Sunday, December 28, 2008

It's Getting Better

I ran a 9:11 mile on Friday during my jog. I had the treadmill up to 6.7 mph (8:54 minutes per mile pace) for a while, but the heart rate eventually jumped to 172 so I had to back it down a bit. In all, I ran/walked 2.3 miles in 25 minutes, including a warm up and cool down walk totaling 8 minutes. I'm trying like crazy to stay within the prescribed limits but I'm too hard headed to comply 100%.

Thursday, December 25, 2008

Up to Speed

On Friday, December 19, I went to rehab. Ed had received my test results from the doctor. He said he had never seen results this good before. Simply stated, my heart was functioning perfectly at rest and when stressed. No concerns about damage to the muscle. He changed my workout and gave me the go ahead to run in addition to the rest of the normal routine. He said we would have to tweak the workout as we go. But he gave me a max heart rate of 165 and a starting point of 5.2 mph on the treadmill without an incline. I had 25 minutes to get it done, which includes a 5 minute warm up and a 3 minute cool down. So, 17 minutes of pure running. Ed said I'd probably want to run for about 5 minutes, then walk for a minute or two, then run again. He was wrong. I ran the entire 17 minutes uninterrupted. My speed maxed at 5.6 mph (just over a 10 minute mile) and my heart rate maxed at 165. It was a good start.

I had eaten lunch late that day and had a slightly full stomach when I went to rehab. Ed said that could affect my heart rate as blood was needed to support the digestion and the exercise at the same time. In short, if I eat at a normal time on Monday, I might be able to increase my speed.

The weekend passed as it usually does. I was told not to run outdoors until I had a few more sessions of monitored running behind me so I couldn't do a Saturday morning run yet.

So when Monday rolled around, I couldn't wait to get to rehab. I ate at a normal time. No afternoon snacks. The difference between Friday and Monday was tremendous. I was able to increase my speed without going over my heart rate. I ran a 9:22 mile during my 17 minutes of running. It felt great. The rest of the routine was just that...routine. I was so proud of myself, I practically dislocated my shoulder patting myself on the back.

Wednesday was Christmas Eve. Rehab closed early so I wasn't able to go. Instead, I had planned to walk for an hour in the morning before I left for work. Didn't happen. The alarm went off at 4:15 and I hit the snooze...again, and again...and again. Never got out of bed until it was time to get to work. Oops.

After work, my mother-in-law was at our house. Rachel and I decided to go for a walk while my MIL watched the girls. For the first time, however, I went against the advice of my rehab physiologist and we decided to run. I had my heart rate monitor and kept the 165 max rate in mind as we went. Three and a half miles later, we were back at home. We had run about 3.25 of it. We had to walk a few times to keep the heart rate down. I maxed at 170 going up hill. I also had a walking warm up and cool down. I found it difficult to contain the bravado. Just 11 weeks after a heart attack and a 3 day hospitalization, I ran 3.25 miles.

The rest of the day was a jumble of bravado, reflection and thankfulness because I realized how unbelievably lucky I was. I had had a heart attack but with no permanent damage. More importantly, I had an awakening without suffering a loss.

Catching Up (again)

So once again, a few weeks have slipped by since I last updated. I took a second stress echo test on December 11. The test usually runs for up to 12 minutes. Most people don't go the entire 12 minutes. The point is to reach a target heart rate and then get pictures of the heart while it's pumping at that rate. My target rate was 185. After 11 minutes, I was only up to 170. I was at 4.5 mph and a 16% incline. A fast walk. As we neared the 12th minute, the doctor said he had what he needed and was going to stop the test and take the pictures. I asked to keep going because the speed was about to increase to 5.2 mph, a slow jog. He said he would let it go one minute over. At an 18% incline and with a ton of wires strapped to me and a blood pressure cuff on my arm, I finally got to jog. It was only for a minute. But it was fun.

When the test was over, the doctor looked at the pictures. His initial evaluation was positive. He said he didn't see a thing wrong. Next step...wait for my doctor to look at the results.

Friday's rehab was normal. They wouldn't increase my workload again until they heard from the doctor.

On Saturday, December 13, I picked up message on our home voice mail to which nobody had listened. Doctor Newton had called the day before with the test results. He said everything looked great and that I could start running again immediately. He cleared me to work my way back up to 10 mile runs within 30 days.

On Monday, I went back to rehab. Ed had not heard from Doctor Newton directly so no changes to my workout. Same for Wednesday. But on Friday, December 19th, everything changed.

Monday, December 1, 2008

Moving Forward - Rehab Days 4 - 9

We started over. Back to light work outs so Ed could gain the level of comfort he needed to ensure no more blackouts and no other issues. Treadmill was 4.0 with 2% incline for a few days. Rower, Monarch, Arm Bike and Leg Bike were all at minimal levels. Boredom set in until today.

December month, new workout. Ed adjusted the workload up. Everything went swimmingly. At the end of the workout, Ed said he might remove the telemetry after Wednesday and we can start a week. I'm certain that Pat will celebrate when the telemetry is removed as she has been nice enough to put it on me every visit.

It has been 64 days since my last run. I have put on about 10 pounds. The holidays certainly were not good for me. Time to get serious. Time to take advantage of the time remaining in rehab to drop weight, strengthen the heart and get Superman out of the Kryptonite cellar.

The Highly Anticipated Stress Test Results

It took 2 days. Doctor Newton finally called me and confirmed the beta blocker caused my blood pressure drop. He took me off of it. He said the stress test pics looked good. He had no worries about the heart rate and said he can't find any damage in the heart. He said Ed can move forward, remove me from the telemetry and move up the work out load.

Of course I couldn't wait to get to rehab that day. Ed didn't share my enthusiasm. He wondered how I could have a "normal" outcome of a stress test when I passed out. He understood the point of stopping the medicine, but felt that he still had a lot of work to do. First, he had to monitor me and get baseline data when I'm not on the beta blocker. Second, he wanted to be sure I was having follow-up appointments with Dr. Newton. Now here's where Derek's situation becomes more important. Had I not known that Ed's insistence and intervention lead to fixing Derek's pacemaker, I would have considered Ed paranoid. However, I trusted Ed not as paranoid, but concerned and I followed his lead. It meant more rehab at lower paces, but better safe than sorry.

The Highly Anticipated Stress Test

So Superman's ego had been deflated. I thought I would breeze through rehab and start running again in only 2 weeks. That is until the "crash". On Monday, November 17th, I went for my stress test.

The test was administered by Dr. Weaver as Dr. Newton, my Doctor, had appointments elsewhere that day. Dr. Weaver and I didn't get off to a good start. Her bed-side manner didn't agree much with me. I told Dr. Weaver of Friday's setback. She kept it in mind.

For those who have never had a stress test, you essentially get on a treadmill from the 1970s, strapped to a machine with about 10 electrodes and heavy cabling. You start out at a slow pace with no incline. Every 3 minutes, the technician increases speed and the incline. The goal...get the heart rate over 155 then very quickly jump on a bed and have the tech take pictures of your heart before the heart rate drops to its resting level. Simple, right? Not so much.

To avoid boredom with the details, the program ran about 12 minutes. My heart rate got up to 125. Someone forgot that the beta blocker I take would keep my heart from getting any higher, even though they reviewed my meds package before starting. here I am only 20 seconds away from hitting my first real jog since the heart attack (5.2 mph) and the blood pressure fell off again. I had no choice but to move to the bed and have them take the pics with a heart rate of 125. Unfortunately, within the 20 seconds that it took to move to the bed and get in position, my heart rate already dropped to below 90 when the tech snapped the pics.

Dr. Weaver in her very "calming way" told me either I needed a meds adjustment or open heart surgery. She'd let Doctor Newton decide which. Oy!

Rehab Day 3 and the Crash

(Ok. I've fallen behind in my documenting efforts. Thanks Jeffry for reminding me to continue the story...if not for others, then at least for myself. This picks up on November 14th.)

Looking forward to my stress test on Monday, I couldn't wait to get to rehab. With any luck, they would remove my monitor pending the outcome of my stress test. Plus, Ed upped the workout. I might actually break a sweat.

As always, I started with the treadmill for 20 minutes. While walking, I met Derek. I thought I was the youngest patient by far for the first two days until meeting Derek, 43, and was once a runner like me. Derek had been sick for about a year and had a pacemaker installed 5 weeks before I met him. In my first few days, I watched Derek interact with Ed and the nurses about a clear problem he suffered. After talking to him today, I learned that his heart rate would not get up over 65 during exercise. Ed thought the pacemaker was set wrong and advised Derek to see his doctor for an adjustment. After 2 appointments (and a great deal of persistence by Ed), Derek convinced the doctor to take another look. Sure enough, they missed a setting. They did a quick fix (non-invasive). An hour later, Derek hit the treadmill and said he felt like a different person. This event has a second level of'll see in 2 more posts.

As I said before, my workout was increased. I went from 4.0 mph on the treadmill with a 4% incline to 4.0 with a 6% incline. Not yet a run, but it was closer. After the treadmill (on which I finally broke a sweat) I hit the arm bike. Two minutes moving at a rate of 1.8 revolutions per minute. No problem. Then came the leg bike.

I started the leg bike for 10 minutes at 1.8 rpm and moved up to 2.2 and eventually 2.4 for today. About 6 minutes in, I started to get winded and felt "funny" I stopped pedaling to catch my breath. Adele was monitoring and she asked if I stopped early. I said yes. Next thing I knew, I was laid out on a stretcher with people taking my blood pressure and pouring water down my throat. The pressure dropped quickly from 100/60 to 80/42. Not enough to sustain consciousness apparently. Within 20 minutes, it came back up and Ed released me.

First thought...I'm not Superman. It was a bummer. I always thought I had a Superman quality. One who could stand a lot of stress, absorb a lot of push back and recover quickly from illness or injury. Clearly, I was not taking this seriously enough. It didn't help that one of the other patients chuckled and said "sucks when you find out you can't do what you used to". (These words will hold some significance in a matter of wait.) And my Superman flew out the window. I was left sitting on the bench. Still sidelined for the season.

They say if you can't be an athlete, at least be an athletic supporter. Rachel ran the Richmond Marathon on November 16th and did awesome. We loved being out there to cheer her on and to remind myself that I'll be back here next year once again.

Wednesday, November 12, 2008

Rehab - Day 2

When I arrived on Monday, Ed immediately ushered me over to get my workout card and to get my monitor on. He had to remind me of how the monitor goes down on this side up on the other side. Eventually, I won't have to wear the monitor. But for now, it's standard issue.

The workout this time was different. 18 minutes on the treadmill walking at 4 mph and 4% grade. 8 minutes on the rowing machine. 10 minutes on the bike for legs. 4 minutes on the bike for arms. 2 minutes on the Monark. My assessment level was 11 - fairly light workout.

The stress test is next Monday. So I'll have rehab 2 more times with a lighter workout and, pending the results of the stress test, will begin more intense workouts next week.

During this visit, I took a closer look around at the other patients. I spoke to a few of them. I am the youngest by far but the stories don't differ that much. I spoke to one gentleman during his 22nd visit. He told me he recently got out of the hospital for more complications and was glad to be back in rehab. He survived throat cancer 2 years ago and now works harder than anyone in the room 3 days a week to make himself better. Another gentleman could barely ride the bike for 2 minutes when he started. That was 50+ visits ago. Today he claims he reached a new milestone. His muscles tired-out before his heart. A tremendous feat considering.

Others in the room do their thing and keep to themselves. They seem to appreciate the quiet alone time during which they are solely focused on them. I believe some of these people will be my friends before my 12 weeks end.

Rehab - Day 1

As expected, I spent more than half of the 75 minute appointment completing assessments and establishing goals. I was fitted for a monitor that I wear during my work out. They take my blood pressure at certain intervals as well. Gotta make sure I'm still alive. Kathy is my case worker. She is a very warm person who took her time to complete my assessment even though she probably got more information about me than she wanted to know. She showed patience and seemed to understand very quickly that I had no idea how to handle all of this. She showed me how to attach the sensors for the monitor and then how to attach the leads to the sensors. I'm sure I'll never get it right.

The rest of the staff, Pat, Adele and Alese, welcomed me to rehab as though I had some sort of VIP status. They seem to treat everyone with that level of caring and respect. They will surely make the rehab process more enjoyable and less clinical.

The workout only lasted about 20 minutes, but I welcomed anything at this point. Since I have not had a stress test, Ed, the physiologist, ran me through a few light efforts to see how my heart reacted. I walked on the treadmill at 3 mph and 10% grade for 6 minutes. No problem. I worked on the bike...first arms only, then legs only. Speed goals remained low and duration remained short. Again, this was just to see how my heart would react. Finally, I worked on the Monark machine which looks something like a postage meter. For two minutes, I simply turned the handles and kept up a certain speed.

Dr. Newton, my Cardiologist, said that the rehab group would probably try to treat me like a 60+ year old heart patient when planning my rehab. Just the opposite was true. Ed said he recognized my unique situation and said he would create a rehab plan geared towards that. Day 2 would be more challenging.

Injured Reserve Week 2

The second week back showed promise. It proved to be an exciting week. I went to the Redskins game on Monday night with my father. Though the Skins lost, we still had a great time...until we realized someone towed the car. Delaying our return to Richmond by about 2 extra hours, we finally got a cab, got to the impound lot, recovered the car and made it home by 3:10 am. I snuck in about 2 hours sleep before Rachel and I took turns going to vote in the biggest Presidential election ever. I had already taken the time off of work, so I plodded through the rest of the day with the family, trying not to look as I tired as I felt.

Back to work on Wednesday and things seemed a bit easier. I held meetings with my new department and put together an agenda for the next few weeks. I updated myself on my regular duties and suddenly found myself fully engaged for the first time.

The highlight of the week was my first cardio rehab appointment. Jonesing for some actual exercise, I impatiently awaited through every hour, minute and second until I finally hit the treadmill.

Injured Reserve Week 1

I came back to work on October 27th. Nothing felt the same. The company was different. The office atmosphere was different. My motivation was different. It was as if the tiny part of my heart that was damaged was the same piece of heart I put into my work.

The first 2 days were overwhelming. My coworkers walked on eggshells around me and I thank them for that. Some had absorbed my other responsibilities during my leave. Taking those things back did not top my list of to-dos. Plus, I had an entire new department and new staff (of 2) to take on. An obvious starting point eluded me. I was starting over; starting over in the middle.

I spent much of the first week observing everybody as they worked. Trying to find the things I can avoid to lessen the stress load while still accomplishing assignments. I decided to stay out of conversations that speculated on the financial health of the company. I wanted to stay away from talks that dissected the changes and staff losses from the previous week. I wanted to remain complety separate of those speeches and conjectures and venting. Unfortunately, after the third day, I realized I was leading those very conversations which I endeavored to avoid. They provided a catharsis, but still left my ire up...and probably my blood pressure to some extent. Now I work harder to not participate in such unproductive conversations.

By the end of the week, I realized I needed to do more to reduce the stress at work. I left my computer at the office for the first time in memory. When I walked out the door, I disconnected.

I did my best to not think about work all weekend knowing I still had my budget to turn in as well as an annual review of an employee. I knew the importance of both and the consequences of non-compliance, but I didn't let myself worry about it. I slept well over the weekend for the first time in many years.

Tuesday, November 11, 2008

On the Disabled List

Upon leaving the hospital, the looming question for Rachel and I to answer was how do we reduce stress at work and home? A tough question to answer for anyone with two young children, a busy work schedule and the regular high demands of being a grown-up. I spent 3 weeks at home trying to answer the home half of the question.

During that time, I got to walk Morgan to school most mornings and pick her up afterwards most days. I spent a lot of time bonding with Olivia, playing with her and learning to better communicate with her. I also learned how to communicate better with not keep in things I was previously tentative about saying.

The first week was the toughest. I wanted to find the proper balance of helping around the house and resting. Week two, Barry came to visit and help out for a few days. Then Rachel had to go to San Diego for Stroller Strides, so Steven came to visit while she was gone. Their help and company...invaluable.

I can't say enough about the Stroller Strides families who mobilized and came to our aid. We had dinners prepared for us every night for as long as we needed them. Our friends in Atlanta also sent us prepared food. All of our friends had it right...let's help them with the little stuff so they can focus on the big stuff. The amount of support we experienced was overwhelming and wonderful and I thank everyone!

Week three was just the 4 of us again and I spent that week preparing myself to go back to work. Staying at home and eating good for me foods and remembering to take my meds became the big challenges.

Of course, during my leave time, things severely changed at work. We lost a few good people and restructured some departments. I picked up the HR department in addition to my already significantly piled on responsibilities. The transition back to work looked even more difficult now. All I wanted to do was stay home and play with Morgan and Olivia.

Friday, November 7, 2008


Life is a lot like a sporting event. It's played on an open field in a finite amount of time (though we don't know how long the game clock will run). It has its own set of rules and penalties and comes with its share of players and coaches, cheerleaders and competitors...and goals. Life has its injuries, enders;season enders;career enders.

I just suffered a season ender. At 37 years old, I was benched by a heart attack.

The heart attack struck on Friday, October 3rd at 3:25 PM. But it really began about a week and a half earlier and I had no idea.

On Wednesday, September 24th, during a 6 mile run, I noticed a discomfort in my chest when my breathing peaked. It felt respiratory in nature. Like I was breathing bad air. As soon as I ended my run and my breathing returned to normal, the discomfort went away. I suspected it was a symptom of running during a bad air quality day, but the DEQ listed the air as green and clean. Then I thought I might be getting sick and with only 5 weeks until the Marine Corps Marathon.

On Saturday, September 27th, I ran 15 miles with Rachel. We left around 8:00 am and the humidity had already climbed to about 80%. Breathing comfortably became a challenge early on and I experienced the same sensations as on my previous run. I struggled through this one, posting a miserable 11:40 per mile average. After the run, as my breathing returned to normal levels, the discomfort disappeared again. I chalked it up as a bad day and started thinking about what I can do next week to improve the long run.

I took a few days off after that run to recover the lungs. I considered seeing a doctor, but took echinacea instead which seemed to help. The night of the Vice Presidential Debate, the discomfort came back. This time, I wasn't running. I was relaxing and watching the debate. Again believing this was respiratory, I spent 10 minutes in a steam bath trying to loosen up whatever it was. No good.

On Friday, October 3rd, I had a particularly long day planned. At work by 3:30 am to finish up compiling packets for a new client just before a long drive to Roanoke, VA. By 4:30 am, I had the same discomfort in my chest and I began to get worried. As soon as my doctor's office opened, I phoned and made an appointment for later that day.

The rest of the day went as scheduled. We left for Roanoke at 5:00 am and arrived at our meeting at 8:45 am. I felt fine all throughout the meeting. It wasn't until we were about an hour outside of Richmond on the way home that I started to feel bad again. The same discomfort came back, but this time it was more severe. As we neared Richmond, I felt worse and worse. When we were about 10 minutes away from the office, the discomfort had turned to pain and it spread to my arms, my hands and my jawline. I knew something was seriously wrong.

We made it to the office and dropped off Eric and Tarrah. I was considering whether to get in my car and go to my doctor's office as scheduled, or just go to the hospital. When I got out of the car and couldn't stand up straight, I knew the answer. Elizabeth drove me to Chippenham which was fortunately right across the street. On the way I called Rachel. I didn't want her to panic but I began to cry when I tried to tell her where I was going. I simply couldn't grasp what was happening to me and I didn't want to find out the answer.

I arrived at the ER at 3:15 pm. The cardiac team worked quickly to stabilize me. The pain was unbearable now. I got an aspirin and a nitro patch. The nurse said the nitro patch would either make the pain go away, which would indicate a heart attack and probable heart damage, or it would give me a headache, which would mean no heart attack occurred. Within seconds of the patch being applied, the pain began to go away. Good and bad news at the same time.

Rachel made it to the ER within 15 minutes of my call. I was impressed with her composure. I was the wreck. At first I was told it was not a heart attack...that the EKG didn't look abnormal and my first blood test came back fine.

The Cardiologist, Dr Newton, visited after about an hour and looked things over. He initially assessed this was a stress induced event. He said he'd keep me in the hospital over night, do a stress test in the morning and then release me.

However, the longer he stayed with me, the more he realized I was still in a great deal of pain and should not have been. He ran a 2nd blood test and it came back with elevated enzymes. He decided to admit me to the IVCU and said I'd be there for a couple of days.

After settling in the hospital room, the last place I wanted to be, they took a third blood test and hooked me up to the monitors. Rachel stayed the night. She slept in a chair. I'm glad she was there.

Around 12:30, Mike, my nurse, came in and woke me up. He was explaining something I didn't understand. Rachel told me to do what Mike said right away. He handed me a phone and Dr Newton was on the other end. I wasn't quite following what he was trying to tell me, but the result was an emergency heart catheterization. Apparently, my third blood test came back with extremely high enzyme levels. Dr Newton was in his car on the way to the hospital and ordered me to be prepped for the cath lab.

The procedure took about an hour. I was sedated so I don't remember anything other than thinking about my daughters and hoping to see them soon.

My next point of lucidity was back in my room. Dr Newton was explaining his findings to Rachel. They didn't have to put in a stent or do any invasive work. In fact, my heart grew a colateral...that grew its own bypass. Dr Newton said this is something that is genetic, but you have to have a strong heart for it to work. He credited running for giving my heart the strength to do it.

But the news isn't all good. There was damage to a tiny vessel which was blocked, and there was damage to the heart muscle. The extent of the damage will be unknown for sometime. The 2 marathons I trained for were out. In fact, Dr Newton said running is out for a long time. Over the next few weeks, he wanted me to rest. The most activity I could do for exercise is to walk. And then came the meds. Blood thinners, alpha blockers, beta blockers, cholesterol reducers, blood pressure droppers, anxiety reducers, sleep aids and aspirin.

I was in the hospital from Friday night until Monday afternoon. I was glad to get home. I was glad to see my daughters. I was glad it was only a season ender.

The next 3 weeks at home were difficult. That will be in part 2.