Dietetic Dressing
Dietetic Dressing
Quartered Tomato
Lime Sherbet
Salt-Free Crackers ...
Tea or Coffee
Honey
Baked Fresh Pear ___
Tea or Coffee
Breakfast
Noon
Evening
Orange Juice
Clear Consomme with
Broiled Veal
Cream of Wheat
Salt-Free Crackers
Steak
Toast... Jam
Toasted Beef Sandwich
Sliced Onion
Tea or Coffee
with Dietetic Dressing Baked Potato
Skim Milk
Sliced Peaches
Baked Banana Squash
Tea or Coffee
Mixed Vegetable Salad
Pineapple Juice
with Dietetic Dressing
Orange Ice
Tea or Coffee
Rest. Sleep and rest are important. With a return of normal
health, the heart patient may be inclined to do more than he
should. Avoidance of fatigue from work or social activity,
however, is the wisest course.
Most patients should get from eight to nine hours of sleep in
these hectic times. Some people, it is true, seem to get by with
only five or six hours of sleep. But they are exceptional people.
Patients must also be guided by their own reaction to work and
daily activities. If they find themselves feeling tired or "run
down" during the day, they should take a little time out for a
nap. A good time for such cat-naps is the middle of the day
and just before the evening meal.
I often advise businessmen patients of mine to take a half -
hour to rest, either in their offices or clubs, once or twice during
the day, while their secretaries or business associates "cover"
for them. The y find that being "out" a half hour once or
twice a day causes no great inconvenience, occasions no comment
from their clients and is most refreshing.
Social activities must be pleasant, non -taxing, and of the
CARING FOR YOURSELF AFTER A HEART ATTACK
171
kind that induce a cheerful and relaxed mood. The coronary
patient has always to bear in mind that he is better off away from
scenes of anxiety, tension, or conflict—at play as well as at
work.
The value of relaxation to the coronary case and development
of keen interest and enjoyment in activities outside work is
especially appreciated by the physician. Several years ago in
Los Angeles, a number of my colleagues formed a "Coronary
Club." To be eligible, you had to be a physician and you had to
have suffered a coronary thrombosis. Club members have de-
veloped the highest skills in their hobbies. Some of the most
widely enjoyed of these hobbies are oil paintings, chess, sculpt-
ing, and water-color painting. Several of the doctors have already
won recognition and prizes during the annual "shows" that local
and national medical societies give for painting and sculpture.
Indeed, one of my colleagues finds that he can hardly wait to get
away from his office in order to work on an oil painting of
his daughter!
Should you exercise? The kind and amount of exercise
you take assumes a more important role in your life following
a heart attack. Some people are almost fanatical in their belief
that physical exercise is the only way to maintain good health.
They are the persons who insist upon the efficacy of such gadgets
as treadmill machines, Indian clubs, bar bells, and a variety of
exercising machines. They will assure you that your heart
trouble was caused in the first place by lack of exercise. The
only way to regain your health now is to "restore the vitality and
muscle tone that can come only from exercise."
Some years ago I treated Dr. B., a brilliant and well-known
biochemist and bachelor. After he recovered from his coronary
attack he tried to live the exemplary, perfect life, living at home
alone with his mother. After one year of excellent physical
health, a new symptom developed: severe and persistent head-
ache.
The following conversation took place in my office:
"Doctor Morrison, this headache of mine is just about killing
172
CARING FOR YOURSELF AFTER A HEART ATTACK
me. I feel as though a vise were squeezing and crushing my
head."
"Well, Dr. B., you know your heart and blood pressure as
well as the rest of your 'physical exam' are now perfectly nor -
mal".
"But, Dr. Morrison, why do I suffer from this infernal head-
ache? I lead an ideal life. I watch my diet, I don't smoke, don't
drink, retire every night at 10 p.m., never keep late hours, am
home every night with mother, never go out, don't even bother
with women. What can it be?"
Looking him straight in the eye and with a grin, I said: "It's
simple, Ben, your halo is just too tight".
There was a startled minute of surprise and silence. Then Dr.
B. himself grinned and saw through this joke into his own
overstriving for perfection, having forgotten that the body needs
more than physical tending to—it needs diversion, recreation,
mental relaxation. I prescribed a holiday, a large dose of fun, a
deep draught of gaiety and diversion, to be followed by regular,
frequent doses of the same "medicine." His headache, obviously
from tension and accumulated anxiety, vanished quickly!
Actually, the extent of your physical exertion in any activity
is a matter that must be decided by your physician. He knows
that patients vary widely in their capacity for exercise and their
body's tolerance to physical exertion. He knows also that
exercise is nothing more than a means of stimulating the body's
metabolism, of changing the body's chemistry through its effect
on both circulation and on improved elimination.
At least one half of all patients who experience a coronary
thrombosis make a complete recovery and are able to resume
normal physical activities. Of the other 50 per cent of patients,
about one quarter find they are definitely limited as to their
physical exertion or work. The remaining 25 per cent are either
retired from work and normal activities entirely, or assume a
disabled status.
President Eisenhower is a good example of those who recover
CARING FOR YOURSELF AFTER A HEART ATTACK
173
completely. Despite the complication of ileitis added to his
initial trouble, he made a satisfactory comeback following a
coronary thrombosis. Although he was placed on a prolonged
program of anti-coagulants (drugs that prevent clotting in the
blood), he continued to play golf occasionally; he exercised with
care and moderation, and returned to his customary Presidential
duties.
What kind of exercise is permissible? Among muscular
activities that are suitable to patients who have recovered from
heart attacks are swimming, walking, square dancing, fishing,
gardening, bowling, and horseback riding. They may also
resume normal sexual relations and otherwise live normally.
More violent forms of exercise, such as tennis or squash, how-
ever, are definitely dangerous.
Moderate physical activity is recommended for coronary pa-
tients because during mild exercise, there occurs a nutrient with-
drawal from the blood to meet increased metabolic needs. This
withdrawal, in turn, results in a lower serum concentration of
fats and consequently of cholesterol.
Should you smoke? One of the first questions a smoker will
ask his physician following a heart attack is, "Doctor, do I have
to give up smoking?" In most instances, the doctor will have
to say "yes."
In general, smoking is not good for the circulation. In fact, it
is often quite injurious to circulation in the legs, if the patient
is sensitive to nicotine, as many are. In some persons, smoking
produces a tightening or further narrowing of the blood vessels,
an action that physicians call vaso-constriction. In cases of
coronary artery disease, the added squeezing down of the ar -
teries as a result of smoking can be quite dangerous.
Available evidence from research is not sufficient to show that
smoking causes heart attack, but physicians know that some
patients with angina pectoris (a form of coronary artery dis -
ease) may easily aggravate their condition by heavy smoking.
Many of my patients have found it extremely difficult to give
up the tobacco habit. For them, I usually recommend filtered
174
CARING FOR YOURSELF AFTER A HEART ATTACK
pipes instead of cigarettes or cigars. For others, denicotinized
tobacco, or a substantial reduction in smoking is effective. A
discussion of the role of smoking and its effects on your health
may be found in Chapter 8.
Should you avoid alcohol? The use of alcohol in modera-
tion is permitted and is, in fact, often beneficial. Refer to Chapter
9 for the full story on alcohol and health. Just a few reminders
will be touched on here.
Temperate use of distilled liquors and wines is usually health-
ful, for they tend to dilate or open up the arteries, and thus
to improve circulation. As a rule, I do not recommend the use
of beer, because it is a gas-former. When beer is taken with a
heavy meal, the resulting gas in the stomach may embarrass
the heart or restrict its free function.
My experiments, as reported in Chapter 9, showed that severe
gas-pressure could damage the heart or even arrest its action
and thus affect the coronary arteries adversely. Many deaths
that have been attributed to "acute indigestion" occurred in this
way—gaseous ballooning of the stomach that actually squeezed
life out of the heart. An additional disadvantage of beer, other
than its gas-forming properties, is its salt content, which may be
harmful to certain patients.
For most coronary patients, moderate amounts of Scotch,
brandy and wines, however, are recommended.
What about coffee and tea? Coffee and tea are also stimu-
lants which, if used in moderation, may be helpful, since they
too tend to dilate the blood vessels, permitting an increased flow
of blood.
But, as in the case of other stimulants, they can be harmful if
they are used to excess.
Care of the bowels. Proper care of the bowels is essential.
Constipation, which often results in straining at the stool, is
harmful and may even be dangerous. Not infrequently I have
known patients to precipitate heart attacks by straining to force
a bowel movement.
CARING FOR YOURSELF AFTER A HEART ATTACK
175
Because the importance of easy elimination in treatment of
coronary patients is not generally known to the lay public,
there was a good deal of surprise and amusement throughout
the country when Dr. Paul Dudley White, the President's cardi -
ologist, issued his now famous medical bulletin on the second
day after the Chief Executive's coronary attack. At that time
he stated that the President's condition was encouraging and
that he had had a good bowel movement! This celebrated event
is said to have been reported around the world. And the re-
joicing was reflected in an upward swing in the stock market!
On the matter of regulating the bowels your doctor is, of
course, the best advisor. Most individuals require a well - bal-
anced diet, containing fruits and vegetables, together with an
adequate intake of water. They also need to take sufficient time
for a relaxed bowel habit.
Many of my patients have found that a glass of prune juice
on arising in the morning, or one or two glasses of hot water
with lemon juice or tea, are beneficial. Others have found that
strained vegetable juices (cabbage juice, for example) or fruit
juices taken upon arising stimulate natural bowel function.
Still others have to resort to the natural, bulk-producing mild
vegetable laxatives such as plantago (called Metamucil), psy-
llum seeds, "Saraka," "Serutan" and so on.
Can you continue to have sex relations? Mr. L., 43, had
just recovered from his first coronary attack and was about to
leave the hospital. His attractive young wife, who was his con-
stant bedside companion, stepped out of the room to pay the
hospital bill, leaving us al<me for the first time without either his
wife or his nurse in the room.
The first question he asked: "Doctor, when will it be safe
for me to have sexual relations with my wife?" This is one of the
most pressing questions in the mind of most male patients under
60 (and even in some who are older!). This spoken or unspoken
fear is so intimately linked with the patient's fear that he has
"lost his manhood" or his virility, or that he is to be an invalid or
176 CARING FOR YOURSELF AFTER A HEART ATTACK
semi-invalid from then on, that it is a deep psychological concern
to men. It is a fear profoundly linked to the male personality, so
shaken by a threat to existence as brought on by a coronary attack.
Some men are like my patient, Mr. A., aged 63, who, when-
ever he attempted the sex act following his coronary attack,
developed severe anginal pains. Even administration of nitro-
glycerine for pain prevention was to no avail. Mr. A. finally had
to resign himself to the inevitable and seek gratification from
other things in his life. This he did with resourcefulness. He
developed the hobby of water-color painting and derived keenest
pleasure and pride from this art.
To most men and women who have made a good recovery
from their "coronary," however, the sex act is an expression
of love and devotion and is generally a relaxing, healthful ex-
perience. However, this is always so when carried out in modera-
tion, never to the point of strain, or when fatigued or during
unfavorable circumstances, since the heart actually does signi -
ficantly increase its action during the sex act, as shown by recent
published medical research.
One businessman, a 44-year old European patient of mine,
Mr. H., is an example of a well-recovered "coronary" case with
a relaxed, philosophical attitude toward life. A devoted hus -
band, deeply in love with his attractive, loving wife, he finds
great satisfaction from frequent sexual relations. Mr. H. assures
me this is the best "sedative" he knows, and that it banishes
the daily tensions of his work. Love-making both refreshes and
soothes him and is as necessary to "nourish" his love-life, as his
daily food is necessary to nourish his body.
What is the best "coronary climate"? The ideal climate,
as far as the coronary patient is concerned, is a temperate one.
Extremes of heat and cold should be avoided. High altitudes,
especially those above 5000 feet, are also a strain on the heart.
Newspaper readers are well aware that during heat waves or
hot spells, hospitals and emergency treatment rooms are kept
busy treating patients who have collapsed from both heat strokes
CARING FOR YOURSELF AFTER A HEART ATTACK
177
and heart strain. Similarly, patients who suffer from angina —
a heart or coronary disease—experience their worst pains when
they walk about in cold or freezing weather.
Sections of the United States that are favorable to the coronary
patient are the central and southern areas of California, the
southern portions of New Mexico, Arizona, and Florida. There
are other temperate localities in the country where the coronary
patient will experience no discomfort from the weather. Your
physician can advise you which locality would be best for you.
To demonstrate how some men with initiative lick a climatic
problem, there is a 59-year old former patient of mine who
came to see me 10 years ago from a northern part of the state
of Washington. Mr. 0. had had a coronary but, on exertion,
suffered from anginal chest pains only during col d weather,
in the winter season.
I persuaded him to leave his wheat farm after harvest time
to the care of his son-in-law, who farmed with him, and to drive
down and live in a trailer during the winter months in a charm-
ing spot between Los Angeles and San Diego, by the ocean and
the desert. He now spends practically half the year working
on his Washington farm and half the year living with his wife
in their trailer in Southern California.
For 10 years now he has had no anginal pain, but here is the
"pay-off": After his first winter spent in Southern California,
he returned to Washington so tanned, healthy, and happy that
his friends (and even people he did not know but who had
heard of him) formed a "Coronary" Club, and established a
trailer settlement in this Southern California spot. Here a size-
able settlement from North Washington was formed, and the
amount of fishing, bathing, card playing, and general fun and
relaxation for members of this "Coronary" Club are a delight
not only to those who have had a coronary attack, but to those
men and women who are desirous of avoiding one and who wish
to enjoy life and good health in their older years.
When may you return to work? When the coronary pa-
178
CARING FOR YOURSELF AFTER A HEART ATTACK
tient's heart has healed and its function has returned to normal
(as determined by his doctor), he is usually allowed to return to
his customary activities as soon as is practical. Of course, it is
wise to do this gradually, rather than to plunge into a job where
he left off. Even if it means only part-time activity at first, most
people derive a great satisfaction and a lift to their morale
when they can return to some useful routine of life.
If the patient was engaged in very strenuous physical labor
or factory work which he really did not enjoy, but which he was
forced to do to earn a living, he is usually better off to find a
lighter kind of work, provided it does not involve the frustrations
of a long apprenticeship. There are many ways of reevaluating
the kind of work a man or woman has been doing. Many of
my patients were engaged in occupations that were a continued
source of irritation, causing a state of alarm. Their coronary at -
tack may even have been partly due to the unbearable and pro-
longed tension. For such patients I always recommend a different
occupation or way of life. Then the question arises, "How can I
find the right work for myself?" The American Heart Associa-
tion has developed splendid programs in most of the large cities,
aimed at rehabilitation of heart patients. An important part of
these programs is helping the patients find the right kind of
job. Some centers have also created 'heart kitchens," where
housewives who have suffered heart attacks are taught many
labor saving devices. Here women learn for the first time that
housekeeping need not be a drudgery.
The Association also sponsors vocational rehabilitation serv-
ices which analyze each patient's skill, educational background,
physical condition, and so on, to produce a profile of his job
qualifications. Often it turns out that the average person possess-
es hidden talent or unsuspected skills that may open up entirely
new vistas that might have remained closed to him all of his life,
if he had not suffered a heart attack.
Develop a constructive, optimistic attitude toward life.
The case of W. K., a brilliant and successful lawyer, is a perfect
CARING FOR YOURSELF AFTER A HEART ATTACK
179
example of the vital necessity for the right attitude and
philosophy of life.
W., who was 52, certainly had a frightening family history.
He was the only one of four brothers still alive. His three
brothers had all died of heart attacks. Clearly, W. was a familial
or hereditary candidate for coronary thrombosis, particularly
since his blood cholesterol level was abnormally high. But Bill
was a cynic, a disappointed father, and an unhappy man.
By nature a pessimist, he believed that it was his fate to die
of a coronary thrombosis. He proceeded to help fate along—as
had the rest of his former family. No amount of pleading by a
devoted and concerned wife* no amount of urging by his doctor,
could induce W. to change his philosophy and his living habits.
Bill insisted on eating everything, the richer and fatter the better.
He drank to excess, smoked heavily and took as little rest as
possible. In short order the ax fell. Bill had his coronary throm-
bosis and joined the rest of his family—48 hours after his attack.
On the other hand, Charles, an optimist and, of all things, an
airplane pilot, was confronted with the same problem. He also
had lost 3 brothers from coronaries, but Charles believed in
helping to direct his own fate in a positive way. At the age of
37, he had the most vital of reasons, other than himself, for re-
maining in good health. The lives of thousands of passengers
were in his hands. Characteristically enough, Charles also had
an abnormally high blood cholesterol level. But being of a
practical turn of mind, he set to work immediately in following
a strict low-fat diet with dietary and vitamin supplements out-
lined in Chapter 5. His blood tests rapidly became absolutely
perfect in every way. He felt and looked marvelous. Today, 10
years after the original examination, he is the perfect physical
specimen.
What a sharp contrast in attitude and philosophy of living
between Bill and Charles. What a striking contrast that meant
perfect health in one case and death in the other!
An equa