WHY WAIT?

"I think there's something wrong with me. In case I don't get back in time, you'd better stay here and take Owen to camp."

I said something like this to my husband around 8:30 a.m. on a Sunday morning, after I'd spent the whole night awake, whimpering in pain and popping Advil four at a time. Once I finally told him how I was feeling and we decided I had "better get checked out," I didn't call 911 or rush to the ER.

Nope. I ate breakfast, helped pack for camp, took a shower, styled my hair, supervised a pre-schooler potty break, and put on makeup. For my date. With a heart attack.

Why do people who suspect they are sick or in danger delay seeking help to attend to family, work, pets, or in my case, my hair? That is the question that a group of researchers at Yale University are trying to answer through the Yale Heart Study.

I took the study myself about a month ago. Funded by the National Institutes of Health, it is a simple online survey designed to understand why people wait, on average, four hours to go to the hospital when having heart attack symptoms. If you are a member of the heart disease awareness community (I am now, of course, card-carrying), you know that "time is muscle." Every minute counts.

The problem is, heart attacks can be sneaky, particularly in women, and it is not unusual for people to mistake heart attack symptoms for indigestion, heartburn (my excuse of choice), anxiety disorders, fatigue, or asthma. Add to that our tendency to put everything and everyone else first.

Here's how the study's primary investigator, Dr. Angelo A. Alonzo, describes it:

We are so embedded and invested in our daily lives that we are very, very reluctant to just drop everything and seek medical care. We have to be certain it is a real problem, we have to finish the task at hand, we need to make arrangements if we are hospitalized, we have to cancel appointments, our work activities are important to our identity, and we are too strongly tied to our social obligations to just leave them. . . only when the signs and symptoms become so overwhelming do we willingly go.

This is indeed exactly what happened to me, and the denial didn't stop in the parking ramp (yes, I drove myself). I called home to make sure rain gear was packed for camp. I called again from the ICU to give instructions on what to pack for my younger son's trip to my brother's house while I was in the hospital. I emailed work colleagues after my first surgery. It took nearly 24 hours in the hospital before I gave in and let go.

The idea behind the study is to understand why individuals like me make the decisions they do. With this knowledge, an effective intervention strategy can be devised to get people to the hospital faster. Says Dr. Alonzo: "The irony is that one gets the most therapeutic benefit if one is in the hospital within the first hour of acute symptoms onset."

The study has reached about 15 percent of its goal of 2,300 participants. They are seeking survivors of all ages, men and women, willing to share their experiences to help others. It takes about 30 minutes to an hour to complete (you can save and return to the survey if you are short on time). It is also completely anonymous.

If you or someone you know has had a heart attack, please encourage them to take the study. It may save someone else time and muscle, or quite possibly, their life.

For more information, visit https://heartstudy.yale.edu/hacs/ or email heart.study@yale.edu.

CLOSE TO MY HEART

Owen, two weeks old, 2001

There is nothing like watching helplessly while your child is in danger or pain. Compared to that, my heart attack was a breeze. Any mom knows what I mean: My kids? Never. Oh, just me? Bring it on.

My oldest son was born nine weeks premature as a result of HELLP syndrome, a very rare but serious complication of pregnancy for which there is no treatment. Baby must be born or both baby and mother will die. But all we knew then was that I was sick and Owen was going to be born. Right now. 
All 1 pound 13 ounces of him.

Owen on his 10th birthday, 2011

During those eight weeks in the NICU, we entered a universe we didn't even know existed, where you live and breathe and sleep by the monitors, your baby's weight, and your favorite nurse. You learn never to miss rounds; your baby's life depends on it. You buy clothes impossibly too large because it is comforting somehow. You stay at the hospital until midnight, then wake at 2 a.m. and then again at 4 a.m. to call the unit to see how he's doing. You feel completely alone as the world swirls by without you. Without him. And seemingly without end.

But we weren't alone, and more mothers and fathers and babies enter that parallel universe every day. Each year, more than half a million babies in the United States are born prematurely, an increase of 36 percent over the last 25 years. Today, 1 in 8 American babies are born too soon.

November is Prematurity Awareness Month, and today is the first-ever World Prematurity Day, observed by the March of Dimes along with organizations in Africa, Europe, and Australia. (Worldwide, an estimated 13 million babies are born preterm.) Follow these links to find out more about the March of Dimes' prematurity campaign and World Prematurity Day and how you can help. Then please pass it on. It's a cause close to my heart.

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.

JENNY

If you are one of the millions like me named Jennifer, you know the Jenny song. You know, "Jenny, I got your number. I'm gonna make you mine. Jenny, don't change your number . . . 867-5309 ee i en." That one.

(Once at a work/social event for my husband, the band asked if anyone was named Jenny. To my mortification, Scott's hand shot up as he shouted "My wife!!" And that's how I ended up on stage in front of all his co-workers and bosses and a bunch of strangers. Not cool.)

But this is pretty cool. Plenty campy, but nonetheless fun. "Jenny please know your numbers, blood pressure, lipids, and BMI ee i ee." I had to share it.



Mayo Clinic is using this video to promote its free Facebook app that makes it easy to know your numbers and your potential. Check it out.

Love,
Jen(ny)

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.

START TODAY

Did you know today is National Start Eating Healthy Day? I didn't either, but thankfully not too much of the day has passed and I didn't eat unhealthy yet. Phew.

But seriously, in honor of today - a campaign of the American Heart Association - here are some eating healthy resources I like.

• "25 Ridiculously Healthy Foods" - featuring lots of my favorites and some I've never had before, like guava. Was sad not to see pumpkin on this list, but maybe it's time for a new obsession.
•  "Superfoods Everyone Needs" - from another favorite site, WebMD. (WebMD has also helped me when I freak out about drug interactions and the dozen pills I take a day.)
• Allrecipes.com - this is not a diet/health focused site, but it is my go-to site when I have an ingredient I know I should use, like kale, tofu, or salmon, and I'm looking for inspiration. Read the reviews for modification suggestions and then use the recipe as a guide. I've found many favorites, new and old, here.
• "The World's Healthiest Foods" - a website with exhaustive information about the nutritional benefits of foods, down to the most obscure micronutrient you've never heard of. Just search "Nutritional benefits of . . . "

I hope you are inspired to start eat healthy today and keep it that way. Eating right is one of the best ways to prevent heart disease, and take it from me, you really do want to prevent it. Once you have it, you always will.