The aftermath and interim

Beth headed home about 8:30, and left me to my own devices. I read for a while and flipped through the TV channels. Once I was allowed up, I went to the bathroom and checked the location. Although the site in my groin was covered by a four-inch square bandage, it was clear that the bruise was going to be a doozy. I finally shut off the lights at 10:00.

Several times during the night, I had the obligatory wake-ups from the nursing staff. Blood pressure checks, meds, and even a blood draw. Finally, I woke up for good at 7:00.

About 9:00 Beth called and told me she was hitting the shower and would leave soon thereafter. About 10:00 I started entertaining a parade of visitors, all getting me ready for departure. First was a dietician, telling me how to eat healthily. She left me with a booklet, which I have yet to open.

Some words about eating: Since my clean stress test in 2002, I’ve monitored my cholesterol and triglycerides aggressively. While somewhat high back then (in 2002, my total cholesterol was 265 versus a target max of 180), it has been below 200 since 2004 and below 180 since 2006. Since 2002, I’ve had my cholesterol checked more than a dozen times. For many years, I have tended toward salads and almost never eat red meat. Chicken and shrimp probably represent the majority of the animal protein I eat. What I have always struggled with is portion control: It’s the old joke about see-food diets… I see food, I eat it. I made a vow to focus on portions, since I was already eating better than many people.

Next up was a cardio-pulmonary rehab nurse. She told me that I would be in rehab, and my local hospital would be contacting me to set up a schedule. This was the first time it really hit me that my life was going to change, and change in a significant way.

Finally, the cardiac physician’s assistant came in. She did an exam to check the puncture site, asked me how I was feeling, did the usual doctor things, and added new prescriptions for me. The final thing she did was to go over the procedure, tell me what was coming (the second procedure on June 1), and then she gave me a “stent card.” Who knew that you’d have to carry a card with you at all times explaining that you had a small tube stuffed inside a coronary artery?

How big is a stent? Do this: Open a typical ballpoint pen. The tube that holds the ink (in slimline pens, at least) is about 3 millimeters in diameter. Now, for the metrically challenged or resistive among you, there are 25 millimeters to an inch (25.4 to be exact), so 3 millimeters is an eighth of an inch for all intents and purposes. Hack off a piece of the pen tube 18 millimeters long (again, about 3/4”). That’s what saved my life; that tiny medical miracle was holding open my widowmaker (the left anterior descending coronary artery). To put in perspective just how small the stent is, see the accompanying photo.

The PA set up a follow-up visit for a couple of weeks away, gave me a slew of literature, and left me to get dressed. Beth showed up, and we headed out of the hospital. I was moving slowly (I was sore), but we headed home. I was told to take it easy (no driving for 48 hours). In the next installment, the joys of cardiac rehab and the second procedure.

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.