AFFAIRS OF THE HEART

I haven't blogged for awhile. I had a reason. It's not that I haven't had adventures to write about. Matter of fact, I've recently been on one of the biggest, scariest adventures of my life.

Eight weeks ago, I suffered a heart attack. Believe me, when I called my ‘medical power of attorney’ and told her she might be needed we were both REALLY surprised. I’m only 62. I consider myself an ‘active’ senior. I hike regularly, backpack when I can, have been practicing yoga for years, and cycle in the annual El Tour de Tucson road race. I rarely eat packaged foods and really love my fruit and veggies. How could this possibly be a heart attack? The hardest call I had to make was to my 26-year-old son who would shortly be leaving Tucson for seminary in Washington DC.

I’ve always prided myself on my rather intimate relationship with my body. I can scan my body in the morning and know just what yoga poses would help me limber up in preparation for the day. I have a good sense why a particular muscle hurts or exactly which muscles I need to keep in shape to keep those torn ligaments from hurting so much. I’ve exercised or yoga’d my way out of chronic back and shoulder injury. I opt for physical therapy instead of pain relievers. By god, I am active. But I soon realized I had no such relationship with my heart. I'd always taken it for granted.

Now I am living with a history of ‘heart disease’. I’m eight weeks out now and have just recently got the diagnosis. In my case, the diagnosis is really important because I don’t ‘fit’ the demographics or the common medical signs for people living with heart disease. And I didn’t have to be shown how to properly perform a squat the first day in cardiac rehab. I already can do a pretty decent standing row. I could easily plank for 30 seconds and immediately pushed it up to 60 seconds while most of the newbies to rehab were being taught how to sit in a chair safely without crashing over.  And all along, my EEG’s have been showing nice even little mountains and absolutely no valleys. Zero heart disease, especially of the common clogged artery type – at least until the heart attack.

I've thought a lot about whether I would publicly give any details but since the diagnosis is kind of an equal opportunity diagnosis I thought it might be helpful for the people I hang with and other family members and friends who are generally also healthy and some quite fit. My diagnosis is exertion- or exercise-induced hypertension. Great. A diagnosis that is just becoming more common and is still not well understood. Just like me to wind up with something a little out of the ordinary and susceptible to 'trial and error' treatment.

Generally, when exercising or climbing mountains or hiking up and down with 30 pounds on your back, your body sends signals to the heart to relax its arterial walls in order to accommodate an increased need for oxygen which is delivered by blood volume going up. For some reason, my heart no longer can respond to this signal so when I reach a certain level of exertion (IMHO not a very high one at that), my blood pressure literally spikes through acceptable pressure limits. So it's kind of like a big flood coming through a small culvert. Something's got to give.

This type of hypertension can be treated somewhat with ordinary heart drugs prescribed to a person with hypertension caused by more normal reasons but ultimately ‘treatment’ is about finding a 'new normal' for exertion - one which will not cause the culvert to burst. This entails a lot of exercise and exertion under very controlled circumstances in cardiac rehab to help the patient better ‘read’ his or her heart’s signals that things are about ready to blow.

In the meantime, I'm working VERY hard on becoming fitter than I've been since my 20s and 30s in the hopes that this, too, will help. It's unknown and perhaps unlikely whether this will have much of an effect but it certainly can't hurt, especially since I am constantly monitoring my blood pressure as I exercise to determine where the heck my 'new normal' is.

So if you are healthy and like high exertion sports that may go on for fairly long periods of time (running, backpacking, hiking, cross country skiing, cycling, etc.) and begin to experience shortness of breath, redness in your face, pain in your chest, or angina that does not go away during or after periods of high exertion that you think is ridiculously out of sync with your overall condition, please visit your doctor and get a stress test.

It's amazingly apparent once you know what to look for. Your blood pressure will be going up as to be expected during exertion then BOOM it hits pressures over 200. You do not have to have super high cholesterol levels or resting blood pressures for this to happen. Pay attention please. Don't wait like I did until a heart attack brought this problem to my attention. By the way, doctors might miss it if you don't press them on this issue. I was in urgent care with what I thought was some pretty serious angina but because my bloods were acceptable and I have a history of activity, I was sent home. That night I had the first serious heart attack. Three days later I had my second heart attack in the emergency room of the hospital.

Recovery takes time and patience (yup, I'm also not good about patience). Depression often accompanies a heart attack. I experienced a little of that at the beginning but then I realized my addiction to the endorphins I was not getting sitting on my ass on the couch for a week was likely to be one reason for my ‘blues’. I negotiated a different get-well regime with my primary care doctor (she says every appointment is a ‘negotiation’ with me) and then I got up and went for a walk along the Rillito. I bought a Fitbit to shame me into getting up and moving the days I am not hiking or in cardiac rehab. I am not yet confident I will be able to backpack down and back up into the Grand Canyon but I am working my heart out to get there. I promise you - I'll see you down the trail.