Heredity really gets you at 50. I did some searching for a week regarding the topic. For me the heart attack was in the cards along with the glucose levels. The good news 1% damage, due to luck and the fact I have been  active. I figure many ski or snowboard afterwards and maybe I can add to the information. Cardio Doctor makes the call. Comments welcome. 

Goal- Be able to ski easy with limits, moving to the ability to ski hard.

You will be treated like a common Avg person who is obese, sedentary, horrible diet, smoking, drinking type. I am not.I could not find anything to say I could not ski.  

My cardio Doctor 10 days after-I convinced  him that I was active keeping a record of treadmill walks for last  week. 30 min a day 3.0 rate. Heart Rate <110 bpm. wear Heart Rate Monitor Must carry Nitro on person and medical card.

permission to add light weights to cardio walk. Add LIGHT GREENS BLUE HR <110 bpm 

Next Milestone: 1/22/2015 (24 days) Stress Test for MAX HR. then I can ski hard. and Cardio doc will set limits to HR bpm.

The other Caution: Blood thinners - ie. Death due to bleed out internal / external. Research showed nose bleeds, etc but no other info. NSSA says 1 major injury per 1 million visits. To mitigate risk, I will carry a first aid kit with tourniquet and clamp, tampon for nose bleeds. Ski patrol is within 5 Mins. If a fall occurs or chest pain stop. follow protocol.then access by ski patrol.

I going through the exercise, I was able to access my risk. At 540 days skied. No Issues requiring Ski Patrol. No broken bones etc.

My wife's a "clotter" with a blood disorder that keeps her on anticoabulants for life.  Doctor's specific orders are that she is to avoid  all un necessary activities like skiing, even roller coasters at amusement parks.  Anything where she could possibly band her head or sustain a deep cut like from a ski or board edge in a fal or collsion with another rider is a no no according to at least two hematologists that she has had.  That said, I know at least two others taking almost identical chemicals that ski every week.  I know I wouldn't stop skiing for life if I was on anticoagulants, but I would stick to blue and single black groomers and avoid the park most likely.  No doubt I would definitely wear a really good helmet.

Hang in there.  Rehab systematically and push it a bit, to the extent that you and your family are comfortable.  You will get back what you put into it.  For some time now you are going to feel a little stronger and better with each passing day and week.  Take advantage of that.

i can provide an example.  In about 1995 i had a heart attack without symptoms, at least not that I recognized.  Age 53.  It was discovered in 1997 after a series of suspicious tests culminating in an agiogram that showed 100% blockage of the right coronary artery at the top and 4 large bypasses that my heart had built by itself.  For several months in spring 95 i felt diminished and got out of breath easily but no chest pain.  Health care providers and media information sources do a serious disservice by emphasizing chest pain only and never mentioning that serious shortness of breath is equally alarming.  I had run all my life but in this period could only go a half mile or so before needing to stop.  I attributed this to a slow recovery from a bad case of flu.  I could cycle, although not as fast as i was accustomed.  I began doing a 50 mile ride on the W &OD trail 1-2 times a week.  By late summer of 95 i felt fully normal, recovered my running ability, etc.  this is probably what stimulated the collateral circulation.  In 97 the cardiologist was impressed with the self repair and declared it adequate for my active life style but prescribed a daily beta blocker as protection against arrhthmias and pushing heart rate too high.  Later i was put on a statin and a blood pressure med.  

Fast forward to 2006.  I began having what I suspected was angina and some shortness of breath running.  To me, angina is not pain nor pressure, but it is uniquely uncomfortable and weird.  I'd recognize it if it happened again.  I had tests which showed a 70% blockage of the left main coronary artery.  Lose that one and you are dead.  The cardilogists verdict was that this would slowly worsen and diminish my life style but that it was not yet critical on a 1-2 year timescale.  I decided to be proactive and have a triple bypass while i was still in good shape with an excellent prognosis for recovery.  It was done in June 2006.  I walked out of Inova Fairfax on the third day.  The doc trusted me to manage  my rehab, which started with prescribed walking.  4 walks per day with one "long" one.  I set a goal for the long walk at 1 mile after 1 week, progressing by a mile per week until 5 weeks, then progressing to longer hikes with hills in Shenandoah and Dranesville district parks.  Breaking the 2 mile barrier was tough, after that it went easily.  In late august i took a business trip to Boulder, CO and after business went to Loveland Pass for a several miles hike at 12 -13,000 feet altitude.  In late Oct. after another business trip to Pasadena, CA i took the tram from Palm Springs to 8500 ft. and hiked from there to the summit of Mt. San Jacinto.  It was 6 miles and 2500 vertical, one way.  I felt fine after both of these altitude tests and skied a full season in 06-07 both lift served and backcountry, often alone in WV.  I now have a pacemaker implanted in 2012.  It is programmed to do one thing only, kick in if my heart rate drops below 40.  Pacemakers are also tattle tales and are read out every few months.  I have not gone below 40 since but do have occasional arrhythmias of very short duration that i dont notice.  No A fib so no need to take strong anti coagulants but only an aspirin per day.

Having proven my ability to block coronary arteries, there will no doubt be future episodes of some kind.  I get tested and watched carefully, but I'm not willing to live life in fear.  I have slowed down a lot over the last 20 years but believe it is primarily, perhaps entirely normal aging.  My wife and I are both OK with the possibilities.  Any of us could be hit by a bus stepping off a curb.  I'd be found a lot quicker of course, but are you really much less alone on a city sidewalk amid hundreds of strangers than in the wilderness?

i hope this tale does someone some good.  It is meant that way, although truth be told, there may be a bit of bragging in there too.

D.I.Y Heart Bypass?  I've  had a hunch that the body can self repair like that in some cases.  Had you gone in for regular physicals between 95 and 97 where they totally missed that when they listened to your heart in the doc office or had you just not gone for regular chekp ups during that time?

I did not have any check ups in that period.  'Knew' that i wasnt a heart attack type, having been a record setting HS cross country runner, who had continued running  recreationally since.  One day i felt poorly at work and went to the clinic.  They took an EKG as a precaution, gave me the printout and said i was fine.  On the way out the door i read it and saw, 'past myocardial infarction'.  Those are fancy words for heart attack.  I asked, if I'm fine what the hell is this.  They said to take the print out to a cardiologist if i was concerned.  Its just a dumb machine.  They were not cardiologists and saw no cause for alarm.  I took it to my brother in law, a cardiologist, who said there was cause for alarm.  The story proceeded from there.

Thanks for give all of more insight into health issues as we age.  I like the attitude you and your wife have about your continued enjoyment found in skiing!  Take care of yourself, my friend.

The Colonel

Thanks Colonel.  You too.  And all DCSkiers.

Awesome, Thanks for the info: I hit the slopes today: Roundtop. 

Assessing risk: Training, prepare, feedback, protection, stats

Lessons, First aid/cpr, concussion protocol -  I have many years off lessons & race training. First aid cert. and Concussion coach cert.  

Med Kit- Carry on person a first aid kit w/ Note of meds, doctors and contacts. Nitro, Tourniquet, tampons, artery clamp.

I like this product.http://www.swattourniquet.com/  Tampons for nose bleeds. Friends know what I  carry and never ski alone.

Feedback: -Heart rate monitor  bpm range 90-100

Protection: racing- full top body armor. 

Stats: 17 yrs 540 days skiing no broken bones, ski patrol not used. Slight concussion once.

1 fall a year. Last fall - racing 45 mph . slight concussion.

NSSA- 1 major injury per 1 million skier visits.   510 major injuries last year  out of 54 million visits.

-Yesterday 1.6 miles 35 mins treadmill. Medium Weight circuit

Everyone has to evaluate the risks. Not high altitude, Ski Patrol within 5 mins.

Protocol:  today

ski green blue runs moderate to slow. HR 90-100 bpm max 110

Chest pain: STOP , Nitro, Ski Patrol   

Fall/Injury: STOP , Control Bleeding, Concussion Protocol, Ski Patrol

I wonder if a ski patroller can add info. RE: how many chest pains? Major broken bones skin penetrate, and concussions. Have they  had issues with bleeders?  

thanks.

Wish God would have installed a check engine light.

My father skied  whales tail at breck at age 72. just take it easy... God will make evrything workout...

Tourniquets don't do much for head bleeds, which are the be-all end-all as far as badness from anticoagulants. Unfortunately even a good helmet won't prevent a bleeding-type head injury that could be sustained while skiing. I think it's just a risk vs benefit assessment you have to have with yourself. As for me, not sure what I'd do. Tree skiing might have to stop. I know I'd for sure be increasing the amount of time I spend on XC skis vs alpine skis. Also, not much good could come of unstable angina leading to a heart attack while on the slopes, especially on a not so busy day. Tampons, lol...

Athough I did meet a guy who once dissected his aorta (ie. super badness) who would have died if he wasn't, you guessed it, ontop of Squaw Valley, less than 5 minutes from a chopper lifting him off to downtown Reno. 

David, yes correct head injury leading to brain bleed is the concern. I race and I have had a concussion (11 out of 100 SCAT2 Test). I do not ski tree/glades. No joke on tampons they work for nose bleeds.:o)  I found a person epicski that had a nosebleed on the slopes. 540 days skiing 18 years never had Ski Patrol help me. knock on wood. 

It is a personal decision. I like to write and explore, plus it makes me think about the risk. Then having people add info. I found a site that links FDA adverse issues ie brain bleed and a chart of incidence.  Average percentage for all medicated patients(effient) where HEAD INJURY is reported as a complication: 0.0609%.  Unlikely. Of course  the site has a long list of meds that have been reported..ie Aspirin is #4.  Link to list of meds w issues

The other reason is family, they worry. 

Good input from all of you.  thanks

Word of caution: usually takes 6 weeks for heart to reconfigure. I am an exception since I worked out and ski 30 times a year.

not a smoker or drinker.  Take meds as directed. 

Passed the stress test Heart rate max 81% 135  bpm. Above Average. no issues. 3 weeks after stent. so 135 bpm is my new top rate up from 110.

As for heart rate- 90 -100 bpm gear setup walk haul from car. medium speed blue - 110 - 

Ski hard fast -125 bpm.  profile: lift 6 mins resting  1 min or less intense repeat

in 3 hours burned 545 cals. 

As for risk:  blood thinners I rate it low 1%, follow concussion protocol and have  ski patrol check out and stop for the day.

Followup - 2 races run Sunday - 125 bpm.

In SUMMARY-

If you were active before procedure you can get back to exercise.

for  Heart rate train at 60-70% of max HR

then work up to 75-80% of max

Treadmill 35-30 mins day 3.3 mph walking 1.0 + miles

Other cardio machines. 

For weight lifting start at 25  - 35% of one lift max

each week move up a bit. Form is most important. After 28 days I am lifting med to heavy.

Creatine monohydrate & Glutamine 5 gms each a day helps recovery, heart, and diabetes.

Glad I am back skiing...Great week coming up.

Will call this forum topic closed. thanks for the info. 

Completed top to bottom GS on Saturday 126 BPM.  the SL I figured would take me near or above my cutoff so I only ran GS.

I would think the same for a mogul run.

The avg person- smoker, overweight, sedentary takes 6 weeks to get to 30 min walking. The heart takes 6 weeks to reconfigure.

Wore complete body armor. Needed the warmth.That is one thing I am colder with the blood thinners.  

Sweet, Ticker is great up to 136 bpm.  Skied all day Friday and night. 2 separate races. about 3 % better than last year. 5% off best.  Next Milestone in 2 weeks (9 total) Blood Work & echocardiogram. 

check out my write-up with sourcing. http://skidome.org/skidome2/exercise/sports-med/heart-love-skiing/

The main thing is the amount of damage, Staying on meds, Eating right  I was lucky and was active the last 20 years.

The HDL, LDL, Trigyl, Vitamin D, and glucose can be managed by meds and diet. 

For many DIET does not fix the LDL, HDL issues. Then again, a 2 liter bottle of coke per day is equal to = all 3 meals with snacks combined.  Yes, 2 x as much sugar as needed. 

Cool, 8 weeks no real sugar ie coke a cola. Better Diet, lots of skiing.

My A1C was 11.4 now 6.6  My Lipids are cut by half now all normal.

23 days skiing, 7 race days. 

Medication, diet, testing, tracking, exercise works.

Skiing is a life saver!!!

Strong work on that A1c!

A1C drop  and the Lipids dropped 60% in 8 weeks. - Thanks, That was mostly the 2 liter a day coke a cola habit.

Just used metrics and goals. I am hoping for a 5.2 a1c in a month to combine insulin with metformin then move to pill for control. 1 pill can drop A1C by 1 point a combo 2 pills different meds can get 2 points.

http://skidome.org/skidome2/exercise/sports-med/heart-love-skiing/diabetes/

In a way it was good timing since I love to ski and exercise is great for diabetes and heart.

Since my last post I have received the echocardiograms from day after and 3 months. In researching to convert to laypersons terms, I find the heart an amazing device. 

KNOW YOUR  BODY - Do not rely on your doctor, it is your job to know these values both baseline and periodic testing.

Keep a copy of every test, report etc.

Lipids-HDL, LDL, Total, Triglycerides

A1C and Fasting glucose.

Vitamin D

Comprehensive Metabolic Panel with eGFR

Got in 31 days/nights total 10 of which were race days.  

Well now Poof HFCS in excess is a bad thing. clogs the arts bypasses liver, Makes blood 2x as thick.

Results: Be a year in3 weeks.  all I cut was 1/3 bread and all SODA.

45lbs lost. now 205  lbs 6'1"  Have had no issues since cold turkey.

kidneys increased function by 20% ( think blood) 

Last A1C was 5.4

Now off Night insulin. No more Insulin. totally transformed. 

Many of you are like me addicted to HFCS.

I do not even need stevia in my tea. Lost the crave and tastes for sweets. my portions are smaller etc.

Nice job, ski on!

One of the neat things about my nine week ski trip last year was that I dropped about 15 lbs from high 170s to low 160s, most of that during first month.  I cut back on caffeine, snack  food, and sweets.  Ate a lot of oatmeal for breakfast and soup for dinner.  I was busy either skiing or sleeping and did not have a lot of couch potato time, which is when I get my biggest food cravings.  Also, it was not convenient to keep a lot of junk food laying around my motel rooms so meals/eating took place during a finite span of time.  Unfortunately, I’m back to old habits and weight, but try to stay somewhat active.  Bring on the snow and cold:-)

OFF Insulin the big GOAL.(hassle and cost) Second was keep heart healthy. My issue HFCS. I read labels now. 

on metformin only and diet control. A1C came back up to 6.0 but still good. Need to adjust a couple of meds. should come down. 

Added protein powder extra 30-45 grams a day (helps control sugar and carbs) and 5x5 weights to get some muscle and strength back. It worked. 21 days and a difference. 80% legs / 5% cardio/ rest upper body. ready to ski..