Month: April 2018

Making it Work > 2018 > April

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.

Bit of a Heart Thing

Posted on April 17, 2018 by pioneerintrees

On Sunday I was having a snack (healthy, I will add) after being out for a walk in the freezing rain and scraping off the ice encrusted hot tub lid. I figured I wouldn’t make it to dinner (I was around 3 pm… the time where you know that if you stay hungry, you’ll be so ravenous during dinner prep that you’ll eat half of everything you chop up). Mid snack I found myself experiencing some chest pain, coupled with pain between my shoulder blades and also pain down the backs of my arms and into my baby fingers. Not little pain. Serious pain. Out of nowhere. My thought process went like this:

– am I having an angina attack … or something? Am I stressed? Did I pull muscles in my arms when scraping that ice?

– I said “calm the fuck down” to myself, even though I felt perfectly calm.

– I thought hmm. I wonder if I’m having a heart attack? Well, if so, I’d better have a shower.

– so I had a shower. Nervously. And quickly.

– pain still there a bit, but better, maybe I’m ok? Lay my chest on the bathroom counter. Calm the fuck down. Breathe.

– wondered … is this caused by the Herceptin? I’d better look that up. (Google search ensued) No connection to chest pain. Hmmm.

– back to snack area, had another episode … hurting again. Wondered – am I allergic to avocado?

– decided I should likely go to the hospital – didn’t want to scare the kids.

– went upstairs and quickly packed a bag with practically all of my technology, a book and my wallet

– decided that it would be stupid to drive myself and not tell anyone – I would get serious shit for that from … everyone

– texted Paul and asked him to bring over the ribs now. And maybe he would need to drive me to the hospital. Now.

– told the girls I wasn’t feeling well – that I’d text them – and that I would be ok … (Annie looked traumatized.)

– figured I’d be fine by the time I got to the hospital, but that I should still go, even though it was in the middle of an ice storm. Fine.

What happened at Emerg – Day One:

I sat in chairs for a bit as there were no receiving nurses in their little booths. The lady who came in behind me was having a hard time keeping her young daughter awake (she had hit her head) – so when the nurse finally came out I told her to go first. Got checked in eventually, put on a face mask (since she made me).

I was ushered into a little room for an ECG. I took off my jacket and sweatshirt I realized that I looked a bit like a skinhead – all in black with my Doc Martens (for the icy roads). Had Paul take this pic …

Skinhead Halloween costume — It’s a keeper.

Then some blood work and into an exam room to wait for the results of the ECG and blood work. Eventually saw a doc who did a history and told me that everything looked fine in the tests so far. Went to the “lounge” to wait 3 hours till I could do a repeat of the ECG and blood work. Waited. It came back showing elevated levels of Triponin which is a marker of a heart attack. It can go as high as 40 … once it’s over 40 it’s considered a “massive heart attack” and they don’t measure it anymore. My first test was a .1 which was why no one seemed too concerned, second test was a 3 which showed that something definitely happened. (Eventually these markers went as high as 9.7 before they came back down again.)

So I had a heart attack. My head was spinning a bit.

I was put in a different room in emerg where the doc asked me if I still had any pain. (Everyone was taking it more seriously now.) I told him that I had some pressure in my throat and carotid (neck) but that I wouldn’t call it pain. He just stared at me. I guess I’ve become so used to discomfort with the chemo side effects … a bit of pressure in the throat is no big deal. He gave me some pills to thin my blood. And some big huge potassium pills – had to break them in half. Lots of pills.

Oh, and some morphine. I said I didn’t want any thanks. They said it was important to take away the remaining pain in my throat and carotid – but also because it also acts as a vasodilator, which is important apparently. Once high as a kite I was much less upset about having a heart attack. Go figure. Saw the cardiologist who had a great handshake, the same haircut as me and explained that I’d need an angiogram. This was the quote of the day: “Dr. Ball? B. A. L. L.?” (Said morphined up Janice. Deanne thought it was hilarious.)

Transferred to my the ICU at 1am. Much quieter there. Sleeping pill. Annnnnnd out.

What happened at the ICU – Day Two:

I lay in bed all day waiting for the angiogram. Had a muffin that Paul got me at Tim’s – the Hospital food was not quite appealing enough…

Cereal for the elderly — *This begins to look good when you’re not allowed to eat anything …*

Wasn’t able to eat anything after 10 until after my procedure was done. We all placed bets on when we thought it would happen – one of the nurses was hopeful with a 1:30 slot – Michele went long with 5:00. No one won since they couldn’t fit me in. I know it’s a good thing that I was low on the priority list for an angiogram, but being hooked up all day in bed (and hungry) kinda sucked. And so many things attached to my body … heart, finger, wrist. Yeesh.

Needle and the damage done — Necessary. Evil.

Highlights of the day included a visit from Michele and Deanne where we suddenly realized that Paul and Michele were dressed exactly alike. Which we found outrageously amusing.

Quote of the day: “You’ve kind of had a shit year.” (Deanne) … seemed a lot funnier in the moment.

Later a visit from Alison when we determined that yes, I could knit if I put the oximeter on my toe. Works like a charm. Called Bree and Annie to have them find me a Zauberball and some needles to be delivered the next day. Excited!

Toe jam — Good thing I have long, skinny toes!

Sleeping pill. Annnnnnd out.

What happened at the Hospital – Day Three:

After a breakfast of grapes had a visit from my 2nd cardiologist (who I also met yesterday and his name is impossible to spell, I will add). He confirmed that this regimen of pills will be my “new normal” (minus the needle they put in my belly at night – I don’t have to do that one at home). He explained that I’d be moving to Telemetry which sounded to me like a Hogwarts class (he didn’t laugh). He told the nurse to get me up and moving HURRAY! And he explained what will happen with the angiogram – that if there is a blockage in the vessels they will put in a stent right then, but if there are several they will not do open heart surgery since I’ve just had chemo (ok, …. was that a joke? … he didn’t laugh..) I filed it under ‘that’s good to know’.

So I’m signing off now … will post again after the angiogram. So exciting, this life of mine! Stay tuned…

Recovery Looks Like a Y

Posted on April 12, 2018 by pioneerintrees

Well, this is my first “week off” from treatment since January (over 3 months ago). When Shelley sent this text on Wednesday morning I panicked a little bit at first …

text from Shelley — *I just love Shelley cookies!! Hoping for the PB and m&m ones …*

I’m DONE chemo (all 12 weeks of it)!! I still am in treatment (it’s not over till it’s over) since I continue with Trastuzumab every 3 weeks until January 2019 (brand name is Herceptin). But Trastuzumab is no where near as toxic as the chemo. I can function with it. I wrote about it in an earlier post so I won’t bore you, but as a quick recap, Trastuzumab – ok, let’s just call it Herceptin from here on in – is a targeted therapy (not like chemo that annihilates every growing cell). It’s an antibody that blocks the protein that causes HER-2 positive cancer cells to grow. A revolutionary discovery. The guys who discovered are total heroes – they were unwavering in their beliefs that there were cancer cells that overproduced certain proteins – but they couldn’t get the finances and research support to prove it. Before Herceptin was discovered, this type of HER-2 positive cancer essentially killed women … and fast. Women had a very low chance of survival. This drug changed everything. Dennis Slamon and Axel Ullrich. Thank you. And thank you to the goddess at Revlon who was diagnosed with breast cancer, heard about these two and proceeded convince Revlon to fund their research to the tune of 13 million.

diagram — *How is this helpful?? Seriously don’t understand it.*

The one rather nasty part of this very positive story is that Herceptin causes heart damage. I have to have a MUGA scan every 3 months to be sure that my heart function is not being compromised. And I have to watch for signs of cardiac distress. Like passing out.

What Happens in Recovery?

Basically, I have to heal from the effects of the toxic sludge that was poured into my body. I also need to heal the tissues and muscles on my chest, expand the range of motion. That kind of thing. And at the same time I need to keep my heart strong so that it has a better chance of not being negatively affected by the Herceptin. Sounds like a walk in the park. (That’s May 6th folks… in case you forgot!)

What’s Happening So Far?

On the outside I def look like a cancer ~~victim~~ patient. I’m bald, pasty, have minimal eyebrows. On the inside I’m fucking tired! My nasal passages still bleed and crust up. But I’m feeling better. I don’t notice a change every day – not that kind of thing. I just notice that:

my guts don’t hurt
I can eat tomatoes now (spicy stuff still burns, sadly …)
I don’t have mouth sores
I don’t have to take Senekot to poop

How am I Facilitating my Recovery?

Well I am tired a lot so I try to rest. L. M. A. O. Ya so, I’m not just sitting around waiting to get better. None of that shit. I want to be better NOW! Lucky for me, my cousin Cheri is a prof in the Kinesiology Dept at the U of Windsor who is researching the relationship between recovery from cancer and exercise. (Yep. That’s my cousin! Doing it all for me! LOL) She was very quick to tell me that research clearly indicates that exercise offsets some of the detrimental cardiac and vascular effects of Herceptin (yes – the biggest side effect is a weakening of the heart). Here’s a great quote she sent me:

“Most impressive of all, moderate to vigorous intensity progressive exercise training prevents recurrence and death from breast and colon cancer. The overriding message, is that exercise training is beneficial.” – American College of Sports Medicine 2016.

Ya. So that means I HAVE TO EXERCISE! (oh, and I love it soooooo much…)

Here are the guidelines that she has sent me (a combo of suggestions from Cancer Care Ontario and the American College of Sports Medicine):

aerobic exercise (aka cardio):
- 150 minutes of accumulated moderate intensity aerobic exercise (seems reasonable till you figure that 150 min is more than 2 hours … just sayin’)
- using large muscle groups
- spread over 3 to 5 days / week (so that’s 30 – 50 min of cardio at a time … gak)
- I can be biking, walking, swimming … as long as I have a noticeable increase in breathing and sweating while still being able to talk. No gasping or falling over either.
resistance (aka weights):
- 2x / week (that’s feeling more reasonable)
- 8 – 10 muscle groups (8?? 10?? what?? I’m good with biceps, triceps, shoulders, back, chest. That’s 5. Oh dear.)
- 8 – 10 reps, 2 sets (simple. It’s the number of muscles that’s the problem.
- can use free weights, weight machines, isokinetic machines (ummmmm whaaa?), resistance bands, circuit training (no thanks if this involves me pushing someone sitting on bench or something daft like that), functional exercises (like splitting wood??)
- if combined with aerobic session, I can scale back on my aerobic exercise (20 min max) HALLELUJAH. Must. Do. Weights.
flexibility (aka Yoga):
- 3x / week
- 20 seconds / stretch, 2 – 4 reps / stretch
- static stretches of hips, knees, shoulders and neck
- This is TOTALLY manageable. I can watch Netflix and stretch like a pro.

Do I want to do this? No. Do I have to do this? Yes. So, motivated by my fitnfreakinfabuless friend Kate, I started my exercise regime 6 days after my final chemo. Lemme tell ya, I’m no spring chicken, but I can still kick some exercise butt! For example, today I did a 1 hour Hatha Yoga class at the Y (just slight tenderness here and there), yesterday 30 min on the treadmill with about 1 minute of RUNNING (and I nearly collapsed trying to push the arrow down button), the day before 40 lengths of the pool (aka 1,000 metres). I love the feeling of the water on my bald head by the way. Very cool perk to baldness.

Sadly, part of the chemo aftermath is the feeling of exhaustion. Which I hate. But it’s still there even with the hating. Go figure. So the trick is to do this exercise stuff in the morning since I have very little energy by 2 pm.

See you at the Y!