Good News and a Stern Warning (Heart Sick, Pt. 4)

First allow me to apologize for taking longer than I had planned to write this. I genuinely didn’t mean for so much time to pass before continuing. All I can say is that it’s right near the end of the school year and I’ve been quite busy. And now…

To recap… the doctor who had first diagnosed me wasn’t even my own primary care physician. But I had called their office – unable to do anything but breathe very shallowly – and another doctor in the office saw me that day. It would be tough to complain about that level of quality service, and I won’t. The doctor realized there was something amiss with my heart, not my lungs, and took an x-ray of it.

Let me be clear. I saw it. It was huge. When I was referred to the cardiologist, he ordered an ultrasound. The ultrasound confirmed that I had an oversized heart and that there were going to be complications and problems.

I have an arrhythmia. In my case, it takes the form of an atrial flutter. This means that it might, for no good reason whatsoever, simply start racing. The risk of sudden death, of going into congestive heart failure is minimal. It can happen, but it would have to get up to about 300 beats per minute and stay there.

There is also an increased risk of stroke, which is why they’re pumping me full of Coumadin and trying to thin my blood out.

On its own, an atrial flutter can be managed by medication, which is the goal.

While the doctors were learning what was wrong with me, I encountered a situation and had to visit the emergency room (story told here). The ER doctor who took care of me (I think I’m going to have to call him Dr. Doug Ross because… well, he was handsome) made sure I stayed there until my heart slowed and the beat got stronger. Before I was discharged, my heart had slowed to 94 beats per minute – the lowest it had been since this whole blasted thing began. He said the rhythm was strong and the beat was steady, and it was safe for me to return home. And he also gave me some really shocking news.

I’ll get to that in a moment.

A few days later, after I’d spent time at home doing nothing but thinking, I went to the cardiologist’s office for a previously scheduled appointment. The first thing he did was order an EKG. I sat through it and waited until the results were in.

It beat at 75 beats per minute – strong, steady, and constant. He smiled at me and said with some real deserved pride, “We are now chemically maintaining your heart.”

It’s better than it sounds. It means that the various pills I’m taking had taken hold and started working. As of right then, we are able to count on having my heart working like it is supposed to. I’ll have to keep taking the various medications for some time, though he and my primary care physician both said I may not have to be on them for eternity.

There is always the chance that the atrial flutter will kick in again and my heart will start racing, but the experts say the chance of that is much less now, and will be even less in the future. Apparently a heart in rhythm wishes to stay in rhythm.

The one thing I haven’t mentioned is the first thing that I was told – about my enlarged heart. There’s a reason for that. In the emergency room, Dr. Doug Ross told us that my heart, actually, was not enlarged.

My jaw dropped, and my girl and I immediately started questioning him. He insisted that he could tell the heart wasn’t enlarged. In fact, he had the hospital’s tech take two separate x-rays of my chest, to make sure. I asked him about the first x-ray taken and described what I saw. He made a point of telling us that if a chest x-ray was taken at an angle, it could ‘shadow’ and make the heart and heart cavity look much larger.

Between leaving the ER and seeing the cardiologist, we wondered if a terrible mistake hadn’t been made. Was that first one nothing but a shadow? Why did I have a hard time breathing the first time? Was it a racing heart that sent me to the ER or just a mad, bad panic attack?

With a list of questions written up and ready to go, I waited until the cardiologist had given me all the good news and started to ask…

No. He was firm about that. The ER x-rays were not accurate. I have an enlarged heart, he insisted. I gave him the same spiel that Dr. Doug Ross gave me about angles and heart cavities and misrepresentations…

No, the cardiologist said. An x-ray is like a shadow animal made on a wall – you can see the outline and shape of what I’m doing, but you can’t actually see what’s wrong with my hands.

Assuming that’s right, I asked, what is the best way to see what’s wrong with my heart? An ultrasound, he answered. He’d already given me one.

He reminded me of the same thing that Dr. Doug Ross had reminded me – I could seek a second opinion. I decided that everything would wait until I saw my primary care physician and see what he said. I had a chance to do that a little less than a week later.

He strongly suggested that I listen to the cardiologist. This is what he does, he said. He is a cardiac interventionalist. It’s his job to intervene and save peoples’ lives.

Neither my primary care physician nor the cardiologist said anything nasty about Dr. Doug Ross’s findings. Instead, they pointed out as an emergency room physician he knew a lot about a lot of different things. But a cardiologist is a specialist who basically knows everything there is to know about his specialty – which I fell into.

I’m still considering getting a second opinion, but I haven’t yet. It’s not because of what they disagree about; it’s because of what they agree on. An atrial flutter can be managed by medication, and that’s what we’re doing. But it can also make a pre-existing situation worse… which is why I don’t think the second opinion matters that much.

I weigh too much. Up until mid-October, I was a somewhat-regular smoker of cigars. I don’t get enough sleep, I wallow in too much stress, and I’m not getting enough exercise. Oddly enough, I do eat pretty healthily, but that’s about all I’ve got going for me, healthwise.

Whether or not my heart is enlarged – and for the record, let me state that I suspect it is – it doesn’t really matter. I need to continue to make some sweeping changes in my life. Improving my heart health happens the same time that I improve my all-over health. The doctors all agree that the best way to shrink my heart is to improve everything. The more weight I carry, the harder my heart works. I’ve quit smoking entirely, so my lungs will begin to return to a like-new condition and I’ll get more oxygen into my system with less effort. Getting sleep, removing stress… these keep my heart beating well, strong, and slowly.

I received good news. It just happened to come alongside a very stern warning: fix this or nothing will change.

I’m fixing this. I’m making the changes.

More next time.

From Bad to Worse to Pretty Good, Actually (Heart Sick, Pt. 3)

Click here to catch up on what's gone before.

November 10 went wrong from the moment I woke up. Within minutes, my heart started to race. I couldn’t breathe. My thoughts muddled then sharpened. I was upstairs and needed to be downstairs. Since I was brushing my teeth when this began, I left the bathroom, grabbed the nearest clothes and my phone, and hurried down to the living room.

As bad as I hate to say it, I have suffered a panic attack once or twice in the past. Needless to say, I didn’t like it. I was familiar with the feeling of helplessness and anxiety, the racing heart, and that adrenalin-fueled desperate need to fight or fly that marked a panic attack.

I don’t think this was it, but I’m not so naïve to fail to note the similarities.

I thought I was dying. Trying to take deep, calming breaths, I sat on the couch in the living room and tried to take control. My breathing was shallow and difficult – like it was the first time – but my heart beat so quickly that my fingers began to turn red and when I tried to pick up my phone, I was unable to operate it.

I dropped the phone and sat for some time, doing nothing but taking controlling breaths, as long and deep as I could. When I had control of my hands, I picked up the phone and called my doctor. I left a message about my condition and asked for someone to call me back.

I hung up and still sat there. Taking those controlling breaths, I realized I should call 911.

I didn’t. Just about the moment I’d decided I needed to do it, I couldn’t. Oddly, I focused on the realization that I had managed to grab a few little bite-sized chunks of control, and I held onto that. It seems to me that the moment I realized that I held some control, my heart slowed just a bit.

I knew that if I called 911, I would lose control. I’d be on their schedule, I’d have to get them in the gate, and go with them in their bus, and do whatever they wanted me to. And, speaking with complete honesty, I didn’t think I’d survive that.

I needed that control.

I called my girlfriend at work and told her what was happening. I asked her to get here as soon as she could, but safely.

She did. Knowing that she was coming gave me a bit more control. Very slowly and deliberately, I took the meds I was scheduled to take a bit later. I put the pill bottles in a zip bag, grabbed the clipboard with the pertinent medical information on it, and even let the dog out to handle his early-morning business. I put on my shoes and waited.

My girl picked me up and got me to the emergency room very quickly. I sat in the passenger seat and took those breaths and tried to ignore the rapid beating.

I survived, but I’m guessing you already knew that. The staff at the hospital was tremendous. They got me triaged and in to see someone in about a minute. I grew calm and my heart slowed down. By the time I was laying in bed with all the little various wires and whatnot attached, by beats per minute were down to 94 – which is almost 40 points lower than the last time they’d checked it with an EKG.

I was exhausted, freaked out, emotional… and my heart was beating better than it had since this whole thing had begun.

My girl was as frazzled as I, if not more. I may have been the guy in bed, but she was the one sitting there next to me, asking good questions of the doctors and putting things in perspective.

We went home that night, and I had orders to stay mellow over the weekend. My doctor called the next day to tweak my meds and reminded me that I had an appointment to see the cardiologist.

The emergency room doctor had given me some shocking, but wonderful news. The cardiologist had a different take on things… but it was still good.

Next time: The Good, the Bad, and the Unimportant.

Read "Heart Sick" here.

Read "Heart Sick Pt. 2: Pills, Pills, and More Pills" here.

Pills, Pills, and More Pills (Heart Sick, Pt. 2)

I’m having health issues. We’ve established that now, right?(Go here to read “Heart Sick.”)

One of the annoyances of chemically trying to manage one’s heart – besides the possibility of it all just going feet-up with no warning – is actually taking the medication that’s been prescribed. I’m on a few things right now. Most of these I’d never heard of before being diagnosed, but now I’m becoming good friends with them.

As one of those people who really would benefit from some nifty single-payer insurance, I opted to go ahead and get the generic of everything, providing it did the same thing – which it does.

Having the name brand didn’t mean a darn thing to me. It’s not like I was going to be showing off my pill-bling at the 7-11. I just went with what was effective and what was relatively cheap.

Everyone knows these blasted things by their bling names, though, and it’s easier to just refer to them that way. So when I say I’m taking the blood-thinner Coumadin, I’m actually taking the generic version Warfarin. And let’s be honest, that has a much cooler name.

I’m also taking Digoxin and Cordarone to keep my heart beating regularly and slowly, and on Furosemide to get excess water and salt out of my body. And I’m taking a metric poo-ton of Potassium, because that also tends to get washed out by the water pills.

It’s the combination of side effects and warnings that are the most fun. These cover most of the usual medication side effects: nausea, dizziness, dry mouth, you know the kind. But they also have some really spiffy ones, like possibly losing short-term memory, liver damage, and… something else. I can’t remember.

That was a joke. Rest easy.

I can’t have ibuprofen or aspirin, since those may affect the blood-thinners. So when I get a nasty headache, I have to take Tylenol instead. As far as I’m concerned, that’s like a painkiller on training wheels.

I also have to watch how much leafy greens I can have. I can’t have cranberry juice, cranberry sauce, grapefruit juice, or grapefruit. And – even better! – I get to have blood drawn at least once a week to see how all these are working.

Woo boy. Good times.

I can’t stand needles. I used to be phobic about them, but over time that’s gone away. I still don’t like them. I also don’t like taking excess medications. Grapefruit juice and cranberry juice are two of my favorite things. And when a migraine comes roaring in, I want nothing less than real aspirin to go to work on it.

But those are fairly unimportant in the scheme of things. If it will help keep me going, I’ll make all those changes, take all those pills, have blood drawn every week, and miss out on all the rest.

Man, I want some cranberry juice.

Heart Sick

I am sick. I found out on Halloween that I have an enlarged heart. This discovery has already forced numerous changes in my life – none of them I am really happy about, but all of them I must accept.

Because not only is my heart oversized, according to the cardiologist, it’s also weak and arrhythmic, beating two or three times as fast as it should. If the doctors are unable to come up with a plan to treat me, and I am unable to commit to that plan, it’s a certainty that this big heart is going to kill me.

IT’S BEEN A LONG WEEK

Tuesday before last, I attended a journalists’ awards ceremony in San Diego. My throat was a little sore, but I felt fine. By the time I drove home, I had started to feel bad. Wednesday morning I was sick – quite sick. I left home only on Friday night, to attend a math class and take a test that simply could not be made up.

Made me happy, that did not.

But I survived, and still feverish, went home that night and collapsed. Saturday was little better. Around 3 am on Sunday morning, my fever finally broke and I fell into real sleep for the first time in days. Sunday was a good day – I did laundry, ran errands, felt great.

Monday morning I ran down two flights of stairs, grabbed some towels and a bath mat from the dryer, tossed my t-shirts and socks into the same dryer, and ran back upstairs to shower. After that, I took my fine dog, Adam, for his morning walk – and ended up just a bit winded. That’s unusual, since I love to walk, but I ascribed it to the lingering tendrils of illness.

After that, I ran downstairs, grabbed my t-shirts and socks, and ran back upstairs…

I thought I was going to collapse. I couldn’t breathe. I simply had no wind. I had to sit on the bed for almost ten minutes, trying to catch that breath. I am no dummy, so I walked slowly back downstairs to my phone. I was breathing hard when I got downstairs.

An hour before my noon aquatic class, I called in and said I couldn’t attend. An hour after that, I was on the phone with my new doctors’ office, trying to get an emergency appointment. At 3:30, I arrived at San Diego Sports Medicine to meet with a doctor who was helping out mine. I assumed there was an asthmatic or bronchial problem that had to be addressed.

After listening to my heartbeat, he said he wanted to do an EKG. I’m a firm believer in doing what a doctor wants, so I said “sure.” Already deeper into this than I imagined, I lie still while they did their work. After that, the doctor said he also wanted to do a chest X-ray.

I was starting to worry, but not that much. After all, I’d had a full physical in June, had my blood tested, and have seen a doctor about every six months for years.

I’ve never quite felt a bomb go off in my lap – not until the doctor told me, “You have an enlarged heart.”

He showed me the X-ray because it was clear I didn’t believe him. To my best visual estimate, it was somewhere between one-and-a-half and two times as large as it should be.

It turns out that the shortness of breath wasn’t a bronchial issue. My heart is so large that it is pushing against my lungs, stealing my breath. When I wheeze or cough, it’s not because of my lungs, it’s because of my heart.

I have no real history of heart disease in my family. My family has always trafficked in cancer. But my girlfriend’s dad – who I was never able to meet, but would love to have – died of an enlarged heart. I knew this was serious.

WHY WRITE ABOUT THIS?

I’ve spoken with several people who would be impacted by this. I have the blessings of my parents to do this, and a slightly concerned blessing from my girlfriend. Khari Johnson, the editor-in-chief of Imperial Beach Patch, said that he was okay with doing this, but insisted that I don’t allow it to become a stressor.

Max Branscomb, my journalism professor and the publisher of the phenomenally bad-ass Southwestern College Sun that I write for, told me to go ahead and do this if I wished, but he also made it clear that it should never take over my life.

It’s not going to. Let me assure you of that. I felt an urge to write about this, and I still have that urge. I need to make clear why I’m doing it.

There have been blogs and essays and brilliant writings by people who know they are going to die, and there have been even more versions written by people who are working to recover.

I don’t know what’s going to happen. I will be making two or three trips to San Diego each week for a while, having tests done and medications tweaked. Right now, we don’t really know the exact nature of the problems or if they can be fixed at all.

This could end in a few weeks or it could go on for a long time. I have no way of knowing. I am writing this believing that it’s going to end in one of two ways – with me happily detailing my new lifestyle and continued existence, or with a short note on this blog saying that will be last one.

I’m crying a bit as I’m writing. I rarely cry. I think that’s why I’m writing it down. Because I just don’t know.

WARTS AND ALL

One thing that I knew from the beginning was that this was going to be a “warts and all” version. I’m not going to gloss it over. I want no part of a glossy, easy-on-the-mind version. I want people to realize how fast, and how hard, this can be. If you are willing to stick with this, I see no reason why I shouldn’t be honest.

For the sake of privacy, I’m not going to name my doctors. They didn’t sign up for this, and all of them have done, or are doing their best to keep me alive. I’m going to return that respect.

Here we go…

I am a big guy. And by big, I mean, “really tall and really fat.” I am the guy that comes into a room and causes people to say, “Holy crap, that’s a big guy.” And they don’t always mean that in a good way.

I get that. I understand. I’ve been a “big guy” since my college days. I held it to a minimum for about a decade, but a series of sedentary jobs created a situation where I ate, ate, and ate, but never got enough (or in some jobs, any) exercise. I blame no one except myself.

But for the past fifteen years, my health has actually been pretty good. I’ve seen doctors pretty regularly, I’ve eaten better than you think, and I’ve kept tabs on my various issues. This past June, my doctor did a full battalion of blood tests on me. My blood sugar count was outstanding and my cholesterol total was about 117.

A few years ago, I started working to lose weight. Nothing happened. I started eating much healthier and getting more and more exercise. I didn’t expect to be svelte for swimsuit season, but I did think I should lose a few dozen pounds without any problem.

Never happened.

Last winter, a doctor suggested I try the lap band to lose weight. I told her I preferred to lose weight on my own if I could. Since then, I think I’ve lost a few pounds, but not more than that. During that time, I’ve eaten much less, walked much more, and started spending a couple days a week in the pool, swimming and exercising. By any human standard, I should have lost a lot of weight. It hasn’t happened.

So my June visit also included a look at my thyroid levels. According to the test results, there’s no problem with my thyroid. My blood sugar and cholesterol are excellent. I was told that both my heart and lungs were strong. But I was fat.

Quite possibly, at the time I had an enlarged heart.

LONG-TIME OR RECENT?

The cardiologist informed us that either my heart has been growing a long time, or that a recent viral infection could’ve caused it. I worry about both.

The long-term scenario seems impossible. In the past 15 years, I’ve been examined by four different doctors – none of whom reported anything about it – and I was seen in two different emergency rooms (for unrelated issues). Nobody said a thing about my heart, except that it always beat strong.

The recent scenario seems more likely, particularly if this illness last week may have triggered it, or somehow made an existent problem worse.

But I worry that if my heart can swell and grow and affect my lungs the way it has within a week…. then I worry that it is even more dangerous to me right now.

WHERE ARE WE?

For now, I have been told to rest and not exhaust myself. That’s extremely hard. There’s a lot that exhausts me right now. Starting Monday and Tuesday, I went from taking no regular medications to taking five. I have medications to slow my heart, medication to remove water from my system, and medication to thin my blood. 

They’re afraid of clotting causing a stroke, you see.

Personally, I don’t expect that this will last long. The first action of the cardiologist was to get me on meds to stabilize my heart so I can breathe easier.

I suspect that very soon I’ll be breathing fine again. But I’ll still have an enlarged heart that’s both arrhythmic and weak, and I’m going to have to follow any course of healing that will salvage it.

I have at least two visits to doctors next week. One is a follow-up visit to the cardiologist. I have questions about the medications, about what I can and can’t do, and about the road we’re traveling.

The other is a lengthy visit to my primary for tests and a new, complete workup.

And there we are.