Alternate Voice

So the last time Dr. Garg worked on my heart in October, he told me that the locations of the further known blockages made the prospect of using stents to prop them open untenable. He would just be pushing this nasty arterial plaque out from one location into another at a junction of arteries,  possibly causing more damage than it would fix.

So I’m hoping this bypass thing can be put off as long as possible. At least I had until the next stress test in June (09) and then I was hoping he’d tell me another 6 months. This was not to be.

I took the Stress test on June 1. It’s called a nuclear stress test because they inject you with a a radioactive trace dye and then put you on a treadmill.  The treadmill starts off slow and then gradually builds to a fast walk up a sharp incline. Your heart is beating at it’s max rate and you feel the pain starting to creep up your left neck to your chin and around your shoulder and down your left arm. I made it all the way to the highest level and am hardly breaking a sweat but I am breathing hard. I can feel the pain.

Next they put you on a table and take pictures of your heart. The nuclear dye will show areas of the heart where the blood flow is diminished. So they have done this twice, once at rest with no strain on the heart and once after heavy stress.  The news is not good. I felt it during the test and now it’s confirmed. Dr. Garg is not pleased with what he is seeing.

Friday rolls around and I’m back in the Cath Lab at Fairfax Inova Hospital. I’m becoming an old hand at this and know the drill;  I tell the nurses who come to prep me for the catherization procedure. When I had these done before I was not exactly awake. They use a drug called Versed. Versed has the property of letting you be awake but totally unaware of the passage of time. You think you’ve been only laying there for a few minutes and are asking when they’re going to get the ball rolling when in fact they’ve been done for 5 minutes and are just wrapping things up. Cool.

Dr. Garg saw what he feared. The blockage was progressing and could not be stented. He suggested I make an appointment to see the surgeon as soon as possible.

I’ve had Coronary Artery Disease (CAD) for some time. This means the arteries in my heart are slowly narrowing due to plaque buildup. I first had a near miss with a heart attack in 1998 when I was living in San Diego. I was 49. The Cardiologist who treated me, Dr. John Gordon, noticed that my Left Anterior Descending Artery  (also known as the Widow Maker) was 90% blocked and also that another main artery was 100% blocked and had been for some time. He noticed that I had grown my own bypass called a collateral. Whew! He stented the LAD and left the other alone. All was well for 10 years.

Then in 2007, I was out walking my dog at 10:30 pm on the friday before Labor Day and boom, a lead weight fell on my chest. The pain was pretty intense and did not stop when I stopped moving. Somehow I made it back to the house (about a 1/4 mile) and called 911. I spent the Labor Day weekend in ICU and then got a few more stents on the next tuesday including opening up the original stent which had closed down.

All was well until a year later when I woke up in the middle of the night with severe angina. I took some nitroglycerine tabs and waited until first thing in the morning and then had a neighbor drive me in to the hospital. Two days later I had another stent put in.

This disease was progressing and nothing was stopping it – not diet, exercise, statins or any other medicine. My Cardiologist , Dr. Jayat Garg, told me that there was another blockage that would not be stentable and the only eventual option was a Coronary Artery Bypass Graft – in other words open heart surgery. Oh shit. Chest cracking time.