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Men and Heart Disease

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John Kelly
Washington Post Columnist
Tuesday, February 19, 2008; 12:00 PM

The Post's John Kelly made a guest appearance from his Oxford sabbatical Tuesday, Feb. 19 at noon ET to discuss his column about men and heart disease in today's Health section.

A transcript follows.

John's previous columns about his heart attack:

Flashing Back to My Face-Off With Mortality (Post, July 17, 2007)

Five Years Later, a Toast to Life (Post, July 17, 2006)

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John Kelly: Greetings from jolly old England. I have a cup of tea by the keyboard, decaf of course. I'm sitting in a lovely Victorian building not far from Oxford's City Centre, overlooking the verdant University Parks. The sun (yes, it comes out occasionally here) is streaming in through the windows. It's nice to be alive.

If you read my little squib in The Post today you know that about six years ago it looked like I might not ever enjoy a sabbatical, unless you count a sabbatical from the irritation of, uh, breathing. In the prime of my life I had a heart attack, something I share with plenty of seemingly healthy folks. "Sudden cardiac death" is what it's called when you don't come back, and it's a pitiless expression that leaves nothing to the imagination.

On some level, my heart attack has been.... No, I won't say it's the best thing that ever happened to me. That would be crazy. But it is a part of who I am now, like being right-handed or having brown hair. And I hope that while it changed my heart in bad ways (that dead muscle never comes back), it changed my outlook in good ones. It's great to be alive and we should treasure each moment we're able to say that.

I must confess that I don't know much about heart attacks beyond the pesky fact that I had one. In the months after my coronary event I did do a lot of reading on the subject--there's a whole genre of literature I call "heart attack porn"--but I am far from an expert. So let me start off with a disclaimer: My comments on this chat are for informational purposes only. The chat is not intended to replace the wise counsel of a qualified medical professional. John Kelly, "John Kelly's Washington," the John Kelly Foundation, "John Kelly: The Musical" and Kellco LLC will not be liable for any direct or indirect damage that may result from usage of this chat. If you experience chest pains, dizziness, shortness of breath, anxiety, nervousness, cold pallor, increased or irregular heartbeat or an impending sense of doom call 911.

Here are some recent articles on heart disease, courtesy of the Guardian, one of the British papers I read: Pollution can bring on heart disease, and even trigger a heart attack. Just one more reason for us all to ride bikes. (As long as we're not riding them in pollution.) And people who have lost weight can keep it off by exercising from 60 to 90 minutes a day
And then there's this bit of research, courtesy of the Onion: Heart disease may be linked to use of the phrase
"Don't skimp on the..."

And on that note, let's go. I'm happy to chat about my own coronary adventures, but please feel free to share your own. If you've had a heart attack, what was it like? If heart disease runs in your family, what are you doing to help beat the odds? Come on, don't skimp on the questions and comments.

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Hartford, Conn.: Hi John. My dad passed away when he was 101. He pretty much ate what he wanted to, didn't smoke and was a very, very, light drinker. hHwever he played tennis every weekend, and usually walked a mile every other day weather permitting, and swam twice a week. At least exercise wise, he was he ahead of his time in understanding exercise and the heart health.

John Kelly: What a wonderful story. It's really pretty simple, isn't it? I remember after my heart attack when I had lost a lot of weight, Gene Weingarten passed me in the hall and said, "How did you do it?" I said I'd been eating less and exercising more. He said, "Wow. That really works, huh?"

These fad diets and weird exercise tools come and go but the basic equation remains: Eat smart and exercise. And yet why do we have so much trouble actually doing that? And I include myself. I've put back some of the weight I lost and while I exercise more, and more regularly, than I did before my coronary, I'm no gym rat. I wish I was more of one.

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Alexandria, Va.: 28-year-old male:

In early January I went to a pulmunologist because I somehow got pneumonia. At this time I had a chest x-ray taken.

Last week, I went for my follow up. At this time, my pulmonologist tells me that after looking at my x-ray, I have a "slightly globular-shaped heart" and that I should be aware of that.

So, as I'm getting worried (and the doctor should get huge negative points for her delivery of this news...making it sound fatal) the doctor proceeds to tell me that I need to monitor my blood pressure and if my blood pressure becomes high then I might have to take medicine to correct that. But, isn't that true with or without a "slightly globular-shaped heart"? My bp is normal now (120/80). And if it ever isn't, isn't that an issue in and of itself?

I'm confused. Why did the doctor tell me all this (seemingly useless) information?

I happen to have a friend who is a radiologist. he looked at the same x-ray and said he didn't notice anything.

Should I just pretend none of this happened and monitor my bp periodically as I would have done anyway?

John Kelly: My first reaction to this is that a pulmonologist is not a cardiologist, so she is not the final word on this. Of course, neither is a radiologist. It's also disappointing that the first doctor didn't convey the information in a way that was useful. You're obviously confused as to what exactly is up. It sounds like this is something you should talk about with your general practitioner. He or she might recommend that you see a proper cardiologist. Good luck!

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John!!!!: Is it really you??? I hope you're enjoying England, but we really need you back here. Hurry back!

John Kelly: Thanks, mate. What have I missed since I've been gone? Is it true that the taxis in D.C. have meters, the public school system's been reformed and we have a new ballpark? Drivers are considerate, the Beltway never gets backed up and teenagers on the Metro offer their seats to little old ladies?

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Washington, D.C.: I want to start exercising, but I get funny chest pains that I cannot tell if they are heart, stomach, digestive or what. They don't occur during exercise, nor do my arms or left side have pains that are precursors of heart attacks. It's just that my chest or the area between my ribs and lower left breast gets tight and feels like air needs to be released or pressure relieved. Any idea or direction?

John Kelly: As I mentioned in my intro, I'm no doctor and thus can't diagnose what's going on. I think any sort of pain or discomfort during exercise is something you should have checked out. Your doctor might recommend a stress test, where they take an EKG or even fancy X-ray-like images of your heart while it's working. That could tell them a lot. Also, not all heart attacks, or heart problems, have the classic heart attack symptoms: the crushing chest pain, the pain in the left arm. It might be something as (relatively) benign as a pulled muscle, but it could be something more serious. Definitely get it checked out.

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North Carolina: My father died at 52 of heart disease. He smoked, ate poorly, didn't exercise (though he wasn't really overweight) and was stressed. I'm now 30 and am trying to do everything I can to avoid problems as I enter middle age. I eat well. Exercise regularly. Get sleep. Never smoked. Don't really drink. Etc. One thing I've wanted to find that I haven't been able to is some kind of health guidebook for men. Something that might have things like what you need to be doing (in terms of checkups) at certain ages. I even asked my doctor, who had no recommendations. Any suggestions?

John Kelly: I'm sorry to hear about your father. It sounds like you're doing all the right things. I don't know of any books that specifically address what sort of checkups to have when. Possibly something from Men's Health magazine? Any other men out there have any suggestions?

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Herndon, Va.: Sounds as though you and I had the same thing -- the dreaded "widowmaker" (LAD blockage). Mine occurred 16 months ago, at age 40. As luck would have it, my wife and kids and I were visiting her parents in Rochester, Minn., so I was treated at the Mayo Clinic. (Good place to have a heart attack if one insists on having one.)

Anyway, I just wanted to put a plug in to any cardiologists out there and recommend something that helped me a great deal, and it was totally by accident. About six or seven weeks after my heart attack, I had my sole episode of chest pain (turned out to be nothing), but to be safe, the doctor had me undergo a nuclear thallium stress test, which involved putting me on a tread mill and really cranking it up. "Surviving" that workout gave me a world of confidence and really changed my post-MI rehab. I really haven't looked back since then.

John Kelly: Yes, that nickname tells you all you need to know about that particular tube of tissue. I was amazed seeing the angiogram how small the arteries on the heart are. Some are bigger than others, but none is what you'd call gargantuan. But your life literally flows through them, and the slightest constriction can really ruin your day.

I am very appreciative of Dr. Laurence Kelley, the cardiologist who happened to be on duty when my ambulance pulled into Washington Adventist Hospital. He was an expert RotoRooter man, cleaning out my blocked artery.

The stress test five weeks later was, well, stressful. I passed it physically, but when a friend told me ahead of time that "They basically try to give you another heart attack" I wondered about the wisdom of the procedure. But it provides vital information. I get one every year now and I actually look forward to it.

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Providence, R.I.: I am afraid, given my husband's diet and lack of exercise, that he is headed for a heart attack some day. I want him to eat better and exercise more, but when I express these concerns to him, his reaction is along the lines of "silly girl, I'm not going to have a heart attack."

Any pointers for how to have this conversation with him in a way that gets through to him?

John Kelly: What a great question. You could print out this chat and leave it for him. I think for many men, myself included before my heart attack, our reaction would be the same as his: It's not gonna happen to me. After my heart attack I started noticing all the obituaries of men in their 30s and 40s who just dropped dead one day. Now, exercising, eating right, being sensible might not have saved every one of them, but surely it would have helped some. You might start by getting him to have a full physical, the sort of thing many men have around 35 or 40. The doctor can deliver the message that you've been giving, but hopefully your husband will listen.

Anyone else have recommendations about how to broach the subject?

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Alexandria, Va.: Yay! John, you've been greatly missed here.

Have you had any difficulty with your diet in London? (I'm thinking specifically of all the fatty foods, like fish and chips, and all the yummy Cadbury chocolate.)

John Kelly: Yes, it's been hard. Some of my trousers (mustn't call them "pants") are a bit tight. The problem isn't so much the food--although when you're used to Giant or Whole Foods, finding your way around a British supermarket takes some practice--but the drink. The British are an amazingly thirsty people and Oxford University seems to run on the fuel of alcohol. I think those are the calories I need to be better about. Of course, I welcome those stories that say moderate drinking can be good for the heart, but just the other day I saw one that said benefits from red wine cease after the first glass and subsequent glasses can be harmful.

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John Kelly: Here are a few web sites for those who are interested in learning more about the ol' ticker:

The Cleveland Clinic
American Heart Association

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Vienna, Va.: Two years ago I was diagnosed with a 90 percent blockage in the LAD and 40 percent in the RD arteries. Thankfully, prior to a heart attack. I now sport two stents. But rarely do three hours go by without me at least thinking about my having heart disease. How did you "cope" with your change in condition?

John Kelly: You know, it was really psychological at first. Yes, I felt beat up--my chest sore, my body beaten up from where they punched into my arterial highway--but that healed fairly quickly. But my mind, that took a bit longer. It freaks you out, confronting your mortality. I had to tell myself that I had been through something really bad but had survived. That was a good thing.

It probably took me a good two years to ratchet back on my heart obsession. I'm reminded every day when I take my beta blocker and my statin, and when I feel the little bottle of nitro rolling around in my pocket (never used, thank goodness), but I don't dwell on it. Eventually you won't either. But it does inform part of our being now. I liken it to having a hobby you didn't really ask for.

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John Kelly: One interesting heart difference between Britain and the U.S. involves aspirin. I was taking 250 milligrams a day back home. It is almost impossible to buy a single pill that large here. I had to see a National Health doctor here about a pulled muscle in my foot and she was horrified. You have to get special dispensation from the pharmacist to get 250 or 300 mgs. They're worried about bleeding. Instead, they dispense it in 75 milligram doses, tiny little pills.

So, for the time being, I've switched to that. According to this story a low dose is as effective as a high dose.

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Anonymous: Your essay in today's Post really resonated with me. I have a similar history of genetic heart disease (great-grandfather died at 56, grandfather died at 56, currently dad is 66, aided no doubt by a triple bypass a decade ago). Now that I have a young son, I really feel that I need to get my act together and try to live healthier, for him more than anyone. I look forward to buying your book. Any thoughts on how the process of writing the book affected you or your views about family?

John Kelly: Ah. I didn't write the book that was excerpted in The Post's Health section today. I just wrote the teensy little sidebar. In fact, my situation is the opposite of that author's. My dad is strong as an ox and I had the heart attack at age 38. But I do hope that I can be an inspiration. I have a friend who says that I had his heart attack for him. In other words, it could have been him, just like it could be any of us, if we don't take care of ourselves.

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Not a heart attack but...: GO TO THE DOCTOR!!!! After about 10 years or so of shooting pain in his shoulders and neck/back we finally talked my dad into seeing a specialist and to give up on his weekly chiropractor visits. To our shock he had a brain tumor which needed to be removed immediately. He is doing well now, although complications persist. While not a heart attack, he had really tempted death by refusing to go to the Dr. and insisting of just going to the Chiropractor when it was obvious he had a serious problem. So whether it is chronic pain that feels like it is just muscle pain, or chest pain or whatever, be smart and go to the Dr.

John Kelly: Whoa. Is it okay for me to point out that going to a chiropractor isn't a substitute for going to a real doctor? I'm a firm believer in going to the doctor when you just don't feel "right." That was one of the main reasons I said to My Lovely Wife "I think I'm having a heart attack." I just didn't feel RIGHT. Listen to your body.

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Philadelphia, Pa.: How much difference does a positive attitude make on one's health? I ask because I have several relatives who are Christian Scientists who never saw a doctor and who lived into their '90s. They told me the secret to long life was to not die, to be positive and live and not worry about death. Has science confirmed some aspects of this type of wisdom?

John Kelly: I think it makes a lot of difference. Science seems to focus more on stress and the detrimental effects it has, as opposed to a positive outlook and the beneficial effects it has. But they're different sides of the same coin. Laboratory tests on monkeys have shown that stress can cause coronary arteries to degrade. Reducing stress is easier said than done--there's nothing more stressful than someone shouting "Relax! Relax!"--but I think it's as important as eating right, getting exercise, taking your medicine and seeing your doctor.

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Richmond, Va.: Salt, salt, salt! There is SO much salt in any prepared food. Why can't food preparers cut back? I do try to cook from scratch as much as a normal active working life allows, but sometimes I'd like to be able to open a can of soup without eating the RDA of sodium for a small country!

John Kelly: Yeah, and have you noticed how awful low- or no-salt foods taste? Soup, especially. Forget the car that gets 300 mpg. Can't someone please invent a tasty low-salt soup?

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Anonymous: Do you think there is something to the idea of "quality" to the type of exercise one gets? I'm trying to get my boyfriend to go for long walks on the weekends with me and the dogs, and he says he gets plenty of exercise at work -- being the IT guy and running around all day full-tilt fixing things. I tell him he needs to have the walk in the park, "isn't it a lovely day and it's great to be alive" type exercise, too.

He's diabetic and overweight and I know that can lead to heart disease. I tell him often I want to have many more years with him, and I would love his company, but nothing seems to sway him!

John Kelly: I think walks like that might help in the stress equation, too. I used to exercise furiously every few days. Now I think that moderate exercise every day is better all around.

You know, another idea is yoga. I took a course as part of my rehab. I was amazed at how hard it was, not in a bad way. It was physically challenging AND relaxing, two things I hadn't thought could go together. Maybe the two of you could sign up for a class.

I should really take it up again. This chat is inspiring me.

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Loudoun County, Va.: John:

I had an MI 5 1/2 years ago. I was by myself in Southwest Virginia had had massive chest/arm/neck pain. I decided to head for home and stop at a hospital if I didn't feel better. I walked into the emergency room in Harrisonburg and got excellent care. About twenty minutes later I went into V-fib and they had to shock me to get me back. That's why you should always call 911 -- don't ever drive yourself.

I was a 30-year smoker and smoked my last one 10 minutes before my heart attack. Quitting was easy, but, then again, I was highly motivated.

Hurry back.

John Kelly: Yes, nothing like death to provide motivation. The week before my heart attack I was hiking on the Isle of Wight. A week before that I was staying in a remote beach in Denmark. I shudder to think what would have happened had my heart flipped out then. As it was, I was at the YMCA, pedaling the exercise bike, when I started to feel extremely lousy. I drove him and slumped into bed. When I explained this to the paramedic he said, "You know, you shouldn't have driven yourself home. We'll pick you up anywhere."

Congratulations on surviving and good luck.

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Arlington, Va.: JK: "the little bottle of nitro rolling around in my pocket"

This is something I've never understood. Presumably you read the same comic books I did, and so you learned that nitroglycerin is a high explosive that has to be handled extremely carefully or else it will go off. How can it be rolling around in your pocket so nonchalantly?

John Kelly: Well, it's highly diluted. It can only blow open little blockages in your arteries, not the door off a safe. In fact, what it does is cause the vessels to expand. It's interesting stuff. A century ago observers noticed that men working in explosives factories had fewer heart attacks than was typical. Breathing in the nitro-laced fumes had that effect. It also gave them tremendous headaches. Or, rather, lack of it did. Once the workers went home their bodies missed the nitro. Many took to rubbing it on their hat bands to continue to get a low dose.

By the way, people also noticed that men in explosives factories had more children than those who didn't. It worked a bit like Viagra, sending blood, um, everywhere.

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McLean, Va.: Hallo John! Regarding alcohol's affect on heart health: Physicians will not recommend even the odd glass, as the chances that a non-drinker will develop a drinking problem or even alcoholism are high enough that the risk outweighs the benefits of the odd glass. Get it? Then explain it to me.

John Kelly: I don't have a problem. I drink. I fall down. No problem.

Alcohol is certainly demonized. Doctors will answer questions about alcohol but you're right, they don't write out prescriptions for it. It's like anything: Too much is bad for you.

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Christian Scientists : Don't smoke or drink caffeine due to religious beliefs, so a lot of that good health is due to substantive choices, not just a positive attitude.

John Kelly: Quitting smoking is the single best thing you can do for your heart. Caffeine seems to go back and forth. Some studies laud it. Others criticize it. I've cut myself off completely, since the whole idea is to reduce the work my heart has to do, not increase it.

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23112: Pay a visit to the Radcliffe Arms in Jericho and have a meal for me. Loved that pub. I'm 34 now and starting (anew) on diet and exercise. I guess it's about time to start thinking about screening for heart disease and other issues. Sigh.

John Kelly: I'll do it. I'm always looking to expand my pub knowledge. Good luck on starting--and keeping to--your healthy ways.

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Rockville, Md.: When does the column come back to Metro?

John Kelly: I'll finish up here in mid-summer and be back at The Post in July. I hope that my column will start up again after I've gotten over my jet lag and flushed all the English toxins out of my system: pasties, sausage rolls, Scotch eggs, chip butties and best bitter. That may require the use of a hyperbaric chamber.

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Asalam alaikum!: JK, my good man! Thanks for popping up, you are sorely missed and I, for one, anxiously await your return to these weekly lovefests.

Did you bring me anything?

John Kelly: Just my good wishes. And the message that hard as it is to quit smoking, start exercising, begin eating right, reduce stress, etc., etc., it's worth it. We all know it, deep down. Don't let it take a heart attack to convince you.

Well that's all for now. Thanks for stopping by today. I may be gone from the newspaper for a while, but I've been blogging away from Oxford. Check out John Kelly's Voxford for a daily dose.

Cheers!

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