Thursday, August 1, 2013

A Carnivore's Guide To Cardiology: The Just In Case Coronary Clearing Conga

Short Version:
I needed another stent due to some shifting of previously existing vessel plaque, but my cardiac health overall is excellent, and my cardiologist continues to be awesome.

Long Version:

The first lake weekend warm enough to even think about entering the water was my first swim of the summer: five laps across the lake and back (a little over a mile). I was tired but had no issues.

The following weekend, I swam Saturday (June 29) and stopped after only two laps because I felt much more tired and winded than usual, even after the first lap. I felt my heart beating hard when I finished, and afterwards.  When I did my night time blood pressure check my heart rate was still up.

Up for me being 80bpm, which, of course, freaked me out, and probably explains the recheck being 90bpm…Yay biofeedback.

It felt like it stayed elevated for a while through the night, but was back down around 70 by morning. 

It went from nominally around 60 to over 70 after getting cortisone shots in my knee on Thursday morning.  This is one reason I didn't execute a panicked flee to the Up the Lake ER.

There was no chest pain, or at least none that was heart related. My left shoulder has a mechanical issue that spreads pain around the whole left side of my body.  But I felt “all right”  HA HA!

I was planning on calling the cardiologist Monday about it, but since I had some chills and sweats into Sunday, I figured better safe than sorry and went to the ER near home that I have confidence in.

To provide context as to why I figured other reasons were involved:  the week before I also flew to California Monday morning for work and came back on the red eye that night.  Also I had to get up at 4:30AM to take my wife to a procedure Friday morning. Therefore besides possible side effects of the cortisone (which I’d found included anxiety attacks and insomnia, along with palpitations and chills and fever) that week had crazy amounts of stress and minimal sleep.

However, with a Disney trip on the horizon, I needed to be officially cleared for roller coaster duty.

All the ER blood results came back normal and the ECG matched the one they had on file from the panicked visit to the ER in June of 2010 that was then blamed on Sudafed.

For the rest of the week my heart rate went up to about 110 while exercising and was back to the sixties at bedtime, and often lower by morning.  My primary physician said, “Maybe it’s time for another stress test.”  Since it was his suggesting one that led to my original lifesaving procedure, I bugged my cardiologist’s office until I got an appointment scheduled.

My heart doctor was covering the hospital during that (Fourth of July) week, and by the time we finished playing phone tag the test ended up being two weeks after the initial call.

In the mean time, I had one weekend with two normal two mile swims, and one with a one mile warm up on Friday, followed by a personal record breaking five mile jaunt Saturday - twenty three times across the lake and back.


The three hour swim was not only without incident, but also followed by a normal nine lap two mile swim the following day.

Aside:  I am often asked, “what do you think about when swimming for that long?”  My answer:
“For pretty much the only time in my life…ABOSLUTEY FREAKIN’ NOTHING! And it’s wonderful.”


Needless to say, I entered my Tuesday morning nuclear stress test with a higher level of confidence than my previously successful attempt.

Once more, I reached level five on the treadmill with no problems or symptoms and impressed the attending cardiologist and nurse.

After the test, instead of being allowed to leave and wait for a phone call (past results:  good news, two days:  bad news: under an hour) I was told to wait while they reviewed them.

The nurse came out, and gravely sat down to inform me it wasn’t a normal reading…however, we know I have a fully blocked artery with collateral flow around it. Therefore, I shouldn’t have a normal reading. The area in question was, “the same as before.” Unfortunately she couldn’t answer if that meant “the same as my known blocked artery” or “the same as where I have a stent that shouldn’t be blocked anymore.”  That would have been really key unclenching information to have. She said I had to see my own cardiologist who could review it better, knowing my anatomy, that it might be nothing, and I “shouldn’t worry…much.”

I began to believe that scaring the crap out of me was an added level to the stress test.  I also believe that part of her worry and demand for me to see my doctor “tomorrow” was misunderstanding my five mile swim. She thought it was coming up, not a past event.

I went to the appointment with my cardiologist the following day, after taking a couple of home  blood pressure readings that nicely screwed up my average.  I tried controlled breathing to keep my pressure down for the in office measurement.  My breathing worked a little too well…
I fell asleep in the chair and jarred awake as I was about to pitch forward onto the floor.  This generated blood pressure values well above everything I had recorded for the last month.

He walked in looking upset, a look that is highly contagious in a cardiologist’s office.  My newly begun panic attack faded considerably when he led off by informing me he didn’t believe the scan showed anything serious.

Reading those scans wasn't his prime area of expertise  but he could clearly see it was where my known blocked artery with adequate collateral flow around it is.  He also explained that there were two people who read the scans in the office, and my two very similar looking scans were each read by a different one.

We discussed my latest swimming addiction results, which impressed him and added more confidence to his initial opinion, especially considering my exercise performance, ECG and ejection fraction were all still normal.

Further conversations led to a continuation of the “better safe than sorry” approach, based on.

1) Having to address a documented report.
2) My being young and active.
3) Procedures being a hell of a lot quicker, easier and safer than in the cardilogical past.

He used phrasing containing “due diligence” and "some visible differences" while I used phrasing containing, “take my daughter on the Tower of Terror without any second thoughts.”

He said he could be in and out in five minutes, which is the only way to tell since he can’t “look inside my chest like Superman.” (Is there any doubt I have the right doctor?)

With that kind of speed I offered, “Are you busy now, I haven’t eaten since before seven?”

His deadpan answer, “Nice try.”

We set a date two weeks later - a massive difference from my first bad scan reading, which prompted the question, “can you come into the hospital tomorrow?”  He was also happy with the blood pressure readings I had been tracking over the past month and told me I could keep swimming…something I made sure to tell all the people Up the Lake who already gave me a hard time for swimming too much.

I don’t think I've ever finished a conversation with him that didn't result in a massive increase in my confidence that my heart was in good hands and going to be healthy…awesome.

Let us pause to consider the amazing progress in the healthcare sciences…  Both my cardiologist and I didn't believe there were any immediate issues going on, but for complete confidence in my continued health (and taking my daughter on amusement park attractions, and continuing with my exercise routines) he was going to stick a tube through my arm into my heart because it would be no big deal.

The mind boggling part of the phone calls to set up the procedure time, was the overwhelming concern the scheduler had in her voice when telling me I had to come in three hours ahead of time, which could be very early in the morning.  Sadly, I still get surprised by people’s foolishness. Are there really individuals who have the thought process, “I don’t want to have to get up that early for a possibly lifesaving and/or extending procedure?”

Dumbass doesn't begin to cover it.

I assured her that I would be there as early as he wanted me to, and was willing to camp out the night before if he asked.  The test was scheduled for a week from the next Tuesday, giving me time on the first Tuesday to get the pre-op testing done.

I learned the previous year to take it easy the week after a big swim to prevent long lasting unhappiness in my joints.  Therefore the following weekend I only did five lap one mile swims Friday and Saturday, with a normal nine lap  two mile swim Sunday. Again, there was no incident, and my blood pressure and heart rate both seemed to be reducing the more I swam.

A week before the procedure, I had to go for pre-op testing.  Why they couldn't pull most of it from the exact same tests the other hospital ER ran a couple weeks before is one of the intricacies of the modern medical system that is beyond me. The only test that wasn't repeated was the “Ice Cold Handed technician Chest X-ray.”  Once again, being “in the business” proved a detriment.  I mentioned to the phlebotomist that I’d been inserting product into sheep’s blood at work. Because she figured I’d understand, she went through details of what each vial was to be used for while she was drawing my blood.  The problem was, she forgot to fill one of them while the mini IV was still in.  I got to come to work with a band aid on both inner elbows.  (There is probably a better way to describe that section of anatomy.)

As the time for the procedure grew closer, my mind got really annoying.  Every surprise was a palpitation, and every sore muscle was angina…oddly my blood pressure continued to improve for the most part.  I also kept fearfully flashing back to the one image on the scan my cardiologist pointed to and said, "That one looks different."

My boss noticed a "slight" change in my behavior, sat me down, and basically warned me that no matter the actual condition of my coronary vessels, I was sure to give myself a heart attack if I didn't calm down.

She also mentioned trying to get information and samples while I was laying there in the cath lab.

So noted, thanx boss.
(To be completely honest, she did talk me down from some panicked moments, and encouraged me to fully rest and recover the week after the procedure, making the thanx truly sincere.)

The weekend right before the procedure has a mix of a late arrival Friday and a rainy Sunday.  Therefore, not counting the goggle test lap when we arrived, there was only one swim, my usual nine lapper.  My “bonus cookie lap” for this and previous weekends was done escorting my daughter while my wife came along with a noodle in case of emergency.  The kid speed swims took a great deal more time and endurance than a regular single lap would.

The one full swim that weekend marked the premier of trying to use goggles to protect my eyes from whatever allergens rend me blind, tearful, and full of eye boogies after most swims.  As anti-eye-boogie wear they worked great.  The only issue was the piece of the bridge of my nose was the one we picked when we thought Anabelle was going to use them.  This resulted in my brain being thoroughly squeezed during the swim.   The biggest problem, however, was whenever I needed to tighten one side it would loosen the other.  Considering they already impeded most of my vision above water, causing my swim route to be even more off course than the considerable amount I usually am, there were some major problems.  Half way across on a later lap, I pushed the left eye on tighter and the right eye totally flooded.  This rendered half of the smidgen of vision I had left totally gone.  It also was about as uncomfortable a plunger full of water stuck on my eyeball, I guess. I became disoriented enough to make it hard to distinguish between when my face was above or under water as I swam feverishly for the dock on the other side to allow me to hold on and fix the darn thing.

 Hence, I would like to apologize profusely to all the families across the lake for the loud and profane word I thought I shouted underwater, but apparently (based on ear witness accounts of my family and everyone else I know on our beach) echoed loudly down the lake.

The doctor called the day before to let me know that his Cardiology Today interview about radial insertion technique he said may be occurring was going to happen while I was there.  I figured this was some kind of karmic retribution for all the cath lab procedures I'd watched for work.

My wife and I awoke insanely early, I donned my lucky Batman underoos, and we drove to Morristown Medical Center for my 6AM check in.The paperwork went smoothly since most of it was done at the pre op testing, another benefit of having the procedure not be done in "Good God can you go in tomorrow!" mode.  In a short time we entered the cardiac prepping section.

Along with basic vital signs and stats, of course, I was sheared like a sheep.  They shaved insertion sites, alternate insertion sites, ECG lead sites, IV placement sites, and I think a site where the Cardiologist could rest his coffee mug. 

Once my artistic collection of bald spots was completed, I was given the customary Valium and benadryl.  (Sadly, Rosa, who could have used them more than I could, wasn't offered any.) It turned out the Cardiology Today folks wanted to talk to me as well.  I made sure to tell them the quick recovery time to the radial procedure was key to the mind set that I could fight my genetics. However,  I was glad I had already taken the Valium.  This way I could appear experienced, knowledgeable, but drugged out, instead of experienced, knowledgeable, but terrified.

See, I had one overwhelming fear: that the angiogram was going to show increased blockages and coronary artery disease, despite all the exercise and diet changes I've implemented.  This would mean I'd not only lost the taste for cannoli for no reason, but more importantly would give ammunition to people who have told me, whenever they see me eat healthy or exercise, that it's all genetic and I'm wasting my time because what I'm doing can't change anything.

As we reach the point where I was wheeled into the cath lab, I need to stop and, yet again, point out how phenomenal the people in Morristown Cardiac Care are.  Over and above professional skills and competence  they are amazingly good at instilling confidence and providing information to their patients.

Luckily, due to the extra people from the magazine being there, (even though they were thoroughly professional, polite and awesome) one of the nurses added something to help me relax into my IV.   It was probably the infusion of that substance that prevented me from weeping openly when I heard the Cardiologist say the words, "bite lesion," "plaque rupture," and "stent."

A bit more explaining calmed me down, both at the moment, in a later meeting, and the follow up call.  The small bite lesion in question was most likely caused by a very localized rupture of pre-existing arterial plaque that led to some reduction in coronary flow.  He was placing a stent to fully open the right coronary artery.

Translation for laymen:  A little bit of the gunk that had been in the vessels supplying blood to the heart from before my diet and exercise change broke and was sticking into the vessel reducing the blood flow around it.  He pushed the gunk out of the way, and held it in place with a little tube with good drugs on it.

The great news was that the rest of my coronary arteries look as good or better than they had on my last visit to this hospital. Also, the three year old stent was "pristine" and looked like part of my own anatomy.  Everyone in the cath lab who saw the scans congratulated me and told me to keep doing what I was doing.

The first thing I asked my doctor, before any other recovery questions was, "Am I cleared to take my daughter on roller coasters in Disney World."  His answer,"Of course," raised my spirits further, and made every single part of the ordeal worth it.  Therefore I was in a much more upbeat mood when the Cardiology Today gang came around for the post procedure interview.  

There were two extra awesome parts of the meeting:

A) Finding out my cardiologist told them what a great job I was doing taking care of myself.
B) Them asking me to send a picture of my family in Disney World as a capstone for the article.

The former is great for reaffirming what I'm doing is worthwhile, the latter because I also plan to send a link to this post in the name of shameless self promotion.

There was one difference to the procedure from my first stent that led to some unpleasantness.  My first radial insertion site was closed using a pressure bandage: it stopped the bleeding, but also squeezed and bruised the snot out of my arm.  This time they used a device that is Velcroed on and an inflatable bulb puts pressure on the site.  Its called the TR Band, and I actually had a box of them at work to compare with our similar device, the Air Band. (More weird karma.)

Everything was done, and I was supposed to go home at 3:30.  The first sign of trouble happened when I was allowed to walk myself to the bathroom on my own as soon as I was wheeled back to recovery. (Yay radial insertions!)

In the can, blood starting coming out from under the TR Band.  Not in a "little oozing" way;  more like in a, "Ah, this is why they told me to call an ambulance if it bleeds after I leave." way.  Fortunately, I have first aid training, and a clue.  I put pressure on the inflated part with my other hand to stop the bleeding.  My smugness at my quick action faded immediately as I realized I had no way to open the door.  After being rescued by a nurse once I pushed the call button with my nose, she brought me back to the bed and added an extra 3ccs to the air bladder with the syringe they had taped to my arm next to the device to allow them to gradually deflate it before removal.

Every time they did try to gradually deflate it, I started leaking again.  3:30 rolled around and I was still fully Banded with no hope of going home.  The doctor checked it out, we discussed the pros and cons of it, pressure bandages, and (sales depended bonus that I have) I also threw in a plug for the Air-Band.  

They decided to go old school and called in yet another competent and experienced technician to use manual pressure and stop the bleeding.  (The nurses commented that this was in no way the first time they saw this occur with the device in question.)  He pulled off the TR-Band and a disturbingly large amount (to Rosa and I) of me leaked out in the brief period before he placed a clotting agent under some gauze and squeezed my wrist hard.  I may have forgotten to breathe while I saw my life's fluid pouring down my arm at that time, which could have added to what happened next.

This was when we learned about the, common for femoral sites, but -lucky me- also possible for radial "Vaso Vagal Response."  Turns out pressure on arteries and nerves simultaneously can feed back and cause a  person to pass out.  Kinda wish we knew this previously.

From my point of view, I was feeling a little dizzy and nauseous. I was about ready to mention this, and suddenly found my self flat on my back with my feet raised, surrounded by nurses and with oxygen tubes sticking up my nose.  I simultaneously tried to say, "What happened?" "Take care of my wife" and "Am I bleeding out or did it clot off?"  Then they argued about smelling salts for a bit, and someone waved what smelled like an old blueprint copier under my nose. Once things calmed down a smidgen, they sat me up a little and I was relieved to discover at some point in the chaos the bleeding stopped.  I'm glad the tech was professional enough to hold on the whole time, as he said he'd never seen it happen on a radial patient in seven years. This may be why he popped in about every fifteen minutes afterwards to see if I was OK.

Rosa's point of view was slightly different and even less pleasant.  She saw me turn white and unfocused, followed by hearing the monitor go crazy when my already low heart rate (made even lower by the meds) dropped to 30.  The room rapidly shifted into a scene from  Grey's Anatomy or E.R. with bunches of people running in, and laying me down. At that point my glasses went flying and I started doing something that, while not convulsing according to the medical experts present, looked enough like it to freak Rosa out further and make her resist their efforts to get her out of the room.  The fact that all she could make out of my simultaneous babbling that started shortly thereafter was the word "clot" leading her to think I had a stroke didn't help matters much.

I may be a loyal company man with nearly twenty years of service, but if I ever need this procedure again, regardless of which device they stock, I'm asking for an old fashioned pressure bandage.  Its tourniquet like grip may bruise more, but the bleeding stops without the TV drama moments.

I can't print my wife's opinion of the TR Band, because my keyboard would catch on fire.

Things finally calmed down, and I got to spend a bonus hour there before they let me sit up and walk around a bit.  Instead of the healthy applesauce I had with my turkey sandwich for lunch, I decided on a pack of Lorna Doones with the second sandwich.  Besides deciding I had a rough day and deserved them, I figured the fat and sugar would raise my pulse and blood pressure, which would calm Rosa and I down some more.

The doctor did say the rupture could have caused the initial swimming scare, with the aspirin in my system clearing away any thrombus forming before the symptoms could grow.  However, since I was also on prednisone during the Sudafed blamed hospital visit, I don't believe I'll be allowing any substance ending in "sone" to enter my body again.

 I got all the precautions, prescriptions and paperwork and we went home.  I'm once more on Plavix, which means my internal furnace superpower is due to vanish again. Still, better to get chilly than get infarctions.  I also have to be very ginger with the insertion site for a few days.  Seriously, you have no idea how often you twist your wrist in a given day until someone says,"Don't twist your wrist or you could bleed to death."  

Conclusion A- Personal Growth:

With my genetics, cardiac geometry and past plaque development, it was foolish to believe I would never need another interventional procedure.  They are so routine and safe now, I need to view it not as setback, but as a piece of the puzzle which will keep me alive and healthy for quite a while.

Conclusion B- Personal Statement:

There are some who subscribe to the opinion that cardiac matters are solely caused by genetics, and there's nothing else that can be done about it.  They have given me a large amount of flack when I am seen setting greater and greater exercise goals, and eating as healthy as possible -

I have now been told by an entire cath lab to keep doing what I'm doing as my vessels look as good or better than they did three years ago.  My cardiologist stressed to me, and mentioned to a trade publication how all the hard work I've done has a three year old stent looking "pristine" and like part of my own vasculature   He expects me to be around for a very long time, as opposed to if I followed the "genetics only" people philosophy which could have easily made this event an open heart bypass instead of stenting a minor bite lesion.

Based on this clinical evidence:
To those who believe I should eat, drink, smoke and do whatever I like because nothing matters except my genetics, I say -

Kiss my
spinach salad eating,
multiple mile swimming, 
medication rule following,
lucky batman underoos clad heiney!


Unknown said...

OMG...Glad to hear all is ok!

Jeff McGinley said...

Many thanx for the well wishes. It's amazing the lengths I go to to be able to take Anabelle on rides that will make me change my underwear.

JoAnn said...

So glad to hear you're OK. You are an inspiration to all of us. Hope I get a chance to see the article - you were a perfect candidate for an interview. Hope you have a great time in Disneyworld - take a few extra pairs of underwear just in case!

Antonia said...

Aside from the fact that I am so sorry you had to go through all of that and so glad you are okay, I want you to teach me how to get my heart rate in the 60's, and also how to fall asleep while taking blood pressure. Both of these skills would be very useful for me. Thank you.

Jeff McGinley said...

Thanx Jo. Technically it was the Cardiologist being interviewed...leader in the radial approach and all. I was just along for the ride. Thanx again!

Jeff McGinley said...

Thank you Antonia. If you keep doing the swim laps you started, your heart rate should keep decreasing. As for falling asleep, you have Frissora blood. That means you should be genetically predisposed to fall asleep any place any time any...zzzzzzzzzzzzzzzzzzzzzzzzzzzz.

Chris said...

Glad to hear you made it through this procedure and all of that discipline is paying off for your ticker! :)

I am going to look up TR band and the Air Band you mentioned. I remember going through all of the numbers on a potential radial project.

Jeff McGinley said...

Many thanx. The good side is I have almost no bruising, so the bands would probably be good for people with less propensity to pass out. I'd rather bruise.

longbow said...

I think it's called the "crook of the elbow"

Who is telling you to just enjoy the pork rinds & recliner and let "destiny" takes its course? point them out to me and I'll repose of them for you.

Jeff McGinley said...

Thanx for having my back pal. Some people don't get that "you can't change genetics" doesn't equal, "you can't fight against the effects of genetics. "

Brian said...

Way to go Jeff! You are awesome. I look forward to the article and word of your Disney trip.

Jeff McGinley said...

Many thanx Brian. You've done some serious awesomeness yourself this year. Way to keep fighting.