Category: Heart attack

Making it Work > Heart attack

Twice Sanded

Posted on June 20, 2018 by pioneerintrees

Today as I continue to inch closer to cardiac rehab at an alarmingly slow pace, I got to participate in a stress test. As the technician was sanding my chest ELEVEN times for ELEVEN electrodes, I thought OK THIS IS DEF A BLOG POST. But before I get to the test, let me tell you about the destination. Cardiac Rehab. I am ALMOST in rehab. Almost.

Why Cardiac Rehab?

Once you’ve had some kind of heart attack (stemi, non-stemi, total, partial, added stent, surgery, some drugs, lots of drugs… so many choices…), and it’s been repaired, you still feel a bit, shall we say, scared shitless to do anything. When I was released from hospital after my SCAD heart attack two months ago I was told not to lift anything over 30 lb, not to do any vigorous exercise other than walking and yoga. Pay attention. “YOU KNOW THE SIGNS NOW”, said the nurse with a meaningful look. Ya, ok… sure thing. Yes I do. No showers. Call 911.

So now, when faced with various and sundry activities such dancing like no one’s watching at a wedding, or swimming in cold water at the lake, you tend to second guess yourself. Your brain has this conversation:

I’m so freaking hot – I’ll just jump in the lake and swim to the raft. (Dip the toe.) Holy Christ, the water is freaking cold! Hmm. What if it’s such a shock to the body that I have a heart attack?

YOU’RE NOT GOING TO HAVE A HEART ATTACK!!

How do you know? I might.

IT’S NOT GOING TO HAPPEN AGAIN.

How do you know? It might.

YOU ARE A TOTAL WUS.

Seriously, we are in the middle of nowhere. If I have a heart attack it’s going to be a serious pain in the ass. Maybe I’ll just put my feet in.

FOR CHRIST’S SAKE. ARE YOU KIDDING ME?? WALK DOWN THE LADDER GRADUALLY.

I never do that! That’s def for a wus. I jump in or forget it.

OH. MY. GOD.

So ya, in my opinion, cardiac rehab is going to allow me, the boobless wonder with the questionable heart, to exercise AT THE HOSPITAL and build confidence. That’s basically why I signed up. Let me exercise with a stretcher in the same room. Thanks very much.

What is Cardiac Rehab??

Yes yes, it’s seems a bit obvious – rehabilitation for your heart. True. But what IS it? Apparently it’s not just working out in the same room as someone who can operate a defibrillator. Nope. Nope it’s not.

Side note: I was given the choice of doing Cardiac Rehab at the hospital or at the Wellness Centre. I mean really?? What heart attack survivor wants to exercise away from the hospital? I know I know. I have a long way to go.

*It’s a destination. Not just a process. Who knew?*

Before you can start Cardia Rehab, you get tested tested tested and fill in questionnaires and have interviews. And THEN you are expected to exercise in a variety of ways (kinda like I was going to do BEFORE the heart attack). AND you are expected to eat better (I figure that this healthy eating thing is just for the atherosclerosis people, you know, the ones with crap in their arteries- mine are just falling apart – totally different. I say this as I sip on some Kim Crawford Sauvignon Blanc. Hey, I was sanded today, I deserve it!). Anyhow, you meet all of those expectations and eventually you are strong and HEALED!

Side note: I’m so thankful I don’t have atherosclerosis because it’s a bitch to say. I can never seem to pull it off in a conversation with the nurses.

Last week I went for my first appointment at Cardiac Rehab – had the tour and met with a nurse (?) therapist (?) who was very friendly and laughed at all of my jokes. I liked her obviously. I had to fill out a massive questionnaire about my eating habits – indicating on a sliding scale things like # of portions and healthiness for each food category. For example: light and healthy oils for cooking on the left, margarine in the middle, butter butter butter on the right. I knew I should be circling shit on the left, but it was almost always on the far right. Oh well. Good to have a crappy baseline. Easy to improve.

Once she knew everything about my health and diet and what I’ve been doing since my heart attack (nothing), she told me about all of the classes that I can sign up for. They’ll teach me about the heart. And heart attacks. What to do. That kind of thing. As I was thinking lots of things in my head that weren’t very positive and likely on the arrogant side (but keeping my face interested), she told me that there was a class about to start that I might be interested in some day. She swept the curtain back with a flourish, and there, seated in a semi circle attached to various oxygen machines or mobility devices were my comrades. It was so hilarious. I mean. OMG. I was just so funny. Anyway.

Then I was told that I couldn’t start till I had a stress test. Wait for the call. Okie dokie! Outta there.

What is a Stress Test?

Ahh well, it is actually a bit stressful. I went to Cardiac Rehab on time but by mistake, then had to rush to the Cardiology Clinic downtown to find that I was an hour early. Sheesh. CHEMO BRAIN. (I’m for sure going write about that next.) PLUS, during the test I couldn’t take a selfie – I was holding on for dear life. Stressful.

First the technician had me sign something. I didn’t read it of course. It was likely about having a heart attack – but I figure that’s her job, so it’s as good a place as any to have my next one (inside voice). She gave me a cute little pink top that I thought about stealing to go with my hospital pants. I had to leave it open at the top so that she could attach the 11 electrodes.

*Yes, my chest is not perfectly flat. I have boob buttons. Booblets. Boob babies. But that’s another ~~rant~~ post, just sayin’.*

THEN I SAW THE SANDPAPER, and without any “I’m really sorry that I have to do this”, she just started scratching away at my lily white skin. OMFG LET ME TELL YOU! The last time I was sanded was just before my angiogram and I thought I was going to punch the nurse in the face. At the time my skin was almost transparent from the chemo so it was horrifyingly painful. This wasn’t as bad since my skin is healthier, but ELEVEN TIMES, PEOPLE! How good of a connection do you really need? Why not just hack away at it? Grab a carrot peeler? For reals.

Then she put on a blood pressure cuff. Took a reading and we got started. I had to walk on the treadmill with 11 cables, a chest pack and a BP cuff till my heart rate got over 140 beats/min. I figured that would take no time at all, I’m so out of shape. But alas, apparently the beta blockers that make me so tired also slow my heart (for obvious reasons), so it took longer than I would have liked. She told me that every 3 minutes the machine would speed up and the incline would go up and she would take my BP. I was doing well till it felt like I was power walking up the hill to my cabin (which is freaking steep). I was starting to worry about the next 3 minute interval and I was only at 130 beats / min … and then JESUS GOD I HAD TO RUN! Now, this is not something I do. I find running to be TOTALLY UNNECESSARY. After a while as I was holding on for dear life and likely looking totally panicked she said “getting tired?” and I gave her a WTF ARE YOU JOKING kind of face. She turned off the machine. By now the sanded chest was SCREAMING from sweat and I was ready to lay on the floor. But I decided to not do that.

I did it. All done. I wait for the call for my first Cardiac Rehab session and hope that I don’t have to do that test again. If I do, I’m taking the pink top.

Moving Forward #asonedoes

Posted on May 15, 2018May 15, 2018 by pioneerintrees

Just to look back one more time … I present to you, my timeline of wtf.

The first bit:

Sept 14 2017 – routine mammogram #squished
Sept 21 – mag view mammogram (to get a better look, ya know?) #surewhynot
Oct 6 – biopsy #holyshitthatsawkward
Oct 19 – family doc reads results – CANCER. No biggie, I figure. I can deal. #cancerwtfareyoukiddingme
Oct 24 – surgeon appt – omg so HOT. phew. #silverlining #thereisagod
Oct 31 – MRI – met mr. lorazepam – weeeeee #notanaddict
Nov 17 – surgery – bi-lateral mastectomy – 53 staples, 2 drains and ms. oxy – weeeeee #thatsgoodshit #ihavesomeleft
Nov 23 – drains out – NASTY NASTY #justtrytorelax #didntpunchherout
Nov 27 – staples out – omg noooooooo – #breathebreathenamaste
Dec 7 – hot surgeon reads path reports – lymph nodes negative YAHOOOOO but not so fast he says, you’ll hear from an onc soon… #soonmeansnothing #merrychristmas

The Next Bit:

Dec 29 – fast talking, eye rolling oncologist explains treatment plan #shedidntbreathe #wedrovetothedirtyshwaforthis
Jan 4, 2018 – MUGA scan (heart test) #meh
Jan 9 – portacath insertion – FASCINATING #heyicanfeelthat
Jan 10 – first chemo #icandothis #circlebackwiththosecookieswouldya
weeks and weeks and weeks of awesome friends visiting and sending me shit, and me doing my damnedest to mitigate some rather nasty side effects #loveyoupeople #chemosucks
March 6 – Jenny shaved my head! #liberated #peoplelookbetterwithhair
March 14 – 10% reduction of chemo due to neuropathy development in hands & feet – I start freezing my extremities with ice – people stare #shutupimbeingproactive
March 28 – last chemo WOOT WOOT – feel like shit, but so happy it will be downhill from here – EXHAUSTED #imisswinesomuch

The last bit:

April 15 – heart attack WTF?? (It really does feel like your chest is in a vice. And it’s hard to breathe. NASTY NASTY) #shouldhavecalledanambulance #itwasnttheavocado
April 17 – angiogram to confirm SCAD “Spontaneous Coronary Artery Dissection” – it’s a thing #lookitup
April 24 – meet with stern oncologist who I notice thinks with her eyes shut – no Herceptin for me until she talks to my cardiologist (ya, well, I don’t have one… OMG REALLY?) #idontwanttorestanymore #fuckoff
May 6 – Hike for Hospice (in a wheelchair, but I did it!) – My team raised over $11,000 WOOT WOOT – I love my peeps #fundraisingwin #dontaskmetodothisnextyear

Ok what? Unplanned meets planned. Did it all.

The final straw bit:

May 7 – @ 2 am I start passing a kidney stone – think I’m dying – mr. morphine saved my ass – SWEEEEEET – CAT scan confirmed it #thankspaulforholdingmypukecontainer
May 10 – cardiac ultrasound – technician is no nonsense – asked her to ultrasound my boob bumps – NOT IMPRESSED WITH ME #omgsofunnyinmyhead
May 11 – kidney stone expelled – the mother fucker had two sharp points #shouldibronzeit
May 15 – met with oncologist who actually smiled (maybe she thinks I deserve ONE smile) – clears me for treatment and agrees to send my kidney stone off for analysis #inquiringmindswanttoknow #heyyoudidsomethingnice
May 16 (tomorrow)- Herceptin resumes (this is my 6th treatment) – have to have a loading dose again because it’s been 6 weeks since my last treatment (double the amount and a 1 hour observation period CRAPPY but I like the chemo suite … free cookies, ya know?) #petitioningfororeos

So the breast removal is done, the chemo is done, the heart attack is done, the kidney stone is done. All I have left is my targeted therapy, Herceptin. I continue to get it every 3 weeks till I have had a total of 18 treatments. In order to make it fun I have decided to take the remaining number of treats to the nurses. 12 tomorrow – a dozen of blueberrry muffins, me thinks (last time it was 13 chocolate dipped oreos! NOM NOM). #gottamakeyourownfun

The only other thing is, well, recovery. I somehow keep forgetting that I’m actually IN recovery. Both from the chemo and now the heart attack. So ya, being slow and tired is the new normal and being patient with it all is also pretty new. #workingonit

Thanks for all of the lovingkindness. Strength in numbers, I say! #peaceout

SCAD

Posted on April 19, 2018 by pioneerintrees

So it’s now Day 5 (with Day 1 being the day that I had the heart attack). Before we go too far, a bit of a recap. I had a heart attack. I went to emerg. I had tests. The bloodwork showed elevated levels of troponin which confirmed heart damage. I had more tests. An angiogram showed why it happened – not a buildup of plaque or gooky lard from the cake I eat (surprising, really…), but from a sudden rupture: SCAD (Spontaneous Cardiac Artery Dissection).

I went home with some instructions about my wrist (where the angiogram needle went in), and vague directions about resting and a promise that a cardiologist would call me. Fine. So I’m now sitting here analyzing the little info that I have.

Non-STEMI

After my 2nd set of blood tests came back I was told my the emerg doc that I had a non-STEMI. (Often written NSTEMI.) Here’s an overview of what it means:

STEMI means ST-elevation myocardial infarction (heart attack)
non-STEMI means non-ST-elevation myocardial infarction (duh)
ST refers to the ST segment, which is part of the ECG heart tracing used to diagnose a heart attack. The ST that shows up on the ECG creates a specific appearance on the monitor. (see below)
A STEMI shows up well on an ECG, my non-STEMI didn’t show up at all.
A STEMI happens as a result of a complete blockage in a coronary artery. A non-STEMI heart attack is when an artery is partially blocked and blood flow is severely reduced.
A STEMI attack carries a great risk of death and disability. A non-STEMI is less damaging to the heart.
They like to write STEMI in CAPS.
An ECG and an EKG are exactly the same thing. (EKG has been translated into German. Go figure.)

The photocopy

Looking at the printout of my arteries that I posted in my previous blog entry you can that the damage is in the dLAD. Here it is again:

Of course my first question was what the hell is dLAD??

Well, it’s the Distal Left Anterior Descending Coronary Artery. I obviously needed to know a bit more about arteries so that I could understand the photocopy better. Here they are:

The LAD is an important artery since it supplies over half of the heart muscle with blood. Of course it is! So the dLAD is:

on the left side of my body (looking out at the world from my eyeballs)
runs down the front wall of my heart

Second question is what does 95% mean?

Ok I know what 95% means …, but what does it mean in the context of SCAD? I believe it means that I had 95% blockage because of the SCAD. So only 5% of the blood was getting to my heart muscle. Yes?? I think so.

The Diagnosis

SCAD. I can never just SAY that in expanded notation. It takes me a LOT of thought to bring it forward in my chemo induced state of crappy recall. Spontaneous (not sudden). Coronary (not cardiac). Artery (not arterial). Dissection (not disaster). Say it with me: spontaneous coronary artery dissection. There.

What I know to be true about SCAD:

it’s relatively rare
it happens most commonly to women in their 40s and 50s
80% of the time the women are young, healthy and active with none of the risk factors that you would normally think of (like diabetes, high blood pressure, eating crappy food 24/7)
there is no known cause – happens a lot after childbirth, doing extreme exercise, after lots of stress – but nothing definitive (NO WHERE can I find chemo listed in any of the literature as a cause)
the symptoms are the same as those for any kind of heart attack (chest pain, rapid heartbeat, pain in arms / shoulders / jaw, shortness of breath, sweating, tiredness, nausea, dizziness)
treatment is generally blood pressure meds and beta blockers (prevents clotting)
there is a high risk of recurrence (oh shit.)

What Actually Happens in SCAD:

The artery wall has 3 layers. When a tear occurs, blood is able to pass into the innermost layer and get trapped there. In some cases a clot forms there. This trapped blood or clot starts to bulge inward, narrowing the artery and preventing blood from getting to the heart muscle. BAM! Heart attack.

Types of Arteries — *The blue arrow represents blood flow, in case you were wondering (just like in the pad commercials).*

Remaining Questions

So… the event happened. I’ve seen the needle and the damage done. But I still want to know:

– Is this because of the chemo? Or is it because I had just spent 30 min scraping 10cm of ice off of my hot tub? Or is it because I started exercising again?

– Can I continue with my Herceptin treatment?

– Why doesn’t a cardiologist call me? Can’t he/she see that I have so many questions? Calling me “within 4 weeks” doesn’t work for me. OMG!

And now back to my quiet, sedentary activities. Somebody pass me a chocolate.

Angiogram Highlights

Posted on April 17, 2018 by pioneerintrees

It’s nearing the end of day 3 and I’m ready to go home. I’m typing with one hand and this floor feels prohibitive to sleep. I would leave now if I had this needle out of my arm!

Yes, it’s sore and it looks sore (Liam flinches) but since the angiogram procedure in which a wire (?) was shoved in and up my other arm, my left feels great comparatively. I think it’s bloody from all of the typing.

Overview of the Angiogram:

The prep took as long or maybe longer than the procedure itself. The team worked incredibly efficiently and with very few words through the entire procedure. So impressive.

During the angiogram I had to:

– ditch my stolen (and favorite) hospital pants with the penis hole sewn up so that they could prep my groin – in case they couldn’t use the artery in my arm (the nurses kindly stowed them in a bag for me)

– have new and fancy heart monitor stickers put over specific areas of my body that they had SANDED clean. Yes, sanded. With “hospital grade” sandpaper. WTF!! It burned, as you might have predicted. Nice.

– get positioned perfectly with my head craned to the left so that I could see the monitor (big wall of 4 flat screen TVs that lowered down to eye level for the doc)

– promise to stay absolutely still for the entire procedure (“if your nose is itchy, ask the nurse to itch it”)

– endure freezing on the inside of my right arm (where the carotid artery is, obv). I’m not going to lie, I honestly thought Dr. B.A.L.L. forgot the freezing and was shoving the thing up my arm without it! Made me tear up. But I didn’t flinch.

– accept some kind of delicious relaxant in the port my left arm since the nurse saw my eyes turn into ponds of misery

– watch and learn

Best parts? Warm blankets. Seeing my arteries on the screen light up. The drugs that took the searing pain away.

The Doc’s Analysis:

No sign of heart disease. No blockages. No need for a stent. He showed me the area that is damaged and went to quickly consult with the other cardiologist while I watched re-runs. Mesmerized.

The doc told me that what happened to me is called Spontaneous Coronary Heart Dissection. (SCAD) Essentially there is a sudden tear in the artery wall that blocks blood flow and causes a heart attack. From what I’ve read so far there is no known cause and no known prevention. It’s very common in women. Young, healthy women. Ahem.

Recovery:

Easy part: I had to stay in the cath lab until my pressure cuff could be taken off – about 1 1/2 hours. During that time one of the nurses printed off some info on SCAD, so I was able to understand it a bit better. I will do a lot more reading on it obv, and look forward to hearing from the doc tomorrow and getting the Cole’s notes. Remember those?

Harder part: My understanding from the literature is that the artery will have to heal and I’ll have to do a few things to help that process along. Keep my blood pressure low, don’t stress the heart, that kind of thing. Of course my greatest concern is that this SCAD doesn’t interfere with my breast cancer treatment which continues till January 2019 (thirteen more treatments to go!). Fingers crossed that the cardiologist I see tomorrow (for discharge) will refer me to a cardiologist who will treat me (?) and talk to my oncologist.

But First… I have to see how well this last sleeping pill blocks out my restless roommate’s vocalizations and the exceptionally loud nurses hanging out at the nurses station. Annnd out.