Day 2922: Stent #1, 20081222, Smart Choices

Day 2922: Myocardial Infarction [Stent #1]
252,460,800 seconds
4,207,680 minutes
70,128 hours
2922 days
417 weeks and 3 days
8 years

I almost forgot what happened 8 years ago with my heart.  I’m not sure if this is a good thing or not.  Not remembering things can be bad…. but this can also be good, I’ve recovered psychologically.  Meaning – that the event that took place 8 years ago around this time of the year that almost took my last breath away does not have deep imprint in my mind.

I don’t have confidence with my heart anymore or my body.  I am well aware that the next moment can come at any time.  I am now perfectly well and back into long distance cycling, swimming and hiking but my activities does not assure me of the future. I am grateful for my extra days but I am also vigilant/embracing of the day when it comes.  It feels like I have a scheduled meeting with with my Stent #3.  I’m not afraid anymore to face what will happen.  In fact I am more excited to meet the day.  The excitement is what makes me truly grateful for what I have now.  We normally value things in our lives when we know we don’t own it forever. 

Enough for the self-made drama, it’s not me.  I just want to mention here [for the record] that I am not that all 100% happy… maybe 90% …. because of what happened 8 years ago.  It changed my life, my mindset and my views in life.

If you want to know what happened 8 years ago, here’s the link to the event. Related Post

 

Book-Smart Choices by Hammond

Today, I finally finished the book “Smart Choices”.  It’s a “must read”.  Someone already made a summary about the book and it is very detailed [see link below].  When you get a chance, please read the summary.  And if the summary is not filling you up, buy the book at Amazon.  I applied the principles from the book and made a powerpoint template before completely reading the entire book, I came close but not perfect.  Anyway, I’ve accomplished my objectives.

BookSummary-PersonalDev-SmartChoices-Binder1.pdf
DecisionMaking-RescueTrip-AUS-CEB-AUS.pdf
DecisionMaking-RescueTrip-AUS-CEB-AUS.pptx

NOTES: Shift of My Heart-Day1832 +Endurance Formula

Shift of My Heart-Day1832
It’s been 5 years since my Stent #2 [tags: cardiac notes] and I’m still waiting and expecting Stent #3 soon. But I’m a half-full type of person so I will look at the brighter side instead.  Many months ago, I’ve noticed during my bike rides that my heart rate can never go above 125 bpm [beat per minute] no matter how hard the effort or the workload is.  Yesterday, I was totally surprised that my heart rate went up in the “green zone” [130 bpm] on the first climb [see Fig 1 at the beginning].  I had been pacing/limiting myself during my bike rides thinking that my heart did not fully recovered from my myocardial infarction in 2008.  I’m still in recovery mode and will not execute abrupt changes in my exercise soon.  Having the heart rate data available is really a plus for a cardiac patient.  It is important that I don’t over exert myself in my endurance training.  I will run another test this week and see if the data below is not just an anomaly and after that – heavy training is coming.

Tool Box:
Mio Strapless Heart Rate Monitor
Adidas micoach
MapMyRide

Endurance Formula
I came across a formula for long term relationship from Stosny’s book Living and Loving [youtube webinar]. Long term relationship = Passion + Intimacy. p160  But the topic that I’m sharing is about swimming and cycling endurance and not love relationship.  That will be your homework – to prove that LTR = P + I is true or not.  The “I” is very important. No wonder one-night stand seldom lasts…

“Passion is the fast food of love, immediately gratifying and filled with
calories but with little of the nutritional value of true intimacy. In
terms of relationship function, passion brings us together, but intimacy
keeps us together; passion moves us, but intimacy makes us grow.
Hence they dominate different stages of relationships, with intimacy
becoming prominent as passion wanes. This fact is hardly surprising.
The nuance of intimacy—truly knowing another person—can
scarcely emerge in the thrall of passion.” Stosny Living and Loving

While swimming today for 1 hour and 20 minutes, I have to think of something beautiful and challenging to occupy my mind during the long and boring swim.  Today, I asked myself, “why am I doing this swim, it is 90”F in the pool and it is so boring”.  A 2.4mile swim in a pool is easy in terms of physical effort, the pool is only 25 yards long but the hardest task is “mental” –  which is surviving the boredom of swimming.  In cycling it is easy for me to switch to a good song and sing along [yes, I sing during bike rides ;-{] or listen to TED Talks or change the route to make the ride interesting.  Swimming for >1 hour non-stop is just not a very interesting exercise.  While doing all the inquiries in my mind during today’s swim, I came home with the following formula synthesized from the LTR=P+I.  I am not going to explain each item because I think the definition is very clear.

Why use formula?  I started using formula lately just to keep myself reminded of what the solution of a specific problem is.  It is hard to remember the stuff you learn without having a systematic way of memorizing facts.  Once a formula is created, anyone can just simply recall the keyword and then attempt to regulate or investigate or define the underlying variables on how to cope, on how to solve or how to endure life.  Please note that the formula mentioned here has fine prints, use at your own risk or craziness level!

Endurance=Passion + Knowledge + Fitness + Ability
Endurance-The power to withstand hardship or stress
Passion-A strong feeling or emotion
Knowledge-having extensive information or understanding; possessing or exhibiting knowledge, insight, or understanding; intelligent; well-informed; discerning; perceptive.
Fitness – Good physical condition; being in shape or in condition
Ability-Possession of the qualities (especially mental qualities) required to do something or get something done

Fig 1. My normal training heart rate during a long distance bike ride
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Fig 2. My heart rate during my last ride-July 11, 2015

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20150712, Sunday
An empty community pool, flipper, floatation device, swim goggles and 16 ounces of blue Gatorade.

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Heart Function Study with MIO Alpha Strapless HRM

Diminished Heart Function
December of 2008 when I had my MI, it took me a longer time to accept the fact that my heart function had diminished.  I used to be able to push my heart rate to somewhere around 150-160 bpm on the bike.  Recently, I’ve noticed that I can barely get to 130bpm on a small hill climb.  I’ve asked my cardiologist for an explanation as to why my heart rate does not go above 130bpm and he just told me not to worry about it and mentioned that it might be due to my heart meds.  I can still exert an sustainable effort for >3-4 hours of cycling without slowing down – but just not good on hill climbs.

Nuclear Heart Stress Test
When I had my first Nuclear Stress Test right after my MI, I did not know how to interpret the images below.  During my 2nd Nuclear Stress test, I did some research beforehand on how to interpret the post stress test images.  Normally, the cardiologist will only show you the images very briefly – maybe at most two minutes and  does not dwell too much on the explanation.  With my limited knowledge about the interpretation of  test results,  I was able to to take a quick glance of the images [like a spy agent] trying to memorize the images and later did my own interpretation. I discovered that I had a portion of my heart not receiving enough blood flow during the stress test.  This means that my heart is not the way as it was before the heart attack at the age of 42 [present, 47]. I now humbly accepted the fact that my heart is never the same as compared to the pre-MI days.  Mostly doctors will not openly discuss that type of information because it does not really help the cardiac patient mentally to know that the heart function had diminished or had somewhat lost its ability to work.  Doctors only care about how the patient is able to function back to normal life without chest pains or shortness of breath.

Some patients don’t need to know that type of in depth information regarding heart function but being an active person as I am, I should know my body especially my heart function so that I can detect or predict my next MI or coming sign of death because I am not a normal person – I do weird and abnormal activities like a 25 second subsurface swim using 0 breath, or >40Miles bike ride alone every Saturday or 2.4 Mile swim.

Here’s some information regarding Nuclear Stress Test:
http://emedicine.medscape.com/article/352401-overview#aw2aab6b5
Cardiac-SPECT Information

Below is an example of a Nuclear Test result.  You don’t need to know more…it’s just for show and tell for other interested readers.  A healthy heart should have the same/or almost the same pre and post stress test images. Note: this is not my the picture of my heartimage

Beating of my heart!

This entry is not about my previous MI, those are the old story.  I took the oath of acceptance already with the fact that I will never be able to get back to my previous fitness level on the bike or much more run a 10K and I should drop my Ironman aspirations.  Yes, I can bike 100Miles and swim 2.4Miles at a comfortable pace but at this moment, to even run a mile, my heart rate shoots up to 130bpm and I’m already maxing out.  I’ve already accepted the fact that I will remain to be a long distance swimmer and a cyclist  and not a runner, I think I can live with that.

I am sharing to everyone my “heart experience” because as you all know – you have one in your chest too.

I want to raise awareness here about how important our heart is, neglecting the health of your heart can mean life or death – meaning – you are in big trouble unless you have good collateral arteries.  I’ve been advocating for cardiac knowledge here in this journal since the beginning of this blog and also sharing these stories at work and to everyone who listens and I am really surprised that no one really paying attention about cardio exercise.  Some will just say “I exercise but does not really pay attention too much about heart rates” or some people will say “I’m ok, I don’t need to exercise”.

I understand that not everyone has access to heart rate monitors, a bike or swimming pool or a treadmill.  But I want to challenge and stir up my readers to at least attempt to raise your heart rate to an “uncomfortable level” daily.  It is very important to know that your heart can take up the load at some point.  Please don’t wait for a cardiologist to tell you that you really need to do a regular cardio workout.  You can start now.  Take a brisk walk or run for at least 10 minutes and then later on advance to a longer workout at the same intensity or a bit higher.

It’s not too late to save your heart.

Findings/Observation/Notes:
The Heart Rate table listed below are unique to my body.  There is no standard  values to compare to, so please don’t compare your data to mine.  I am male, 47, long distance cyclist, swimmer and a cardiac patient since age 42.

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Tool Box
1. Mio Alpha Strapless Heart Rate Monitor – At Amazon, just by the returned item for half the price.
2. Adidas micoach App on IOS7 – So far, this App serves my needs for now.

Other Resources:
MIO Alpha Review
myheartrateLog-20140331.xlsx

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DIY Cardiac Bypass-Building Collateral Arteries

Three days ago, I made a tiny discovery of a new heart symptom that I felt while riding indoors with my bike.  The next day, I pushed myself to the to limit at the pool to find out if I will be able to execute my 65miles bike ride plan.  Results were the same, no chest pain even at higher heart rate.

The following articles supported my theory of why I need to do more hard workout – to build collateral arteries.

Please read…

https://dl.dropboxusercontent.com/u/80421698/Medicine-BuildingCollateralArteries.pdf
http://www.health.harvard.edu/press_releases/do-it-yourself-cardiac-bypass-surgery

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3 Years Since My Heart Attack-Day1093

I would like to remind myself from time to time that life is too short.  In 2 days, It will be 3 years since my heart attack.  I am counting the days because I know that my time is limited.  It can happen today or tomorrow and who knows that I will not have the time to write something about what happened.  To my wife Britta, daughter Brittney and son Brent, be it all known unto you that I did my best to keep myself in perfect health; to finish what I had started to do – build my family the best I can.

There are two numbers that I am currently tracking:
1. Stent#1-December 22, 2008 [1093 days]
2. Stent#2-July 2, 2010 [536 days]

To those who don’t know me, here’s a quick summary of the dreadful event including my journal entry in 2008. I don’t want to scare anyone about my heart attack. My reason of exposing it here is to raise awareness of the danger of a heart condition and how it can dramatically change your life.  Heart attack is still the #1 killer in the US. [I did not know that fact until I had mine]. Now you know… so that you too can try to make dramatic changes to your lifestyle, diet, exercise and life in general.

At the age of 42 [Dec of 2008], I had my full blown heart attack [100% occlusion at LAD-Left Anterior Descending].  Nothing changed much except that I am taking medication now and had been very careful not to swim in really cold water. I am a little careful on my diet also but not so fanatically obedient to the cardiac diet laid out my nutritionist. My cardiologist was not giving me a perfect explanation why my LAD was 100% blocked.  Many reasons came up – genetics, diet, age, and mine – a cold water swim.  I am a very active person, I swim, bike and occasionally run.  Most of my activities every week is centered in distance cycling and swimming.  I had always been active since childhood [cardiac wise].  When I was in the US Army, I can finish my 2-mile run in under 16 minutes.  Since I got out from the service in 1996, I’ve switch to cycling and then later in 2005, I included swimming in my training then running.  In short, I am not the typical high risk factor guy that you can pick in the line and say that I will have a cardiac problem down the road.  I said to myself – no way to cardiac problem – since I do 100-mile distance ride every year and I know that my body is in perfect condition and in fact, 2 months before the incident, I just did the Annual Outlaw 100Mile Bike Ride and did my best time.  How so that in the following 2 months, my heart says that it is blocked and no blood flow. What happened in Dec of 2008 will remain a mystery to me.  Was it a life changing event meant to happen? Was it a message to the rest of the world that there are risks out there even if you kept your body in perfect shape?  No one knows.

Today, I just finished a 2.4mile swim at Clay Madsen Pool. The swim is a non-stop race pace event that I intentionally schedule every Tuesday. I’ve added a 25-yard sub surface swim [meaning at 25-yard under water swim – no breath at all]. I had been improving since I started doing this and can comfortably reach the other end of the pool with just 0 breath.

In summary, I think I am doing well as a cardiac patient, 1093 days and counting…

Progress Report:
2008
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2009
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2010
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2011
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Below are my journal entry in 2008

20081222, Monday
0000, Sleep
0100, Sleep
0200, Sleep
0300, Sleep
0400, 1 hr indoor cycling, 15 miles, aveHR=119bpm, felt fine
0500, Shower
0510, Breakfast, left over from Texas Roadhouse
0520, Iron clothes
0525, Sharp chest pain 9 rating +left arm numb and did not subside POF: Heart  (Point of Failure)
0526, Decided to go for ER
0530, Left home, Britta driving, kids are still sleeping
0535, In car, chest pain at 9 rating, breathing was fine (normal) thinking of dying but was not scared. I felt at peace and was ready to go. Thought about how I organized everything for my family in case of my departure like this. The notebook I built for them and the notes, the passwords, the accounts we have, my insurance policies that I placed in the firesafe.
0544, Arrived at ER, walked from the parking lot to ER, chest pain still at 9. Information/paperwork started.
0600, Starts. Nitro, Maalox, blood works, EKG
0700, EKG non conclusive for heart attack, heart enzymes non conclusive also.
0800, Chadd arrived. Echo Cardiogram done, upper part of heart moving very slow, sign of heart attack/blocked arteries. Cardiologist informed. Nitro in IV started, pain now at 8
0900, Cardiologist came in, Dr. Wozniak, ordered immediate treatment to save heart, blood thinners, BP meds to lower blood pressure and Nitro to keep pain low. Cardiac Catherization scheduled later in the afternoon but no exact schedule.
1000, Pain threshold=8, waiting for ICU room vacancy. Britta left for home to check on the kids
1100, PT=8, still waiting for ICU room, alone by myself. Did a lot of thinking, mostly of the things I done for my family. So at peace and was ready to go. Weird feeling of peace. Nothing bothers me even the pain the fear of dying.  I know there was something wrong and anything can happen.
1200, PT=8 Moved to ICU, briefing about cardiac cath
1300, PT=7, waiting in ICU, Brittney and Brent came in with Britta/Bettina
1400, PT=6, waiting in ICU
1500, PT=6, moved to Cath lab
1600, PT=6, Cardiac Catherization procedure. Found Left anterior descending 100% blocked and right coronary artery 80% blocked. Removed blockage and installed Taxus Express2 OTW Stent on LAD-PLOC 3x16mm REF38968-1630, LOT 11693163.
1700, PT=0, FIX: Unblocked Left Anterior Descending artery.
1800, Rest
1900, Called Mom/Bebs in Cebu, inform-OK
2000, Rest
2100, Britta left with the kids
2200, PT=0, Heart treatment resumed
2300, Rest, did a lot of no thinking, just enjoying the pain and the thrill of surviving. 
2400, Sleep
 
20081223, Tuesday
0000, Sleep
0100, Potassium IV treatment so painful, PT=10 but chest pain is 0
0200, Sleep
0300, Sleep
0400, Britta came in
0500, Bath in bed by Britta
0600, Rest
0700, Breakfast
0800, Mauro arrived
0900, Dr. Wozniak came, debriefing regarding MI, no root cause he can find. Cholesterol levels are within spec. Mentioned that my being active physically for a long time developed the so called collateral arteries which are normally inactive but when the main arteries are blocked, they opened up and supply blood to the heart as a backup system.  He did not see any permanent damaged per lab works but need to monitor.
1000, Boyboy and Stephanie came.
1100, Rest
1200, Rest
1300, Cardia rehab briefing,
1400, 2 laps in ICU 1MPH pace, Heart Rate=89 but BP=160/100. Failed the test. Funny part, one surgeon yelled, "hey you don’t belong here in ICU, you walk too fast"
1500, Called Samsung Ahmed Ali- 672-1583 inform OK but needed 2 weeks PTO. He promised to arranged my PTO and inform DY.
1600, Mauro left
1700, Britta left with the kids
1800, Sleep
1900, Dinner, Chadd came, talked with Mom and Bebs on the phone.
2000, Rest
2100, Rest
2200, Rest
2300, Mauro came for sleep over
2400, Chat with Mauro
 
20081224, Wednesday (Christmas Eve)
0000, Sleep
0100, Sleep
0200, Sleep
0300, Sleep
0400, 3 hours of sleep. Woke up at 0400 and started a standing up stress test for 2 hours- reading and writing simulating work without sitting down. Ave Heartrate=69, no shorteness of breath and no chest pain. I figured that if I collapse at this moment, I have the full ICU team with me.
0500, Standing up workout, HR=69
0600, Standing up workout, HR=75
0700, Breakfast
0800, Chadd came, Mauro left, breakfast with Britta at the cafeteria. Talked with Mom and Bebs.
0900, First bowel movement post MI, HR=85 steady/stable. Chadd left
1030, 2 laps in ICU walking and my heart rate was 89bpm and BP was 117/70.
1230, Lunch
1300, Rest, waiting for discharge
1400, Dr. Wozniak cleared me to go home.
1500, Arrived home; wear Heart rate monitor, HR=75 Chest Pain PT=0
1600, Barbecue dinner, smokey moos. Hmmmm.
1700, Sleep
1800, Sleep
1900, Sleep
2000, Sleep
2100, Sleep
2200, Sleep
2330, Christmas with the family, Britta Brittney and Brent.