How to Avoid Being a Cardiac Arrest Statistic

Jan. 23, 2019
Alan Berkowsky shares his story of weight loss and bypass surgery, and offers key takeaways for firefighters to avoid being a cardiac statistic.

Every day when I sit down at my desk to catch up on emails, I glance over the Daily Dispatch, an electronic clipping service of links to fire-related stories. It is organized with stories from your local area first and then fire-related news stories from around the world. Lately, it seems like every time I read the teasers to the links, I see a story about a 40–50-year-old firefighter who suffered a fatal heart attack. These sad situations are also sent to many of us through Chief Billy Goldfeder’s FirefighterCloseCalls.com—Home of The Secret List. These incidents seem to occur much more often than in previous years.

So you might be wondering why I am qualified to write on this topic. The answer is because if I did not take the action I did, I would have been one of the stories you glance over. The story might have been titled, “Illinois fire chief dies during training evolution.” 

My story

I have been in the fire service for 38 years. I started in 1980 as a fire paramedic for the Chicago Fire Department. In 1981, I joined the Evanston, IL, Fire Department, working there for 28-plus years, with seven as fire chief. In 2011, I joined a smaller department in Winnetka, IL, just north of Evanston, where I currently serve as the fire chief. 

The two departments are very different. Evanston is a small city fire department with five stations and over 100 sworn members. Winnetka has a single station with 24 sworn members.

When I joined Winnetka, I weighed 210 pounds and was trying to work out when I could. The difference in being a fire chief for a smaller department is that you are more in touch with the shift and culture than with a larger department. I found that most of the members of the Winnetka Fire Department were very focused on health and fitness. It had an influence on me. 

The first thing I decided to do was lose some weight. This is a tough process for many of us. The key is that it’s not just about dieting to lose weight, but rather the need for a lifestyle change to keep it off.

I joined the Jenny Craig Weight Loss Center near my house and began to shed the pounds. I was able to bring my body weight down to 169. As a result of the change in my diet, I began to change my lifestyle. Anecdotally, I have not had a single french fry for the last four years. I use this as my reminder to be diligent in the choice of foods to eat.

As I began to lose weight, I started to focus more on exercise. I joined a fitness club and signed up for some lessons from the on-site trainers. Although I was not particularly impressed by the trainers, I was able to pick and choose some of the exercises that I now use for my weight-lifting routines. My current exercise routine is about 60 minutes a day, ideally six days a week. I alternate daily between the treadmill and weight-lifting. I work out half the time at the fire station and the other half at the fitness club. 

I think it is also important to note that, like most fire departments, we require all sworn members to take an annual physical. Our physical is done by a medical facility that is very familiar with NFPA requirements. The annual testing includes a blood workup, a stress test or an echocardiogram (depending on the age of the firefighter), a spirometry, eye test, hearing evaluation and a routine exam by a physician. We decided to switch any member who is over 50 to a stress echo instead of the routine stress test due to false positives. These false positives would have resulted in the further evaluations, including a stress echo, so it was a bit of a cost-savings concept to do the stress echo for employees over 50 years of age.

In 2015, I was at the peak of my weight loss and trying to be diligent in my workout routine. In December, I went through the department’s annual physical and stress echo and “passed” with flying colors. I was feeling pretty good about myself (for being 57 years old). I lost the weight, was working out and never smoked. I felt so good, in fact, that I decided to participate in the department’s annual firefighter challenge. It was, at the time, a new annual testing process for all sworn members.

The challenge requires each person to don their full turnout gear, go on air, and perform several firefighting tasks while being timed. These tasks included climbing a four-story training tower carrying a hotel pack, pulling a 50-foot hose roll of 1¾-inch hose up to the fourth floor of the training tower via a rope, carrying the hotel pack back down, using a sledge hammer on a sled to move the center piece, pulling a charged line and carrying a heavy dummy 100 feet. 

I thought I was ready.

Most of the members completed the test in less than 4 minutes. It took me 14 minutes and several rest stops to finish. I survived, and my recovery was OK. However, I realized that I was not “out of woods” when it comes to fatal myocardial infarctions. My body was telling me something was wrong. With all my effort to watch my diet and workout, there was still a problem. Of course, my family history of heart disease added to my risk factors.

I decided to seek out a cardiologist. I met with the doctor and informed him of my concerns. In hindsight, I was experiencing some atypical chest pains that ran across the chest. I had no other symptoms so I assumed the discomfort was due to the weight-lifting and push-up routine I was doing at the gym. 

Because I just had my annual stress-echo, the cardiologist recommended an angiogram. At first, I was reluctant, knowing that they cut open the thigh to access the femoral artery. But I quickly learned that there is a newer procedure that allows them to use the wrist instead. This was a much less painful procedure yielding the same test results. As they were performing the procedure, I was in a “twilight fog” but was able to hear the doctor indicating his concerns regarding some of the low-pressure readings of my carotid arteries. 

The test results indicated that the only course of action was bypass surgery. After having two parents go through this process, I knew more about the procedure than I wanted to know.

Dr. Patrick M. McCarthy, a cardiac surgeon and executive director of the Bluhm Cardiovascular Institute at Northwestern Medicine, would perform the surgery with his team. Prior to the surgery, I asked Dr. McCarthy about my atypical chest discomfort. He suggested that if it is no longer there after the surgery, then I was having angina, chest pain associated with poor perfusion in the carotid arteries.

The surgery was in 2016, and I can honestly say that I don’t remember any discomfort during the recovery period. The Bluhm Cardiac Unit at Northwestern Medicine anticipated just about every step of the recovery process, and I returned to full duty in about 12 weeks.

About a year after the surgery, I took part in the same firefighter challenge and was able to complete the entire process in just about four minutes without any rest stops. Since then I have completed the challenge in under the four minutes. Incidentally, the chest pains never came back—a symptom of a potential heart attack I somehow rationalized as normal. 

Key takeaways

Cardiovascular disease is prevalent in the fire service. We need to get ahead of the problem or we will lose more firefighters to fatal heart attacks.

With this in mind, here are some thoughts to consider:

·      Listen to your body. If you have a gut feeling that something is not right, you are probably correct. Get it checked out. Do not hope it is indigestion or overwork; that is how we end up finding firefighters dead after the fact.

·       Develop a relationship with a cardiologist prior to 45 years old. This will allow the doctor to have a baseline and for you to have a person who can monitor any problems or address any concerns.

·       After going through my experience with stress tests and annual physicals, I have determined that the only true test to determine if you are a candidate for a myocardial infarction (MI) is the angiogram. If you are 50 years or older, I would recommend you consult with your cardiologist who will take into consideration your general health, occupation, family history and other risk factors. An MI can be prevented with early detection!

·       Take advantage of your department’s wellness programs. Do not ignore high blood pressure or high cholesterol counts.

·       This is not your department’s fault. You need to be accountable to yourself. Watch what you eat, stop smoking, drink in moderation and start exercising. 

Our work is stressful, and we can go from zero to 100 mph in the blink of an eye. This is not a new phenomenon or revelation. We know what the job entails, so we must take care of ourselves. Pay attention to the signs, and do not ignore the obvious. Take care of yourself!

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