A Carnivores Guide To Cardiology- That's Not What "Routine" Means

The shortest version of this- The conclusion of my cardiac catheterization was: I’m good but weird. There are some medication changes to maintain the good part. It took me more time to recover from freaking out than from the actual catheterization.

 
The short version of this- A new, complete, right coronary artery blockage was found twelve years after my last catheterization (fifteen after my first one.) However, I had and have no symptoms or loss of quality of life because of the collateral flow around it due to my high activity levels and diet. Due to those life choices, the vessels carrying the blood around the blockage have made themselves larger, stronger, and better able to deliver blood on their own. I will be starting a new, but statistically proven through trials, injectable medication that will drop my cholesterol WAY down to maintain keeping the remaining coronary artery pathways open.
 
 
The really long version of this- Apologies for how “really long” this is. I usually break up stories of this size, but it’s a thing I needed to do to maintain what mental health I have left. There was a lot to cover, and I didn't want to have any, “So I’m in the Cath Lab with a tube near my heart… Tune in Next Time!!!” cliffhangers.

Yes, I realize this is about the length of one "Disney Day." Also- shut up.
 
 
I was feeling good.
 
Why do my cardiac issue stories always start like that?
 
Whenever I go into these tests confident I am on the right track, or get all kinds of health compliments during the treadmill test, I end up in the Cath Lab.
 
My organs all showed normal function, my cholesterol was in the "acceptable" range, and I finally figured out exercise (slightly shorter but more intense cardio and adding some lifting back in) and diet (returning to “The Joey Falco Diet Plan”) with my over fifty metabolism to get my sugar numbers to start going down, and to keep my weight consistently under 200.
 
And then there was clomping around Disney World for a week in May AN AVERAGE OF EIGHT MILES A DAY IN RECORD HEAT AND HIGH HUMIDITY WEARING AN ISOLATION BOOT with no issues. (Details of the ankle injury that required that are in the Planning Section of the upcoming Disney World story. There are side effects of me obsessing over proofreading my multiple part, writings. Another of many obsessions, Transformers, is also delaying the start of that one.)
 
Rosa and I were planning a celebratory dinner on our anniversary at Fogo De Chao, the all you can eat Brazilian Barbecue, meat fest that Anabelle had been to for work the past two summers, but we hadn’t enjoyed in over three years.
 
I had some “routine” Five Years Later tests. (After the age Fifty batch.) The laser in my eye (pew pew) cleared up some post cataract removal starbursts. The unpleasant package I mailed in instead of getting a full colonoscopy had negative results. On the cardiac side, the blood work came back good and the early summer echocardiogram and vasculature testing were normal and healthy as well. Due to my Achilles tendon snapping like the rubber band on an old action figure in early spring, I had to delay the Nuclear Stress Test until it was a bit more healed. 

(Spoilers- No, it did not delay the aforementioned Disney World clomping. Also, shut up.)
 
The test was Friday, October 24, two days before our anniversary. I went in feeling strong, healthy, and confident. The first scare came for the people running the test. (Spoilers- Mine would be later.) While I was stretching they freaked out that my right calf was very swollen. Once I explained my calves are normally that big and the left had atrophied after the surgery, we all calmed down. Even stopping my blood pressure pills for several days, my heart rate wouldn’t go above eighty beats per minute through increases in treadmill speed and incline. Therefore, we had to go to the medication induced stress test again. I referred to it as, “Panic Attack in a Bottle.” They assured me that’s not what it was. (Spoilers- That is EXACTLY what it was.) My body reacted the way it needed to, they made me radioactive, and I had the second scan for the evaluation.
 

Aside- My physical therapist and I talked for a while about how ridiculous it was, given the age and condition of most people who need stress tests, that it is done on a treadmill and not on a less impacting elliptical or bike machine. When I asked the team who ran the test why it had to be a treadmill, the answer was, “All the standards we have are for the treadmill.” 

(Spoilers- Basically, “We do it that way, because we do it that way.” Great.)
 

Much like a flashback to my very first stress test, my confidence only lasted under an hour. I should have had an inkling when they were insistently telling me to call my cardiologist if I didn’t hear by Monday. I said, "He always calls quickly for these, and I’ve learned if you let me leave the room after cardiac testing, it can’t be too bad." They just said, “You should call your cardiologist Monday.”
(Spoilers- I didn’t have to wait that long.)
 
A short while later, even though I spent most of that time staring at my phone, I got a missed call from Morristown Medical Center. Since it wasn’t from the Cardiologist’s office, I didn’t freak out… yet. (Spoilers- It was a very short “yet.”) I figured it was a survey or check in or something. That is until the transcript of the voice mail appeared. I had already been trying to check the call location and dial the doctor’s office because I saw “This is Doctor Safirstein.” (Spoilers- My Cardiologist, not a nurse or receptionist who usually make the "its all good" calls.) I focused on several words in no particular order, “abnormal” “diagnostic” “because I know your family history it would be better” and “catheterization.” Unfortunately, due to the frantic button pressing I was engaged in, the message vanished.

(Spoilers- AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAHHHHH!!!!)
 
This is when I freaked out. The next few actions were in highly quick succession but felt like they lasted days.
 
I called his office and found he had already notified them to have the scheduling group for procedures contact me. However, he was doing procedures that day (Spoilers- Hence the “Morristown Medical” location of the call.) and left no other information for them, other than it was “just” diagnostic. (Spoilers- It was.) I dialed the number of the missed call his message came from and miraculously hit the right combination of keys to reach a human. I explained what happened, and even more miraculously, because my Cardiologist was between cases, they were able to transfer the call to him.
 
I told him, in what was likely near incoherence, about the vanishing voicemail and stated I wanted to hear the information from him before I panicked. (Spoilers- I didn’t quite make it.) Awesome as always, he told me not to do that. It was “only” an abnormal reading on the scan of the nuclear stress test. Based on my other test results, what he saw in that test, and my activity levels, he felt it was nothing to worry about. However, given my personal and family history the best action was to check things out and “take some pictures” in the Cath Lab. He indicated it was “no rush.”
 
After speaking to him I was much calmer.
 
As an indication of the state I was in before I was “much calmer” I ignored his “no rush” statement and called his office immediately, and for the second time that day, to talk to the scheduling group. I was well acquainted with my personal and family history he mentioned.

 
I have been a subject matter expert in Cardiac device risk, including failure modes, hazards, and misuse conditions for about thirty years. The less time I have to think about this stuff before anything gets done to me the better for what's left of my sanity.
 
I was told they were just notified but the doctor still had paperwork to do before they could formally schedule anything, which meant I would probably hear Monday. The fact that he said, “No rush” as opposed to, “Can you come to the hospital now” (Spoilers- A not uncommon reaction to many cardiac issues.) was equally valuable to what was left of my sanity. This is because the medical group sent me the notification stating I had new test results. Much like most radiology reports, the stress test write up, which I thankfully read after speaking to him, basically said, “You died yesterday.”
 
Rosa came home from shopping, and I explained the plan to her as if it was no big deal. She took it remarkably well but immediately suggested our planned “meat fest” on Sunday should be cancelled for the time being. I had to agree, alas. We had a very nice (and healthier) delivered sushi lunch instead. I may have “played it cool” a little too hard. The reason she took it so well was she understood “take some pictures” as an external thing and didn’t realize it required an invasive catheterization until I explained it to Anabelle later that night. (Spoilers- This revelation was clearly indicated by her facial expressions)
 
She may have taken it less well after that, leading to my manifesting another aspect of over thirty years of experience in this field, confidence in my Cardiologist, the Morristown Medical Center staff, and the engineering behind the devices and equipment that have annual use numbers several orders of magnitude above the ones I have worked on. 

(Spoilers- Depending on who I am talking to, “Are you nervous about the catheterization?” has multiple different answers. They are all true. “Especially the lies.”)
 
The fact that I cleaned leaves in the yard for over three hours that weekend and was able to keep up my increased exertion exercise program added to my calm. Not as much as the Doctor’s speech, but they helped.
 
I called his office Monday to check if the paperwork was done.
Fine, I called twice, but it did get me updates by the next day on it even though it was “only diagnostic.” Procedures were done on Tuesdays and Friday mornings. I initially asked for the first Tuesday coming, but that day was reserved for TAVR. (valve replacement) There was no need to be jumping into surgeries my issues aren’t connected with. Therefore, it was set for the following week, November 11th. His office staff was awesome as always and did call me back to confirm the date, stating they didn’t want me to think they forgot about me. He already had a procedure scheduled that day and was getting a time slot special for me. (Spoilers- I was honored.) The “when” of that time wasn’t confirmed yet.
 
The next two weeks I kept up a confident front to prevent my family from freaking out, while my risk management experienced brain ran through every single possible worst case sequence of events. (Spoilers- There are SO MANY.) Going harder on the stationary bike, another equally extensive leaf clean up, and several long walks with Rosa tempered that bit of mental hazard analysis with a dose of reality.
 
A week before the procedure was a twenty minute online class… which, in all honesty, I probably could have taught a chunk of. It was a very nice offering and would have calmed me considerably before my first experience. Having a short video of Doctor Safirstein show up in the middle to explain that they can now do everything that used to require femoral access through the radial artery was another confidence bolster. Rosa called in as well and I texted her, “THAT’S MY GUY!”
 
The test was scheduled for noon, meaning we had to get there at Ten AM. I much prefer the medical things that have Six AM arrival times. I did not need a few extra hours to ponder probabilities.
 
Check in went smoothly for myself and the guy there for an ablation. I killed time by explaining that procedure to Rosa instead of thinking about my own. (Spoilers- For the risk management minded, distractions are a must.) The attendant, who previously had his own open heart cardiac procedure, walked us back and maintained the “safe and effective’ conversations everyone on Morristown’s highly competent and comforting staff used.
 
Because it’s all radial now, instead of beds in the waiting and preparation area, there are comfy recliners. I donned the hospital gown and put on the little sock booties. Hey, design improvement! The little sock booties have treads on both sides, so they are easier to don.
 
While they were starting to prep me, an intern came by and asked if I could be wheeled in three quarters of an hour early. Since I wasn’t ready yet, they told him to come back. This whole encounter was odd, as there was a long space until we saw him again. The nurse went to check and found out the Cath Lab was running about a half hour behind. That meant if they did send me with him, I might have been waiting alone in a hallway somewhere for close to an hour. Because of the patient focus, the hospitals with the most excellent care sometimes slip a little time management wise. 
 

My IV was set up, and they shaved both wrists and hands for the chosen, and back up radial arterial access point. One nurse would get uncontrollable giggles looking at the difference between my smooth wrists and sasquatch like arms every time she came by for a blood pressure reading or to check on something pre or post procedure.
(Spoilers- Yes. Post procedure. Meaning I did survive.)
Then she would apologize and say, “At least it’s cold, you can wear long sleeves.” I didn’t have the heart to tell her I never wear long sleeves. But any source of comedy is worth it.
 
My initial blood pressure reading was on the high side.
(Spoilers- “Perhaps I am nervous.”)
 
Doctor Safirstein came by to add more to my confidence by saying we were hoping to get in there and, “Do nothing.” (Spoilers- He did.) He said some more comforting things and went back to his other cases.
 
With the myriad forms and paperwork (Or is it tabletwork now? I don’t think that word will change.) were interesting moments. They went over my medication list, which the woman who ran the training session had called me to review the day before. There were still corrections needed. Honestly, the “folded paper list in my pocket” method always works better for that than whatever computer system the healthcare provider administrative team are using that particular week.
 
One of the multiple release forms was the details of the benefit risk analysis for the procedure. While the nurse leaned down to explain what that meant, I whispered, “I’m a writer on the benefit risk procedure for a multinational company.” She replied, “Wow, I didn’t know that was a job.” As I read through it, she leaned down again and then it was her turn to whisper, “But you’re reading the whole thing because it’s you this time.” And I replied well above a whisper, “You betcha!”
 
When they were finally ready, my comfy recliner and I got wheeled to the Cath Lab. We said good bye and Rosa walked to the outer waiting room. As soon as she was out of sight, I asked the nurse, “Can I look nervous now?”
 
As happens in all medical procedures, efficiency had increased over time. There were only a couple of nurses and/ or assistants in the lab when I was there, a significant drop from over a decade earlier. Due to the massive reduction in monitor cost, I presume, there was one enormous screen instead or multiple smaller ones. The down side of that was I couldn’t see the images. Visually following what was going on was a helpful bit in keeping me calm and focused on my previous visits. Also, the cardiologist entered at the same time I did rather than coming in afterwards once it was all set up, likely because preparation time was shorter.

 
Surrounded by the collection of amazing technology, there was a small footstool that I had to use to rise from the recliner to the operating table. In a flourish of quick movements by the nurses and technicians- I was placed under blankets and drapes, told to hold the handle on the right side to position my wrist properly, and felt my gown whisked away.

At that moment of extreme vulnerability, I was extremely thankful for all the knowledge I do have to give me confidence in this location and all who work there.
 
They noted that the other alternate insertion sites, for the femoral arteries (Spoilers- Yes… the groin.) had not been prepped (Spoilers- Shaved.) when my wrists were done. He said the staff outside the lab leaves this preparation for them because of the use of the recliners. I pointed out, “I was wondering what position I was going to have to get into out there for that…” and before I finished, he said,
“But you figured it was better not to ask.”
Exactly.
 
He said they had more experience, and I stated, “You all know what you’re doing, I trust you.”
His response, “Don’t worry, I watched a YouTube video how to do this last night.”
At that point my cardiologist, once more proving we have the same sense of humor, yelled from across the room, “SO DID I!”
 
They finished the other back up site preparation.
(Spoilers- The word “Mohawk” comes to mind. 

“I pity the fool with a sharp and tortuous brachiocephalic entry angle.”
We now pause for the tiny cross over in the Venn Diagram of those who know vascular access procedures and those who know Eighties Pop Culture Trivia to compose themselves.)
 
One part of this I always forget is that while the preparation statement is the same, “A little pinch,” the pain involved with radial artery access is significantly above that for a venous IV line. It could be the fact that I am learning about the functioning of my heart shortly afterwards makes me forget this larger “little pinch.”
 
While I was awake and didn’t consciously feel any different, I learned by asking at the end that I was given a sedative. In the training she mentioned people falling asleep under that medication and not remembering anything, which didn’t happen on my previous procedures. I asked if they changed it and she said, “No,” but did note I wanted to be lightly sedated. Whether that was communicated or it was just how I react to this type of sedation I have no idea. (Spoilers- The fact that I didn’t undergo a complete panic attack at any time indicates the sedation did its job well.)
 
Given that I couldn’t see the screen and they weren’t talking directly to me, it was hard to tell what was going on from moment to moment. Perhaps the sedative helped with that as well. At one point I heard them discussing the correct pronunciation of “Calcified.”  This is not a word one wants to hear when a doctor is poking around your arteries. More evidence of the quality of the sedative as I was remarkably calm about it. At another point he was talking to the others in the room and yelled over to me, “Tell them how much you exercise.” To which I answered, “I’ve been doing 35 minutes on the bike the nights I do my ankle exercises, and an hour when I don’t.”
Doctor Safirstein said, “See?” Then went back to work.
Another good sign was him mentioning to them the need to bring my LDL way down because  I needed to keep going to Disney every year. Nice to know he understands the critical goals.
 
When he finished up, he came over and said something that (in hindsight) made me even more grateful for the sedative. “There is good news and weird news.”
 
The good news- The left side looked almost the same as it did a dozen years ago. There were a couple tiny vessels with some occlusion but they’re so small stenting them always closes up again, anyway.
 
The weird news- Above where I have my two stents in the right coronary artery, there is a 100% occlusion. He continued after telling me that before my mind and mouth could finish forming, “Why am I alive?” (Spoilers- Thank you, sedative, for keeping me from leaping off the table.)
The way he explained it is my heart made its own bypass. The coronary arteries look like separate branches on each side, but really make a circuit. The left side and other arteries have gotten thicker, stronger, and larger, and the blood is now coming from other vessels including UP the right side from them (instead of the usual way DOWN the right side) and perfusing that area of the heart that way. Pushing through a complete occlusion of that size would require using a much stiffer and thicker guide wire to place anything, which has a far higher chance of complications. That is- the complication would be pushing through something that it shouldn’t be pushing through. (Spoilers- That something being a part of me.) My heart is getting the blood flow it needs, and my exercise tolerance remains high, therefore, there was no need to do anything in there. 

 
I had a near infinite amount of questions running through my head:

Was the muscle pull over my ribs in Disneyland really a heart attack?

(Spoilers- No.)

Is the calcium in my vitamins and the milk for my healthy cereal a cause of the occlusion solidifying?

(Spoilers- No.) 

Was the fact that I had to sit down and take a break in the middle of doing hours and hours of yard work on a hot summer day an indication that this was happening?

(Spoilers- No.) 

Was there anything on my older scans that, in hindsight could have predicted this?

(Spoilers- No.) 

Was my not wanting to ride the Tower of Terror a second time first thing in the morning caused by a reduction in cardiac flow?

(Spoilers- No.) 

Was there an interaction between medicines that I've been taking successfully for about a decade that reduced their efficacy?

(Spoilers- No.) 

Was my eating more low sugar items to balance that issue out instead of focusing on low fat items a trigger for this?

(Spoilers- No.) 

However, the only question I could voice in my sedated state was, “Did not being able to exercise at all for five weeks do this?” referencing my separated ankle tendon. 

(Spoilers- Also, no.)  

The doctor said there was no way to know when it formed (other than after the five years ago scan) but the size and state of the blockage meant there’s a good chance it was already there well before that time period.

 
My wrist artery access was closed up with a collagen plug and the TR Band inflatable closure device was placed on top of it.
 
I do not remember them mentioning a collagen plug twelve years ago. A lack of one may explain why the site kept bleeding back then whenever that TR band pressure was lessened, until they had to use the direct pressure method, leading me to pass out with a vaso vagal response and scaring the crap out of Rosa.
I did mention this incident while I was being prepped. I do not know whether that was the reason for the collagen plug this time, or (as always) medical technology and methods get better over time.
(Spoilers- I did not pass out, much to Rosa’s relief.)
 
I did my best to explain what happened to Rosa when I returned to the “Radial Lounge.”  Either she shut down when she heard “100% occluded,” or in my sedated state, the explanation was less than coherent. A combination is probable. Luckily, the Cardiologist came out right away. Before he said anything to me, I asked, “Please explain to her why it is OK.”
(Spoilers- He did. Hurray!)

He also pointed out that if everything is working, "fully occluded" can actually be more stable than an open vessel. As an open vessel can close, but a fully occluded one is not going to change.
 
The pressure reduction steps for the TR band worked perfectly this time, if you ignore the nurse giggling at the furry/ clean borderline on my arms. (Spoilers- Another side effect of aging, it is taking WAY longer for the hair to grow back than it did over a decade ago. "Quite the fashion choice.") I didn’t bleed or pass out. (Spoilers- These are excellent metrics for a good day.) The band was removed by Three PM without incident. The plain turkey sandwich and juice were exceedingly tasty because recovering from a two week long anxiety attack always helps enhance the senses.
 
I couldn’t lift anything above ten pounds for five days (Spoilers- The paper said three, but I trusted the the nurse to know what she’s talking about. I do appreciate a good benefit risk analysis.) I had to keep the packing tape (Spoilers- Probably not what it was.) on top of the little sponge (Spoilers- Also probably not what it was.) covering the recently open access point to a main artery leading directly to my heart (Spoilers- EXACTLY what it was.) for a full twenty-four hours before showering.
 
There’s nothing like being in the cardiac section of the hospital to make one feel grateful, and not just for the amazing staff. Yes, I was freaked out about what I was going through, but I also heard another doctor say, “When I went in, he was in full stroke.” I also heard a different doctor talking to the guy in the next area (who was clearly way younger than me) about options for getting on heart transplant lists. For these and many other reasons, I felt incredibly lucky.
 
Rosa took me home. As always, infinite thanx are due to her for taking care of me. Both before and after the procedure was a chunk of fighting waves of anxiety. I have a pinched nerve in my neck which manifests in radiating pain in my left arm, chest and back. Stretches alleviate it and I usually can ignore it. Achieving that ignoring got a little harder during this time.

(Spoilers- My Cardiologist's completely accurate medical assessment of this condition: "That sucks.")
 
The next day the sponge was reluctant to come off with the packing tape, and I put a new band aid over it after showering. The next night, while gingerly removing the band aid, the sponge popped off. I survived yet another impromptu stress test and the plug remained in place.
(Spoilers- AAAAAAAAAAAAAAAAAAHHH!!!)
 
Over the next two days I rested, read Spock’s Autobiography, a Veitch Swamp Thing collection, and finished the few episodes I had left in season four of The Witcher. I’m not a huge fan of binging television shows, therefore with Anabelle at school and Rosa out shopping Thursday, even though I was multiple seasons behind on various series, I Watched Apocalypse Now.
(Spoilers- When else am I going to have three hours to sit still alone, AND crank up the volume on the TV? "NEVER GET OUT OF THE BOAT, MAN!!!!!)
 
By Friday I was back at work remotely, and either on the stationary bike or walking with Rosa each day. This came after calling the Cardiologist's office to ask when I could exercise, being told to wait nearly two weeks until I saw Doctor Safirstein, begging with the answering service to ask him instead...

And then finding the discharge paper that said, "Resume normal activities immediately," about a day before he called me back.

(Spoilers- "Perhaps I am nervous.")

 
The next week and a half were yet another stress test while I thought up additional terrifying sequences of events while working out what questions to ask at the follow up appointment to help ensure:
1) Nothing else gets blocked.
And
2) We get an inkling something is going on well before “100% occluded.”
 
My question list reached a full page. To prove my gratitude, it started with:
"Twelve years between needing Cath Lab visits goes in the good column.
RCA completely occluded- didn’t die. Also in the good column."
 
After the required wait to protect my wrist, I went back to more rigorous bike work outs, plus another three plus hours of leaf cleaning, in the dark this time. Rosa found a cute little “head light” flashlight headband for me to use. This meant every time I got to the bottom of the driveway, I’d see the light on the road and freak out thinking a car was coming. (Spoilers- Anxiety manifests itself in many forms.)
 
Those weren’t the only ongoing stress tests in between the catheterization and the Cardiologist follow up. Thanks to the reports that came out of the EKG during the test, another “you died yesterday” result, I still felt a great deal of concern in that time that there was more of an issue than I originally thought. The fact that Doctor Safirstein didn’t indicate any of this concern during or after the procedure kept me marginally sane. (Spoilers- The noted items were confirmed by him to be nothing at the appointment, leading me to calmly ask, "THEN WHY DO THEY WRITE THEM??!?!")
 
As always, I felt FAR better after my visit with him. He listened to my entire page of questions. (Spoilers- Many of which I knew the answers to, but wanted confirmation, mostly for peace of mind, but also because it’s easier to explain things to others by starting with, “My cardiologist said…”) The conclusion is that I’m still functioning well, and I need to continue my diet exercise and medications.
 
A large portion of my anxiety and sadness came from thinking this was a, “In spite of all the actions I took and maintained for my health, I either did not do enough or could not do enough to prevent my crappy cardiac genetics causing a blockage.” 

However, what really happened was, “Due to all the actions I took and maintained for my health, when my crappy cardiac genetics led to a blockage, not only did I not die, but I continued with unchanged quality of life.”
 
Due to those crappy cardiac genetics, the blockage still happened with my cholesterol in the current “acceptable" range. Therefore, I will be put on one of the new, injectable medications that drive the lipid profile WAY DOWN. The “acceptable” range border has dropped already and is due to drop again. Additionally, high statistical powered studies have shown no ill effects of extremely low cholesterol, and that these injectables lead to reductions in both blockages and mortality rates. At this time I am waiting to find out if the doctor's preferred medication will be covered. My Cardiologist filled out all the paperwork, and the pharmaceutical company sent me their "Coronary Artery Activity and Coloring Book" to guide me through the process. I'm still waiting, though, because someone with no medical degree at an insurance company has to decide if it is financially worth keeping me alive, and for how long. (Spoilers- Our healthcare system is SO broken. Sadly, much like several key problems, it is impossible for us in this nation to figure out what nearly every other civilized nation on Earth has to alleviate them.)

(Later Spoilers- I called our insurance help line to see if this could be expedited, was given a phone number for the section that handled that... and told I would be hung up on because I am not a provider. SO BROKEN!)
 
The main side effect of the new stuff is the same as the statin I will continue taking, joint pain. Well, at this age, they all hurt all the time anyway, so bring it on. 

There is also a very slight chance of bronchitis, however:

A) I know how "side effects" in studies work. There were colds in both groups but a one percent higher occurrence in the test group compared to the control group. My suspicion is it has less to do with cause and effect, and more to do with what season the groups were checked.

B) That old risk benefit thing that guides every medical decision. If the choice is a bad cough versus a heart attack, Shoot me up, Doc!
 
The key to any medical condition is to do whatever you can to keep on going. This way, when you need a treatment everything has gotten safer and more effective.
 
I’ll will keep fighting this with what I eat, how hard I exercise and these old and new medications.
 
I will also keep following my cardiologist’s advice on mental health along with physical. 

When I said I had been reducing caffeine but still needed some to function, especially on long drives, he said that was fine.
When I said on weekend nights, I have a glass of rum and root beer while playing video games, he said, “I’m glad you do.”

(Spoilers- Technically, most of the time it is Rum and Birch Beer, but I am a fan of alliteration.)
 
And when I told him about cancelling the Brazilian barbeque after getting the stress test results, he said, “What? No! That place is the best. Did you go? You barely eat that stuff. You have to go.”
 
Some doctor’s orders are more fun to follow than others!

(Spoilers- And now we get to share it with Anabelle!)