Hey, I Was Only Following Directions

The Joy Of Nitroglycerine 

When I was discharged from the catheterization lab on Monday the 19th I was given a set of warning signs to watch out for and things to do if I saw them. Now given the fact that I had a probe inserted through my arm into my heart; most of the things to do were the same: "Call 9-1-1"

Heck, even I could remember that instruction.

The next day, Tuesday the 20th, went without incident as I chilled on the couch reading up on bridges and wondering how severe mine were? Where they were? Etc. I had an appointment the next day scheduled with the prescribing cardiologist so I knew I would get all the details soon.

The day was uneventful and by 5:00 pm I was bored and hungry. So I figured I could just walk to a great little restaurant near where I lived and grab some dinner. After dinner I came back home took care of some administrivia and went to bed.

That was when I started feeling a burning and uncomfortable pain in my chest. It was not severe at first but it was getting worse. So I lay there for a second sort of taking stock. It was not like the attack in Sedona. No "sports injury" starting point.

This was new and did not feel good at all.

Okay follow directions. In case of chest pain take a Nitroglycerine tablet (original instructions given by cardiologist on first visit). No problem. I got one tiny tiny pill out of the tiny tiny bottle and placed
it under my tongue and.....

BANG!! 

Some malevolent spirt or whatnot tackled me and placed my entire head in some invisible vise. Then, while I imagine it was cackling maniacally, started cranking the thing tight. On the tiny tiny bottle the tiny tiny warning label says "May cause headache" and that is like saying Donald Trump is "an atypical presidential candidate."

Understatement of the century.

I now understood why they prescribed these things for chest pain. The pain in my head was going to make me completely forget about the pain in my chest. Or at least completely stop caring if I was going to die as at least then the pain in my head would be gone.

But, I had to admit the pain in my chest was getting better. I thought: "Okay, trading chest pain for headache, probably not a bad thing…and then the chest pain started coming back…Damn."

Back to the directions again. They were pretty clear: in case of persistent chest pain – dial.

Does voice dialing work when your head is being squashed into a pancake? Let's see: "Hey Siri, call 9-1-1"…ring…ring…(+2 pts for the fruit company)

Conversation --> Sirens  (elapsed time ~5 mins)

The great paramedics (who were nice enough not to bust down the front door of the house waiting for me to open it instead) did a repeat of the Sedona EMS experience after which it was off to Stanford. It turns out when you say you are a cardiac patient with Stanford that pretty much ends the whole conversation and you are on your way to Stanford regardless of what they find.

I was admitted to the ER and they did the cardiac emergence: life in peril workup. Which was completely Myocardial Bridge like and thus totally normal. So once again there I was in an ER with all of the tests coming back completely normal. At least this time they had access to the Angiogram and the other data so there was proof that although I still felt like a gigantic idiot I was not completely crazy. There really was something not right.

Probably the best part of the ER experience was the nurse that was taking care of me was a post operative bridge patient! He had a severe bridge unroofed (without median sternotomy) a few years ago in his early 30s (although not at Stanford). He was thinking about becoming a patient of the Stanford bridge clinic because the unroofing was only partial (sternotomy required for full access) and he was becoming symptomatic again. He suggested if I ever was going to be looking at surgery to do the full thing if it was offered. "You don't want to go through it twice."

In the ER the attending physician gave me the official results from the Angiogram. They had identified two severe myocardial bridges. One was on my LAD which during systole completely closed the artery (100% occlusion). The other was on my left circumflex artery and during the heart beat the artery was 50% - 60% closed. As if that was not enough they also identified a plaque in the LAD that was blocking ~60% of the blood flow.

Well…Crap.

Given that it was now approximately 2:00 am and with my history they decided the best place for me to be was in storage. I was told they wanted to admit me and since I had no car, was in my pajamas,  was exhausted, and more than a bit worried about the results from the cath I was not going to argue. So I was admitted to the cardiac floor for observation and monitoring.

The Hospital:

Having spent months and months in hospitals with my kids when they were born I knew roughly how everything worked and what to expect. So although I had never been a hospital patient myself at least I was not totally unprepared. That having been said being a hospital patient really sucks. Stanford does an absolutely amazing job of making it as comfortable as possible. They have some really nice amenities and benefits but it still is a hospital. 

The next day my cardiologist dropped by. He went over the results with me again with a little more detail than the ER doctor. The bottom line was that I officially was a "complex case" and when your cardiologist, at one of the top heart clinics in the US, calls you a complex case you know it is not good. So due to the complexity of my case he, and all of the other doctors in cardiology, wanted to discuss my case in their weekly conference (Oh…Joy™).

The core of the complexity was that the plaque might be causing problems but they did not want to treat the plaque because of the bridge. Also, the bridge might be causing problems – but there was debate amongst the medical community at large about what role the bridge played as bridges are often thought to be benign things. 

But, he assured me, that there were some great doctors here at Stanford that were studying bridges. One of them was a Dr. Schnittger and she was going to be at the conference. They would come up with a plan of action and for me not to worry.

The bad news was that the conference was not until Friday and today was Wednesday. So between now and then they wanted to try and get some more tests run. Specifically, they wanted to do a test called a stress echo but the lab was booked solid into next week with no openings. So while they continued to try and somehow get me into the stress echo lab they would do a nuclear stress test. The nuclear stress test was set for next day and by keeping me as a hospital patient hopefully that would improve chances of getting the stress echo too.

Okay a plan to get more data. Data is good. I guess I could hang under the microscope a bit longer. 

So I spent the rest of the day in my room getting ECG-ed, poked (every hour on the hour), watching movies, reading, and looking online for anyone else whom had a bridge and was talking about their experience. (My difficulties finding the experiences of anyone with bridges is part of the reason why I am writing this blog)

Glow in the dark:

The nuclear stress echo test the next day was pretty interesting. It was a much smaller room than the catheterization lab but was just as cold. To start, I was wheeled in and hopped up on a table where they did the now all too familiar 12 lead ECG setup. Then a baseline scan by the imager and then it was time for the "fun stuff."

Specifically, the "nuclear" and the "stress" part of the deal. The "nuclear" is that they inject you with a radioactive dye that has a ~10 min half life and watch it flow through your heart on a scanner. Because the half life is so short they make the dye right in the building in a device they call a reactor. They then bring it to your room in a syringe transported inside a solid lead thermos which is mounted to a massive cart. The whole thing looked like it had been around since the 1950s.

So although it was not a "nuclear reactor" in the way people would expect I still can honestly say I was injected with 15ccs of radioactive stuff taken directly out of a reactor that was delivered in a 60 pound lead container.  

Take that spiderman. 

The "stress" part is a chemically induced 2 mile sprint. Basically, a full 45 min workout in a syringe. Aside from the whole possibly killing someone aspect of the deal it seems like a great idea. I bet you really could make a fortune in Beverly Hills with the 10 min - sitting in a chair sipping a smoothie - full workout.

Anyway, the tech quickly set up the two syringes (stress drug first) in a robotic injection machine and then got the hell out of the room fast. That nuclear stuff is clearly serious. I think it even glowed a bit. 

Over the intercom the tech asks if I am ready and I let him know that I am. "This is going to feel strange" but try and hold still I am told – and we are off. 

All I can say is that the stress drug really did make me feel like I ran 2 miles in about 10 mins. I felt my heart race, became short of breath, and that was followed by a sort of hollow pit in my stomach – just like the one that you get if you really crank an exercise hard.

Sometime while that was going on the reactor gravy was added to the mix – but I have no idea when. All I do know is that I can't shoot webs from my wrists, lift cars, or climb up buildings – I know…I tried. 

Another scan, 12 lead, and that was that. Simple. (I am really bummed about the superpowers though)

Back to the room:

Once back in my room that was pretty much the end of my adventures. I hung out in the hospital doing blood draws, ECGs, and other fun things until the morning of Thursday October 22nd when I was discharged. I had an outpatient appointment for the important stress echo set for the following Thursday October 29th plus an appointment with Stanford's lead on bridge studies Dr. Schnittger the day afterwards. 

Never officially figured out what set off this little adventure but my guess is indigestion. Next time I am taking 2 Tums before I start following directions. Certainly, before I take another Nitroglycerine tablet anyway. 

Now I just had to wait a week for the conference to happen and for the stress echo.