Friday, October 4, 2013

What I Hope is Not My Final Decision!

By Tom Jennings, MD
Dallas Ophthalmologist 

The day before I had just finished running, and my heart was pumping really hard. I thought to myself that I couldn’t have any heart disease because if I did I would certainly be getting chest pain now!

I was driving to pick up something from the hardware store, and I went into the wrong turn lane. I got really mad at myself (something I since decided not to do … see below) and developed chest pain. I had chest pain like this before, but after belching the pain would disappear. Despite belching and taking antacids, the pain was crushing, persisted for the next hour, and got a lot worse (8-9 out of 10 on the pain scale). It was really deep in my chest and seemed to move slowly upward. Esophageal spasm, I thought, that must be it. I bought what I needed from the hardware store and went to buy some more antacids. I went to clinic, sat down, drank some water, and popped the antacids. The pain was radiating into my jaw. One of the residents told me I looked bad and suggested I go to the emergency room (ER). I agreed. He drove me. We stopped off at the drugstore to get some baby aspirin. I went up to the desk at the ER and immediately they took me to get an electrocardiogram. It looked normal. The pain was beginning to subside.

I waited for an hour before I was brought into a room. The emergency physician told me he was concerned about the chest pain radiating to the jaw. This was a very strong sign the pain was cardiac in origin. I was given a nitroglycerin to put under my tongue to help widen my blood vessels. The remaining pain discontinued over the course of a minute.

I still didn’t think I had a heart attack. I was 57 years old with no strong family history of heart disease. I was in pretty good shape, exercised every day, ate healthy, and took vitamins. I never smoked or took drugs. My blood pressure was always normal. I was something of a Type-A personality … I get angry at myself when things don’t go well. My lipid levels (the levels of fatty acids and cholesterol in the blood) were normal.

My lab results were normal. I was ready to go home. Fortunately one of the physician assistants convinced me to stay and have more labs drawn. These labs came back to reveal I did have a cardiac event. An angiogram (a kind of x-ray for blood vessels) and possible angioplasty (a procedure to widen arteries) were scheduled for the next day.

Later that evening the cardiologist came and discussed my case and impending angiogram. I reluctantly agreed to have the procedure though I still did not think I had any significant cardiovascular disease. He felt that I probably had had a very small heart attack. I think he was just being nice.

That night I discussed with my daughter what she should do if I died. It’s odd, I really didn’t expect to die. I was a pretty matter of fact.

The next day while I was waiting for the angiogram, I was more concerned that the procedure would knock a plaque off an artery and I would have a stroke. The thought of not being able to speak and being disabled frightened me. I thought of all the patients I knew who smoked and placed themselves at risk for a stroke. Confronted with the immediate potential of a stroke, I was even more perplexed by their choices.

After the angiogram, I learned I had a 99 percent blockage in the second branch of my left anterior descending artery. The cardiologist placed a stent to open it up.

After the angiogram, I went to the cardiac intensive care unit (ICU), where an internist reviewed my record. She was surprised I had had a heart attack. My lipid levels drawn in the ER were normal even though I was having a heart attack, which often raises them. The internist placed me on medication.

I generally wallow in self-pity, but after realizing I have coronary artery disease, I wasn’t depressed, bitter, or envious of those who smoked or never exercised, though theoretically these people are more likely to have a heart attack than me. I felt lucky that my heart was basically undamaged from the heart attack. I resolved to do everything I could to prevent another heart attack from happening again. I felt that if I hadn’t been doing those things before my heart attack, I probably would be dead. The first thing I resolved to do was not to get so angry at things and stop cursing … a manifestation of my anger.  Somehow going into the wrong turn lane seemed pretty trivial.

I decided to stop eating saturated fat completely. I was disappointed that the hospital food, even though I was placed on a low-fat diet, contained a lot of fat. I also resolved to walk or run daily. I would continue my vitamins and start drinking a serving of grape juice every day. I don’t drink alcohol, and I understood this is an equivalent alternative.

Once home, I examined the contents labels on my food for saturated fat. If I found it contained some saturated fat, I donated it to the food shelter. The thought of eating food with saturated fat, a hamburger for example, something I used to love, no longer appealed to me.  

I started walking every day and was quickly walking from one mile to one and a half miles each day.

When I went to my cardiologist, he told me to keep doing what I did before my heart attack ― only do more. He told me it is possible with a low-fat diet and medication to dissolve plaques.

With my cardiologist’s OK, I started running and after about four weeks was up to about one and a half to two miles. I run about six days per week.

I was concerned about taking the medications. Before I had never completed a course of antibiotics. I knew I would have to change. I decided to put a daily alert for my medications, vitamins, and grape juice in my iPhone calendar. One day I forgot whether I took my evening medications. I bought a pill holder with the days of the week on it so this would not happen again.

Ten weeks after my heart attack, my health improved. It seems the exercise, dietary change, and medications helped.

What are the lessons that I have learned?

  • I learned that I should think of cardiac pain when I have chest pain.
  • Getting angry at myself only hurts me.
  • I decided that if I am going to have another heart attack or a stroke, I didn’t want to look back and regret not doing more.

I hope you find my experience helpful.

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