In late December, I mourned myself, perhaps prematurely.
It came almost to the day upon my 20th anniversary of starting exercise, which is probably why I’m still here to discuss it.
I’ve known since 2010 that I had issues with cardiac artery blockages, but 15 years ago they were mostly just a warning to stay active and keep eating healthy.
Because I felt great during the 10x Ironman and had absolutely no symptoms of heart problems, it felt like a gut punch when after almost a month of increasingly expensive and invasive tests and a cardiac stress test, I learned I have problems with my cardiac arteries: specifically, significant blockages in the left anterior descending artery (the LAD, or widowmaker) and the obtuse marginal artery, which is a branch of the circumflex. Both the LAD and the circumflex come off the left main artery.
The good news was that according to the cardiac cat scan, the LAD was only 50 percent blocked, and I had normal ejection fraction and practically normal fractional flow reserve (FFR), which means the vessel was still about half open. But only a cardiac catheterization would be able to tell for sure.
The other good news was that in the coronary CAT scan (CCTA), the obtuse marginal–that’s the third vessel after the curved one above, the one with the blue gap–appears to have “bypassed” a 100% occlusion on its own. The only question was how much flow I had through the “baby” collateral vessels.
The ramus, which was also 100% blocked, I was told was too small to bypass. By the way, I have since leraned that 75% of people don’t even have a ramus, which maybe that means that one of my smallest blocked arteries was a “spare.” And apparently even THAT one had either a twin brother or collateral vascularization. At any rate, they were enough to keep the heart muscle alive.
The bad news was that my stress test showed severe inducible ischemia in the vicinity of the circumflex and the cardiac CAT scan showed severe coronary artery blockage.
The signals were mixed. Of four cardiologists I saw, one said that I needed a stent IMMEDIATELY in the LAD, another said to watch and wait, and a third felt I needed open heart surgery and a double bypass.
Regardless, I suddenly felt, and continue to feel, very mortal.
“Nobody here gets out alive.”
The Doors musical frontman Jim Morrison once famously said, “No one here gets out alive.” It’s a simple truth about impermanence, but every time I hear it, it sounds like a hostage threat. That’s as close as I can come to describing how I felt when I got the news from the stress test and the cardiac cat scan. Like I’m the clever bank patron who knows how to overpower the bank robber, but we’re all going to die anyway when the bomb goes off.
Now I’m entering a new chapter in my life: fresh uncertainties, compromises, and difficult judgment calls.
What’s my blood pressure right now? How does my chest feel? What’s my emergency plan if I have a massive heart attack out on a run? Did I bring the unbuffered full-strength aspirin? Do I have the nitro in my pocket? Can Leslie locate my phone to tell 911 where to pick me up? Will I survive it? Will I even FEEL it if I have a heart attack? Should I have opted for horribly invasive but preventive bypass surgery? Should I have gotten a stent while the vessel was more open? Did I overlook other options like MIDCAB (minimally invasive coronary artery bypass graft)?
This is not the post I wanted to write on my 20th anniversary of being fit. This can’t be that post, I keep telling myself.
But this IS that post.
I find myself looking back on the last two decades as if it were a dream, as if it happened to someone else, and as if the unsettling reality I’m in now is one where I was never active at all.
A chance at a reboot
Recently, I joined a Facebook group called “Cardiac Athletes.” I was grateful to find them but a little sorry I had to look for them in the first place.
Fortunately for me, the group’s membership is mostly a bunch of super-badass ultra athletes who are still capable of ultra events despite heart attacks, arrhythmias, heart valve problems, stents, off-pump bypasses, minimally invasive bypass (MIDCAB), and standard bypass surgery.
Some had procedures before a major cardiac event, some only after obvious symptoms or something imminently life threatening, like a heart attack. Some had single-vessel coronary artery disease; some had totally asymptomatic coronary artery disease. Just like me.
What’s really going on here?
On March 19th, after four cardiologists and an extensive consult with top-rated a board-certified interventional cardiologist who I felt fully understood my situation, I had a cardiac catheterization done.
I arrived at Baylor Heart Heart Hospital in Plano just before 6 AM and was told the prep for the procedure would take about an hour or two. Jodee, Jocelyn and Frank put in an IV and took a blood sample, explained the process, and Courtland wheeled me up to the 4th floor, where the cath lab was. Another nurse prepped the site in my groin where the introducer needle would go for the cath wire Dr. Stone would use to fully investigate the previously reported blockages and check out my mammary artery and radial arteries as potentially viable vessels for bypass. It was a full-day affair, and I left the hospital in the late afternoon, this time shocked for a different reason.
The news was better than expected.
This time, with the miniature camera right there in the artery, Dr. Stone said that while the obtuse marginal branch of the circumflex was still 100% blocked (albeit with collateral vascularization), the LAD was probably not even 30 percent blocked. “A few minor bumps here and there,” she said, “not worth doing anything about right now.” This was quite in contrast with the dire news my first cardiologist delivered on a 5-minute phone call while I was in the grocery store, in which he announced unceremoniously that without the stent he said I needed immediately, I’d be dead within 3 years.
It’s not that I was shopping for a better answer, but as I am told, “what the CAT scan don’t know, the cath lab will show.” Now the diagnosis has switched from pervasive multi-vessel disease and serious blockage of the “widowmaker” to something like watch-and-wait (for what?) or some kind of single-vessel treatment to address what’s going on in the circumflex, which seems to be managing okay at the moment but really needs a 60,000 mile service appointment. 🙂
Dodging a bullet <> bulletproof
The fact the the day before, I’d had a long needle poked directly into my femoral artery and been told to spend most of the day recovering in a hospital bed, plus the significant co-insurance charge remind me that this was no walk in the park, but something more like a warning shot across the bow.
Despite the better-than-expected news, I still feel quite mortal.
I know people with coronary artery disease live long, productive lives. I’m not looking forward to the prolonged recovery and rehab, or being on blood thinners for who knows how long, or having to try to be even MORE aware of food’s effect on my body than T1D already made me.
I know I’ll have to work on how I handle stress. I know that in many ways, I’ll have to start over, carefully calibrating exercise to whatever is medically safe to do, so that I can continue to reap the benefit of fitness without keeling over from a massive but silent and asymptomatic ischemic event.
But I apparently have a little more time to decide what to do. I also need to choose wisely, both on what to do as well as to how I spend the rest of my time.
It reminds me in some ways of Buddhist sand mandalas, art made by carefully pouring grains of sand into an intricate pattern…then destroying it. Time is like those sand sculptures. It comes, it goes, and all our tomorrows and yesterdays don’t matter as much as our RIGHT NOWs.
A lesson my dad taught me…five years after he died
For a guy with severe coronary artery disease, I’m about as healthy as it gets. I’ve had time to run tests, work my way through cardiologists until I found one that listened and understood my perspective, and even time to pick out a cardiothoracic surgeon if needed for a bypass. I’ve had time to get a cardiac cath done–by someone who wasn’t judging me as a diabetic and assuming facts not in evidence–before it became an emergency.
All of this reminds me how lucky and privileged I’ve been to get this far, and it gives me hope. But it also gives me pause. It’s a reminder that our time here is not permanent. T1 or not, our stories all share the same ending, and if we want to do or say something important, now’s the time.
A few months before my dad died in 2020, he made it a point to to tell family and friends how he felt about them. On a GOOD day, he was never very open about his emotions. But I knew his health was failing, I knew he felt the cold wind at the door, and I reassured him that I was proud of him, that he’d been a great father. I wanted him to hear that, because I knew THAT was my chance to tell him…while he could hear it and know it.
One of the lessons he still managed to teach me–FIVE years after his passing (my God, has it really been that long?)–is that we all need to say the quiet parts out loud, while we can.
So whatever happens with the bypass, or MIDCAB, or stent, or Optimal Medical Therapy (OMT), that’s the lesson I want to learn from it: that the only moment we have is NOW, and THAT’s when to say the things that matter.
Once you recognize the transience of all things, some things become easier. Grudges don’t hold. Arguments don’t last. You think about whether a sharp comeback during an argument is truly the last thing you’d want your loved one to hear.
I had a similar epiphany back in 1988 when I survived an armed robbery. I was SO glad the last thing I had said to Leslie was that I loved her and would see her soon.
It really doesn’t matter if you’re cut off in traffic. It doesn’t matter if someone said something hateful to you–it’s probably just a reflection of their pain anyway. It doesn’t matter any more who’s right or who’s wrong. None of that matters, and clinging to it does more harm than good.
Instead, you take more time to watch the sunrise, smile, and appreciate the flickering beauty that is life.
