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.

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.