The art of medicine consists of amusing the patient
while nature cures the disease.
– Voltaire
As I mentioned in my last post, I suffered a heart attack on June 24 of this year while staying in a cheap hotel in a tiny village in France. I should have died, but didn’t. Why not?
Let’s go back a few years. In the summer of 1979 I was climbing an old tree in my backyard. I was planning to use a chain saw to cut off a large, dead branch that I was sure would one day fall down on the head of my two-year-old daughter, who spent a lot of her time toddling around under the tree.
In order to cut off the offending branch, I needed to pull myself up onto a nearby limb, from which I could reach the dead branch. To do this I had to grab hold of the limb with two hands and pull myself up – like doing a chin-up except that I needed to pull myself up higher than that, up to my chest at least so I could swing my legs over the limb.
But I couldn’t do it. I simply lacked the physical strength to pull my one hundred eighty-five pound body up onto the branch. I couldn’t believe it. I’d always been an athlete, pound-for-pound the strongest person I knew. I’d lettered in four sports in high school, played football in college, and even spent a season with a semi-pro basketball team.
But that was then. Seven years earlier I’d been mustered out of the Army, then spent a few years in law school, then joined a large corporate law firm where I worked eighty hour weeks. For seven long years I’d done nothing physical at all, and I was now a wreck.
Embarrassed and disgusted with myself, I headed off to my favorite sporting goods store(1) and bought two twenty-five pound dumbbells and some running shoes and sweats. I developed a simple routine that involved stretching exercises, weight training, stomach crunches, and jogging. By my late fifties I’d stopped jogging when my knees gave out (I ran on streets and sidewalks) and switched to walking. However, I modified my route to make it much more difficult.
Over the years my workout routine evolved slightly, but it was always pathetic. I hate working out. I never met anyone who had an easier workout routine and who still claimed to work out. But that was the genius of it. It was so easy even I could do it every day. Which I did. For thirty-five years.
Lots of people do kickass workouts – running three miles a day, Zumba three times a week, spinning, PX90, whatever happens to be trendy at the moment. But for how long? A year? Five years? Fifteen years? However great you think your workout routine is, come and see me when you’ve done it every day for thirty-five years.
Because, you see, it’s the discipline and persistence of an exercise routine that is crucially important, not how intensive it is. Nor is it crucial for the reason you think: it won’t keep you from getting a heart attack. (I’m Exhibit A on that point.) But before we get to why it’s crucial, let’s look at what the workout needs to accomplish:
- Keeping you physically strong. Physical strength turns out to be so important to surviving major illness and major surgery that some surgeons now postpone surgery on feeble patients until they can become stronger. A quick and dirty metric for strength is your grip. Average grip strength for men peaks in their 30s at 45 kilograms and declines by their 60s to 28 kg. I’m 67 and even with my pathetic workout I’m at 60 kg on a good day.(2)
- Keeping your lungs large and powerful. I don’t mean powerful enough to run a three-hour marathon, I mean powerful enough to get you through your most stressful days with energy to spare.
- Making your heart the strongest muscle in your body. When I was a young athlete my resting pulse rate was in the low 40s. A nurse who was taking my pulse in college once said to me, “Either I counted wrong or you’re dead.” Pushing age seventy, my resting pulse rate has moved up, but only to the mid-50s. (The average pulse rate for a 25-year-old male is 72.)
Here’s why discipline and persistence in your workout routine is so vital. As my coronary arteries began to be dangerously occluded – say, in my early sixties, when I became symptomatic – my heart muscle wasn’t sick at all, it was in terrific shape. I pounded up steep hills every morning (okay, I was walking by then, not running) and my heart had no choice but to keep up.
Of course, as my heart was getting stronger my arteries were getting weaker. So what we had was an irresistible force (a very powerful heart muscle) colliding with an immovable object (arteries that were hopelessly clogged). Normally, this is a stalemate the heart can’t win, and in relatively quick succession (as noted in my last post) heart cells die and ventricular fibrillation leads to death.
Except that a healthy human heart has an ace up its sleeve: angiogenesis, the process by which new blood vessels form.(3) It sounds science fictionesque, but it’s a common and well-known phenomenon.(4)(5)
At some point in time, probably in my early sixties, the deteriorating condition of my coronary arteries caused my heart to move to Plan B: launching the process of angiogenesis. Tiny new blood vessels began to form, spreading out across my heart like it was the Mississippi delta, showing up on an MRI scan as what scientists call “blushing.” Each of these vessels was small, capillary-like. But, in the first place, there were a great many of them, and, in the second place, capillaries are actually much more efficient at delivering oxygen to heart muscle than are larger vessels.
Which brings us to the evening of June 24, 2014. Without the growth of new vessels in my heart, I would have suffered the classic Type 3 myocardial infarction: sudden cardiac death. Painful, but brief and decisive. Instead, as the battle raged between a heart-that-refused-to-die and arteries-that-refused-to-let-it-live, I suffered what was, in effect, a six-hour heart attack.
At first, shortly after the attack started, heart muscle began to die and my lungs began to fill up with fluid. But, very gradually, the newly formed vessels began to deliver oxygen to my heart faster than the old, clogged arteries could kill heart muscle. (And, remember, there was a lot of heart muscle.) By six a.m. on the morning of the 25th I was able to fall asleep, mostly out of exhaustion, and when I woke up at eleven, I didn’t feel that bad. In fact, we continued our tour of France for roughly another week.(6)
By sheer luck – and an almost insane doggedness – it turned out that I had spent thirty-five years of modest-but-persistent exercise preparing for those few hours on the evening of June 24. And, my friends, it’s that doggedness that is the lesson. You can run marathons for twenty years, but as soon as you stop it’s all over. But a simple workout that addresses muscles, lungs and heart, a workout that even the laziest among us can handle, persisted in every day for decades, that’s what will do the trick. It won’t prevent a heart attack, but it will make your heart damn hard to kill.
It’s probably too late for most of my readers, but not for your children. Please pass it on.
(1) It was called Honus Wagner Sporting Goods, founded by Wagner himself, along with his Pittsburgh Pirate teammate and business partner, Pie Traynor. The store closed for good in 2011 after ninety-three years in business.
(2) These are hand dynamometer measurements. Metrics for women are about 60% of the male numbers.
(3) It’s long been known that most diseased hearts can’t support angiogenesis. More recently, however, scientists have made progress in encouraging angiogenesis in even the most hopeless heart patients. See http://news.harvard.edu/gazette/1998/05.14/NewArteriesGrow.html.
(4) In the womb a process called vasculogenesis launches the initial formation of blood vessels, but after birth angiogenesis is responsible for all further growth of new vessels.
(5) Note that angiogenesis can be good (helping the clueless, like me, survive heart attacks) or bad (rushing additional blood supply to cancerous tumors). One of the most prominent companies involved in angiogenesis research, Israel-based VBL Therapeutics, aka Vascular Biogenetics, describes its platform technology as the “systemic administration of gene therapy to either destroy or promote angiogenic blood vessels.” Amusingly, VBL Therapeutics also seems clueless, having recently mounted the famous “IPO-that-wasn’t.” After announcing that it had been taken public by Deutsche and Wells Fargo (who were apparently also clueless), VBL quickly about-faced. According to its press release, “the underwriting agreement for its initial public offering has been terminated by the Company’s underwriters … due to an unexpected situation…” The newly public stock traded for six days before everything had to be unwound and the stock became, again, unpublic.
(6) We returned to the US late on a Sunday. On Monday I was rushed to the ER and on Tuesday I had an unsuccessful heart catheterization. On Thursday I had sextuple bypass surgery. Friday was the 4th of July. Not my best week.
Next up: Strange Bedfellows
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