Angina II - 2009

I can’t believe that after only ten short months I am writing again. Things were going well in the heart department, and we were at the end of our third vacation trip in two months. It was Saturday morning in Christina Lake, B.C. We were putting the finishing touches on packing to go home. I cranked down the tent trailer and was putting the final hook-up connections on, breathing a little heavy from the turning and bending. Suddenly, I met an old friend, the start of some pains on the left side of my chest. I recognized it immediately.

I was finished and sat down to drive home. The pain subsided quickly but the effect did not. I recalled the chastisement I received last time for not going directly to the hospital by ambulance, but was this really the same pain, or was I imagining it, as you do get over sensitive to chest pains after two angina attacks? My main thought was, I do not want to end my holiday in Osoyoos hospital and then being transported somewhere else.

We stopped near Crawston to visit a winery we were told was very good. Due to the size of the driveway, I decided to park on the side of the highway and walk the 5 minute distance to the wine shop. By the time we reached the shop, that pain was starting again, not severely, but enough to get my attention. Joanie thought I was a little quiet during the wine tasting. Go figure!

The walk back to the car, though it made me nervous, went well. We reached the car before the pains returned. The rest of the six hour drive home was not as pleasant as I had hoped. The trip was measured in my mind by hospitals. Ok, if anything happens now, I guess I would end up in Princeton hospital, now I am getting close enough to go to Hope hospital, now Abbotsford, and finally, we’re in home hospital territory! Maybe its time to tell Joanie. On the other hand, she can be so picky when it comes to health issues.

The weekend went by and things went well. We didn’t unpack the full trailer and so I didn’t have to exert myself too much. I felt no pain, but the visions of anginas past danced in my head. This can’t be happening so soon again. Only a few days ago I was running around playing frisbee keep-away.

Monday morning I returned to work. I left the train downtown, but before I got to my building, only half a block away, I felt the pain start, and I had to stop and let it go down. I knew I couldn’t ignore it. I better call the doctor. See, I am learning much more quickly! I even prepared my co-workers that I may have more problems, and would work from home until I knew things were right.

My doctor checked things out the next day, and had an ECG done immediately. She did not notice any significant irregularities except that I had some should muscle bruising, probably from cranking the trailer. She advised me to carry on and she would schedule a stress test the following Monday. However, a short walk to the mailbox that night confirmed for me that all was not well. As soon as I did any activity that caused my blood pressure to go up, the chest pains would begin, and as soon as I relaxed, the pain disappeared.

The next days I stayed home, working only an hour or two per day, checking and responding to e-mails, and relaxing for the rest of the time. This was during a record heat wave. In fact, the hottest day on record, 38 degrees in the shade, I suffered at home with my cold water and fan while the rest of the family gallivanted in Stanley Park. I even had to make my own dinner, nuking some leftovers! They don’t treat heart patients like that in a hospital.

I went to see the cardiologist, a substitute for my previous cardiologist, who was on vacation for four weeks. He could not get me in for an angiogram until the following Thursday, but assured me that he preferred to do angiograms through the wrist, a less invasive approach, and that he had experience. I was instructed to keep relaxed, and go to emergency if I began feeling pain even when I was in a relaxed state. For the next nine days, I continued my difficult journey, sleeping in, donning shorts and working tirelessly for one to two hours per day before retreating to a book or a photo album I was working on. That can be difficult to concentrate on with the noise from Joanie mowing the lawn in the heat of the day, or vacuuming and cleaning. I wanted sooo much to help, but alas, all I could do was to helplessly watch.

Friday night was a scary time. Having put in several hours of work that week, I sat down to relax and watch the B.C. Lions game. Things did not go well. Their offence stunk. Their defence stunk. Their specialty team stunk. They rejected numerous chances to win the game, insisting on humiliating themselves. My blood began to boil. The chest pains started. I was supposedly in a relaxed state, but I was feeling pain. This could mean a 911 call. And its all the Lions’ fault! I had to talk myself down. It’s only a game. My life won’t change whether they win or lose (yeah, right!). Just watch the game but don’t get emotionally involved. It worked to some degree and the pains subsided, mostly. This was the ultimate stress test. I did say a few prayers, and they weren’t even about the game any anymore.

I managed to survive, emergency free, until my scheduled angiogram on August 6, 2009. I checked into the hospital at 7AM (Leah and Joanie were very excited about having a reason to get up early for a change although they were awfully quiet on the drive, and Leah spent much of the day threatening to climb into the unused beds in the hall.) The nurse gave me one of those wonderful gowns, which serve only to cover up your belly button. She went to shave my groan area. Being old fashioned, I did not relish a strange woman shaving my private parts, so I assured her that the new radiologist, Dr. Dorval, was planning to use my wrist so shaving down there was not necessary. However, I think this shaving job is the highlight of a nurse’s day, so she insisted on doing it anyway, along with my wrist. With my summer tan, I now looked like I had an oriental right wrist, all nice and brown and smooth.

By 8:00 AM I was wheeled down to the lab and lay there, listening to a grossly over-weight cardio patient being lectured about his self-admitted addiction to junk food and snacks and his attempt to slowly cut out those cigarettes. I am by no means slim, but a tiny sense of self-righteousness does set in. He was being told that unless there were real and immediate changes, the procedure being done would be a waste of time.

Dr. Dorval came to see me before the operation. He began with, I have some bad news. For some reason, that was not what I wanted to hear at that time. He explained that while entered through the wrist would be best in terms of quick recovery, after studying my previous procedures, if he needed to repair my original stent, put in six years earlier, he would need a larger balloon and stent, which could not go through the arm, and so he would have to use the groan area anyway. Therefore, rather than risking having to go through both areas, it might be better to start with the groan area right away. I hate that kind of logic. How do you argue? I said, do what you gotta do doc.

I entered to lab area quite relaxed. It was old hat. This was my third time, and the previous times it was painless, and actually quite interesting. I shimmied onto the operating table. It was just after 8:30. I should be out of here by 9:15, and could be up and ready to go home before 2PM. Dr. Dorval proved to be Mr. Cautious. He worked slowly and meticulously, a good thing when you are at the other end, but maybe no so if you are part of the nursing staff assigned to assist. I became a little nervous when he kept asking the nurses questions. I thought he should be the one with the answers. He asked what procedures they used for this and that, what sized stents they had available, how they might get more clear pictures of certain arteries, etc. He left the room several times to consult with the staff operating equipment from another room.

Meanwhile, I am beginning to sweat. I am now getting full bore chest pains, which I did not get in previous angiograms. I thought I might casually ask one of the attending nurses if this was normal. Apparently not, because twice they quickly proceeded to inject some hemo something-or-other before the pain died down. While it was difficult to see what was happening, although I got the occasional glimpse of the wire in my chest, and the shots of dye which then showed my arteries pumping blood when the camera was not in my face, I could of course hear everything. What size stents do you have between 8 and 15 mm.? Do you have a 13? OK, lets try that. Move the camera a little. I don’t like where the stent is sitting. I can see the end of it. Should we try “gobbly gook”? Every time I thought we were almost done, he seemed to move to a new location or want to have some more dye to see something. It was a full 2 hours before he was done.

I don’t know how to approach this next topic delicately. Prior to the surgery, I had a slight issue with passing gas. I have no idea if this became an issue during the procedure, as I was distracted by the chest pain, but as I think back on it, perhaps the reason the doctor left the room was for some fresh air.

I admit this freely because one loses all dignity in the hospital. At the end of the procedure, the doctor said he was taking a picture of my groan area. I thought that was a little perverse but if he saved my life, I wasn’t going to argue while lying on an operating table. The nurse (what was she doing looking at my groan???) said she could see that I had a full bladder. No kidding, now that it was over, I could concentrate of the fact that I had to pee. They took a pee jar and put it in place and told me to go ahead. Are they kidding. I once had to pee so badly at a football game that I stood in the long line-up for urinals, only to find once I got there that there is no way I was able to pee in a crowd. I pretended to pee and left unsatisfied. Nothing has changed. I tried but nothing happened. They suggested they could leave the room but, I could see them huddled against the wall. No way was that going to work. As I lied there I thought of how stupid it must look to lie there in the middle of the crowd of staff, with a bottle between my legs. It was only some time later, while lying by myself (a key factor) in the recovery area, that I was able to empty my bladder.

Waiting outside in the recovery area, Dr. Dorval came over to say how pleased he was with the angioplasty, but that he thought perhaps I should stay over night. I said I preferred to go home since not much happens over night anyways, and he agreed to let me go home at 7PM.

The nursing staff in the room I was assigned were nice. I had to lie with my effected right leg motionless for 4 hours. Any attempt to lift my head, even a little, was greeted with a quick reprimand. Apparently, the artery used is the thickness of a little finger, and if, due to pressure on the groan area, the plug should come out or not seal properly, one could loose a great deal of blood very quickly.

The nurses rolled their eyes when they saw the instructions not to release me until 7PM. Over cautious but he will have to learn if he plans to stay here. There were grumbles the rest of the day about a procedure this morning that went well overtime and put the rest of the day’s operations behind schedule. I wonder which one that would be?

Due to slight bleeding, my nurse had to sit, putting pressure on my groan artery, for 15 minutes to ensure that the bleeding stopped. This too is not the most flattering of moments. However, she got her revenge on me. She put large bandages over the wound, showing absolutely no discretion on where the applied the adhesive parts or what follicles might be captured in its grip. Removing those bandages a few days later may be the most painful part of the whole procedure. I am still not sure if everything works down there or if it is in shock.

During the day, several patients came and went in my 4 bed room, while I lied there for hours. One elderly man with a heavy European accent came in. He was very friendly, thanking the nurse who wheeled him in. The room nurse, who had a slight oriental accent had a great time trying to communicate.

“What hospital did you come from?” “Yah, very goot.” “Nurse, I have to make a de poop.” “Do you have to pee?” “No, I have to make a de poop. Very sore. I like to get up and go to the bathroom” “No, you can’t move anything. Stay there, you will have to use a bedpan. “ “Do you have trouble peeing?” “I am getting very sweaty.” “Do you have trouble with your hearing?” “Nooo, I hear everything very goot.”

Then, after some loud groaning, gaseous sounds, etc. “Are you finished?” “No, I no poop. Only fart. No poop on it. I keep bedpan for now.” “They are coming to transport you soon. What hospital did you come from?” “Yah, I go back soon.” “What hospital?” Silence. “Was it Abbotsford?” “Mission, or something”. “Maple Ridge?” “Yah.”

The defecation issue went on for some time and escalated until it was discovered that he had a full bladder and needed a catheter to relieve it. Why didn’t they just give him a pee jar on the operating table?

By 6:45 I was able to get dressed, get deposited into what looked like a converted shopping cart, and get wheeled off to the car before anyone could change their mind. Just to ease you mind and relax you, the nurse reminded us that if the plug should come out of my artery, I could loose blood quickly, so someone should put very firm pressure on the area, while someone else called 911 right away. And no, I wouldn’t notice this by blood coming out, since most of it would run into the cavity of my leg. I would notice it by the hardening around the wound. How comforting. You might be bleeding to death but there are no physically obvious signs to warn you. Great. I think I am ready to tackle this on my own then!

Post script: No, I did not bleed to death, but did almost die taking off the bandages.