A few days ago I was in a doctor's office when a horrible text winged it's way through the wireless networks now encircling the globe and lit up my phone with devastating news: an old friend had just died unexpectedly. The details of his death pointed to massive heart attack, he was probably dead before he hit the floor. The news stressed me out in more ways than one: two weeks earlier I suffered a major heart attack at age 50. I'm talking 100% blockage in a primary coronary artery (I wrote this post while I was actually having the heart attack).
This is the kind of attack sometimes referred to as a widow maker, the classic myocardial infarction where the patient grabs at his or her chest, eyes bulging, and hits the deck, bowels voided, like a sack of potatoes. But my heart attack was different, it felt like someone punched me lightly in the pit of the stomach followed by several episodes of moderate indigestion, the sensation was just above the belly button and radiated down and to the right of all places.
It started right before New Year's Day, I'd been eating the usual holiday fare, lots of it, and working out hard. What would you think, life threatening heart attack or well deserved indigestion? Why some people barely know they are having a heart issue at all and other patients experience extreme pain and all kinds of distress is a topic of debate among cardio-pathologists to this day.
I'm adopted, so family history is not a guide in my case. But if you told me a month ago I was going to have a massive heart attack, I would have laughed and pointed at you! I was a light smoker and I had gotten a bit overweight over the last few years. But being out of shape was unusual for me, I spent most of my adult life in gyms or outdoors.
There's little doubt, that cardio conditioning probably carried over into my late forties when the inevitable weight gain and slower lifestyle underscored that I was mortal after all. Doctors call it collateral circulation, but it just means lots of cross connecting arteries and veins develop in the muscles and heart. That's one reason your stamina goes up when you work out consistently. Genetics may have conspired against me, smoking is a terrible burden on anyone's cardiovascular system, but a lifetime of activity almost certainly helped offset those risk factors.
I'm lucky. So lucky I'd like to believe in some sort of innate cardio superiority; it isn't just appealing, it's downright seductive. I AM SUPERMAN! But it's also bullshit. What saved my life was medical science or, more specifically, the hard-working nurses, administrators, the engineers who design the things like x-ray machines and MRIs, and of course the physicians those professionals work with. In the United States the term medical science is almost a synonym for comprehensive health insurance.
My friend wasn't so lucky. He didn't share my lifetime workout addiction. He also was in between jobs, had been for a couple of years thanks to the Great recession, and he had exhausted most of his savings by the time he died. Even if had seen a doctor last month, how long would it have taken to navigate the uninsured maze and get to a cardiologist? How much longer to get an echo and a cath? In Texas, probably months, if he was successful at all.
I have about the best employee sponsored insurance available. The day I felt a weird tweak just below my sternum an appointment was made. I chose my PCP specifically because she had been a staff doctor on a military base for ten years and had seen tens of thousands of patients in that time, with a definite bias toward men of all ages.
My cardiologist would soon tell me several times she read my EKG with the skill of a cardiologist: my heart was so well conditioned that even at age fifty it could have faked out a less experienced family doctor. He took out my initial EKG and pointed out the indicator: it was one itty-bitty tiny wiggle on the EKG that caught her eye, a feature shorter than a four letter word in this post. It wasn't that up and down big spike you see, the one that stands out when you think of an EKG. It was a single little "u" shaped deal in between them on one lead that should have been a little more "v" shaped.
That's it, the rest of the EKG was completely normal. In fact the rest of the EKG indicated a powerful athletic heart. She was thorough, even though her suspicion leaned toward a gall stone or a hernia or just a really bad ulcer, because those possibilities fit the symptoms I was having way, way better than any heart trouble. But that teeny little u-shaped deal caught her eye, it bugged her, that's the reason she referred me to a heart specialist, just to be safe (And that's the reason she'll by my primary care physician until the day she retires or dies). My insurance was good enough that I had a topnotch cardiologist in network, there was no arm wrestling with a bean counter, no protected wait for approval of the tests he ordered. The echo sound showed an ejection fraction slightly lower than it should have been for a reasonably fit middle aged male. The stress test results offered further subtle hints.
The day came when the cardiologist reviewed my results. You could have knocked me out with a feather when he reached out, gently put his hand on mine, and said my test results might be consistent with what he called a mild heart attack. Or at least one waiting in the wings. Again my insurance was good enough that getting a heart cath approved wasn't an ordeal, it was just a matter of scheduling.
Some of you may be facing a cath in your near future, others reading this have already had one. In the event you are terrified about that procedure -- and I assure, I was -- don't be. I'd rather be cathed than have a root canal as far as discomfort. The staff was awesome they totally calmed me down, they gave me anxiety reducing drugs, by the time I got in there I was so relaxed and confident it was almost like a holiday.
We expected minor blockage, probably requiring a small baloon to be inflated and that would be it. My cardiologist was probably almost as surprised as I was when, later on, I found out the details: when the dye first lit up the arterial networks it showed a blockage almost an inch long, crawling all the way down my coronary artery and into two diverging branches! He had to rout it out, like drilling through congealing cement clogging a pipe. And he told me later a funny thing happened -- which I have no memory of thanks to anesthesia. Right when the stent went in, the moment they first saw the blood surge through, I gasped and shouted out "Whoa!".
Naturally, the surgical team was concerned and asked me, loudly and several times since I was tightly wrapped up in the sublime embrace of Mr Fentynal and the Lady Versed, why I said that.
"Did something hurt just now?" they asked?
Reportedly I said "No!," took two or three deep breaths and exclaimed with glee, "I feel fucking incredible!". My cardiologist explained to me later, after my head cleared, "There's no way you could have known when that stent first opened like that, we didn't say anything and you were in twilight land anyway. That was blood flow returning to your heart for the first time in who knows how long."
The first clear memory I have is telling the tech in recovery that I was pretty sure I wouldn't need the traditional wheelchair to go from recovery couch to gurney and be rolled up to my room. I explained that if he wanted me to I was pretty sure I could have walked from one bed to another on my hands.
The sensation of having that blood flow restored, probably for the first time in weeks and after it had been slowly pinched off for months or years, it's tough to put into words but I am a science writer, so here goes: imagine jumping into ice-cold freezing water, that feeling where a giant invisible hand grips the torso, you gasp as the chest seems to constrict. Go it? Now run that in reverse, that's what it felt like. I didn't notice the symptoms of reduced blood flow to the heart and probably the effect of that reduction on my brain and body, that had all come on too slowly.
But suddenly taking those symptoms away, oh baby, that was quite noticeable and nothing short of exquisite. Like going from dead drunk to razor sharp sober in the space of a few seconds. Even in recovery, with the drugs still doing their work, my vision was sharper, I was so energetic it's almost too much at times, almost like a raving healthy feeling mania. One week post op and I can barely sit still. My libido, well ladies and gentlemen, let's just say it's restored in spades. And the coolest thing of all, my favorite part about it, it's as though someone reached into my brain and dialed my memory and IQ to the Rain Man savant setting.
Two weeks before the cath I had run ten miles just for fun, so they expected I would do well in rehab and let me sign up for as soon as possible. First day in cardio rehab, eval time, they put a heart monitor on me and wanted me to go ahead and get the rate up to a modest 140 beats per minute (BPM), with the warning I should stop if I felt anything the least bit odd. I walked a leisurely mile, no luck, heart rate stayed under 100. They turned up the angle higher, the treadmill sped up, soon it was fast enough that I had to break into a slow, comfortable jog. It still took another three-quarters of a mile to hit the BPM they wanted.
The cardiac nurse looked at me, clearly satisfied, and said "We see this from time to time but it's not the norm, maybe one case out of a few dozen ..." She then looked at me sternly and added, "You're very lucky."
Now, make no mistake, I did not escape unscathed. I'll be paying for the rest of my life. I'll be on blood thinners for a bit, probably a year. There are tons of little minor blockages being blown out by the inflated artery and blood thinners, and they feel like little twinges, like the ghost of a mini heart attack, bad enough that the cardiologist took pity on me and gave me a supply of Xanax. I'll be on aggressive high blood pressure meds and statins like Lipitor for the rest of my life.
I can obviously never, ever smoke again, good riddance, but it also means no fried shrimp and french fries, no cheese burgers or chocolate milkshakes so thick they can only be eaten with a spoon, no more heaping plates of BBQ ribs! Those and hundreds of other meal choices are no longer menu options for me and they never will be again. The way it was explained by a nutrionist, I can taste all those things from time to time, but I'll never be able to eat them as a meal, assuming I want to max out however long I have before another cath or -- shudder -- full-blown chest-cracking bypass; or death. With my genetics and blood pressure, another cath or worse is just a matter of time.
But you know what? Those restrictions don't bother me in the least. Thanks to things like patches and Chantix to ease the craving, it turns out quitting smoking has been a lot easier than I would have ever believed possible. Folks, I can't emphasize this enough: it was so much easier to quit smoking than I ever envisioned that I feel like a grade A utter ignoramus for not at least trying to quit a long time ago. If you're a smoker, and you want to quit, what do you have to lose by trying? Talk to your doctor, be truthful, tell him or he you are afraid of the withdrawal, ask if there's anythign they can offer to help with that. Worst case scenario? You relapse and have to try again. Big Fucking Deal: you're no worse off than if you never tried and your body gets a break for at least a day or however long you stay clear of that poison. And BTW, my cardiologist told me the sparse data in so far on those vapor smoking deals every hipster in my hometown of Austin now smugly totes around thinking they have it licked have yet to demonstrate any significant benefit.
Even with the lifestyle restrictions I'm obviously incredibly lucky. In cardiac rehab are people half my age on the transplant list, teenagers and kids with congenital heart defects, older patents who have lost significant cardiac function for life, many have probably lost years of life expectancy as a result. I don't now yet if I shortened my life or not. But everyday the sun hits my face I bask in it, every time a dog licks my face I lay back and let him or her get their fill. If I see a car that clearly plans on trying to cut in front of me, I slow down, smile, and wave them right in.
I'm lucky I had a great PCP, I'm lucky I had a history of working out, I'm lucky I have enough brains and willpower or whatever it is that makes quitting bad habits feasible. I'm lucky I have a new lease on life and friends and family who love me, and who will ride my ass like a stubborn bronco should I ever fall off the many wagons I'm now condemned to ride. But most importantly, I'm lucky I had good health insurance and the medical science that comes with it.
Without that insurance I might have shrugged off the initial signs out of fear it was a bad case of indigestion and the anxiety of being in debt for life if I were admitted. In that dismal scenario I would have either progressively lost more and more cardiac function, until it was impossible to ignore and probably irreversible to some degree, until it required bypass or a heart transplant. Or just as likely, I would have suddenly keeled over dead like my buddy. These things would have happened soon, probably within months and maybe within weeks.
February is healthy heart month and that's what insurance is for and yet, as I write this, fifty million (Or is it even more now?) of our fellow Americans do not share my good fortune. They are uninsured. Millions of others have junk insurance policies. Many of them will die preventable deaths because of it. Some from cardiopulmonary disease, the number one killer in the US, others from the other 60 zillion completely treatable conditions we are all heir too.
That is simply unacceptable, and at the risk of touching on politics, 2014, when all Americans can go to the ER without fear of being turned away or indebted for life, can't come fast enough for them. And for those of you have comprehensive insurance, for crying out loud, if you feel the slightest twinge in your back or chest, a weird lump or shortness of breath, a change in bowel habits, if you're getting into your forties or fifties and think a fried cheese sandwich with a side of Marlboro's is a tasty meal, don't be a fucking idiot: use your damn insurance, use the living shit out of it.
It might just save your loved ones needless heartache, and it might just save your life.