Heart of lightness

I have never been cut on by a doctor. Never spent a night in a hospital. Never had anything more serious done to me by a member of the medical profession than setting a broken bone (a couple times), a little probing here or up there (a few rather awkward times) and, you know, the general screwing that all doctors give you every time you see them.

Health care in America. AmIright?

Anyway, as I said, I’ve never been cut on. (I’m not counting a mole done in a strip-mall outpatient clinic once.) Ever.

Well, that’s about to change. In a big way.

***

This is my heart. Or so they tell me.
This is my heart. Or so they tell me.

When I was in my mid-30s, living for a long year in Columbus, Ohio, a doctor detected, for the first time, a murmur in my heart. He didn’t seem too concerned about it, so I wasn’t either. But he told me to keep track of it. So I have.

Every year, I’ve had my primary care physician here in Atlanta check on it. And every year, she has said, “Yep, I hear it.”

Several years ago — maybe 10-12 years — she sent me for a trans-esophageal echocardiogram, where doctors stick a probe down your throat to get a better picture of your heart. They found the culprit: My aortic valve was bicuspid — two leaves — instead of tricuspid. Congenital, they said. Some 2 percent of the population has it. That’s 6 million people in the U.S., if you’re counting.

Every year after that test  — sometimes twice a year, just to be careful about it — I’d head to see a cardiologist, in addition to my regular doc. “Yep,” they’d say. “I hear it.”

Still, no symptoms. No restrictions. No drugs. No worries.

A few years ago, though, during a visit to my cardiologist, he finally laid it on me. Or maybe he had told me before, and it hadn’t sunk in.

He’d take me over to the computer to point out how my blood flow was getting more and more restricted. The two valves, after years of doing the work of three, simply were beginning to wear out. The measurements of how the heart was performing slipped a bit each year.

“You know,” he said, “You’re going to have to get that valve replaced some day.”

Still, I had no symptoms. No shortness of breath, no pain. No numbness or fainting or bright lights in the distance. Today, I’m probably in close to the best shape of my life.

About a month ago, I went in for my annual echocardiogram (just a regular one … no probing) and a stress test. I’d taken a stress test once before — you know, running on the treadmill, all hooked up to a bunch of wires. They’re a bitch, stress tests, but I wasn’t concerned. I play ball a couple times a week. I work out at least three or four times a week. I was sure I’d get winded. I was also sure, if I got too winded, I’d back off on that baby in a blink. I know my limits.

After my echo, the tech looked down at the results, walked into the other room to talk to the cardiologist on call (not mine) and, between the two of them, they decided that a stress test maybe was not the best idea at that time. They sent me home.

Well, crap. Now they got me to thinking. Now I hear it.

***

OLYMPUS DIGITAL CAMERA
Dr. Michael Balk.
Used without permission.

“So, this is the deal …”

That’s my cardiologist, a pretty straightforward guy with a detectable sense of humor (many doctors are absent this trait) named Michael Balk, as he walked into the room the week after my aborted stress test.

Dr. Balk told me the valve was deteriorating further, and asked me about symptoms. I told him I didn’t have anything worth mentioning.

And that’s when Mary Jo spoke up.

Yes, Mary Jo came along for my appointment. Once she heard they canceled the stress test, she wanted to get involved. And so, immediately after I told Balk I didn’t have any real symptoms, she spoke up. She told him about me complaining occasionally about not feeling right and once in a while getting a little dizzy. She, in a sense, ratted me out.

So … yeah. OK. You got me. For a stretch there, when I swung myself out of bed in the morning, I got light-headed sitting on the edge of the bed. It lasted for only a few seconds, and I was fine. And those episodes lasted for maybe two weeks. At the most. That was it.

And once or twice, yeah, playing basketball, I felt a little funny. But it passed. I fought through it. I was fine by the end of the night.

Those problems, I am convinced, may just as easily have been sinus congestion, or something I ate. My head playing games on me. You ever lie in bed at night and listen to your breathing, or your heart beating, or feel your back tightening up? I’m not saying these things were all in my head. But if I didn’t think about them, if I just fought through, I was fine. Every time.

Balk made some notes, explained to Mary Jo what was happening with my valve and decided, given all the negative numbers floating around on that chart and Mary Jo’s comments, that I should go in for a cardiac catheterization, where they send two tubes into my heart to check things out.

The doc made it clear. This catheterization was just to confirm things. His guess: It’s time to get this thing fixed.

We scheduled the cath (yeah, I’m talking like that now) for a week later

***

I’m back from my cath. It went as planned. Maybe even better than planned.

The King and Queen, on the Perimeter in Atlanta. Strange to think that two big life happenings will occur in the shadow of these two buildings.
The King and Queen, across from Northside Hospital on the Perimeter in Atlanta. Strange to think that two big life happenings will occur in the shadow of these two buildings.

Mary Jo and I went down to Northside Hospital — the same hospital where Luke was born — for my 11 o’clock test. As with everything health care, of course, the test was not at 11. The check-in was at 11. Getting through the paperwork started at 11:30. Heading back to get prepped started at around noon, I’m guessing.

Health care in America. AmIright?

I walked down the hall from check-in, pushed a button and two big, oak doors swung open to a long corridor. Kinda spooky, actually. I picked up my pace — didn’t want to seem like some invalid walking into a cardiac ward — and met a nurse named Joanne on the other end.

And so it went.

  • Sit me down. Go over my health history. Explain what’s going on. Joanne told me they plan on going through my right arm with two — for lack of a better word — probes. One probe is to go through one side of my heart. The other, the other side.
  • Answer questions. I had a few. Like … probes? Am I going to be awake? (The answers: Kind of. And yes.)
  • Get undressed. Completely. Put on a gown. Open in the back. Awkward.
  • Put me a monitor, attached by tape to my right thumb. The monitor is over my left shoulder. I look. Heart rate is in the high 60s. A little high for me.
  • Quick EKG. I mean, quick.  A minute or two.
  • A quick shave of my left forearm, where they will put a catheter for administering drugs and the such. They shave my right wrist, where one probe will go, and clean up inside my right elbow, where the other one will go.
  • In case they can’t go through my arm, Joanne says, they’ll have to go in through my femoral arteries in my legs. So … shave there, too. Which isn’t really shaving, like, your upper leg, if you get my drift. It’s more a shave or your upper, upper, leg/groinal/junk area. And Joanne did a pretty thorough job of it. Pride, see you later.
  • They put the catheter in my left arm. It hurts. But only for a while.
  • I think they do the same for my right arm, though that might have happened a little later. In fact, Mary Jo says it did happen later. Let’s go with her story.
  • Joanne has them play a little Ray Charles for me, by request. I calm down a little. This is a plus for Northside.
  • A physician’s assistant comes in, one of Balk’s. My heart rate, I see, pops up from about 59 to 66 when she’s there. We’re getting close.
  • Mary Jo comes back to join me. We hang there a little.
  • Derek, a big dude of a nurse, comes to get me to wheel me down the hall. Mary Jo leaves to go back to the waiting room. Turns out Derek has a family member, a niece I think he said, that plays volleyball at Luke’s high school. Or did last year. Derek takes me down to a room — I’m calling it an operating room, though this is only a test — and helps me to get off the gurney and into the room. My gown, of course, is all bunched up around my chest, so when Derek flips the covers off me in the hallway — wheeee! Look, everyone! I feel like going back to compliment Joanne on the close shave.
  • I walk into the room. I’m completely sober, which I know because I’m acutely aware that my ass is hanging out for the, oh, four or five nurses in the room to see. Which, I’m sure, they don’t give a damn about.
  • I step up onto a stool. Another nice woman nurse — forget her name — tells me to put my bare bottom on the table.
  • At this point, I’m just following orders.
  • The nurses ask my name and DOB and flitter around preparing things. Blankets are lifted, gowns are moved, hips get stuck up in the air. A paper cover goes over me, though I’m thinking my upper leg/groinal/junk area feels exposed. The paper cover is bunched up at my chest, so I can’t see. But I’m thinking I’m exposed. I’m guessing no one but me cares. Still, I feel the need to explain to everyone in the room that it’s cold in there.
  • Someone sticks something heavy on me down there, resting on my hips. I’m guessing that’s some leaden curtain kind of thing to keep out the X-rays. Whatever, I’m feeling a little less exposed, and a little more grateful.
  • Derek adjusts my right arm and tapes down my right fingers so my right wrist is up. Evidently, they put the two catheters in my right arm now.
  • “Hey, John.” I hear a familiar voice and look over. “It’s Dr. Balk.”
  • I knew it was Dr. Balk, dammit. It better have been Dr. Balk.
  • “Doctor …,” I say. “How are you?”
  • And we go. A nurse/anesthesiologist puts something in my left arm. I relax a little. Balk, sitting at my right wrist, goes to work.
  • I’m awake during the whole thing. When I can glance over to my left, past the camera which is inches from my face, I can see what Balk is seeing. Which looks like an X-ray of some unfamiliar place in some unfamiliar body. The X-ray has a little hook of fishing wire in it.
  • I feel no pain. I feel little of anything, except cold, and an occasional movement in my arm which feels like someone tracing a finger along my skin, down my arm.
  • I think the whole thing takes maybe 45 minutes. Maybe an hour. I didn’t check. Time flies, you know?
  • “Looks good,” Balk says. He’s out of there. The nurses bounce around some more. Someone puts a clamp on my right wrist, where the probe was. They detach me from whatever monitors they had me on. They bring a gurney over to the right side of the table, and I plant my elbows and swing my bare ass (I’m mostly covered up front now) over. They wheel me back into my little curtained area.
  • Mary Jo returns. I have to wait a while, mainly so the clamp on my right wrist can stop the bleeding there. Joanne slowly ticks back on the clamp’s pressure over the course of maybe an hour until there’s little but a small drop of blood there.
  • Balk returns and tells me the good news. My arteries are clear. No backup there at all. That’s good. So there’s no chance of me having, say, a heart attack because my arteries are clogged with 50+ years of Wendy’s and Burger King. That’s real good news. To me, it means I can have a Whopper on my way home. With a small fries, of course.
  • Joanne wheels me to the front door, where Mary Jo is waiting with the car. Just in time for rush hour traffic. Perfect. No Whopper, dammit.
The heart's a funny thing.
The heart’s a funny thing.

So it all went well. But the thing is, I still have a bicuspid valve. We knew that going in. And, given the rapidly sliding numbers, it’ll have to be replaced. We knew that, too.

When?

Our thinking on this whole process — yeah, Mary Jo has a pretty big say in this — is the sooner the better. Because … well, why not? I’m healthy now. They tell me I’ll be healthier after the surgery. But they still don’t want me overexerting myself between now and the time my valve is replaced. Whenever that is.

So, we’re meeting with Dr. Jeffrey Miller, a cardiac surgeon, on Monday.

I’ll get back to you.

1 thought on “Heart of lightness”

  1. […] an appointment today, Mary Jo and I, with a heart surgeon. (If you need background, it’s here.) And after an hour stoning him with questions about valve replacement and surgeries and second […]

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