The Triad Triage Trio

Working together to beat heart disease and stroke

In a crowded church in Greensboro, North Carolina, all eyes are on the podium as two men and a woman recount their personal tales of survival. The three aren’t delivering a sermon but rather a cautionary tale—all have waged a battle against heart disease and/or stroke and are sharing their experiences in the hope of educating others about the number-one and numberfour killers of men and women in the United States.


David Layton, a stroke survivor, travels to venues across North Carolina accompanied by Anne Howell, a heart transplant recipient, and Randy Ludington, a heart attack survivor. They call themselves the "Triad Triage Trio," and their mission is to share the information about cardiac risk factors they wish they had known years ago.

"Prevention is so much easier than recovery," says Layton, who was 55 when he suffered a massive stroke in 1999. A former pack-a-day smoker who worked in a high-stress job and had high blood pressure, Layton still remembers the day he awoke feeling dizzy and fighting blurred vision.

"I didn’t realize I was having a stroke because I wasn’t aware of the warning signs and symptoms," he says. Layton was taken to the hospital later that day where doctors determined that he had experienced a small brain hemorrhage (a type of stroke). In the emergency room, Layton suffered a larger brain hemorrhage that took away all functional use of his left arm and hand.

While in the hospital, Layton learned how smoking increases the risk of stroke two to four times, and he vowed that day to kick the habit. He also learned that uncontrolled high blood pressure, or hypertension, increases a person’s stroke risk. Over time, hypertension leads to disease of the large and small arteries of the brain. This, in turn, can lead to a weakening of the blood vessels in the brain, causing rupture of the blood vessels and then a brain hemorrhage.

"Two months before I suffered a stroke, I had lost 35 pounds and my doctor had taken me off high blood pressure medication," Layton says. "I thought I had my hypertension under control, but I learned that my risk of stroke also increased with age and certain lifestyle factors."

Layton viewed his stroke as a wake-up call and vowed to take control of his health. He knew that having a stroke put him at risk of having another, and he also hoped to share his story with others in the hope they might benefit.

"After my stroke, I told my family to give me six weeks until I was good as new," Layton says. "The reality was it took much longer than that. I had to learn how to swallow and to walk again, and I underwent both speech and physical therapy."

Layton spent six weeks in the hospital and 18 months in outpatient therapy. When he wasn’t working on his own recovery, he was serving as a cheerleader to other stroke survivors and their caregivers.

"I’ve met with over 3,000 stroke survivors and their families to let them know that it’s possible to lead a fulfilling life after a stroke," says Layton. He founded the website to inform other stroke survivors how to successfully navigate exercise, hobbies and other activities of daily living. "I also began making presentations about stroke risk reduction to any and all groups that invited me to speak."



Intent on reducing his chances of having another stroke, Layton made it a priority to change his lifestyle. While he had long been sedentary, he developed an appreciation for exercise during his outpatient therapy.

"After I completed rehab, I joined a gym and started swimming," he says. "I swam 32 laps two to three days a week using only my right arm."

Layton also eliminated fatty foods from his diet and learned how to reduce stress through exercise and prayer. He credits his wife of 47 years, Charlotte, with helping him to continue making positive lifestyle changes and meeting his goals.

"I couldn’t have asked for a better wife or caregiver," he says.


At an American Heart Association function in 2001, Layton met Randy Ludington, a heart attack survivor who expressed an interest in joining him to spread the message about cardiac risk factors and prevention.

"Over the next several years, Randy and I spoke to as many civic and church groups as we could," Layton says. "Many of our speaking engagements were arranged through the Greensboro office of the American Heart Association."

Clyde Yancy, M.D., Northwestern Memorial Hospital’s chief of cardiology and associate director of clinical programs at Northwestern’s Bluhm Cardiovascular Institute in Chicago, says it’s imperative that people know their cardiovascular risk factors.

"Eighty percent of the risk factors associated with heart disease are modifiable, meaning they can be changed or treated," Yancy says. "This includes quitting smoking and managing high cholesterol, high blood pressure and diabetes."

Yancy notes that 20 percent of cardiac risk factors are considered "non-modifiable" because they can’t be changed. These include advanced age, gender, family history of heart disease and race.

"Some of the most important steps that people can take to lower their cardiac risks include stopping tobacco use, maintaining a healthy weight, getting at least 150 minutes of moderate intensity physical activity per week, avoiding trans fats and eating less saturated fat and more produce and fiber," he says. "I encourage my patients to aim for a Body Mass Index (BMI) close to 25; hard to get there but anything close is still a good outcome."

Yancy adds that maintaining a healthy weight can also go a long way in improving cardiac risk factors such as elevated cholesterol and blood sugar, and high blood pressure.

"One of the easiest ways to lose weight is to cut your portion sizes in half," he says. "You don’t have to go on a fad diet, just eat half the amount of food on your plate."


For Ludington, who suffered a heart attack in May 2000, speaking out on heart disease was also a way to let others know that cardiac symptoms can vary greatly from one person to another.

"Several days prior to my heart attack, I experienced a pinching feeling across my shoulders, but I never had the shortness of breath or intense chest pressure that often accompany a heart attack," he says. "I originally thought I had a pinched nerve."

Only 52 at the time of his heart attack, Ludington admits cardiac disease wasn’t even on his radar. He still remembers the morning he awoke with shoulder pain that intensified as the day went on, and how the pain began to radiate down his left arm.

"I didn’t lose consciousness but the pain was so severe," Ludington says. "In addition to my shoulder and arm, I began feeling pain in my jaw and teeth."

Ludington’s pain landed him in the emergency room where an angiogram showed he had suffered a heart attack. A subsequent test revealed that Ludington’s arteries were blocked. Doctors inserted a stent, a small mesh tube to support the inner artery wall and to reduce the chances of the arteries becoming blocked again. Ludington was also told he needed to make some lifestyle changes in order to avoid another life-threatening attack.

"My doctor said if I didn’t quit smoking I’d be back in the hospital within two years, so I quit cold turkey that same day," Ludington says. "I was also overweight and led a sedentary lifestyle so I started [watching what I ate] and lost 40 pounds in three months."

Ludington also joined a gym where he began working out on the treadmill and doing low-impact aerobics three days a week. He also changed his eating habits. Before his heart attack, Ludington admits that he primarily ate starchy foods and didn’t pay attention to portion sizes. Today, at 66, he adheres to a diet that emphasizes quality over quantity, and is composed of lean beef, chicken and fish, and a variety of vegetables.

In retrospect, Ludington wishes he had made lifestyle changes years ago. Even though his own father had died of heart disease in 1977 at the age of 58, Ludington never believed he was at risk.

"My doctor used to tell me that my cholesterol was high and that I should lose weight and quit smoking but I thought I was immune to heart disease," he says. "Today, I take a statin for my cholesterol and am very proactive about my health. When we speak to groups, I tell people that while no one is super human, we can take steps to reduce our risk of heart disease."


In 2011, while waiting for the Annual High Point Christmas Parade to start in Greensboro, Layton and Ludington met Anne Howell, a former teacher and heart transplant recipient who was also in the parade representing the American Heart Association.

"After we heard Anne’s survival story and learned she was raising two active teenagers as a single parent while also participating in triathlons, we knew we had to add her to our group," Layton says.

The group called themselves the "Triad Triage Trio"—triad being the geographical name of their area in North Carolina made up of Greensboro, High Point and Winston Salem, and triage referring to the medical action necessary in an emergency situation to minimize losses and maximize survival.

With Howell rounding out the group, the trio was able to include a woman’s perspective, an important component since one in every four women dies from heart disease. Howell was also able to talk about transplants and inherited risk factors for heart disease.

"My mother died in 1981 at age 41 of sudden cardiac death," Howell says. "We didn’t know at the time that she had an enlarged left ventricle, known as cardiomyopathy, which caused her fatal rhythm, or that two of her four daughters, my sister Jane and I, had inherited the condition."

Howell was 28 and in the best shape of her life when she started feeling sick while running a 10K race in February 1993.

"Around mile 5.9 I got dizzy and collapsed to the ground," she says. "As an avid athlete, I knew something was seriously wrong."

As her heart raced, Howell managed to stumble to the finish line, where paramedics checked her vitals and rushed her to the hospital. Howell was given fluids and told to make an appointment immediately for an electrophysiology study, a test that records the electrical activity and the electrical pathways of the heart.

"I failed the test and was told I needed to have a defibrillator implanted, a small device placed in the chest, that would use electrical pulses to help control my arrhythmias and prevent sudden cardiac arrest," Howell says.

Over the next 16 years, Howell saw doctors frequently who checked on the progress of her degenerative disease.

"I was slowly getting worse and because of the gradual decline, I just didn’t know how poorly I was feeling," she says. "I just knew that I felt tired all the time and was unable to play with my two young sons."

Howell received four replacement defibrillators in 16 years, when the batteries in her device would wear out. Eventually her heart deteriorated to the point where a transplant was her only option for survival.

"My medicines were no longer holding the disease at bay and in January 2008, I met with a transplant team at Wake Forest University Baptist Medical Center," Howell says. "I was still in denial that I had gotten to that point in my treatment. I didn’t realize how sick I truly was, even though I had several bouts of congestive heart failure and several hospitalizations between January 2008 and March 2009."

Doctors began administering a series of exams, tests and procedures and put Howell on the waiting list for a heart transplant. She was approved and was added to the waiting list for a transplant on March 30, 2009. On October 5, 2009, Howell was admitted to the hospital as her condition continued to deteriorate.

On October 7, the mother of two was told a heart donor had been found, and Howell remembers it being a bittersweet day.

"I was so very, very sad for the person whose life was lost, and I felt so much sorrow for that person’s family," she says. "Yet another part of me was relieved to think I might have a normal life again."

Although her recovery was long and her legs shaky when she first started walking, Howell, now 49, has reclaimed her life. In August 2011, she completed a triathlon in Winston-Salem and she also enjoys cycling for an hour each day and swimming. Most of all she appreciates spending quality time with her teen sons, Adam and Emory.

"On my bike rides, I pass High Point University’s billboard that states, "Choose to be Extraordinary!" I am trying to be extraordinary and share my miracle with others," says Howell, who has also returned to college to pursue a career as a cardiac sonographer. "I’ve been given a second chance at life and I want to make the most of it."

This information is provided as a resource to our readers. The tips, products or resources listed have not been reviewed or endorsed by the American Heart Association.

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