Great Recovery Despite PrognosisI had sudden onset of monster angina while on vacation in a small town in Central America. I had just started a short walk, headed up a steep one block street. Half way up, as I took another step, my chest filled with pain and grew more and more painful in just a few more steps. I was forced to freeze in the middle of the street, like playing a kids game. That was the only way to stop the increase in unbearable pain. 10 on a scale ? I would say off the scale. By not moving, for perhaps a minute or two, breathing slowly, the pain disappeared. I had no idea what happened. I had never heard of anything like it. With my father's heart attack, he had said it was as if an elephant was crushing his chest, until paramedics or doctors gave him something for it. I resumed walking, slower, taking the street on a gentle diagonal angle to reduce the apparent stress on me. About 10 minutes later, on an almost flat street, more pain, but I stopped right away, keeping the pain tolerable. I took a taxi to where I was going. Heart disease does not always give you good sense. Then I went to a local doctor. He had me try a step test, but no pain occurred, and he was unable to detect any subsequent abnormal EKG response. He recognized classic angina of heart disease, so he still prescribed Lopressor and some nitroglycerin tabs, shouId I need them. But heart attacks do not just "go away". Something was building up, in me.
A few days later, two more bouts of this heavy angina occured with almost no activity at all. These repeat bouts were really scary, because there was nothing I could do to relieve the pain. Just wait it out, breathing slowly. The third incident was about 15 minutes long, in the middle of the night walking to the bathroom. Sweating profusely, in tremendous pain. But it did finally subside on its own. and I was able to get a nitroglycerin tablet. It was definitely time to get out of the hill country of a poor country, get back to the U.S., with the best possible medical care. I notified my PCP, and told him all that occured. Flying back was delayed 10 days so I might stabilize, hoping to prevent cabin pressure inducing a heart attack.
Two weeks later, an angiogram revealed a scary diagnosis: large blockages amidst long ectatic sections near the head of all three main coronary arteries, and collections of more blockages and aneurysms on down all artery branches. My entire heart showed capillary collaterals wide open, providing my heart oxygen. The primary blockages were 99, 99, and 80 %. Doctors thought I had been bedridden and on oxygen for months, not active and returned from vacation. The collateral network they saw is rarely seen except in people dying of massive heart attacks during surgery. They said I could not walk, and not to lie to them. This was very strange. Bypass surgery was scheduled for the next morning, 10 am. I was to stay in the hospital, monitored, until then. That evening at 9 pm, I awoke from sleep with angina. The cardiologist came in, who then ordered a bedside EKG. Despite my pain, he refused to administer nitro paste until after the EKG. A mystery, the EKG showed nothing. The cardiologist requested my surgery to be made even earlier. 7 AM was the earliest. Did he wonder if I would make it to surgery ?
Surgery was uneventful, fortunately. The week in recovery, I heard whispers outside my door near the nursing station. Shadows near my door at night. A furtive glance inside my room. Nurses asking about a miracle man. Was he ok ? Turns out they were talking about me.
Early on, after going home, recovery was very slow. From being able to play basketball, to being exhausted walking slowly to the bathroom was a huge change. The first week, I don't think I got up even once unless I had to use the bathroom.
I did return to work after two months at home, though with a walking speed much slower than my normal brisk pace. I had forgotten about all the walking at my work site, but managed. I did get very minor angina occasionally, just momentary flicks of pain. Or a few in sequence, like a 4th of July sparkler. Those became more rare, slowly disappearing entirely over the course of many months as my lifestyle changes brought more and more improvement. The walking, to and from parking, the restroom, the cafeteria all were tiring at first. From a 100 feet or more to many hundred. I just took it slowly. I improved little by little. After a few months, I developed some chest pain walking after lunch. More exams. A new blockage at the bottom of the heart would need a stent, and required a difficult placement going through a bypass and turn a sharp left angle. It was not inserted, too difficult. I reminded the doctor he had said part of my heart tissue would die without the stent. He said he forgot. The tiny stent was placed later that day. The morning after release from the hospital, I had a minor heart attack at 3 am. I needed a 2nd tiny stent to the right of the first one, immediately. Through the same bypass, again with a sharp turn, this time to the right, a difficult placement again. I was awake for that surgery and felt relief when it was open, 90 minutes after the heart attack started.
A few weeks later, visiting the cardiologist on my case, I asked about my longevity prospects. He said nothing, looked at me speechless, with his jaw dropped. I think he forgot to tell me something before. I asked him about diet and exercise recommendations. I was already on a very low fat diet, did well-tolerated exercise almost daily, and feeling much better. He said he did not have that knowledge or expertise, that I should contact nutritionists and exercise rehabilitation people and find someone to help me. The rest of the conversation I can't recall. I did then go to the records section of the hospital, and requested a copy of everything. They were wonderful, providing all records, even a DVD of my four angiograms. In the doctors statements, he stated clearly, he expected development of congestive heart failure, worsening health, with about three years to live, despite anything I might change in my diet or exercise. Statistically, no one recovers from my level of heart disease. In his opinion, I was a doomed man with maybe a thousand days to live.
That was harsh. I felt ok. The first months after bypass surgery I had been very cautious, and I made good progress, becoming fitter and stronger than in the weeks after bypass surgery, when I could hardly do anything. I have always been slim, ate moderately healthy before bypass surgery, more so than most people. In only 8 months since bypass surgery, my LDL was halved, to 70, great results from diet, exercise, and a statin. The cardiologist said that much LDL reduction was not just the statin. I could and would continue all I had been doing. Driving to the preferred hospital-based rehab took 30 minutes driving each way, and had costs per session, so I still did my rehab at home, where my exercise barely took 30 minutes at that point. I was knowledgeable, cautious, and had a book collection from an interest in exercise training and exercise physiology. I planned to continue with the same caution, as I had been. I already was learning and implementing important new information to guide my rehab. I took the prognosis as a not impossible challenge. I would continue with more research, seeking new and advanced medical research that might identify specific beneficial foods that produced clear results, advanced and safe exercise protocols, as I had been. I would try to learn as much as I could of the mechanisms of arterial blockages and arterial health. Take advantage of leading researchers around the world whom I could never meet. I already owned most equipment I might need, with a treadmill, exercycle, rowing machine, and weight set. I also bought a very good exercise heart rate monitor, that I think played a crucial part in my self-managed exercise recovery. I tracked my heart rate during nearly every minute of every workout for the first few years, and most workouts after that. Not everyone does this; not everyone is told they are going to die soon no matter what they do. I was, so I did.
It is now 10 years later, 2016. I have learned a tremendous amount from hundreds of legitimate research articles amongst thousands of titles that came up in related searches. Inintially, it even took a lot of time to learn what to search for, and to limit it to the most reliable sources. Ten years later, the volume of articles has grown tremendously. Much of what I found 10 years ago has been further validated or even improved upon.
I can walk at a sustained 4 mph pace for 30 minutes. I can exercise at a sustained heart rate of 160 to 175, excellent for my age, not just for a minute or so, but 5, 10, even 15 minutes or more. I have added an adjustable weight vest to my equipment collection to use on the treadmill. I rarely run to exercise because my pulse goes up a bit too fast, but my treadmill work allows me to play some half and full court basketball again. I roughhouse with my dogs, run with them some. I resumed my hobby of sculling, rowing on the water, and play recreational volleyball. Other volleyball players half my age have been amazed at my energy and hustle. Comments from people under 30. The previous three years, I played up to 6 hours of volleyball a day on weekends, in the sun, year round. I am almost totally free of any angina. Angina I do still get is slight, and rare, unless something I eat has hidden salt or fat content. Never during exercise, even vigorous exercise. No shortness of breath, no chest pain. No breathing hard, unless I am doing a strong rowing interval. But that is normal. Rowers have a huge VO2 requirement when working hard, using all the major muscle groups in the body 15-40 times a minute, for power. I am having fun. In 2015, I attended a multi-year college alumni rowing re-union. I rowed my old position, 3 seat, in an alumni 8, mainly heavyweights in their 20s and 30s. I rowed as well as they did, at age 62, including some intervals and power strokes. I needed no break for my age or "condition"; I rowed a long powerful stroke, as I always did. They had no hint I was a heart patient. Got a nice pat on the back afterwards, too, for a job well done.
Now and then, I or my wife show my pre-surgery angiogram to medical people, colleagues of my wife, an RN. There are gasps. Some ask when the person died. Others simply ask how I am alive. Some tell me I am a miracle man. On three other occasions, nurses interviewing me to check on my recovery progress have told me I should write a book on all I have learned and implemented for my amazing recovery. It is in progress. Too many things seem unimportant without explanation. But I do nearly all of them, still, 10 years after bypass surgery. Life is fun. The book will have a toolbox orientation, not a long narrative, with the reason or research findings behind everything I eat or do. It answers the "why" questions people always ask. It will give people choices, so they know how any or all of the tools should benefit them, as they do me. If they need a few tools, or many, they can pick them for themselves. Recovery exercise rehab can be as slow as needed, but exercise needs to be an almost daily activity, as long as it is not too demanding. As simple as walking some days. Just not a casual stroll.
I know there is hope, for more people than just me.