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.

Mea Culpa

Just a quick post to let you know that I will be posting new material soon. I was pretty busy over the past week, a you'll read about in an upcoming post.

Food Sense 3- Bulking up with rice

One of the best ways in my experience to get a feeling of fullness is to eat bulky foods. White and brown rice work well: One cup of rice (a lot... trust me) contains around 240 calories with just 4 from fat.

Many "instant" rices suffer from the same problems as other prepared foods: A lot of sodium and other additives. But regular rice can take a long time (up to an hour) to prepare if you follow the directions. While I love rice, I often skipped making it because of the time. But now I've found a solution. In How to Eat Supper, an outstanding book by Lynne Rossetto Kasper, she presents a recipe called "Dumbed Down Rice". With it, you'll have rice prepared in the time it takes you to make the food to go with it.

The process is simple: You treat the rice like pasta. Here's the process:

1. Bring 3 quarts of water to boil (salt the water lightly).
2. Add one cup of white long-grain rice.
3. Boil for 8-10 minutes, stirring on occasion.
4. Dump the pot into a colander, then turn the rice back into the pot. Make sure to take the pot off of the burner.
5. Cover the pot and let the rice rest for 5 minutes. Fluff and serve.

I was amazed at how nicely the rice turned out, and as a consequence I'll make rice much more frequently. Buy this book!

The Procedure Begins

I had to fast after midnight. I woke up Friday morning and wandered around the house. I was nervous, but Beth helped keep me grounded. We had to be on site about 50 miles north at 9:30, so we headed out about 8:00. We stopped for gas, Beth picked up some coffee, and we got on the road. Shortly after 9:00, we pulled into the lot and headed inside.

I’ve been in a lot of hospitals in my day. I have to say that this was one of the nicest I’ve ever been in. The outpatient heart institute had a large, comfortable waiting area complete with a large waterfall. We checked in and took a seat.

Shortly after, a nurse came out; when we checked in, the volunteer assistant noted where we sat, so the nurse walked directly up to us. I hugged Beth, and she was told that she could come in to join me in a few minutes. The nurse and I walked back into the outpatient cardiology suite; she did the obligatory weigh-in (278.1 pounds) and took me to a small room. The room had a bed, a nightstand, a chair, and a wall full of medical gear. One whole wall was a sliding glass door. They had me strip down and put on that most comfortable of items, the hospital gown. I swear the person with the highest self esteem in the world would lose it with his or her nether regions catching the breeze from the non-closing flap in those things.

I climbed into bed and settled down to wait. The nurse returned and started an IV. It wasn’t without some excitement; one of my veins kept rolling and all that ended up happening was copious bleeding. She gave up on that one (she apologized profusely) and popped the IV into the other wrist. My blood pressure was high (170 over something), but I put it off to white coat syndrome. Twelve chest electrodes for my EKG, and then I settled in. Beth came in, and we started to wait.

While waiting, we talked, answered the occasional medical history question, and chatted. I was still nervous, but time passed. After about an hour, I had a couple of visitors: Two folks from the research arm of the hospital briefed me on a study that was running in the unit. The hospital was participating in research on a new stent, and the two asked if I would be interested in participating in the study if I was a candidate. The benefit to me? As part of the study one of the necessary drugs would be partially covered each month, for years. They left and Beth and I discussed whether or not to participate. For me it was easy, because in a previous life I was a research scientist. The two researchers returned and I consented (it took a fourteen-page consent form, which is hard to initial when you’re right-handed and have an IV hanging out of the back of your wrist).

The interventional cardiologist stopped in and briefed us on the process; he was straightforward and put us at ease. He answered our questions and then headed back into the procedure room.

Time dragged on; there were some procedures that took longer than anticipated before me. As an added bonus, the nurse popped in a video for us to watch on heart catheterizations; I was surprised that was never put up for an Emmy. Finally about 12:15 they chased Beth out, and got me ready to go. About 12:30, the team came in and wheeled me into the suite. It was time.

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.

Reality Rears its Ugly Head

Day 2 of the stress test was a walk in the park compared to the first day, but without the walk. In this type of stress test, on day 2 the technicians image your heart at rest as a comparison to the imaging that was done on day 1 when your heart was under load.

I showed up at the imaging department at 10:00 AM. The nurse injected me with the thallium, gave me a glass of milk, and told me to come back in an hour. I headed to the coffee shop in the hospital (giving the cafeteria in the place wide berth based on my experience from the day before), grabbed a cup of coffee and a glass of milk, and started killing time.

As an aside, Beth bought me an HP netbook with a solid-state drive for my fiftieth birthday. I love that thing! With public wi-fi in the coffee shop, the hour went quickly. I checked email, worked on the online class I was teaching, and did some more reading on angina. Then, I headed back to the imaging department.

Day 2 of the imaging was the same as the first day: You lie down on a table and hold your hands and arms above your head. The table has a strap to hang on to; keeping your arms out of the way gives the imaging head of the unit (which looks almost exactly like an open suitcase) a clear shot at your internal bits. If I had more sense (or been in less of a state of denial), I probably would have brooded. However, yours truly was fat and happy, so I dozed, did breathing exercises, and waited for the process to finish.

At the end of the 16 minutes, I headed out of the hospital. Since it was nearly 11:30, I decided to grab lunch so I headed to a hut that served pizza to eat a salad and a couple of slices. That done, I went back to the office. When the stress test was set up, I made an appointment with my personal physician for Friday morning to go over the stress test.

Several hours later, at work, the phone rang. You hear about times when everything changed? This was mine. The doctor who had ordered the stress test was on the line. She said, “The cardiologist is in the clinic. Could you please come in now?” I gathered myself together, called Beth, and we headed to the hospital. After that, things started happening fast.

Next up, the cardiologist and the vagaries of the healthcare insurance system.

Food Sense 2- Black bean croquettes and fresh salsa

The first cardiologist I met with turned out to be out of my healthcare network (more on how I started up with him later), but he gave Beth and me some great advice: Make time together for dinner. He told us that dinner was a time for us to wind down, have a glass of wine, and prepare the meal. What great advice!

Neither of us realized how wonderful it would be to break our routine and actively do something together at the end of the day like cooking. For us, it’s hard not to smile and have fun when you’re cooking and talking. This is the first recipe we made under doctor’s orders. This recipe came from Food Network’s site, although I’ve made a few modifications:

Black Bean Croquettes with fresh salsa
4 servings

Make the Salsa
Salsa is one of the easiest, quickest, most flavorful things you can make:
Ingredients: 1 lb. grape tomatoes, 2 green onions, 6-10 sprigs of fresh cilantro, salt and chipotle pepper powder
1. Coarsely chop 2 cups of tomatoes. For more sweetness use grape tomatoes, although regular tomatoes would work as well. You can pulse the tomatoes in a food processor; don’t over-process the tomatoes or you’ll end up with sauce. You want to see recognizable chunks of tomato.
2. Thinly slice 2 green onions, both the green and white parts.
3. Finely chop the cilantro sprigs
4. Combine the ingredients from the first three steps. Add chipotle pepper powder to taste (I used about 1 tsp measured by eye), and a pinch of kosher salt. Refrigerate.

Make the Croquettes
Ingredients: 2 15-oz cans of black beans, 1 tsp chipotle pepper powder (divided), 1 c frozen corn, 1/2 c bread crumbs (divided), 1 tbsp extra virgin olive oil, 1 ripe avocado
1. Preheat the oven to 375.
2. Open and drain the black beans. Pour the beans into a bowl, add half of the chipotle pepper powder, and mash until the beans are smooth.
3. Work half of the breadcrumbs into the bean mixture, and add the corn.
4. Mix in half of the fresh salsa you made.
5. Combine the remaining breadcrumbs, chipotle pepper powder, and the olive oil in a small bowl until the breadcrumbs are completely integrated with the oil.
6. Take the bean mixture and press into a half-cup measuring cup. Take the mixture from the measuring cup and form it into a ball. You should get about eight croquettes.
7. Take each ball and roll lightly in the bowl of crumbs until it has a light coating of crumbs. Place the croquette on a baking sheet sprayed with low-fat cooking spray.
8. Bake until heated through and the breadcrumbs are golden-brown, about 20 minutes.
9. While baking, stir the chopped avocado into the remaining salsa.
10. One serving equals 2 croquettes and a half-cup of salsa.
Per serving: 400 cals, 12g fat (2g sat), 61g carbs, cholesterol 0g, fiber 16g