I was a little disconcerted when I found out from a cardiologist today how utterly blocked some of the arteries that wrap around my heart are. Not talking about the aorta here — I’m talking about the arteries that supply the heart itself with oxygen. One of them is completely, 100% blocked. One is 80% blocked.
I asked “then how on earth am I not in serious trouble”? The cardiologist said “fortunately, you seem to have a lot of redundancy here. That one there is blocked, but this other one over here is still able to supply that area.”
Diet and exercise are not likely to ever open those up; it’s a case of trying to keep it from getting worse. I may have had a mild heart attack with few lingering symptoms, but I still have a time bomb in my chest.
As I mentioned in this blog post on September 18, I had a mild heart attack sometime in the wee hours of September 13. I went in to the ER the following day (d’oh) and was promptly admitted, poked, prodded, and eventually catheterized before being discharged with three new prescriptions and a whole lot of follow-up appointments.
So: I am doing well.
Correction: I am doing really well.
It’s just plain strange, but within a day or two of being discharged, I stopped feeling any lingering pain in my chest, any excessive fatigue, any anything out of the ordinary. I got back to feeling pretty much 100%.
I went for a two-mile walk the day after I was discharged. I would have turned around if I’d felt even the slightest discomfort or warning sign. I think I might have been a little tired at the end, but never felt excessively weak or in pain. Otherwise, I was just fine.
I walked another mile on Saturday (there’s a story behind that one mile1On September 6, I was appointed to fill a vacant seat on the Richmond, Vermont town selectboard. The seat was open because of a resignation six months into a three year term. I will serve until Town Meeting in March 2022 at which point in time I’m welcome to run for the remaining two years of the term. One of the first things I had to do as part of my official duties was perform a ‘site visit’ of a Class IV road in our town, a road that exists on the maps but has become completely overgrown and all but invisible. The people abutting the “road” have petitioned for it to be officially discontinued. The “road” was only a half mile or so long but it was a bushwhack and a half., but again, felt fine afterward.
The following day, Sunday, people at church who’d heard about my heart attack were poleaxed to see me wandering right on in, none the worse for wear. After church, Carole had an English country dancing event to head out to and I had nothing better to do, so I had her drop me off at an intersection about seven miles from home. I walked on home from there via relatively quiet Vermont dirt roads. Amusingly, a couple of miles from home a passing car came to a stop and the very bewildered driver called out “Jay?”
I didn’t recognize the driver at first, but it turned out to be a member of our church whose husband had helped Carole by driving my car home from the hospital while I was an inpatient. Thus, she knew perfectly well that only three days earlier I’d been in the hospital for a heart attack. The last thing she expected, I’m sure, was to see me toddling down the shoulder toward her, not a care in the world. I assured her that I was taking breaks and making sure I felt okay, which I was, and I gave effusive thanks for the help she and her husband had given Carole with my car and everything. She seemed a little doubtful about me being out walking so soon after discharge, but I told her I was fine and we went on our separate ways.
I was completely prepared to wake up Monday morning regretting that seven mile walk on Sunday.
Nothin’. I felt fine.
I walked five more miles on Wednesday. On Saturday, I walked eleven miles and then went for an eight mile bicycle ride with Carole. I wore a Fitbit Versa 3 GPS-enabled fitness watch, which tracks my heart rate among other things, and the post-walk and post-ride heart rate plots showed I was never really laboring, never actually even getting up out of the base heart rate zone (well, except for the bicycle ride, because there’re a couple of hills along the route we took that do tax me a little bit).
As for my blood pressure — it’s been fantastic. It was fantastic the day I got home and it’s stayed fantastic. 112 over 79, stuff like that. Sometimes lower. Before the heart attack, before a change in my medications, my systolic blood pressure was rarely below 135. Without the medication I’d been on, it was usually over 150. Now it’s routinely in the 110-115 range. It’s almost surreal to sit down and take my blood pressure and see numbers like that after so many years of seeing the display turn an angry red or amber when the check completed. It’s also possible the Roto-Rooting the cath lab did made a difference by opening up key blood vessels.
I have been carefully tracking my sodium (2000 milligrams of sodium per day, max, which is slightly lower than the RDA of 2300 milligrams per day), saturated fat, and overall calories. I’m trying to lose weight to get down from my current weight of 220 pounds or so to a more reasonable 190-195. I had a “bwah!” moment a couple of days after my hospital discharge when my scale showed me weighing ten pounds less than I’d weighed a week earlier. All I can say is, one or more of my new meds must be a hell of a diurectic, or cutting sodium has worked wonders, or both, but either way, that big of a drop has to be a lot of water being shed.
I had intake for my cardiac rehab program this past week and I have a stress test scheduled for Tuesday morning. After that, I’ll start three-times-weekly cardiac rehab sessions… but as I’ve said to several people in the last few days, the cardiac rehab folks are going to be very confused by one of their new patients rattling off the miles and miles they’ve walked lately. I think part of rehab is walking on a treadmill while connected to an EKG, which makes sense, but otherwise, there’s a certain amount of humor in the idea of them saying “yeah, we need you up on the treadmill, got to get up out of your chair and get you exercising.” (No, I’m not out running or anything really ambitious like that, and I follow a few friends on Strava who go out every weekend and bicycle eighty miles straight up mountains, but I suspect that compared to the average heart attack patient, I’m doing a lot better than most.)
My co-workers have been nonplused, to say the least, by my coming right back to work without taking any time off. I put in four hours the day after my discharge and worked more or less normal hours this past week (except for time spent at various appointments). They think I’m crazy, or really driven, or both. A couple of co-workers who’ve had their own heart problems have been very supportive and full of good advice, for which I’m grateful, but it’s been a little hard to tactfully get across that not only am I already doing all the stuff they advise me to do (watching sodium, trying to do a Mediterranean-style diet, etcetera) but that I’m already feeling this well. I’ve had a few things recommended to me (like Coq10 enzyme pills, or adding a lot of ground flax to my diet) that sound interesting, but I’m going to talk to a doctor first.
Long story short: I feel really weird and confused about this whole thing. The hospital swears I had a heart attack, based on the troponin levels they saw in my system, which kept climbing for the first day and a half before finally starting to go down a day after the catheterization. I don’t know what else they saw on the ultrasounds or chest x-rays or EKGs, but they were quite clear, I had had a heart attack and I had a lot more plaque in my blood vessels than they would have expected for a man my age.
So why do I feel weird and confused? Well, it’s like getting diagnosed with cancer, going in for one treatment session, and seeing it just plain gone afterwards. You’d almost wonder if you ever really had it, right? Or to use another analogy, it’s like telling your parents that you’re too sick to go to school one day, only for one of them to come home early and see you out back jumping on the trampoline without a care in the world. One possibility, in that case, is that you miraculously got well really quickly, but the more likely possibility is that you were faking it.
I have to wonder if people aren’t wondering “did he really have a heart attack? Maybe it was just indigestion!” because I am totally not feeling or behaving like someone who just got out of the hospital after having had a heart attack. I’ve had co-workers ask me if I need or want them to bring meals by, help with errands, anything like that… only to be told “No, no, I’m good, I just walked ten miles, I think I’m recovering fairly well.” There’s a term for faking illness to get attention: “factitious disorder” (also called “Munchausen syndrome”). If I didn’t know better, I’d think I was faking the whole thing.
It also worries me a little bit that my experience might cause others to take their risk of heart attack a little less seriously than they ought to. You know, “Jay had a heart attack, and a few days later he was back wrestling mountain lions, it’s no big deal.”
I have a follow-up appointment with a cardiologist this coming Friday. It’ll be my first chance since being discharged to sit down and ask someone who would be in a position to know how severe my heart attack really was and whether there was anything on the ultrasound or X-rays or EKGs that would have helped spot this sooner.
For what it’s worth, some of you might be thinking “I hope the fact that he recovered so well, so quickly, doesn’t make him take rehab, diet modification, losing weight, and so on, and so on, less seriously.” I’m taking those things very seriously. I don’t ever want to find out the hard way what a bad heart attack is like.
On September 6, I was appointed to fill a vacant seat on the Richmond, Vermont town selectboard. The seat was open because of a resignation six months into a three year term. I will serve until Town Meeting in March 2022 at which point in time I’m welcome to run for the remaining two years of the term. One of the first things I had to do as part of my official duties was perform a ‘site visit’ of a Class IV road in our town, a road that exists on the maps but has become completely overgrown and all but invisible. The people abutting the “road” have petitioned for it to be officially discontinued. The “road” was only a half mile or so long but it was a bushwhack and a half.
I woke up Monday morning with a sore left arm and a bad case of heartburn. I rationalized the sore left arm as having strained it carrying heavy scuba tanks and dive weights on Saturday. I don’t know how I explained the heartburn, though, because taking Alka-Seltzer and Gas-X and Zantac did absolutely nothing to help with it. Being stupid, though, I took Tylenol for the pain and got on with life.
Until Tuesday, when the symptoms were still there and not going anywhere. I did a telemedicine appointment with some doctor or another using Teladoc (which my insurance and employer encourage us to use) and the doctor had been on the call with me maybe five minutes before he bluntly told me to get a cardiac workup at an urgent care clinic or something ASAP. I called my primary care physician’s medical practice and my regular PCP was unavailable, but the doctor they could squeeze me in with basically said “Don’t bother coming to see me, get to the ER.”
I wasn’t too sanguine about that, given that our local hospital, the University of Vermont Medical Center, has been lambasted in the media recently for really, really long wait times to get scheduled for specialist services… not to mention Covid-19 patients taking up hospital resources in the emergency room and elsewhere. So I grabbed a thick book and headed on in to Burlington and to the ER.
The ER waiting area was maybe a third to a half full, which boded well. I checked in at the desk — they already had me in the system from seeing various UVMMC doctors over the years. When I said “I need a cardiac workup” the reception clerk said “Chest pains?” I nodded. She said “Take a seat, we’ll call you.”
And what happened next was, frankly, amazing. Almost as soon as I sat down, I was immediately called back up and was whisked into the mazy environs behind the ER desk where they promptly did an EKG. They sent me back out to the waiting room and again, almost as soon as I’d sat down, they called me BACK in and proceeded to do ultrasound and two chest x-rays and take multiple blood samples. “You had a heart attack,’ they said. “Your heart releases an enzyme called ‘troponin’ after a heart attack. Based on your level of troponin, you had a mild heart attack — it could have been much worse, but you definitely did have a heart attack.”
Within an hour I’d been formally admitted and was parked in a bed in a room that used to be the pediatric emergency area (it had all sorts of cute art on the walls) and was scheduled for heart catheterization the next morning, Wednesday. I didn’t get into a real bed (as opposed to an ER bed) until 11 pm or so, but then it was in a nice room on the fourth floor of the Miller building at UVM, the cardiac care floor. Every four hours or so while I was there they did more blood draws to keep an eye on my troponin levels; they kept climbing slowly and minutely but consistently.
I don’t remember much about the actual heart catheterization because once I was on the table where all the magic happens — where they inject the dye and watch your innards on the big screen and then send in the catheter and stents — they’d given me some sort of happy juice in my IV drip that was supposed to leave me awake but not in pain, but in actuality, basically knocked me out. I don’t recall sleeping but I do recall thinking I’d been there five minutes and then asking “Have you started yet?” only to be told that they were actually almost done.
The attending physician was blunt after the procedure was over. I asked how much plaque they found and he rather firmly said “A lot more than we expected.” But that’s why they wound up putting in four stents. They were not able to clear all the minor vessels around the heart but hope to get some of those cleared via the cardiac rehab outpatient program, which I’ll be starting in this coming week. Later on, when I had another chance to talk to him (and after multiple people had mentioned the importance of a low sodium, low saturated fat diet) he said “well, a lot of it is probably heredity. You mentioned a family history? High BP and multiple heart attacks and such?” It’s vaguely comforting to be able to blame my genes for the wretched state of my coronary arteries but it’s also a bit embarrassing to have “a lot more than we expected” at the age of 53 (I turn 54 on Monday, but I was 53 at the time).
I was kept inpatient until my troponin levels started to decline; they kept going up throughout Wednesday and on into Thursday morning. It wasn’t until they analyzed the 9 am blood draw that the troponin had finally begun to go down and I was safe to release.
I can’t say enough about the staff at the hospital. Every single person I encountered, from resident to fellow to nurse to attending, you name it, was extremely courteous. Every question I asked — and I asked a lot of them — was answered thoughtfully and fully, without any of the “oh, you wouldn’t understand, it’s all medical stuff” that I might have expected. I was also just flat-out amazed at how fast they got me back there and started administering care. I didn’t get a chance to even crack that book I’d taken along until along about 10 pm or so the first night; I was always being whisked from one test to the next. (I got three ultrasounds, including one in the middle of the night administered by a rather worried looking doctor that I didn’t encounter again while I was there, so I don’t know what that was about.)
I’m also very grateful to Carole, who didn’t say “I told you so” even once and who came to visit multiple times — Tuesday evening and twice on Wednesday — to see how I was doing and let me know she cared. She knows that going forward some things are going to have to be different around our house; we need to work on reducing stress, balancing chores more evenly, cooking with a LOT less salt (she can add more if she misses it) and avoiding fat, and getting a lot more exercise.
I got a ton of walking in over the winter — going out at night with an orange reflective vest and headlamp on and walking in the dark, in the snow… but come spring, work got so busy that I was often still at my desk at 9 o’clock at night and was too fried to walk. Two things have to change there — one, I have to balance work/personal life better and not BE working at 9 pm, and two, I have to get back in the habit of exercising. Since I have the 2021 San Diego Susan G. Komen 3-Day breast cancer walk (sixty miles in three days) coming up in mid-November I really need to get a lot of walking in.
I feel extremely lucky. Like “six standard deviations from the mean” lucky. I live near a major medical center and in an area where people have taken Covid-19 vaccination seriously. I’ve got insurance, which thoughtfully emailed me a letter the day after I was discharged informing me that they would, indeed, cover the whole thing.
Now I just have to be worthy of that luck and take my own health much more seriously. I can’t guarantee I’ll be so lucky a second time.
Parenthetically, I’m on a caffeine fast. I started on Sunday and am most of the way through a week and am doing pretty well.
This will be the second time I’ve tried weaning myself completely off caffeine. The last time I tried was a decade or more ago when I tried going cold turkey at the beginning of Lent. I had been drinking in excess of a pot of coffee a day at that point and all sorts of bad things were happening, like my nodding off behind the wheel of a car because my sleep at night had been so poor. I wasn’t able to function at all going cold turkey so I cut back to one cup of coffee a day and then went cold turkey again with two weeks to go in Lent. And I survived. My head felt like it was stuffed full of cotton balls for a while there but I managed to tough it out. I stayed off caffeine entirely for six months to a year before slowly adding back caffeinated sodas and tea, but I never did go back to drinking coffee. I’ve managed to rationalize consuming other caffeinated products by saying “well, at least it’s not coffee.”
But with all that said, I can truthfully say that I’m not (currently) the kind of person who needs a cup of some hot caffeinated beverage just to get going in the morning. Some days I don’t have any at all and some days I have a whole pot of tea. But it’s not a “I have to have it to function” kind of thing.
Now, though, I’m trying now to cut it out entirely. No Excedrin, no caffeinated tea, no caffeinated sodas, much much much less chocolate, and so forth. I’m doing this for two reasons:
Insomnia. I have terrible insomnia. It seems to have no direct, obvious connection to caffeine; I sleep just as badly on days I have little to no caffeine as on days that I have plenty. But with my doctor trying one thing after another and in ever increasing doses with little to no beneficial effect, it’s worth a try to see what happens if I just cut caffeine out entirely.
On the way down to North Carolina for our Outer Banks vacation, Carole and I listened to most of an Audible Original audiobook titled “Caffeine: How Caffeine Created The Modern World” by Michael Pollan. Pollan made a good case that without caffeine, the Industrial Revolution and the era of colonization would never have gotten off the ground. (Ask yourself when London suddenly had coffeehouses on every corner and then ask yourself what else got going around that time.) But he also compared caffeine to other psychoactive drugs and pointed out that many of us will literally never know what the world would be like without the brain-altering effects of caffeine in our system. He talked about his own caffeine fast and what it was like before, during, and after and I found myself going “you know, it’s probably time I tried one of those myself.”
I don’t regard abstinence from caffeine as an especially virtuous thing. It’s just that there’s always been a part of me that resents the idea of being chemically dependent on something. I’ve never smoked, never done narcotics, and while I do drink alcohol on occasion, I remember acutely what an ass I was back in college when I drank a lot and consequently try to avoid repeating that mistake. I don’t think my life will suddenly be transformed into something magical and wonderful with bunnies and rainbows and stuff overnight, but I do hope that getting caffeine out from behind the steering wheel could have some beneficial effects.
I’m a long-time member and supporter (and former treasurer and board member) of NAMI Vermont — the National Alliance on Mental Illness, Vermont chapter.
As someone who suffers from depression, anxiety, ADHD, and borderline personality disorder, I depend heavily on the efforts of NAMI to advocate for the rights of those who suffer from mental illness, to make sure treatment and care is available to those who need it, and to offer support from peers and for families. There are few nonprofits out there that matter more and that touch so many parts of our lives.
This October 9, NAMI Vermont will hold its annual fundraising walk in downtown Burlington, starting at the Unitarian Universalist church at the top of Church Street. The event starts at noon. All are welcome.
I am captain of a (currently very small) team called “Music for Mental Health” and it would mean a lot to me if you would join our team and help raise funds, or, if that’s not an option, sponsor the walkers on our team.
So some of you may be active enough on YouTube to know that you can’t “monetize” your “channel” unless you have over 1000 subscribers and over 4000 hours of viewers watching your videos in the last 12 months. Monetization means you can add advertisements and such to your videos and get revenue from them.
OK. Deep breath.
So I’ve been getting notifications every day of one or two people subscribing to my channel. No idea why they’re doing it, but there they are, regular as clockwork, one or two notifications a day. And today, I apparently crossed the 1000 subscriber mark — and, as it happens, have also exceeded that 4000 viewing hours mark.
I say this because, today, I got the email everyone wakes up every day of their life hoping to get:
But — the question inevitably comes up: what the hell are they watching?
I don’t have that many videos on YouTube. And nothing I have out there is worth watching unless you either know me well or you’re really bored.
The views kind of drop off after that — a video of my wife’s sometime concert band playing the theme from Hogan’s Heroes, the local minor league baseball team’s mascot shaking its ass at the opposing dugout, and a 360 degree video of the Richmond, VT July 4th parade. And so on down from there.
So I have to ask: what the hell is it about cement mixer trucks? And ice cream trucks? I mean, really?
And what makes a person, after watching three minutes of cement mixer trucks driving by, go “I don’t want to miss any more videos like that — I’d better subscribe!”?
Carole has had both her shots — several weeks ago, in fact, through her employer. She works for Burlington Housing Authority and they have a population of elderly residents in some of their buildings, so as it happened, the state went ahead and offered all BHA staff shots at the same time those elderly residents were getting theirs. Nice!
I had to wait until this past Monday to get my shot — I didn’t qualify as part of any priority group so I had to wait until Vermont allowed the 50+ cohort to register. My appointment was for Monday, April 5 at Montpelier High School, about a half hour from my house and less than a mile from the Vermont state capitol. It was apparently State Employee Volunteer Day at the Montpelier vaccination center; lots of the people doing non-medical tasks (like reading off screening questions, taking temps at the door, checking people in and out) were state employees who had been given paid time away from their jobs to go help out. I was signed in, for example, by Vermont’s current Lieutenant Governor, Molly Gray.
I received the single-dose Johnson and Johnson vaccine instead of one of the two-dose vaccines — that was just what the vaccination center had that day. No need for me to go back and get another shot, so I guess I should circle April 19 on my calendar as the day our household will theoretically be 100% safe, or as safe as safe can be.
For some strange reason, a New England Cable News reporter and cameraperson singled me out from the dozens of other people arriving for their shots and filmed me at several stages of the process. I got filmed getting my temperature taken with one of those forehead thermal scanners, got filmed getting checked in by Molly Gray, got filmed getting the shot, and got filmed in the hallway outside after it was all over and asked my opinion about what the governmental employees volunteering meant to me and how I felt about getting vaccinated. I gave permission and signed a release and all that, but I still don’t know why they looked at me out of all the others and said “Him!” Perhaps I just looked so utterly completely middle-of-the-road safe/boring that they figured I’d make for a good vox pop.
The footage aired that night on local NBC channel WPTZ and on the NECN cable network itself. If you’re really, really bored you can watch the WPTZ version here. The NECN version, which is a bit longer and also features Vermont’s Governor, Phil Scott, getting his vaccination, is here.
We hadn’t either until recently. One day, when I was grooming our oldest cat, Marie, I noticed that she had a strange raised lumpiness on her skin about halfway down one side. I thought at first it might be scar tissue from the time Carole cut her skin open trying to trim matted fur (Marie does not do a good job cleaning herself) but it turns out that that cut was on her hip; this was on her side.
We took her to the Richmond Animal Hospital and they’d never seen anything like it; they took a cell sample and sent it off to be analyzed but the results were inconclusive. They asked us what we wanted to do and I said “well, I’m open to surgery if that makes sense”. So they first tried to schedule us in at the Peak Veterinary Referral Center in Williston, but they were scheduling out to January. So the vets here in Richmond said they’d do it. They shaved Marie basically bald on that side of her body and found that she had not one, but four of those strange lumps on her side — one large and three smaller. All were removed, stitches were put in, and the tissue was sent off to the oncologists at Peak.
We took Marie back a couple of weeks later for the stitches to be taken out, and then yesterday we took her to see an actual oncologist and dermatologist at Peak. Their conclusion: feline progressive dendritic cell histiocytosis. It’s not at all common. Something similar apparently happens more often in dogs and in dogs apparently the lumps go away of their own accord.
In “a proportion” of cats (don’t you love medical trade journal terminology?), the disease leads to tumors and stuff internally, so they suggested an ultrasound and an X-ray. I don’t know what I would have done if they’d come back and said “OH DEAR LORD IT’S EVERYWHERE” but they didn’t — they came back and said there were no signs at all of anything unusual.
Throughout all this, Marie has had her regular appetite and hasn’t shown any signs of feeling bad, so we’re hoping that this is just one of the lesser cases that doesn’t progress any further. They did recommend we have her checked every three months or so to see if her lymph nodes have enlarged or anything like that.
What makes me bring all this messy feline medical data up here on Facebook is the cost, frankly. I think we’re up around $2,500 in bills so far — initial exam and labs, surgery, removal of stitches, visit to oncologist/dermatologist with ultrasound and x-rays… it’s all cost a lot. And yet, I’d do it again; Marie may not be the friendliest cat (she was, we assume, abused in the house she lived in before she wound up at the Humane Society) but I want her to be happy and healthy. I wasn’t about to go “well, we’ll just let it run its course and if she starts feeling bad, we’ll have her put to sleep.” She’s a family member and she deserves to be treated like one.
But that said — we’re very fortunate that this expense, while frustrating, is something that won’t absolutely wreck our household finances. As I sit here thinking about this, I can’t help thinking about (and feeling bad about) all the people out there who aren’t in a relatively Covid-19-proof line of work and who couldn’t possibly afford all this… whether for a cat or an actual human member of their family. It pisses me off that Senator McConnell and others are playing politics with stimulus checks — and that we’re in this dire economic situation because our “President” had his head firmly up his ass. People shouldn’t be in a position of deciding whether to get health care for their family (human or cat) or, instead, afford to buy groceries.
(I should mention that this episode just reminds me again how terrible cancer is. Marie’s condition is not even technically cancer, I think… but worry over her “strange lumps” was upsetting enough when it was a cat. Now imagine how bad you feel and how worried you’d be if a loved human member of your family got a diagnosis of cancer and found that it was already metastasizing. Cancer may be inevitable, but no one should have to make choices such as “well, I have to divorce my husband so I’ll qualify for this low-cost insurance program that will treat my cancer”. No one should have to worry about the cost of necessary treatment for life-threatening health conditions. Our society is beyond f___ed up. Our priorities are crazy wrong.
The documentary is about Me2/Orchestra, the world’s only orchestra dedicated to people with mental illness and their friends families and allies. The documentary was filmed in 2017, went through post-production for a year and some change, and has begun being shown at film festivals. Tonight, however, will be the first time that it airs on national television.
I mention this not because of vanity, but because I think it’s a really worthwhile film that a lot of people will enjoy and learn from. Me2/Orchestra has changed many people’s lives for the better, including mine.
Check your local listings for “Orchestrating Change” on PBS World/PBS Plus and tune in tonight!