Monday, November 06, 2006

Out of the Blue: When You Suddenly Go From Robust Health to Death's Door

I recently suited up for an alumni ice hockey game on the campus of Merrimack College in North Andover, Mass. I played hockey there for four years, graduating way back in 1962.

That's 44 years ago. I wasn't a greybeard then as I am now at left in the photo with a fellow player, Mike Cassidy. I also had hair, a lot of it. Mike still has a lot of hair. Very annoying. Then ice hockey was as natural to me as breathing. Now? Taking to the ice again after all those years? At age 68? Competing with players thirty years younger and more? In an unforgiving sport that demands speed, stamina, reflexes and strong legs and immense lung power?

Was I asking for a heart attack or humiliation or both? The last thing on my mind was a heart attack because I felt in good shape from a full schedule of singles and doubles tennis and a highly physical life. As far as humiliation is concerned, if I made a fool of myself, who cares? Certainly not me.

I won't give you a play by play, except to say that I survived the game. The photo, taken right after the game is proof that I and Mike Cassidy came off the ice under our own power and in one piece. That Mike, 67, was out there at all -- that is, not dead -- was remarkable.

Almost six years before, out of the blue, he had suffered a massive heart attack and had played with three coronary arteries propped open with metal stents. The stents didn't seem to affect his play. He was the same smooth skater that I remembered from those long-ago days. He hustled. He mixed it up. His passes were crisp. He belonged out there.

In an E-mail, Mike described his sudden rendezvous with death:

"Re: my surgery. The heart attack came right out of the blue on Feb 12, 2001. (a day to remember) I had skated in the Friday night before it happened and had never had any ill effects. I had also been running regularly and actually had run 10 marathons in the years before this happened.

"I woke up on the following Monday with chest pains. Judy asked me what was going on and of course (denial) set in. I said I'm ok. I went to take a shower to go to work and when I got in the shower I realized that I wasn't ok. In the meantime she called 911. So, needless to say, the police fire department decended on the house.

"They took me to Beverly Hospital by ambulance. When I got to the ER, they started doing test to see if I was in fact having a heart attack. They administered a clot busting drug to me (I saw a copy of the bill the HMO paid for this medication and it was $16,000) and admitted me.

"I have a friend who is a doctor there and he told me that I would be better off going into Boston. So, I ended up at Beth Israel. The next morning I was second on the list for angioplasty. I can remember the doctor saying that they didn't know if they could get all the blockages.

"They did however and implanted the stents. The implants were the regular old types without the medication. ( Seems like a better choice since they are having a lot of problems with the medicated stents) My EF (ejection factor) had gone down to 30%.

"I spent a week at Beth Israel and then started Rehab shortly after. I was on blood thinners for about 6 months and when my EF got back up they took me off and my doctor said it was ok to start skating again.

"In the meantime, I had started running again and I think that it was a real positive. I still run regularly. Do cross country trail runs during the summer. And that's my tale of woe. Been fine ever since. See the cardiologist every 6 months."

Doesn't sound like a tale of woe to me. Sounds more like a miracle. Mike not only survived the kind of heart attack that kills tens of thousands every year, but he is back playing hockey, running, and leading a normal life. He ended his E-mail by saying that he and his wife, Judy, were going on a 10-day cruise out of Ft. Lauderdale to Jamaica, the Panama Canal, and Costa Rica, among other places.

The fact that Mike Cassidy was a marathon runner before suddenly suffering his near-fatal heart attack is something that should give pause to all us aging athletes. We're a smug, self-satisfied lot. We tend to think that because we regularly play singles tennis or ice hockey are jog up and down hills, we are somehow protected from what happened to Mike.

Well, we aren't. What's more, this has been well established for more than twenty years, ever since runner James F. Fixx, the author of the mega-selling The Complete Book of Running, the book that turned millions of Americans into runners, collapsed while running and died. He was 52. His body was found lying beside a leafy road in Vermont. The date was July 20, 1984.

America was shocked. I know I was. How could a man in seemingly peak condition, who had run 60 to 70 miles a week for 12 years die of a heart attack? The photo is of Jim Fixx running. Wouldn't he have had a powerful heart? Wasn't a heart attack something associated with the sedentary life?

Not necessarily. In the case of Jim Fixx, despite his athletic conditioning, he was actually at high risk for a heart attack. There had been warning signs that he chose to ignore. He had a family history of heart disease before age 55, a potent risk factor. His father had a heart attack at 35 and died of one at 42.

The autopsy also found that he had high blood cholesterol. In those days, this risk factor had yet to be widely recognized as a major risk factor. In addition, he was male and his age of 52 was considered advanced in terms of cardiac risk. Contrary to his super-fit image, Fixx had no less than five major risk factors for a heart attack.

The lifestyle of his earlier years had been like a death wish: heavy smoker -- two packs a day --, overweight, trouble handling stress, poor, high-fat diet. He started running in 1967 at age 35. Ten years later when his book came out, the cover of which showed Fixx's muscled legs in full stride, he was 60 pounds lighter and smoke-free.

The book sold a million copies and set off a new nationwide running craze. Jim Fixx inspired millions. He became a household name, appearing regularly on TV extolling the health benefits of running. Appearing healthy and vigorous, he himself was the living proof to an adoring public.

Yet, unknown to his many fans, the state of Fixx's health was not what it seemed. He experienced periodic throat and chest tightness -- clear warning signals -- which he ignored. He did not go to the doctor. He was urged to get a stress test but declined. He kept his old high-fat diet. He told friends that his daily run was all he needed to stay healthy and avoid his father's fate.

Back to the alumni hockey game at Merrimack College. Mike Cassidy played well with his three stents. He seemed to take the game in stride, without huffing and puffing, and was far from exhausted at the end of the game. No one would ever guess that he was at death's door a few years before.

I held up better than I expected, considering that most of the players out there were twenty and thirty years younger. I was not out of place. With my two titaneum knees, I could still skate with the other players. I could still pass and catch a pass. I could still handle a stick.

I played the entire game. Not only did I not die of a heart attack on the ice, I felt great afterwards. I felt like I had had a great workout, though my teeming army of faithful cells must have howled in unison, "What the hell is he doing? He hasn't done this for 40 years! Quick, send in the reserves! Shit!"

I owe a lot to hockey. It gave me a place in this world as a foster kid and, later, the chance for an education -- with a four-year hockey scholarship to Merrimack College. Funny, after not playing for so many years, how it all comes back. You don't forget how to ride a bicycle.

I quickly felt quite at home out there when I realized I was not going to embarrass myself and that, despite my age, everybody took me as just a hockey player like all the rest. Our team won 7-6 and I scored a goal.

Afterwards, I was presented with the game puck.

"Is this because I dominated out there?" I asked.

"No," I was told, "It's because you are the oldest."

I beat out Mike Cassidy and Jim O'brien, both from the class of '61, for that dubious honor. I graduated in '62 but had worked a year and served two years in the U.S. Army (1956-58) before going to Merrimack College.

"Thanks. Thanks a lot," I said with a hurt look. It reminded me of my old days in publishing when other editors and writers got awards for creative genius and I got them for attendance. A half a century later, I'm still getting attendance awards.

Actually, lacing up the skates and putting on all the equipment and getting out there after all those years and playing a hockey game was a thrill. It was an old man making believe he was a kid. It was utter foolishness -- but packed with joy and meaning.

It was great seeing Mike and Jim O'Brien after all those years. Jim was the one who called me about the game. When I told him that I didn't have any equipment, he said he would scare up some equipment for me. He showed up with a duffel bag of everything I needed. Thanks, Jim for making me an offer I couldn't refuse. (And Jim, you can still skate!)

Mike may be the only person in the world who remembers when we were playing Northeastern at the old Boston Arena and I took a puck in the mouth and lost two front teeth. "I'll never forget it," he said. "There was blood all over the place." And when I asked Mike for details about his heart attack, he came through "under deadline."

Besides making believe that I am still a hockey player, I also live under the delusion that I am still a working writer and editor with important deadlines to meet. This could mean the onset of dementia. Or perhaps -- and I'm hoping for this -- it is no more than a little harmless self-delusion which, by enhancing feelings of self-worth, can actually be helpful to health and longevity.

Delusional or not, recipient of the award for being the oldest instead of MVP, I have a new resolve to keep on living after hearing Mike's story and recalling that of Jim Fixx's.

Now I want to find out if I have arterial blockage that could lead to a sudden heart attack. I have already tried and failed to take part in a university study (WPI) to determine levels of placque build-up.

I am interested in taking a new 15-second heart scan that enables doctors to see where where placque has built up. The scan, just introduced in the Journal of the American Heart Association, is called a multidector computed tomography, or MDCT.

At my next doctor's appointment at the VA -- which is terrific for preventive care -- I'm going to come in armed with information on the MDCT. Considering the experience of Mike Cassidy and the fate of Jim Fixx and my own high cholesterol (see an earlier post), I know that my vigorous exercise, good diet, and steady habits may not be enough to save me from a heart attack.

In fact, a new study presented at an American Heart Association in Chicago has found that competitive exercise, like marathon running (Mike Cassidy take note) may increase the liklihood of a heart attack. Healthy men over 50 who had run at least five marathons in the last five years were more likely to have major calcium deposits in their arteries than healthy men who did not run as much. Calcium build-up is a sign that arteries are hardening, even when there is a lack of symptoms.

The study was conducted by Dr. Stefan Mohlenkamp, a cardiologist at University Clinic in Essen, Germany. Dr. Mohlenkamp, himself a marathoner who runs 12 miles a week, got the idea for the study after learning about some healthy older male runners who had heart attacks when running marathons.

In his study of 108 older marathon runners, Dr. Mohlenkamp found that 36% had coronary artery calcium scores above 100. A score above 100 is possibly a sign of increased cardiovascular risk. As a runner and physician, he was surpised that long-distance running may pose heart risks. A follow-up study is planned.

Note to Mike Cassidy: Could you please get your calcium level checked and get back to me? I think it's important that you do this for your own peace of mind. Also, because I have an important deadline to meet, could you please get your calcium score to me ASAP?

So long and keep moving.

E-Books by George Pollock

"State Kid: Hero of Literacy" is fiction based on his  real-life experiences  growing up in foster homes; "Last Laughs," is the true story of how five foster kids (he and four younger siblings) found their way in life and each other. "Killers: Surprises in a Maximum Security Prison," is the story of his being locked up for 23 hours with killers in a maximum security prison;  "I, Cadaver" is about his postmortem adventures and mischief in the anatomy lab at UMass Medical School. “A Beautiful Story” demonstrates the art and process of creative writing as a 16-year-old boy goes all out to write a story that literally saves his life;  "A Long, Happy, Healthy Life," which is about how to live the title every day; and "Unlove Story," Writing anonymously as "Elvis," a husband, dumped after 38 years of marriage, lets it all out on love, marriage, life, everything. A guy doing this? Unheard of.