My Starving Heart

675 miles (thanks, Brooks)

2012-03-25T21:29:00.002-04:00

This is what 675 miles over 8 months looks like.

That isn't how far I ran, because sometimes I ran in the other pair of Brook Adrenaline GTS 11s I have, or a pair of light blue Vibram FiveFingers, or, of late, a pair of Saucony Kinvara 3s (which I am quite enjoying, by the way). But these shoes saw 675 miles.

I don't really think I need to get rid of them, they seem to run OK still, but mentally it's time for them to go. I can't really say why, it just is.

The matching pair will become my longer-distance shoes. The Kinvaras will be my shorter-distance shoes, and the Vibrams will remain my treadmill shoes. And these will go to the donation bin.

When I took that photo, I sort of thought I'd see more in it. 675 miles is a long way. They ran in the hot heat of August in Ann Arbor. They ran in the moderate winter we had, through a little bit of snow and ice, but not too much. They ran through a warm and muddy spring. They ran with Tim and Reed and Matt and Michelle and Maggie and, once, Kelley. Mostly they ran by themselves. They never tripped, they only led me nearly into a car once. They followed along with the rhythm of Daft Punk and Girl Talk, Kevin Rudolph and Eminem, Bon Iver and Mumford and Sons and MGMT. They finished one race (the Ann Arbor Turkey Trot). Most importantly, they kept me injury-free for all 8 months.

For me, 675 miles is about 54,000 calories, or about 277 bottles of a decent I.P.A. For that, they more than earned their keep.

Thanks, Red Brooks Outside.

p.s. Yeah, this isn't strictly a Starving Heart blog post, but is sort of is. After all, doing this to a pair of shoes as part of running over 1,000 miles in 8 months is heart healthy, or so they say.

two year stent-iversary!

2011-12-28T08:33:00.000-05:00

It's been two years since my stent was placed. Only 35 more years to go (although no one seems to know or want to say what the mortality is for a 38 year old with a stent). What will I be doing for the next 35 years? If the last two years are any indication, I'll be doing a lot of running:

In the past two years, I've run the Ann Arbor Turkey Trot 5k twice (2010: 23:09, 2011: 22:46), the Big House, Big Heart 10k twice (2010: 47:41, 2011: 44:10) and the Dexter-Ann Arbor Half-Marathon (2011: 1:51:40). I've run over 1,700 miles (2010: 655 miles, 2011: 1050 miles), burned over 200,000 calories, and lost 35 pounds.

Why would anyone do that?

I've seen my daughter's 3rd and 4th birthdays, three Christmases, her swimming, tennis, and soccer lessons, and spent millions of valuable minutes with her.

I've celebrated my 12th and 13th wedding anniversaries with my wife, and travelled with her to Japan and Croatia and Las Vegas, NV, Marquette and Petoskey, MI and spent millions of valuable minutes with her.

I've spent countless hours with friends, most of them were either running or drinking or with cameras in our hands. I've turned two of them into runners (and they've lost a combined 100 pounds) and helped return one to running, so the health effects spread.

That's why someone might run 1,700 miles.

Happy second stent-iversary to me, happy second stent-iversary to me, happy second stent-iversary to me, happy second stent-iversary to me.

And thanks for all the help - you know who you are.

a year and a half

2011-06-28T08:31:00.002-04:00

A year and a half, yay!

My RunKeeper Log

2010-12-31T16:23:00.002-05:00

My RunKeeper Log
Originally uploaded by Andrew Caird

I'm not saying that moving 700 miles in one year (mostly running, some biking, walking, and hiking) will keep you alive after a stent, but other people claim it helps. Who knows. In any case, 700 miles between the end of March and the end of December isn't bad.

The sad part is that 74,642 calories is only about 15 Anthony's Pizzas, or one piece every three days. Which is far, far less than I would like to eat.

On the other hand, it is 487 bottles of beer, which is more than one a day. That has its appeal.

Thanks RunKeeper!

one year

2010-12-29T10:33:00.001-05:00

hey, I lived a year. yay for me!

Thanks, everyone. :)

50,000 calories

2010-08-28T10:12:00.002-04:00

50,000 calories
Originally uploaded by Andrew Caird

aka:The Data Driven Life

I'm sure there is some psychological insight to be drawn about my desire to look at the numbers. And my desire to make them come out even(ish); I waited until I could run for about 600 calories so that I could cross both the 100 activities and 50,000 calories mark - if I had known I'd be at 419 miles, I probably would have run another mile today.

Psychological insights aside, using tools like RunKeeper and LoseIt work for me for trying to make sure I get my 30 minutes of elevated heart rate per day and don't eat too much saturated fat, doing both of which I'm told improve my odds of staying out of the hospital.

I met with a nutritionist yesterday and in preparation added up all of the calories, fat, carbohydrates, protein, etc. I've consumed since 12/31/2009. I averaged 1,936 calories, 13g of saturated fat, and 195mg of cholesterol per day over almost 9 months. More numbers. More boring.

These milestone-type posts might be sort of lame, but it's a nice journal for me.

Six Months

2010-06-29T13:27:00.000-04:00

As of yesterday, I've lived six months with a stent. Which is, perhaps, longer than without, but we'll never know.

What changed in six months?

I eat less cheese. Far, far less cheese. Including on pizza.
I eat practically no chips and salsa. For me, that is a powerful change.
I run 20 miles a week, or so. That's a lot more than I used to.
I weigh 30+ pounds less.
My blood cholesterol and triglycerides are far lower than they used to be because...
I take more medication than I've ever taken in my life.
I'm addicted to LoseIt and RunKeeper to keep track of all of this.

For my 6-month anniversary I went for a 10k run and had lunch with friends (lunch: Chipotle burrito, 890 calories because I splurged and got the 290 calorie tortilla).

Somewhat surprisingly, to me anyhow, is how little has really changed. Life moves on. There's a lesson in there somewhere, I'm sure.

Why not you...

2010-06-07T21:12:00.001-04:00

To my 7 faithful readers (that's what the Google Blog Follower Sidebar Reporter Thing says, anyhow - seems high to me). I'm sorry.

I actually have content. Ideas. Words. Things I want to say. But time and focus are lacking.

I am not dead yet. Neither is this blog.

Please bear with me.

Got away with one...

2010-04-19T22:29:00.000-04:00

This year, I got away with one.

So, Happy Birthday to me.

I thought the tibial stress fracture last summer was a bummer. It just goes to show, I guess.

Here's to getting away with one more.

And the weird photo? A tradition.

Medical Numbers and Medical Arts

2010-04-08T23:19:00.000-04:00

Here I am, approaching five months of living with a stent.

Because there's no peeking back inside my heart, everything is measured with, at best, a secondary view. Often it's not even that close. And I think the path from a lot of those measurements back to the health of my heart is filled with a lot of forks, branches of which are chosen for reasons that aren't always based in any sort of firm science.

Recent numbers are along these lines:

Bad cholesterol: 54 - that's a nice low number, yay for Lipitor
Good cholesterol: 43 - that's a nice high number, yay for exercise and moderate alcohol consumption
Fitness as measured by VO2 Max: 56 ml/kg/min - that's also a nice high number
Calories consumed per day: 1700-ish - this is a low number, but I'm still supposed to be losing weight
Cholesterol consumed per day: 180mg-ish - this is about 100mg/day less than the recommended allowance

All of that, I'm told, bodes well for heart health, mortality, and other things we're all supposed to want.

And this is where the art of medicine comes in. Like any art, it's subject to the skill, desires, and motivations of the artist and left open to interpretation by whatever audience the artist can muster to look at her art.

What makes 54 a good or bad number for LDL cholesterol? Some guidelines say under 100 are good. My hospital seems to think the people who think that are pikers, and that under 70 is better. But there is no published science just yet that supports that. So we're rapidly away from numbers and squarely in the realm of art.

What makes 43 a good or bad number for HDL cholesterol? As far as anyone has told me, nothing makes it good. In fact, it seems to matter so little that there isn't even a drug to raise it (and if the drug companies can't find a way to promote it and make a profit, that's surely an indicator of something). HDL apparently "clears out" LDL cholesterol, so there is no upper bound on how much of that you should have. Yet. (Also, I have this mental picture of little fatty blobs wearing white hats racing around my blood stream rousting out other little fatty blobs wearing black hats and sending them away to my gut where they are expelled ignominiously and sent to perish in the waste water treatment plant, where I'm sure they are ganging up and plotting against me, one day to come to my house while I'm sleeping and clot every artery in my body all at once the night before something good was going to happen.) Anyhow, stories aside, alcohol raises HDL, but don't have too much. One to two drinks a day is good for me, so that's 8oz of wine, two cans of beer, a few shots of liquor. The American Heart Association tells me to drink 14 drinks a week. Family Doctor says that if I drink more than 14 drinks per week, I'm at risk for alcoholism. Apparently it's a fine line between being heart healthy to being a drunk. Choices, choices. If only we had some science to help us... alas, we're still in the realm of art.

I think the calories and fitness are "real" numbers, because they are so distant from my heart health that they stand alone. Eat fewer calories, lose weight. That actually is sort of like science, or its big brother, math. Weight loss seems to be a third or fourth order measure of heart health - carrying less weight makes your heart work less. But so does Atenolol, evidently; being in shape keeps your heart rate low (which no one can say is good or bad, so there's that), but so does Atenolol. So fitness is nice, and raises your HDL levels, but it seems like no one can attribute longevity to either of those things directly, so big whoop. Speaking of the, in my mind dubious value of Atenolol, cardiologists love beta blockers. My pharmacist once said "If cardiologists had their way, there would be low-dose beta blockers and loop diuretics in the tap water." I've mentioned that to a few doctors, and they all generally agreed that it does, indeed, seem like a thing cardiologists would do.

My favorite art, though, is the art of proscribing diets. I am on a reduced cholesterol diet - not much cheese, easy on the eggs, most of what I get comes from meat. With the help of LoseIt I can tell you roughly how much cholesterol I ingest, which is right about where I'm supposed to be. However, recent studies and articles in the popular press suggest that dietary cholesterol doesn't affect blood cholesterol, at least not as much as what the guidelines were based on. I asked a nutritionist about this, and she said that's pretty true, and some eggs and cheese probably wouldn't kill me on the spot (although the saturated fats in the cheese probably would). So I asked why I was on a reduced cholesterol diet. She said "we put all heart patients on a diet like that". But it doesn't seem to matter. Art. And in this case, it sounds sort of like amateur art.

Next time you feel bad and go to the doctor, don't expect an answer. Get over it, there is no answer. And almost no amount of numbers or data or statistics or measurements are going to help. It's art. With luck, you'll get a good artist. Another MRI isn't going to help the artist any more than a digital camera would have helped Ansel Adams. The tools are useful and necessary, but the interpretive art is what you're going to get. Like all art, it takes time and adjustment. It doesn't take the greatest new tools, but good application of reasonable tools. So stop expecting an answer firmly based in science, and hope for a pretty picture. It will reduce your stress, which is good for your heart, or so they say.

Well, that's just great...

2010-03-30T22:18:00.000-04:00

I read in the New York Times that the F.D.A. just announced that they "... sent warning letters last week to two drug makers ordering them to stop marketing unapproved nitroglycerin tablets. But the drugs are still being sold at pharmacies while the order takes effect."

Well, that's just great.

I've never used my nitro, and of course never hope to, but it would be nice to know that it would actually help.

To the F.D.A.: better late than never, thanks.

To Konec and Glenmark: I hope it was worth it to you, and I hope you get what you deserve.

diet coke!

2010-02-23T10:27:00.002-05:00

I love Diet Coke. I drink way too much of it. My nutritionist asked me how much Diet Coke I drink. I asked her how much there was. My cardiologist suggested that since the caffeine raises my heart rate, it might be good to cut back. However, that would make the list of things I "cut back" on untenable. The things already on the list:

Cheese (and its all-important delivery method: pizza)
alcohol (and its vectors: beer, wine, and gin)
chocolate (in all its glorious forms: cake, brownies, -chip cookies, injected)

are very nearly enough to risk a heart-attack (note, Cute Doc disagrees with this. However, she's washing down chocolate-covered pepperoni pizza with a martini as she says that (ok, not really, but she could)).

So at this point, changing my Diet Coke consumption isn't open for discussion.

Happily, I am not alone in this sentiment. My artificially-caramel-colored overlords at the Coca-Cola company are on my side. Diet Coke and The Heart Truth have joined forces because

A healthy, happy heart is essential to staying extraordinary and making the most of every moment. Diet Coke and The Heart Truth are partnering to raise awareness for women's heath programs.

So every time I drink a Diet Coke (like now!) I am supporting the National Heart, Lung, and Blood Institute, who, I assume, are working very hard on my behalf to figure out how, not only women, but I, too, can eat more pizza, drink more wine, and celebrate every day with a brownie (and/or chocolate cake).

So, Dr. Smarty-Pants Cardiologist, this Diet Coke is for you.

... just like Bill Clinton.

2010-02-11T22:11:00.003-05:00

That's my new line.

When someone asks about it, I can say it's the same thing Bill Clinton had done. So anyone watching CNN (here or here), reading Newsweek, or the New York Times will know.

I, not being a former President, did not get two stents. I only got one.

Also, I am not 63, I'm 38.

Nor did I ever have any, much less quadruple, by-pass surgery. So there's that.

The idea is the same, but I wouldn't have minded waiting a few more years. Like until I was 63. That would have been 25 more years of eating cheese. Dammit.

I wonder if the ex-President got a copy of his imaging so he, too, has a picture of his ribs and heart and the catheter. I did. So there.

I now return you to our regularly scheduled rambling. Thanks for reading.

medicine

2010-02-10T21:50:00.000-05:00

Other than a brief run of Prilosec (a freaking miracle drug, as far as I'm concerned) more than a decade ago, I've never taken any medicine regularly.

Now:

Lipitor, forever. Keeps the cholesterol down.
Baby aspirin, forever. Yeah, it's not recommended any more- unless your doctor says it is. Mine does.
Metoprolol, for 3 months, or forever, depending on who you talk to. Blocks the Betas, keeps the heart rate down, and generally mellows me out. I don't know why exactly this is needed, but in this case, I'm doing what I'm told. Transient effects include dizziness, lightheadedness, drowsiness, tiredness, and unusual dreams. It may also reduce blood flow to the hands and feet, causing them to feel numb and cold. Word.
Plavix, for a year. Reduces blood clotting. Apparently, clotting off that stent is Bad. This works to prevent that. Also, adverse effects include hemorrhage.
Omega-3 capsules, 2 a day for the "slippery fats" to keep the blood moving.
A daily multi-vitamin, mostly for the Vitamin D. 400 IUs.

The bad part: That's quite a change, going from zero medicine to 7 pills per day. Most of the change is in my routine - don't forget to take the medicine. Various doctors, physician assistants, etc. have said (and this is a very, very light paraphrasing) "If you stop taking the Plavix, you will die". So that's some sort of motivation.

The OK part: As far as I've noticed, I've suffered no side effects. All that stuff you hear on the TV ads - not for me, at least not in the first month or so. So, yay. Except for the lightheadedness from the metoprolol, but even that is getting better.

Thanks for reading. Next week: food. Maybe.

weight loss

2010-02-04T21:15:00.000-05:00

I'm 5'7" tall. When this started, I weighed 167lbs. That is a BMI of 26.2. 25.0 is overweight. Bummer.

I was instructed to lose 27 lbs. That's a BMI of 21.9 - right in the middle of the normal range.

27 pounds! Dammit.

In the first month, I've lost almost 12 pounds. That's too much, too fast, but I'm sure it will slow down.

How, you ask, did I do that? My iPhone saved my life. (I've always wanted to say that.) The iPhone app LoseIt is very handy, and is well suited to my slightly data-obsessive mindset. I met with the very nice nutritionist at the end of January. She validated LoseIt for me - her pen-and-paper calculations for weight loss matched the phone. Yay.

I've been obsessively entering everything I eat and all of my exercise into LoseIt. It is compelling. And annoying to everyone around me - it's just something else to get me to stare at that tiny screen. To that I say: don't worry, my iPad will have a bigger screen. Ha.

I've also started eating at home, and dragging CuteDoc and Tinykins through my cooking and experimenting with recipes. I've only cooked from Cooking Light (the magazine), Cooking Light: Everyday Favorites (thanks, LawyerInLaw!), and the slow-cooker cookbook Fix It and Forget It Lightly. But more on that later...

The first two weeks were terrible. This blog was almost titled "I want to eat my laptop because I'm so God-damned hungry". Then I got over it. Now, it's not so bad. I know why diets fail though - those two weeks are almost not worth it. If I wasn't quite so motivated, I probably wouldn't have done it. And then I think it gets boring, and hard again. We'll see how long my motivation to not have a heart attack offsets my desire to eat 2-pound burritos and drink beer. I don't see myself lasting another 40 years that way. Plus, CuteDoc and Tinykins really do like to eat out. Hopefully someone will slip a burrito and a mug into my casket for me - I'll owe you.

Anyhow, we still eat out, but less often. Chipotle has good options, as does Jimmy John's, all of the Japanese restaurants, and even the steakhouses (filet is healthy, go figure). Eve, with enough exercise earlier in the day, was nice. It's not as depressing as I first thought it was. But I always want more than I get. My plan is that after I get to my target weight, I'll eat more of a maintenance calorie load, which will be quite a bit more food. My fingers are crossed that that will be as nice as I'm hoping it will be.

And we have found a number of very good recipes. And you'll see more about those as we go.

Thanks for reading.

my first month

2010-01-27T22:35:00.013-05:00

The first month wasn't so bad. I didn't die. I didn't forget any medication, although came close a few times. I lost some weight. I ate pretty well and didn't starve to death, although it felt like I would a few times.

But let me catch you up.

In the middle of November I was in Portland for work, and went for a run - an easy run, but it was 5 or 6 miles - and held a conversation the whole time. Not bad. On Thanksgiving I went for another run - a 5k Turkey Trot, and it was not easy. It was hard, and it hurt. It was a long 31 minutes. But it was a cold and rainy day, so that's probably why.

As November closed itself, and December spun by, I was running more and more slowly and with more and more chest pain, but only when I ran. CuteDoc, my wife, thought maybe it was a cold or a pulled muscle. I went with that.

By the end of December I decided to go to the Doctor. He said they take chest pain seriously. A week later - the Monday after Christmas - I had a stress test - that was pretty much fun. I got my radiation injections, got wired up to a zillion leads, did some light exercise on their nice treadmill, and laid still for a while (which I'm particularly good at) while the single photos were emitted (it was a SPECT study).

That study wasn't good. My left anterior descending (LAD) artery (one of the arteries delivering blood to my heart) was blocked. My heart was starving for blood. Also, I wasn't allowed to go home, and because it was near the holidays, the cafe was closed, so I was also starving for a bagel.

Very quickly, I had my upper legs shaved. Not long after that, I was once again laying quite still (years of practice paying off twice in one day!) and a nice cardiologist had a wire in my femoral artery that was on its way to my heart. A few more healthy doses of radiation, and he found that the LAD was about 90% blocked. That seemed not that great, but then I thought about it more, and it was worse: 10% more and that means a heart attack. Happily, an angioplasty made it bigger, and a stent was put there to keep it open.

To keep the stent from clotting off (there's that heart attack again) I had a lot of anti-coagulants in me, which means that hole in my femoral artery was not going to close easily. Six more hours of laying still (38 years of practice, paying off three times in one day - the trifecta!) so I didn't bleed to death out of my leg.

At midnight on Monday I had to get up and walk. Four laps around the hospital floor. I felt a lot better. Really. Like everything was working. Weird. And there was never any pain during all of that. None. Not before, during, or after. Modern medicine and skilled doctors, nurses, and techs. Wow. Thanks everyone.

So far, I've lived a month with the stent. No running allowed, just walking at 3.5mph or less. A lot less crappy food (which is a bummer, crappy food tastes good).

What does a 38-year-old with a stent do? Blogs about it. Also, uses the phrase "serious as a heart-attack" a lot more than ever before, because it's a lot more funny than it was in the '80s.

I'll try to write about my on-going diet modification, weight loss, use of the modern American health care system, and trying to keep my heart (and my stomach) from starving. Thanks for reading, and welcome.