Today I’ve been asking myself (gently – this isn’t a beating myself up session) how I got here i.e. what caused my heart attack? I thought I’d look through all the common risk factors to see how they apply.

I just finished reading the Vancouver Coastal Health Cardiac Surgery Patient Guide and the Heart & Stroke Foundation Cardiac Care Guide suggestions for having a “healthy heart” diet. I’m not sure if I’m happy or sad that I’ve been doing most of these things for quite a while – no easy fix hidden in here. I would be considered a good practitioner of their program and yet I’m still here in VGH waiting for a bypass. So, I interpret this as my occasional dietary abuses (I love soft cheese and desserts but have rationed them out pretty well, especially the last couple of years) are only a small contributing factor to my current condition. I forgive myself for these transgressions – I have to live a little, too! My cholesterol levels are only slightly elevated and weren’t even in the range for treatment according to my GP. Now that I’ve had the attack the doctors are jumping on it of course…

I get some exercise – at least 90 and sometimes 140 minutes of walking per week for endurance and 2 one hour Pilates sessions for strength and flexibility. I also walk a lot at work and around downtown and tend to walk pretty quickly everywhere. When I put on my FitBit I was averaging 7500 steps per day outside my exercise times. I have a big flight of stairs to get to my office and I’m in/out a dozen times a day. Not a marathon man but not bad.

What other risk factors remain?

I’m not an angry person and I don’t bottle up my emotions (far from it!) so that’s not it.

I never smoked (anything) and avoid second hand smoke so that’s not it.

I’m not diabetic. Apparently not even close.

I’m overweight. Not huge but not just a little bit, either. Probably 25 pounds. I’ve been trying to lose some for the last five years. This prompted all the diet changes I mention above. Results to date? Nothing. Zilch. Nada. Then, my first 9 days in hospital? Down 10 pounds. Probable cause? I’m not drinking wine every day which I do to help reduce stress. Hmmmm….

My family cardiac genetic makeup is apparently a big component of this. Most of the males on my father’s side of the family had significant cardiac trouble in their late 50s and early 60s. The head cardiologist at VGH CCU was VERY surprised at my situation and claimed he would never have bet that I’ve be in here given my relative health and age. When I walked into Emergency they were even skeptical that I was having a heart attack and only really believed me after the heart enzyme test confirmed that I had an event. After the surprising result of my angiogram the cardiologist said “you just got bad cards – play them as well as you can”. Fortunately he believes that given my heart is actually quite healthy except for this one set of corroded pipes with the plumbing rework I should live “to my normal full life expectancy”. I like him.

However, to me, it is still important to look at why this issue has occurred almost 10 years earlier than the others in my family. And after ruling everything else out and factoring in the bits that have had some effect, the one risk factor I’m left with to look at is stress.

Stress. The one constant in my life. The question is not “Is there stress?”. The question is “How do I handle it?”

I’m an entrepreneur who for some reason enjoys creating startup companies. Wikipedia defines “startup” as a company designed to search for a repeatable and scalable business model. At the beginning we essentially know nothing and are searching for answers to a bunch of questions we don’t even know exist yet. We don’t know who our customers will be, why they will buy from us, who else we might be competing with and if what are trying to do is even possible. All we have is an idea or three and some faith that we can figure everything else out.

The dictionary defines stress like this: a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances. Starting and running a company is stressful because the process is FILLED with adverse or demanding circumstances. And I love it. It is one of the most creative, fulfilling things I can imagine doing. It brings me great satisfaction and sometimes even great joy.

I have a belief that people in business don’t feel truly successful unless they’ve had to struggle and overcome significant challenges along the way to their success. In that light, the startup world is a fantastic playground filled with opportunities to test myself against the world and, when I win, feel successful. Frankly, it is kind of addictive. Work to me is not a four letter word. It is not a separate thing I do to fund the rest of “my life”, it is an integral part “of my life”. I manifest my hopes and dreams for me, my family, my community and my world through my work. It is a source of intensely satisfying relationships and opportunities to grow into a bigger, better version of me.

So, given that I’m massively reluctant to give up one of the things that is creating significant stress in my life (the other, family related things are completely non-negotiable and not up for discussion), I’m left with a question: How can I handle the stress better?

It is not as if I’m all that bad at handling it now. In fact, I probably handle it significantly better than most people I know. Major issues roll off my back like water on a duck.

But the long term existential threats to the company and to my personal finances are taking a toll (obviously) and I need to find a way to do it better. Getting the company away from the danger zone would be a huge relief and cause a massive reduction in stress for me. It has been tantalizingly close for a year now but I can’t quite seem to push it over the finish line.

While I continue to try to get the business to a more solid place I’ll search for ways to reduce my stress. Nothing obvious comes to mind so if you have any techniques that work for you in big, long term situations like this, please leave a comment or drop me a note.

Or, bring over a bottle of nice red wine and we can reduce our stress together…

Next up: Live here at ICU