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| I'm not that kind of doctor, but even I know the top is good, the bottom is not so good.... |
If you read the account of our family vacation in England and Scotland entitled "UK 2010," linked above, it ends with the cryptic words once we were back home, "Little did I know what was coming next …." For a while I was more circumspect about it than I am now, but what came next was that as we began to deplane in Houston, and I stood after the long transatlantic flight to pull our cabin luggage out of the overhead bins, I felt like suddenly every muscle in my upper back pulled all at once, from elbow to elbow. It took my breath away. I managed to get our bags down and stagger out onto the jetway, but I was not doing well at all. I told my son, fourteen at the time, "You're going to have to take some of these," which he did -- and I immediately felt better. By the time we were in and through customs and passport control, I was feeling fine. "What happened?" was on my mind, I remember, but the pain had subsided as my sister-in-law picked us up and drove us to her home. Everything seemed good.
Then, overnight I woke up with the pain returned, although not as sudden or intense. I didn't sleep any more, unable to get comfortable. "Man, I really pulled something bad!" I said.
Then, in the morning, I just felt worse and worse as we started getting ready to go to Mass. I ended up going back to bed, begging off that I just didn't feel well. But I was getting worried now, and eventually, just before they were to leave for Mass, I told my wife, "I think you need to take me to the ER. It's probably nothing...."
It was not nothing. I was having a heart attack. I presented at North Cypress Hospital about 10:30, I believe. On that Father's Day morning, nevertheless, the head of cardiology was in the ER, so I got immediate attention. It was a whirlwind from that time. By 13:00, I was in recovery, having had two new stents put into my Right Coronary Artery.
Then I spent the next three days in CCU, being released on Wednesday....
Now, although I certainly have not done everything I should have to get and stay healthy in the years since, I have had no problems. Until a week ago.
There's actually some background that even predates the 2010 heart attack. 2004-2005 was a bad time. In short order we lost my paternal grandmother (January 2004), my father (February), and his only sibling, my only aunt (July). There were other things going on that I don't want to detail, both personal and professional, as I desperately worked to try to establish myself to get tenure at my University, which was going through one of its periodic shakeups. Long and short, I was under a great deal of stress when, toward the end of 2004 I suddenly started having "fainting" spells. I would not completely lose consciousness, but I would suddenly "brown out" with tunnel vision, my ears would roar, I'd break out into a cold sweat, and I would (usually) have to lie down. It would pass in a few minutes, but leave me wiped out for the rest of the day. Sometimes they wouldn't be quite so intense, and I would feel an attack coming on -- if I closed my eyes, remained still, hanging onto something to make sure I didn't fall down, it could actually pass without anyone around me being the wiser. Nevertheless, with a history of heart disease in my family, although there was no chest pain involved in these spells I was worried.
My doctor ran blood tests, and I wore a Holter monitor around for either 24 or 48 hours (I don't remember which, now), and nothing showed amiss. After a couple of months of these spells happening at least once or twice every couple of weeks, at random, with no discernable patterns or triggers, they just disappeared ... or more accurately, got a lot less frequent. I might go a year or two without having one. Ultimately, we attributed either to stress or maybe inner-ear, more likely the former.
2010 and the heart attack came and went, seeming to make no difference. I would still have one of the spells every couple of years or so, but they would pass and I'd go about my business. I figured it was just stress. If in fact it was not related to what eventually developed, it may well have been.
Then, last October, I had a particularly severe "fainting" spell on a Saturday morning. I remember telling my wife that if it were accompanied by chest pains I would be really worried. But it passed, and even though I felt "wiped out" for the rest of the weekend, I just thought it was more of the same. Except that it did seem to mark a shift.
Over the next few months, I started experiencing what I considered "abortive" "fainting" spells. I would feel like one was coming on for a few seconds, but it would never manifest. A short-lived period of dizziness or lightheadedness would pass and I would feel fine. Odd, but since I just figured it was a different, less intense form of the same problem of undetermined cause, I really wasn't worried. Even though they seemed to get a bit more frequent with time, I just went on about my business; they just became part of my life.
Except that I really started feeling a sense of weariness over the summer. Now, at the same time, my Restless Legs Syndrome was ramping back up, leading to some degree of sleep deprivation, so weariness was easily explained. The RLS -- people do not understand how it dominates your life, especially the fear that if you start nodding off suddenly your legs are going to go to dancing, waking you up right when you want nothing more than to sleep -- got so bad that I started exploring various options. One was to do an intensive study of my medications, their side effects and interactions -- and I am on a butt-load of medications! -- and it seemed like not only did several have RLS listed as a possible side effect, but even more had dizziness and lightheadedness listed! I had also added a homeopathic herbal/vitamin blend for RLS (with seemingly great results) that also listed dizziness and lightheadedness as a possible side effect.
So as the momentary waves of dizziness grew more frequent, I didn't really think much of them. Well, I thought enough of them that I mentioned them to my family doctor in mid July, along with the list of my meds that have just that as a possible side effect. It was really more just informational, letting him know what was happening. He made no suggestions other than that once I was back from my upcoming travels, we might go back and reevaluate my medications and see if that made any difference.
The first weekend in August was particularly bad. Friday and Saturday I had several periods of a couple hours each where waves of dizziness would hit but pass just as quickly -- every few minutes. At least once, my wife noticed, but I just attributed it to getting up too suddenly -- which sometimes did seem to trigger one, and I had indeed just stood up from the breakfast table. I didn't make a big deal of it. For one thing, it was nothing new to me; for another, we were at a family get-together for my wife's niece's college graduation and I didn't want to be that guy....
Monday came, however, and at mid morning I started having an intense pain just below the juncture of my right shoulder and my neck, in the back, seeming to intensify whenever I would take a breath. My first thought, having just gotten back home from being in a hotel for three nights was that the strange bed and scrawny little pillow had giving me a crick in my neck. Tylenol and a heating pad made it feel a lot better.
Nevertheless, overnight, I never could get comfortable. I had a rough night. On Tuesday morning, I made it to Mass and helped count the collection from the preceding weekend as usual, but the pain had progressed more generally into my upper torso, still on the right, and was pretty persistent -- and increasingly worrisome especially given my prospective departure on the pilgrimage. I finally excused myself and said I had something I needed to take care of.
My intention was to go to my doctor's office, but on the way there I realized that he would not be there (it was about 07:30 at latest), and that if anyone were in his office and I said "chest pain," they'd send me right across the street to the ER, so I decided to just cut out that step and go there directly. I passed my wife headed to work (at the hospital) as I approached our house to get a few essentials before going on to the ER (we live only a few blocks away). I told her what was up and she said she'd meet me there.
So, I presented myself in the ER with chest pains and was taken back in short order. An EKG and blood-enzyme test came back negative. "You're not having a heart attack," which was a relief. Maybe it was indeed just a crick in my neck...? My wife was with me as they started to discharge me and I berated myself for a "useless" ER visit....
... When I felt one of the lightheaded spells come on and the heart monitor, to which I was still connected, went bonkers. "BEEP BEEP BEEP BEEP BEEP!" "What's that?" my wife asked? "I don't know," I replied, "I just had one of those spells.... I'm sure if it's important they'll be back in." And they we waited. And waited. And waited. And then things got all exciting -- the ER doctor ran back in and asked if I have Afib. "Uhhh... not that I know of." He ordered another EKG which was totally different. I don't know the details, but I was having something called bradycardia which is basically slow heartbeat -- it had dropped all the way down into the 30s when it normally runs in the high 50s or low 60s, and has for years mainly due to my heart meds.
About that time, my own cardiologist swept in and started dropping terms like "heart block" and "Afib" and "we need to look at your medications" and "you're going to be in the hospital overnight at least" and "you may need a pacemaker" and so forth -- that quickly -- "and I've got clinic, I'll see you this evening."
Uh, WHAT? The words "heart block" alone are scary! I did a quick Internet search and found a bunch of jargon that I didn't understand (I'm not that kind of doctor), but it seems to be related to but something different than Afib.
Long and short, they ended up putting me in ICU. I don't remember the sequence of events, but over the next couple of hours (we're in the early afternoon by now), there were various things said and so forth. They did give me my Plavix as well as lunch, soon after which my cardiologist came back with a long tape showing my heart beating, then stopping, then restarting -- with long flatlines. [It's not exactly what is shown at the top of this post, but something similar.) My wife says he said, "up to eight seconds" -- !! "This is dangerous," he said. "You need a pacemaker -- right now. My colleague is doing three or four others this afternoon. I'm going to check and see if he wants to do another one this evening. If not you'll be first thing in the morning." To make a long story short, it ended up being in the afternoon -- late in the afternoon -- even though I had eaten lunch and had not stopped my Plavix for three days. It was that critical.
Incidentally, my wife broached the subject of cancelling the trip to the Holy Land. To which my cardiologist replied -- to our surprise -- "Oh, that won't be a problem. They've got better medical facilities than we do. I mean, it's not like you'll be staying on the West Bank or something." "Uh, actually, our last few nights are in Bethlehem." "Bethlehem? Behind the Wall? In Palestinian territory? -- I've never heard of anyone doing that!" And I thought that was it -- no go. But, Bethlehem is only a few miles from Jerusalem itself, and as it turned out all of my doctors and nurses were determined that I would be able to go. My cardiologist even rearranged his morning schedule on Monday so he could evaluate me and give me the final "Go -- No go" clearance.
But first we had to get the pacemaker in, which was it's own bit of trouble! They took me out of my room in ICU about 15:30 and were started about 16:15. They told my wife it would take about an hour or an hour and a half. It took at least twice that long. They put me under Conscious Sedation since I had eaten and could not be fully under. I did not feel a thing, but I could hear everything going on -- the banter among the OR team, specifically joking about the stupid new California law banning plastic straws -- but also I can hear the surgeon getting more and more frustrated and have a sense that it's taking a long longer than it should. I was right. It took at least twice as long. They did keep my wife apprised that I was okay, but that things were taking a long time -- but no information beyond that. Finally, they brought me out. The surgeon assured my wife I was fine, and specifically that -- in light of my still being on Plavix -- he glued me back up really good. More importantly, he explained the long procedure. It seems I'm weird on the inside just like on the outside. I have a one in a thousand benignly abnormal configuration of my heart plumbing which makes some the arteries go upside down and backwards. It doesn't interfere with function, but it means that the surgeon putting the pacemaker into its customary position by the left collarbone did not have a straight shot down into the heart to put the leads. No, he had to make a couple of switchbacks and U-turns and generally would have been a lot better off going in from the right side. Nevertheless, he finally got it in.
And I passed a good night. It wasn't until in the afternoon -- after lunch -- that we found out things weren't quite right. The tech from the pacemaker company, who was in the OR, came in to run a diagnostic, and obviously did not like what he saw. He disappeared for a bit, then came back in with the surgeon. They ran more diagnostics, then the surgeon said they needed to take me back to the OR. One of the leads was not seated well and was misfiring every once in a while. I wasn't even feeling it, but it needed to be corrected. So, once again, having eaten, having had my meds, I went back into surgery. Once again it took longer than expected, but that was not because of anything unanticipated, rather that the surgeon took the opportunity to reseat the other lead as well. He said, however, that he was very pleased with the results. The only thing is, now the wound had been opened and closed, then reopened and reclosed, and that made the trauma there a lot more painful. Tylenol alone did not really help that second night even though it had pretty much knocked out the pain the first night. Nevertheless, everything checked out fine the next day and I was released.
It was a rough couple of days painwise, as well as adjusting to being effectively one-armed since my left arm had to be in a sling so I wouldn't extend it and possibly pull the leads out of my heart before they had a chance to scar into place. But to make a long story short, I was considerably better by Sunday, and Monday morning I met my cardiologist first thing in the morning and got my clearance to fly.
I still don't advise heart trouble immediately before or after international flight, however....
P.S.: I still don't know what the right-side chest pain was Monday and Tuesday. I think it may have just been God telling me to get myself to the ER....
P.P.S.: Fri 31 Aug 09:07 -- I just got back from a follow-up visit with my cardiologist. Everything is good. He did clarify a bit. With my heart stopping for seconds at a time, the heart muscle was protesting the lack of blood flow (i.e., oxygen), and that is, medically speaking at least, probably the cause of the chest pain I experienced, since it immediately subsided. Be that as it may, I still think it was a divine kick in the rear, "Get thee to the ER!"
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