Wednesday, July 26, 2017

Coronary Artery Disease, Stents and Improving Maximum Heart Rate


Dale Matson

I previously wrote an article, which may serve as a useful introduction: http://sanjoaquinsoundings.blogspot.com/2017/03/cardiac-stents-dual-antiplatelet.html
I believe there is a lack of understanding in the scientific literature on the extent of the personal devastation brought about by a diagnosis of Coronary Artery Disease (CAD). This is especially true of those like myself who have led competitive and active lives. Much of our lifestyles and even identities are based on being active. The grief, anxiety and occasional depression are difficult to live with especially since there is little good guidance available that can cushion the devastating diagnosis with hope for the future. My following comments are as an individual lay person and I do not recommend anything I have done for anyone else without that person first consulting with their medical specialists. However, I have found my primary care physician to be invaluable as a consultant and for looking at the overall picture. He has also been encouraging.
Yes, there are good recommendations on diet and food, which can be more than fuel. Food can be medicine. I am not convinced by personal research that the usual protocol cocktail of statins, blood pressure medications, and blood thinners save or even prolong lives. For me, it always seems to come down to the fine line between living the most ‘risk free’ life and a quality life. Additionally some measures and medicines may actually endanger lives with bleeding and anemia.
The most important number to me is not my cholesterol LDL or other measures. It is my Safe Maximum Heart Rate. My Maximum heart rate of 110 was set by my cardiologist following my treadmill stress test, which indicated Ischemia even thought I reached the maximum predicted heart rate of 148 (I am 72 years old)
I wanted a definitive test and we decided on an angiogram, which resulted in having drug-eluting stents implanted. Within two weeks I had a severe bleed resulting from the combination of dual antiplatelet therapy (DAT) (Plavix and aspirin) and undiagnosed ulcers. The GI doctor was able to stop the bleeding with hemoglobin of 7 and with antacids was able to keep me from a reoccurrence. He did caution me that I could bleed again.
The long road back began with the anxiety of another possible bleed or a thrombosis in my stents caused by a clot if I stopped the DAT. This anxiety has been severe enough for me to have ‘as needed’ Xanax prescribed by my primary care physician. I believe it has kept me out of the emergency room more than once.
Three Variables I can control
1. Since the stents were inserted, I have lost 17 pounds. I now weigh less than when I completed Hawaii Ironman and the Western States 100 mile endurance run.
2. I continue to build my iron levels with an iron rich diet and iron supplements. My current hemoglobin is up to 12.8 but not optimal. I hope to raise my hemoglobin to about 16. This will allow better oxygen availability.
3.  I intend to incrementally increase the intensity and duration of my exercise to strengthen my heart. This includes cycling, swimming, walking, and weight training. I can do this because I have a “new” maximum heart rate of 120bpm to work with. The cautionary low heart rate guidelines I have been using have actually ‘detrained’ my heart. Much of my exercise will be in the Sierra Nevada Mountains so there will be additional acclimatization. All of this is done wearing a Suunto heart monitor and chest transmitter. I also keep careful records.
            I have places in the mountains I want to get to and photograph. Each place is progressively more difficult with the final destination requiring four days and three nights of backpacking. Of course this is all predicated on discipline, patience and knowing when to back off if necessary. My next scheduled appointment with my cardiologist is set for January of 2018. I don’t think of this as “heart rehabilitation”. I think of it as I have thought about it for the last 30 years, “Training”. I hope this makes sense to others out there like me.  

    

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