Paul's Heart

When The Body Tries To Warn You – Part 3

I arrived by 5:30am as instructed for my 6:30am procedure, to have at least one blockage, possibly more, to be stented via trans catheterization, simpler put, fixing my heart through my leg. As opposed to doing this by open heart surgery which would take weeks if not months to recover, this is why Dr. S said he would have me up and going in a week or two.

My nurse’s name was Heather. She took me back to a holding area, for me to get changed into a hospital gown. And then, again probably the most stressful part of my procedures, trying to get an IV into my arm, you want your best tech to have at me, not one who draws the shortest straw. I had gotten real good at warning techs and nurses that I am a hard stick due to my chemo history, that back when I was treated for Hodgkin’s Lymphoma, ports were not an option (so there, here is my PSA… GET A PORT IF THEY OFFER IT TO YOU!!! It is not worth being stabbed repeatedly trying to find a working surface vein.).

Everything was going smoothly, and quickly. Heather would pop back in frequently to see if I was comfortable or if I needed anything (as in to calm down). I cannot say what prompted me, but I brought up a totally unrelated conversation. “This is the first time I am having anything done since I was diagnosed with Hodgkin’s Lymphoma back in 1988.” I had Heather’s interest. “I went through radiation therapy and chemotherapy, and have been in remission ever since.” Heather’s face showed more than a little intrigue, she had something in her thoughts, and it was serious. I assured her that I was fine, the only lasting issues that I had from it, was that I was not able to biologically have kids, my thyroid was messed up, and that I had no spleen from my laparotomy, so doctors need to take extra precautions to make sure I don’t contract any infections. She wrote down that I was “asplenic”, without a spleen. Turns out this was an important detail (as with any surgery for me). Heather said, “that’s good to know because it is important. We will probably get some prophylactic antibiotics into you before starting.” Okay, made no difference to me. They were the professionals and I had all my trust in them.

At that point, I was given a sedative as I remember nothing after that.

When the procedure was finished and I came to, groggily, I was in a private room. There was Dr. S and a friend of mine who had stopped by to check up on me. My head was woozy, so I know it was hard to focus on what Dr. S was trying to explain. Even with newer pictures and a drawing, I could barely make sense of it, not to mention, apparently take it seriously.

“We were unable to do the stents as the cath revealed extensive scarring to the left anterior descending artery, producing a 90% blockage.” Just then, my friend, who happened to be a paramedic and also happened to recognize in plain English what the doctor just explained medically, blurted out, “oh my God, a ‘widow maker’!” Dr. S interrupted, “yes, but we don’t like to refer to it as that. Paul actually has two other blockages to be dealt with as well, so I have him set up for an emergency triple bypass first thing in the morning.”

I kind of heard everything, but understood nothing. Out of the word “bypass,” I got the word “by” out if it, and just started babbling, “bypass? bye-bye. bye-bye bypass…” At this point, I do remember the clock on the wall saying 3:00. Dr. S left the room, and I nodded back off to sleep.

I woke up a little just after 4pm, not nearly as groggy as I was. On the table next to my hospital bed, were the two sheets pictured above, the photo and the diagram. I remembered vaguely what these things represented. Just then a nurse came in. Clearly I was confused as to what was going on. I had pain in my leg where they went in to do the catheterization (and failed). The nurse recommended that I stay in bed until the cobwebs were definitely gone from my head, and the pressure had gone down in the incision in my leg. I asked the nurse what happened and what was going on.

She explained that when they went in through my leg up to my heart, they discovered that my cardiac system had been so badly scarred from the radiation therapy I underwent back in 1989, making it impossible to implant stents to open up the blockages. There was the worst blockage, the one that was 90%, the LAD or “widow maker,” another that was 40% blocked, and the third, with the right coronary artery (RCA) blocked 30%. I was set for an emergency triple bypass at 6:30am. My head may have been clearer from the anesthesia, but still I was not reacting to this news the way I should have been. I was focused on one thing, two actually, my daughters.

My daughters were only three years old and five years old at this time, but already they had been exposed to the situation of having friends who had lost a parent. Of course, even at their young age, and explained age-appropriately, they still understood the loss their friends experienced, never to see their dad again. And I began to cry. I did not want to die. The nurse tried to console me, eventually giving me something to calm down as I was getting worked up over the situation. There was a lot that was going to happen over the next several hours, pre-op to be done, as well as get my one and only meal in, as I would be fasting as of 8pm for my early morning surgery. The last thing I felt like doing was eating. All I could think about was my daughters.

Just like that it started, in came phlebotomists to draw blood, a wheelchair to take me for an ultrasound of my legs to see which veins or arteries could be harvested for my bypasses. Everything was happening quickly now. And with my head clear, I was also paying attention now to everything being said around me. Up and down both legs they went with the ultrasound wand and a standard thick sharpie, outlining my veins on each leg that they felt were suitable for harvesting. Then it was off to x-ray for a chest pic and an echocardiogram.

I got back to my room around 6:00, food was waiting for me. I did not feel like eating, nor did I think it would make any difference as the next day was going to be without food anyway, well, at least orally. All I could think about was wanting to talk to my daughters. I had to reach them some time before they went to bed. I needed them to know what was going on, what to expect, on a small child level. I had to be careful how I explained everything so as not to scare them, not wanting to remind them of their friend’s father who passed away from a heart attack.

I got ahold of them just before 8:00 when they would be heading to bed. I told them, that I was seeing doctors who wanted to fix me up. They are very nice to me, and have a good plan that after the next day, I will be good as new, and that I would be home a few days after that. Not to worry about me. I was going to be fine. This was the second night in a row I had not seen them, been able to hug and kiss them goodnight. But I let them know how much I loved them and could not wait to see them again soon. The doctors would make sure of that.

I held myself together while I was on the phone with my daughters, and broke down immediately as soon as I hung up. Somehow, I was lacking the confidence that I clearly portrayed to my daughters. A nurse came in and asked if there was anything she could get me, and I said I just had one favor. If there was any chance that I could get a ride down to the hospital chapel. I am not an organized practitioner of religion, but I have my faith. And I wanted to make sure my surgeons were being watched over, and my daughters were being watched over. And of course, if there was anything that could be done to get me through the surgery.

(photo courtesy of IMDB)

At 3am, a huge man, who resembled Michael Clarke Duncan, dressed in green scrubs came into my room. He was there to prep me for my surgery. He would also be my valet to the chapel, and eventually downstairs to the operating room. Just like Duncan’s character in the Green Mile, he was a gentle giant of a man, towering over me. I was beginning to think my age and what I was about to undergo was having an impact on those taking care of me.

5:30am rolled around, and into the room came a gourney instead of a wheelchair this time. Some extra help came into the room, to lift me from my bed onto the gourney. It was go time.

When The Body Tries To Warn You – Part 2

If you haven’t yet, I recommend that you read part 1 of this series, so that you understand how I got here.

I arrived for my appointment on April 16th, early, not out of enthusiasm, but just because that is how I am. An IV was placed into a vein in my hand. This would be used to inject the radioactive isotope for when they would take any pictures for the nuclear scan. Of course, the hardest part of any procedure for me post-cancer, is getting an IV into me or blood draw, chemotherapy having destroyed my veins. Before I would head to the treadmill lab, it was off for my first set of pictures with the isotope having been injected, showing my heart at rest, a.k.a. no stress.

Once that was done, I was connected to telemetry, which would monitor my heart once I got on the treadmill. At this point, there were now four others in the room with me; a nurse, a tech watching the telemetry, and I am not sure who the other two were.

Then it was go time. I climbed up on the treadmill. The “exercise” tech explained to me how the test would work. The test would last approximately twelve minutes (I was definitely confident that I could handle that). Every three minutes, the belt would speed up, and the treadmill incline would increase. This would be done until my heartrate got up to the desired result they needed for the test.

Aaaaaaannnnndddd, go.

Of course as the test began, the belt was definitely slow walk pace, and flat incline. Got to the first three minute mark. And then, the first increase in speed and incline. Almost immediately, I began to get that tightness feeling in my chest and shoulder. But as I was not suspecting anything, I said nothing. I had nine more minutes to go. Then a nurse asked, “are you okay?” I responded, “yes, I am just starting to get that ‘tightness’ that I mentioned before.” The nurse asked, “can you go a little further? We are almost getting to where we need your heartrate.” Confidently with a bit of bravado I answered, “go for it.”

By the time I got to the six minute mark, I had the full tightness and pain in my chest and shoulder as usual. No one was saying anything to me at that point, so I just kept going. And then the belt increased again, and the treadmill raised its angle some more. In less than a minute, the tech said, “stop the belt. Mr. Edelman, you can step down.” All that I heard was that something showd on the EKG, something had happened. I was still oblivious, not connecting how I felt with the result of the EKG.

I was taken back to the lab, for another dose of the isotope, and then back to radiology for another set of pictures, this time, my heart having been “stressed out.” I did not feel any differently, as usual, the tightness and pain had gone away. Once this was finished, the IV port was removed from my hand, and I was told to wait out in the waiting room before being released. In the meantime, I could enjoy something to drink and something to snack on. I was starving.

And then I noticed something. People who had come in to the office after me, were leaving before me. I mean everyone. This was not a good sign. Something did not feel right. Was I forgotten? Then a nurse appeared and said, “Mr. Edelman, will you come with me please. The cardiologist would like to talk to you.” Yeah, this was deja vu, just as I wrote in my book. Cardiologist? Wants to talk to me? There’s nothing wrong with my heart. Right? Riiiiggghhtt?

Dr. S was a young doctor, quite possibly my age, very friendly demeanor, but had a serious message. “I don’t usually put things this way, but I am 100% certain that you have a blockage. The good news is, we can check you right in to the cath lab next door, pop a couple of stents in you, and you will be as good as new in a week or two.”

Blockage? Cath lab? Stents? Couple of weeks? The doctor did not need to tell me what the actual problem was when the Kubler Ross stages had already kicked in. Denial first. And then bargaining.

“Listen doc. I am sure this is serious, but listen, I have a wedding I have to DJ this weekend. How about if I come back Monday after the wedding and we can get this done?”

This was his response, “perhaps you did not understand me, you have a blockage to your heart. Your heart is not getting the blood supply it desperately needs. Time is crucial to get this repaired.”

These are the images that the doctor was looking at. As long as I picked out the right picture from my records, this is a photo of my pending death, or what would like be my demise. Though the doctor did not put it in those words.

Ok, the doctor had my attention. I would forget about arguing about the wedding. The doctor was saying I would be good in a week or two, if I got this done, and doing stents were going to be that easy, I was sure I would still be able to pull off the wedding anyway. But I was still not done tryin to gain some sort of control by bargaining.

“Look, this really caught me off guard. I need to go home tonight, I need to wrap up a few loose ends. Most importantly I need to see my daughters. I’ve never been apart from them, and I need them to know I am fine.” The doctor replied, “okay. Just please, do nothing else at home. Just relax, get here first thing in the morning.” So I replied, “perfect. Nothing but relaxing. In fact, I’ll spend time relaxing mowing my lawn.” His actual response, “are you an idiot? Didn’t you hear me? I said nothing but relaxing.” I interrupted, “but mowing the lawn is relaxing to me.” I could tell from his expression I needed to rethink my idea of relaxing.

It was an hour drive home, and it still really had not hit me, “I’m going to have heart surgery tomorrow morning.” How could that be? I’m too young for this. I’m in good shape, I’m happy, things are going good for me. This isn’t right or fair.

When I put my daughters to bed that evening, I told each of them how much I loved them, hugged them, and kissed them goodnight. I explained that I would be gone in the morning before they headed off for school and daycare, but that I would see them afterwards. We had never been apart from each other, and it was not going to start now.

When The Body Tries To Warn You – Part 1

Every year around this time, my mind plays this endless loop. I cannot stop it. This story, and the parts that will follow, are not just about cancer survivorship, because the situation applies to everyone, regardless if you have ever had cancer or not. Because the truth is, you do not need to have gone through cancer to experience this. And we all have heard it referred to as this, “the silent killer,” and likely know someone who suffered this fate. My story still haunts me to this day, and every time that I hear someone describing what I experienced, something clicks and I urgently try to convince them, to seek emergency help right away. In fact, there are several reading this who are alive today because I heard them describe their symptoms and I urged them to go to the emergency room.

It had been eighteen years since I finished my treatment for Hodgkin’s Lymphoma. As any cancer patient hopes for, I was living my life again, without cancer. Sure, it was not as I had planned, but life was good. I got through my first five years of remission without relapsing, so I was told I no longer needed to see my oncologist as the chances of my cancer coming back at this point were slim.

Over this time period, I had done my share of traveling, literally all over the world. Finally I locked into a job I could call a career. And the most important part of my cancer survivorship, I became a Dad. I was now 42 years old, and still cancer free. My focus was now on my daughters, ages 5 and 3 years old.

Now, here is the part YOU MUST PAY ATTENTION TO!!! What I am about to share with you, you do not need to have had cancer to have this happen to you. And not hyperbole, it might just save your life.

In early to mid April, I made a phone call to my family doctor (who I had known for decades). I was not someone known for complaining about my health issues, and truly she only saw me maybe once a year to administer an annual seasonal allergy shot. In spite of my cancer history, I was fairly healthy. There was this one time I tangled with some poison oak, ended up with painful huge blisters. I went in to the office, and even the receptionist was like, “this has to be pretty bad if Paul is in here.”

This was the conversation that I had with Dr. J. on the phone:

“I need your advice. I am dealing with this weird pain/tightness, in the upper left side of my chest. It doesn’t last more than a minute, but it happens damn near all of the time when it does. I am doing something physical, I get that discomfort, and about a minute later, it goes away. I could kind of describe it as the sensation you get, when you go jogging in the cold, like a “side sticker”, only not in the side, but in the upper left of my chest and shoulder. It is so annoying, is there anything I can do to get this to stop? It has been going on for months.”

I want you to re-read that last sentence again. It is bolded and in italics for a reason. Because what you will read later on, will hammer the point home, just how lucky I was.

Over time, I play back this time period again and again. I don’t recall when this sensation started, but I am able to remember as early as January of 2008, because I was shoveling snow when I would get this feeling. But as the weather warmed, and I would mow the lawn, yep, got that feeling. At work, I moved heavy equipment, and felt that pain every day. And though I could never be misidentified as a Mr. Olympia, I was in good shape because I went to the gym every day, and yes, I felt that chest tightness while at the gym.

The eliptical machine. This exercise machine gets both the credit with saving my life as well as almost costing me my life. And to this day, the trauma of my experience still terrorizes me when I am made to use it (as in ordered to use in physical therapy). My daily routine back in 2008, in April and before, I would go to the gym, get on this machine (I preferred it because of the calories I could burn), and then head over to the weight room for the rest of my workout. If you notice on the handles, just below the control panel, there are two silver grips. These are sensors. I chose to hold on to there, of course not getting the full workout by using the full handles but what this allowed me to do, was to watch my vitals, mainly my heart rate, to make sure I got the heartbeat into the range to burn calories.

But as I said, I had this tightness in my chest whenever I began doing something physical, and the eliptical was no exception. But as I held on to the sensors, I saw the display with my heart rate. It was climbing, rapidly, like an 18-wheeler rolling down a road with no brakes. And that tightness and pain was getting worse. It was less than a minute, and my heart rate was at 152. It should only have been less than 110. This lasted approximately a minute, and then the tightness and pain stopped, though the heart rate remained. I kept going as I felt more comfortable, finished the eliptical an hour later, and went over to the gym to finish my workout. I had a feeling something was not right, which is why I called Dr. J. She would not take this call lightly, as I said, I don’t complain about anything. From my description to her, this was her response:

“Given your history with cancer, I don’t think it is unreasonable to order a nuclear stress test.” Okay, so if you read my book, I had no idea what an oncologist was when I was sent there for my cancer, I had no idea what a nuclear stress test was or what it was for. But that is the trust I had in my doctor. She knew what she was doing, even if it might have been a hunch on her part. She was always spot on.

Now, if you personally have ever tried to make an appointment for an xray or any kind of test, hell, even an appointment to see a doctor, we, as the patients are lucky if we can get seen within a year these days. Back in 2008, it was not that bad, but yes, you could wait weeks or even months to get in. This is where I really got lucky, as she (her staff) called and set up the appointment for April 16, 2008, six days from today’s date.

I continued on with my routines, work, exercising, mowing the lawn while I waited for that date, and still experiencing those symptoms. I was given instructions how to prepare for the test, fasting orders, what to wear (as I would be walking on a treadmill), and how the test would be performed. With my history as a cancer survivor, I can say, I was not afraid, nor concerned. I was a happy and health 42 year old Dad, with everything going for him. This wasn’t going to be anything serious.