Paul's Heart

The “Oh Sh*t!” Moment

Continuing on from yesterday’s “anniversary” post, as promised, I arrived at the Cardiac Cath Lab at six in the morning for what the cardiologist had described as an “in and out” procedure, “a stent or two and would be good as new.”

Without getting too lost in the weeds, a catheterization process involves a thin tube being inserted through an arm or leg, in my case a leg, fed through a blood vessel to the heart with a small camera to look for issues such as blockages or irregular heartbeats. During this process, if the doctor sees something that needs correction, which was already assumed in my case, he fixes it, again, expecting to place a stent to open up what is expected to be a blocked artery. Textbook procedure.

My nurse Heather had prepared me for the procedure. I do not remember why, but a conversation about my surviving Hodgkin’s Lymphoma came up. It might have been, because I was only forty-two years old, way too young for heart surgery, and I had explained that I had already been through a major event, so, age really had nothing to do with it.

My biggest concern, was that I had no spleen, removed as part of the diagnostic and staging procedures for my Hodgkin’s. So, I urged Heather to make sure all involved, knew that I was at an increased risk of infection and to take all necessary precautions. I wanted this to go as simple as possible.

When I came to, in my room, I saw my cardiologist, and a friend/co-worker who had stopped by to see how I was doing. The looks on their faces were serious. Though I remember the conversation, at that moment, it was not sinking in.

These are the actual images from my heart, and a drawing to make sure I could clearly see and understand the moment. A moment that was so extreme, and because of coming out of the anesthesia, I could not grasp how dire the situation was. Perhaps that was a good thing.

It was explained that I had three blockages that were of concern, one to the degree that even as a cancer patient I had not given the prognosis a possibility. The most serious of the blockages was the main artery, blocked between 80-90%. My friend, who also happened to be a paramedic, blurted out, “oh my God, it’s a ‘widow maker.'”

This simplified exclamation from my friend, though accurate, caught my cardiologist by surprise. “Yes, though we don’t like to call it that.” As I mentioned, I was fortunate to still be groggy from the anesthesia. I had no idea, that I could die at any moment, a fact that my cardiologist would tell me at my first follow up appointment a month later.

A blockage like this, nicknamed “a widow maker,” is referred that way, because the result is a major and fatal heart attack and unless it is able to be responded to immediately, the likelihood of survival is zero. The fact that I had symptoms for as long as I did, and did nothing about the situation, even more astounding as to my luck of survival. As my cardiologist phrased it, “it was not a question of ‘if’ you were going to die, but ‘when.'”

Oh shit! But as I was not understanding fully what was going on, my cardiologist was also confronted with his own “oh shit!” moment, clearly not expecting to have run into what he did.

I was scheduled for an emergency triple bypass the next morning, April 18, 2008, which was Friday, as in the anniversary of that day is tomorrow.

I thought the worst I would have ever had to deal with in my life, was going through cancer. My heart said…

As the anesthesia wore of, I discovered I had a busy twelve hours ahead of me in preparation for this surgery. The doctor had to find a vein to be used for the bypass, likely from either of my legs. Chest x-rays would be done, and tons of blood work. All of this had to be done quickly, as I was scheduled for surgery first thing in the morning. But there was one thing that I could not do before then.

See my daughters one more time. Hug my daughters one more time. It was an awful feeling. I could not even tell them I loved them one more time. And as long as the surgery was successful, it would still be days before I could see them.

A Heartbeat Away

This machine almost killed me, literally. To this day, it still haunts me when I see it. Yet, repeatedly, I have had to face this demon, as part of the recovery from not one, but three heart surgeries. For at least four months that I can recall, I would climb up on the eliptical, begin, and moments later, develop such a tightness in the left side of my chest. The heartrate on the telemetry of the machine, had climbed from 83 to 152 beats per minute in less than a minute. And then, the tightness was gone. I continued with my exercise for a full hour on the piece of equipment, then proceed for an hour’s worth of strengthening and weight training.

But I was annoyed by the way my trip to the gym always began. Only in hindsight, did I discover, this issue developed anytime I was putting a physical stress on my body, such as snow shoveling, mowing the lawn, or certain tasks at work. And just as with the gym, the tightness would disappear soon after it began.

I reached out to my doctor, who, on a hunch, and I do mean a hunch, especially for a forty-two year old man, felt that given my past history with Hodgkin’s Lymphoma, and the treatments of radiation and chemotherapy, that a stress test on my heart was warranted. It made no sense to me, as I had no heart problems (spoiler alert, there is a reason they call cardiac disease the silent killer) that I was aware of.

Though the date was April 16th in 2008, today, it is actually today, Wednesday marks fourteen years since that stress test was given, and would change my life forever. Cancer survivorship took on a whole new meaning for me.

The following sentences and phrases were written on my report:

“Exercise stopped due to EKG changes with chest tightness, indicating some sort of ischemic response.”

“There is a large in size, moderate in intensity defect involving the entire anterior wall (of the heart), anterior apex, and anterior septum on stress images. This is consistent with significant left anterior descending artery territory ischemia. Ejection fraction is 38%.”

I was told I needed to speak to a cardiologist about what all this meant, because just as my first visit with an oncologist (aka cancer doctor), I knew what a cardiologist was. I just did not expect to need one.

The doctor did not mince words with me, completely confident that I was dealing with a blockage. It was not known how bad but he was certain I had at least one. Confident and casual about the situation, he assured me, “I want you checking into the cath lab right now. We will pop a couple of stents into you first thing in the morning, and you will be good to go in about a week.”

For the full conversation, check out the page “CABG, Not Just A Green Leafy Vegetable” here on “Paul’s Heart.”

I had an appointment to keep in the morning.

Gone, Not Forgotten

I am planning on this post being my last one about Covid19 for a while. No, I know it is not completely gone, if it will ever be. Everything we have learned over the last two plus years, hopefully will have us not only better prepared, but hopefully a better way for all to unite together for the common cause, next time something like this happens.

With other news stories dominating the headlines from the war in Ukraine to the slap heard round the world, the United States passed 1,000,000 deaths from Covid19, and there was never even any mention of it. Just as mass shootings or other tragedies, we have grown immune to the numbers coming from Covid19. There is good news however, as we finally seem to be nearing a sustainable level, to allow a “new normal” way of living, yes, with Covid19, just as we do with the flu, and other illnesses.

And with the lowering of the numbers, I felt with all the safety precautions still in place or at least advised, it was time to do something I had not done in over two years, travel to see my mother. In my lifetime, I have done my share of flying, but returning to the inside of an airport terminal for the first time since Covid19, the changes and procedures reminded me of when airport procedures changed following September 11. Yes, going through TSA had not changed with all of the inspections, although for me, having three new metal devices implanted in me from recent surgeries garnered me some extra attention.

The airports were a lot more crowded than I honestly felt comfortable with, but, I felt safe enough, as mask requirements were still in place. With the exception of the time on the plane, I kept safely distanced. I knew, with considerations planned ahead, this was a trip that would become how I live in a world that will always have Covid.

There was one moment however that stuck out to me, and one that I am okay with no matter what the attitude is or where.

The mask. I live in a state that has a kind of naive approach to the mask in either not believing in at least some benefit to the protection from the mask, or political theater. But back in my home state, the looks I was receiving for continuing to wear a mask, were more militant and threatening, assuming I believed in their claim that their state was tyrannical (newsflash – we have no state that is run under tyranny). It was really odd, just how strongly different the two states were in attitudes. Where I live, the numbers have shrunk of those advising me that I “do not have to wear a mask,” with some still trying to convince me that masks have no worth. But where I was now standing, back in my homes state, were glares that I was supporting a communist regime operated state government.

Here are the facts. After 28 months, I still have not tested positive. And that is not because I have not taken a test (remember that old theory – cases will go away if you stop testing?). I was in fact tested, three times, all for surgical procedures that I needed a negative test for, to save my life. It is simple, if you have it, it has nothing to do with the test.

Throughout the pandemic, I supported local businesses and restaurants with either take-out or curbside pick-up, only from businesses however, that demonstrated concern for the customers back in the beginning. The fact that some restaurants were only actually cleaning tables regularly after every customer at the beginning of the pandemic, and not before, is gross enough. And to their credit, the places I solicit, do still provide that better cleaning and sanitation. But others, went right back to the attitude, cleaning tables was secondary in thought.

Along with picking up take-out, I go to the grocery store and pharmacy myself. I put gas in my car myself. I do it at times that are slow, such as early morning or later in the evening to avoid crowds, something I do not care for anyway.

Physical fitness has been a little more difficult to pull off, but probably most important of all, especially with all of the cardiac issues that I have. But as I completed cardiac rehab, now for the third time, I learned how to exercise during Covid19 from air circulation, to sanitation of equipment, to distancing between others. And yes, all while wearing a mask. During that period, even those that were in their 80’s of age, were able to exercise while wearing a mask. My only decision is where to exercise. Do I go to a commercial establishment with all the fancy and current equipment, but with complete disregard for sanitation? Or do I use the fitness room where I am at, with no improvement to air handling, an honesty system for cleaning the equipment and for being positive or not for Covid19? I chose the latter with one other step, I go to exercise when I am the only one there. And I am okay with that, again, regardless of Covid19. If someone comes into the exercise room, I am okay with leaving.

I even took a small vacation with my daughters last year, during a previous “low Covid19 count” period. And we did it without testing positive ourselves afterward, because we followed recommendations.

My point is, the war cry by some, “living in fear,” ironically is not about how I choose to do things to protect myself from Covid19. I am actually living smart. My cardiologist has been clear right from the beginning, a diagnosis (at least unvaccinated) of Covid19, would kill me because of the condition of my heart. And we know the danger to heart from Covid19 as cardiac complications are up to six times higher if unvaccinated. And take it from someone with a compromised heart, the risks of something else make things all the more risky. Over the last few days, a fellow long term Hodgkin’s survivor passed away from cardiac arrest, following successful surgery from breast cancer. The human body can only take so much trauma. And I gave up nothing as far as the other war cry, “freedom,” as I have listed everything I have been doing, freely.

Do I have to go to the movies? Nah. I have not felt the need to see anything, and have no desire to see a movie that should have been a catalyst to get me back into the theaters, “The Batman,” but nope, not interested. Concerts? I have seen my share in my life.

Besides no desire to sit in a packed theater or arena wearing protective gear as if attending Galagher doing stand-up sitting in the splash zone just to protect myself from ignorant pigs who do not cover their faces when they sneeze or cough (as I have mentioned, this fact worries me more than Covid19 itself), the ticket prices are outrageous. And I understand, artists livelihoods were cut off over these two years, and they obviously want to make up their losses. I do not fault them for that.

Look, there were things that were done correctly during the pandemic, and there were things that were done wrong. Discoveries for diagnostics and treatments happened at lightning pace, while preparedness for medical supplies, staffing, and patient capacities fell way short of need. Communications were rushed, often incorrect, that when anything followed after, would be automatically subjected to doubt. And for the first time that I can remember in my lifetime, politics would erode common sense, when faced with a common enemy, disaster, or epidemic/pandemic (keep in mind, our country always did what it needed to do to stop other virus outbreaks).

It is my hope that we have learned so much over the last two years, for when the next “outbreak” occurs, because we know it will happen again. History has taught us that. Covid19 was no flu, no matter how anyone wanted to say it was. With eradication of Covid19 impossible, there will be flare ups just like there is a seasonal flu, and that will be the only comparison. It would take 17 years for the flu to have a death toll as Covid19. Unlike the flu, Covid19 had no test, and had no treatment or prevention. At best, all we could do was follow recommendations that would help reduce the possibility of contracting and dying from Covid19.

Yes, people will still die from Covid19, and people will die from the flu. Both have tests, both have treatments, both have vaccines. But what those three solutions and mitigations will not do, is resolve the politics that got in the way of common sense that could have and should have saved hundreds of thousands of lives.

But now, like every other virus I have had to deal with, I have now learned how to live in a world with Covid19 and I can do it. Are the masks perfect? No. Distancing? I do not like crowds anyway. Food? I still get great takeout. But when you seem me with a mask on, I will not apologize if it triggers something in you. Nor will I explain why I am still wearing the mask. I know why I do, and it does not affect you.