Monday, December 29, 2014

Heart Attack

On December 12, 2014, I had a mild heart attack. I was rowing on the Concept II Ergometer on Friday afternoon when about eight minutes into what usually would have been a 10,000 meter row, I got chest pain and tightness. I continued to row for another 12 minutes, but the tightness did not go away.

 Linda was out playing music so I decided to call 911 for an ambulance to take me to the ER. They got here pretty quickly. I wrote a note to Linda about what was happening. After I lay down in the ambulance the pain went away, but it was still a good idea to get evaluated. I wasn't scared. I was more curious. Probably in denial. I had made it 17 years farther than my dad.

Here are some of the ideas that passed into my mind as I waited through the week in the hospital.

My father Norman Jacobowitz had had his first heart attack at age 55 in Los Angeles. Then he decided to stay there. So I had been expecting my own heart attack, but just didn't know when. Norm had smoked heavily as a young man -- Pall Malls. I smoked for about ten years between graduating from high school in 1960 and getting Bell's Palsy in Los Angeles in 1970.

I decided that I should not continue bad habits, so I quit. Linda tried to quit as well, but it certainly wasn't as easy for her as for me. I was able to just ignore the difficulty. She was envious and pissed that it was relatively easy for me.

When we moved to Vermont, I got into bicycling and then one winter I tried running with Bear, our Malamute.  I had tried running in North Carolina because a friend Marilyn Rall in Grad School used to run a mile a day in the late afternoon. Surely I could do that. I tried running around the block we lived on in Carrboro and was wiped out about half way. But in Vermont things went better.

When we first moved to Winooski I rode my bike up to Colchester and was passed by a guy on a snappier bike. A challenge, but ride fast is what I wanted to do.

On Pearl Street in Burlington in the years just before we were married, I was running 3 miles a day in the mornings. I could hardly walk down the stairs to start, but after heading out on the run, things got smoother before I climbed Cliff Street. By the time I was into the third mile, I was running pretty fast.

The Plattsburgh Marathon was happening in May of 1975 across Lake Champlain, so I figured I could run ten miles to train, and then finish the marathon. I did that in 3:53 minutes. When I got home I couldn't climb the front stairs. Matthew Zettimer ran with me. He had many more issues about being so physically active.

Once I got into running I realized that I was chronically depressed. Running lifted the cloud that I hadn't known I had. I ran well for about 10 years from the early '70s to the mid '80s, although the high point was 1980, when Saul was born and I ran 3:03:52 at the Dartmouth Medical School Marathon.
In all I ran 11 marathons, including three Bostons as a "bandit." These runs came into my memory as I found myself reviewing my physical life.

Sean McMahon was the ER cardiologist who treated me Friday night. He lives in our neighborhood and has very nice eyes. There was a gang of about 7 docs who oversaw my case. Kevin Carey did the catheritization procedure on Saturday morning assisted by Naveen Seecheran, a Clinical Instructor. They don't call it a surgery because nothing is really cut. They inserted a catheter in my right arm and threaded it up to my heart where they found two blockages. They use radioactive dye to make images of the arteries as they go. Two stents were expanded to undo the blockages. This is known as a "subcutaneous cardiovascular intervention." Only about a third of these are successful, because you can't cover up the whole stent.

Dr. Carey or Seecheran said that my heart was now better than ever. We'll see. Actually my heart has been pretty good. I have run 11 marathons, the fastest in 3:03; I won the Stowe Bike Race Novice Class in 1976; I have climbed Mt Washington on my bike; I raced the Burlington Criterium and the NH/VT Regional championship. I won the Northern New England Indoor Rowing Championship in my age group; That sent me to the World Indoor Rowing Championships, CRASH-Bs, in Boston. So it would be hard for my heart to improve over those historical performances.

After the successful procedure I went into a condition that looked like a stroke or a mini-seizure. I was not processing language and could not speak (aphasia). "I can't talk," is how I put it when I recovered enough to comment at all. The word "this" seemed to me to be pronounced with an unvoiced th, like "thistle."

How long do stents laste? They have to be installed correctly, not covering everything, or 2/3 of drug-covered stents will malfunction.

Doctors and Nurses:

Call Zahid Parvez Shaikh on Monday 29 Dec, 2014.
Listed on my discharge papers are Daniel L. Wolfson (a fine name, but I don't remember meeting him); John Fitzgerald (ditto); and William E. Hopkins. I did see his name on the white board each day, but again, I don't remember meeting him. Naveen Anand Seecheran came by several mornings and seemed quite pleasant and focussed.

Neurologists: Shaikh and Katherine Ann Wayman.
Scott Luria, my primary physician, came by, but he defers to the neurologists about taking me off the anti-seizure. There were never any signs of a seizure or stroke (except for the severe aphasia.)
They don't know what caused the Nstemi (Non-St Elevated Myocardial Infarction). But they are treating me for several possible causes:
Stroke, Seizure, Infection (a course of anti-biotic)

Medications:
- Aspirin (Keep plaque from adhering)
- Keppra (levetiracetam) anti-epileptic drug; used to treat partial onset seizures; 
Side effects: 
  • Aggressive or angry
  • cough or hoarseness
  • dry mouth
  • irritability
  • mental depression
  • sore throat
  • stuffy or runny nose
  • trouble sleeping
  • clumsiness or unsteadiness
  • loss of memory
  • outburst of anger
I am pushing hard to get off the anti-seizure meds that are making me irritable and unstable, The neurologist said they were "covering their bases," but you know what she was thinking. Since they don't know what caused the mental event they are treating every possible cause. They gave me a sheet on reducing stress and a sheet of side effects of KEPPRA that includes ANGER, IRRITABILITY, DEPRESSION. LOSS OF MEMORY and AGGRESSIVE. Why give this to a guy who already is pretty judgmental when there is really no evidence that I had a stroke?

- Plavix  (clopidogrel) keeps the platelets in your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions. Plavix is used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart...
Side Effects:
  • Chest pain  (not yet)
  • collection of blood under the skin
  • deep, dark purple bruise
  • itching, pain, redness, or swelling
  • pain in general
  • red or purple spots on the skin, varying in size from pinpoint to large bruises
- Lipitor  (atorvastatin)  (Lowers cholesterol) belongs to a group of drugs called HMG CoA reductase inhibitors, or "statins." Lipitor reduces levels of "bad" cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood, while increasing levels of "good" cholesterol (high-density lipoprotein, or HDL).
Side Effects:http://www.drugs.com/sfx/lipitor-side-effects.html

Speech and Language Therapy is scheduled, but not for a month.

Upcoming early next week is an evaluation for cardio rehab with Cheryl McNeil, and an orientation to the program. Phil Ades put together a pioneering program 20 years ago. Everyone thinks it is great.

Eli came up on Tuesday through Friday and had a rational take on the situation, food and recovery. I don't remember the particulars but he asked the right questions and pushed the docs on their explanations (or inability to explain) what was going on. He and Natalie are expecting our grandson in May. I am not worried that I won't get to meet him.

What inference I take from this event is that my body will shut down when I die and I won't be aware or in pain when I go. I always imagined the end would be a quiet comfort. This may be projection, but why not take it?

On Sunday Dec 14th, 2014, Saul came up. He told me later that I seemed to understand things but I wasn't able to respond appropriately. Like I would say OK if I was asked to stick out my toungue, but I didn't do it. The neurologist wrote "Close your eyes" on my clipboard. And I read aloud it rather than do it. My mouth was very dry. I had thought about bringing the CPAP, but I didn't. They ordered one for me, but I must have been pretty out of it, because I never did use it.

I couldn't see Saul when he was on my right. It was not a surprise when he appeared, but it was obvious that my right vision was in neglect.

My favorite nurse was Bridget. She was pregnant and due in January. She told me that I fought the stent procedure and they had to hold me down to be able to do the insert. I couldn't express my objection verbally. I don't remember a thing.

Over the weekend I had an ongoing dream that I was in a hospital in the Boston area using their software to put in genealogical data, but I couldn't articulate what I wanted to put in. I thought that this facility was great so I would donate some money when the crisis passed.

Saul tells me and so did the docs that I was improving 100% a day from Tuesday. I must have been pretty incapacitated over the weekend.

Jay came up on the Friday a week after the event. He cooked a soup that would last several days and took us shopping for the kinds of foods and supplements that he was deeply convinced would be helpful. I have been trying to follow his suggestions, but I can't do the homeopathic stuff, because it is guaranteed not to have anything in it. If it utilizes the placebo effect, it should be reserved for believers. I believe in standard medicine. My primary care provider is a serious bike rider and commutes from Williston most of the year.

Linda predicted that my breakfast on Tuesday would be a pumpernickle bagle with cream cheese. I had that and wanted to document it, but I couldn't communicate that idea. Here is the documentation from the next day.
Update Tuesday, Dec 30, 2014: Went to cardiac rehab orientation at Phil Ades' well-recognized program in Burlington/South-Burlington. People say it is life-changing.

11 comments:

Ron Manganiello said...

Hi David, For someone who couldn't find any words a short time ago, you've written a very articulate and detailed tale. Sounds like you are recovering quickly. All the best - Ron.

Chapin Kaynor said...

Thank you for the detailed account, Dave, and best wishes!

I remember well running the Hanover 1980 Marathon (and of course Plattsburgh's 1978's swelter) with you! I hope your recovery is good and find your account both scary and heartenning. Thank you for sharing!

--Chapin
PS I didn't know that you (or Linda) ever smoked!

George P. Lynes, II said...

Hi Dave,

I never knew that recounting a heart attack could look like a Ph.D. thesis, but I'm grateful that you've put it all in writing - helpful to many, I suspect.

Though I've never had a heart attack, in 2001 I suffered a minor stroke. I was trying to do the NYT Sunday crossword puzzle, couldn't get words onto paper, tried to write a letter on the computer and found it was all gibberish. When I went to tell Jane something was wrong, I simply couldn't verbally articulate anything. Fortunately, one of her best friends, a physician living in the next block, came over, asked me a couple of questions and immediately got me to an E.R. where the stroke has confirmed. My left carotid artery was nearly 100% blocked and the first of many stents was inserted; the rest were in coronary arteries--six in all--as I have CAD. I see a cardiologist twice a year, take nuclear stress tests every other year and follow a medication regimen that includes Plavix, statins, baby aspirin and Diovan daily. While climbing stairs becomes difficult after two flights (as you know, we live in a vertical abode), my neurological problems, e.g., failure to come up with words, improved over time and seems now to resemble nothing more that "senior moments."

I'm convinced the stroke was caused, in large part, by cigarette smoking for many years, though it happened about a month after I quit,thank goodness, for the LAST time. My other "affliction, " aside from being a bit neurotic (!) is COPD, again caused by smoking, I'm sure. The pulmonologist says chronic obstructive pulmonary disease is a combination of bronchitis and emphysema for which I use three inhalants daily. Thanks to three years in the Army, one of which you remember, I qualify for [cheaper] medications through the V.A., the only benefit I get; there was no G.I Bill for "Cold War" soldiers when I needed it!

Unlike you with a life devoted to physical fitness activities, my somewhat sedentary existence includes a fair amount of walking and as much golf as I can get in, alas riding as a hip replacement, six back surgeries and arthritis slow me down a bit. At 77, I'm just glad to "be," let alone to "flourish!"

O.K., I take back my remark about a Ph.D. thesis since I have rambled for too long. At least yours was interesting and informative!

In hopes that 2015 is a year of great health, I send my best!

George

MBC said...

Hi H. I've known your writings for many years. Always smart and articulate! But this!? Fascinating! Informative! Who knew that you ran a marathon in just over 3 hours? The best news is that you are on the mend (big time). Great good wishes to you, Linda, Saul, Eli, SO's, Jay, little ones (the ganze meschpuchah). H

PS After 70 years of good health, this year has been one thing after another for me, starting with a trip and fall, corrective surgery, MRIs, bone scans, etc. Here's hoping for a healthy 2015 for us all.

Don Cohon said...

Dave,

Thanks for including me in your email list. It's been a few since we pedaled the Paradise loop in Marin, but judging from what you've written, we'll see you out here again in the not-too-distant future for another loop ride. All best for a healthy and happy 2015.

Don

Dan Walter said...

Well, David!
As others have pointed out, this account is scary but also very enlightening. Physicians do like to medicate, don't they? It's kind of their job, though, so it's understandable. The biggest factor in being a successful patient is advocacy - by yourself if you can, and by your family if you cannot.

I'm glad to hear you are on the mend. And thanks for the perspective on what death might be like. Comforting, in a weird way.

Best,
Dan

Unknown said...

Thank you so much for including me in the conversation, David - I had no idea...
Reading you very detailed, very cogent account of this journey to the brink and back, the first thing that occurs to me is that a clot was dislodged when the stents were inserted and you had a minor stroke as a result - it doesn't sound at all like a seizure!
I witnessed a similar, much less severe set of symptoms (more like a TIA) in a very close friend some days after he had 4 stents inserted. Could it be that your docs just don't want to admit that their life-saving treatments often have very nasty consequences? I hasten to admit my bias as an allopathic insider, but...
Please give my love to Linda - I know that this must be really stressful for her, and I can relate.
Sending both of you much love and good wishes for a new year rapid with recovery!
LInda

Jarlath O'Neil-Dunne said...

Get will Dave. Your commitment to physical fitness has always been an inspiration.

Chapin Spencer said...

Thanks for sharing all this. Your heart has powered you through much over your long and wonderful life. ~ Chapin

BH said...

Dave: That's quite a story. I like the little comments about eyes and the like.
You talked a lot about your genetics, and your working out, but nothing about diet, except for maybe the cream cheese bit.
What goes in counts too, but you know that.
Bud

Meredith said...

Amazing story, and hope you'll be able to go back to rowing in recovery! Stay well!