Bill Gives Us All A Heart Attack
David
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David
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David
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David
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(This email went out to the hunting club)
Deer Season May be Cancelled: Bill Had an MI last nite
This is not a joke. Bill had a heart attack last night. He is at Good Samaritan, he has had a cardiac catheterization and one stent placed. He is in the CCU (or will be in a few minutes). He will be in for a few days.
David
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| Here is Bill in the hospital on September 1, in the Cardiac Care Unit, the evening of his catherization, around 7:12 pm. Don't be fooled: this is the best 1/40th of a second I saw him, during a stay of about 45 minutes. There was still danger of cardiac arrythmia and death. |  |
(all subsequent emails went out to family and hunting club)
Sept 2, Wed., 9 pm: Have not spoken to Bill or Mom directly this eve (no answ at Golf Links), but thru Brenda I hear that Bill is OK. Not much to report, but that is good in itself. Will post again tomorrow.
David Nelson
Thu, 3 Sep 2009 07:49 am
Bill is still in the CCU, but only because they did not have any free beds in the step down
ward. Bill said to expect a call from the MD today, he thinks he might get out Fri.
No arrhythmias so far, no chest pain.
David Nelson
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Sept 3, 9:44 am
For all of you worried about Bill's coffee needs, Mom got permission from the MD and brought him some of his own coffee from home (he did not like the hospital coffee). She did not bring him any cigarettes, though; that will be up to Bill when he gets home. He already knows our opinion on this topic, so we are keeping our opinions to ourselves and letting make his own choices. That is what we want with respect to our own habits, right?
David Nelson
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Just spoke to the cardiologist. Bill's heart attack (MI) was very large. Very. We measure the injury to the heart muscle (remember, the heart is just a mass of muscle that acts as a pump) by measuring a marker, CPK. The normal level of the marker (CPK) for most MI's is in the range of 200. Bill was 6500. The doctor has not seen a CPK of this level since he finished training at the Mayo Clinic and Texas Heart Institute. The posterior-lateral wall does not move well (hypokinetic) The complications related to a MI of this level is failure of the wall integrity, with a sudden catastrophic rupture. He puts the risk of this at 5%, but he also said, "The book has not been written for MI's this large". The key time is the first 5 days, so he may keep Bill to Sat, although Fri or Sun are possible.
Sept 4 9:34 am
Yes we saw Bill. He is in room 345--it looks like the room Dad spent so much time in after his by-pass. Bill wanted another book to read. He was in good spirits. Wanted us to bring him a paper today besides the coffee. - Mom
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Sept 4 Fri 5 pm
Bill is doing OK today and may be released today. No problems.
(based on a report from Mary Ann, 11 am; I have not spoken to the MD
today. )
David Nelson
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Sept 5 Sat 4pm
Sept 5 9:54 pm
Just talked to Bill. Feeling great, complaining about the low sodium
diet, so I think he is close to ready to get out. The CPK was 278, so
he stays tonite. MD thought he will have a better CPK tomorrow and
might go home.
No word on cardiac rehab. Hunting in No. Ca is out, OK for the Ranch
in a week but cannot do anything, cannot lift, must be sedentary.
Wyoming and Nevada are up in the air, will be discussed when he has an
office visit followup. He still is not ready for phone calls, so just
send him an email directly (ie, do not send to Reply All).
Will keep you posted. It ain' t over yet. We need to see how the
damaged wall functions, how he responds to cardiac stress, how he
responds to the blood thinner (Plavix), and lots of other, both
medical and nonmedical issues. None of this is defined. Or cheap.
David Nelson
(Still at the Hand Society Meeting)
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Sat Sept 6 3:09 pm (from Bill's room)
Bill has been discharged! We are still in the room, waiting for the
RN to bring in the meds and paperwork.
MD said that the data I had been given previously regarding the CPK
levels is not quite right. Although the 6500 level is high, it is usu
this high when you place a stent. In the old days, before stenting,
would be high.
This was a moderate MI; not minor, not huge. It is moderate because he
has not had any heart failure (accumulation of fluid in the lungs) or
arrythmias. Prognosis is good, with compliance with meds and smoking
cessation, and some diet changes.
David Nelson
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Bill is complaining, so things must be back to normal!
End of narrative - David
Back at the Ranch, Sept 12
Bill's Excellent Adventure. In his own words.
I hope this reaches all of the recipients of David's updates (thanks, kinda, David). And I've tossed in some others of interest who I didn't find on the address list, and made you all "blind carbon copies" so that this doesn't become one huge spam-o-rama to you'all. David won't be thrilled with the BCC idea because, sensibly, he'll want to use this as a "teaching moment", but you can all talk amongst your own little groups and can look up a truckload of info on the web.
I really would have preferred the episode to have passed and then have been related, not performed as a sing-along. It was, truly, an episode; not a period of recovery from weakness or illness begging for updates on changes and calling for visits for goodbyes or get-wells.
Thanks to all of you who care. I'm low and slow on all the formal niceties Western Civ has built up-- for instance, individual, handwritten responses with thanks. I sure won't knock such, but I've long been out of that stream. Please accept this, and any personal thanks I may eventually get to you, as a sufficient BillEquivalent.
I'll write the story from my viewpoint, and let the facts change that view as I go-
The last weekend of August was the Big Event of our local deer season - our Old Timers' Weekend. So, after having put in an extra overnighter at the Ranch Wed/Thurs, Fri to Mon was a long, hot, full weekend of excitement, exertion, and lack of sleep. I got rid of my last pest - I mean, guest - Monday afternoon, showered, ate, vegetated in exhaustion, and then finally went to sleep at 1:00 AM.
At 2:00 I awoke feeling very hot, with my right hand/arm and my jaw aching. Dang. I'd felt a short version of that while resting Monday evening. I'd been stung on my trigger finger (right hand) by a yellowjacket on Thursday, perhaps my first-ever sting, and that had swollen and ached and then by Saturday reduced. Followed by another sting on my right ring finger Saturday! So by Monday that finger was swollen tight and aching. So now at 2:00 AM it returned with a fever or something! Dang! I tore back my sheets and lay exposed to the cool night air from my open windows, but soon realized that that wasn't enough. I turned on our new whole-house fan and went into the bathroom to lie beneath its window, letting the fan pull a nice breeze over me, while I began to sweat buckets. And I also took two aspirin for my aches. But that still wasn't the answer, because I felt not only hot but feverish. I couldn't find our Tylenol, which I knew I could add to a full dose of aspirin, so I went as far as to waken my poor 85-year old Mommy, asking for Tylenol and the thermometer. She got a reading of, I think I remember, only 97 degrees - not the fever I expected.
I returned to my room to gut out the problem. There was no sense in Mom staying up while we waited for the pain relievers to kick in, so she went back to bed but set an alarm for an hour hence. I spent that hour bouncing from bed to living room chair to walking to bed, etc., and from bare to bathrobe to pants to sheets, etc. She checked back in with me but I could report little change. Much of what I was feeling, in a sense, was similar to the 6-week episode I'd had a few years earlier with a [we suppose] pinched nerve- inability to sleep, inability to stay still or get relief from or in any one position, a tense and aching jaw strained against the pain, an aching arm, and breathing shallowly from my curled-in-on-myself condition. So back to bed, unable to help, she went.
Sleep did not return that night, though I spent much of the next few hours in bed, which just added more exhaustion to that I'd accumulated over the fairly sleepless, and strenuous, weekend. No wonder I was achy in my jaw and chest, on top of the double yellowjacket stings paining my arm.
At 7:00 I got up for the day, with Mom nearly ready to leave for morning Mass. I reported no significant change and sent her on her way. I spent the next hour, after downing another round of painkillers, suffering more of the same; though after the pills got a chance to help, I could feel more that I had a separate pain in my chest- just another steady ache, all of them similar to the general leg ache one feels when resting a sprained ankle. I used some of that time playing with the computer, searching on WebMD's Symptom Checker for info on aching jaws, insect allergies, chest pain, and shock; without conclusive help, except to learn that subsequent insect stings can trigger increased reactions.
At 7:30 I took my blood pressure, found it 137/92, pulse 70. High but not out of line.
By 8:00 I began to feel, to notice, the accumulation of symptoms, including jitteriness and, to break my camel back, I found that I wanted to breath in strange short puffs: gently and briefly in, with an audible 'huff' out. It wasn't, to me, "labored" or a "shortness", and I could breathe deeply or normally if I wished, but what now felt normal was this new short puff. This yellowjacket reaction was heading downhill. So I packed a duffle with hospital supplies: a blanket and a fleece vest to combat what Dad always found a chilly atmosphere, some books, a toothbrush and nail file, cel phone and charger, extra cigarettes, and a thermos of coffee. I closed the windows that were letting in the morning coolness, ready to abandon the house. I checked for a banana and such for Mom to bring as a substitute breakfast. And I wrote up a list of my symptoms, timetables of the week (exertion, exhaustion, stings) and of the morning, as well as a list of other possible "outdoors" diseases: Lyme, Hanta Virus, Bubonic, etc- things that I could have been exposed to over the past few weeks of deer season; things that do not first come to an urban doctor's mind.
I expected Mom to return around 8:30, but she didn't. I sat on the front porch, and had a last cigarette, getting more desperate with each passing minute. When she did arrive, around 8:45 after attending an extra monthly event after Mass, I was near to calling an [expensive] ambulance. I turned away her suggestion of calling her doctor for an opinion of my condition, said we were going to Good Sam now.
(Going to the hospital was a choice of mine, not just a following of the usual chain of decisions. I've no insurance, don't like what some call "health insurance" and don't consider the issue a 'public' one, and intend to pay for my own repairs; and intend to send the clunker to the salvage yard when it's not worth the cost of repairs or exceeds my budget. But I chose to risk a certain amount of expense for this event, hoping that the yellowjacket theory obtained but willing to go a certain distance along the coronary path. ((PS- not soliciting, but if you'd rather donate to my doctor fund than a post-mortem memorial fund, and save my 401K from complete depletion, I wouldn't refuse any reasonably small contribution.)))
(And, to my pleasant surprise, I wasn't fearing death. Not as a man; I came to terms with that years ago. Nor as a soul; I came to terms with Him years ago, too. It was nice to learn.)
So Mom dropped me off at the emergency room at 9:00 AM and drove off to find a parking spot. I went to the bank window labeled "Triage Nurse", was handed a pad of forms and asked why I had come. I said that I was in the midst of perhaps a heart attack or anaphylactic shock. I sat down and got through perhaps four lines of form while the nurse took care of someone already there, and then he called me in, hooked me up to a BP monitor (results similar to the ones I'd gotten), got a few pertinent personal details, and then led me around to a table and ran an EKG on me. Without comment, he sat me back in the chair and said that a doctor would soon arrive. That doctor looked at the printout, and, I think, asked if I had a cardiologist. I said, "No", but offered Mom's man's name. The Dr. said he'd call him. (Mom had come into the ER waiting room by this time. I'd waved and shrugged at her, and informed Nurse Triage of her existence, but could rest her mind no more of my own.)
Soon I was wheelchaired around to a bed in the ER, stripped and gowned, had techs starting an IV and putting nitroglycerin under my tongue and offering morphine and asking questions and handing me forms and ............. And that's the room where I last saw my long-time coffee mug. They likely had to nuke the room after discovering that filthy-looking thing. I have another of the type, but it might be my last. Boo-hoo.
The ER cubicle was an active little place, with highly trained worker bees buzzing all around me. The Dr. reported that Mom's Cardiologist had passed the buck, requesting that the current Card. on call handle my case. The Dr. used innocuous phrases similar to "We have concerns about your EKG", etc. Mom was around during much of this. When a break came, I told her that she might as well go home and get some breakfast, and get herself better prepared for a visit at the hospital -I'd popped the project on her rather suddenly that morning- , that nothing important should happen soon. So away she went.
And very soon the Card. was before me, saying we're going to the Cath.Lab in a few minutes, and having me sign releases. No, Mom, nothing important should happen soon- I'll just get invaded while your back is turned!
So I was rolled to the Cath.Lab. With a procedure imminent, I kinda wished I'd accepted the morphine- just in case some pain was in store. The lab techs were a serious and efficient lot. My attempts at banter deflected off stony faces.
No doubt the procedure was explained to me, but my memory of most of that time is fuzzy; I think I must have been given a general, as well as the local anesthesia at the groin insertion site. But this part I knew well from the parents' adventures. I think I slept through most of it, or at least was in a deep fog. I felt no pain whatsoever, but I did notice the warm flushes that come at dye introduction- they felt as if the catheter had popped out, letting a gush of hot blood squirt over my thigh (a comforting thought!).
I suppose that at the end they lifted me out of my fog. My feeling then was one of great discomfort, as that I'd been far too long in a very uncomfortable position. I so wanted to shift, to move my legs and bend my back. But the Card. droned on as he showed me replays of the procedure (I wanted him to shut up, let me move, and give me a history lesson later!) But what he showed was the blocked circumflex coronary artery, in which he'd placed a medicated stent, and also the Cracker Jack Surprise I'd given him- another artery, I don't know which, that had spasmed, (probably in reaction to the disturbance of the procedure (probably, because there has been no subsequent such spasming)), and locked itself tight, in effect causing another blockage. The Card. had had to run up and down a few side streets with the catheter to find and get to it, and blew it open with some nitroglycerin.
Then I was wheeled to the Intensive Care ward. The Cath.Lab detour had taken almost exactly (I know: 'almost exactly') two hours. The next few hours are blurry to me, but I think Mom was there a short while, a tech did a sonogram of my heart, and I rested. And ate from the 'boxed lunch' they had waiting, as well as picked from the regular lunch tray that arrived. Item One-- what they call "coffee" tasted as if it came from no bean known to agriculture, and also tasted adulterated. I won't go into all that I did and thought about their coffee during my stay, but it seems that it's normal for hospitals and is, simply, cheap trash. The other food, while I was stuck with what they sent me, was pretty yucky. I have my tastes, and many of them are not the usual tastes. But I ate what I could, picking and choosing. Dad had been, to the general consternation, a nearly total non-eater in hospital. I intended to be different (news flash!), so I ate all that I could within my tastes. So, I repeatedly left on my tray the cartons of milk I'd not requested, to be tossed and wasted; and so a few other items. I'll take no blame for that, though I will have to pay the bill!
The only pain I felt after the catheterization was a chest pain, one that soon settled down to a movement chest pain- the sort one feels when an episode of coughing makes the diaphragm sore, and for awhile there's a little twinge during inhalation, swallowing, or twisting of position. I think that that disappeared during the night; I was pain-free during the rest of my hospital stay, a stay for observation.
After that first day in ICU/CCU I felt fully myself. The wonders of current cath./stent technology have turned what once was major invasive surgery -a chest cracking- into a minimal procedure, as far as patient effect is concerned. I was chipper, stayed awake most of the daytime, had an adequate appetite (as far as the lousy food would allow), etc. The main drag on my psyche and activities was the constraint of all the tubes and wires that bound me. They had the effect of keeping me "in". I did without the oxy as much as I could get away with. My left nostril stayed wet and I sneezed whenever the canula was in place.
I was in the ward until, I think, Thursday afternoon/evening, a day longer than intended because there was no space for me on the regular floor. During that time Mom and Mary Ann would visit me each mid-morning and evening. The hospital would allow me one regular coffee and an unlimited amount of decaf, so my visitors brought coffee to enable me to stay away from the 'trash'. Although smuggling would be easy, I decided to just play by the rules. I received a few surprise visits -thanks, guys (no names named)- but really didn't want much more. I was not bored, didn't need moral support, have little to say, ...
Hans helped Mary Ann take my Bronco in to the shop, Sis driving the rig. She came away feeling aggressive and powerful and high-on-the-road! And dusty.
On Wednesday (day 2) my Card. (34 yrs of age) visited me. I complained, as gently as I could, that he hadn't told me how serious my situation was Tuesday. I think he and I will continue to disagree on the matter, but. I wish he'd looked me in the eye and said something like, "We have a very serious situation going on Right Now. You've been having a heart attack for eight hours. We've got to go in there and do something about it Right Now and stop the damage that's going on, and hope we can save you from invalidity or death." Being told that there were disturbing aspects to my EKG, is weak. Since I had no experience with ERs and 'usual' sequences, the level of activity and the speed of my flow through the system did not indicate to me the seriousness of the situation; it did to him. He had used the term "emergent". Well, Mom uses a pre-emergent spray on her fruit trees, butterflies emerge from their chrysalises, other things are 'emergent'. He hadn't used the 'loaded' word, "emergency". He hadn't mentioned that he'd abandoned six patients to come work on me.
Be that as it may.
So he told me then that I'd had a significant heart attack. It didn't reach "massive" but would be classed as "moderate"; not at all "minor". His review of the sonogram had been delayed by technical difficulties, but it confirmed to him the accuracy of the portrayal given him by the sono tech- that my heart had a weakened section. It was good that it was the circumflex artery, not another, that'd been clotted; bad that the blockage was near the root of it, so the damage extended to all its branches' destinations. Now they had to keep me monitored for arrhythmias, signs that the heart was now going to harmonize out of tune, and other indications that the damaged muscle wasn't stable. And they were making regular blood tests to track the direction and duration of changes in some enzyme levels, indicators of, at least, the extent of damage. 48-72 hours should tell the important parts of the story.
(David, also, spoke with the Card., but came away with an exaggerated view of my condition. I wasn't there, I don't know what the miscommunication was, but David was passing along a sense of greater damage and danger, alarming his hearers. I apologize.)
So on Thursday I was moved into a double room on the recovery floor, without IV and some other monitoring, though with leads on my chest wired to a telemetering portable box. Here I could order my own meal trays! I cherry-picked the menu, and arranged it so that I could clean the plate and enjoy all my food. David reported that I complained about the low-sodium diet; I think it was just that I'd bumped into my daily limit, disallowing me for the next meal as many pieces of bread as I'd requested, and no cookies. I might have 'commented' (I need to say something!), but I wasn't complaining; and I don't think that my condition or state of mind was changing, indicating any readiness to go home. I was ready to go home by Wednesday; I got antsy never. I was glad to catch up on my sleep, and happy to be able to sit in bed and read books!
I had a roommate Thurs/Fri(maybe some Sat) who was experiencing hospital life entirely differently. He was itching to get out, complaining of inability to sleep amid the corridor noises and the frequent interruptions, etc. His problem was a seemingly benign burst vessel on the outside of his brain; if stress was its cause, he wasn't helping any.
I lost him to discharge, gained a new roomie. We both enjoyed our time together. Visits by friends are not very private in a double-occ room, so we had to treat each other as family or as nosy neighbors. Family sounds good. Heck, I've been invited on their annual cod fishing excursion! I was trading experiences and banter with him and his girlfriend, and with his family friends- we had a great old time. His fishing buddy is also a hunter (mainly lapsed). I visited him in his new room on my way out of the hospital-- oddly, his cath experience included pain and distress.
Mary Ann, who stayed at our house to support Mom, and Mom continued their twice-daily short visits, bringing de-caf and regular coffee, and a few items (nail file, more books, ...) Mom brought me the cards some of you sent; thanks. Thanks even to the one who used the Post Office to move a card a house or two on Golf Links. And Mom reported to me all of the calls and emails she was getting, for herself and for me. Thanks, all.
I spent most of my time reading Nero Wolfe novels in bed. I'd get up and walk/exercise for half-hour intervals a couple of times a day. I stayed awake daytime so that I'd have no trouble sleeping at night. I watched all of two minutes of TV my whole stay. The cooler the temps were, the happier I was (sorry, Dad; and no need for my blanky and vest).
I noticed no symptoms of caffiene withdrawal, though I was drinking only one cup of regular coffee each day. Perhaps one is enough; perhaps my constitution is iron; perhaps the environment aided. Under normal circumstances. the only straight liquid I drink is coffee; until 8:00 PM when I switch to a small cocktail so that I'm not hopped up at bedtime. If I take a sip of water once in a week, I'm splurging. No milk, no juice or soda, beer only in the heat or with jalapenoed food- just coffee, fairly strong.
Neither did I have a problem being unable to smoke. Perhaps a half-dozen times I had the thought that it'd be nice to step out the nearby exit for a puff, but it was only a random thought. Again, no symptoms like headache, etc.
Boy, am I glad that I'd showered Monday afternoon! I usually wait until the next morning. Can you imagine my stench after the long weekend of hunting, and with deer blood up both arms, and chainsawing chips in my hair and underwear and...? I might have had to be run through decontamination before admittance!
The quality of the nursing staff varied. Everyone involved in the more critical positions and departments, at least during the daytime, was sharp and good and communic-able. Others, not so much. Mental capabilities showed; shared culture showed; familiarity with English, and with the flow of logic, showed. I was on my toes as necessary, depending on the staffer; I'm glad that I was not a complicated case with diminished capabilities.
I saw the Card. a few times. When I learned that he would not be attending to my discharge, I finally broached the subject of my various fall hunting plans. The short version- some of them, the near ones, are canceled or altered; the rest are up in the air, will be discussed during my office visit in a week.
My enzymes were dropping satisfactorily, and the odds for a Sunday discharge looked good. I'd shown no irregularities on my monitor.
Sunday arrived, and so did David, exhausted from a long weekend of Hand Society Meetings. He stayed for the duration. The replacement Card., an associate of my Card., dropped in and gave me my walking papers. Expansion of instructions will wait for my office visits; for your interest, he wants me to A) cease smoking; B) reduce my caffiene intake; and C) go on a low cholesterol/low saturated-fat, no added-salt diet. He recommends a "Mediterranean diet", like the South Beach.
I got home at 4:00 PM, and was glad to. But, I could have been happy if I'd had to stay another day or two.
I waited until 9:00 or so before having my first cigarette. Just because.
I've got Nitro in case of angina; I'm on a statin for cholesterol, a med to keep my BP low, and Plavix and Aspirin, for at least a year -on penalty of death-, to keep my stent from attracting protective plaque.
I didn't have what I expected as classic signs of a heart attack. That could be a defect in my understanding (for instance, does an "attack" last eight hours?!), or it could be simply the way I, I, experience an attack. And, not giving much credence to coincidence, I was involved in, simply, some complication of insect stings, with hard Ranch days on top.
I felt no 'pain' as I think of pain; I felt only aches. My left arm, a standard, was not at all involved, and my right had the sting swelling going on. I felt no sense of 'pressure' on my chest, no 'tightness'; just another ache. And my breathing did not feel 'labored', I never felt 'short of breath' as in having difficulty finding oxygen; I was just tending to, not maxed out at, short breaths. If that helps you in your tomorrows, you're welcome to it.
I'll see what the program is supposed to be, and choose how I want to go. (Hmm, is there a double entendre there?) My current status, which I expect to be more strongly based within a month, is that I'm free to do nearly anything, short of climbing Mt. Everest. There's no known reason to expect trouble from my heart, in the near term. The blocked artery has been stented, no others are too bad. We'll see if the damage done to my heart enforces some limits; and perhaps it'll be the heart itself that tells me, in lessened stamina, shortness of breath, or ... I'll take it easy for awhile; no need to test the system right away. The heart, after all, really has been damaged. I might not feel the need for any recovery, but I guess it would request a period for it.
I'll be talking with my doc, trying to figure out what role yellowjackets played, if any.
Thanks again to all who called, wrote, emailed, visited, -or just plain cared. And a special thanks to Sis & Bro. Once again, they helped and supported Mom and me, and it's nice to have a nurse and a doctor hovering over my caretakers' shoulders (even though in my case the diagnosis and work were straightforward, not to mention finished before any of us could say Jack Robinson).
Ok, class-- any questions?