Posts Tagged ‘Heart attack’

So I had a heart attack…

Monday, August 31st, 2009

I left home at noon on Wednesday, August 27, to begin a tour that would take me to three solo gigs in Utah, one in southwestern Colorado, and a Rubber Souldiers show in Carson City, and end right back here in Berkeley with a Reptiles reunion in honor of our rhythm guitarist, Al Feldstein, who died of a heart attack on June 21. I was planning to spend my days off wandering around various desert sites, indulging in my adult-onset interest in geology. I had plans to drive highways and visit sites I had never seen before, guidebooks and camera in hand.

Tioga Pass

I had two days to get to Salt Lake City. I wanted to take CA-120, Tioga Pass, through Yosemite’s amazing back country, and I planned to spend some time Thursday at Berlin Ichthyosaur State Park, way out in the middle of the Basin and Range country of Nevada. I thought I might get as far as Hawthorne, Nevada, on my first day, but my attempts to book a hotel online didn’t yield any promising results. I stopped instead in Lee Vining, California, where Tioga Pass meets US-395 at the edge of Mono Lake.

This was, as it turned out, the first of several very lucky decisions.

I got a room in a motel overlooking Mono Lake. I got out my guidebooks, fired up Google Maps (even funky old fifties-style wood-panel motels have Internet access these days, even though this one didn’t even have three-pronged electrical sockets), and started making plans for the next day’s explorations. I had some doubts about Berlin Ichthyosaur, after reading that Thursday is the day that the fossil exhibit is closed, so I began to consider Great Basin National Park as an alternative.

I walked across the street to a barbecue joint for dinner, rather than drive to the famous Whoa Nellie Deli, which bills itself as “the most unusual deli, inside a gas station, you will ever visit.” Rita and I had dined at Whoa Nellie in May, and I knew it was likely to be the only decent meal option in town, but I was lazy and I also wanted to visit the Mono Lake Committee bookstore next door.

My dinner was, shall we say, unspectacular. The bookstore was quite the opposite, and I spent a good deal of time there examining their huge collection of John McPhee titles, a shelf full of geology books, lots of literature about saving Mono lake, maps, photo books, etc. I bought a pair of earrings for Rita and walked back to my room for the night. I watched a Ted Kennedy documentary for a while and went to sleep early, planning to get an early start toward whichever destination I settled on.

I woke up at 6:30 am and made myself a cup of Blue Bottle coffee in the French press mug I bought in Moab a few years ago. I had bought a small carton of organic milk in the general store, and I poured that over some Udi’s granola I had brought from home.

Something wasn’t right. Ordinarily I would have made another cup of coffee before hitting the road, and I would have had more to eat in anticipation of a long drive with few dining options. I can’t say I had an upset stomach, but I found myself uninterested in food or coffee. Last night’s dinner wasn’t all that bad, but I allowed myself to believe I might have a touch of indigestion or food poisoning.

It was a sort of hot pressure in my chest. One of the reasons I didn’t immediately go for help was that I had felt the same thing four days earlier, after a vigorous bike ride across San Francisco for a lunch date at the Beach Chalet with a group of friends. On that occasion, the burning subsided in ten or fifteen minutes and I didn’t think much more about it. I had no further discomfort on my ride back that day, nor on subsequent days’ rides.

And I know I had had this sensation before the San Francisco experience, because I mentioned it to my doc when I had a physical on Friday (8/21); he and I agreed it was likely related to my recent habit of riding my bike upwards of 10-15 miles a day and pushing myself to ride up hills and max out my heart and lungs. I have taken to this born-again biking thing with great gusto.

When I woke up Thursday morning, I had a much more intense version of that pressure in my chest. And this time, the hot pressure didn’t subside. I decided to wait a while before getting in the car and driving even farther from help than I already was.

I called Rita and told her I wasn’t feeling quite right, but at that point I wasn’t terribly alarmed.

In retrospect, I think I knew this was more than indigestion, but I didn’t want to give up my greatly-anticipated explorations and performances, and I didn’t want to find myself in some expensive out-of-plan ER situation that would cost me my house. I mean, fuck Sarah Palin and her “death panels,” but we are living in weird times when it comes to health care. Plus, you know, I’m a guy, and something of an overachiever; guys tend to tough things out, and overachievers tend to ignore obstacles.

I had looked on “the google” for hospitals. Mammoth Lakes had one, half an hour or so south of my location, and there were a couple of possibilities northward in Bridgeport.

map

I decided to head toward Reno, the largest city in the area. I figured if I felt better by the time I got there, I’d take a right on US-50 and go on out to Great Basin; if I didn’t, I’d have access to big-city resources. So I drove up US-395, listening to my body and still pretending this was just a touch of indigestion.

My GPS showed me a hospital in Carson City: Carson Tahoe Regional Medical Center. I passed a couple of strip-mall doc-in-the-boxes as I drove into town, but I was aiming for the real hospital. When I got there, I knew I was in the right place: it’s brand spanking new and big enough that I knew it would have what I needed, whatever that might be.

I parked my car near the main entrance and walked in. Still not quite ready to admit I was in crisis, I sat in the lobby for a few minutes deciding whether to go to the ER or not. I got my computer out and discovered that I couldn’t get email there, nor telnet to the WELL. Dang.

After ten or fifteen minutes, still feeling this burning pressure in my chest, I decided I needed to go for it. The person at the information desk pointed me toward the ER.

When you come to an emergency room and say “chest pains,” you don’t have time to say another word. I was handed a clipboard with a form to fill out, but I hadn’t written much before a nurse took me to a room and went to work on me. The paperwork happened later.

IV

I saw the ER doc, and soon I was given an EKG and then an echocardiogram. The initial diagnosis was pericarditis – an inflammation of the sac that encloses the heart. The cardiologist, Dr. Anthony Field, told me my initial EKG was a “textbook” example of a pericarditis reading.

However, there were two other test results that confounded this diagnosis somewhat:

My sedimentation rate was 2. According to WebMD, “When inflammation is present in the body, certain proteins cause red blood cells to stick together and fall more quickly than normal to the bottom of the tube.” A low sedimentation rate argued against inflammation.

My level of troponin, a “diagnostic marker for various heart disorders.” was 2.68; normal is .04 – “almost undetectable,” said Dr. Field.

“If this was a heart attack, we’d expect it to be 10 or 20,” Field continued. “There were EKG changes indicating problems underneath and on the side of the heart,” he said. A level of 2 “made me a little bit uncomfortable,” he said, but the EKG was classic pericarditis and I had responded to a dose of the anti-inflammatory toradol.

After it was clear I was going to be admitted, I called Rita’s school (she’s a kindergarten teacher). No one answered, so I left an urgent voice mail message and tried her cell phone. She rarely leaves it on, so I left a message there as well. Another call to the school was answered, and I was connected to her classroom. I busted out crying trying to tell her what was going on: “I may be having a heart attack.”

The next time I spoke with Rita, a little before 5, she was at home. She had left work early, assuming she would be coming to Carson City sooner or later to bring me home. I spoke to her again later when the first (and less frightful) diagnosis was afloat, and that’s what she thought was happening as she rode up from the Bay Area (driven by our good friend Sandy Sonnenfelt).

My first tests took place at 2pm; a second round of tests at 7pm yielded a troponin count of 10. And the second EKG looked more like a heart attack.

The first injury could have been on the outside of the heart, irritating the pericardium; that could account for the misleading indications.

As soon as it was clear that I was having a heart attack, they sent me downstairs to the cath lab for an angiogram.

Weird as hell lying on a table with a tube stuck in my thigh, watching my heart on a monitor while they pulled a balloon through the arteries and then implanted little mesh tubes to reinforce the artery walls.

It was Field who handled the angiogram, but when it was clear that the plumbing needed work, he called Dr. Carl Juneau to wield the balloon and install the stents.

angio

The procedure took more than two hours, and I was awake through the whole thing. I was given a modest amount of Versed to ease my anxiety – but not enough to send me away nor to make me forget what happened. (I think it’s because I had been given a meal during the time I was thought to have pericarditis, and a larger dose would have cause me to puke.) And that turned out to be okay – I enjoyed chatting with the technicians and I found the process fascinating.

What they found was a 70%-80% blockage of the main artery that serves the front half of my heart and a “non-occlusive” blood clot that broke loose that morning and caused me the distress that sent me to the ER.

Rita left home Thursday evening thinking I was being treated for pericarditis; when I found out it was a heart attack and I was going to the cath lab, I chose not to call her because I didn’t want her five-hour automobile ride to be a miserable and frightened one.

When she arrived at 3 am, I had to tell her what had happened to me while she was en route. So over the course of her day she had two nasty scares separated by a bit of false relief and followed by news of a successful treatment.

I spent the next 60 or so hours in the Telemetry Unit, with EKG leads stuck to my body and a wireless transmitter sending heart info to a remote monitor. Aside from the sort of irregularities that were expected due to reperfusion, my circuits and systems performed admirably.

We had a long meeting with Dr. Field, the cardiologist, on Friday morning. He expects I will make a more or less complete recovery. We discussed the time lines for various activities, and I need to be very conservative with physical activities while the hole in my femoral artery knits, but I did not not experience any significant discomfort.

Field used two very amusing words in his advice to me: for now, I am to “mosey” around the house, and maybe around the block once or twice a day. And pretty much for the rest of my life, “no grunting”: It’s the sudden exertion that can raise my blood pressure and cause problems. He also told me that I can be back on my bike in three weeks and back to a full range of activity in two months; I just need to warm up a bit rather than charging out the door and immediately up a steep hill. That, I can live with!

I was not thrilled to be spending 48 hours peeing into a jug, taking walks around the third floor a couple of times a day, and eating unexciting (and unsalted) hospital food, but I had Rita with me and enough Internet access to keep from going completely stir crazy. The incision in my thigh didn’t hurt – just looked weird, with my half-shaved pubes, a faint blue shadow where some sort of fluid had been painted on me where they were working, and a thick wad of gauze over the puncture held in place by a large square of transparent plastic material.

I have to say that every single person I dealt with at Carson Tahoe was great. The nurse who practically snatched me up when I presented at the ER window with chest pains; the case management workers; the nurses; the cath lab techs; the cardiologist, Dr. Field; and the “interventional cardiologist,” Dr. Juneau – all were friendly, responsive, informative, and damn good at their jobs. I don’t know if I could have had better care anywhere else on Earth.

As I lay in the cath lab waiting for the angiogram, I got into a conversation with a tech named Scott. I was nervous and probably a little bit disinhibited by the Versed, and babbling about my thwarted desert mission. We got into a conversation about John McPhee‘s books. I asked him if he’d save the balloon catheter and stent packages for me as souvenirs, and he agreed; the following day he visited me in my room and handed the boxes over. (See photo above.)

The RNs and CNAs took care of me 24/7, delivering meds, drawing blood, taking my blood pressure and pulseox – all great. Kind, funny, compassionate, informative, and deeply helpful. I suspect they were happy to have a patient who wasn’t suffering nor demanding nor unpleasant. Most of them were willing to chat a bit, banter and joke – but always taking care of business, too. I had some Barlovento chocolate bars from our farmers’ market that I had intended to deliver to friends on my tour, and I gave them to the nurses instead, along with copies of my CD which they received politely. I hope they listened, and I hope they liked the music. I am especially grateful to an ER nurse named Kathy, who was pleasant and informative and reassuring when I was at my most vulnerable and uncertain.

Another thing I am very glad about from my time in the hospital: I watched all of Ted Kennedy‘s memorial (Friday) and funeral (Saturday); that was an inspiring and emotional experience, especially the speeches by Teddy Jr., Patrick, and President Obama. It was benefit of being incapacitated; I might not have plunked down in front of the tube for all that if I had been ambulatory.

They sent me home at around noon on Sunday, with some brochures and a list of meds to start taking. I was ordered to stop once every hour or so and take a walk around the car. We stopped at a cafe in South Lake Tahoe for lunch, and then again in Placerville for a bathroom break. We hit a Wal*Mart near Sacramento to buy a blood pressure machine, and then we were at home.

The hospital had phoned in prescriptions to my pharmacy here at home, so we stopped to get those meds on our way. I have Plavix, simvastatin, Metoprolol, and nitroglycerin. The latter is only for emergencies: I if I get chest pains, I put one (or two or three) under my tongue and either call 911 or head for an ER.

meds

(BTW, here’s a weirdly amusing bit of info sent to me today by Stev Lenon regarding nitroglycerin:

I’m sure that they warned you of potential headaches related to using nitro tabs sublingually. What is seldom included in physician talks is this little tidbit. It applies primarily to patients using nitro patches but may also affect tablet users:

In some instances, partners who are particularly sensitive to nitro may develop instant headaches while having oral sex with a partner taking nitro.

I’ve never directly experienced that problem but know people who have.

However, I am so sensitive to aspartame that until Gloria quit using it I would get an instant and smashing head ache if I kissed her after she had drunk something with aspartame in it. You can run the further conclusion.

Hope this brightens your day and that you never have to choose between headaches and happiness!

I have an appointment with my primary care physician tomorrow morning, and his practice will connect me with a cardiologist. East Bay Family Practice and Steve Bryzman took very good care of Rita during her lymphoma treatment, and I have every confidence that I will get what I need from them in my case as well.

So here I am, lucky to be alive, grappling with the news that my body is imperfect and I might actually die some time. It probably won’t happen soon, but my beliefs have been shaken a bit. I’ve received hundreds of warm wishes from all over the world, and you know that stuff really does make a difference.

I am still pretty weak, and I am not pushing myself at all. I’ve been talking with friends on the phone and online, and worrying about my cousins in southern California whose home in La Crescenta is in the evacuation zone but not in the fire zone.

*

I just went outside to walk for a bit, as I have been advised to do. I started hearing Cat Stevens’ “Miles from Nowhere” (from Tea for the Tillerman) in my head – “Miles from nowhere, guess I’ll take my time… to reach there… Lord my body has been a good friend, but I won’t need it when I reach the end.” Came back into the house and couldn’t find the CD, so I downloaded the song from iTunes. As I started to listen to it, I began to cry. I have a feeling I’m going to be processing a lot of emotions as I emerge from this event and settle into my new life. Truly a “before and after” experience..

I have to take it easy for a while, but I am assured I can get back to all my various gigs and hobbies pretty quickly. The guy who fixed me up in Nevada is extremely optimistic about my prospects for a full recovery.

I will continue my healthy lifestyle and use drugs to overcome my genetic predisposition to heart disease. All the good things I’ve been doing in recent years – healthy eating, bike riding, fish oil pills, low-dose aspirin, etc – may have made the difference between life and death. The blood clot that came loose on Thursday morning didn’t completely block the artery; if it had, I would not be here today.

Upon reflection, I also have to admit that part of my concern on Thursday morning had to do with the expense. Do I want to put myself in hock for untold sums in pursuit of a false alarm? As it turns out, the whole deal cost me a hundred bucks. And I realize now that it was stupid of me to have allowed that consideration to delay my trip to the ER. How close did I come to “toughing it out” and dying on a remote Nevada highway?

Adding “heart patient” to my list of occupations and attributes is damn weird. But hey, I made it through, and that puts me ahead of quite a few wonderful people we’ve lost – most recently, and most grievously, my musical partner and friend of 35 years, Al Feldstein, who had a heart attack in June and did not survive. For that reason – and because our old band and circle of friends are reuniting this Friday in his memory – surviving my own is extra poignant to me.

It’s going to take me a while to trust my body again, to stop being afraid that I could die any time. Every little twinge is gonna give me The Fear. I will get past it – the cardiologist gave me every reason to believe I will be okay, and able to ride my bike a hundred miles if I want to – but still. The ground beneath me is less stable than it was last week.

Every bit of advice and information I’m getting, from friends and strangers all over the place, is hugely appreciated as I make my way into my new life as a heart patient who is goddamn determined not to be an invalid about it.

I have, as you know, the finest support system on the planet. Her name is Rita.