Rich Dlin – Reader Beware

Husband, Father, Math Teacher, Weightlifter

Archive for the month “September, 2014”

So This Guy Has a Heart Attack

On Tuesday, August 26, 2014 I had a heart attack. I’m not the type of guy you would expect that to happen to. Shortly after it happened I wrote a long description of the events to share with friends. Some have told me that it may actually prove helpful for other people, so I am reposting it here on my blog.

First, as soon as it happened and as people found out, I received so many emails, texts, phone calls, and visits that I can’t even begin to count them. It’s like the support system of family, friends and colleagues is a big inflatable cushion that kind of hovers underneath as I move through life, inflating like an airbag in a crash when they are needed to carry me through. It’s overwhelming. Thank you.

I’ve gotten a lot of the same reaction from people when they find out.

“WTF? You’re so young and you exercise and eat right. How could this happen?” is a basic summary. Trust me, it summarizes my reaction as well. People have also asked more specific questions like how did I know it was happening and what did it feel like. I will answer with a narrative of events.

On Saturday August 23 I was doing cardio on the elliptical. Lately I’d been doing 45 minute sessions, 3 times a week. Towards the end of that session, I felt some pain in my chest which I thought was odd, but I chalked it up to asthma aggravated by the dust in the basement because we’ve had contractors in to finish the other side of the basement (my gym is the left side) for a couple of weeks. Once I got off the elliptical the pain went away, confirming my suspicion. It was not intense pain. Sunday, August 24 we went to Gravenhurst to spend the day at the cottage with my dad. It was a relaxing day where I didn’t do much, although my dad did buy a new barbecue and I carried it in from the car by myself, with no discomfort or trouble at all. The drive home took a lot longer than we thought because of traffic and I went straight to a rehearsal for the show I was supposed to be in. Rehearsal was fine and I went home and went to sleep. Monday, August 25 was the day I planned to start getting ready for the new school year. I had some boxes of vases from old parties and we are donating them to the school where I teach so I loaded them into the trunk of the car, along with a plastic bin full of empty binders. Got to school and brought the bin in and upstairs to the staff room. I was struggling quite a bit with it but attributed it to the heat. On my way up the stairs with the bin I had chest pains again and was sweating quite a bit, which I found very odd because the bin was not that heavy. At that point I was a little scared, but I sat down and recovered quickly. I went home, told my wife Marla what happened, and had a nap. Apparently Marla checked on me a few times during that nap to make sure I was breathing. I thought she was overreacting. Monday night we had rehearsal again and I went, and felt fine. Went home and went to sleep around 11, with slight pain in my chest but it felt a lot like heartburn, which I do suffer from regularly.

Tuesday morning I woke up at 4:00 and the chest pain was still there, only more intense. It still felt like heartburn and I wasn’t sure what to do. I was up for an hour, and Marla woke up around 4:45 or so asking if I was ok. I really wasn’t sure. I googled symptoms of heart attack and it’s a pretty wide range of things it can feel like actually, although chest pain that lasts for more than 5 minutes is not to be ignored. I also read that driving (or being driven) to the ER is not recommended, since if you call an ambulance you will be treated sooner (by the EMT’s) and also because the EMT’s can assess your condition and potentially take you to a different facility. At 5:00 am I decided to call 911. I was very upset at the thought of the kids waking up and finding emergency vehicles and people in the house. If the kids were not home I probably would have called earlier. I desperately didn’t want to scare them. It was bad enough I had already scared Marla. When you call an ambulance for chest pain they will also dispatch firefighters, because they can respond more quickly and are trained for first aid. While waiting I got dressed, brushed my teeth and sat down on the couch. The pain didn’t go away. Firefighters arrived and asked me a lot of questions about where the pain was and how intense. Shortly after that the EMT’s arrived and the firefighters filled them in as they hooked me up to an EKG monitor. The first readout showed something that concerned them a little, but two more readouts showed as normal. They asked me to rate the pain on a scale of 1-10, which I’ve always found odd since if I say 6 what does that mean to them? For all they know I would call a papercut a 10 (and now that I think about it I’ve had some pretty painful papercuts – every get one from cardboard? The worst). I said it was around a 3. They decided based on the first concerning readout not to take me to the closest hospital, which is Mackenzie Health, but to go a bit farther to Southlake, which is in Newmarket, because they have a cath lab there which is needed for angiograms and angioplasty. Score one for calling an ambulance instead of driving to the ER. We stopped at some point between my house and the hospital to meet another ambulance and a different EMT came in to attend to me. He’s the one who put the IV in and they gave me morphine for the pain (which was fluctuating between a 2 and a 7) and baby aspirin to thin my blood. At this point I still didn’t know if I was having a heart attack or they were just taking precautions. They called ahead to Southlake to have a team ready at the cath lab. We arrived and they wheeled me straight to the lab – do not pass Go, do not collect $200 – but there was no team there. Turns out they had accidentally called Sunnybrook, where there was certainly a team waiting for me, so they wheeled me to the cardiac care unit (CCU). This was around 6:30 am or so. The nurse in the CCU at Southlake called the team, which is always 20 minutes out. Meanwhile the cardiologist on duty came to see me. He looked at the EKG readout and was the first person to tell me with certainty that I was having a heart attack. In the meantime Marla had woken the kids and followed the ambulance up to the hospital, so they were already there. The kids were a little freaked out for sure, but I think the calm way everyone was dealing with it helped them a lot.

So anyway the cardiologist decided not to have the team come in since the morning shift was starting at 7 and they could do the procedure. He explained it to me and I had to sign some forms, and they wheeled me back in to the cath lab. They said the procedure would take about an hour. Nurses had shaved and washed my wrist and groin since those are the sites where they may insert the catheter. Once in the cath lab they must have put some good stuff into my IV because although I was conscious throughout the procedure it seemed to me to last about 15 minutes. It was actually an hour. The doctor decided to go through the wrist, and he explained everything as he did it. There was some pain from the freezing, and I could feel the catheter going up my arm. That sounds worse than it is – it’s really just a kind of pushing feeling. At one point my whole chest got warm. I said “My whole chest just got warm – is that you guys?” he said it was the dye the use for the angiogram. There’s a huge bank of screens that he watches as he does the procedure, and an x-ray device that moves back and forth over your chest as he works – it’s very cool. Kinda robotic. Anway I heard him asking the nurse for stents and I swear I could tell the moment he put them in because the chest pain went from about 5 to zero in an instant.

Once the procedure was done they wheeled me back to my room in CCU where Marla and the kids were waiting. There was a blue clamp bracelet on my wrist that was pretty damn tight (still bruised a month later) but otherwise I felt fine. My brother came and stayed for a while, then left and took the kids home. Marla stayed with me every second. The nurse came in often and was slowly releasing the clamp until he felt he could apply a pressure bandage instead, which he did. At that point I was overcome with nausea from the anesthetic and I vomited, which turned out to be bad for my wrist, which immediately swelled up and started bleeding (which it turns out is the reason I am still bruised). After applying pressure with his fingers for a while the nurse reapplied the blue clamp, leaving it on for much longer this time until he felt he could replace it with a pressure bandage.

In the meatime I was visitied by the cardiologist who performed the procedure. He told me I had one fully blocked artery and 3 partially blocked. He had stented the big one and two smaller ones but left one very small artery partially blocked and unstented, because it is very small and because it is not fully blocked and because too many stents at once is not the best thing for the body in any case. Additionally with a small artery like that one the body will create new arteries to replace it. I have before and after pictures of my arteries from the angiogram. They are spooky. That cardiologist also said that “most guys take at least a month of work” which shocked me as I felt ready to rock right then! I was also informed that I couldn’t stay at Southlake because I live closer to Mackenzie, and that as soon as there was a bed at Mackenzie I would be “repatriated”. Yes that is the word they used. I would have preferred extradited but it turns out there is no extradition treaty between Newmarket and Vaughan. A few hours later and they did have a bed at Mackenzie, so they called an ambulance to transport me there. I was sad to leave Southlake. It’s beautiful there, the nurses were superb, and I had a private room, but alas I am not a citizen of Newmarket.

At Mackenzie they wheeled me into a quad ward staffed with two dedicated nurses. The nurses there weren’t quite as attentive as the ones at Southlake, but then again I was somewhat out of the woods. They were very knowledgeable and answered all my questions patiently and thoroughly. Marla had followed the ambulance from Southlake to Mackenzie so she came right into the ward with me, and immediately got kicked out so that the nurses could apply about 763 new electrode pads to me (in addition to the 451 I already had), hook me up to a blood pressure cuff that automatically inflated every hour on the hour, and in general affix me to my bed with wires. Once that was done Marla came back in. She didn’t leave until long after visiting hours were over, and then only reluctantly. At Mackenzie I had a lot of visitors including my dad and his girlfriend, my two sisters, and my brother who came back.

Once everyone left and the night nurses settled in I tried to sleep but I had slept so much during the day that I could only drift in and out. Instead I answered texts and emails throughout the night. In the morning I saw the cardiologist at Mackenzie, who explained more specifically what had happened. I asked him what caused it. He said genetics – would have happened no matter what. He ordered some more tests, and left. The nurses told me that once he saw the results from the ECG I could most likely go home if I wanted to. ECG is an ultrasound on steroids, and shows the extent of damage caused by the heart attack. They wheeled me down to “nucular medicine” (I always laugh when people pronounce nuclear that way) and the lady there did the ECG. Marla was there too and got to watch. Said I might be pregnant. After that it was a short time before the cardiologist came back. He said that they rate hearts on a scale of 1-4, where 1 is a perfectly healthy heart and 4 is, well, not. Apparently there was damage done to the underside of my heart and I am at a 2. That’s good. He said that with a good rehab program getting to a 1 is possible, either by improving the damaged section or, if that’s not possible, by improving the parts that are not damaged to compensate. He put me on about 19 different drugs, gave me the prescription and sent me home. I didn’t have any clothes so Marla’s sister, who had driven in from out of town and was with the kids at our house, raided my wardrobe and brought some stuff for me. I was also visited by a good friend of ours who is a doctor – not my doctor but does rounds at Mackenzie – who was so nice to stop by and answer my stream of questions. Again the support from the community was overwhelming. I can’t even wrap my head around it.

When I saw the cardiologist again I asked him (I also our friend) if there was anything I did to bring this on. He said no. My blood cholesterol is normal, I have a low blood pressure, my heart rate is around 60 bpm, I am not diabetic, I exercise regularly, I don’t drink and I don’t smoke. He said it was hereditary. The good news to me is that arteries don’t block overnight so I imagine I’ll be feeling better than I have in a long time pretty soon. I am also on a drug regimen now that is designed to keep this from happening again. I certainly hope so! In retrospect it wasn’t that much fun.

If there’s a moral to this story, it is this:

DON’T IGNORE CHEST PAIN.

Follow up:

I have since been to a cardiac rehab orientation session that was chock full of information I already knew, have seen my family doctor and been to the cardiologist for follow-up. I’ve asked a lot of questions about why this happened. The answer is fully genetic. My arteries are bent a little too much in places. The bends cause turbulence as the blood flows awkwardly around them. The turbulence causes cholesterol to gather, which blocks the arteries. The stents prevent this from happening again, as does the regimen of drugs I am on now. The cardiologist did a cardiac stress test, which is basically a session on a treadmill where you are wired to machines that monitor your heart, and they slowly make the exercise more difficult. Since then I got the go ahead to resume exercise, so I have been lifting weights and doing cardio on the elliptical. I wasn’t significantly overweight before, but now that I am much more conscious of eating only heart-healthy meals I have lost about 12 lbs and am still losing fat. I am naturally concerned about a repeat episode, but the doctors assure me that with healthy living and the drugs, there is no reason to walk around worrying I might have another heart attack. So I do not.

Thanks for reading,

Rich

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