The Yoga Teacher's Heart Attack

Chapter 11: ER Visit Followup
"Your chest pain is in your head..."

April 12 2017
 

Ironically, my post-treadmill meeting with Dr. Worth-the-Wait is just two days after my wire-in-heart ER visit. I'm looking forward to learning more about the tunneled artery and about the greyed-out part of my heart that isn't getting blood flow. 

James takes off work to come with me to this visit; it seems like finding a blockage in my artery is a serious problem and a second set of ears is needed.

I’m still in shock that he found a problem in my heart. While the wire was removed from my beleaguered heart, it left behind a 24/7 news crawler in my brain.

“Our heroine sleeps through her alarm … is the heart problem to blame?.”

“Our brave heroine gets terse email from Head Honcho at work … will her heart problem block her career?”

“Chest pain while riding her bike to work last week… did that make the heart problem change gears? Experts weigh in at noon!”

I feel pretty rotten when I wake up, but nothing a ginger ale and a Pepto won’t fix. On the drive to Better Hospital, James notices that I’m looking sweaty and clammy.

“You okay over there?”

“Sure. Just umm … didn’t really eat breakfast.”

When we are 20 feet from Dr. Worth-the-Wait’s office, I realize that Pepto didn’t work and that I need to throw up. In about seven seconds. I send James ahead, telling him to be sure to sign me in with the snippy receptionist; if you are more than 15 minutes late, then Dr. Worth-the-Wait will reschedule you ... six weeks into the future. 

Somehow, the vomit just won’t stop. This is the serious, sweating, roll on a cool tile floor kind of urping incident. Five minutes go by, then ten minutes go by. Well, there’s nothing to be done about this.

A woman comes in, wearing nice and sensible arch support shoes.

“Excuse me, ma’am. I don’t mean to intrude … but it seems like you’ve been unwell for a while. Do you want me to call someone for you?”

How very nice!

“Thanks for asking. I just have a doctor’s appointment and he’s really booked out a long time … “

“Ooo, cardiology, right? They do book up. Who are you seeing?”

And I tell her, trying to sound non-urpy, so she’s not alarmed and will leave me be.

“Oh! Aren’t you lucky. I hear Dr. Worth-the-Wait is the best in the business. Well, now I understand; I wouldn’t want to miss an appointment with him either. Feel better!”

Seriously? In the middle of barfing and someone is cooing over his skill set. Feels like overkill to me. Is he paying these people?  

Thankfully, he’s running a good 45 minutes late, so my stomach’s rebellion hasn’t set me back.  

As I had hoped, he’s super warm and even nice enough to ask about my awesome Seattle Town Hall event.

I bring up the angioplasty, the tunneled artery.

“Actually, it is called a myocardial bridge.”

“But the artery is tunneled into the heart muscle, right? I don’t understand the terminology. “

 

He turns on a high-wattage charming smile. “Ah, you must have been an English major. Good question. The word bridge refers to the muscle that’s built a bridge on top of the artery.”

“Do you have a brochure or a treatment plan or something? This sounds serious.”

He puts his foot up on the wheelie stool and leans in, placing his forearm on this thigh. It feels like the sort of thing you’d do when you want to make eye contact with a tantruming toddler.

“Listen, this myocardial bridge is completely benign. That’s why there’s no brochure, there’s no treatment plan per se, you’ve had it your entire life. There’s nothing to treat.”

“But the other episodes? And the chest pain? And the shortness of breath … I have had inexplicable shortness of breath for well over 15 years, so wouldn’t a blocked artery be a cause? Also, the ischemia ... ? ”

 

Again, for just a second, his handsome boy visage tics into a sneer.

 

He sighs. Loudly. Takes his foot off the stool. Kicks the stool back under the desk. It feels hostile, tinged with violence.

The warmth from his voice is long gone. He sounds genuinely annoyed that I’ve dared ask him questions. He exhales a long, exasperated sigh.

“The only reason you have chest pain is because you are stressing out about what I told you. Anxiety can really do a number on you. Also, your hormones are … (dramatic pause) … shifting … and that can often cause the heart to feel a little off.

Remember, you come from a long line of fainting goats. There’s a decent probability that the myocardial bridge and the fainting are completely unrelated. Any more questions?”

“What about the ischemia the treadmill found? Doesn’t that mean something?”

Again, a snorting sigh.

 

“I’m not seeing that as a concern; there are lots of reasons for that.”

Clearly he has me pegged as some shrill woman. I'm quite certain that if this was James's heart we were talking about, he would even try to pass it off as ... hormones. 

“So, Dr. Worth-the-Wait, when an artery is blocked, how do you treat that?”

“Well, when I find a truly blocked artery, I start with medication to address symptoms and if that doesn’t work, then there’s surgery. But a bridge isn't really a real heart blockage.”

“What kind of surgery?”

“Very minor, actually. Similar to the angioplasty I performed on you last week, I go in through a vein, slide a guidewire into the heart and then insert a stent. A stent is shaped like a slinky, or a metal mesh straw.”

“Then I want that, the stent. I want my blocked artery unblocked.”

Now he’s turned off his charm mode and slides straight into condescension.

“Listen, heart surgery is not something you just jump in to. Myocardial bridges, yes, they are rare. But are always benign. Always. Sometimes women in their 70s have complications from a myocardial bridge, but that’s not a concern for you. The only drug that’s  recommended for a bridged LAD is a beta blocker. Let’s start you a low dose for a month.”

“What happens after the month?”

“Well, that’s up to you. On your way out, make an appointment for a follow up in six weeks. I do tend to book up quite a bit. Course, as I always tell patients who are mad about how hard it is to get in to see me: you never regret waiting for quality, right?”

Obedient patient that I am, I book the next appointment on the way out. Dang, the last week in May. How is that possible, that a heart doctor makes people wait that long? How many patients just die during those six weeks, "waiting for quality"? 

I start taking the beta blockers. It seems weird that there’s only one drug indicated for a myocardial bridge, but, pffft, since when do I know about heart mechanics?

Within a few days, I have a persistent squeezing headache. Not quite a migraine, but certainly a lazy cousin, lounging behind my left eye, tossing ball peen hammers against my eyebrows.

I force myself to still get in two yoga classes and two dragon boating sessions the first week.  My feet swell cartoonishly, I’m forced to just wear my Keen hiking shoes, and even then the puff oozes out between the laces.

My mouth is always dry, an unquenchable thirst. The second week brings on dizziness as well. At the end of two weeks, I’ve gained three pounds.  That’ll take three months to slide off. I re-upped my food tracking with MyFitnessPal.com and aim for 1,100 calories a day, 1,350 if I exercise. It cannot be my fault. 

I check-in with Dr. Vivian, just to review the whole myocardial bridge / no blood flow to the front of the heart thing. I tell her I loathe the beta blockers and tell her I was hoping she’d have some kind of homeopathic magic trick up her sleeve.

Sternly, she says “This is a serious heart problem. You have to ride out the full dosage of the beta blockers. Give it two more weeks; sometime the body takes a while to adjust to a new med.”

I tell her that Dr. Worth-the-Wait mentioned stenting as a surgical option and that James and I agreed that surgery was the way to go. Dr. Vivian also agreed that, yes, if it were her, she’d want it structurally fixed.

I’ve come to view this heart problem as akin to finding out you have kink in a section of your rain gutter. Yes, you could run around inside your house, waterproofing everything with cans of Scotch Guard to prevent the eventual ‘side effects’ of the kinked gutter.

(And you’d probably get headaches and dizziness from Scotch Guard fumes.)

Or you could unkink the gutter to fix the problem once and for all.  I don’t necessarily want to sign up for heart surgery, but there’s a kink in my heart . Plus which, the stenting fix does sound pretty non-invasive.

 

Thank heavens it wouldn't be open heart surgery, with the sernum sawed open. I rmemeber when my grandma had triple bypass open heart surgery in the late 1970s. She was in the hospital a month.  

(note to self: check in with mum and dad about family history of heart disease. I had always answered 'no' to that question. But with grandma's bypass, my dad's pacemaker and mum's mitrovalve prolapse, maybe we do have a family history of heart disease?) 

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