Heart Health and Cardiac Rehabilitation Part I
[with apologies to J. R. R. Tolkien, who wrote an excellent adventure story by that name, better known as The Hobbit]
By David T. Jones MBA
Editor, Healthy Living
I’m sorry if this series sounds as if it’s all about me (as an Editor, I know better than to allow my ego to intrude into my message]. But, it’s really about you, and about our excellent medical and surgical services, that are facilitating the extension of our lives every year. Our young people can confidently expect to live well past 80, in reasonably good health, and many people are now surviving to the age of 100 with good quality of life.
As a well-prepared writer will do, I’m going to expose you to an early crisis, some ups and downs, a couple of plot twists, and a happy ending. But this is very much non-fiction – I know, because I was there from the beginning, and as you can see, I’m still here at the end.
I have never been an athlete, and physical exercise has never been amongst my favourite pastimes. Growing up in England, I was a sickly little boy, with bronchitis, the usual scattering of childhood plagues – and a close brush with death when I contracted Scarlet Fever at age 7. In those days, they had no antibiotics and thus no treatment. I was placed in an isolation ward, and they waited to see if I would pull through. I did. More about that later.
My family emigrated to Canada when I was 12 – thanks to that decision, I live in the greatest country in the world. I went to school, and university, and grew up, and went out to work, and eventually got married, with kids and grand-children, and most recently a great-grand-daughter, my pride and joy.
Generally, my health has been good – no major sicknesses or injuries, and I’ve been lucky. I’m a little under-tall, my blood pressure is a little above normal, but under control with medication.
But, possibly due to that Scarlet Fever, or heredity, I have known for many years that I have a faulty aortic heart valve. This causes a murmur, which has been monitored for decades, and two years ago, my family physician, a thoroughly modern practitioner, warned me I might eventually require surgery to replace the valve, which was beginning to exhibit stenosis, or narrowing. It could block the blood flow, or fail completely in time.
He referred me to Cardiologist, a specialist in heart disorders, who put me through a battery of tests. Electrocardiograms (ECGs), echocardiograms (essentially ultrasound to view an image of the heart structure), stress tests (to see how my heart and respiratory system responded to controlled exercise) and so on. It was agreed that I would go on medication to control cholesterol, which could block arteries, resulting in a heart attack or stroke. Continuing monitoring carried me through two more years.
But, early in November, despite all this, I found that I was increasingly out of breath during my thrice-weekly walks with my wife. Things deteriorated, and I began to be breathing hard by the time I reached the end of my driveway. One day, I felt particularly punk following my afternoon nap, and decided the time for action had arrived.
I had my wife drive me to the nearest hospital Emergency Department, and they checked me in for tests and diagnosis quickly. Right away, I knew I was THERE, because everyone treated me with dispatch, and I began to assume it might be all over for me.
The doctors told me it was one of three things:
1.I had had a major heart attack, with damage to my heart
2.I had a clot in my lungs
3.I had a blockage in one or more coronary arteries
Amazingly, I found myself wishing it was the third alternative, which still didn’t sound terribly attractive—but, at least, it offered some possibility to live.
Laboratory tests, blood work, X-rays eliminated the first two possibilities within two days, and the hospital cardiologist said he would schedule me for an angiogram. This is a diagnostic test that locates any blockages in chest arteries, and may permit immediate treatment.
I was sent to see my own cardiologist on Friday, and I though oh good, we’re slowing down, I’m going to be all right. Wrong! My cardiologist said I did need an angiogram, but couldn’t have one till Monday (don’t get sick on Fridays!), and he wanted me in hospital, with more tests, medication, and constant medical monitoring. You cannot be walking around. Off to hospital #2.
They checked me in, assigned a bed, attached a walk-around monitor to follow my pulse, blood pressure and ECG, and said take it easy. After a couple of hours, I was bored crazy, had read my two books, and wandered off. In fact, a nurse changed my bedside board from independent to really independent. Luckily, I found the TV and could watch the growing excitement of the US presidential election, met an interesting chap waiting for a heart valve operation, and chatted with everyone who was willing.
So, somehow, I got through the weekend. Surprising to me, the care was great, all the staff were polite and pleasant despite the pressure they exist under, and the food was good!! Someone handed me a menu, and they came around three times a day to take my order. Of course, I was woken at 6 am to take medication and have my blood pressure checked.
On Monday morning, I was whisked into an ambulance and taken to Hospital #3 for my angiogram. They checked me in – by this time, half of Toronto knew all my vital signs –and plonked me into a bed. An hour later, I was wheeled into a huge operating theatre labelled Angioplasty, to be met by a complete surgical team of 6 people!!!
I saw an operating table, tons of instruments, anaesthesia equipment, a dozen TV monitors, a colossal X-Ray camera hanging from the ceiling, and an operator up in a booth who would monitor and record all the proceedings. The Chief Cardiac Surgeon told me everything that was about to happen, with the following reassuring words.
“Mr. Jones, we are a full cardiac surgical team, and can handle anything that may arise. We’re going to slide a tube up your artery in your right arm, across your chest, until we can see the condition of your coronary arteries with that X-Ray camera. Then we’ll decide what to do. We may be able to fix your problem with stents (tiny plastic and metal tubes that squeeze the plaque blockage back against the artery walls). If the blockage is more serious or extends over many arteries, we will do bypass surgery – I can call in an anaesthesiologist, have you asleep in minutes, and we’ll do it today. In that case, since we’ll need to open your chest, we’ll also do the heart valve replacement surgery.”
Naturally, I was reassured—not!! Anyway, they knew exactly what they were doing. I remained awake while they inserted a catheter up my arm, I could move as instructed, they kept me relaxed and administered anti-clotting drugs, and I could see everything that happened.
They found a 100% blockage in my main coronary artery, and little damage elsewhere. They inserted stents to handle that situation. Then they move the camera to view my heart wall, and discovered that the damage had been minimal. They were also able to examine my heart valve up close.
After the procedure, which took about 45 minutes, the surgeon shared his remarkable findings with me. The blockage had been dealt with, my heart wall had not suffered severe damage (your decision to check yourself into hospital probably prevented a massive heart attack), AND –I don’t see any real need to replace that heart valve, it is constricted, but will probably last as long as the rest of you does.
Unbelievable!!! But he seemed confident in his findings. So, good news all the way around. Back I went to my home base at hospital #2, and the following day they released me, with diet instructions, and fairly major changes to my medication regime—to control blood pressure, cholesterol, blood thinning, and platelet formation, to keep my stents from blocking up.
My cardiologist registered me for a cardiac rehabilitation program, and has scheduled me for frequent checkups for the next year, after which my medication load will be reduced. The entire experience has been incredibly smooth. All the staff, doctors, diagnostic and support staff alike, were pleasant and helpful. Our medical/surgical system functions efficiently and effectively, and we are truly fortunate that they look after us so well.
After everything that had happened, I was BACK AGAIN.
Please see Part II for what happened next…