Is That a Catheter in My Heart or Do You Just Adore Me?

Hello, friends, I'm back from the other side! Just the other side of the cath lab table, that is, which I had to use a metal stool to reach. I could go on about the indignity of being a short woman, but I think they just set that sucker for the doctor's height and leave it because it's quite the assembly line of weary hearts wheeled in and out all day. 

I spent all of about 20 minutes in the lab, which was 1/18th the time I spent in waiting and recovery. All of the nurses were kind and efficient, even the youngest one, who had the delightful duty of groin prep. Even though the plan was to snake the catheter through my wrist, the team likes to prepare for uncooperative radial arteries so this lucky RN was in charge of womanscaping. Naturally, Dr. Catheterization chose the moment of peak buzzing to enter my cubbie to explain the procedure. A quick survey of the scene, along with my "Sir, really? Right now?" sent him right back through the curtain and me to a one hour delay. I guess I should have crossed my legs and just talked to him (title of my memoir)!

When the doc came back and I signed all the consent forms, I was rewarded with a trip to the icy confines of Cath Lab 6, staffed with two Joannas, a Katie, Kirsten and Monika, plus my new favorite cardiology fellow, Dr. Chris, who asked why I was there because "You seem young for this procedure. You're only in your fifties!" Yes, friends, I'm living by Dr. Chris rules now: I will be IN MY FIFTIES until December! I'm pretty sure the flattery was a distraction because one of the Joannas immediately put me on oxygen and slapped a freezing gel pack on my flank, Monika swabbed my wrist and groin with chilled betadine, BFF Dr. Chris started injecting my wrist with lidocaine, and the other Joanna pushed the good drugs into my IV.  

And then I woke up. 

I was required to spend about three hours in recovery, during which the nurses gradually let out the air in my wrist pressure bandage while I dozed and sneezed. Eventually, Dr. Catheterization came to see me and the Captain, who had balanced on a rickety chair in my cubbie from post-prep through post-op. I was a little loopy but Dr. C explained that the LAD blockage was only about 30% so I hadn't needed a stent. The stenosis in the first diagonal branch was 70% but because it was a relatively small branch he wasn't concerned and thought it would be fine with medication. Cap quickly texted the good news to all the family and I sneezed some more. 

When it was finally time for discharge, the IV nurse took me for a walk around the unit to make sure I was fit to go home. 

"How long have you been married?" she asked. 

"Thirty-four years," I answered (confidently cheating ahead by a few months). 

"Wow! Thirty-four years! You're like newlyweds," she said. "You can tell he really adores you." 

Now, it is true the Captain adores me. But I think she should have higher standards for newlyweds than a partner who scrolls instagram for kitchen hacks and chef reactions while patiently waiting to find out if their betrothed is dying from coronary artery disease. 

Okay, that's a little dramatic. I'm not dying from CAD. But I do now have a diagnosis of non-obstructive coronary artery disease, or NOCAD, which is not nearly as exciting as NORAD, the folks who track Santa (and maybe bombs). And despite the initial relief about the not-as-bad-as-we-thought blockages, I'm still concerned about that diagonal branch. I may be overreacting, but shouldn't I want oxygenated blood to flow freely to the front and lower part of my heart? A family member told me two of her friends have this diagnosis and it's really just part of getting older. Sure, but as we all know I am only IN MY FIFTIES so that can't be the reason! 

After my walk with Nurse Low Expectations I was given my discharge instructions: leave the wrist paddle on for 24 hours; don't lift anything over five pounds; don't bend or push on the wrist; if there's a hematoma call 911; if there's spurting blood after you remove the bandage call 911 (I think this should apply all the time); if your dog or children are bad call 911 (I made that one up but Barkley is still available); and follow up with your cardiologist. I thanked everyone on the floor and wheeled out of the unit, sneezing. Guys, this was the weirdest side-effect of the whole day. The sneezing and runny nose got progressively worse. I took Claritin, Benedryl and Flonase for the whole weekend and didn't stop sneezing until Monday! Naturally, I researched "sneezing after sedation" and found out I was either allergic to the medications (NOOOOO, NOT THE GOOD DRUGS!) or the nasal cannula for the oxygen. I guess we'll find out the next time!

Despite the rhinitis, I had a lovely brief recovery. The boys were attentive and caring (Two went to the florist AND Starbucks but both were closed lol) and Erin made them do all the lifting and carrying of things. The Captain captained, and friends and family reached out to check on me. I explained to all how women shouldn't ignore a NOCAD diagnosis because all the literature says it still means an increased chance of myocardial infarction! But I think folks want to hang on to the good news, and maybe I should, too. So I've stopped citing medical studies.

At least until I have the delightful Dr. Dutta trapped in a room with me, where she will be obligated by oath and Aetna to listen to all my concerns!

Stay tuned and be well!

Goodbye, Boston Creme

Goodbye, Boston Creme

I fear I've known you all too well

But you've gone and clogged my arteries

And now I don't feel very swell

After many tests

It's time for the ultimate one

Where they snake a camera up my wrist

To ask my heart what's going on

And it seems to me

They should have guessed

It was the donuts all along

That made my legs weak

And my heart beat like a bird in song

I would have liked to know 

When I was more a kid

Without a catheter and camera

Taking a medical vid

Yeah I would have liked to know

When I was more a kid

So I could make the appropriate diet and exercise changes to help my candle blow

Longer in the wind

Apologies to Elton and hello old friends! This installment of the blog brought to you by Plavix! Folks, I've got some good news and some bad news. I always take the bad news first because then there's a slight chance things will improve with the good, and because this is my blog you've got to follow along. The bad news is I can't eat donuts anymore. The good news is I've been diagnosed with coronary artery disease!

"Megan," you say to no one in particular, "that doesn't sound like good news." You are correct. It isn't great to find out you have significant blockages in two arteries BUT it's better to find out before said stenoses give you a heart attack! So, I'm ahead of the game. And on Friday, I'm going in for a cardiac catheterization where the team will take a look around and, fingers crossed, throw in a stent or two so my symptoms subside. 

About those symptoms...

(title card: Three Years Ago)

At the beginning of 2021, I was on a business trip with the Captain (he was doing business, I was mostly enjoying the sunshine) and I stood up after lunch and felt my legs get weak and heavy. I was lightheaded and my ears were pounding so I stood still until I felt better and could start walking. This happened with enough frequency, sometimes accompanied by a high heart rate, that I went to see my primary care doctor. I had been assembling a crack team of female physicians-Medical Marvels, if you will-because all of medicine is based on male outcomes and it's biased and annoying. I chose Dr. Olympia Sophias first, not just because her name deserves its own Issue #1 origin story, but because she's routinely curious and diligent about my healthcare. 

Dr. S launched me on my odyssey, which began with lots of blood work (rule out Lyme disease, rheumatoid arthritis) and continued with many other physicians and tests. We did an MRI of my brain and spine, plus electromyography (rule out MS); MRI of my pelvis (really, really looking at that spine); a vascular study of my legs (R/O insufficient veins); a two-week cardiac monitor, an electrocardiogram (R/O heart damage); a carotid scan; a heart CT; and finally, after switching cardiologists, an old-timey treadmill exercise stress test which showed changes in my EKG. That earned me one more fancy, schmancy test: a computerized tomography coronary angiogram ("It's really fun to take the CTCA, the CTCAay!") which takes a bazillion (256 per minute) pictures of your coronary arteries and lungs. 

I'm going to digress for a moment to add that since 2019 I've gone to the ER three times for what we call "my fake heart attacks." My father died from heart disease when he was 55 so I've tried to be a grown up and pay attention to what my body is telling me. Three times my body said, "hey, this feels wrong" so I went to get checked out, most recently at the end of January. Each time I've gone, the staff does blood work, an EKG, maybe a CT scan and chest x-ray. The blood work comes back free of cardiac enzymes and the EKG looks normal because my heart rate isn't elevated. Everything was fine until they made me breathless on that treadmill. 

My adorable cardiologist, the young and kind Anjali Dutta, actually felt bad ordering another test but I was excited to get some answers! I went to the CTCA lab at the hospital where the fun nurse (she was low-key playing the Sex Pistols at the unit desk) tried to get my hummingbird heart to slow the fuck down so the machine could get a decent picture. But John, the super-reassuring CT tech, said that didn't matter because the advanced scanner would compensate! He once again explained what the contrast dye would feel like (cold, metallic, like you wet your pants) because this time "we're quickly giving you at least three times the amount you've had." Thanks, John! I popped a nitroglycerin pill under my tongue (hot and spicy?) in one last desperate attempt to dilate and relax my coronary arteries and went into the machine. It was all over in less than ten minutes and I went home. 

The Captain and I had an appointment that afternoon and as we entered the office he said, "If something was wrong they'd call, right? They wouldn't have let you leave the hospital, right?" And I said, "It was a technician with me. They aren't calling until the radiologist reads it." Five minutes later Dr. Dutta called. 

"There are some abnormalities on the scan. You have some blockages, and one is in an artery we can't usually stent. I'm going to give you to my front desk so we can get you into the office to talk about what's next." Lesson: They WILL, in fact, call if there is something wrong.

"What's next" happens tomorrow. I'm scheduled for the cardiac cath in the morning and maybe they'll stent me and maybe they won't. I'll be under "moderate" sedation so I hope they ask my opinion because in the time between getting my results and talking to the doctor I became the world's pre-eminent non-academic expert on robot-assisted MIDCAB (that's minimally invasive direct cardiac bypass to you), which has the greatest success rate on women. You heard that right: someone actually took the time to find out what works best for FEMALE bodies! Bite me, male doctors! Except you, Dr. Man-who's-doing-my-procedure. 

I'm not nervous about the catheterization. I hope it's successful and I get to go home the same day. My sister Erin flew in from Arizona just in case I, or the many people who rely on me, need help this weekend so I might really milk these blockages for serious naps. Wouldn't it be awesome if some minor coronary artery tweaking fixes everything? Sure, I have to give up animal fat but I've been slowly trending toward vegetarianism anyway (the cows and pigs are too cute to eat!) so the fam and I are going to learn to love our greens even more! Once I'm assured I won't die from it, I suppose I'll have to EXERCISE ugh, because I love my family and friends and wildlife and flowers and sunshine and the ocean and trees and my cats and music and poetry and the human condition. I want more of all that and I want more of YOU, so when I say listen to your heart, I mean the actual organ! 

Stay tuned for updates and be well, friends!