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(Note: Surgery did not happen when planned; a sicker heart had priority and occupied my Surgeon for 8 hours.  Bad news: I was bumped. Good news: I can still wipe my own bottom.)

As I left you faithful reader, I had just learned that my heart was sick and that despite my age, outward appearance, physical activity, and general good health (at least compared to the others on the cardiac floor…) I had heart disease. Whether it was lifestyle or bad habits or a predisposition to generating plaque were irrelevant to the situation at hand –  my heart liquid plumbrarteries were in need of some cardiac liquid plumber.

The angiogram was still a bit of a mystery, but the diagnosis was clear:

  • My main heavy-lifting arteries were pristine, clear and showing no distress whatsoever
  • A series of secondary arteries, that wrapped the heart, were bunged up; substantially, and for some length. In some places the arteries only had 15% capacity – that’s a shit-load of gunk lining the artery walls. Further constriction and the possibility of the plaque destabilising and completely blocking the artery were real concerns.

And the prognosis was clear: sort this out, STAT before it sorted me out.

But the question was how? The location, length and thickness of the blockages meant that the “Master AngioPlaster” would have her work cut out for her. This fix would need a lot of stents and in some uniquely, weird locations. And because some were near junctions of arteries and veins, the Doctor was unclear of second and third order effects on the major flow patterns. It was not a simple case of one, or two, or even three stents removing the pea from under the mattress. If it was angioplasty and shoring with the mesh stents, this was going to be the equivalent of a cardiac Chunnel.

This required a major cardiac huddle between the Interventionist and the Artery Plumbers to discuss options.

And so, with that, my femoral artery was closed up and I was wheeled back to my room and my wife.

Now it is not easy to look someone you love in the eye and deliver the emotional equivalent of throwing them in a pool of ice water. But I figured, since my face said it all already, it was best to take the Band-Aid off in one quick and rapid motion.

“It’s not good. I have several blockages that need more than a simple stent.  We’re here for a while.”

And with that, we entered a whole new realm.

A bypass?

Jesus.

I had heard about those. I knew that they opened your chest and stopped your heart and sewed some stuff on. And I had heard about singles and doubles and triples and quadruples. It sounded desperate and complicated and scary.  But honestly, I knew nothing. I only had notions.

There is a lot of good reading on the topic of heart health and heart disease, on heart maintenance and heart repair. And over the next 12 hours, between moments of sheer disbelief and bitter acceptance, I read a lot.  I read about angioplasty and stents; about all those drugs I was taking and all about coronary artery bypass grafts. I read about probabilities and risks and success rates and quality of life after.

And I thought. And then I though some more.

I asked myself is this all my doing. Did I just ruin the most important thing that I have been given; my heart. Did I ruin because I like eating the fatty bits of the medium rare prime rib? That I enjoy my fine scotches and craft beers? Love my occasional bag of potato chips? Cream cheese? M&Ms?

I have always believed that you can live a Wilde life: everything in moderation, including moderation. But maybe I was wrong. But how can this be? I just ran a half marathon five weeks ago. I quit smoking over 4 years ago. I dropped 30lbs from my heaviest in 2004. I was not exactly a poster child for the healthy heart foundation, but I definitely wasn’t a poster child for heart disease either.

lets-make-a-deal-doorsAnd I brooded and worried and became stressed. In hindsight I expended a lot of energy wondering how I got here. It made me a bit of an angry man. I was experiencing all the stages of loss. I had moved through denial and was now working through the anger. I was bitter that this had happened to me. There were fatter and very idle people out there…how come they weren’t having heart attacks? Why were they out enjoying the weekend sucking on their cancer sticks, drinking Kilkenny’s, and scoffing down large bowls of gravy and cheese curd laden poutine while I had to decide between Cardiac Curtain Number One or Curtain Number Two. It just wasn’t f*cking fair.

But I am not by nature an angry man.  I like to think am rationale and at times I am a fatalist.  Que sera, sera. My mom always told me that things happen for a reason. We just don’t see it until later. And after a day or two, I started seeing it. It sorted came at me like a ship through the mist. Maybe this was an opportunity.

I talked to the specialists. As we all know, I could have helped myself by being a little lighter, by making a few smarter eating choices, but overall I understood and ensure that I got the necessary OMEGA-3s and grains and greens and vegetables and fruit and proteins. I was not a fast-food junkie or a cola addict. I ran and rode my bike. And though I enjoyed life and its finer things, I was doing all the things you need to do to be good to my heart – not dogmatically, but sufficiently I thought.

The only joker in the deck was my ancestry.

I am not blaming anyone, but you cannot run from genes. High blood pressure, diabetes, and stroke are part of my ancestral family medical history. But there is so much that is unknown – in pre 1960s India, people died and no one knew or cared why. There was grief. And then there was land to be divided. Who knew whether it was heart disease or not?  All I know is that I have heart disease. My body produces cholesterol and plaque and my body will continue to produce cholesterol long after my arteries are repaired.

Maybe, this episode, this minor heart attack, this signal, was the chance to start over again. To take stock, and assess the devil-may care attitude, and perceived invincibility of my youth and early middle-agedness, and decide if I could keep up that pace forever. And I could…if forever was 49 years. But in my vision, forever was much longer than that. Yes there would be moments of craziness, but I needed to make sure that “Crazy ASF” understood that in the future there would be some cheques he shouldn’t write – his heart may not be able to cash them.

So eventually, after a day to think about, I chatted with the cardiac surgeon. And I was ready. I had three options:

  • If I was an 80-year-old man, who was unable to stand the rigours of surgery, and who was going to sit on his butt and do nothing but stare out the windows at the pigeons, then perhaps we could go with medications to control pressure and flow and rates and stuff…meds would buy the time for something else to fail catastrophically, like my liver

stent

  • If I was a relatively inactive fellow who was willing to live a relatively sedentary life of long walks in the rain, and wanted to always watch what I eat while taking a very large daily medical cocktail of anti-rejection drugs, cholesterol pills and a host of other heart regulating agents, then the stents would be perfect. Upside? Less intrusive, quick recovery. Downside? Second guessing every tweak and pain as I tried to live my life as I wanted would cause me mental distress. And anyway, a stint was like paving a pothole. Effective, but eventually you have to pay the piper and replace the road.
  • And the granddaddy of the option, the coronary artery bypass graft (CABG). A complete new superhighway for my heart akin to replacing Montreal’s crumbling turnpikes. The downside? My chest would be displayed to the world as a machine kept me alive. Risks include stroke and infection and just bad luck. The upside? After convalescence, I would be the old me – minus a few bad habits. I would be able to run, to dance. I could even swim the dolphins if I wanted. I would be on a less strict regimen of heart pills, but I would be me again. Plus I would have a pretty wicked scar to show off as part of the Zipper Club
Go for it!

Go for it!

For those that know me, I am pretty sure you could guess which I would choose. Being active and full of life, being who I am, there were no half measures. As a young lad, with great prospects at recovery, and with a robust immune system, I was sure. And I decided.

CABG it was. I knew what I had to do.

End of Act Four…

Later,

ASF

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