Peter Marbach had been feeling fatigued last spring, but the 45-year-old photographer blamed it on the rigors of his freelance work and being father to his 6-year-old daughter, Sofia.
Then he went to hike Dog Mountain to photograph wildflowers. Carrying his backpack with 40 pounds of gear, he was out of breath in 10 minutes.
"I remember thinking that I probably shouldn't go all the way up," he said of the steep climb on the Washington side of the Columbia River. It was a strange thought for Marbach, who is an avid hiker and backpacker. Not only had he done that hike countless times before, he'd hiked the Pacific Crest Trail, the Appalachian Trail and completed a 600-mile trek across England and Scotland.
But he brushed off his fatigue, blaming it on a cold and muttering to himself about getting in better shape.
A week later, hiking around the Sandy River looking for photographs, he began to feel pains in his shoulder.
"I thought, this is probably more than a cold," Marbach recalled. "I was pretty scared."
He drove back to Hood River and called his physician at La Clinica, Dr. Mike Harris, who had Marbach come in for a check-up. Harris gave Marbach an EKG (electrocardiogram), but the test's results were normal.
Then, in a decision that likely saved Marbach's life, Harris gave him an "informal" stress test. He instructed Marbach to walk "laps" around La Clinica, including a up short flight of stairs. By the third lap, Marbach could barely catch his breath.
Harris hooked him back up to the EKG, took one look at the readings and gave Marbach some grim news.
"He said, `I'm afraid it's your heart'," Marbach recalled. "I said, `Okay, what does that mean?'"
It meant that three days later, Marbach was at Providence St. Vincent Medical Center in Portland for an official stress test, which showed blockage in his coronary arteries. Doctors scheduled him for an angiogram that same week, a test that determines the degree of blockage.
The angiogram on June 22 showed three blocked arteries. Doctors told him he was "on the brink" of a heart attack and wouldn't let him leave the hospital -- keeping him until the "next available slot" for open heart surgery.
There turned out to be a cancellation of a scheduled surgery an hour later, and Marbach was whisked in for open heart surgery that lasted five hours.
"For me, it was a blessing," Marbach said. "I didn't have time to ponder my mortality." For his wife, Lorena Sprager, "it was devastating" he said, his voice trailing off.
But the surgery went well and five days later, he was home in Odell recuperating.
Marbach had opted against getting a blood transfusion during surgery, which slowed his recovery. But as soon as he could get on his feet again, Dr. Harris recommended he check out the Cardiovascular Conditioning Center at Providence Hood River Memorial Hospital.
"I was pretty intimidated at first," said Marbach, who at that point could barely walk, much less work out on a treadmill or an exercise bike, the main equipment used at the center. "I was doing the `old man shuffle'," he said.
But he went to the center and met with registered nurse Laney Gale and Jan Polychronis, the center's exercise physiologist. They put him instantly at ease.
"They are genuinely interested in getting you back to where you want to be," Marbach said. As soon as he was able, he signed on for the recommended three-month "post cardiac event" program, where patients exercise according to a tailored regimen and under strict monitoring for 36 sessions.
Marbach soon found the program -- and his exercise session every other day at the center -- invaluable.
"The security of being here with people who have gone through the same thing was so helpful," he said, calling the people he met at the center an "extended family."
"It's kind of like `Cheers'," he said, referring to the popular TV sitcom. It also gave him the structure he needed to adhere to a workout regimen, as well as information on diet, stress management and other factors that can lead to coronary artery disease.
Cindy Truelove, who lives in Carson, Wash., is another regular at the Cardiovascular Conditioning Center. In September, at age 36, she had a stent inserted in one of her coronary arteries to open it back up after it was nearly closed from blockage.
Despite having heart disease in her family -- her father had his first heart attack at age 48 and died of his third one at age 60 -- she thought she was just having bad heart burn when she began experiencing chest pains.
Finally one day, after lifting her grandson out of the bathtub, she could hardly catch her breath. Her husband drove her the emergency room and she had the stent inserted the next day.
Truelove just finished her first three-month exercise regimen and has started a second one, this time without being on a heart monitor. Between warming up, doing the treadmill and exercise bike and some weight lifting, followed by cooling down, she spends nearly two hours at the center three days a week. But for her it's worth it -- as is the drive from Carson.
"I don't think I'd keep exercising if I didn't have this," she said. With the help of the center's educational classes and registered dietician, she's also changed her diet. She's lost weight and -- through a combination of exercise and cholesterol-lowering medication -- decreased her cholesterol levels.
"And I've just gotten really serious about exercising," she said, adding that having "a safe place" to do all of it has made the difference for her.
Eight months after his open heart surgery, Marbach continues to work out at the center at least once a week, sometimes more in what Gale refers to as the "maintenance" program.
"A person can stay in the maintenance phase of Cardiovascular Conditioning as long as they want to," she said. One patient who came to the center following a cardiac "event" in 1996 still exercises regularly at the center.
Another regimen the center offers is the Risk Reduction Program -- for anyone who has not had a cardiac event but has two or more risk factors, which include high blood pressure, high cholesterol, sedentary lifestyle, overweight, smoking and family history of heart disease. Gale said people don't need a physician's order to participate in the Risk Reduction Program, as you do with the cardiac rehab programs that brought Marbach and Truelove to the center.
"But (we) ask that you have had a conversation with your physician and he or she thinks an exercise program is a good idea for you," she said.
Marbach blames his coronary artery disease on stress. He lacked many of the common factors involved in the diagnosis: he was not overweight, was generally fit and exercised through his work, ate a pretty healthy diet and didn't smoke. As for a hereditary component, his grandfather died in 1940 of coronary artery disease, but none of his seven brothers and sisters has any problems so he questions that link.
But being self-employed, he said, puts him constantly under "self-imposed" stress.
"Stress is the silent killer," he said, adding that he's learned it can lead to a build-up of cholesterol -- a major factor in heart disease. Until his condition reared its head last spring, Marbach had never had his cholestorol checked. When he did, it turned out to be high.
"I encourage people to get their cholesterol checked," he said.
Another thing he had lacked was a regular aerobic exercise program. He walked and hiked for his photography work, "but it's not the same as a regular aerobic workout," he said. Now, on days he doesn't exercise at the Cardiovascular Conditioning Center, he goes on a 30- to 45-minute walk or hike.
With the help of the center's nutritionist, Marbach made some dietary changes -- which "were not that hard," he said -- including cutting out most animal fats. He and his wife had already adhered to a healthy diet before, so the changes they made were minor.
Marbach credits Dr. Harris with having the foresight to give him an EKG when he didn't have many symptoms that indicated heart disease.
"He saved my life," Marbach said, adding that his subsequent care at the clinic, under the supervision of Dr. Orlando Acosta, has been equally diligent. He also feels that counseling he got from Dr. David Wade at Gorge Counseling and Treatment Services helped him get through the difficult period after his surgery.
"I was caught off guard by the emotional challenge," Marbach said. "My way of dealing with it was to get back to work as quick as possible, to not think about it." Wade made him realize he had to allow himself to think about what had happened -- "to cry about it." He also had to learn to cope with panic attacks that would sometimes wash over him.
"He was very insightful," Marbach said. "He gave me the tools to cope with what I was going through."
He said one of the things that struck him most after his surgery was his doctors and others warning him that people who have an event like his often are gung-ho about exercising and diet for a few months, then they slip up and return to bad habits -- often showing up, again, to undergo the knife.
"I said, `You're not going to see me back here again'," Marbach recalls. "I look at this as a gift, a wake-up call. I've got a 6-year-old daughter and a wife I want to hang out with for a while." He says the "steady support and love" of his wife during his recovery was vital.
"I couldn't have gotten through this without her," he said. And there were two other women who have helped him through it all.
"Jan and Laney -- I think of them as my cardiac angels," Marbach said. "I don't know where I'd be without this program."