What the doctor found

First, I want to let you know why it’s been a while since the last post: I’ve had a second procedure, which was stacked up on the end of the school term. This blog comes after my day job! Now, what the doctor found.

I was back in the room by 1:30. There was no pain, and I felt pretty mellow (probably due to the sedative injected just before the procedure started). Shortly after getting back into the room, Beth showed up. “The doctor said you had three blockages, but they only fixed one, with a drug-eluting stent. You had a 99% blockage.”

“What?”

That’s when reality set it. I learned I had a 99% blockage in my left anterior descending (LAD) coronary artery. It’s one of the few coronary arteries with a colloquial nickname (in fact, it’s the only one I’ve ever heard): It’s known as the “widowmaker.” Suddenly, everything that I’d done the weekend before to try to make the angina return came rushing back. Plus, all of the times I’d been winded over the past winter running the snowblower. And all of the hours I’d spent at the YMCA on the treadmill at 3 miles per hour on a 12% grade. With a 99% blockage, I was (as Daughter said to Beth) walking around with a time bomb in my chest.

I’ve read about people coming face-to-face with their own mortality. This was my moment.

Once I swallowed that, I learned more. The procedure showed two more blockages, both in my right coronary artery. The doctor estimated those at around 75% and 85%. The reason those weren’t fixed right away was due to caution on the medical team’s part: The molecule that makes up the dye is large and difficult for the kidneys to excrete. Fixing the other two would have meant pumping in more dye, which may have stressed the kidneys. Thus, the team decided to come back in later to fix the remaining two blockages.

Up to this point, the procedure had been relatively painless. What lay ahead was six hours flat on my back, on a hospital gurney with no movement of my right leg. While I was alone, I explored my groin area and was surprised to find a piece of plastic sticking out; I had found the introducer sheath (if you’re into such things, you might check out this web site for pictures. I’m not sure it’s the exact device used, but it gives you the idea what an introducer sheath looks like, courtesy of Gore Medical). Because home was an hour away from the hospital, I also learned that I would be spending the night in the hospital.

Those six hours were awful. I’m a big guy (as I noted in an earlier post, almost 280 pounds at the time), and six hours flat on your back without even a pillow was very painful. The medical team was good, and provided medications to ease the pain, but those six hours were the worst part of the whole process.

At about 4:30, the nurses came in and asked Beth to leave for a while; the plan was to remove the introducer sheath. After getting all sterile, the nurses exposed my groin. They explained that they would remove the device, then apply direct pressure to stop the bleeding. After some tugging and pulling, the first nurse told me, “This is going to be uncomfortable.” This turned out to be an understatement.

She took her two thumbs and leaned hard into my groin. It felt as if she was trying to make a dent in the mattress by pushing through me from the top. When she got tired, the other nurse stepped in. This continued for what seemed like an eternity, although it was just 40 minutes or so. At the end, they slapped a bandage on it, covered me up, warned me not to move, and brought Beth in. We talked, I dozed, and we waited. I was in quite a bit of pain, not from the procedure but from being flat on my back for hours. Around 6:00 they told me my room was ready, and we headed out.

In the room, they transferred me to the bed from the gurney, again admonishing me to not move my leg. I felt bad for the nurses and medical staff, having to slide more than an eighth of a ton from the gurney to the bed. But the bed was such a relief after the hard gurney; the mattress was soft and supportive.

Once we were in the room, Beth took control. By this time I was coming up on 24 hours without food, since I had been instructed to fast after 7:00 the night before. In short order, a tray appeared. Have you ever tried to eat dinner when you’re flat on your back? It’s a lot easier when you have a loving spouse who feeds you (thanks!).

By 8:00 PM, the nurse came in to raise me into a sitting position. Soon thereafter, I sent Beth home to sleep in our own bed while I spent the night at the hospital. At 9:45, more than eight hours after the procedure I was finally allowed out of bed. I was sore, but it felt good to get up. In the next installment, the aftermath and interim.

The Doctor Visit

I went to the doctor’s appointment on Wednesday. I had convinced myself that it was anxiety (I’ve had anxiety attacks before), and the doctor would tell me that I had been worrying for nothing. What I got was something else.

But first, some background. I have a family history; my father had his first heart attack at age 45, ended up on permanent disability, and died at age 54. He died six weeks before my daughter was born, who would have been his first grandchild. It wasn’t a heart attack that killed him. Rather, he died from a ruptured aneurysm on his abdominal aorta. The aorta is a huge vessel, about the size of your thumb. The University of Maryland Medical Center web site says “Many patients do not even survive long enough to make it to the hospital, and among those who do, more than half eventually die of complications. In fact, ruptured aortic aneurysm[s] are the 13th leading cause of death in the US…” (Source: http://www.umm.edu/vascular/aaa.htm). Back in 1988 when my father died there wasn’t a good treatment for abdominal aortic aneurysms (AAA), so he never had bypass surgery; it was simply too risky.

Because of this history, I had been aggressively treating my cholesterol and getting screened for AAA, both of which have hereditary components. I have an annual physical, I’ve had a couple of stress tests before (both clean), I've had an abdominal ultrasound to check for AAA, and my blood work numbers were pretty good (target numbers are in parentheses):

Total cholesterol: 159 mg/dl (110-200)
Triglyceride: 189 mg/dl (38-150)
Good cholesterol (HDL): 43 mg/dl (60+)
Bad cholesterol (LDL): 78 mg/dl (0-100)

All this lulled me into a false sense of security: How could it be anything but anxiety when I had numbers like these and I was taking statin drugs?

Blood work at the doctor’s visit showed that I hadn’t had a heart attack or pulmonary blood clots; the doctor diagnosed me as having “exercise-induced angina” and scheduled me for a stress test the next week. The stress test involved two days of tests, first under exercise and then at rest. I went through the weekend convinced that it was anxiety, bolstered by the fact that I tried to induce the angina over the next few days without success (in hindsight, this was kind of like the old Bugs Bunny cartoons where a character bangs a cannon shell with a hammer... But more on that later).

I will also post recipes here as Beth and I try to get back into healthier eating. Only good stuff... If a recipe doesn't make the grade (we're foodies, you know!) it won't be in here. And in the next installment, the test.