Thursday, February 10, 2011

A Carnivore’s Guide to Cardiology: The Beginning

This is how my new lifestyle forcibly began, and how I told friends and family the news.

 “What a week I’m having” – Splash
“Your genes suck too kid” – Dad
Events leading to, on and after 2-19-2010

Executive Summary:  I’m OK.  I had no symptoms and am in good shape, but because of my family history I had early tests done that led to a stent, and new medications.   Combining these with my current exercise level and better attention to diet should be very strong preventatives.  The day after the procedure I did a half hour on the treadmill and felt great, so, really, I’m OK.

Presidents Day week was supposed to be pretty peaceful, my daughter was off, I had some vacation scheduled and my brother-in-law returned from travel. Therefore there were a bunch of family activities planned.  I had my physical the Friday before.  My weight was down a bit, and I’d been exercising every day, so I felt healthier than I had in a while.  Thanks to 40 looming on the horizon the next month, the doctor ordered pretty much every test known to man.  Instead of a normal vacuum tube, my blood test consisted of a small IV and a hand full of vials that deflated me like a Macy’s balloon on the day after Thanksgiving.  He also needed to find my prostate (I’m pretty sure that isn’t where I left it.) Then ordered an EKG which is where this all started.  There was a slight change in the waveform from when I had a pre-op one before my knee surgery.  Based on where I work, I was able to look it up and find out it looked like a “down slope in the S-T interval”.  When I used this phrase as an answer to, “What brings you here?” at the hospital, the tech’s said, “You’re an engineer, aren’t you?”  It’s nice to be recognized.

It could have been nothing, but based on my family history the Doc didn’t want me to wait.  Because he knew I wasn’t having any problems with my normal exercising, he figured (correctly, as it turned out) that a regular stress test wouldn’t show anything.  I had to call the cardiologist and set up a Nuclear Stress Test.  At first I thought this was where they tell me Iran and North Korea are going nuclear and gage my stress reactions, but apparently it involves having your heart scanned before and after running on a treadmill.

I was supposed to go for the test Tuesday, so of course the stomach virus that worked its way through my whole family hit me Monday night. (So all that family relaxation fun stuff was already kinda fried.)  Not wanting to royally mess up the cardiologists test equipment, I rescheduled for Thursday.

The results of the test were reported to me as “good news” and “not so good news”.  The not good news was that the post scan showed that there was uneven distribution of blood on the lateral side which meant I needed to go for a catheterization to see what was going on.  He said it could be at my convenience but sooner is always better, and, in fact, was I available the next day.  The good news was I showed no symptoms on the treadmill and “set the record” in the cardiologist’s words.  They had to bring the speed and angle up to Level 5 (which I guess is the cardiological equivalent of “going plaid”) to get me to just barely reach my target heart rate. They said they hadn’t seen it up than high in at least a month and probably longer.  Translation:  I’m in really good shape, but there’s some coronary flow restriction.  It would have been nice to receive the news in the order listed here, but what happened first is that I got the immediate feedback on “breaking the record” and the cardiologist told me he was switching to the “McGinley Exercise Plan”.  That coupled with the fact that I cleared away two snowstorms and moved a couch the week before the test made the “not so good news” phone call an hour later hit quite a bit harder.   The doctor even said it when he was starting the procedure, “You’re the last guy I expected to see here after you broke the record yesterday.”

Since I’m educated enough about this stuff to know, “if I ignore it, maybe it will go away,” is never a viable medical strategy, we set everything up so I could go Friday for the procedure.  This included no less than five calls to the cardiologist’s office with “I forgot to ask this” type questions.  I heard the operator actually say, “He seems a little overwhelmed” to someone as she hung up after number four.  For the record, I was not “a little overwhelmed” I was “scared shitless”, accuracy is important.

Everything went fine for the set up and the procedure.  There were a couple minor bumps.  Check in took forever because apparently “McGinley” is far more difficult to spell than I could have imagined.  There were also some I.V. issues.  There are often problems with drawing or giving blood from my left arm so I always use my right.  However, the procedure was to be done through the right radial artery, so they had to set up the I.V. in my left. It ended up taking three nurses with multiple attempts (and even more apologies, they were all really nice) before they got it in. It worked out well because the post op automatic blood pressure cuff was too small, and the series of bruised dots are my arm compliment the black and blue pinch marks from the cuff. 

As I am a large fur bearing mammal, I ended up leaving a fuzzy trail behind me for most of the two days.   My right arm needed to be shaved for the procedure. I kept getting startled when I looked over at it during the I.V. attempts as it looked like someone else’s arm.  I don’t think mine has looked like that since I was ten (not counting some Up the Lake campfire/kerosene accidents).  I actually discovered a three inch forked scar I was completely unaware of.  The hospital code says they have to prep the alternate sited as well, so they also shaved for a femoral insertion.  Between all this, the I.V. and cuff marks, and the hair patches forcibly torn off by ECG leads and bandages, I looked like an auditioning extra for Thundarr the Barbarian.

Since most of the forms have an occupation place on them anyway, I ended up telling most of the nurses and techs where I worked, which I think allowed me to get much more technical information than I would have otherwise.  The first nurse was saying that since I was “in the business” I know how routine and safe the procedures are.  I agreed but said the one thing that makes it not routine is that it’s going into ME this time.  Luckily I could keep the hospital’s reputation and positive statistics in the front of my brain, and force the fact that my job frequently deals with medical device risk analysis in the back of my mind.  (People say, “Just don’t think, ‘what’s the worst that could happen?’  Sorry, but that’s what they pay me to do.)

They gave me a Benadryl and a Valium before going in which made the ceiling in to a very interesting (and often moving) pattern for most of the procedure.  I asked if they had a Valium for my wife too, but apparently that’s against policy.  I took it as a good sign to see a Datascope CS100 pump on the way in.  I mentioned it to the techs setting me up, and Joe (I think there’s a happy, semi goofy Joe who works in every cath lab) told me when I get back to make the connector tubes longer so they’re easier to get around the bed.  Request noted Joe.  He also told me the Doctor was on his way but he liked to have a couple drinks after lunch.  Thanks Joe.  At this point they needed to do the sterile wash of the possible insertion sites. “This is going to be cold and wet,” was probably the most descriptively true statement I heard all week.

Combining bits of what I could make out during the procedure (again, distracted by the moving ceiling) with what I learned afterward this is what happened:  There was a complete occlusion somewhere in my circumflex artery, that he originally thought was very new, but turned out to be too hard to push a wire through without risking damaging anything, which means it wasn’t really new after all.  Luckily there was plenty of collateral flow around it that he didn’t have to do anything with it.  There was also a partial, but high percentage occlusion at the distal end of the right coronary.  He was able to open that one completely and put a stent in.  Fixing this not only keeps the flow there but adds to the collateral flow going around the other blockage.  It took longer than usual because I apparently have a “bumpy” right coronary artery.  I heard him trying several different styles of catheter tips until he got to it.  Telling how much time passed (2.5 hours) wasn’t really obvious for me (as opposed to my wife who the Doctor sympathized with and ran out to talk to as soon as he was done).  There was some evidence as to the length though.  For one, after a while, I could clearly feel the catheters and wires going up and down my wrist, it just felt like when you feel something go through a hose you are holding. (No pain, just sorta severe willies.  This also highlighted that I’ve been at my job way too long as I could tell the difference between when he was moving a wire and when he was moving a catheter by how it felt in my wrist.) The other obvious thing was when I figured the valium wore off as I noticed that the ceiling was no longer interesting. He mentioned something about the time and when I told him he said that, yes it would have worn off.  They slapped a compression bandage on my wrist and sent me recovery.  After a short while my wife came in.  The nurse gave me the, “You will remember your medication and alter your diet,” speech punctuated by the “mom finger” as she called it.  My wife backed up the “mom finger” with “the look” so, message received.  Then they took us up to a room.  I guess the valium wasn’t completely worn off as my first thought when the nurse let go of the side of the bed as we were rolling and I continued to go in the proper direction was not that there was another nurse behind me (which there was) but that there was a magnetic track in the floor (which there was not).

They managed to get me a sandwich and a late delivery hospital dinner. Against most stereotypes, the food was fantastic. (Note: Between the stomach virus, and fasting for the tests and procedures, I had subsisted primarily on soup and Gatorade for the week, so perhaps this colored my viewpoint.)

My wife (very grudgingly) went home to get some sleep, and I settled in for the night.  By 10:30 they replaced the compression dressing with a more basic bandage and after midnight I could disconnect from the automatic pressure cuff and unplug my leads from the room monitor. The "air beds” they have now are a wonderful invention that subtly adjusts pressure and placement to prevent bedsores.  By wonderful, I mean wonderful for someone needing a long term stay…for me, it seemed that as soon as I found a comfortable position, the bed would move and scare the hell out of me.  While I didn’t get what you could call a continuous night’s sleep, I was relaxed and managed to finish the new Hitchhikers book, most of a Pearls Before Swine treasury, and start a Pro Wrestling Hall of fame Tribute book.  I know I got some deep sleep because I was woken out of one by the 4:30 AM visit of the Blood Fairy.  The pretty young nurse who came in to take a sample had a very tiara looking headband on. I complimented her on it and she told me (in an accent I didn’t recognize) that she “felt like a princess today”.  I’d chalk the whole thing up to a dream except that I had a new bandage on when I woke up for the 5:30 AM vital sign reading.

My wife came back in the morning and we basically hung out, and took a couple walks around the floor until the Cardiologist came in that afternoon to release me.  He seemed actually pleased that I had written down a list of questions.  When I asked when I could start exercising again the answer was, “Now.” Pretty cool.  Same answer for driving.  He even said I didn’t have to give up caffeine and a Diet Dew a day is still OK.  The only real restrictions were no heavy lifting, and be careful with the insertion site wrist for 48 hours.  I asked about clearing the driveway from possible upcoming snow, and he said he didn’t want me shoveling till the next storm, which would hopefully be next year.  I told him we had a snow blower, and he started to say that might be OK, until she shot both of us the “the look” and he wisely added, “But I’ll leave that up to your wife.”

I’m on plavix and aspirin now to keep the stent clear. Also I’m on Crestor to lower cholesterol, but it should also help out with the “bumpiness” of the RCA.  When I was on the treadmill for the stress test he asked if I smoked and I said, “No, but sometimes I wish I did so I had something easy to target to make this stuff better.” As he was discharging me he said that my LDL cholesterol was high and that was my “smoking”.  He reminded me of my comment on the treadmill and said that this was the thing to target to make things better and I was a perfect candidate for the Statin to fix that, adding that those types of drugs weren’t available in time to help my dad. Therefore he proved that he paid attention not only to my family history, but also my jokes, gaining even more of my trust.  I was able to walk out of the hospital on my own, with no wheelchair.  Unfortunately I walked a little too fast and my nurse hadn’t told whoever was monitoring the radio transmitted ECG signals I was discharged.  Therefore as we passed the desk, a very concerned nurse bolted out of my old room, after going in to check and finding only a monitor and gown on the bed.  Luckily they could tell her I was discharged before she sounded “Code naked cardiac patient loose on the floor”.

I think I’m in a good place now. That’s not to say this was a good week.  I’m not stupid enough to think that this stuff would never happen (given my family history), but I was expecting it to start later, and with more warning, maybe a period on meds first or something.  Any time the least stressful days of a week contain a sleepless night spent staring into a toilet bowl waiting to see your shoes come up, is definitely a bad week.  Also the fact that this all happened mere days before my daughter’s Girl Scout cookies come in is just plain rude.

However, I know I am very very fortunate.  First of all, that my primary care doctor was smart enough to order the early tests. I am lucky that we have access to Morristown Memorial Hospital. Having dealt with them through work, through my Dad’s treatment, and as a patient, the facility and all the people are phenomenal.  This is both in their competence and ability, as well as bedside manner.  I saw many different people explain things separately to both my wife and I, knowing I had a background in the area and she didn’t, with equal clarity, information and comfort.

I am also lucky in how much technology has changed, both in the drugs available and the procedure itself.  Dad’s first catheterization (no stent) was less than 30 years ago, and he had to spend two days with a sand bag on his leg afterwards to seal the site.  I had a pressure bandage on my wrist for 4 hours and by the next night did thirty minutes on the treadmill and was feeling great.

The new medications will help my family factors, and I know I can keep up my exercise schedule, which is helping already.  My diet can also be changed, I’ve done it before, so I know I can do it again, and with these stakes keep doing it.  What this comes down to is the answer to the question, “What are you giving up for lent?” has now become, “damn near everything” as I have apparently grown past the age where I can eat whatever I want as long as I’m exercising.

Ten days later, the tale continues…

Had my post procedure check up at the cardiologist...went great.  He told me my ejection fraction was normal, my exercise tolerance was well above normal, and now my EKG is "beautiful"   He cleared me for snow removal (the wait was only to let my wrist heal) and to pursue a very active life.  When I asked if I could go on roller coasters with my daughter he said, "You better, you're a Dad."
So I have to go for the blood test follow up in April, and see him again in June.  Stress tests will only be yearly/as needed.  Exercise and diet modification will continue.  (I do have willpower, I've just chosen not to always use it in the past...I’m a bit more motivated now especially since a friend just sent me a article about a study saying that losing weight not only stops plaque forming, but can actually reverse it.  So it's extra motivation, even if the Crestor keeps my LDL low)  

But, man, there's nothing like getting the snot scared out of you to build up the old willpower. My daughter’s Girl Scout cookies came in and we had 11 boxes in the house, and I only ate  cookie a week...

Although I did find myself hugging the boxes like Dorothy at the end of the Wizard of Oz, "I think I'll miss you most of all."

And finally, for further evidence that I have the right Cardiologist for me:  I was asking about taking ibuprofen for tendonitis (which is permitted) and I told him it was easier to let reason win over panic now, but the day he called and said I needed a catheterization, I started thinking about the pain in my left arm joints (from previous snow and other heavy object lifting) and went into my Fred Sanford impression.  Instead of meeting that statement with a blank stare, like some of my younger co workers, he grabbed is chest and let out a gravelly voiced, "It’s the big one!"

Shortly after this was not only my fortieth birthday, but also the tenth anniversary of my superhero tattoo.  It was complimented by many people in the doctor offices and hospital and this event really drove home why those three characters are my favorites.  Batman symbolizes overcoming adversity, Green Lantern symbolizes willpower, and Superman symbolizes hope.  Along with the medicine, focusing on these three things will help me to beat this. (I probably should also include faith and family support, but I couldn’t tie them in to a tiger and dragon and wanted to end this cleanly instead of with a rambling parenthetical…oh heck.)

Use the Label to see all further adventures

Click here for a later procedure

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