The Heart of the Matter

14 Oct

Well, for those that follow me on Facebook – you know what happened Thursday.  And for those that don’t … well, buckle in for the ride.

Thursday, after a long time of feeling strange (much more below) and having odd pain in my back, shoulder and chest, I had an angiogram test to see if the source of this pain was my heart.  Short answer – it was.  Thankfully we live in an era of amazing medical technology, and they were able to fix the problem – a coronary artery blockage – and I’m around today to write about this.  I feel like I’ve really, REALLY dodged a bullet here.  The blockage was in the left anterior descending coronary artery – this is the big “pipe” that feeds the front of the heart and the big part of the muscle that runs the left ventricle – which of course is the main pump chamber of the heart.  Lose that ventricle and you’re done, unless you’re Dick Cheney and they replace your ventricle with a mechanical device. Heart attacks in that artery are called “the widow maker.”  This is a blockage in the same place where Rosie O’Donnell recently had her heart attack.  Lucky, lucky, lucky.

So, that’s the short story – had a big problem, they fixed it.  Onwards.  But of course, I’m a blogger.  200 words isn’t going to cut it is it?  Here’s the entire story.

For more than a year now, I’ve been feeling odd pain in the middle of my back that would occasionally work its way into my chest.  I’ve always been one of those people who “carries his stress” in his upper back – after a long, stressful day, my upper back and shoulders are very stiff and tired, and for the most part, I could work that pain out of my back with a good workout – sort of “burn out the stress”.  In 2010, I lost more than 20 lbs, had started running again, and felt really good – I was doing it as a way of dealing with the tremendous stress of the last year of my previous job and it was working.

Fast forward to last summer – the first significant episode of this pain was middle of the summer of 2011 – I did a lot of biking that summer, and took a long bike ride with my next door neighbor and spiritual coach, RavMarc.  About halfway through that ride, after a very long uphill, I felt wrung out, my back was sore and I had a little bit of pain in my left shoulder and in my sternum.  Me being me, I chalked it up to being hunched over the handlebars for a long uphill – gave myself a rest and pressed onwards.  But at the end of that ride, I was cashed – I felt a fatigue like nothing I had felt before, and wondered if I had a problem.  Should have done more research to see if I did, in hindsight.

That summer, when I had my annual physical (I always have it around my birthday), I told my doc about this occasional pain and he wrote me an order for a stress test.  He said that I should go for it if I have another episode that concerns me.  I held onto it.

I exercised on an off through the rest of 2011 and into 2012 and would occasionally get this pain, but nothing alarming like that bike ride day.  At this point, the sore spot in my back was pretty much there all the time and occasionally with exercise, I’d get pain migrating to my left shoulder, down my left arm, and into the center of my chest.  It was never severe, like a “twinge” – on the “1-10” pain scale, maybe a 1 or 2.   A pinch.  Coming into the summer, I started to exercise more, and biking season kicked up and I found I could not ride my bike this year – if I got on the bike and went much distance at all, I’d have a pretty severe ache in the middle of my back and of course, also in my chest.  I had taken the time to clean up my old road bike that has taken me across Iowa four times on RAGBRAI when I was in high school and college, and went for a ride on  it, pushing nice and hard, and only made it two miles before I had to turn back and limp back home, my back in a spasm and my chest aching.  Again, I thought it was my back.

A couple of weeks after that, I went for a “powerwalk” with my wife, and felt the chest pain again, this time with a feeling of pressure, and of course, my back hurt too.  At this point, I really was beginning to suspect that I had a problem.  I spoke to my friend Dr. Steve (aka “Faltese”) and he said I really needed to get a stress test immediately.  OK, I may be dense, but not stupid. I went for the test.  And … the test was inconclusive – I more or less passed.

I went 11 minutes on the treadmill, got cranked well up, had no chest pain, a little back stiffness, but no pain.  They did an echocardiogram as part of the stress test, and that was normal – the only indication of something potentially amiss was my EKG had an “ST wave, downsloping depression”, which is indicative of coronary artery disease.  That said, absent of pain, and with a normal echo result, the Cardiologist released me to exercise.  They did find that I had quite high blood pressure, so we started treating that right away, and I got aggressive with exercise.

I started an exercise regimen, and the intent was to begin a “couch to 5K” jogging program – where over the course of about 8 weeks, you incrementally train up to being able to jog/run for 30 minutes straight.  But I found I could not run for more than 1 minute, and after more than two 1 minute intervals, I had back pain, shoulder and chest pain. Again, being convinced of a back and neck problem, I stopped the jogging, and kept powerwalking.  I started working on my form and posture to try to sort this out, and that helped somewhat.  But when I’d go to the healthclub for a non-powerwalk workout, I’d get pain in my chest on the elliptical machine.  I again chalked it to my back.

About 3 weeks ago, I had a physical with my primary care doctor, and after discussing this with him, he recommended I go for a cardiac consultation. He had heard a heart murmur during my physical as well so he wanted me to check that out.  I scheduled a resting echocardiogram with the cardiologist, as well as a consult with the cardiologist afterwards.  The heart murmur turned out to be nothing – I have a minimum level murmur that the cardiologist said that if you tested the entire population, 70% of everyone would have one.  But, my doctor had provided him all my current and past labs and my history file, and well, given that data, plus the abnormal EKG, he thought we should book an angiogram.  With the brighter light of labs and history, he didn’t like the EKG abnormality in my stress test and thought we should get it checked out.

The angiogram was scheduled for this past Thursday, October 11th.  An angiogram is really an amazing thing – while invasive, it is something you’re 100% awake for (they do give you a mild sedation just to keep anxiety down), and you literally watch on TV.  It was truly amazing, once you get past the freaky part of “holy shit this TV show is going on inside my chest.”.  They have an X-ray fluoroscope going which generates the images on the big high-def monitor which was next to me.  They put a catheter into either your femoral artery in your groin, or in your wrist.  The cardiologist doing my procedure went with the wrist (although I was prepped for both femoral arteries in case there was a problem getting it into my wrist.  If you have this, you want it in the wrist – in the groin, the recovery is very uncomfortable!).

After injecting my wrist with a local anesthesia, the doctor made a small incision in my wrist (no bigger than if I had poked myself with a ballpoint pen!), found the artery there, and pushed a large bore needle into the artery.  He then threaded a catheter (a thin tube) up through the artery, and using the x-ray as a guide, steered it up into my heart.  Once there, he injected x-ray opaque dye and voila – all my arteries lit up.  The picture below is the “before” picture – the black ellipse is around the blockage in the LAD artery – you can see it is very narrow there.  It should be nice and thick like it is up and downstream of that point.

He let me know I had about a 70-75% blockage in that artery and that would certainly be causing me problems.  He did see some lower-level blockage in both my rear artery (that serves the back of the heart) and the right artery (serves the right front side), as well as downstream of where this big blockage was, but nothing that needed angioplasty and stent placement.

He recommended we do the angioplasty and stent placement, and of course, I agreed, which they of course documented by recording me saying it.  The angioplasty and stenting came next.  They ran a different catheter up the artery – this one with a narrow balloon on it – they warned me that this would be “uncomfortable” and I might feel some chest pain.  “Some”????  Holy shitballs – now I know what a full-on heart attack feels like!  When the surgeon inflates the balloon, it cuts off the flow of blood in that artery – in this case, the big main serving the biggest part of the heart.  BAM!  I immediately felt a big pressure in my chest, and a wave of pain that started in the middle of my chest, radiated down both arms and up into my neck and jaw.  OOOF!  I let them know the pain was really intense, but in seconds, it was over – the balloon is only inflated for 15-30 seconds.  He inflated it one more time in the blockage just for a quick few seconds, and then they prepared to stent it.  At this point, they gave me a narcotic pain reliever to push down the pain – that was quite pleasant!

In prep for the stenting, they first push a burst of nitroglycerin medication down the IV line in my other wrist – this is a powerful vaso-dilator – it dilates your blood vessels – and it’s a bizarre feeling when it goes in – I could feel every blood vessel in my head throbbing (sort of hurt but not), and also in my hands and feet – very weird feeling.  Then, using a balloon catheter, they put the stent over the balloon and slid that into the blockage – again, they inflated it for about 30 seconds or more – and again, the heart attack pain, although much less this time as they had hit me with the pain med.  About a minute after that, the doctor pronounced, “Ok, Stew, we’re all done.  This was an easy one and will give you great results.   Your part of the bargain is to change how you live, and take your medications like your life depends on it.  Deal?”

Deal, doc.

Here’s the result – the circle is where the blockage was – notice how nice and big and fat that artery is now?  Like a big ‘ol bratwurst.  Oh, crap.  Not that.  LOL.

The recovery was cake – they wheeled me back into recovery, and Robin came in – I let her know what they did – she was shocked.  She had always been convinced that my problem was in my back.  I was hungry and thirsty – they brought me a bottle of water, which I drank in about 30 seconds, and then a turkey sandwich – which was about the best damn turkey sandwich ever.  Hunger is the best sauce!  So is being alive. After about an hour, they wheeled me upstairs to the “Comprehensive Cardiac Care” unit – basically the heart unit but not intensive care (which was down the hall), and settled me in my room.  And boredom set in.  Robin stayed with me through the afternoon, then my pal “Beavis” showed up – we were goofing and laughing so much that my nurse pronounced my room “the fun room”.  Robin, along with my twin sons, Alex and Brian came back to hang, then left about 8:00 – I watched Joe Biden pummel Paul Ryan on the debate, and went to bed.

I stayed overnight at the hospital, and was discharged at 10:00 AM on Friday – the hospital stay was just to monitor me and push fluid through me to wash out the x-ray dyes they use during the surgery.

So, how do I feel? Physically, I feel great – there is a different feeling in my chest that I can only say is “absence of feeling” – I think, for the last year or more, I felt “tight” in my chest pretty much all the time.  That is totally gone. I went for  a 2.2 mile hike through the forest preserve with Robin and our friends yesterday and felt great – I got much less winded than normal and no chest pain or tightness.  My back is still a bit stiff, but now I know it’s my back there – we can stretch and work that out. Mentally, I’m immensely relieved, and well, chagrined at the same time.  I’ve had high cholesterol for years, and wasn’t diligent about treating it – going on and off meds for it.  Stupid, stupid, STUPID.  I have a little apprehension as the reality is that this wasn’t a cure, but a treatment – once you have coronary artery disease, you have it for life – this is now a management effort. I would imagine that this won’t be the first time I have this done (although that’s my goal) and there is possible bypass surgery in my future, I’d bet.  It is what it is.  I’ll pay laser-focus attention to my health now.

That said, I’ve been really pissed at myself about how I look and feel for more than 5 years.  I am probably 60 lbs overweight, and while there are folks in far worse shape than me, still, I’m in crap shape.  While I used my 50th birthday to make a new commitment to exercise and fitness, now I have a real motivation to make sure I do it.  I’ll completely change how I eat now.  Much leaner, much lower fat, smaller portions.  Of course everyone and their brother has advice and to all of them, I say, thank you – I may not follow all of it (Paleo, vegan, Atkins, South Beach, etc. etc.) but I’m sure there will be nuggets from all.  I will invent my cooking style to be healthy, whole foods, cooked imaginatively and with big flavor. I will take my meds like my life depends on it.  Because it does.

Now, one humorous thing about this all – most of  you know I have a humorous obsession with bacon – and I imagine there are folks that think that’s all I eat – it wasn’t.  I am a bacon lover for sure, but the amount of bacon I was eating was probably less than 15 strips a month.  Will I still eat bacon?  Sure!  But less often and in less volume.  The reality is it is a great seasoning for many dishes and that’s how I used it the most.   The humorous part though is all my wag friends – my pal “Professor Troutstream”, when he called me Thursday afternoon opened with “Stew, what are the pork farmers going to do?”  My friend in Charlotte, “The Consultant”, said “So, does this mean fewer bacon posts on Facebook”?  Other funny comments “Well that’s it, I’m selling my pork belly futures”, “You know, they make tofu bacon”, etc. etc.  Gotta love my wiseass friends.  If you can’t laugh at yourself, who can you laugh at?

What did I learn?  LISTEN TO YOUR BODY.  Folks, if you get chest pain, go get it checked out.  Guys are the worst about this and I was among the worst guys.  I am so lucky that this didn’t blow and put me in a box in the ground. Get checked if you have chest pain – period. It is not something to screw with.  GET. CHECKED. OUT.  And take your cholesterol meds like your life depends on it.  Don’t settle for good enough like I did.

I was lucky. I am lucky today to be alive – while I wasn’t in the middle of a heart attack when I went to the hospital, that blockage was big and in a very dangerous spot.  It could have easily ruptured and killed me.  But it didn’t and I’m here to blog about it.  And here to be the wiseass I always was.  Thank G-d for that.

I love all my friends and family and I have to say thank you to all of them for the support.  Onwards. I’ll still be cooking for you, but you’ll be amazed at how healthy and tasty everything will be versus how decadently I cook!

As you were,

Stew

PS:  I have to make sure I put a word in here about some great folks involved in my care.  First of all are my primary care physician, Dr. Dan Goldstein of Physicians of the North Shore and my cardiology team of Dr. Jason Robin, Dr. Walligora and Dr. Tim McDonough (who did the stenting procedure) of Cardiology Associates of Glenbrook and Evanston- these folks are all top-level physicians and have my most sincere praise.  And, I also have to thank two great doctor friends, Dr. Steve Malkin, currently Chairman of the Illinois Medical Society and a good pal, and Dr. Jonathan Fudge, who is a cardiologist in West Des Moines, IA.  Both Steve and Jon kept disagreeing with me when I would say “but I think it’s my back” and say “you need to get it checked out.  Glad I finally listened to you guys.

Finally, I have to commend the care I received at Evanston North Shore hospital – they have a top-notch cardiology care department there, and everyone I spoke to there was kind, helpful, and professional.

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One Response to “The Heart of the Matter”

  1. Reisa October 14, 2012 at 4:05 pm #

    Stew: your description is gripping and eye-opening for those not versed in what can happen if we become a bit lazy about our own health. So glad you are changing your habits. It’s all to the good. Love you…

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