Monday, October 12, 2009

Food Sense 5- Four-bean Vegetarian Chili

When August rolls around, things get hectic. School starts, and that means lots of effort at the college getting things up to speed. Throw in a couple of new staff members, and things really get hectic. Having said that, here’s a recipe with my own twist based on one from a web site I stumbled upon called ProfHacker. What made the original recipe great (and in my opinion, my own version better) is the simplicity. This is literally a “dump it in and walk away” recipe.

Four-bean Vegetarian Chili

2 15oz cans dark red kidney beans
2 15oz cans black beans
2 15oz cans Great Northern or cannellini beans
2 15oz cans pinto beans
2 15oz cans diced tomatoes
1 cup frozen corn
1 medium onion, diced
1 tbsp chili powder
2 tsp garlic powder
2 tsp cinnamon
1 tsp black pepper
Salt to taste
Hot sauce to taste

1. Dump the beans and tomatoes (including all of the liquor in the cans) into a large crock pot. Reserve the frozen corn.
2. Add the onions.
3. Stir in the spices (Note: be careful with the salt; most canned beans have some salt in them).
4. Turn the crock pot on low, and cook until the beans are at the desired consistency. Add the frozen corn 20 minutes before serving.

Nutritional information:
Serving Size 232 g.(one cup) Per Serving: Calories, 74; Calories from Fat, 4; Total Fat, 0.4g; Cholesterol, 0mg; Sodium, 14mg; Total Carbohydrates, 16.9g; Dietary Fiber, 6.8g; Sugars, 4.3g; Protein, 3.9g

Sunday, August 16, 2009

An interesting observation

Friday was college in-service, the day the faculty return to the college where I work. In-service also marks the end of the more casual days of summer, so I was back in a dress shirt and tie for the event. So imagine my surprise when I came out of the shower on Saturday morning and noticed a large bruise on my right forearm.

Now, understand that before all of this, I almost never bruised. However one of the side effects of drugs you take after stents have been placed, like Plavix, is (according to ”…pale skin, easy bruising or bleeding, weakness, fever, and urinating more or less than usual.” On Thursday night my friend Kristopher held an event here in town called Downtown Classic Cinema Under the Stars. Beth and I helped with logistics; after the event we were loading the large screen (20 feet wide) into the truck and I was supporting the heavy cardboard tube around which it was wrapped with my right forearm. It wasn’t until Saturday morning that I noticed it. Make sure to touch base with your healthcare provider, just to keep them in the loop on this.

Tuesday, August 11, 2009

Rehab and the second procedure

I was home on Saturday, May 2 with one of my three blockages corrected. I was sore and pretty slow; when I got home I took an opportunity to look at the site in a full-length mirror. What I saw surprised me: A bruise, the color of black velvet, extending from my midline to my right hip. It looked very much like I was wearing a quarter of a black Speedo. It wasn’t a pretty sight. I haven’t had the body for a Speedo since I spent the summer in the Bahamas during my undergraduate days at the Community College of the Finger Lakes field station.

Over the next few weeks the bruise continued to spread, eventually moving into my upper thigh and beyond the midline. The color moderated somewhat but persisted for at least three weeks into May. At the site of the insertion of the inducer sheath, I had a lump that started out the size of the last segment of my little finger; the lump decreased over time. I knew that I was going back into the operating room in four weeks, so the lump was a concern. The cardiac physician’s assistant told me that the second procedure would be performed from the right side as well, since she said it worked better to go in via the right side from an anatomical perspective, although I haven’t found a clear explanation of why this is so.

When I was being discharged from the hospital, I was told that I would be slotted into cardiac rehab. According to The American Heart Association, “Cardiac rehabilitation is a medically supervised program to help heart patients recover quickly and improve their overall physical, mental and social functioning. The goal is to stabilize, slow or even reverse the progression of cardiovascular disease, thereby reducing the risk of heart disease, another cardiac event or death. Cardiac rehabilitation programs include:

  • Counseling so the patient can understand and manage the disease process
  • Beginning an exercise program
  • Counseling on nutrition
  • Helping the patient modify risk factors such as high blood pressure, smoking, high blood cholesterol, physical inactivity, obesity and diabetes.
  • Providing vocational guidance to enable the patient to return to work
  • Supplying information on physical limitations
  • Lending emotional support
  • Counseling on appropriate use of prescribed medications."

My first rehab session was scheduled about a week before my second procedure, which was due on June 1. I showed up at my session; I brought along some workout clothes because I was told that the rehab folks would do a physical assessment. At the rehab session, the staff took a detailed history and gave me a set of questionnaires to complete. They measured my waist, right below my navel; I measured 46.5 inches. The Heart and Stroke Foundation of Canada showed that men with waist measurements larger than 40 inches (at least for European Caucasian, Sub-Saharan Africans, Eastern Mediterranean, and Middle Eastern men) are at risk for high blood pressure, high blood cholesterol, type-2 diabetes, heart disease and stroke. Not good. They ran me through 10 minutes of exercise on a recumbent bike, and 10 minutes on a treadmill. They set me up for 36 sessions, Monday, Wednesday, and Friday from 8:00-9:00 in the mornings.

Monday morning I showed up for my first rehab session. What struck me was the age difference between me and the other men (by chance, my group was all male) in the group. I was youngest by probably 20 years at least. When you go to rehab, the nurses need to monitor your heart. After all, you were just diagnosed and treated for heart disease. Thus, you wear a battery-powered heart monitor. You stick on three electrodes, one just below your right collarbone, and one each just beneath your rib cage on the left and right sides. The electrode leads snap on to the adhesive electrodes, and you clip the monitor to your waistband. Then during exercise, the rehab nurses monitor your heart rhythm and heart rate.

During a typical rehab session you’ll do several things. Understand that one of the purposes of rehab is to learn about how to safely exercise. Thus, you’ll start out by stretching and warming up with hand weights and then move into some very low-level calisthenics like marching in place. Once you’re warmed up, you start working out. Most rehab facilities have a variety of equipment; mine had recumbent bikes, treadmills, and rowing machines. You work out for 40 minutes (that’s the target, although you’ll work out for less time at first), and then go through a cool-down. Several times while you’re exercising, the nurses will take your blood pressure. All of the measurements during and before exercise (including your weight and resting heart rate) are entered into a computer program to track your progress.

During my first week of rehab, I went Monday and Wednesday. Friday I was scheduled for the second procedure. I was a lot less nervous the second time.

The second procedure went off the same as the first, with two significant differences. First, the bruising at the insertion site was completely different; the bruise was just quarter-sized, and after a few days was barely visible. As I described in this post, the nurses put pressure on the inducer-sheath site with their thumbs, pressing directly down into the soft portion on the front of my pelvis. That left a mammoth bruise. This time, the nurse pinched the site against the ilium or hip bone. The pressure was much less, and there was much less pain. Second, the two remaining blockages were in my right coronary artery; the blockages were about 80% and 90%. When they stented the blockages, I didn't feel a thing, unlike the first time when I had significant pain and shortness of breath. I'd heard of people having "silent" heart attacks; the stenting process reinforced to me just how that was possible.

In the next installment, how to get into an exercise routine.

Sunday, July 19, 2009

Food Sense 4- Lebanese garlic marinated chicken on the grill

Beth and I started a dinner club, a group of friends who get together periodically to enjoy dinner together. Each couple brings one of the courses. The inaugural event had a Mediterranean theme; a Mediterranean diet is quite healthy. As hosts, we prepared the main course. I chose a recipe from The New Mediterranean Diet by Nancy Harmon Jenkins. The chicken was moist and flavorful, and the accompanying garlic sauce was quickly used up, to the disappointment of those assembled. This recipe is dead easy, and well worth it:

Ingredients: 4 garlic cloves, peeled; 1 tsp kosher salt; 1/2c fresh-squeezed lemon juice; 3/4c extra virgin olive oil; 1 tsp sweet paprika; freshly ground black pepper to taste; 2 lbs boneless skinless chicken breasts.

1. Mince the garlic. Then, place in a small bowl and add the salt. Using the back of a spoon, mash the mixture until you have a creamy paste.
2. Add in the lemon juice, olive oil, paprika, and black pepper. Mix well.
3. Dump the chicken into a zip-lock bag, and pour the marinade over the meat. Seal the bag and toss a few times to ensure all of the meat is covered.
4. Refrigerate for at least four hours (longer is better).
5. Grill over medium heat for at least 10 minutes per side.

Nutrition Facts
Serving Size 136 g. Per Serving: Calories, 397; Calories from fat, 258; Total Fat, 28.7g; Saturated Fat, 5.1g; Cholesterol, 101mg; Sodium, 389mg; Total Carbohydrates, 0.6g; Protein, 32.9g

Garlic sauce
This sauce is outstanding. Note that the recipe in the book calls for ladneh, which is a Lebanese soft cheese made by salting yogurt and then letting the whey drain off for 24-36 hours. There are recipes online and in the cook book from which I got the recipe, but I can tell you that the sour cream I substituted should work just fine.

Ingredients: 6 garlic cloves, peeled; 1 tsp kosher salt; 1/3 to 1/2c extra virgin olive oil; 3-4 tbsp low-fat sour cream.

1. Coarsely chop the garlic. Then, place in a small bowl and add the salt. Using the back of a spoon, mash the mixture until you have a creamy paste.
2. Slowly beat in the olive oil, like you were making mayonnaise. If you can do so without the sauce breaking, add the entire amount of olive oil.
3. Gently fold in the sour cream, making sure to fully incorporate it into the sauce.

Nutrition Facts
Serving Size 23 g. Per Serving: Calories, 136; Calories from Fat, 133; Total Fat, 14.8g; Saturated Fat, 2.6g; Cholesterol, 3mg; Sodium, 295mg; Total Carbohydrates, 1.0g; Protein, 0.3g

To complement the main course, I grilled slices of sweet onions, tomatoes, eggplant, and bell pepper, brushed with olive oil. Serve the chicken breasts, and pass the garlic sauce for guests to spoon on top of the meat. Outstanding!

The aftermath and interim

Beth headed home about 8:30, and left me to my own devices. I read for a while and flipped through the TV channels. Once I was allowed up, I went to the bathroom and checked the location. Although the site in my groin was covered by a four-inch square bandage, it was clear that the bruise was going to be a doozy. I finally shut off the lights at 10:00.

Several times during the night, I had the obligatory wake-ups from the nursing staff. Blood pressure checks, meds, and even a blood draw. Finally, I woke up for good at 7:00.

About 9:00 Beth called and told me she was hitting the shower and would leave soon thereafter. About 10:00 I started entertaining a parade of visitors, all getting me ready for departure. First was a dietician, telling me how to eat healthily. She left me with a booklet, which I have yet to open.

Some words about eating: Since my clean stress test in 2002, I’ve monitored my cholesterol and triglycerides aggressively. While somewhat high back then (in 2002, my total cholesterol was 265 versus a target max of 180), it has been below 200 since 2004 and below 180 since 2006. Since 2002, I’ve had my cholesterol checked more than a dozen times. For many years, I have tended toward salads and almost never eat red meat. Chicken and shrimp probably represent the majority of the animal protein I eat. What I have always struggled with is portion control: It’s the old joke about see-food diets… I see food, I eat it. I made a vow to focus on portions, since I was already eating better than many people.

Next up was a cardio-pulmonary rehab nurse. She told me that I would be in rehab, and my local hospital would be contacting me to set up a schedule. This was the first time it really hit me that my life was going to change, and change in a significant way.

Finally, the cardiac physician’s assistant came in. She did an exam to check the puncture site, asked me how I was feeling, did the usual doctor things, and added new prescriptions for me. The final thing she did was to go over the procedure, tell me what was coming (the second procedure on June 1), and then she gave me a “stent card.” Who knew that you’d have to carry a card with you at all times explaining that you had a small tube stuffed inside a coronary artery?

How big is a stent? Do this: Open a typical ballpoint pen. The tube that holds the ink (in slimline pens, at least) is about 3 millimeters in diameter. Now, for the metrically challenged or resistive among you, there are 25 millimeters to an inch (25.4 to be exact), so 3 millimeters is an eighth of an inch for all intents and purposes. Hack off a piece of the pen tube 18 millimeters long (again, about 3/4”). That’s what saved my life; that tiny medical miracle was holding open my widowmaker (the left anterior descending coronary artery). To put in perspective just how small the stent is, see the accompanying photo.

The PA set up a follow-up visit for a couple of weeks away, gave me a slew of literature, and left me to get dressed. Beth showed up, and we headed out of the hospital. I was moving slowly (I was sore), but we headed home. I was told to take it easy (no driving for 48 hours). In the next installment, the joys of cardiac rehab and the second procedure.

Saturday, June 20, 2009

What the doctor found

First, I want to let you know why it’s been a while since the last post: I’ve had a second procedure, which was stacked up on the end of the school term. This blog comes after my day job! Now, what the doctor found.

I was back in the room by 1:30. There was no pain, and I felt pretty mellow (probably due to the sedative injected just before the procedure started). Shortly after getting back into the room, Beth showed up. “The doctor said you had three blockages, but they only fixed one, with a drug-eluting stent. You had a 99% blockage.”


That’s when reality set it. I learned I had a 99% blockage in my left anterior descending (LAD) coronary artery. It’s one of the few coronary arteries with a colloquial nickname (in fact, it’s the only one I’ve ever heard): It’s known as the “widowmaker.” Suddenly, everything that I’d done the weekend before to try to make the angina return came rushing back. Plus, all of the times I’d been winded over the past winter running the snowblower. And all of the hours I’d spent at the YMCA on the treadmill at 3 miles per hour on a 12% grade. With a 99% blockage, I was (as Daughter said to Beth) walking around with a time bomb in my chest.

I’ve read about people coming face-to-face with their own mortality. This was my moment.

Once I swallowed that, I learned more. The procedure showed two more blockages, both in my right coronary artery. The doctor estimated those at around 75% and 85%. The reason those weren’t fixed right away was due to caution on the medical team’s part: The molecule that makes up the dye is large and difficult for the kidneys to excrete. Fixing the other two would have meant pumping in more dye, which may have stressed the kidneys. Thus, the team decided to come back in later to fix the remaining two blockages.

Up to this point, the procedure had been relatively painless. What lay ahead was six hours flat on my back, on a hospital gurney with no movement of my right leg. While I was alone, I explored my groin area and was surprised to find a piece of plastic sticking out; I had found the introducer sheath (if you’re into such things, you might check out this web site for pictures. I’m not sure it’s the exact device used, but it gives you the idea what an introducer sheath looks like, courtesy of Gore Medical). Because home was an hour away from the hospital, I also learned that I would be spending the night in the hospital.

Those six hours were awful. I’m a big guy (as I noted in an earlier post, almost 280 pounds at the time), and six hours flat on your back without even a pillow was very painful. The medical team was good, and provided medications to ease the pain, but those six hours were the worst part of the whole process.

At about 4:30, the nurses came in and asked Beth to leave for a while; the plan was to remove the introducer sheath. After getting all sterile, the nurses exposed my groin. They explained that they would remove the device, then apply direct pressure to stop the bleeding. After some tugging and pulling, the first nurse told me, “This is going to be uncomfortable.” This turned out to be an understatement.

She took her two thumbs and leaned hard into my groin. It felt as if she was trying to make a dent in the mattress by pushing through me from the top. When she got tired, the other nurse stepped in. This continued for what seemed like an eternity, although it was just 40 minutes or so. At the end, they slapped a bandage on it, covered me up, warned me not to move, and brought Beth in. We talked, I dozed, and we waited. I was in quite a bit of pain, not from the procedure but from being flat on my back for hours. Around 6:00 they told me my room was ready, and we headed out.

In the room, they transferred me to the bed from the gurney, again admonishing me to not move my leg. I felt bad for the nurses and medical staff, having to slide more than an eighth of a ton from the gurney to the bed. But the bed was such a relief after the hard gurney; the mattress was soft and supportive.

Once we were in the room, Beth took control. By this time I was coming up on 24 hours without food, since I had been instructed to fast after 7:00 the night before. In short order, a tray appeared. Have you ever tried to eat dinner when you’re flat on your back? It’s a lot easier when you have a loving spouse who feeds you (thanks!).

By 8:00 PM, the nurse came in to raise me into a sitting position. Soon thereafter, I sent Beth home to sleep in our own bed while I spent the night at the hospital. At 9:45, more than eight hours after the procedure I was finally allowed out of bed. I was sore, but it felt good to get up. In the next installment, the aftermath and interim.

Thursday, June 4, 2009

Mea Culpa

Just a quick post to let you know that I will be posting new material soon. I was pretty busy over the past week, a you'll read about in an upcoming post.

Sunday, May 24, 2009

Food Sense 3- Bulking up with rice

One of the best ways in my experience to get a feeling of fullness is to eat bulky foods. White and brown rice work well: One cup of rice (a lot... trust me) contains around 240 calories with just 4 from fat.

Many "instant" rices suffer from the same problems as other prepared foods: A lot of sodium and other additives. But regular rice can take a long time (up to an hour) to prepare if you follow the directions. While I love rice, I often skipped making it because of the time. But now I've found a solution. In How to Eat Supper, an outstanding book by Lynne Rossetto Kasper, she presents a recipe called "Dumbed Down Rice". With it, you'll have rice prepared in the time it takes you to make the food to go with it.

The process is simple: You treat the rice like pasta. Here's the process:

1. Bring 3 quarts of water to boil (salt the water lightly).
2. Add one cup of white long-grain rice.
3. Boil for 8-10 minutes, stirring on occasion.
4. Dump the pot into a colander, then turn the rice back into the pot. Make sure to take the pot off of the burner.
5. Cover the pot and let the rice rest for 5 minutes. Fluff and serve.

I was amazed at how nicely the rice turned out, and as a consequence I'll make rice much more frequently. Buy this book!

Monday, May 18, 2009

The Procedure Begins

I had to fast after midnight. I woke up Friday morning and wandered around the house. I was nervous, but Beth helped keep me grounded. We had to be on site about 50 miles north at 9:30, so we headed out about 8:00. We stopped for gas, Beth picked up some coffee, and we got on the road. Shortly after 9:00, we pulled into the lot and headed inside.

I’ve been in a lot of hospitals in my day. I have to say that this was one of the nicest I’ve ever been in. The outpatient heart institute had a large, comfortable waiting area complete with a large waterfall. We checked in and took a seat.

Shortly after, a nurse came out; when we checked in, the volunteer assistant noted where we sat, so the nurse walked directly up to us. I hugged Beth, and she was told that she could come in to join me in a few minutes. The nurse and I walked back into the outpatient cardiology suite; she did the obligatory weigh-in (278.1 pounds) and took me to a small room. The room had a bed, a nightstand, a chair, and a wall full of medical gear. One whole wall was a sliding glass door. They had me strip down and put on that most comfortable of items, the hospital gown. I swear the person with the highest self esteem in the world would lose it with his or her nether regions catching the breeze from the non-closing flap in those things.

I climbed into bed and settled down to wait. The nurse returned and started an IV. It wasn’t without some excitement; one of my veins kept rolling and all that ended up happening was copious bleeding. She gave up on that one (she apologized profusely) and popped the IV into the other wrist. My blood pressure was high (170 over something), but I put it off to white coat syndrome. Twelve chest electrodes for my EKG, and then I settled in. Beth came in, and we started to wait.

While waiting, we talked, answered the occasional medical history question, and chatted. I was still nervous, but time passed. After about an hour, I had a couple of visitors: Two folks from the research arm of the hospital briefed me on a study that was running in the unit. The hospital was participating in research on a new stent, and the two asked if I would be interested in participating in the study if I was a candidate. The benefit to me? As part of the study one of the necessary drugs would be partially covered each month, for years. They left and Beth and I discussed whether or not to participate. For me it was easy, because in a previous life I was a research scientist. The two researchers returned and I consented (it took a fourteen-page consent form, which is hard to initial when you’re right-handed and have an IV hanging out of the back of your wrist).

The interventional cardiologist stopped in and briefed us on the process; he was straightforward and put us at ease. He answered our questions and then headed back into the procedure room.

Time dragged on; there were some procedures that took longer than anticipated before me. As an added bonus, the nurse popped in a video for us to watch on heart catheterizations; I was surprised that was never put up for an Emmy. Finally about 12:15 they chased Beth out, and got me ready to go. About 12:30, the team came in and wheeled me into the suite. It was time.

Wednesday, May 13, 2009

The Cardiologist: First Verse

When I called Beth I used the same "successful" dorky guy “if-I-tell-you-something-do-you-promise-not-to-freak-out” approach. “Honey? The doctor called. She wants me to come in now and see the cardiologist.” This was just as successful as the first time I used it. I could tell she was worried; I told her “It’s going to be OK… I’ll see you in the lobby of the hospital.”

I was nervous driving to the hospital, but I still kept telling myself that things were going to be fine. The bigger part of me characterized it as whistling past the graveyard, but I kept up the mantra: It’s going to be fine. It’s going to be fine. It’s going to be fine. I pulled into the parking lot, locked up the car, and walked inside. Since Beth works four blocks away, she was there already. When I saw her I could tell she was scared and nervous, so I put my arm around her and tried to be strong. Inside, I felt the same way that she did.

We took the elevator up to the top floor and headed to the cardiologist’s office. Within minutes, we were ushered into the exam room and the nurse started taking my history. I tried to keep a stiff demeanor, because I knew that if I let down my guard I’d lose it myself.

Soon enough, the doctor came in. He had enough age on him to make me feel comfortable. He seemed to be my age or a bit older, so that meant he had experience. It’s not like you say to yourself, “Hey. I want to be a cardiologist” and head off to med school in your late forties. He didn’t pull any punches; he asked why I was there and what my symptoms had been. I recited the litany again, and I kept telling myself “You’re just fat.”

The doctor disabused me of that: “You have some blockages. We need to do an angiogram.”

While I was wrestling with that, he went on: “There are three things that can happen. We can go in, find out that the stress test was completely wrong and you have no blockages. We can go in, find out that you have major blockages and immediately perform emergency bypass surgery. Those are the two extremes. Or, most likely, we’ll go in and find out that you have blockages and we’ll fix them right there either with angioplasty or stents.”

Lots of things went through my mind: I’ve taken statin drugs for years. My cholesterol has been good. My LDL and HDL have been good. I had a clean stress test seven years ago. How could this be? The fact was, it probably was what the doctor said.

Now for the vagaries of the healthcare system: Last year, my employer made us an offer. Choose a narrow provider network, and we’d get a reduction in our insurance costs. After discussion, Beth and I decided it made good sense. As I sat there trying to wrap my head around all of this, it suddenly occurred to me that this doctor (who I had grown to like in the short time we spent together) was outside of my narrow network. The doctor who had referred me to him had referred me out of network.

As an aside, we live in a rural area of Wisconsin. The joke is, we’re 100 miles from everywhere: Madison, Eau Claire, La Crosse, Appleton, Green Bay. But we’re blessed to have multiple world-class hospitals within easy driving distance. In one town, we have a major research hospital with another large hospital right next door; in a town of 30,000 there are more than 1,000 doctors. Nearly the same distance north, there’s another hospital that was ranked in the top 50 in the US recently. The hospital to the north is in my network, and this doctor was from the other hospital. When this dawned on me I put the brakes on and asked the doc if I could call my insurance carrier. He stepped out, and the nurse helped me dial out.

Bottom line: If I went with this doctor, my deductable would double and insurance would only cover 80% of the cost. After discussion, Beth and I decided that as much as we liked this doctor, we had to stay in network (we were scared about the cost of the procedure, and as it turned out, rightly so). When he came back in, I explained and he understood completely. I asked him for a recommendation and he gave us the name of one of his former students at the hospital to the north.

Before we left, the doctor told us about his wife. She had started a kitchen store and cooking school in the town where his hospital was. She focused on the Mediterranean diet, and had great success working with patients trying to move to a healthier lifestyle. This doctor was the one who told Beth and me that we needed to come home, turn on some music, and make food together. This has been some of the best advice either of us have even been given.

We left the office, crossed over to our family doctor’s office, and got the number for the in-network cardiologist. We called and they told us to expect a call; they wanted to schedule the angiogram for Thursday or Friday. So, we did what we often do: Instead of going home, we went to our friend’s wine bar and had a glass to calm our nerves. We came home to a message, and at 7:00 AM on Thursday morning I called. We scheduled the angiogram for 9:30 on Friday morning.

Next: The procedure begins. Plus, some good recipes we’ve found just following doctor’s orders.

Saturday, May 9, 2009

Reality Rears its Ugly Head

Day 2 of the stress test was a walk in the park compared to the first day, but without the walk. In this type of stress test, on day 2 the technicians image your heart at rest as a comparison to the imaging that was done on day 1 when your heart was under load.

I showed up at the imaging department at 10:00 AM. The nurse injected me with the thallium, gave me a glass of milk, and told me to come back in an hour. I headed to the coffee shop in the hospital (giving the cafeteria in the place wide berth based on my experience from the day before), grabbed a cup of coffee and a glass of milk, and started killing time.

As an aside, Beth bought me an HP netbook with a solid-state drive for my fiftieth birthday. I love that thing! With public wi-fi in the coffee shop, the hour went quickly. I checked email, worked on the online class I was teaching, and did some more reading on angina. Then, I headed back to the imaging department.

Day 2 of the imaging was the same as the first day: You lie down on a table and hold your hands and arms above your head. The table has a strap to hang on to; keeping your arms out of the way gives the imaging head of the unit (which looks almost exactly like an open suitcase) a clear shot at your internal bits. If I had more sense (or been in less of a state of denial), I probably would have brooded. However, yours truly was fat and happy, so I dozed, did breathing exercises, and waited for the process to finish.

At the end of the 16 minutes, I headed out of the hospital. Since it was nearly 11:30, I decided to grab lunch so I headed to a hut that served pizza to eat a salad and a couple of slices. That done, I went back to the office. When the stress test was set up, I made an appointment with my personal physician for Friday morning to go over the stress test.

Several hours later, at work, the phone rang. You hear about times when everything changed? This was mine. The doctor who had ordered the stress test was on the line. She said, “The cardiologist is in the clinic. Could you please come in now?” I gathered myself together, called Beth, and we headed to the hospital. After that, things started happening fast.

Next up, the cardiologist and the vagaries of the healthcare insurance system.

Friday, May 8, 2009

Food Sense 2- Black bean croquettes and fresh salsa

The first cardiologist I met with turned out to be out of my healthcare network (more on how I started up with him later), but he gave Beth and me some great advice: Make time together for dinner. He told us that dinner was a time for us to wind down, have a glass of wine, and prepare the meal. What great advice!

Neither of us realized how wonderful it would be to break our routine and actively do something together at the end of the day like cooking. For us, it’s hard not to smile and have fun when you’re cooking and talking. This is the first recipe we made under doctor’s orders. This recipe came from Food Network’s site, although I’ve made a few modifications:

Black Bean Croquettes with fresh salsa
4 servings

Make the Salsa
Salsa is one of the easiest, quickest, most flavorful things you can make:
Ingredients: 1 lb. grape tomatoes, 2 green onions, 6-10 sprigs of fresh cilantro, salt and chipotle pepper powder
1. Coarsely chop 2 cups of tomatoes. For more sweetness use grape tomatoes, although regular tomatoes would work as well. You can pulse the tomatoes in a food processor; don’t over-process the tomatoes or you’ll end up with sauce. You want to see recognizable chunks of tomato.
2. Thinly slice 2 green onions, both the green and white parts.
3. Finely chop the cilantro sprigs
4. Combine the ingredients from the first three steps. Add chipotle pepper powder to taste (I used about 1 tsp measured by eye), and a pinch of kosher salt. Refrigerate.

Make the Croquettes
Ingredients: 2 15-oz cans of black beans, 1 tsp chipotle pepper powder (divided), 1 c frozen corn, 1/2 c bread crumbs (divided), 1 tbsp extra virgin olive oil, 1 ripe avocado
1. Preheat the oven to 375.
2. Open and drain the black beans. Pour the beans into a bowl, add half of the chipotle pepper powder, and mash until the beans are smooth.
3. Work half of the breadcrumbs into the bean mixture, and add the corn.
4. Mix in half of the fresh salsa you made.
5. Combine the remaining breadcrumbs, chipotle pepper powder, and the olive oil in a small bowl until the breadcrumbs are completely integrated with the oil.
6. Take the bean mixture and press into a half-cup measuring cup. Take the mixture from the measuring cup and form it into a ball. You should get about eight croquettes.
7. Take each ball and roll lightly in the bowl of crumbs until it has a light coating of crumbs. Place the croquette on a baking sheet sprayed with low-fat cooking spray.
8. Bake until heated through and the breadcrumbs are golden-brown, about 20 minutes.
9. While baking, stir the chopped avocado into the remaining salsa.
10. One serving equals 2 croquettes and a half-cup of salsa.
Per serving: 400 cals, 12g fat (2g sat), 61g carbs, cholesterol 0g, fiber 16g

Thursday, May 7, 2009

The Active Stress Test

I’m an early riser: I’m usually awake by 5:00 AM and sometimes even earlier. On Tuesday morning I had to be at the hospital for the first part of my stress test at 7:00, and I was up quite early. My doctor scheduled me for a thallium stress test, which would take place over two days.

The first day of the test would take place under exercise; they essentially stand you on a treadmill and work your heart rate up, then inject a nuclear material into your bloodstream. Afterward, they take pictures of your heart to see where the material was taken up by the muscle. The second day was similar, without the exercise: An injection, a wait for the material to be taken up, and pictures at rest.

I showed up at the hospital at 7:00 AM. I had been on caffeine restriction for the previous 24 hours, to ensure that the test wasn’t influenced by that drug most of us crave and subsist on. I only fell off the wagon once; I brought in doughnuts for my staff and somehow a chocolate-covered cake doughnut leaped into my mouth of its own accord (healthy, eh?) but that was at 8:15 AM the day before so I figured I was safe.

They had me change into workout clothes, popped on a slew of electrocardiogram (ECG) leads (12, in fact), a blood-pressure cuff, and then we waited for the doctor. The ECG leads are a pain for me, as I’m a rather hirsute guy; the tech whipped out a set of electric clippers and made some dandy racing stripes for me. Classy. The respiratory technician said a 9-minute test would be a long one, so I set my sights on that.

The doctor showed up and we started the test. At first, walking was slow and easy, about 2.5 mph and a slight grade. Every three minutes, the treadmill sped up and the incline increased. At my weight (a bit more than an eighth of a ton… Do the math) and age, they were trying to get me to 150 beats per minute. At six minutes, the treadmill went to 3.4 mph and a 14.5 percent grade. Still, I kept working; my heart rate was 154. Then, near the end of the 9 minutes the nuclear medicine tech showed up, opened up his little lead-lined carrying case, and pulled out the syringe. A few seconds later, I had a glow about me. They kept me working hard for another minute, to get the tracer through my entire system. Then they moved the treadmill into a cool-down mode.

After the workout, they made me drink a couple of glasses of whole-fat milk (fat helps increase the uptake of the thallium), and scheduled me to report to the imaging department in an hour. In the meantime, they told me to go eat (the fattier, the better they told me: Something I don’t expect to hear any more any time soon!).

I went to the hospital cafeteria. Not being a big fan of cafeteria food, I can honestly say the experience didn’t change my opinion. My meal? An omelet, a bowl of oatmeal, and another glass of milk. The omelet was right up there with the worst I’ve had (and I’m a foodie, mind you); when I first saw it I thought it was a taco of some sort. I had that corn-meally look, and about the same size as an Ortega shell. The oatmeal approximated school paste from my elementary days, and wasn’t much better. But I ate it all, just to kill time.

I showed up to the imaging lab, and they laid me down on the table. The process took 16 minutes. The test works by looking for where the thallium was taken up by the heart muscle: No thallium means reduced blood flow to that part of the heart. From reduced blood flow, the doctors deduce that there is a blockage somewhere in the web of arteries that supply the heart. A good overview of the test and a picture can be found here:

After the test they sent me on my way. None of the technicians would tell me anything; since they’re not doctors they’re not qualified to perform diagnosis. So I went blithely back to work, thinking I was fine. The dialog went like this:

Me: Hey, that went ok. I mean, I’m fat and all, but I made 9 minutes.

Me2: Yeah, there’s that.

Me: And no chest pain. That’s got to be a good sign.

Me2: Yeah.

Me: So it’s got to be anxiety. See, I was worried about nothing.

In the next post, reality rears its ugly head. Plus, a healthy recipe that was really good.

Tuesday, May 5, 2009

The Doctor Visit

I went to the doctor’s appointment on Wednesday. I had convinced myself that it was anxiety (I’ve had anxiety attacks before), and the doctor would tell me that I had been worrying for nothing. What I got was something else.

But first, some background. I have a family history; my father had his first heart attack at age 45, ended up on permanent disability, and died at age 54. He died six weeks before my daughter was born, who would have been his first grandchild. It wasn’t a heart attack that killed him. Rather, he died from a ruptured aneurysm on his abdominal aorta. The aorta is a huge vessel, about the size of your thumb. The University of Maryland Medical Center web site says “Many patients do not even survive long enough to make it to the hospital, and among those who do, more than half eventually die of complications. In fact, ruptured aortic aneurysm[s] are the 13th leading cause of death in the US…” (Source: Back in 1988 when my father died there wasn’t a good treatment for abdominal aortic aneurysms (AAA), so he never had bypass surgery; it was simply too risky.

Because of this history, I had been aggressively treating my cholesterol and getting screened for AAA, both of which have hereditary components. I have an annual physical, I’ve had a couple of stress tests before (both clean), I've had an abdominal ultrasound to check for AAA, and my blood work numbers were pretty good (target numbers are in parentheses):

Total cholesterol: 159 mg/dl (110-200)
Triglyceride: 189 mg/dl (38-150)
Good cholesterol (HDL): 43 mg/dl (60+)
Bad cholesterol (LDL): 78 mg/dl (0-100)

All this lulled me into a false sense of security: How could it be anything but anxiety when I had numbers like these and I was taking statin drugs?

Blood work at the doctor’s visit showed that I hadn’t had a heart attack or pulmonary blood clots; the doctor diagnosed me as having “exercise-induced angina” and scheduled me for a stress test the next week. The stress test involved two days of tests, first under exercise and then at rest. I went through the weekend convinced that it was anxiety, bolstered by the fact that I tried to induce the angina over the next few days without success (in hindsight, this was kind of like the old Bugs Bunny cartoons where a character bangs a cannon shell with a hammer... But more on that later).

I will also post recipes here as Beth and I try to get back into healthier eating. Only good stuff... If a recipe doesn't make the grade (we're foodies, you know!) it won't be in here. And in the next installment, the test.

Monday, May 4, 2009

Food Sense 1- Eating out

On Sunday Beth and I went out to do what people do, putzing around the shopping area about 15 miles from where we live. We decided to stop for lunch.

Now, being on a healthy eating kick for some reason, I flipped to the "Guiltless Grill" section of a mid-priced family place. Emblazoned across the top of the section was copy that screamed "...All items are under 750 calories, 25 grams of fat and 8 grams of saturated fat...". I have a love of vegetables, so of course I locked on to the black bean burger with a side of seasonal vegetables. It was good.

When I got home, I added it to my food log: Surprise! The black bean burger was the most calorie-dense main-course selection in that section of the menu, with more than three times the calorie load of the least calorie-dense menu entry (609 calories for my choice, versus 199 for the other).

Lesson: When you're on your way to correcting a lifetime of bad habits to mitigate coronary artery disease, do your homework before eating out. It's hard enough!

Sunday, May 3, 2009

Welcome to Dodging the Bullet


I've been thinking about blogging for a while. I'm a successful guy, with a couple of master's degrees and a doctorate. I have a great wife and daughter, a small but dedicated and fun-loving group of friends, and a job I love at a two-year college. So why start blogging, and why the title of this blog? Therein lies a tale, my friends.

In mid-April, I was in Chicago for the annual meeting of our regional accreditor (you education types will know all about that stuff, for the rest of you it won't matter). While rushing down the Magnificent Mile, I found myself very short of breath. A pause, for just a minute, and I was just fine.

Now, once I could have passed off on any number of things: It was cold and rainy, it was after dark and I was in the big city, I missed my own bed, et cetera ad nauseum ad infinitum. But it wasn't just once: It happened the next day, and the next. I drove home after the meeting thinking about it; five hours is a long time to be left to yourself, mulling scenarios over in your brain.

At dinner that night with my wife Beth, I did what I like to think most dorky introverted husbands would do: I botched it.

Me: Honey, do you promise not to freak out if I tell you something?

Beth: (Panic-stricken look on her face, smoke pouring from her ears as I hear the gears working so quickly in her head) WHAT?

You see, three graduate degrees does not a genius make.

So, I told her about the pain, and asked her if she thought I should see the doctor. The final vote: Yes, 2. No, 0.

I called the doctor on Wednesday morning; my regular doctor was off, so I visited another. This blog will be about what I found out, what I learned, and what changes are going on in my life. My hope is that others out there in similar situations will learn from my experience. Stay tuned for more.