You gotta' have heart--saving lives and prostate glands
Don't miss onco-cardiologist Dr. Darryl Leong's webinar Saturday for PCa patients on preventing heart disease. Also, a urologist's personal story on his 'widowmaker.'
By Howard Wolinsky
Back on February 14, I observed the 20th anniversary of my widowmaker heart attack.
It was on Valentine’s Day 2005 that I came thisclose to dying. Only 12% of men who have this type of heart attack outside a hospital make it out alive.
I ran a first-person article on my experience back in 2005 in the Chicago Sun-Times, where I was the medical editor/writer. I got a big reaction then—as readers told me they had read the story, remembered what I had written, and saved a loved one’s life.
This gave me pause. I was trained not to tell personal stories back in journalism school in the mid-1960s.
But I discovered the power of the personal story--and how it can impact readers, even save lives. I suddenly had a super-power.
I put this to work again five years later when I was diagnosed with low-risk prostate cancer and began writing about little-known management approach, Active Surveillance, in my mini-blog the then-new Facebook. I started hearing from friends, their family members, and their friends who wanted to know about AS since they were being pressured into treatment.
The pen was mightier than the robo-scalpel.
Eventually, this work evolved into a column for MedPageToday, “A Patient’s Journey,” and for the past three years in this Substack newsletter, The Active Surveillor.
I recognized that I and millions of others of men were hit by a public health disaster—overdiagnosis and overtreatment of low-risk prostate cancer. We were becoming incontienent and impotent from treatment of a “lazy” tumor in most cases that was unlikely to spread or kill and one which some urologists considered a noncancer.
I dedicated myself to trying to “save prostates,” or at least doing my best to inform men of all their choices and avoid unnecessary treatments and side effects.
When we’re told we have low-risk prostate CANCER. We tend to hear only that C-word. We think our life race is run; we need to get our affairs in order.
In contrast, when I was diagnosed with a myocardial infaction, the deadly widowmaker, I didn’t have the same reaction. My MI was a fluke because I was in excellent health: thin as a dime, following a heart-healthy diet, exercising daily for the previous 30years or more.
I guess I was in MI denial. I was ready to go back to work the next day—but I was advised that would be unwise.
Heart disease is generally considered more dangerous than both diabetes and prostate cancer in terms of overall mortality rates. Heart disease is the leading cause of death in the United States. While prostate cancer is a serious disease, most men diagnosed with prostate cancer do not die from it, and more deaths occur from other causes, including heart disease.
I reprinted my Sun-Times column here recently:
Feb 14, 2010
By Howard Wolinsky
ASPI tackles heart attack-PCa link
Don’t miss the Active Surveillance Patients International webinar on helping PCa patients reduce risks of heart disease. Featured speaker Dr. Darryl Leong, of McMaster U. (Go Marauders!), is a rare cardiologist who studies prostate cancer.
The onco-cardiologist is on from noon-1:30 p.m. Eastern on Saturday April 26. Register here: https://zoom.us/meeting/register/xgT8w-i3Qp-iJkvOby0M9g
Meanwhile, I heard from several readers about their experiences with myocardial infarctions.
I’m going to share one of these stories below: The Marathon Man & The Widowmaker
I know Dr. David Schulsinger as a urology researcher. I consider him a friend. We’ve lunched at a vegan place in Chicago Chinatown during the American Urological Association meeting. David is the guy (above) with the chopsticks.
He is also a marathon man—who like me nearly died from a widowmaker MI.
He is Director, Center of Endourology and Stones, Program Director, Endourology and Stones Fellowship, and associate professor of urology at Stony Brook University Hospital in Stony Brook, New York,
Here’s his David’s story:
‘Marathon man’ & The Widowmaker
By David Schulsinger, MD, FACS
Thank you for sharing your story! This is an incredible account of your cardiac event. The more I learn about you, the more I admire your perseverance and accomplishments.
I have a similar story to share. This past October 2024, I was home alone, three hours before my long OR day. I woke up at 3 AM with an “elephant on my chest!” Mind you, I was training for my 26th NYC Marathon, 26 days before the race, and as you know, it is 26.2 miles.
(Dr. David Schulsinger finishes the New York City Marathon)
I immediately took two aspirin and called the ambulance. Due to construction on our driveway earlier in the week, a truck needed to be towed out. To avoid the risk of a similar situation with the ambulance, I walked a steep hill and situated myself on the driveway apron awaiting the ambulance arrival. As the ambulance approached, I was focused with questions regarding themarathon: How I was going to run it? How this event was going to affect my training for the next three weeks?
Dressed in surgical scrubs, in anticipation of my operative day ahead, the paramedic asked, “Sir, what do you do for a living?” Immersed in the thought of running, myr esponse was: ”MARATHON RUNNER.”
Despite having two neighboring hospitals, each without a cath-lab, the EMT had the foresight to send me to a hospital further away, with a cath-lab. I passed out twice, once in the ambulance and a second time in the ER after receiving individual doses of nitroglycerin.
Like you, my proximal LAD, the notorious “widowmaker”, was blocked; it was 99% occluded. Following the angiogram, they placed a single stent. The “pain-to-balloon time,” that is the onset of chest pain to the time necessary to inflate the vascular balloon in the LAD, was 81 minutes.
The literature states that mortality rate is extremely high with an MI of the LAD after 90 minutes. As I learned from your article, survival rates are only 12% when the event takes place outside of the hospital.
Fortuitously, I had a new internist who is a cardiologist that I started to see two months before this event. I had a baseline echo with an ejection fraction (EF) of 65%. Unfortunately, after the cardiac event, I lost over 60% of my heart function. The conversation in the hospital for the next 24 hours was one of: medication, placement of an ICD, shock jacket, and possible cardiac arrythmias, which included the typical management and sequela of patients post-MI with poor cardiac function.
I would remain in the hospital for 1 week. This length of stay was complicated, in part, due to the wrong medication given to me by a resident, an infection of the heart, and acute kidney injury (AKI) compromising my kidney function.
Upon arriving home, I made it my mission to start my own cardiac rehabilitation. I was walking six miles/day in my first week. I needed to keep my heart rate below 100 and not exceed 115 BPM.
This was difficult to do given the hills and valleys in my neighborhood. As you could imagine, I needed to take many breaks along the road to keep my HR in the normal range before resuming my walk. Needless to say, six miles took several hours, unlike the sub-60 minutes it would normally take during my training, and a far cry from 48 minutes in 1997 when I had my fastest marathon of 3:30.
I was given the green light to run after three months which made me feel elated, as much psychologically as it did physically. This was complicated by getting hit with Norovirus the next day, only to be hospitalized for dehydration. I would receive 3L of fluid in the ER before my blood was thin enough to draw for testing.
On a positive note, I returned to work after 3.5 months. I did 11 surgeries my first week back, still a far cry from the 20-25 procedures I was doing previously. After 4 months, my echo and EF reported normal cardiac function. I am currently running up to 3-4 mile/run.
People have asked me after my 25th marathon completed in November 2023, “how many more races I will run?” Pondering this, I realize that it’s actually not the number of marathons as much as it is who I run with! I have run 10 marathons with friend and colleague, Marc Goldstein, three marathons with my friend and best man Philip Li, and 15 marathons with medical school classmate and close friend Andy Schneider.
My goal was always to run a marathon with my family. I have done three marathons with my wife, Kari. My current goal is to put the “widowmaker” status behind me and strive for “wedlock maintainer”! Both of my daughters said they would runwith me when they graduated college. Ariel is graduating Cornell in May 2025 and Hailey has two more years to go. My journey and race continue!
Inspired to get a physical
Tim Balon is a retired engineer who lives in Tampa. He makes an important point about heart fitness and cycling vs. raised PSAs and cycling:
“Your heart health warning prompted my overdue cardiology checkup. My doctor reiterated that cycling benefits (for cardiovascular fitness) outweigh any prostate concerns—wise words from Dr. Laurence Klotz: ‘Life must be worth living.’ Moderation is key.”
What else is new in Low-risk PCa-land?
—Confirmatory testing. Please tell The Active Surveillor about your experience with confirmatory testing for PCa? The poll is here: https://docs.google.com/forms/d/1jVJJodEUdd5x6nRTAArDUI2VMsdW6GlkAAxcdEGfplE/edit#responses
—Watch the videos on the new The Active Surveillor’s YouTube channel. I have started posting some interviews I do to research articles in the newsletter. Why not join in? https://www.youtube.com/@TheActiveSurveillor Watch for exclusive interviews.
—New study at NYU Langone Health seeking Black or Hispanic patients with prostate cancer,. Dr. Stacy Loeb, a prostate cancer and men’s health expert at NewYork University Langone Medical Center, needs the help of Black and Latino patients in a study about how these men use online informatiopn about prostate cancer,
Who may take part in this study?
• Black or Hispanic U.S. adult male,
• Age 40 or older OR diagnosed with prostate cancer.
• Have internet access with audio/video capabilities (if planning to participate virtually).
What will participation in this study involve?
• Completing a questionnaire online.
• Taking part in a focus group discussion lasting about 60-90 minutes.
• Option to participate virtually via WebEx/Zoom or in-person at NYU Langone Health.
• A $50 electronic Amazon gift card for study participation
Participation is voluntary. For more information, please contact:
• Nataliya Byrne: Nataliya.Byrne@nyulangone.org • 646-501-2681
• Tatiana Sanchez Nolasco: Tatiana.Sancheznolasco@nyulangone.org • 646-501-2550
• Mariana Rangel: Mariana.RangelCamacho@nyulangone.org • 646-501-2552
• Evangelia Pitsoulakis: Evangelia.Pitsoulakis@nyulangone.org
I usually only read prostate related articles currently, but this was very informative and uplifting. Just had an appointment with my husband at Mass General with urologist, did my best to sit there and not say too much. He did not say one thing that I did not fully understand, thanks to the education I have received here.