(The Angina Monologues, part 4)

The place I work at, the American Speech-Language-Hearing Association, was just annouced as one of the top 25 best small companies (defined as under 500 employees, I think) to work for in the U.S. It had already garnered the distinction of being one of the best places to work in the Washington metropolitan region two times running from Washingtonian magazine. How does it do it? Not through pay scale--the human resources department makes no secret of the fact that pay is tied to the "50th percentile" of the region. That is, for a similar position in the Washington area, half of your peers make more than you do, while half make less. No, it's the benefits that make people want to stay with ASHA. Benefits like "casual dress" during the entire summer (unless you need to meet with outside people), once a month gatherings with catered food like pizza or bagels or ice cream (just yesterday, actually), flexible workplace and worktime, and a compressed work week (work longer hours for 9 days out of 10 to get that tenth day off). Lately, one of the benefits was a health fare where you had the opportunity to have your blood pressure tested, an analysis of your body fat, and a test of your flexibility. They also handed out pedometers and had people sign up for the "Step Challenge": every time you walk 10,000 steps in one day you can enter your name into a drawing for a $25 gift certificate at a local outdoor retailer. As someone who has difficulty with a regular exercise regime, even a moderate inducement that can make it more like a game is good enough for me to actually start thinking walking is more than something you do to get from point A to point B.

Following my cardiac catherization procedure, the attending cardiologist told Jill that he didn't want me to become "vegetable man" and encouraged her to make sure I got some exercise. But in follow-up meetings with my consulting cardiologist and primary care physician, I was warned not to exercise in such a way that aggravated my angina symptoms such as playing tennis as I had been doing in the month before my procedure. The fear is that stressing the blocked arteries feeding my heart might break some of the plaque build-up from the walls of the blood vessels and cause a 100% blockage somewhere, precipitating a stroke. As this was an event not to be desired, I've been somewhat cautious in the past three months, being much more aware of when my body was telling me that it needed more blood than the heart was providing. I discovered that I would get angina symptoms often directly after a meal with any exertion more than an ambling walk and proceeded to change my habits, trying to avoid situations where I knew there was a possibility for pain. I did start playing tennis again, modifying my game to reduce the amount of chasing around the court (particularly avoiding the net game I had been fond of before) in favor of a baseline game.

But my main exercise has been simply walking: to and from the Metro to work and home. When I strapped on the pedometer, I thought for sure that my normal walking would add up to an easy 10,000 steps. The first week didn't, but that was because Jill had been out of town and I had been driving to work. When she got back, then I would be blowing out the little digital device. Except I didn't. The walk to work from the Metro was around 1,000 steps; to home from the Metro was only 2,500. So, unless I did some major walking around the building during the day or walked somewhere for lunch, my normal steps in a day barely made 6,000 steps.

This has prompted more nightly walks made only slightly more tolerable through the judicious application of the iPod and the fairly level surface of the quadrangle at American University. Simply exercising for exercising's sake is probably my least favorite thing to do, unfortunately, and I might have to figure out some new inducements to keep up with this.

On the other hand, it seems to be paying off in conjunction with the extreme dosages of medicine that have been prescribed for me. My consulting cardiologist, Manuel Cerqueira, took a new position in Ohio, so my primary care physician referred me to a new one, Ramin Oskoui, who just happens to be in the same building as my PCP and extremely convenient to our home. I had my first meeting with Dr. Oskoui this past week. He greeted me with the statement that mine was an interesting case and an apology for saying the same: "It's better to be an interesting person than an interesting case, and I'm sure you are." Although he had obtained the narratives from Dr. Cerqueira, he was concerned about trying to treat my angina through solely medical means and asked if I was willing to redo the treadmill stress test and undergo an echocardiogram to determine if any progress was being made.

An echocardiogram (which may not be the exact term for it) is basically a sonogram for your heart. Laying on my side, I could turn my head and watch the triangular-shaped black-and-white video of my heart beating. (As my buddy Matt said when I told him about this afterwards, "Look, it's a boy!" in reference to the more-oft utilization of the technology for watching a fetus in the womb.) After getting an "at rest" baseline, I moved to the treadmill and did the Bruce three-phase test. Surprisingly, compared to the last time I did it, I was able to make it through the entire test, albeit somewhat winded during the latter minute, with only a minor level of angina discomfort in phase three. Dr. Oskoui was surprised, I think, but also delighted. After taking the "stressed" sonograms, he informed me that the fact that I was able to get through the entire test meant that I had already moved into the "low risk" category for "an event" (i.e., heart attack). I'm assuming he didn't mean "lowest risk" but "low risk for someone with heart disease."

My cholesterol is down from its high a year ago of a total of 400 to a total of 193, 113 of that which is the LDL cholesterol. Both Dr. McBreen and Dr. Oskoui want to bring that LDL number down to under 80, so I'm using a new drug called Zetia in combination with the Lipitor (currently at 60mg per day). Dr. Oskoui prescribed an additional drug, Welchol, to be taken 30 minutes before lunch and dinner that, if I understood him correctly, binds to the cholesterol in the food and prevents the cholesterol from being absorbed into the bloodstream, instead passing out of the body through the intestinal track. I'm to go back and see him in two months to see how well this works.