So who is going to be the next Tim Russert? Will it be Chris Matthews, the hard throwing host of “Hard Ball” on MSNBC cable television? Or maybe Andrea Mitchell, a Washington insider (Alan Greenspan’s wife) who has been getting lots of air time lately covering the presidential primaries. Or how about Chris Wallace, another insider (Mike’s son) and the host of the Fox News Network’s imitation of NBC’s “Meet the Press.”
Or me? I could easily follow in Russert’s footsteps — I’m more than qualified. Or perhaps you? No way, you say. But you never know.
The next Tim Russert I’m talking about is not the person who will sit in his chair as moderator of “Meet the Press.” The next Tim Russert of this discussion is the next one of us who will keel over at our desk from a heart attack. It could be any of us — sudden cardiac arrest kills more than 300,000 Americans a year, more than breast cancer, lung cancer, AIDS, and stroke combined. And while men seem to be the high profile cases, the American Heart Association states that heart disease is the No. 1 killer of women. Sorry, Andrea.
We now know Russert had a history of coronary artery concerns. His doctor, Michael A. Newman, said that the 58-year-old commentator had been diagnosed with asymptomatic coronary artery disease, which was being controlled with medication and exercise, as opposed to more aggressive intervention such as angioplasty and installation of a stent. That treatment protocol reflected the results of a study released about year ago, the aptly named COURAGE study.
So in the past Russert may have felt some symptoms that led to this treatment. Wouldn’t it be nice if we could have pulled him aside and said, “Hey Tim, are you sure you aren’t feeling some additional symptoms these days? How are you doing in your exercise program? Are you getting tired quicker than usual?” If so we could have ordered up the most definitive study of Russert’s arteries: the invasive but very revealing angiogram. If the physician spotted a blockage, he could clear it out with a stent. The show would go on.
But it’s not that easy. In the first place just a small buildup of plaque in an artery can break off and trigger a coronary thrombosis, causing the heart to fall out of rhythm with virtually no warning. Russert may have had this.
But even arteries that are almost totally blocked can give off many different telltales, or none at all.
I have documented my own case in this space before (U.S. 1, June 19, 2002), but it’s worth summarizing. Seven years ago I was in the middle of a divorce trial and being grilled by the opposing attorney. His questions were so leading that I had resolved to make every answer begin by disagreeing with the guy’s basic premise. When he asked “So you’re in perfect health, aren’t you Mr. Rein?,” obviously a set up for something, my immediate response was “No, I don’t know that I am in good health.”
The lawyer immediately changed the subject, but I began thinking: I hadn’t had a physical in two or three years, and it might be a good time to have one now. I saw a doctor on September 10, 2001, and when he asked if I had any health complaints I couldn’t think of any, except an occasional episode of heartburn — hardly worth mentioning. If the appointment had been one day later, with people dying at the World Trade Center and the Pentagon, I certainly would not have mentioned it.
The doctor had a different opinion. Even though I had great cholesterol numbers, low blood pressure, and didn’t smoke, I still had a family history of heart disease. He prescribed a nuclear stress test, which revealed “a shadow of a doubt” in one area, which in turn led to an angiogram and the discovery of a 90 percent blockage of my left anterior descending artery — the LAD or “widow maker.”
After the installation of a stent, I began to exercise, switched to a low-fat diet, and began a regimen of Plavix (the anti-coagulant) and aspirin to thin the blood. I lost 15 pounds in about six weeks — most of it from my waistline.
A year later I had some of the classic symptoms of heart trouble, including sharp pains down my left arm. I went for another angiogram — not a problem in sight. But two years or so after that I began to feel that slight heartburn again. This time they found another major blockage in the LAD and inserted another stent.
Then last year the heartburn came up again, subtle as always. The angiogram revealed a 50 percent blockage. But this time the physicians did nothing. Why not? Partly because there’s a certain risk involved with inserting a stent, and there’s another risk that the stent itself might block up. Like Russert’s doctor, my doctor cited that COURAGE study, which has shown that treatment of some blockages with drugs, diet, and exercise can be as effective as stents.
A year after that angiogram I met again with my cardiologist, Charles Paraboschi of Penn Cardiac Care. “How are you doing?” he asked. “How should I know?” For the past year I have been walking around with a 50 percent blockage, which was indicated by only the subtlest of symptoms. I quote Joe Paterno, the football coach: At any practice a team can get a little better or a little worse. If you can’t tell the difference then you are probably getting worse.
Paraboschi wouldn’t buy Paterno as a medical expert. In fact, he said, it’s a mistake to think that blockages are linear events, progressing inexorably from 50 percent to 90 percent to . . . you know what. The good news is that some 50 percent blockages can go in the other direction, helped in part by high levels of the “good” cholesterol. The bad news, though, is that some other partial blockage, even in some other artery, could suddenly become a major blockage.
The advice: stick with the medicine, the diet, and the exercise. If those subtle heartburn symptoms last longer or feel more pronounced, or if you can’t get through that exercise routine, raise your hand for help.
The Tuesday before Tim Russert died, on a night when I had to stay on the job until 10 p.m. to cover a high school awards ceremony, I didn’t do my exercise. The next night I had another late night assignment, followed by a 5 a.m. wake-up call. I skipped the exercise again. Thursday night I decided to get a few extra hours of sleep.
On Friday, I felt a twinge of heartburn. I decided to get back on that exercise wagon. I did OK Friday night. I improved to my average on Saturday (just under 5 miles an hour for a half hour on an elliptical), and then I exceeded that on both Sunday and Monday, all with no further heartburn. For the time being, I decided, it was not the time to call for medical intervention.
We don’t know if Tim Russert was following his exercise program in the weeks preceding his death. (But if I thought a high school awards program was a good excuse not to exercise, I can only imagine how he might have felt about in impending interview with a presidential candidate.) We don’t really know if such an exercise program would have alerted him to the trouble that was lurking. And we certainly don’t know who will be the next Tim Russert. In this game you never do know.