Rehab and the second procedure

I was home on Saturday, May 2 with one of my three blockages corrected. I was sore and pretty slow; when I got home I took an opportunity to look at the site in a full-length mirror. What I saw surprised me: A bruise, the color of black velvet, extending from my midline to my right hip. It looked very much like I was wearing a quarter of a black Speedo. It wasn’t a pretty sight. I haven’t had the body for a Speedo since I spent the summer in the Bahamas during my undergraduate days at the Community College of the Finger Lakes field station.

Over the next few weeks the bruise continued to spread, eventually moving into my upper thigh and beyond the midline. The color moderated somewhat but persisted for at least three weeks into May. At the site of the insertion of the inducer sheath, I had a lump that started out the size of the last segment of my little finger; the lump decreased over time. I knew that I was going back into the operating room in four weeks, so the lump was a concern. The cardiac physician’s assistant told me that the second procedure would be performed from the right side as well, since she said it worked better to go in via the right side from an anatomical perspective, although I haven’t found a clear explanation of why this is so.

When I was being discharged from the hospital, I was told that I would be slotted into cardiac rehab. According to The American Heart Association, “Cardiac rehabilitation is a medically supervised program to help heart patients recover quickly and improve their overall physical, mental and social functioning. The goal is to stabilize, slow or even reverse the progression of cardiovascular disease, thereby reducing the risk of heart disease, another cardiac event or death. Cardiac rehabilitation programs include:

• Counseling so the patient can understand and manage the disease process
  
• Beginning an exercise program
  
• Counseling on nutrition
  
• Helping the patient modify risk factors such as high blood pressure, smoking, high blood cholesterol, physical inactivity, obesity and diabetes.
  
• Providing vocational guidance to enable the patient to return to work
  
• Supplying information on physical limitations
  
• Lending emotional support
  
• Counseling on appropriate use of prescribed medications."
  

My first rehab session was scheduled about a week before my second procedure, which was due on June 1. I showed up at my session; I brought along some workout clothes because I was told that the rehab folks would do a physical assessment. At the rehab session, the staff took a detailed history and gave me a set of questionnaires to complete. They measured my waist, right below my navel; I measured 46.5 inches. The Heart and Stroke Foundation of Canada showed that men with waist measurements larger than 40 inches (at least for European Caucasian, Sub-Saharan Africans, Eastern Mediterranean, and Middle Eastern men) are at risk for high blood pressure, high blood cholesterol, type-2 diabetes, heart disease and stroke. Not good. They ran me through 10 minutes of exercise on a recumbent bike, and 10 minutes on a treadmill. They set me up for 36 sessions, Monday, Wednesday, and Friday from 8:00-9:00 in the mornings.

Monday morning I showed up for my first rehab session. What struck me was the age difference between me and the other men (by chance, my group was all male) in the group. I was youngest by probably 20 years at least. When you go to rehab, the nurses need to monitor your heart. After all, you were just diagnosed and treated for heart disease. Thus, you wear a battery-powered heart monitor. You stick on three electrodes, one just below your right collarbone, and one each just beneath your rib cage on the left and right sides. The electrode leads snap on to the adhesive electrodes, and you clip the monitor to your waistband. Then during exercise, the rehab nurses monitor your heart rhythm and heart rate.

During a typical rehab session you’ll do several things. Understand that one of the purposes of rehab is to learn about how to safely exercise. Thus, you’ll start out by stretching and warming up with hand weights and then move into some very low-level calisthenics like marching in place. Once you’re warmed up, you start working out. Most rehab facilities have a variety of equipment; mine had recumbent bikes, treadmills, and rowing machines. You work out for 40 minutes (that’s the target, although you’ll work out for less time at first), and then go through a cool-down. Several times while you’re exercising, the nurses will take your blood pressure. All of the measurements during and before exercise (including your weight and resting heart rate) are entered into a computer program to track your progress.

During my first week of rehab, I went Monday and Wednesday. Friday I was scheduled for the second procedure. I was a lot less nervous the second time.

The second procedure went off the same as the first, with two significant differences. First, the bruising at the insertion site was completely different; the bruise was just quarter-sized, and after a few days was barely visible. As I described in this post, the nurses put pressure on the inducer-sheath site with their thumbs, pressing directly down into the soft portion on the front of my pelvis. That left a mammoth bruise. This time, the nurse pinched the site against the ilium or hip bone. The pressure was much less, and there was much less pain. Second, the two remaining blockages were in my right coronary artery; the blockages were about 80% and 90%. When they stented the blockages, I didn't feel a thing, unlike the first time when I had significant pain and shortness of breath. I'd heard of people having "silent" heart attacks; the stenting process reinforced to me just how that was possible.

In the next installment, how to get into an exercise routine.

The Cardiologist: First Verse

When I called Beth I used the same "successful" dorky guy “if-I-tell-you-something-do-you-promise-not-to-freak-out” approach. “Honey? The doctor called. She wants me to come in now and see the cardiologist.” This was just as successful as the first time I used it. I could tell she was worried; I told her “It’s going to be OK… I’ll see you in the lobby of the hospital.”

I was nervous driving to the hospital, but I still kept telling myself that things were going to be fine. The bigger part of me characterized it as whistling past the graveyard, but I kept up the mantra: It’s going to be fine. It’s going to be fine. It’s going to be fine. I pulled into the parking lot, locked up the car, and walked inside. Since Beth works four blocks away, she was there already. When I saw her I could tell she was scared and nervous, so I put my arm around her and tried to be strong. Inside, I felt the same way that she did.

We took the elevator up to the top floor and headed to the cardiologist’s office. Within minutes, we were ushered into the exam room and the nurse started taking my history. I tried to keep a stiff demeanor, because I knew that if I let down my guard I’d lose it myself.

Soon enough, the doctor came in. He had enough age on him to make me feel comfortable. He seemed to be my age or a bit older, so that meant he had experience. It’s not like you say to yourself, “Hey. I want to be a cardiologist” and head off to med school in your late forties. He didn’t pull any punches; he asked why I was there and what my symptoms had been. I recited the litany again, and I kept telling myself “You’re just fat.”

The doctor disabused me of that: “You have some blockages. We need to do an angiogram.”

While I was wrestling with that, he went on: “There are three things that can happen. We can go in, find out that the stress test was completely wrong and you have no blockages. We can go in, find out that you have major blockages and immediately perform emergency bypass surgery. Those are the two extremes. Or, most likely, we’ll go in and find out that you have blockages and we’ll fix them right there either with angioplasty or stents.”

Lots of things went through my mind: I’ve taken statin drugs for years. My cholesterol has been good. My LDL and HDL have been good. I had a clean stress test seven years ago. How could this be? The fact was, it probably was what the doctor said.

Now for the vagaries of the healthcare system: Last year, my employer made us an offer. Choose a narrow provider network, and we’d get a reduction in our insurance costs. After discussion, Beth and I decided it made good sense. As I sat there trying to wrap my head around all of this, it suddenly occurred to me that this doctor (who I had grown to like in the short time we spent together) was outside of my narrow network. The doctor who had referred me to him had referred me out of network.

As an aside, we live in a rural area of Wisconsin. The joke is, we’re 100 miles from everywhere: Madison, Eau Claire, La Crosse, Appleton, Green Bay. But we’re blessed to have multiple world-class hospitals within easy driving distance. In one town, we have a major research hospital with another large hospital right next door; in a town of 30,000 there are more than 1,000 doctors. Nearly the same distance north, there’s another hospital that was ranked in the top 50 in the US recently. The hospital to the north is in my network, and this doctor was from the other hospital. When this dawned on me I put the brakes on and asked the doc if I could call my insurance carrier. He stepped out, and the nurse helped me dial out.

Bottom line: If I went with this doctor, my deductable would double and insurance would only cover 80% of the cost. After discussion, Beth and I decided that as much as we liked this doctor, we had to stay in network (we were scared about the cost of the procedure, and as it turned out, rightly so). When he came back in, I explained and he understood completely. I asked him for a recommendation and he gave us the name of one of his former students at the hospital to the north.

Before we left, the doctor told us about his wife. She had started a kitchen store and cooking school in the town where his hospital was. She focused on the Mediterranean diet, and had great success working with patients trying to move to a healthier lifestyle. This doctor was the one who told Beth and me that we needed to come home, turn on some music, and make food together. This has been some of the best advice either of us have even been given.

We left the office, crossed over to our family doctor’s office, and got the number for the in-network cardiologist. We called and they told us to expect a call; they wanted to schedule the angiogram for Thursday or Friday. So, we did what we often do: Instead of going home, we went to our friend’s wine bar and had a glass to calm our nerves. We came home to a message, and at 7:00 AM on Thursday morning I called. We scheduled the angiogram for 9:30 on Friday morning.

Next: The procedure begins. Plus, some good recipes we’ve found just following doctor’s orders.