Category: Health

Hey, thank you for reading today. This post will summarize the aftermath, the lessons that I’m drawing from my 2nd cardiac event that occurred on Wed Sep 20th, 2023.

On Recovery

• This time around the healing has been centered around healing from the trauma of the events, where my heart was shocked back into life repeatedly on Sep 20th, 2023. 
• It feels as if the CNS (central nervous system) is still very raw. As an example on Friday we were out at a noisy restaurant – first time since the 2nd incident. Suddenly I felt like a lightning bolt of fear ran from my neck down my spine. It was the reptilian/ CNS part (fight or flight) trying to protect me from further trauma/ injury. 
• In the week after the event there were nights that I could not fall asleep at all. It felt as if my body was on high alert, for any signs of ‘wrongness, illness’, a constant scanning of threats. It is now early October, and it feels like the highest stress days/ weeks are behind me, but the events still linger in the background.

On lessons

• The overriding importance of focusing on the present, versus spending so much head-space on thinking about the future, scenarios, wishing etc. Yes there is a time to plan, a time to dream – but most of the time that will just be a waste, something that draws you away from the only thing that really ever exists: the present.
• The importance of the core relationships for me: My wife, my son, my daughter. My family, close friends, my extended family. I want to build on relationships, make existing ones stronger, and nurture new relationships where they feel right.
• All the BS falling away about making more money, and becoming a big success in society. Yes we need the money to support our family, but it should not be at the cost of spending time with family, at the cost of your health.

On things that have helped me

• Writing these blog posts have helped me tell the story – mostly to myself – about how the events happened, to give them perspective, and through that give me distance from the events.
• Thinking about myself as a survivor, rather than a victim of these events. In the beginning I would think ‘why did this happen to me, I’ve lived healthy’ however with time I’ve been able to become more accepting of where I am in the journey of recovery, of life.
• Twice daily meditation – 10-15 minutes, morning and evening with the Calm app. Especially the meditations on Loving Kindness and anxiety relief, as well as having a ‘rain sound’ on when trying to fall asleep. I feel concretely the level of anxiety in my body is lower after a meditation session.

We are all works in progress, learning new things as long as we’re alive, and I wish you dear reader a peaceful, calm day wherever you are on your journey.

As I was dis-charged from the hospital, we’d arranged for the kids to fly home by themselves, and we’d stay in Finland with Jolene until I’d have permission to fly. I started to direct my energy towards recovering, both physically and mentally.

I was very happy that we got to see Ville & family, Mom, uncle Lasse & his family. We met most of my Finland friends (Peter + Erika, Björn + Kati, Basse + Virpi and Lasse) for a great, close-knit dinner at restaurant Kuu – before flying off back to Tampa on August 12th, 2023.

Something that I’d not considered before – was the many different types of recovery that needed to happen:

• Recovering from the electro-physiological (EP) exam included not stretching the groin area in order not to open up the wound in the femoral artery. The EP exam itself was very stressful in that the doctors essentially stress-test your heart to try to replicate the V-fib (ventricular fibrillation) conditions, so my heart rate was between 30BPM to 330BPM, and you feel like you are reliving the traumatic event.
• Recovering from the surgery to install the ICD – Intra Cardiac Defibrillator, which sits above the left pectoral muscle. The surgery itself was carried out while I was awake, and I was discharged from the hospital the next day. I was instructed not to raise my left arm above 90 degrees and not put strain on it for some weeks.
• Recovering from the mental, psychological stresses of having been so close to dying. In hind-sight these have been some of the most difficult aspects.
• Dealing with the uncertainty of not knowing what caused the Ventricular fibrillation to occur.
• The uncertainty of not knowing how much the entire hospital stay, and all procedures were going to cost.

However as we got back to Tampa, as the weeks progressed, I started feeling better and was able to start slowly exercising again – initially just stretching, but working my way up with lighter weights and less strenuous cardio like walking, and eventually Zone 2 cardio. Unfortunately I was also sometimes feeling pain in the throat (thyroid) and chest pain, however I assumed it was part of the medication (beta-blocker) side effects..

I started talking to a therapist about all the events, the stressful things that were bothering me. The therapist recommended that I write letters to Sam, to Kate, to Jolene about these events, how much they meant to me, and how much I still wanted to do together with them. Especially the letter to Sam felt very meaningful as I genuinely think that he saved my life with his actions. Overall it feels like we’ve become closer as a family, and Jolene as ever is my partner, my rock, my love. I am also so thankful to Ville who really stepped up during this difficult time. I also wrote a letter to my Dad, hoping to get closer to him. I’ve invited Dad over to Florida to see his older son, his grand-children – and I hope he follows-through. 

I returned to work on August 14th, 2023, which in hind-sight probably was too early. Even though my work is fun, intellectually challenging most days – I’ve in particular enjoyed the building aspects – there are stressful days/ events as well.

I’d become a hugger, I no longer wondered if it’s OK to hug, I was hugging friends and family more than ever before. I’d become more emotional, and was crying in random movies or listening to music. I’ve become much more cognizant of the briefness of this human life, and what a fool I was to think I could know how long I would live. Even though heavy emotionally, these factors felt that they were helping me mend psychologically.

Practical advice that I’ve learned the hard way:

• If you go out to exercise, bring a friend or family member – it just might save your life.
• If you have things you need to tell some-one – do it today, give them a call – you don’t know if you’ll get another chance.
• If you feel something is wrong, speak up and tell a doctor, get the symptoms checked out.

As we shall see in the next post, this story continues..

OK, short update since it’s about one month since the last post. Some really interesting lessons and concrete hacks that I’m happy to share.

Results TLDR:

In short the glucose readings are getting better – focus on the days marked in yellow:

• During this period we’ve mostly been at home, so it’s been easy to eat relatively clean and exercise consistently.
• The 24h average glucose (last column) is trending down nicely.
• I’ve lost about 6 lbs since starting this journey – without really ‘trying to diet’.

Habits that have worked for me:

• Doing 16-8 intermittent fasting – eating lunch around 11.30AM and finishing dinner by 7.30PM.
• Going for a walk after meals. This really helps to level out any glucose spikes that would result from a big/ carby meal.
• Eating less carbs. I’m not doing keto / no-carb, but I do eat less carbs during meals. Replace with more veggies, protein and healthy fats.
• Being consistent – it’s pretty rewarding to see how the average glucose slowly comes down from ‘slightly alarming’ levels, very happy about this progress.

Thanks for reading,

Oskar

Doctor Peter Attia is one of the foremost thinkers and communicators re: health, longevity and preventive medicine – you can find his work e.g on his website, podcast, Youtube etc. He published in March 2023 his book – “Outlive – the science and art of longevity”. 

Others have written thorough reviews of the book (e.g. on Amazon) so I won’t try to do that as the extensive material in the book could end up overwhelming. Instead this post focuses on a few key concepts from the book.

Concept #1 – Health-span

Instead of focusing on Lifespan – where the last years of a long life can be plagued by tiredness, sickness and low energy – our Objective should be on increasing Health-span. This means we could live a slightly longer life, but also have the energy and strength to be able to do our favorite activities in our last decade. Whether that is hiking with friends, learning new skills, picking up a grandchild or just living independently, I think that is an admirable goal.

Concept #2 – the Four Horsemen

With the Objective of increasing our Healthspan in mind – what are the main causes of death in modern societies that we need to focus on preventing? Those are what Peter calls the Four Horsemen of chronic disease, which combined account for about 80% of all cause mortality (ACM):

#1 – Cardiovascular disease (CVD):

• Is the leading cause of death for both men and women, accounting for about 25% of ACM
• Common types are: Coronary heart disease, stroke and heart failure.
• Causes and factors include: High blood pressure, High cholesterol, Smoking, Diabetes, Obesity, Physical inactivity, Family history

# 2 – Cancer

• Is the second leading cause of death for both men and women, accounting for about 22% of ACM
• Common types are: Lung, Breast, Colorectal, Prostate or Pancreas cancer
• Causes and factors include: Age, Smoking, Diabetes, Obesity, Physical inactivity, poor diet, Family history/genetics, Environmental toxins

# 3 – Neurodegenerative disease, dementia

• Is the third leading cause, accounting for about 8% of ACM
• Common types are: Alzheimer’s, Lewy Body Dementia, Parkinsons
• Causes and factors include: Age, Head injury, Diabetes, Obesity, excessive alcohol, poor diet, Family history/genetics, Environmental toxins

#4 – Metabolic syndrome and insulin resistance

“insulin resistance itself is associated with huge increases in one’s risk of cancer ( up to twelvefold ) , Alzheimer’s disease ( fivefold ), and death from cardiovascular disease ( almost sixfold ) — all of which underscores why addressing, and ideally preventing , metabolic dysfunction is a cornerstone of my approach to longevity”

• Metabolic syndrome is a group of risk factors that increase your chance of developing CVD (#1), cancer (#2), neurodegenerative disease (#3), diabetes, obesity.
• Causes and factors include:
• Abdominal obesity. This means having a waist circumference of more than 35 inches for women and more than 40 inches for men.
• High blood pressure. Blood pressure of 130/80 mm Hg (millimeters of mercury) or higher is considered high.
• High blood sugar. Blood sugar levels of 100 to 125 milligrams per deciliter (mg/dL) after fasting overnight are considered prediabetes. Levels of 126 mg/dL or higher on two separate occasions are considered diabetes.
• High triglycerides. Triglycerides are a type of fat found in the blood. Triglyceride levels of 150 milligrams per deciliter (mg/dL) or higher are considered high.
• Low high-density lipoprotein (HDL) cholesterol. HDL cholesterol is often called “good” cholesterol because it helps remove bad cholesterol from the blood. HDL levels of 40 mg/dL or lower for men and 50 mg/dL or lower for women are considered low.
• If you have three or more of these risk factors, you have metabolic syndrome, as do about 40% of Americans.

Concept #3 – the best medicine is exercise

There are many tools covered in the book to live a healthy life, and to prevent the Four Horsemen – e.g reducing stress, sleeping well, eating a healthy diet, and having meaningful relationships. However one tool stands above the others in terms of impact: exercise.

Any exercise is better than none, and ideally you should do both cardio and strength/ weights training.

Cardio training:

A study found that someone below – average VO2 max for their age and sex is at double the risk of all – cause mortality compared to someone in the top quartile ( 75th to 97.6th percentiles ). Thus , poor cardiorespiratory fitness carries a greater relative risk of death than smoking.

Strength training:

Subjects with low muscle strength were at double the risk of death , while those with low muscle mass and / or low muscle strength , plus metabolic syndrome , had a 3 to 3.33 times greater risk of all – cause mortality

Preventing #1 – Cardiovascular disease (CVD)

John Ioannidis , a Stanford scientist found that in randomized clinical trials, exercise – based interventions performed as well as or better than multiple classes of pharmaceutical drugs at reducing mortality from coronary heart disease , prediabetes or diabetes, and stroke.

To note: The book does go into detail also on the importance of reducing LDL-cholesterol (more specifically APO B) – if needed through medication.

Preventing #2 – Cancer

..I suspect that the association between obesity , diabetes , and cancer is primarily driven by inflammation and growth factors such as insulin . Obesity, especially when accompanied by accumulation of visceral fat, helps promote inflammation , as dying fat cells secrete an array of inflammatory cytokines into the circulation.

What I am saying is that we don’t want to be anywhere on that spectrum of insulin resistance to type 2 diabetes , where our cancer risk is clearly elevated . To me , this is the low – hanging fruit of cancer prevention, right up there with quitting smoking . Getting our metabolic health in order is essential to our anticancer strategy.

Preventing #3 – Neurodegenerative disease

The single most powerful item in our preventive tool kit is exercise , which has a two – pronged impact on Alzheimer’s disease risk: it helps maintain glucose homeostasis , and it improves the health of our vasculature.  

The epidemiology linking strength and cardiorespiratory fitness to lower risk for neurodegeneration is so uniform in its direction and magnitude that .. .. I now tell patients that exercise is, full stop and hands down , the best tool we have in the neurodegeneration prevention tool kit .

Conclusions

I don’t want to sound hyperbolic, but IMO this book should be essential reading for every human being. This book should be taught in class-rooms around the world, until every-one understands these concepts thoroughly, because they are so fundamental for our health.