I jog for thirty minutes four times a week for cardio-vascular reasons. My pace is just under ten minutes-per-mile. Whenever I think about jogging, I think about what a fairly well known presenter and author stated in a taped seminar, words to the effect, "What's the use of running for three years if it only extends your life three years?" When I remember what he said, it never fails to piss me off. Like so many of us he jumped to a conclusion based on what "HIS" perception of the world and in this case, jogging; namely that running was drudgery and a waste of time. It's an ego thing. If I don't like it, how could anybody else like it. For me he was definitely wrong. Even if running was drudgery, there are significant immediate benefits. Here are some of them: Improved heart and cardio-vascular health, reduction of stress, you feel better about yourself, you are more relaxed, helps keep weight down, you have more energy, etc, etc. Sorry, I get side tracked easily and all of the comments related to his remarks are really another issue, I was just venting, so back to the my story.
The real beginning goes way back to when I started running. I visited my family physician, I forget why, nevertheless, he drew some blood and found that I had high cholesterol. He gave me a few bottles of cholesterol lowering pills that I was to take daily. In addition my father had passed away due to blocked arteries; they didn't have the treatments they have today. I took the pills for a couple of days, then read something about a study of athletes found additional arteries formed to by-pass blockages; it was all I needed to know. So, ignoring my doctor's prescription, what did he know anyway, I stopped taking the pills. That was about fifteen years ago. Big mistake, it wasn't my first and I know it isn't going to be my last. We can really fool ourselves when we want to; it's really easy.
On Monday, February 4, 2008, as I began my run, my chest began to feel tight. I attributed it to the cold so I tightened the neck draw strings on my pullover jacket and finished my run. The next day the same thing happened and again I attributed it to the cold. I don't run on Wednesdays. About twenty minutes into my Thursday run my chest began to hurt. I thought it was heart-burn and I was able to force myself to belch and to some measure the discomfort subsided. I was able to finish my run. At this point I should have gone to the Emergency Room (ER), but I didn't. I told myself it was just heart-burn, even though it didn't feel like previous heart-burn. When I got home I took a couple of antacids to support my theory, although I felt fine. I told myself, "Let's see what happens tomorrow."
About five or six minutes into my Friday run the pain was such that I stopped running and started to walk home. By the time I got home I felt fine. My wife asked how the run went. I told her that after about five or six minutes my chest hurt so I stop and returned home. I added that I would rest over the weekend and try jogging again on Monday. Denial! Using my gifted ability to rationalize, I convinced myself that it was just heart-burn, which boarded on being, no it was stupid. Could I be anymore stupid? The answer is a resounding YES.
After resting over the weekend and taking a couple of antacids I performed my pre-running activities: stretching and toe touches, to loosen up. I started my run feeling pretty good and very hopeful. At the two minute mark my chest and under arms began to bother me. Nevertheless I continued (pretty stupid, huh) about six minutes into the run the pain became severe enough that I had to quit. As I walked back the pain subsided as before. By the time I got home, about ten minutes later, the pain was completely gone and I felt just fine. Still in denial, I took an Alka-Seltzer and a couple of antacids, even though I felt no symptoms. Continuing to fool myself, I rationalized it was the time of the day and the low temperature, along with some heart-burn. Yeah, pretty dumb. At this point I was a stupid bci. My wife ask how did the run go. I told her, "Not so good but that I was going to try again later in the day when it was warm and the indigestion medicines I took would have had a chance to work." We went for breakfast.
Around two-o'clock I decided I would give it another attempt. Lest I repeat myself, everything happened as it did during the morning run. Because I felt perfectly fine when I wasn't running, I concluded it must be some form of indigestion problem similar to my wife's, for which she is taking Prilosec. Dumb logic, but it fit what I wanted, namely indigestion and no heart problem. Really, really stupid. I was a proverbial "Stupid BCI." So I took one of my wife's Prilosec, while she checked on how to increase my life insurance because I told her I had decided I would try again tomorrow. As a short side note: one of the doctors that treated me later told me that for Prilosec to work I would have had to use it about a week. I guess that's why they say, "Don't diagnose yourself and prescribed your own medicine."
You might have guessed, I tried again running Tuesday morning. The outcome was the same as the previous three attempts. When I got home I told my wife it was time to go to the doctor. A small glimmer of enlighten thinking, you think? I took a shower and got dressed. ( My mom told me, "You don't want a doctor to see you in dirty underwear and smell badly.") Since I am retired Navy, we kick around going to the local base sick call or the Navy Medical Center (NMCSD) here in San Diego. Because my wife has been an in-and-out patient at the center for the past two years, averaging about two visit a week, and that they would probably have specialists available, as well all the necessary equipment, we decide to go to the NMCSD-ER. It was a good choice. Over the two plus years shes been receiving treatment there the staff proved to be highly competent, caring, concerned, outgoing, super, wonderful, just great, . . .. I cannot say enough good things about them and the care they gave my wife and that I was soon to receive.
On the way down to the hospital we talked about what my problem could be. Obviously, it had something to do with the heart. Nowhere in what I've read or heard did the symptoms included going away on their own. We were puzzled. I guess that's why we have doctors, duh. Could it be a lung problem. Perhaps I had lung cancer or emphysema. What could it be? I thought about dying and the impact on others. I don't fear dying. I fear the pain that might go along with it and the financial burden I would leave behind and to a small measure things that I would leave unfinished. I worried about what they might find. If it were cancer it would likely come with a lot of pain. Would I be able to continue jogging? What would be my limitations? A bunch of similar thoughts crossed my mind but luckily we reached the ER before I could cause myself a stress related heart attack.
At the ER I waited about five minutes in the check-in line; there was one person in front of me. Even when the place is crowded checking in is relatively quick, as is the initial assessment. We've been here several times before, you know, been there, done that. I presented the check-in attendant my ID and NMC card. After entering some data, he asked me was bothering me. I told him that I had chest pains when I was running. I was immediately lead over to vital signs and assessment medical technician or nurse station.
The very caring (that was my impression) attendant took my vital signs and asked my to give him the details of what had happened to me. In detail, I told him about my running and the events, as previously stated. I would repeat this story many more times. He put an ER ID bracelet on me, return my ID and NMC card and took me to see an ER doctor. I was lead into the ER medical care area. In the center was a 20' X 20' area where doctors and nurses did there paper work, used computers to check patients information and view x-rays/CT scans. The central area was surrounded by ten or twelve patient cubicles divided by colorful curtains hanging from tracks by beaded chains. Each cubicle consisted of an examination table/gurney, vital-signs monitor, medical cabinet with supplies, overhead spot light and the typical wall mounded fixtures, i.e. oxygen outlet, vacuum connection, computer network outlet and electric outlets.
I was guide to one of the cubicles (#4), turned over to another attendant who asked me to remove my upper garments and get on the examination table. A nurse joined the attendant, suggesting I relax (yeah, right, their hearts were in the right place) and then they started to wire me up. They put a bunch of tabs on my chest and then hooked up a monitor for my pulse. Then they put a clip device on my finger to monitor my blood-oxygen level. Took my temperature. And finally put an automatic blood pressure cuff on my right arm. After they finished hooking me up, the nurse asked me what was the matter. I went over my detailed explanation of my chest pains. He told me to relax, once again, while he would brief the resident ER doctor.
It wasn't long before the principle ER doctor came over. He asked me to tell him what was wrong. I retold my chest pain story, in detail. He then listened to my heart. The doctor asked me about my medical history. When he completed his examination he told the nurse to have an EKG and a battery of blood work done. Before those things were done, I was sent for a chest x-ray. On the way for the x-ray I stopped to use the restroom; it was a small mistake, because I would have to provide a urine sample soon. I managed to provide the sample but it took some work. You know, it's difficult to go when you don't have to go.
When all the tests, x-ray, and EKG were done the doctor returned to give me the (good? bad?) news. He told me that everything look fine and that I was really healthy, so he was going to get a cardiologist to review my case. I was marginally relieved to find that I didn't have lung cancer or emphysema and that my heart appeared to be OK when I wasn't running. However, I was really concerned about what it could be.
The cardiologist arrived shortly after all the tests were completed. He introduced himself, told he was there to evaluate me, listen to my heart, looked at the EKG and asked me to describe what I had experienced. I did, in detail, perhaps even adding some more data. He said, "Wow, that's text book. It's like you were reading from my medical manual." He told me it sounded like it was probably some heart related problem given my gender and age. It was most likely blocked arteries that supplied the heart. When he completed his examination and review of tests, he concluded that I should be admitted to the hospital for further tests. The testing would most likely include a coronary angiogram. I'll explain later, what it is when I get to the part when it was done. And they might want to do a stress test, logical because that's when I was having the problem. As he departed, he said, "He would start the admission process." and as an after thought, "Oh! By the way it looks like you have high blood pressure." My thoughts were, "Oh, how wonderful."
In a flash, a very affable administrative clerk was by my side. She had a ton of forms for me to fill out and sign. Actually, I just filled in some data, gave her some essential information, signed a few form and she did the rest, filling in most of the data. I secretly worried that, among my real worries, that one of the forms would allow someone to deplete my already small bank accounts, life savings or worst, take one of my body parts while I was still breathing. You can tell that my imaginations runs wild, particularly at times like this. I watched to many "Twilight Zones" and "The Outer Limits."
Then another series of blood tests and the insertion of a catheter for intravenous medicines. Unfortunately for me they had a student take the blood samples and do the IV catheter insertion. The IV catheter was put in incorrectly and although several nurses and corpsmen did inspect and perform flush tests, they did not find the error and said it was fine. They told me that there would be a bubble above the vein if it were in wrong. What they didn't know was that the needle went all the way through the vein and the flushes and the subsequent IV meds were building up in my arm -- when it was discover it looked like Popeys's arm. Fortunate, it didn't do anything bad except make my arm a lot larger, it was really swollen. Lucky for me it was found and redone when it was really needed, that is, when they administer anesthesia. Just before they started to move me the doctor had the nurse put a oxygen breather on me; a plastic tube with two small nose tubes jotting upward.
Once they had the portable monitor and the oxygen tank set, off we went. I was taken to the Cardiac Care Unit via the back allies (really, hallways) of the hospital, which also act as storage areas. When we arrived at the ward I was put in a semi-private room with an eighty-seven year old World War II veteran. Besides having similar ailments, both of our given names were Arthur.
After I was on the bed, they began hooking a portable heart monitor, connecting me to the room oxygen outlet and putting a clip on my finger to that measure blood-oxygen level. When they finished rigging me up, a corpsman put a bunch more tabs on me to run an EKG. They would run several more before I had the procedure. All of them would indicate my heart was OK, when I was lying down and somewhat relaxed. By the time I was released I had accumulated about thirty or more monitoring tab of various design; they never removed any and each time they hook me up to another monitor they used new tabs. I was still removing tabs the day after my release. As the EKG technician left, informing me the printout look good, a nurse came in and took several blood samples. She explained that there would be another set taken later and then another around 3 AM. She told me that they were looking for markers that would indicate if my heart muscles had been damaged. She also informed me that the previous samples, taken in the ER, were negative for the markers. I laid back and closed my eyes to relax, yeah right. It was 4 o'clock now and I had been in the hospital about eight hours.
Before I got a chance to rest, several doctors came by to inform me that they were planning on performing a coronary angiogram in the morning. They told me that they would put me on several medicine consisting of pills and shots. The purpose for them was also given, but I promptly forgot. I think one was for anti-clotting and another for blood thinning. One of the cardiologists remained behind to walk me through the procedure. She explained that they would put a catheter in an artery located on the right side of my groin area. Then they would extend it to my aorta where they would then inject a contrast dye while viewing the area on a x-ray machine. What they found would determine the treatment. There were three possibilities:
She continued by telling me that when they completed the procedure I would be return to the DOU (Direct Observation Unit) until the following day when I would be discharged, unless of course there were complication, for example, the need for by-pass surgery or worse. I didn't ask about the complications, I was already worried enough. The cardiologist, further told me that if I hadn't exercise it is likely I would have had this problem, probably ten or fifteen years earlier and it might have been much worse. I was instructed not to eat or drink after midnight. She then departed.
About 4:30 PM one of the my cardiac team's physician came by to tell me that they decided to do a stress test, which seemed logical to me because it was under stress (running) that I was having the problem. When the group was ready they escorted me to the stress test room, where they put a dozen or so additional monitoring tabs on me. I felt like a post-it note-board. When the hook up was completed, they ran a baseline with me lying down and one with me standing still. They were normal. When they were satisfied that all preparation were done, I was assisted to the treadmill.
While standing on the tread mill they explained that the treadmill would start slow, then gradually increase in speed and incline. I was instructed to notify them as soon as I felt any discomfort. On the ensuing test, I walked through the first two levels without any problems and told the doctors I was still fine. In a matter of seconds after the third level started I began to feel a very slight discomfort in my chest and so informed the doctors to which they said, "We can see it on the monitor." The senior doctor terminated test right then. The leads were disconnect, tabs were left in place and I was returned to my bed. The doctors confirmed I was having stress (running) related problems and that the procedure schedule for the morning would determine what to do.
Between the stress test and when I was taken to the cardiac catheter procedure room a myriad of staff came by to further brief me, give me medicine (pill and injections), perform EKG's, take blood samples, take my blood pressure and temperature.
At 6 PM I was served dinner, which my wife promptly consumed. Between mouthfuls she commented, "Well this is certainly a new way to take me out to dinner." I'm a very picky eater, she not. I settle for the coffee and a piece of pie. I wasn't all that hungry anyway. My wife and I talked for awhile after she had finished her, I mean my dinner. We decided she had spent enough time with me and that she should go home and take care of our family. The family consist of three very special dogs (two Chihuahuas and a mixed, part Malamute) as well as the cats and goats. Just prior to her leaving we also decided that she would stay home tomorrow and wait for me to call her when the procedure was completed and I was coherent.
Shortly after my wife had left, I couldn't help overhearing (I probably could have) the conversation my roommate, Arthur was having with his family. He expressed serious concerns about what was happening and didn't quite understand the forthcoming procedure, which would be the same as mine. I removed my oxygen tube, got up and sort of joined them. I asked if they'd like me to explain what was going to happen to us; I did have a good layman's knowledge of the procedure. They welcomed me (sort of the blind leading the blind) and I told them what I knew about the procedure and the three likely outcomes, that are listed earlier. I told them, base on what was going on, that we would probably be faced with either option 2 or 3. We spoke about how in the end it would help us and that we would not feel any pain during the procedure. After my rudimentary explanation it appeared that Arthur's fear had been alleviate, I went back to bed.
When Arthur's wife and daughter went home, we began swapping sea stories late into the night. There was nothing worth watching on TV; so what's new. Arthur was 87 and a survivor of Pearl Harbor. He told me he was a radioman onboard the Battleship USS California (BB-44). We told each other about our families histories and career summaries. He had a few years on me, 17 to be exact, so he had a lot more history and for once I listened more than I spoke, it was a good feeling that I need to keep up. Us old folks have lots of history. We remember a lot of the good times and choose to forget the not so good. Around eleven or eleven-thirty, I felt the day catching up on me, so I kind of let the conversation die, oops, poor choice of words. I was able to fall into a light, semi-conscious sleep that was periodically interrupted for pills, shots, blood tests and other medical monitoring. One of my wake-ups was to see if I was in trouble. My heart rate had dropped to the low thirties range.
My attending intern came by to inform me that I was scheduled to be the first one in at about nine. My thought was, "right." Well as it turned out, Arthur was actually scheduled ahead of me, however due to a blood problem they passed him by and started with me. First, one of the technicians that would be assisting, that had the procedure performed on him, came by to explain that I would not feel anything and that I would be semi-awake so they could ask me things or to move, which I don't remember if they did. Actually, I don't remember anything that took place while I was under anesthesia. Briefing completed, they unhooked me, left the tabs on, and wheel me to the procedure room.
Inside the procedure suite my anxiety grew rather quickly. I was transferred to the special table which is movable and suitable for use with the x-ray machine. There were eight to twelve doctors and technicians present, that seemed to be scurrying about. They began to prepare me for the procedure. One tech began to shave my groin area while another was preparing to start the IV. Fortunately for me he discovered that my arm with the original IV was twice the size of my other arm. He removed the IV that had passed through my vein and put a new one in, this time correctly. In the end the only problem I had was staying still while the IV was being installed because the tech that was shaving me, kept pressing against nerves that tickled and caused me to twitch. The procedure would include the insertion of a catheter in an groin artery which lead up to the aorta, where they would inject dye so they could determine if there was blockage: where, how many and how severe. In anticipation of what they would likely find, I had already given them permission to do whatever they needed without having to do the procedure a second time. The anesthesia was started and that the last thing I remember until I woke up in the DOU.
After an hour or two or more, the attending cardiologist came by to see how I was doing and explain what they had done. He asked how I was doing. I told hem I was fine. He checked my incision area and listened to my heart. He told me that one of my heart arteries had a ninety percent block that they open with an angioplasty balloon and then put in a stent. He said he would check on me again and I would be released tomorrow. I called my wife and asked her to bring me some underwear, mine had gotten lost after I had to remove them for the procedure. She was there when dinner arrived so she got to eat again. She remarked, "We've got to stop meeting like this." After she left, I read most of the time. I tried to sleep, but between being woke up for checks, pills and shot, and noise from the corpsman's watching "You Tube," it was difficult.
They got me up for breakfast and a couple of tests. Around nine the case intern came by to see me, check me out, ran an EKG and inform me they would send me home today. An hour later the senior cardiologist came by and listened to my heart. He check the incision area and told me that the discharge process had been started. I asked him if I could get dress. He said it was OK and told the corpsman to remove the monitoring devices and oxygen tube. When I got disconnected, I started to remove the monitoring tabs before I got dressed. There were more than two dozen. I was told not to shower until tomorrow evening. When I showered I found another tag that had been hidden by my under-shorts.
It didn't take me long to get dressed and be ready to go. While I was waiting to leave, Arthur's wife and daughter came by to see how I was doing, to thank me for explaining the procedure and to let me known what was happening with Arthur. It was nice of them and I appreciated it. My wife arrived just before lunch, how lucky for her, she got to eat my lunch. I got a cookie. Around two they delivered my home medications and the discharge paper. Though all of this I kept asking myself where did I go wrong? I realized that in life we face many choices. Making the best choice for most things is complicated because we frequently cloud the issue with denial and rationalizations to fit our wants. The problem is knowing when we do this. When I got home, I realized that I had been quite lucky, so to speak.
A short addendum: About a week after I was discharged, my wife had a routine follow-up CT scan for her kidney operation. We were only home a few minutes when her doctor called and told her to return to the ER. He spotted a clot in her leg that need immediate attention. He also told her that the kidney looked fine. From the ER, she was admitted to the cardiac care unit for treatment and assessment. While I was visiting her I found that Arthur was also still in the ward. I visited him and found out that he had by-pass surgery and a stent placed. He would remain in the hospital for a few more days.