My Life After a Heart Attack at 38
nytimes.com
nytimes.com
But now I have kids and they need me in a way I've never felt from anyone before. It's F@#$_ing terrifying because of just how vulnerable I realise I am.
People are having children at older ages these days.
This is why HN is home.
I have some anxiety issues and frequently have mild panic attacks, which can have symptoms similar to heart attacks. I have vasovagal responses triggered by odd and benign things. I also have bad muscle tension in my neck and upper back, which can extend around into my chest. And to top it all off, because I have children, I am often sleep deprived and drink too much caffeine. Heart-related issues are on my mind so frequently that I've almost convinced myself that I'm going to die of a heart attack one day, despite me being in good health.
I spend a lot of time worrying, so if I could share my advice with others: if you are worried, just see a doctor. It's not worth being wrong. One day I had symptoms of a heart attack for hours and went to an urgent care facility and got an EKG and x-ray of my heart. They found nothing, and attributed it to musculoskeletal pain. Considering I've been worrying about my heart for many years prior, those tests gave me a strong sense of relief and allowed me to focus on learning how to control my anxiety without getting into a feedback loop (anxiety -> heart attack symptoms -> more anxiety from worry). I can now calm myself down pretty quickly.
This may seem obvious, but getting extra sleep and cutting out caffeine helps immensely with all of the above symptoms. Easier said than done as a parent whose kids don't even sleep through the night. :)
Get enough to pay your spouses expenses until they are able to get income, pay off your mortgage if applicable, and if you can afford it get enough to cover future college expenses.
Age, health, term-duration depending it will cost you a something on the order of $100-1000 per year. It will cover you to that amount until your term expires, and then it's gone. It's a pure cost - unlike whole life, which seemed to me to be more of a tax reducing strategy for very wealthy people - but you will sleep much, much better.
This is worrying. The habits of doctors can kill. They're not cautious enough. My grand mother was misdiagnosed (not coronary but cardiovascular). My aunt was misdiagnosed and sent home. I had clear cardiovascular issues but got laughed at by half the people I talked to.
Non invasive diagnosis is one the few places where I do want tech to get one or two more decimals of precision.
On this note: WebMD is not a doctor but has the same issue. There's no differentiating between a real emergency issue and a CYA liability one.
They have those online. If you're in your 30s and have a reasonably healthy lifestyle and don't smoke, then your risk of dying from a cardiac event over a ten year period is likely somewhere between 0.25% and 0.5%, depending on how much you exercise and genetic factors.
If anything, Bayesian logic is what leads doctors to ignore signs of heart attacks in young people in the first place.
As an aside, an EKG is not remotely the most important part of diagnosis for myocardial infarction; that's the job of the person taking the history. (Myocardial infarction cannot be diagnosed purely from ECG.)
We need a musk like character to shake the medical diagnosis status quo.
ps: I don't want to spend my life obsessing about monitoring my vitals but I'd still prefer to have the option rather than relying on blind faith.
You first to trust your life and your loved ones to the SpaceX or Tesla of the medical world.
But - disruption! Fake it till you make it!
The cost benefit trade off for additional testing isn't just about dollars spent performing the tests. Its about how many thousands of hours of people's lives will be spent in pointless worry and how many additional people will be made sick or killed by testing Vs the additional people that could be saved by additional testing.
I learned some things from that were never clear before. It’s more about the journey than the goal. I was running on a treadmill and started after recovering from surgery. I started at an 8 minute mile pace and could barely run a mile. My goal was to increase the distance instead of speed and gradually worked up to a 10k (50 mins) 5 days a week. Then I was able to work on speed and resistance here and there. I have asthma and remember running through an attack on one occasion to make my distance goal and break from a performance plateau.
At the time I was eating a lot of fatty, greasy, meaty foods. The foods were heavy and high in cholesterol. I had tried the ketosis diet the summer before and lost 25 pounds, but I was not intentionally practicing any diet at this time I was running.
You don’t achieve performance over night. It’s similar to programming in that it takes practice solving hard problems and listening deeply to your environment. With enough practice and persistence you make goal and are changed as a result.
But this is part of my tone in my above messages. I've seen doctors lie. I did have swollen ankles and hands. When mentioned to them, they'd say "yes that's a cardiovascular issue" just to switch stance the minute after.
They, too, have biases.
Now, people move around more, are less likely to see the same physician for years on end, are less likely to see the same physician as their relatives who may live elsewhere, etc.
I don't know how to fix it, but I think these changes are a very big part of the problem. I don't care how brilliant and dedicated you are, having less overall context is going to undermine your ability to draw accurate conclusions about what's really going on.
But I'm old-ish and I remember when it was pretty normal for Mom to show up with all three kids and a couple of their cousins and get them all treated at the same time. In contrast, in recent years, I routinely hear that people in the family pass the same crud around repeatedly because they get treated as individuals and it leads to recurrent or chronic issues. I've also dealt enough with chronic health stuff that I'm quite confident that when doctors decide "This is your normal. Just get used to it." it becomes self-fulfilling prophecy.
From what I gather, obesity and chronic health issues are vastly more common than they used to be. To my mind, that's probably evidence that something has gone very wrong with our health mental models/practices overall and the change in how we interact with physicians is probably just one grain of sand in a beach of changes. (However, it will also be confounded by medical advances leading to people malingering when, historically, they would have simply died. We often can't cure them, but we can keep them alive longer than we used to.)
But I'm sure that's a case of "Other people won't necessarily see what I see and if they don't, there will be no winning them over." (shrug)
Obesity, perhaps, but chronic health issues? Not really - and a tremendous number of those went untreated. A huge number of people in the past lived with perpetual pain and disabilities.
Because I'm disabled and the internet is a thing, I'm very aware of the existence of people on disability, on multiple meds and not doing much with their lives. Historically, we simply didn't have the resources to support such people.
I'm thinking of those folks -- not simply people living with pain and limitations, but people who historically would have simply died because if it was going to kill you to keep on keeping on, then you were going to die because disability payments, etc, simply did not exist like they do today.
You say this because you are unaware of the risks of overscreening, overtesting and overdiagnosis. Pre-test probability is important to take into consideration. Getting patients worked up over a 0.00001% chance event causes undue stress.
It hurts to quantify it this way, but the pot to fund health care is not bottomless in either a pure public or privately insured system. It needs to be spread across the entire population, and across all of the potential issues an individual may face.
One example: the humble chest X-ray. You may think the main risk is radiation, but IMO you'd be wrong to think that. The main risk is finding something. We call them incidentalomas. You would never have found it if you didn't do the CXR. It would never have caused you worry or morbidity. But now we know it's there, you need to get a lung biopsy. And that leads to a pneumothorax. That leads to a longer stay in hospital. That leads to time off work. You end up with no benefit to a patient who now has less trust in the medical system because they got a pneumothorax for nothing.
A brain aneurysm poses a certain level of risk based on its size and location. So let's say you have an asymptomatic aneurysm with an annual mortality risk of 0.5%.
Now let's say you decide to randomly have a full body MRI and the aneurysm is discovered. A neurosurgeon tells you that you can have an operation to clip or coil the aneurysm with a 10% risk of fatality due to its location. Do you have the op?
Apparently most people do, despite the overall odds of immediate death. A 0.5% annual risk of death would ride most people out to their age of natural death rather than the 10% risk of the op, but people hate having even a tiny risk hanging over their head long term.
As such, there's a school of thought that you shouldn't have such types of screening (or at least to not know the results if they are minor) unless you are symptomatic.
On the other hand it’s ressonable as a patient not to care what it’s like being a doctor, your job as the patient is to be honest, give complete answers, and advocate for yourself. I’m not interested in a public policy perspective as dictated by the realities of insurance company profit, hospital profit, pharmaceutical company and medical device company profit, and so on.
It’s the same thing with letting an intern take their turn with the scalpal. If it’s someone I care about under the knife, I’m making sure the surgeon got enough sleep and no intern or first year resident who’s half asleep touches the person I care about. Arguments that “they have to learn somehow” are reasonable, but so is my reaction that it’s your problem, not mine. I don’t care about how you’re educated, or your burdens except as they impact results.
Life is unfair, utilitarian calculations must be made, but that sets up an adversarial relationship on one level, and only a fool ignores that. You feel free to fight for public policy, I’m fighting for the people I care about, not their doctors. That’s also part of life being unfair.
I've encountered patient advocacy groups who are actively, and passionately, pushing for the wrong thing, that while emotively satisfying, will not help the problem they're trying to solve.
In that last vein, I’ve been in that position. A girlfriend from years ago had a nasty rash on her arm, and a series of dermatologists gave her a series of exams and creams. I did some research and concluded that it was probably an allergic reaction. I talked to her latest dermatologist who agreed it could be that, and I suggested taking s daily allergy pill. It worked.
Sometimes having the time and inclination to do research is more than a busy doctor brings to the table. If you’re skeptical, and understand that cherrypicking symptoms from a list and screaming “oh god it’s a tumor,” is unhelpful, then research is useful.
Have you read much about overtreatment in cardiology? There's currently a minor scandal in the US about unnecessary cardiac procedures being performed. [cardiology overtreatment] is a good Google search term for this.
It's easy, on a message board, to say "I want the extra attention, damn the cost". That's especially true when you just read an article about a "widowmaker heart attack", so that the upside of excess attention is the only thing about the issue that's cognitively available to you. But these procedures can do harm as well as good.
My SO nearly died because she was "too young" to have a thrombophlebitis, yet every signs pointed to that, yet they could have simply tested for it. She not only is incredibly lucky that a better doctor was not too far and heard her complains, she was incredibly lucky that even though it took so long for her to be treated correctly, that she still have her legs.
Maybe over treatment is an issue, maybe cardiology is an inexact science right now and it's impossible to get a good diagnosis. It doesn't change the fact that misdiagnosis is bad and we should do everything we can to improve this, in every side of the coins, including mentioning when doctor just prefer to ignore conditions, because it's unlikely.
A heart attack is not actually your heart stopping. It’s caused by a lack of oxygen to the heart tissue, causing pain and damage. It is often not immediately fatal.
It can lead, sooner or later, to cardiac arrest, which is when your heart stops completely, and often is fatal.
But it also served as a good kick in the behind in terms of taking charge of my life. It motivated me to stop eating like a pig. To get rid of toxic people that were causing me stress. To start exercising and leading a healthy life. In a weird way, the bypass was a blessing in disguise.
So... heart disease can be attributed almost entirely to eating meat? That result seems too good to be true.
As a meat-eater I think the most stupid strawmen vegans hit me with is the belief that I only eat meat. I think very few people advocate "only eating meat" (e.g. recent 0carb hype, which I think is clearly pseudoscience). You can still eat plants but supplement your diet with meat to get more protein and healthy fats. You can still get 75% of your calories from plants but still eat meat. Also, there will be a huge difference between highly processed meat (bacon, salami etc) and unprocessed, grass-fed meat. Studies like this simply ignore all these factors.
Indians have one of the highest rates of heart attacks even though a significant population is purely vegetarian.
I think science has to be focused on biology and science, not social surveys and asking questions to a small bunch of uncontrolled strangers.
Just college kids and mechanical turk penny vacuums
So probably a little predictable
Wait, what's that?
"Participants
This report reviews the outcomes of 198 consecutive nonsmoking patients with multiple comorbidities of hyperlipidemia (n=161), hypertension (n=60), and diabetes (n=23) who voluntarily asked for counseling in plantbased nutrition for disease treatment. These self-selected participants requested consultation after learning about the program through the Internet, the media, prior scientific publications, the senior author’s book (CBE Jr), other authors’ supportive comments, or word of mouth.2,13 A preliminary 25- to 30-minute telephone conversation established disease presentation and severity by eliciting reports of symptoms, history of MI, stress test and angiogram results, interventions undertaken, family history, lipid profile, and the presence of comorbid chronic conditions. In these calls, we outlined the program, established rapport, and documented the need for additional patient information. The Cleveland Clinic Institutional Review Board determined that these were acceptable outcome measurements to evaluate the nutrition program."
"Baseline characteristics of participants are shown in Table 1. (Two patients from the original group of 200 were lost to follow-up.) The remaining 198 participants for whom data were available had CVD, were mostly men (91%), averaged 62.9 years of age, and were followed for an average of 44.2 months (3.7 years). "
Ghee could be part of the cause of that, but I have no idea what to think of saturated fat any more.
Most such research simply monitor the participants' diets through a questionnaire or some indirect mechanism. It's not a scientific, reproducible approach.
I am making a meta-point that such research has started to affect more and more of what we think of as science which is extremely disturbing.
The harder scientific work would be to analyze the effect of specific foods with how the heart works over a much longer epriod of time. Granted that there isn't a way to track or pursue this line of inquiry yet, but taking shortcuts isn't science IMO.
If it's the study I've seen, the improvement can be largely attributed to a tremendous drop in both calories and fat. Instead of their idea of a balanced diet being a bacon double cheeseburger in each hand with a gallon of ice cream for desert, it became rice and legumes and veggies. They shot for keeping fats to no more than 10 percent. They invited participants to dinners so they could experience good tasting, healthy gourmet meals and not feel like this was about deprivation.
Participants dropped tons of weight without trying and without having to try to control themselves. They could eat all they wanted every day and not get enough calories to remain clinically obese.
Downvoters: Please just read the paper.
SFA is now believed to play a much smaller role in CHD than was previously believed while that of sugar, whole grains, and cereal fiber have moved in the opposite direction.
Which is not the same thing as no correlation.
I'm sure it's vastly more complicated than just fat content, but the stuff I've seen indicated that one study of a vegetarian diet as post cardiac therapy explicitly set a goal of keeping fat content down to 10%. Prior to being put on a vegetarian diet, the typical diet of participants was much, much fattier. Participants were just blown away at being able to eat all they wanted for the first time in their lives and lose weight without even trying.
My personal experience: I dropped several dress sizes without intending to by completely ignoring both calories and fat percentage and focusing on consuming nutritionally dense foods to redress known nutrient deficiencies.
So I have absolutely no doubt that it's vastly more complicated. But I tend to get a lot of flak for talking about what I think about diet, the gut biome, medical stuff, etc. So I really wasn't looking to get into that.
I was only looking to add a little more information about such studies. The main takeaway as I understand it: they stopped being obese. There are people who eat meat who are not obese.
Anecdotal, but this is me at the moment on keto. For the first time in my life (I have been obese since 5) I am not ravenously hungry all the time, to the point where I can just eat one meal a day without much struggle. I eat as much as I want now, the only difference is I don't want much at all. Oh, and I can't eat many carbs.
many heart diseases have nothing to do with blood chemistry.
source: i have valves turning to shit and never had a problem with blockages or high cholesterol.
https://www.doylestownhealth.org/dialogue-online/2017/februa...
(No, I am not a doctor.)
Heart attack is tough, especially the first time someone has one:
- The pain is usually dull and can even be subtle
- The pain usually is better with rest and worse with exertion, so you can convince yourself that it was some minor thing that is passing
- The pain is usually not so bad that you'd think you'd have a problem driving, taking the subway, etc.
But, heart attack doesn't kill you via pain. It kills you via arrhythmia, which happens because that ischemic heart tissue is electrically active.
If you have a cardiac arrest from your heart attack and you're in an ambulance, they're going to defibrillate you. If you have a cardiac arrest from your heart attack and you're driving yourself to the hospital, you're going to crash your car and it's unlikely that anyone will figure out what happened in time to defibrillate you.
Now, people who have established angina with known coronary anatomy will get more specific advice from their doctors. But in general, if someone without known disease develops symptoms that sound like a heart attack, they need to be evaluated.
Typical chest pain is on the left side but atypical chest pain often experienced by diabetics or women can be abdominal pain, right sided chest, vague discomfort, or can be completely silent/missed. Sadly not everything behaves exactly the same.
If you're very worried, you're having symptoms, and the EKG comes back reassuring, just ask for a set of cardiac enzymes. However, ED doctors often don't want to get enzymes because it means they have to do it 3x in a row spaced 6-8 hours from each other - so it might get you an observation unit stay.
Anyways, I'm not an ED doctor but I worked in one for a month during residency and I can assure you - there are plenty of providers who are not great at interpreting EKGs. There is pretty high variability in EKG interpretation skill between them. So if someone with weak EKG sensitivity uses that test to screen you out, then that's pretty poor care.
Yet, we don't seem to have anything similar for the human body. How many lives can be saved every year by having a system that grabs some data from your body and has some thresholds for warnings? Something doctors could simply hook into (pull based) or something you could give to a doctor (push based). Some "critical warnings" could call an ambulance straight away.
Do we need more IoT embedded systems to hook to the cloud? Is it a problem with regulation? Physics / biology deterministic measurement?
Most other diseases that killed vast populations at this age have been resolved or worked around, so looks like we are looking at one of the last remaining killer dieases.. would love to strap on Apple Android whatever devices if it will help diagnose or monitor such patterns.
MI (heart attack) can happen at almost any age, but it is rare for it to occur before ~60. "Early-onset" MI is < 50 for men or <60 for women.
38 is extremely young. I know only a couple of folks that young who have had an MI, and I work at a quaternary referral hospital as a cardiology fellow.
My Dad, his brother, and his father all had heart attacks in their late 30's and early 40's. I'm in my early 40's and very concerned.
Should someone with a family history like mine be more aggressive with testing? My family doctor does not think so.
Are there even tests today (like the "CT angiogram") that could detect (and prevent) a person with extreme family history from a 1st heart attack?