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Heart Attack Diary: (Part 5)

Sticking with a lifestyle program designed to combat a killer

Editor's note: Donald C. Drake, a former medical writer at the Philadelphia Inquirer who is now a playwright, has been writing about his battle with heart disease since having a heart attack in 1980 at the age of 45. Since that time, he has undergone an angioplasty, which improved his steadily worsening angina, but did not cure his disease. In this installment, Drake devotes himself to a program of lifestyle changes whose goal was to dramatically improve, if not reverse, his heart disease.

With the repeated weekly warnings and lessons on nutrition, exercise and meditation, I began to apply myself. What helped most were the tricks they gave us to keep us exercising and eating right in a world that constantly tempts you with things that contribute to heart disease. If your life is too chaotic to allow a set time and place for exercise, Yorko said, then each night you must plan for the next day, picking a setting and time for exercise. With constantly changing work demands, I developed a three-stage strategy that I reviewed every night. I preferred to exercise every morning in a gym near work so I could put aside, for 24 hours at least, the dread of having to do it. If my schedule didn't permit that, I would exercise just before lunch. My fallback was using my stationary bike at home while watching the evening news. Morris suggested taking little bags of vegetables and fruit to work, rather than snacking on the cardiovascularly violent offerings of most vending machines. I also started keeping washed fruit -- tiny carrots and grape tomatoes -- on the kitchen table or in a front row of the refrigerator, so when the urge to snack hit, I would run into healthful options. Soon I was snacking on vegetables and fruit rather than peanuts, crackers and, dare I say it, potato chips. Fruit sorbet replaced frozen yogurt. I even began to prefer whole-wheat spaghetti. It tasted better and filled me up more. I started studying food package labels for fiber and fat content. And I came up with the best trick of all to make the long minutes on my exercise bike bearable. Each night, I taped television shows that I didn't have time to watch, and the next day I would look at them while working out. I would always stop my exercise on a cliff-hanger so I would be motivated to exercise the next day.

Four weeks into the program, I began to notice changes. Even though I wasn't trying to lose weight, I had to make more holes in my belts. I could walk a lot farther and do more strenuous exercise before getting tired or developing angina, the chest pain that results when the heart doesn't get enough blood. And most surprising, my friends and family started telling me that I seemed a lot more cheerful. A low level of depression, which I hadn't been aware of, was lifting. I was beginning to feel much less like the victim of a disease and more like a force in charge of my fate. But was Change of Heart really slowing or reversing the disease? There was reason for optimism. Becker had data showing that many of the 19 people in his program last spring did well. Thirteen had lost weight. Eight had significant reductions in bad (LDL) cholesterol. Six people were able to reduce the amount of drugs they were taking and still maintain low cholesterol levels. And three people said they had stopped getting angina.

For me, the moment of truth was last month, one month after completing the program, when I was weighed and given blood tests. I was surprised and overjoyed by the results. I'd lost 14 pounds and was now close to my ideal weight. My total cholesterol count had been slashed by 27 percent, from 183 to 134. My triglycerides were reduced by 68 percent, from 274 to 87. Even though it had taken a full year of treatment with the maximum dose of Lipitor -- the strongest of the cholesterol-reducing drugs -- to push my LDL to just below 100, Change of Heart knocked it down farther, to 87. A few days after getting the encouraging results, I drove to Becker's office for a stress test. Hooked to an EKG monitor, I started slowly walking on the treadmill. Every three minutes, Becker increased the incline and speed. I had not done well on this test when I took it at the University of Pennsylvania just before starting the program. The most I could go was 5 1/2 minutes before I was so out of breath I had to stop. But this time, I went 7 1/2 minutes. An extra two minutes didn't seem like much, but Becker said it was a significant improvement because the speed and incline of the treadmill had been increased at six minutes, boosting the workload by 40 percent. Even at 7 1/2 minutes, Becker said, an echocardiogram (sonar moving picture) of my heart showed that it was still getting an adequate supply of blood, and he thought I could have gone further. Without looking into my arteries with costly and invasive studies, Becker said he couldn't say whether my atherosclerosis had been reversed. But he was sure that I had started to slow it and had stabilized the plaque, making it less likely that I would have a heart attack. My own doctors questioned whether I had reversed my heart disease but were impressed with the results. "That's extraordinary," my cardiologist, Michael Simson of the University of Pennsylvania, said when I gave him the blood-test results. He attributed the benefits to weight loss and the physical training, which enabled my heart to do more work with less effort. The doctor taking care of my cholesterol, Daniel Rader, head of Penn's Cardiovascular Risk Intervention Program, said he thought that the program added to the benefits of my cholesterol-lowering drugs. Studies show the drugs can cut the incidence of death and heart attacks by 30 to 40 percent. He thought programs like Change of Heart might improve on that figure.

It's been four months since that first meeting, when Becker told us all about the benefits of lifestyle changes. The course ended in December, but some of the people in the class still meet on their own each month for moral support. Several have lost weight and the few who had gotten repeat blood tests said they saw improvements in their cholesterol levels. Now the big question is whether we can keep doing all the things we've been taught. So far, we're all trying. The need to exercise constantly nags at me, and I've settled into a routine of planning my exercise each day. I've even come to look forward to snacks of tiny carrots and grape tomatoes. And I'm beginning to forget what chocolate-chip cookies taste like, though I do have a vague recollection that they taste wonderful.

Reprinted with permission from the Philadelphia Inquirer, Copyright February 18, 2000.

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