I recently received an unusual email from a friend in Chicago. The attachment was a photograph showing a cardiac surgery operating room….. with a hockey trophy prominently displayed at the bedside. At first I was confused but then the meaning of the image became clear and I thought of the late Chicago folk singer, Steve Goodman.
Goodman spent most of his career as a folk musician battling chronic myelogenous leukemia (CML). He died in 1984 at age 36. He wrote The City of New Orleans and other great songs, including The Loving of the Game. At the time he died, I was a hematology wannabe on “Red Medicine” at the University of Minnesota and his death touched me. These were the days before Gleevec, a tyrosine kinase inhibitor which is often curative in CML. Steve Goodman’s wife, Nancy, eloquently explained her late husband’s audacious and productive life: “Basically, Steve was exactly who he appeared to be: an ambitious, well-adjusted man from a loving, middle-class Jewish home in the Chicago suburbs, whose life and talent were directed by the physical pain and time constraints of a fatal disease which he kept at bay, at times, seemingly by willpower alone . . . Steve wanted to live as normal a life as possible, only he had to live it as fast as he could.” Excerpt from the Loving of the Game All the good times going by, got to have ourselves a few. Where I'm going has no end, what I'm seeking has no name. No, the treasure's not the takin', it's the lovin' of the game. So how does Steve Goodman’s song explain the photo? Well one interpretation is that Steve was a long-suffering fan of the Chicago Cubs…and rooting for the perennially disappointing Cubs can put a strain on the heart. However, I believe his song was an ode to the game of life. The trophy in the photo is one that members of my old hockey team, Silver Hockey (it has to do with hair color) award to the week’s best player. Silver Hockey plays at 0730 every Saturday at Johnny’s Ice House (West), the practice rink of the Chicago Blackhawks.
Turns out, shortly after my move to Queen’s, one of my teammates needed cardiac bypass surgery. The trophy accompanied him to the OR - a talisman to steady the hands of the surgeon. I am pleased to report that the trophy worked its magic. Every week the boys of Silver hockey compete, forgetting their hernias, prosthetic hips, and defibrillators. Dark versus light jerseys, these grandfathers are briefly transformed into warriors. Once my identity as a cardiologist was known, I was often informally consulted during warm-up on one malady or another. One sentiment I repeatedly heard was that, “If I have to die I want it to be on the ice,” to which I usually responded, “Perhaps it would be best that we delay that eventuality.” The importance of hockey to the over-50 crowd may not be apparent to the non-athlete, but consider the photographic evidence. When the icon of the sport accompanies you in the valley of the shadow of death you know hockey is not just a game. The fact is, the baby boomers are on the ice in numbers. It is estimated that in Canada there may be half a million senior hockey players in ‘Gentlemen’s leagues’ (author’s note: many of these gentlemen are not so gentle, and with the rise in women’s hockey, many are gentlewomen). There are risks to this sport. Hockey routinely elevates the heart to rates that exceed the maximum level predicted for age. A survey of senior hockey players in Nova Scotia by Atawal et al found that participants had numerous risk factors for myocardial infarction. For example, 56% had hypercholesterolemia. In addition, by monitoring subjects during games, they found that heart rates heart rates were very high, on average 184±11 beats/minute, exceeding the predicted age-adjusted maximal heart rates. Many of their 113 subjects had heart rhythm problems - usually nonsustained ventricular tachycardia – and/or ST-segment depression, a marker of heart ischemia or strain. However, when one balances the approximate doubling of hourly risk of death during an episode of anaerobic exercise (the senior hockey player experiences one hour/day) versus the reduced risk of death accrued by being physically active, Mittleman concluded that the benefits of exercise outweigh the risk. In other words, it is safer to be active than to be a couch anchor. In addition to the aerobic benefits of exercise, the loving of the game is invaluable. The need to be part of a team and to engage in play is not diminished by age. So what is the advice for the aging hockey player: 1) Know your risk factors: Use your participation in hockey or any aerobic sport as a motivator to correct your risk factors. Ensure your BP is <120/80 mmHg, your blood sugar is normal (<100mg/dl or 5.9 mmol/l) and your cholesterol is at target (<200mg/dl; or 5.2 mmol/l). Before you begin ice hockey or similar aerobic sports, assess your heart health using the American Heart Association’s Life’s Simple Seven. This web-based self-assessment will quickly show you what you need to fix before your strap on the blades. 2) Exercise regularly: You should exercise at a moderate level for at least 150 minutes per week, or at an intense level for 75 minutes per week. Don’t wait for the hockey season to get active. 3) Stop smoking: Better still, don’t start! There is no safe dose of cigarette smoke. 4) Consider your family history: If you have heart disease, or if others in your family have a history of heart attack or sudden death, consult your doctor for consideration of an assessment and possibly an exercise stress test prior to starting hockey. 5) Know the symptoms of an impending heart attack: If you have symptoms of chest pain or pressure, indigestion/heartburn or shortness of breath that doesn’t resolve between shifts: stop playing and let one of your teammates know. It could save your life, as shown in this remarkable story of off-ice teamwork. 6) Make sure that your rink has an automated external defibrillator (AED): Most of the sudden deaths during hockey involve ventricular fibrillation.CPR and a defibrillator are essential interventions to ensure survival. However, if you follow suggestions 1 through 5, hopefully this point can be avoided. One of the highlights of my new career in Kingston at Queen’s University is the chance to play on two teams. I have great teammates on the X-men, a team of fellow docs, and on Advantage Wealth Planning, in a league appropriately called the Left Overs. Like Steve Goodman, the ancient athlete longs to live as normal a life as possible and move as fast as he can, for as long as he can. So what did I learn at Johnny’s Ice House? I learned the importance of play and team work and that the treasure in life comes from the loving of the game.