I was sitting in my cardiologist’s waiting room and looked around. My immediate thought was, “Wow, there are a lot of older people here”. And then I smiled, because I am of course one of those “older people”. Older is a relative word, but if the shoe fits…
When I was younger, one of the phrases I never thought I would utter was “my cardiologist”. That all changed after I was bitten by a copperhead* and developed AFIB in the summer of 2012. I’ve been in continual AFIB since then, although, honestly, I don’t usually notice it and have continued all of my normal activities.
Yes, I Really was Bitten by a Copperhead.
It did add to the number of drugs I take. For decades, I didn’t need any pills. Oh sure, I took the occasional aspirin or later, ibuprofen, and in the springtime took an allergy pill, but that was about it. Over time, things changed.
First, my allergy pill went from only spring to about three quarters of the year after moving to the farm.
Next came a statin. I spent a couple of years trying to control my cholesterol with diet alone, and while it dropped some, it wasn’t enough. I was tracking my meals at the time and even after I went three months with 90% vegetarian meals it didn’t drop significantly. So, Atorvastatin was added to my mix of drugs and it dropped like a rock. And because atorvastatin can affect CoQ10 levels in the body, it was suggested I take a CoQ10 supplement. It turns out your cells — especially your mitochondria — need CoQ10 to make energy. Decreased CoQ10 levels in the body could mean your muscles have less energy, leading to muscle aches and pains. Pill number three was added.
LDL Cholesterol – Pre and Post Statin – Just Take the Drug!
My doctor and I spent quite a bit of time talking about health in general. In addition to meat, I reduced the amount of dairy in my diet as many people do. Cheese was practically a food group for me for decades, and I cut it back quite a bit. We also talked about sun exposure and increased chances of skin cancer. I started wearing hats more and didn’t spend as much time in the sun.
Perhaps it was no surprise at my next annual physical I showed a Vitamin D deficiency. My doctor suggested I add a vitamin D supplement to my regime. I countered, “We didn’t have this problem before cutting back on dairy and staying out of the sun. Perhaps I should eat more cheese, while working on my tan.” She smiled but I’m not quite sure she enjoyed my sense of humor. I dutifully added pill number 4, a chewable Vitamin D tablet.
After AFIB started, I went from a baby aspirin to a whole aspirin to, eventually, the blood thinner Eliquis. There’s a stroke history on my dad’s side of the family. He, along with an uncle and two of my cousins suffered strokes. When my younger sister, Tanya, had one a few years back, I told my cardiologist, who immediately said it was time to go on a blood thinner.
With the addition of Eliquis, I upped my morning intake to five different pills. I bought one of those neat little weekly pill box containers to dole out my daily stash. I chuckled a bit at that as well. Years ago on visits home, I remember rolling my eyes as mom dutifully filled her and dad’s pill boxes for the week.
Up to Five Pills Every Morning
Cardiologists and pill containers – yep, I am getting a wee bit older. As RiffRaff sings in Rocky Horror, “It’s astounding, time is fleeting…”.**
Maybe it’s not so much astounding as inevitable and we all know it. Still, you have to enjoy the trip and occasionally chuckle at the absurdity of it all. Otherwise, what’s the point?
** I felt compelled to drop in the quote from “Time Warp” in Rocky Horror, but maybe that just makes me look older as well ;-). Do younger folk today still watch the movie?
I’ve had Atrial Fibrillation (AFIB) since the summer of 2012, when I was bitten by a copperhead snake. Normally, it’s not a problem, but in February of this year, I had an incident that sent me to the Emergency Room and on a two month journey of heart tests. The result? Well….
It happened on Valentine’s Day (insert bad joke about broken heart here). Actually, it started around the 10th of February, when I stood up from the couch and walked into the kitchen and almost fainted. I just figured I’d risen to quickly and didn’t think much more about it. Then, on the 13th, I felt dizzy just while sitting, although the feeling went away relatively quickly. However, as the day went on, I felt worse, in an undefined sort of way. The next day, the 14th, I wasn’t any better. I checked my pulse and blood pressure several times, and they were, um, wildly variable is probably a good way to say it. Finally, in the afternoon, I called our friend Janet, a most excellent nurse. She listened to what I had to say, was concerned about a couple of the numbers, and advised me to go to the ER to be on the safe side.
Cathy and I talked, and I decided to drive myself to the ER (perhaps not the smartest thing to do) at Fauquier Health in Warrenton, and arrived without incident. When I described at checkin what was going on, they moved me to a room within five minutes, tops. The ER doctor and nurse were both outstanding. In a matter of minutes, they administered the first three, of what would ultimately be ten heart related tests over the next two months.
In the ER, they gave me an EKG, a blood test and a chest X-ray. The blood test and X-ray were both normal. The EKG showed AFIB and nothing else – no stroke and no heart attack. In the meantime, I was feeling more normal – whatever it was, had passed.
The ER doctor talked to the on-call cardiologist from my regular cardiologist’s office and they took me off of one drug (Metoprolol, a beta blocker, which reduces your heart rate), thinking that may have caused the dizziness. He then discharged me and told me not to drive until I could see my cardiologist. I explained I drove myself to the ER, and he looked at me and said “I didn’t hear that”.
I didn’t drive for the next week, but having no subsequent incidents, did drive to the appointment with my cardiologist, Doctor Shah. We reviewed what happened, and then he scheduled a number of tests.
First up? Wearing a Mobile Cardiac Telemetry Monitor for five days. The monitor is a sort of portable EKG type device which continually monitored my heart 24 hours a day for five days. The result? Nothing apparent, other than my normal AFIB.
Next up? Tests five, six and seven – an Abdominal Aorta Ultrasound, a Renal Artery Ultrasound and a Leg Blood Flow Ultrasound and Study. The results? No ballooning, blockages, closures, or reductions in any of the major arteries leaving the heart and subsequently going to the kidneys and legs. In other words, the major arteries all looked normal.
Let’s keep things moving along….
Test eight was a CT Cardiac Calcium Scoring Scan. This is a scan of the heart that looks for deposits of calcium in and around the heart. Calcium leads to blockages, and this isn’t good. The results? Uh oh. There’s some calcium found. BUT, it turns out just about all people my age have some calcium. The test results go on to say “the total calcium score of 29 is between the 0 and 25 percentile for males between the ages of 65 and 69. This means 0 percent of people this age and gender had less calcium than was detected in this study.” —whew—
Test nine – back to the hospital for a Heart Stress Test. This is essentially a type of EKG while walking or running on an inclined treadmill for a period of time. With all the walking I do on the hills near the farm, this should be a no brainer. Except it isn’t. Something trips about 7 minutes into the test, indicating there may be an issue and I may have a constriction somewhere blocking blood flow around the heart. After they stop the treadmill, they continue to monitor my heart, which returns to normal quickly. Hmmmm. The doctor thinks this may have just been a false positive, particularly since I was wearing a mask during the test (this was in the time of Covid after all).
The test result goes to DR Shah, and he and I have a conference call. Looking at the result, he thinks it might be a false positive as well. He suggests one more test, so we can verify one way or another.
And so, it’s on to test ten – A CT Angio Coronary Test Without Calcium Scoring. For this test, I go to another hospital, a bit farther away. I can have nothing to eat or drink prior to the test. They inject me with iodine and take a series of CT scans of the heart.
Two days go by, and then the results arrive. “No significant stenosis identified. Small area of calcification noted in the left anterior descending which also did not have a corresponding area of narrowing within the artery.” For us lay people, stenosis is the narrowing of an artery or heart valve. We already knew there was a bit of calcification from the Calcium Scoring Scan, so nothing new there. The good news is there is “no significant stenosis”. The doctor is happy with the results, and pronounces my heart to be OK. We talk about diet*, as we always do, and schedule my next appointment, several months from now.
The ol’ Ticker is Looking OK…..
One of the phrases I never pictured using in my life is “My cardiologist said….”. And yet, here we are.
Did the Metoprolol cause the fainting/dizziness? The doctor isn’t sure, but we are keeping me off the Metoprolol for now. My heartbeat has stayed in the normal range without the drug, even though the actual rate varies continually.
So, here I sit over two and a half months later, pondering this recent journey. Part of me is thinking – “What the hell, ten tests!? That’s crazy!” And part of me is thinking “Ten tests, and we still don’t really know what happened.” And part of me is thinking “Ten tests, and they all pretty much show my heart (other than the AFIB) and arteries are in good health. I should be thankful.” The engineer in me says “ten tests and now we have a good baseline for all of these areas.”
All things considered, I am thankful. There’s a history of heart problems in my family – my dad and one of my sisters both had strokes and an uncle and two cousins died of strokes. From my perspective, any good news on heart stuff, is just plain good news and I’ll take it.
I’ve felt fine since the Valentine’s Day visit to the ER, so maybe it was the Metoprolol. Or, maybe it’s something else lurking around, waiting for another opportunity to complicate things, but I’m not worrying about that right now. I have too much living to do, to let this slow me down.
Oh, and one other thing. I did learn a new word. “Syncope.” Syncope is the medical term for fainting or “passing out.” It’s the temporary loss of consciousness, usually related to insufficient blood flow to the brain. So, while I thought this all started with a near fainting episode, it was actually a syncope issue…. ;-).
*Diet – My cardiologist would prefer that I was a vegetarian. I don’t see that happening any time soon. Having said that, Cathy and I both eat healthily – lots of salads, vegetables and fruits. Not much beef or pork. A bit more chicken, and a fair amount of seafood. We’ve greatly reduced dairy – I don’t drink milk, and now eat cheese only on special occasions. We’ve also reduced carbs significantly. Bread and pasta have become a rarity. When we have rice, it’s usually brown rice. Potatoes? We have them at one restaurant we go to, where I apparently can’t resist them, and maybe once a month at home. Neither of us have ever been dessert fans. As my cooking has expanded, I find myself gravitating to Indian, Korean and stir fry dishes – much of it, but not all, vegetarian. My diet isn’t perfect, but I believe it’s healthier than about 90% of America. I realize that’s not a particularly high bar.
Live Life Exuberantly 