“He took the time to ensure I was satisfied that this surgery was the best choice for me.”
Some might argue that chest pain and shortness of breath go hand-in-hand with running, but Livio knew something was wrong when he started experiencing both during his runs, last winter.
A veteran of two marathons, 63-year-old Livio averages three training runs a week, often covering 10 or more miles at a time. So, he’s well-versed in discomfort. But when his chest tightened and he struggled to catch his breath, usually right after turning uphill, Livio recognized it as something more than the usual strain.
In the months before the onset of his symptoms, Livio’s primary care physician had ordered a calcium score test and a CT scan to detect calcium in the heart’s arteries — which would indicate a buildup of plaque that can narrow or block the arteries. This condition is known as atherosclerosis, and it could lead to a heart attack.
Because Livio’s scan found some calcium, he was put on a low-dose statin to lower his cholesterol, a key risk factor for arterial plaque buildup.
With this fresh in his mind, Livio asked his primary care physician to refer him for a cardiac stress test. Stress tests are a common test and used by specialists to determine how well your heart pumps blood, and if your heart is receiving a sufficient blood supply. In the test you are asked to exercise on a treadmill or stationary bike with increasing intensity until you reach your maximum heart rate.
Livio’s stress test showed blood flow to his heart was far less than it should have been. He was sent directly to the ER, where he underwent another CT scan of his heart — this time with an intravenous contrast. The scan showed a significant buildup of plaque in one of his arteries. He was told that it was too extensive to be resolved with a stent, and he was referred to a heart surgeon.
Surgery, But Not What He Expected
Chase Brown, MD, Surgical Director of Coronary Revascularization at Penn Presbyterian Medical Center, reviewed the results of Livio’s recent tests and scan with him and confirmed that surgery was his best option.
Having studied medicine in his native Italy, Livio understood that to mean an open-heart surgery that would entail a significant recovery. But Dr. Brown had told him he was a candidate for a minimally invasive robotic procedure since his atherosclerosis was largely contained to one artery and he was in great physical condition.
Robotic heart surgery has been found to be more efficient, less painful, and easier to recover from than open heart surgery.
“Of course, nobody likes surgery. And I was asymptomatic aside from when I was running,” Livio says. “So, I asked Dr. Brown if he could recommend someone I could ask for a second opinion.”
He pointed Livio to William Matthai Jr., MD, Director of Clinical Research in Cardiology at Penn Presbyterian Medical Center. Dr. Matthai, who remains Livio’s cardiologist today, agreed with Dr. Brown’s assessment.
After taking a couple more days to think about it, Livio decided to have the robotic surgery.
Run, Livio, Run
Livio isn’t just an avid runner. He’s an avid barefoot runner. He’s cultivated a robust following on Instagram by regularly posting short videos and photos from his runs around Philadelphia, many of which include a shot of Livio proudly showing off the dirty soles of his feet.
He started running barefoot 13 or 14 years ago — during winter, no less — after suffering chronic pain from running shoes and finding little relief with the minimalist kind. After finding his footing on a nearby high school track, he began venturing farther out. Today, he runs along trails, sidewalks, pretty much anywhere.
For Livio, one of the most difficult aspects of this experience was not being able to run while he waited to have surgery.
“Running is really good for your mental health,” he explains. “I mean, it’s good for your physical health, too. But I think the big plus is that it really helps you process things. When you’re used to running and you can’t, then you get antsy, nervous, and depressed, and all this other stuff.”
Livio has a hard time remembering the date of his surgery off the top of his head, but easily recalls the date Dr. Brown told him he could start running again (March 23).
Dr. Brown says he often tells patients who undergo this procedure they can resume exercising as soon as two weeks after their surgery, but most wait another couple of weeks until their discomfort is completely gone.
Livio started slowly and in a little more than a month, he was back to his normal mileage.
Livio is now taking a beta blocker, a medication that reduces his blood pressure. It also keeps his heart rate down. As a result — and also because it hasn’t been terribly long since his surgery — Livio is running a little slower than he did last winter. But he still managed to finish in the top third of his age bracket at the annual Broad Street Run in April.
“Running that race was really my goal for my recovery,” he says. “If I could do that, it meant that I was in a better place than I was before the surgery.”
Determined as he was to continue running, Livio says it was Dr. Brown who ultimately convinced him to go through with the surgery.
“As a surgeon, he obviously did a great job,” he says. “But he was also very personable and good at explaining everything. Since I work in the field, I had all these studies I wanted to discuss, and he was super-open to discussing all of them. He took the time to ensure I was satisfied that this surgery was the best choice for me.
Livio continues, “And, really, that’s why I decided to do it because I had been very much on the fence, if not on the other side of the fence altogether, about it.”