Where I talk about my heart attack and the surgery

Saturday April 15. Just a normal Saturday. Did the usual family stuff. Had lunch at Rudy’s BBQ. Went home to cut the grass…

While cutting the grass I started having some pain in my left neck, shoulder and arm…nothing new for me I have a bad neck and muscle spasm are nothing new but this pain was a little different…. It wasn’t the typical “crushing ” pain associated with a heart attack but it was different from my usual pain related to my neck issues…being a guy I sucked it up an moved on.

Throughout the day and evening the pain came and went, similar to my neck pain so I filed it away as the typical nuisance. At bedtime I went and laid down but could not get comfortable. Happens sometimes with my neck pain so i went to go rest in my recliner. At this point the wife asked if I was ok, I told her what was going on and she suggested TUMS thinking it was indigestion…. I have had heart burn and it was never like this, but I took one anyway to make her happy. I managed to doze off for a little bit and thinking it WAS indigestion and tried to go back to bed. Still could not get comfortable so back to the recliner it was. This time was a little different. My dog Faith wouldn’t leave me alone, kept trying to climb in my lap and was whining constantly. Then the pain increased. I yelled to my wife in the bedroom that I thought it might be time to go to the ER. On the way to BAMC, the pain was so bad I suggested she just run the gate…she didn’t.

In the ER i got taken right back and an EKG was performed and labs were drawn. The EKG showed a bundle branch block which could be an indicator of a heart attack but my cardiac enzymes didn’t indicate one. At first. In the ER the pain came back and was relieved with nitro, and they redrew my labs. This time my cardiac enzymes were up and the next set of labs showed them increased even more. I was admitted to the hospital with a cardiac catheterization scheduled for Monday (it was now about 5 am Easter Sunday).

Monday finally rolls around and I am prepped for my catheterization, which basically consists of me being given a Valium and moved to the cath lab. They inserted the cath through my wrist and while relaxing I get to see on the monitor what the Doc is seeing. Now the plan is to see what happened during my MI, and check for blockages, and apply a stent where necessary. Unfortunately for me, Mr Murphy decided to go to the cath lab with me. As I am sitting there relaxing with the Valium, I hear one of the people in the cath lab call out a rhythm change…no biggie. Then the same voice, with a bit more urgency calls out rhythm change again and adds the word V-fib. As the rhythm change is called i get the strangest sensation in my heart. I was asked to describe it, and the best I can say is it felt like my heart was trying to shake itself loose.

Now all hell breaks loose. I hear the Doc call out start compressions and receive 3 halfhearted one’s before I hear the doc call clear and they hit me with a full 360 joules. The pain from being defibrillated was one of the most intense and worst pains I have ever experienced. I was literally thrown up in the air off the table like you see on TV. Luckily, it worked. I went back to a normal sinus rhythm and they backed the catheter out and I was done.

I was wheeled back out to recovery where the doc told me I was missing a vessel and had 2 others that were blocked. They were unable to put in any stents and I was going to be having surgery. Time to wait for the CardioThoracic team to come talk to me.

Monday afternoon the CardioThroacic surgeon comes to talk to me. Dr G immediately puts me at ease and tells me more about my blockages and what he plans to do. Unfortunately, I will have to wait until Friday for surgery because I have to get one of the anticoagulants they gave me out of my system before they can cut on me.

Waiting a 4 days in the hospital is mind numbing. I am used to being the nurse, not the patient. Thankfully my family is very supportive, my Mom comes up to be there with all of us and even Andy (Flynguy) makes the 6 hr drive to come see me. I pass the time catching up on reading and some movies.

Friday morning comes finally. Here things get blurry. The last thing i clearly remember is shaving my body. All of it from the neck down. I have a vague recollection of them coming to get me for surgery but not a clear one. My wife tells me I was talking up a storm right until they injected me with the Versed at which point I was a vegetable.

So while I was sleeping, the CardioThoracic team, led by Dr G, first harvested part of my Saphenous vein from my left leg to use in one of the bypasses they did. Next they cut my chest from the top of my sternum to the bottom, then cut the sternum from top to bottom and spread my rib and chest apart. I was then put on a bypass machine to circulate my blood while another machine breaths for me. The doc use the harvested saphenous vein to bypass one blocked coronary artery then use the left internal mammary artery to bypass my Left Anterior Descending artery (the big one that they call the widowmaker). I had one more vessel that was missing (a hereditary thing) but they figured if I have been this long without it, then they weren’t going to mess with it. Finished with the bypasses, they wire the top of my sternum together, use basically 2 metal zip ties on the bottom half and close me up and I go to recovery.

My wife tells me I came out of recovery fairly quickly, I have no clue really. My first clear memory post-op is being in the ICU room and being HOT. I mean Texas Butt Bake hot. I was still intubated and had a gastric tube in and was unable to talk but using a pen and paper was able to let my wife know I was hot and she was able to apply a wet wash cloth. I kept falling asleep and the staff and my wife kept trying to keep me awake and breathing on my own so they could extubate me. At one point, trying to encourage my wife to be more aggressive with the wash cloth, i wrote “wax on”. She didn’t find it anywhere near as funny as my son did. Being extubated sucked but the pain was nothing compared to what I had coming.

The rest of Friday was spent mostly in a drug induced haze. Breathing was painful and I wont even try to describe coughing, which I was made to do regularly. Saturday, I was up out of bed. The 2 chest tubes I had made movement painful, but I was determined to get through this. By Saturday afternoon I was up walking the corridors with the assistance of a wheeled walker. Sunday I badgered them into removing tubes and lines as much as possible. Foley out (Thank God). Jugular line out. Both chest tubes and pacemaker out. Wow, I didn’t realize how much pain the chest tubes were causing until I had them taken out. It’s immediately easier to get in and out of bed. I am know able to move from my bed to the chair or toilet on my own, at a pace faster than a 90yr old with bilateral hip replacements. Monday they transfer me to a step down telemetry unit. I no longer have a giant room all to myself, I now have a room half the size and a room-mate.  The staff, while professional, doesn’t seem to have their heart in it. I start badgering my Dr G for discharge. Usually discharge is 5-6 days after surgery…I want out now. After much whining and moaning, I get discharged on Tuesday, 4 days post-op.

The pain is exquisite. I have never appreciated how easy something like getting out of bed was until I couldn’t do it without 10/10 pain. I spend the first almost 2 weeks at home sleeping in a recliner I had the wife buy and put in the bedroom. I refused pain meds on discharge, as I want to do this and I need to feel the pain that I brought on myself through my own bad choices.

As I write this, I am 7 weeks post op. I haven’t been in a hammock since before my surgery, mostly due to an abundance of caution where my sternum is concerned. I am still in pain regularly and move like a 75 yr old. I can’t lift more than 10 lbs, yet,but hopefully that will change this week when i go for my final follow up with my surgeon. I never did surgical nursing, not even much in nursing school, so I don’t know how much longer it will be until my chest fully heals but I expect it will be a while, it’s not every day you spend 4 or so hours with you chest spread apart a foot wider than it should be. All my chest and upper back muscles were ripped apart or stretched, all the way down to the intercostal muscles between each of my ribs. Taking a real deep breath still makes me twinge a little, but  I am in cardiac rehab and doing well.

I didn’t write this to make you feel sorry for me. I did this to myself, mostly. Yeah there was some genetics involved with the cholesterol part, but the smoking part was all me. Over 30 years of  smoking, off and on, was a BAD choice. Yeah, i didn’t smoke a lot when I was active duty and on exercises, but if I was off duty i had a beer in one hand and a cigarette in the other. I actually quit a couple times, but picked it back up for some dumb reason, every time. The weight I put on, I blamed on my neck pain and depression. Yeah both contributed but ultimately I made the choice to let them control me. Now I am making different choices. I haven’t had a cigarette since the night of my heart attack. There isn’t a day that goes by that I dont think about having one, but I am holding firm on that one. I mostly quit caffeine and I can count the number of sodas I have had since surgery on one hand. I have lost 15 lbs since i was discharged from the hospital and would like to get down to what I used to weigh. If you read this far, I pray you learn from my mistakes. The night of my heart attack I found out I am going to be a grandfather. If it’s a boy, I want to teach him about the joy of peeing outside. I want to walk my daughters down the aisle. I want to hike the AT. The list of things i still want to accomplish is long, and I plan on learning from my mistakes, and taking this opportunity that God has given me to do the second 50 yrs of my life right.

I hope you do also.

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5 Comments

  1. Avatar

    UncleMJM

    Well written sir. I’ve been thinking about you lately and was actually on the verge of a PM when you posted this. We all make choices and all choices have consequences. We don’t all get wake up calls. I’m glad you did and through yours, I’m waking a bit too. While I don’t have the smoking history, I have been carrying an unhealthy amount of weight for too many years and am now making progress on changing that. Take some credit for inspiring me some my friend. I’m glad you’re on the mend and I look forward to some campfire time as soon as we can get some. Stay strong on the wise choices. I’ll continue to keep you in prayers.

  2. Avatar

    GregD

    Major bummer.

    I imagine you won’t be shooting for a while either.

    I know two people that managed to avoid the heart attack prior to their open-heart surgeries. One, a non-smoker of healthy weight that exercised regularly caught the problem on a stress test that his doc thought would be unnecessary. Another, a former smoker, overweight, that exercised not so much, got a second opinion about his angina. On the other hand one person (my brother) drove himself to the hospital during his heart attack (or so that is my understanding).

    Whatever you have to tell yourself to quit smoking for good is probably worthwhile. Ain’t no way around it; smoking is bad for your health in so many ways. After that, however, I would encourage you to give up the self-inflicted guilt trips. I am prone to guilt and stress; although I’ve got no objective evidence my impression is that those emotions impair my health. But for sure they diminish my quality of life.

    None of my mother’s brothers made to the age of 50. My oldest brother had his first heart attack and quintuple bypass in his late 40s and had a second heart attack last year in his late 60s. My other brother (older than me) had his first heart attack in his early 50s. I have been luckier then that, but odds are mine is coming. The one noticeable difference between myself and my brothers is that I am deliberately low-stress (they are both MDs).

    Good decisions are sometimes hard to make, even when convinced like I am that my heart attack is coming. Loosing weight was about the hardest thing I’ve done. I hate exercise, so I got me a couple of truly PITA dogs that keep me moving as fast and as far for as long as I can. They are why I can’t hike with Sarge; they need to burn far more energy and far faster then they can plodding along with Sarge. One of them wanted to rumble with your lab at Hurricane Cove last year, and that was after a 16 mile hike from PL#1; she needs more weight in her pack. I can’t help but get lots of exercise trying to keep up with them; without them I just wouldn’t exercise regularly.

    Good attitude for the recovery.

  3. Avatar

    gmcpcs

    Glad to hear your story, Tom. Just keep on trucking. It’s good to have life goals, and those sound like real good ones! Hope to see you later in July. I’m pretty stoked on my weight loss; I’m down about 30 lbs from last year. I follow a pretty lenient eating plan that includes high fat and low carbs. That definitely helps with my back mess. I’m doing, get this, water aerobics with the old people at the Pool complex two to three times a week. That sort of exercise gets the heart rate up, and it is low impact on the joints. I don’t care if the company is 20+ years older than me, (Wife excepting) the exercise is fun, and I just have to look around and see the ones who are doing well up into their 80s with regular exercise. You know the spiel…

    Take it easy,
    GMCPCS

  4. kev137

    Thank you for sharing your story. Best wishes on your continuing recovery.I have been since the beginning of the year engaged in a lifestyle changing health kick. I’ve changed my diet, and increased my exercise. I have been able to lose about 40 lbs so far. I’m driving my family crazy at times trying to educate them about better nutrition, mainly the evils of sugar consumption. My wife is open to change, the kids not so much. For me most of my inspiration for change came from the realization that both my father and grandfather died much younger than they should have ( my grandfather in fact died before I was born). Like you I began to think about my children and my granddaughter. I want to see my kids graduate college and be healthy enough to enjoy time with my granddaughter ( she’s a little over a year old now). While living healthy is much more difficult, the payouts are very much worth it. Stay strong and keep us posted on your progress please.

  5. Avatar

    BillyBob66

    Thanks for sharing. Sorry to hear you have been going through this, but glad to hear you are still alive and recovering!

    I sure would love to know what your Calcium Scoring Scan score was. (just as a matter of curiosity, about if there was any warning from that test- no matter now, you have had the pipes replaced! ) This is noninvasive and relatively cheap, and it seems to me the info we get from this is way more useful than anything we get from cholesterol testing. My doc- who has a slight natural bent- told me that anyone else would already have me on statins based on my recently worsened cholesterol testing, even though I had zero symptons on the back pack up a steep hill test, and no family history of heart disease.

    But in order to convince me that I should be on them, he talked me into having this test. Fortunately for me, I scored zero on the scale where 101-400 = moderate Coronary Heart Disease, while 400+ = extensive CAD. So I side stepped the statins so far.But I don’t know why these tests are not more common, a simple picture of how much blockage there is in your heart. Seems like that could be VERY useful info for most of us.

    Do you know what your cholesterol and triglyceride numbers were? I am just wondering if you had any warning from those.

    I hope your recovery is going great!

    http://abcnews.go.com/Health/HeartDisease/calcium-scores-best-predictor-heart-attack/story?id=14334633

    The procedure, called coronary artery calcium scoring — or CAC — checks for calcium buildup in the arteries. It rates heart attack risk and gauges the benefit of certain heart treatments, such as statins.

    “It’s quick, painless and an indicator of heart attack,” Leahy said Dr. Wiliam O’Neill, her cardiologist and chief medical officer at the University of Miami Health System, told her at the time.

    Doctors generally use a blood test to check for high levels of C-reactive protein, which can signal artery inflammation and is a potential predictor of a heart attack.

    But Leahy’s doctor went straight to the CAC scan as his first line of defense.

    A study published Thursday in the Lancet now throws some data on O’Neill’s confidence. The study suggests that screening for calcium buildup in coronary arteries, called atherosclerosis, may be a better method than a C-reactive protein test, which measures the amount of C-reactive protein in the blood, for not only predicting heart attack risk but whether a patient might benefit from statin therapy.

    Researchers looked at 950 patients with no symptoms of heart disease and found that patients with the presence of calcium -– even those with low cholesterol levels — had twice the risk for heart attack or stroke and four times the risk for heart disease than those with a calcium score of zero. . There are also contrarian views in this article on whether this test should be done.

    http://www.medscape.com/viewarticle/822813
    We finally got a real glimpse of the future of calcium scoring during a session at the American College of Cardiology 2014 Scientific Sessions . It seems it’s been the right thing to do, but there are lingering questions. I found the comments provided by the panel that consisted of Drs Kim Williams, David May, and Harvey Hecht as compelling as the data. I hope more front-line providers, family practitioners, internists, and others will embrace it as well.

    First, we learned from a Houston Methodist Hospital study that testing of asymptomatic individuals really has worth. Nearly 1000 patients deemed low risk by the Framingham calculator and a plain treadmill exam were tracked for seven years. Coronary calcium proved a far better predictor of risk. May then said, “Calcium scores are better predictors than routine exercise evaluation,” and Hecht even more emphatically stated, “If you’ve thought about doing a stress test on someone with no symptoms, do a calcium score first. There is no such thing as a false-positive calcium score. It is 100% accurate for coronary atherosclerosis.”

    From Los Angeles BioMed at Harbour UCLA Medical Center came a fantastic 20-year study of nearly 5600 subjects. Mortality data was presented on no-, low-, moderate-, and high-calcium scores of those otherwise considered to be at low risk for heart disease. With an average follow-up period of 10 years, even patients with low calcium scores (1–99) were 50% more likely to die than patients with a calcium score of zero. Moderate scores (100–399) were associated with an 80% greater likelihood of dying, and high scores (above 400) were associated with a three-times-greater risk of dying as compared with patients with zero calcium. These patients had zero to one risk factor, including diabetes, hypertension, current smoking, family history, or diabetes. Ten percent of these “low-risk” patients had a severe burden of coronary artery calcium >400.

    Again, the panel drove several points home. May said, “The significance of that observation period cannot be overstated. Should they have been tested with stress testing? Coronary artery calcium gives us a real measure of individuals they should be focusing on.”

    Hecht replied, “You can have zero or one risk factor and still have significant atherosclerosis. . . . and you are just as dead if you have five or zero risk factors. The key is to start therapy based on the amount of plaque you have.”

    I think you will soon be hiking with renewed vigor and teaching the grandkids important outdoorsy stuff! God bless you, Scuba!

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