Dr John M

cardiac electrophysiologist, cyclist, learner

Choices…

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For the health-inclined and for those who celebrate mastery of the obvious as the key ingredient of wellness, the story of public health guru, Dr. Lester Breslow, shines like a beacon.

As reported this weekend in the NYTimes, the scientist that linked healthy habits to living longer dies (at home) at age 97.

Dr. Breslow’s gems include:

  • “In the long run, housing may be more important than hospitals to health.”
  • “A 60-year-old who followed the seven recommended behaviors would be as healthy as a 30-year-old who followed fewer than three.”
  • (Circa 1964) “Do not smoke; drink in moderation; sleep seven to eight hours; exercise at least moderately; eat regular meals; maintain a moderate weight; eat breakfast.”

In the same week that Slate.com reports, to seeming surprise, that Americans walk far too little, the message of those who live long and well resonates strongly.

The last line in the Times piece sums up the simplicity:

Dr. Breslow himself did not smoke or drink. He walked regularly, practiced moderation in all things and enjoyed tending his vegetable garden.

Not mentioned in the story was the non-quantifiable effect of a life’s work devoted to helping fellow mankind. What of the cumulative benefits of striving to make life better for others? Such is hard to measure, but surely anti-inflammatory in the long-term.

The naysayers, the free-spirited, many smokers, and the like, are often heard citing the former KY Colonel, Hunter Thompson, who famously opined that one should go skidding into the grave totally used up—not quietly next to a vegetable garden in southern California. Okay, I hear you. I ride mountain bikes.

Two thoughts come to mind–call them lessons from the real world of medicine: one is that many do in fact skid wildly at the end of life. The problem of course is that those who turn a blind-eye to Dr. Breslow’s obviousness earlier in life don’t always skid painlessly into the abyss. Not infrequently, they are dragged over rocks and gravel before that final drop. Think smoking-related cancer, obesity-related diabetic complications and sedentary-induced failures of the skeleton and brain.

Second, and most obviously, those who are living life to the fullest almost always want it to continue.

Choices. Oh, the many choices we make.

JMM

Fixing the heart rhythm is but just one chapter…

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The heart’s resilience and fixability is striking.  That is, compared to the frailty of other components of the birthday-ravaged body.  We cardiologists are advantaged by the attention heart disease garners in the minds of patients.  We get priority over the polyp, or the bulging disc.

But should we?

He is an older man living a simple happy life with his cane. There were other medical issues resulting in life on a fine line.  Healthiness for the older is like a narrow exposed trail, with danger lurking on either side, and just the smallest bobble creates a potential disaster.

He had the dreaded ventricular tachycardia (VT) for years. Even though it only raised the heart rate to 120 beats per minute, it scared everyone because of its name–like the friendly old black lab with the loud deep bark. Atrial fibrillation, atrial flutter or other benign SVTs go faster, but VT always elicits more fright.    

The rapid heart rate traversed through tiny channels of living heart tissue inside a scar from a distant heart attack.  It caused him symptoms that were troublesome, but even worse were the side effects from the ineffective rhythm medicines.

Assess and decide: it was time.  It was fun searching out those serpentine-like channels, which created a mosaic of electrical squiggles.  “Wow, that was an amazing electrogram.”  High watts were passed through the saline-irrigated catheter tip.  The tachycardia vanished immediately.  Huge grin!

However.  But.  Not so fast.  This triumph was months ago. The arrhythmia is gone, and the toxic medicines are no longer needed.  Unfortunately, there have been four unrelated hospitalizations since:  pneumonia, urinary tract infection, exacerbation of kidney failure, and then fluid excess.  He is arrhythmia free, but miserable in his wheelchair.  “I am so weak.  I am trying so hard.”

“You heart is good,” I add.

“I know, but I am so weak.”

Chapter 2:

He has intermittent atrial fibrillation.  He is older, also with a cane and a life on that same narrow trail.  His generic four dollar per month rhythm medicines work.  The heart is resilient.  Ah, but that dreaded little colon polyp that could not be snipped with the scope.  Surgery.  It could be cancer.

The surgeon is one of our cities best.  The anesthesia, or all the other factors–bed-rest, immobility, pain, pain-meds, ileus, atrial fib from withholding oral meds, or a combination of all the above–results in weeks in the hospital.  Finally the discharge.  The urinary catheter was pulled and urine will not come.  Sadness ensued.  The heart was rhythmic again as he is back on his generic medicine–that works.

Now a urinary catheter was in place for weeks.  A bag was taped to the leg. That little baby colon polyp.  More urologic surgery is needed.  Office based “procedures” done with rigid catheters through the aged urethra were required.  A little tear drops out from his eye as he tells me of the wide awake urologic procedure.  The heart is good. That dreaded polyp. It was benign.

The heart ticks on, sometimes almost infinitely.  The singular focus required to eliminate pathologic squiggles from the heart sometimes blinds us to the other stories of the aging human body.

Heart disease frightens the most, but often proves easiest to fix.

JMM