THOMAS LARSON

(Psychology Today Blogs #1-8, March-November, 2014)

Cuddling With Mamie

To introduce myself for this, my first blog at Psychology Today, I’m the author of The Sanctuary of Illness: A Memoir of Heart Disease, Hudson Whitman Press, 2014. The book rewinds and unravels my life during and after my three heart attacks.

The core argument of the memoir is a relational one: My recovery, as good as it can get after the damage of three myocardial infarctions, surged once I shared my condition with my long-time partner, Suzanna. In addition, I cut out dairy, ramped up my exercise, and added supplements. A no-oil Vegan and daily walker, I have lost 35 pounds as a plant-based eater, and it’s been three years since my last angioplasty.

Forgoing self-help advice and Vegan recipes, I’m going to write short essays that combine journalism and criticism. I want to explore some of the ongoing mysteries of the heart: among them, how our hearts and their arteries developed as they did and why women avoid the early onset of heart disease while men do not.

I’ll begin with this mystery: How was it that, before bypasses and stents, statin drugs and angioplasty, some heart patients survived longer than others when the only treatment was bed rest?

In September 1955, several months before he had to decide on a second term, President Dwight Eisenhower had a midnight heart attack (his wife Mamie drove him to a hospital). He was put on the blood thinner, Coumadin, and told to maintain his weight at 175 with a low-fat diet. The day of his infarct, he ate sausage, bacon, mush, hotcakes for breakfast; hamburger with raw onion for lunch; and roast lamb for dinner. Afterwards, he blamed his angina on the onion.

Heart patients of the time were routinely instructed to stay in bed for six months. As President, however, he couldn’t stay in bed. The country needed him. His doctor had a novel solution—activate his recovery with movement sooner than was traditionally prescribed. In four weeks, Ike was back at work; in seven weeks, he was climbing stairs; and in four months, he announced his candidacy. He won, of course. And, after he left office in 1961, he lived another eight years.

But the real surprise in his treatment wasn’t just enforced activity; it was also to activate his primary relationship. His doctor ordered the former general to cuddle with Mamie. Don’t work in the evenings and spend time snuggling with her on the couch or in bed. The point was to calm him and lower his inflammation. The key to recovery was already there in his marriage. In a sense, that’s what marriage is for. Apparently, Ike took the cue and cuddled.

There’s a paradox here, especially for us: We believe the more medical intervention we have, the more quality of life ensues—but Eisenhower’s case belies this. Medical fixes, which save us, save us only temporarily. They do not lengthen our time, remake our diets, or relax our competitiveness. Inflammation from stress exacerbates all illness. The lesson is that the body must balance movement and calm, which neither Lipitor nor a quadruple bypass can accomplish.

How odd that heart patients once had—before our surgical interventions—home remedies that cost nothing and worked for centuries, particularly for the willing. How odd also that we seem to have waylaid or lost such native wisdom. How might the caretaking effect be measured nowadays? Is lowering our blood pressure via companionship even studied?

One curiosity of heart recovery is the degree to which our partners contribute to our post-op well-being. What worked for Ike could work for us. The mystery is, why medicine has so little to say about the healing power of partnerships. Why don’t more doctors prescribe activity and cuddling as facilely as they do surgery and drugs?

***

The Heart and a Language to Describe It

As a heart patient, I’m hypersensitive to the languages we use to characterize coronary artery disease. Our culture personifies the heart, often as the metaphoric seat of enduring emotion.

A heart is pure, is given freely; it bends and breaks; it never forgets. A heart is San Francisco where you left it, Christmas within, what goes on after the Titanic sinks. A heart is worn on your sleeve, a lonely hunter, made of stone. It’s where home is sweetest, you know he’s right, the thing you gotta have, miles and miles of which the athlete taps, the lover woos. Its cockles warm, its tick-tock trues. A heart is full of moxie, courage, kindness, pluck, deceit, and compassion: your pain in my heart. We have good hearts and brave hearts and cold, cold hearts. Hank sings “Your Cheatin’ Heart” will tell on you, Pascal knows “the heart has its reasons,” and Jimmy Carter confessed to adultery there.

The heart’s hill-and-dale range helps us communicate how to feel, better yet, how to talk those feelings through. The richness of the representation suggests how difficult such expression is. The language of the heart spills into myriad associative descriptions, which both refine and mystify feeling and meaning.

After my father’s first heart attack in 1970, my mother would tell friends who had not heard, that “John had a coronary. But with rest he’s doing much better.” A coronary? Whence this usage? Is it from coronary thrombosis, the phrase for an arterial clot? Is it the site of its pumping turn? How does an adjective which denotes the heart’s arteries convert to a noun that describes its damage? Why is the passage and its blockage the same?

The word coronate means to crown the head of a special person—a royal, a winner, a pope: to coronate bestows the highest honor. The arteries coronate the heart muscle by encircling it and supplying it with blood. No wonder poets praise it. Its metabolic tack is primary to every organ and cell: it should be pedestaled and peaked. And yet how deftly we label this honorific an attack. The point of “my coronary arteries are having a coronary” is to use language to engage the paradox of the heart’s function: That which most sustains human life, our body’s core pulsing organ, is also that which if harmed most effectively ends that life.

This ploy is what language is good at. Language mirrors the intimacy and distance we have with our bodies. Anyone who struggles to portray an illness so a doctor might pinpoint a diagnosis knows this. Chest pain is “an elephant sitting on my chest.” Medically accurate? Hardly. Emotionally revealing? You bet. We use language—evolutionary linguists would say language uses us—to approximate our bodies’ signals and claims. Language allows us the means to tell others what we do not understand but feel intensely.

If we can say how we feel, using the most precise words we can summon—and a caregiver can then recognize our ache—we feel closer to what’s wrong, as though language enacts the feeling.

But with angina (to take its chief symptom) the heart itself is not what hurts: it’s the shoulders, the chest, the upper arms, the neck. It’s the indigestion and nausea. It’s the heaviness. It could be all these things or just one, nastily intensified. The heart must use muscles and tissue and neurological symptoms to tell the mind that the core reactor is shutting down. With my three heart attacks, I never felt the oxygen-deprived death of heart muscles cells. My body told it to me differently, perhaps cruelly so, so I would get help. The heart tells the body to speak up, a more reliable and louder broadcaster than the organ within.

Language is a system whose imprecision best tells the truth about us. Even still, the paradox has its limits. Words are essential; they animate our dilemmas. But we reveal ourselves most trenchantly outside language because language only poorly captures the inner upheavals and multiple messages our bodies enact. Language, though it aims to be, is never as essential or as accurate or as befuddled as we are. Indeed, we fashion words to label conditions like coronary or heartburn or hand-on-heart and perceive we have said something. Even if words successfully describe feelings, they cannot relieve anxiety or alter symptoms.

“Philosophy,” writes Wittgenstein, “is a struggle against the bewitchment of our understanding by the resources of our language.” Language embodies that which it cannot have and will never possess, yet like Narcissus smitten by what he beholds on the lake’s glossy surface falls for what he believes he sees.

***

Inextinguishably Alive

The human heart has four valves. They control the electrically-timed-and-patterned one-way movement of blood that courses through the heart. As blood collects in the left and right atria, two entrance valves (A and B) close. A moment later, A and B open and the blood drops into the ventricles. At the same time, two exit valves (C and D) close so that the blood remains in those ventricles. A moment later, C and D open, and the ventricles squeeze the blood up—eject is the term—into the pulmonary artery, the lungs, and the aorta. The blood is then dispersed throughout the body and returns via the coronary arteries to the atria.

When A and B close together, the sound is lub. When C and D close together, the sound is DUP. This companioned sound, which the doctor listens for with her stethoscope, is lub-DUP, lub-DUP. Each pulsing pair is a heartbeat. I’m curious—what meaning (for the essayist) comes through in this heartbeat?

A typical human life, in twenty-first century America, accrues, roughly, 1.5 billion heartbeats. If we isolate the first 500 million lub-DUPs, the first third, what can we say about the next third, another 500 million beats? Will they be like the first? Sure, why not. Greater wear and tear but predictably the same. But there is change: that additional 500 million beats, all told, lengthen the function, enforce the pattern, create a new totality. Life is ever-additive.

Via this accumulation, time determines that the amount of every adding up is always different than the amount of every previous adding up.

Imagine the universe as the number of seconds added together to get to where the universe is now. In the second it takes you to imagine that accumulated universe as a singularity, it just got one second older. No matter how you calculate time, time always clocks in a tad more than what you’ve just computed. If the number you imagine is always subverted by the addition of another number (the next heartbeat), it’s impossible to isolate the (or a) present. (Atheist Sam Harris’s step-behind-himself definition of time is, “It’s always now.”) The one thing you can count on is the ongoing passage of time and its accumulation.

I realize death (my three heart attacks have made me rather rueful about all this counting) upends the pattern of all-of-it-so-far plus one. But really, it doesn’t matter. As long as I’m alive, the seconds of my life must accrue. Even though another person may, after I’m gone, figure the number of seconds I did breathe-in/breathe-out (typically we tally the whole in years: he lived a good 87 years), my life to me cannot end. I repeat, to me. My life feels infinite, is experienced, whether computed or not, as an unimpeachable equation: now + one. Which, you may deduce, results in a dynamic (me) vs. a static (end of me) distinction, one I cannot make. I cannot know the end of me.

And so, isn’t this another reason not to fear death? (Dying’s another story.) Death is the final redesigning of the pattern of live events I will reach, unknowable at the end of my conscious ongoingness, my most unmemorable moment. Which is one way of grokking what Wittgenstein was driving at when he wrote at the end of the Tractatus: “What we cannot speak about”—the extreme improbability of recollecting our last ping—“we must pass over in silence.”

Such a silent passing over, however, is not the hard part. The hard part is forgoing the delusion that insists we can speak of death and thereby understand/experience it a priori. This is what each heartbeat seems, in part, to be saying. And yet lub-DUP expresses only what lives. An absent heartbeat spells death, which, whatever it may be to us, is not lub-DUP to the body.

What’s more, the heartbeat along with the rest of the body’s functions—blood coursing, neurons firing, memory constellating—seem by their ongoingness, a running-fence to and into the sea, to appease the mortal terror they generate. We’ll handle your death. You don’t have to. Obviously (dear boy), it’s too big for you to make sense of. So relax. We’ll go. Not you. You can imagine your undying self via your writing and your books and your website and your sons’ inheritance and your belief in molecular life everlasting or whatever comforts you.

That psychic separation the body makes with the self, the inextinguishable one, is what every lub-DUP of the heart announces and denies. Enough times until we hear it, speak it, and pass it over in silence

***

Women Caretaking Men, Part 1

Here’s a curious statistic: when over-40 adults were asked about their caregiving experience with a spouse or partner, 70% say it was a positive experience while 62% report that it caused stress in their relationship. (The study was done by AP-NORC Center for Public Affairs.) Roughly the same amount who said it was positive, two-thirds, also called it stressful. Positive stress sounds a bit like an open secret or based on a true story (long in the tooth) but there’s some rattle here worth shaking.

With editorial input from my partner, Suzanna, with whom I’ve lived 25 years, I want to describe in this post and in a follow-up next month how my heart disease, beginning in 2006, exploded in our lives with the first of three attacks over a five-year period. I also want to show that I learned a great deal, during my subsequent surgeries, treatments, and recovery, about our sensitivities and expectations, and we avoided a relational landmine.

Though women can develop heart disease in middle age, men are more likely to in their 40s and 50s. Later, the incidence of cardiovascular illness is roughly equal in the genders, though types and symptoms differ. Men are often more symptomatic, women less; men are hit by the freight train while women feel heart trouble like the breeze of a locomotive, in short, as indigestion.

Because of this earlier onset, men enlist their female partners to be caretakers of their diseases with relationship-altering consequences. Most women know that if their husbands or partners suffer heart disease, they do, too.

My story, told in The Sanctuary of Illness: A Memoir of Heart Disease, is not atypical. After the first angioplasty, I had faith in the cardiologists, the stents, and the full-blooded feeling I felt that I would heal quickly. I wanted any trace of uncertainty to pass. I wanted to return to the job I loved, journalism. Suzanna’s comments about my ratcheting up diet and exercise fell on deaf ears. I saw her as over-anxious and nagging. For her part, the more she felt unheard, the more she worried. Our relational balance crumbled. (It was not as strong as we thought.) My three heart attacks slowly, doggedly, forced us to change.

As collaborators, Suzanna and I have gathered four things we believe women should know about how men react when heart disease manifests itself in the couple’s lives.

First, with heart disease, a man’s sexual vitality drops dramatically. A man’s plumbing is clogged because his blood flow is constricted. (He’s probably noticed his erections are not as hard and less frequent.) Impotence may result. Sexually weakened, men feel physically and psychologically numb: it’s not so much a loss of libido as it is a systemic shock.

What’s a spouse to do? Remind him that his body has been damaged, not his maleness. Remind him that he can regain his vitality but only via a new diet and increased exercise. That’s a conversion he must make but one that needs support.

One road there is for the couple to realize that even though our culture tells men with heart disease they can’t change, the stereotype is just that. Too often a man rationalizes his inability to act by relying on this exaggeration (at least, trying to make his wife or partner commiserate with him) instead of recognizing that his biology has been revised.

Second, heart disease affects a man’s self-perception. He feels threatened by impotence, fatigue, the mortal jolt of near-death. He usually retrieves his old cockpit character and avoids an awakened vulnerability, an emotion he’s seldom felt. His fears of another heart attack are not expressed but projected onto his partner. Blame gets triggered, tossed back and forth.

“You’re not sharing with me,” she says.

“Well, you’re judging me,” he replies.

“What’s wrong?”

“Quit asking me that.”

“You don’t understand how I feel.”

“Are you nuts? I’m the one who had the heart attack.”

Yes, men know they have been irrevocably altered by a heart attack. But for many waking up to this fact is not in the cards. A woman’s loving advice doesn’t let them (the American male) fix the problem, which is all the more reason women and partners should offer it.

The medical model plays right into this arrogance. If a cardiologist solves a heart problem via angioplasty or a bypass, the male patient thinks it’s over. In the wake, why not have the pizza: the blood is flowing fine. Statistics show, however, that it takes a lot more than surgery to extend a man’s life. Heart operations merely turn over the rock to expose the Gila Monster (the image is from The Treasure of Sierra Madre, a classic man’s film), which is lying in wait. The man, any man, has to wake up or his condition will worsen and he may lose his partner.

Next time, how the medical model also keeps the pair from communicating and the woman in a caretaking role. How do couples and partners get through heart disease together?

***

Women Caretaking Men, Part 2

When the squeamish onset of mortality for a couple facing heart disease arrives, the pair either share it or deny it. Often, the mortal coil infantilizes them: in response, they isolate, they wish it away, or they farm it out. They don’t know they can get through these grimmest times as a couple. Why should they? Everything is new about this crisis; it’s hard to know what to do.

One way couples practice denial is to use hospital appointments to govern their lives, which soon overwhelm them with choices and decisions. In addition, the couple may join a support group where laundering their why-me complaints and medical options takes over. Partners think they’ll grow closer by concentrating on treatment and group sharing. But, the irony is, this avalanche of information supplants their emotional growth. Info often just masks their vulnerability.

Mortality’s arrival—the coming of our last act—may also conjure a couple’s parental patterns, either their own or those unconsciously mimicked from their parents. Suddenly, they’re an old married couple. They order each other around. They ladle out concerns like an annoying, self-obsessed child or adolescent might. At the onset of my disease, when I had myself convinced that the ailment was mine to endure, I treated Suzanna as a meddler. Which made me feel petty and her unappreciated.

For the couple, a heart attack usually means the relational space is redefined. Generally, women create the relational space and value it—and men don’t notice it or take it for granted. With disease, a man snaps awake to this space. He’s fortunate to have a place to curl up in: post-heart-attack, he learns his new role is to become a co-nurturer and co-creator of his and his partner’s worry. We might call it the sanctuary of worry they share.

In the end, Suzanna and I were tutored by my illness. To survive we had to communicate more clearly around my symptoms and her fear. If I felt bad or frightened, Suzanna did, too—with and not just for me. As a result, we uncorked the rawest of emotions, ones which many in the throes of pain delay or banish, rattled as they are by the emergency of heart trauma. Our intimacy grew because we let such emotions erupt.

How did we do this? Through a combination of things. First, after each of three heart attacks, I had to give up those long-lived or sudden protocols in which I didn’t deal with illness, and just let my unconscious patterns imprison me further; Suzanna also had to relinquish her own fear-based patterns of relating. Second, our discussions, we learned, could only happen when we both felt good, which ruled out tired evenings or driving home from a hospital appointment: the best time was a newspaper-placid Sunday morning or during a walk. Third, I woke up to the most patently obvious thing of all: my hastened or slow demise would mean misery for Suzanna, and, in turn, my health would mean less despair for us both. 

Sensitive types, we feel lousy when we’re not relating. I, the thinker, she, the feeler, it’s easy to polarize, costume these roles, and over-think or over-feel any malady. Heart disease was an opportunity for us to reconnect to our core neuronal attraction, piqued by each other’s hot-stove sensitivity, and use it to our advantage. That together we created a loving wave between us that, in order to break ashore, needed re-energizing. Such long-lasting love is not, in my opinion, wired into our species. We have to re-vitalize it constantly, billow its sails, as it were.

With Suzanna’s insistence, I learned that my cardiologist’s treatment plan wasn’t the only path to getting better. There were additional ways, some of which built off the medical model. Suzanna found alternative, practical approaches that, as I look back on their accumulation, jumpstarted my recovery. These involved lipidologists, wellness programs, cardio-scans, books, meditation, movies, cooking, and Veganism. Such adaptations Suzanna was already comfortable with, and I learned to welcome them as well. 

For me, the “blessing” of three myocardial infarctions is to have brought back creative consulting with my partner. Recovery means returning to a kind of nurtured trust with which we built our relationship in the first place. If the fire of renewal remains or can be rekindled in your relationship, this is best way I know of—perhaps the surest way—to heal.

***

From "Not Me" to "Why Me?"

If you’ve had a heart attack, you have heart disease. No question, no argument. It’s clear; it’s permanent; it’s not something you leave behind like a prom jacket. But what if you haven’t had a heart attack or its bullying forbear, angina, but you have a history of the ailment in your family? (This was my case—debilitating myocardial infarctions in my father and older brother that sprung on them with no warning. I lived unaware for 56 years until my boom came along.) How much of your time do you (should you) spend expecting to be stricken?

In a sense this is the easiest of all questions to answer because if you’re unaware, you can’t know what’s coming: you’re too busy occupying the nothing that’s not there and the nothing that is, as Wallace Stevens put it. Even if you are a likely candidate—mid-50s male, stress-laden job, out of shape, no exercise, fat-, salt-, and sugar-rich glutton, smoker. Add in your genetic predisposition to suffer heart trouble and you’ve got solid “F”s in every subject.

Leaving those symptoms aside, the long habit of health disposes us not to think we will be sick. Health is the absence of illness; health does not mean we are in balance or fortified against pain and misery. It just means the disease hasn’t manifested. One noble consequence is civilization, a homeostasis between self and community. This, for many of us, is where our deeper natures lie: maintaining a healthy world that gave us its enhancements. Here, the healthy get things done. The unhealthy don’t. And they, the ill, must be taken care of, making the unsullied even busier. In the process, few healthy people seldom realize they’re deteriorating (no doubt, too strong a term), though they may feel the ache. Instead, entropy catches up with us one day, and we say, how odd to have once been so well-oiled.

In the West, most of us, pre-55, are well most of the time—and if we get sick, we heal far more often than not. Of course, I’m discounting accidents and viruses, injuries and cancers. I’m saying that the middle-aged American avoids illness: To a point. Once laid low, especially with a life-threatening malady, everything changes. That which you obviously didn’t have before, you do now. (How hard it’s been for me to feel fine of late, symptomless, and remember, memento mori, I still have heart disease.) Ill, our expectation about life’s insouciance shifts: we reconstitute ourselves as sickly or, worse, limp gladly into the wheelchair.

My post-55 friends increasingly confirm it: one is riddled with bone marrow cancer and begins chemo; another has stage four lung cancer, and friends within a month of learning the cold fact compile a book of reminiscences for her; still another who thought her breast cancer had left finds it suddenly reappearing in her brain, which takes its time devouring her, unmercifully. As all that happens to them, it also begins happening to me—initiating a kind of stupefaction.

The odds-makers tell me I’m next or should be. But that’s not what I believe, so powerful has the long habit of living in health or near-health been. (TV befouls reason: its ads for drugs, which percolate the senior’s sex life or happiness quotient, show us fit AARP models, ecstatic to be Viagra-primed or nursing-home-bound.) The longer I prolong this “I’m not the one,” the more my life is streaked with a lugubrious fog until one morning, dunderheaded with denial, I realize there’s no escaping disease—which means I’ve contracted the latest ailment sweeping through the hood, which means my own inattention probably brought it on, which means I had no idea I had the power to infect myself sui generis. And if I care to listen to colleagues and friends, I find an adhesive commonality to this condition that’s been bounding everywhere. How did it miss me?

While senescence is not a disease, it’s still an enigma how sudden illness (seldom that sudden) shocks the older population. I don’t think I appreciated this transition enough until I swerved into heart disease. It’s much more than a transition. It’s a leap. From healthy me. To wounded me. From unlikely afflicted. To highly liable. From nothing’s wrong because nothing’s been wrong to something’s scathingly wrong. In my case, three heart attacks from 2006 to 2011 announced their unanimous verdict that I’d been changed and I’d now (each time, that is) struggle to understand how exactly I had a part in that change.

It’s an unwelcomed exit from worry-free to worried me. This card trick that we think we will be ever free from illness is dealt once again.

Next time, I want to take apart this notion of what happens to us heart patients when we are sick and deny it or when we aren’t sick (or, at least, have none of the prime symptoms) but believe we are. Ah, the endless mystery of the heart-mind meld.

***

Thinking Ourselves Heart-Sick

There are two sources that fool us into thinking we are ill with angina and, perhaps, an impending heart attack. The first source is our stomachs—the gut tricks us into believing our heart is malfunctioning physiologically. The second source is our minds—we trick ourselves into believing we’re sick psychologically. Both are symptomatic of something wrong, but not, necessarily, a heart ailment. Often the two states go hand-in-hand; other times, they don’t. In either case, we may be on the cusp of a myocardial infarction and call an ambulance. But it’s probably truer that we are not ill: feelings and sensations mislead us.

Heart patients learn quickly what angina is. Web MD reminds us that angina comes on as any combination of lightheadedness, dizziness, fatigue, shortness of breath, indigestion, and chest pain. In men especially, the feeling is constrictive and heavy, the three-hundred-pound sumo wrestler sitting on your chest, an ache that pulses and radiates—the rollercoaster wobble and dive is the worst—in your neck, shoulders, arms, throat, or jaw.

Pain worried away, or that passes on its own, is labeled stable angina (angina pectoris). If there’s no response to rest, it’s unstable—a true emergency. The stable kind of angina, like a child’s nightmare, can be soothed and forgotten. The unstable kind shrieks for help. A real heart attack doesn’t just pop on, ache like hell for a while, then pop off. It can build over time, a day or a weekend, the grimacing feeling an unmistakable sign. (When a heart attack is truly sudden, it’s cardiac arrest: the fate of James Gandolfini where, mercifully, he went fast; there was probably no way, alone and in a hotel room, for help to have arrived soon enough to save him.)

Thus, there’s a DMZ where angina roams, taking its time to declare its motives. This is where psychological and physical symptoms cohabit. Who wants to believe you’re having a heart attack if you’ve never had one? You’re disinclined to think it’s the Big One if you’ve endured chest tightness and stomach indigestion other times in the past—and, after rest, such symptoms have left.

The physiological problem can be as simple as heartburn. Even that word is misleading: the heart is not burning, the esophagus is—that foul, burped, rag-and-bone smell of an acidic stomach. (The Maximum Strength Pepcid AC package states: “Heartburn with lightheadedness, sweating, or dizziness may not be heartburn. It may be a sign of a more serious condition.” Nicely vague, isn’t it.) The burning reason is that the esophagus curls around the trachea and touches the aorta. Nature bundles our core indeed.

Either angina is agitating the aorta and infecting the esophagus/trachea, or reflux is annoying the aorta and portending cardiac distress. Differentiate them if you can. Misdiagnosing angina as heartburn can be fatal. The one key turn that heart patients learn to identify: with reflux, there’s no sweating; with angina, there’s sweating.

The psychological element is inscrutable. The numbers are astounding: five million people each year go to the emergency room with chest pains; ten percent are actually having a myocardial infarction. What complicates this further is that of those who do have a heart attack, twenty-five percent are asymptomatic—and so never make it to the ER. Thus, there’s a strange simultaneity: most people with symptoms think they’re heart-ailing when they’re not and a sizeable number of those most vulnerable won’t even get to have that false alarm.

So be careful, those who have symptoms: Chest pain can be a sign of pneumonia or pleurisy. The jitters, indigestion, and a pounding heart rate (palpitations) may be a panic attack, not heart trouble. Perhaps you’ve raised your blood pressure and heart rate to a worrisomely high level—because, what? You’re in love, you’re hiking at 8,000 feet, you’ve been in a traffic accident, or your kid did not graduate from high school? You fear some switch in your operational center has shut down—but it’s probably not a clogged artery, despite your feeling of oncoming doom.

Is this a false adaptation, believing the end is nigh and we need an ambulance? One thing’s for sure: many websites and heart-savvy pamphlets declare that “if you think you’re having chest pains, call 911.” The greater availability of emergency wards and fully-equipped first-responders means that we will, we do, use them just like new lanes added to city freeways. And who can blame us. No one wants to wrongly self-diagnosis; few want to be Mr. Heroic and gut it out, which, sadly, is the case for some men who reason that with willpower they can outlast the pain as though it’s a hangover or a hangnail.

The major downside of this availability-upside is malingering, the opposite of the male wish-it-away response. I love this definition in the Gale Encyclopedia of Mental Disorders: malingering, “the act of intentionally feigning or exaggerating physical or psychological symptoms for personal gain.” Sounds rather tawdry—like an adolescent faking sick (cough, cough) to an anxious mother to get out of an algebra test.

As an adult, to whom are you feigning or exaggerating? Your family because you want them to pay attention to you? Your doctor or clinic because such querulousness gets them to take your complaints seriously? “Personal gain” is troubling because when you malinger (and millions upon millions do), you bind the wrists of the emergency staff with your histrionic handcuffs much like the boy who cried wolf.

Yet, again, I wonder whether we will—as we evolve in the West with trigger-point technologies that may soon, based on enzyme levels in the blood, alert our cardiologists remotely and we’ll be rushed in and saved (all at great expense)—give up our ability to self-diagnosis reliably. It may be, evolutionarily, a good thing to err on the side of overreaction; it does save one in ten. Even for the ninety percent who fake an illness or present false symptoms (and both of these can feel as real as the real thing), these are signs that something’s wrong with the person—perhaps more psychological than physical.

Finally, all this is re-informed by a late September essay in the Sunday Review of The New York Times, “The Woman’s Heart Attack (link is external).” The writer’s conclusion, based on her case and study, is that women have a broader range of symptoms, in kind, severity, and bodily location, than men do. What’s more, men typically have sharp chest pain while women experience nausea, a strange new fatigue, insomnia, and a much slower onset of the attack. The other shock is gender bias: Women and heart disease have been ignored and understudied, and often viewed by the medical establishment as having mental, not bodily, symptoms of a disease—it’s all in their minds or it’s pure malingering.

The difficulty is that some women have taken this on as their role, making it that much harder for them to know and to tell their doctors when they are truly sick.

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Inflammation & Heart Disease

Five years ago, between heart attacks #1 and #2, I was plagued by mouth sores. A series of incidents, each worse than the other or, worse still, at the same time. I wasn’t sure if it was just bit lip, bit tongue, or bit cheeks. It was more than those: cankers, periodontitis, and lichen planus. The last, pure misery: I felt like someone had taken a soldering iron to one side of my tongue. I chewed my food on the opposite side, wincing. People who watched me eat thought I was ingesting poison.

Applesauce, topical ointments, mouthwash: nothing helped. Then, coincidentally, I had my wisdom teeth (they were disappearing under the gums) pulled out. Crowded teeth caused gum infections. On the mend, I read the dentist’s brochure about gums and heart disease. If your mouth is infected, it’s likely your coronaries are inflamed, too. More to worry about, what with my freshly diagnosed heart disease.

Inflammation. What is that? We know it as the body’s natural response to ward off a foreign invader or an injury. The redness and swelling accompanying a cut, for example, is the white blood cells fighting off the bacterial or viral infection, or a toxin, whether it’s circulating within the body or is hit from outside. That’s the acute kind, from whose self-healing the body benefits.

The chronic kind is different—and is not good. It occurs when the body over-treats a long-term injury with its own resources. The inflammatory response sets in: the white-blood-cell-rush to repair the hurt produces telltale redness and heat and, as long as the injury continues, pushes more of these resources to the site.

In my case, my gum infections and impacted teeth collected and circulated bacteria to organs already (internally) inflamed from lousy food and cholesterol buildup. I started realizing there was a lifetime of such inflammation, accumulating in the cells of my coronary arteries.

How? Pull back a moment. It’s not just bacteria that infects the cell walls; it’s also sugar from processed foods. Insulin, as we know, pushes sugar into our cells for energy-storage. But when the sugar molecules are too many, they mass together and pass through the larger blood vessels, like a car fender against a guardrail, they scrape the cell lining.

This, along with excess fat in overloaded fat cells, also bombards the arterial walls. More injury. Then, LDL cholesterol enters. These molecules accompany the white blood cells when they come to the aid of their party. The sticky LDL infuses itself into the cell (for repair!) and, at the same time, collects as plaque. As one doctor put it, the body then perceives there’s something wrong with the artery—there’s too much cholesterol, too much sugar, too much fat (sounds like dinner at McDonalds). So the inflammatory response sends more white blood cells and more LDL, slowly building a calcium-domed barrier or covering to isolate/protect the injury. A little Ebola-like tent.

But if nothing changes in the diet or in the body’s stress levels, the plaque site can be constantly inflamed. The site accumulates more lesions and oxidizes. Eventually, the plaque may break and block the artery. Mine did—in the end, a total of three times.

HDL cholesterol is supposed to take LDL away, after it has arrived at the injury and before it enters into too many cell walls. But LDL overpowers HDL if the inflamed spot does not heal. The body, trying to fix the problem, can’t quit trying. The body wears itself out trying to heal itself.

The mystery is, some cardiologists believe that inflammation attracts an overabundance of LDL to the coronary arteries where the cells are occupied by the invader who, in turn, overtakes them. It’s called the inflammation hypothesis. Other docs believe the lipid hypothesis, where too much cholesterol circulating helter-skelter in the body, whether produced naturally or via food, is the culprit. For heart patients, the answer in both cases is lowering one’s LDL number, eating less fat and less sugar, ridding the diet of processed foods, and de-stressing. This is why statin drugs may be the cardiac sufferer’s wonder drug: they reduce the total amount of cholesterol and they may reduce arterial inflammation.

I wonder whether my gum infections and beleaguered coronary arteries weren’t co-productive, like Vladimir and Estragon in Waiting for Godot, a pair of tragic comedians who keep infecting each other. And they don’t just do it for a two-hour play: it was constant over my lifetime while I, heedlessly, consumed all the wrong foods (not to mention my family’s predisposition for heart ailment)—all that crap, the pizza, the ice cream, the hot dogs, the donuts. Please note the linking verb in the preceding sentence, I’m happy to say, is was.

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I moved on from this blog. Thanks to all who read it during 2014 and after.

TL