can't believe it when the scale registers just 139 -- that's 21 pounds in 20 weeks. The only place where I still have a little fat left is in that belly -- serious dieters probably could have told me it would be the last thing to go.
One day I am reading the latest edition of the Joy of Cooking cookbook. The editor notes the new public fascination with "heart-healthy" diets and the conclusion by some fanatics that they should ban fat entirely from their menus. I go home and cook a chicken on the grill. In the meantime I begin doing push-ups -- to see if I have any muscle left to develop. The first day I manage 13. But after a few weeks I am up to 25. My weight edges back into the 140s.
From the day of the angioplasty the prescription is for one adult aspirin a day (325 milligrams of the wonder drug that actually thins your blood); 75 mg of Plavix (an anti-coagulant to reduce the chances of the blockage resuming in the area of the stent -- something that happens within a few months in about 20 percent of the cases); and 5 mg of Zocor (an anti-cholesterol drug). Dr. Charles Paraboschi, another Mercer Bucks Cardiology physician, visits with me just before I leave the hospital and explains that -- while my cholesterol is low -- people generally do better if they can make it even lower yet.
But he wants some blood tests done for lipoprotein (a) and homocystein. "Maybe there is something going on that we don't know about," he says.
Sure enough, after the typical long wait for blood to be drawn at LabCorp on Whitehorse-Mercerville Road in Hamilton Township, results come back: My "lipoprotein little a" is at 30. A desirable level is less than 20; 20 to 30 is borderline high risk, and 31 to 50 is high risk. The bad news is that dietary changes alone won't decrease lipoprotein (a) levels. Dr. George orders me to take a 650 mg tablet of no-flush niacin every day -- niacin is the only thing known to reduce it.
In March, after about a month of niacin, I have my blood tested again. My lipoprotein (a) has jumped up to 36 -- very high risk. Since niacin and Zocor are both unfriendly to the liver, and since my total cholesterol level is now down to 116, George cuts back the Zocor to 5 mg every three days. He ratchets up the niacin to two tablets a day and then -- after I show no immediate side effects -- to three tablets a day. My next blood work is in July. The second number I will look at is cholesterol, the first is lipoprotein (a).
Now I wonder: For years I have lived with the false security of a low cholesterol reading. Why didn't any physician bother to look at the lipoprotein (a). I catch up with Harold Gever, who by now has left the frantic pace of his private practice and taken a position with the Veterans Administration hospital network. Lipoprotein (a) is not nearly as good a predictor of coronary heart disease as cholesterol, Gever replies. By widely testing for it "you could alarm people unnecessarily," he says.
"The story with you is that you have now demonstrated that you can clog up your arteries. Now maybe the absolute numbers are irrelevant -- the important thing is to keep all the numbers as low as possible."
So the diet continues, as do the aspirin, Plavix, niacin, and Zocor. The Heart Association sends out a news release extolling the virtues of high dietary folate, found in citrus fruits, tomatoes, and leafy green vegetables such as spinach and romaine lettuce. Drucker recommends it, and he notes that there are no known adverse side effects. My boys are soon going to be reminded of Popeye and his spinach.
The day after I come home from the hospital I get someone to drive me out to the office. It's payday plus one and I have to do the checks, sign them, and get them out to understandably eager people.
As I am doing the checks I begin to feel that same strange discomfort -- the slight pressure in the chest. So what's going on now? I call Dr. George and report these symptoms. Is it possible that this artery or some other one has clogged up again in two days' time. "Nothing is impossible in medicine," he answers, "but in your case it's highly unlikely." More likely I have plain and simple heartburn.
George prescribes one more medicine: A tablet of Prevacid once a day to combat heartburn. Within a few weeks the heartburn feeling vanishes. That's important, George says, to help me identify true chest discomfort that could be an indicator of heart-related problems.
Probably like a lot of other people who have had physicians poking around inside their heart, I begin to notice some strange feelings emanating from my body. The trouble is I can't tell whether they are new strange feelings or feelings that I had all along but was too busy to notice. Among them: My fingers suddenly go numb on me. One unseasonably cool spring morning I arrive at work and all 10 fingers go numb for 20 minutes or so. I go out on my walk and hit my mark: Good news, I figure.
On some other occasions, particularly after long hours at the desktop publishing console, my left arm feels weak. I check with George, who notes that I passed my follow-up stress test and that with my medications another blockage is unlikely. Maybe it's neurological, he says. I go to the internist, Gever's former partner Sheryl Haber-Kuo, for a referral but she suggests that we wait a while to see if it gets worse. She too thinks my body probably is not announcing a stroke or heart attack -- at least not at this time. "Maybe," she says, "it's stress."
Stress. I've done the diet, I am doing the exercise, I am taking the pills. And I have taken a few steps to reduce stress: For the first time ever the print date for U.S. 1's annual business directory this spring was pushed back a week, then another week. I just couldn't crank out 304 extra pages as smoothly as I used to. The extra person hired to help out during the directory crunch this year got hired to help out year-around.
But I am still hard-pressed to get out of this office. When I do I am still tapping back into the office network via my modem at home. One full day off a week does not always happen. I haven't taken an entire week off since around 1997.
This year I resolve to make some more changes, and not wait until New Year's to do it. Maybe stressed out people are no more likely to clog their arteries than totally relaxed souls. Maybe not. But in either case, if I am experiencing chronic, persistent stress while working in an ergonomically-challenging environment, how do I know if the pain in the arm or the numbness in the fingers is caused by those external workplace hazards or by some newly clogged artery? If the Prevacid is needed for heartburn then surely some rest and time off are needed as an antidote to stress.
It's another Tuesday morning, June 18, 2002. This time I am not lying in the cath lab. I'm strapped to that desktop publishing workstation, cranking out the last of 116 pages that have gone to the printer in the last 24 hours.
What am I doing here?