I Have Congestive Heart Failure.
When the past becomes the present and the present becomes the future.
When you finally come to the realization that you don’t have much time left — one possibility is that you take action and begin to do the things that you’ve always wanted to do. For me that realization came in January of 2017. One of the things I decided I must do, was to take a California Coast golf trip with my son Jesse, my favorite golfing partner and Shelley, my favorite travelling partner and wife of 39 years. It was everything I could have wanted. There would be other trips and loose ends to tie up, as they say, in the days and weeks ahead.
My journey in heart disease started in April of 1998 and led up to the point of this revelation in 2017 and, to my surprise, has gone well beyond. Yes- I am as surprised as you are. My hope here is not to share my story so that I may vent about my condition, or to make myself feel better. I am lucky to have had a great family and an inner circle of close friends and colleagues who will listen to me if I feel the need to feel better. My hope is that in sharing my story that you might learn some of the things about heart disease that I have learned and to share what I believed my treatment options were, about what the warning signs were, and finally and most importantly, what a progressively worsening disease looks and feels like. My hope is that the story which I will share will help, even a little, to make you better husbands and wives, better doctors and nurses, better patients and caregivers, or maybe… even better human beings. My hope - is that my story is one that is worth listening to.
As strange as it may sound, my story, with all its twists and turns, is a story that is not that unique. In fact, it could be the story of one of your children or friends. It could be the story of one of your patients, or — it could be your story.
I love to go golfing. At home on Long Island, I love playing at Bethpage (perhaps the most famous public golf course on the east coast) the most, but I will usually play at the Lido Golf Course in Long Beach when I play with my friend Randy, because he lives close to that course and because his time is generally very short — for reasons I won’t get into here. Randy is the kind of guy that you want as your partner if another twosome wants to play for a couple of bucks. You see, Randy is blessed with a tired appearance and has these old beat-up golf clubs. Quite frankly, most guys who play with any regularity, might well be embarrassed to play with these things. I’ve learned that his fairway wood, a McGregor Tourney Velocitized, was his grandfather’s club that grandpa gave him as a gift when they used to play during summers spent up in Monroe, New York (the birthplace of Velveeta), over 40 years ago.
So…on this particular day, a clear and sunny day in the early spring of 2015, upon approaching the first tee, Randy, as always, takes a few painstaking practice swings with his driver — groaning loudly enough for all to hear, as he tries desperately to limber up. Then, like always, he proceeds to tell me that he probably won’t last even the first nine holes because he had played three sets of doubles tennis with some of his other cronies last week- and he has still not recovered. “I may have pulled something in my back,” he’d say. It’s amazing to me that he doesn’t seem to remember that he makes the same maddening noises and says the same thing every time we play together and it makes me wonder if he ever actually does play tennis with his friends. But, true to form, Randy graciously allows me tee off first, where I will almost always hit a straight but not particularly long drive that stays on the fairway. That’s my game, straight but not particularly long and this particular Spring day brings no exception. Randy then moves to the tee area and takes his first tee shot. Randy’s ball ends up in the high grass on the left side, leaving an awkward second shot - where he has honors to play his ball first. Then, as I’ve learned to expect, He goes to his bag and pulls out grandpa’s McGregor and proceeds to hit a rainbow that lands about twenty feet short of the green. I walk up to my ball and take my second shot and it’s straight again but lands a good thirty yards short of Randy’s ball. A chip and a putt — and Randy has his first birdie of the day. Did I tell you that it is maddening to play with Randy? We play on for several holes and as I walked up toward the fourth green, I find myself dragging slightly behind Randy and I realize that my breathing was labored as the memories return. “Oh no — not again,” I whisper to myself. As I see Randy straighten to look at me I shout, "Don’t tell Shelley, but I think I may need that valve looked at again — it may be time for a new one.”
Spring, 1998
The year 1998 was one of excitement. There was the rise of the cell phone- a Nokia 6120 for most, Titanic, the movie, won 11 Academy Awards, Bill Clinton’s Lewinsky scandals reached their peak with his impeachment, the FDA approved Viagra, Furbies were the best-selling toy, women were all trying to get their hair to look like Jennifer’s, Harry Potter came to The States and Google was founded.* For me, 1998 was the year that a backache would change my life forever.
I was forty-two years old, a wife, two sons — 10 and 5 years-old respectively and I was working fiendishly in my dental practice to support the family. One day in mid-May, my back started bothering me and around the third day of nursing my back with heating pads and Tiger Balm the pain became severe. I figured I’d slipped a disc — from the bending and the strange positions we as dentists often find ourselves taking. So, I called a local physician from my insurance booklet because I was advised by my wife that I would need a referral if I wanted to see an orthopedist.
The young internist walked into the examining room and gently introduced himself. “ I’m Steve Drucker,” he said with a comforting smile. He listened patiently as I described my lower back pain but began the examination by taking my blood pressure. “155 over 98,” he whispered, as his eyebrows furrowed. I found this curious and while I suspiciously considered why he wasn’t running his fingers down my spine looking for bulges, I went along with the young doctor as he methodically went through his motions.
It turns out that about 1 in 3 adults in the U.S. has high blood pressure, but most don’t realize it. High blood pressure is sometimes called a “silent killer,” because it usually has no warning signs, yet it can lead to life-threatening conditions, like heart attack or stroke. As the blood flows normally it delivers nutrients and oxygen to your important organs like your heart, brain, and kidneys. Your heart beats as many as 1oo,ooo times a day as it helps to push blood through your vast network of blood vessels, both large and small. Your blood vessels, in turn, constantly adjust to what ever you’re putting yourself through. They become narrower or wider to maintain your blood pressure and keep blood flowing at a healthy rate. Blood pressure changes with time of day, exercise, the foods you eat, stress, and other factors. Problems can rear their heads though, if your blood pressure stays too high for too long. High blood pressure can make your heart work too hard and it begins to lose strength. The high force of blood flow can damage your blood vessels, making them weak, stiff, or narrower.** Over time, constant hypertension can harm several important organs and for me, it was my heart.
I think I had to this point, viewed myself as healthy but knew that my blood pressure reading was not even close to what most people regard as a normal 120 over 80. Dr. Steve had me take a chest x-ray, which he told me might give him a sense for what was going on in my back. About ten minutes later, he emerged with a large radiograph, something I could easily read, as reading x-rays was a daily occurrence for me. “Well, I can’t say that I see anything wrong with your back, but your heart is significantly enlarged,” he said. The enlargement of the heart is a signal of a deeper medical problem. Most often, it arises as a result of a common condition such as hypertension (high blood pressure) and especially as a result of coronary artery disease. In many cases, the condition is asymptomatic, however, it is generally related to a higher risk of the condition known as congestive heart failure and even cardiac arrest. “Have you ever seen a cardiologist?” Steve asked. “No,” I replied, “My folks have been seeing this one cardiologist, a Dr. Stanley. I could call him,” I suggested. Something (the exquisite pain in my back), told me that I had better make this phone call. After referencing my parents and describing what had taken place with Dr. Steve, the receptionist at Dr. Stanley’s office told me come over immediately. It was now 2 pm, and I was sitting in yet another examining room, bent over sideways from the pain.
Dr. Stanley stared intently into my my eyes and ordered an EKG —an acronym for an electrocardiogram which is a test that measures the electrical activity of the heartbeat. With each beat, an electrical impulse (or “wave”) travels through the heart. A normal EKG will show the timing of the upper and lower chambers of the heart. The nurse placed the sticky electrode pads at certain specific spots on my chest and abdomen. The electrodes are connected to an EKG machine by lead wires. The electrical activity of my heart was then measured, interpreted, and printed out. No electricity is sent into the body, making this a painless and simple procedure. Natural electrical impulses coordinate contractions of the different parts of the heart to keep blood flowing the way it should. An EKG records these impulses to show how fast the heart is beating, the rhythm of the heart beats (steady or irregular), and the strength and timing of the electrical impulses as they move through the different parts of the heart. Changes in an EKG can be a sign of many heart-related conditions. When a doctor suspects further heart disease or problems, he or she will normally order an echocardiogram to be taken and Dr. Stanley did just that. This was to be the next stop in what was becoming a long, concerning day.
The echocardiogram seemed to indicate that my aortic valve was either leaking significantly or not functioning at all, so Dr. Stanley decided to perform an even more specific but this time a more invasive procedure that he had in his arsenal. A transesophageal echocardiogram sends sound waves through a transducer which is passed gently down your throat while you are under sedation. This test provides a closer, more detailed evaluation of your heart. This was the final diagnostic test used by Dr. Stanley on me- to definitely determine that my aortic valve was stenotic or not functioning. As I was being put to sleep I foolishly thought that I was stubborn enough to fight the sedative. Funny, the games we play in our minds. As I began to awaken I wanted to stay unconscious, not wanting to hear the inevitable. I imagined hearing the doctor say that everything was fine. But as the sedative annoyingly wore off, I was told without hesitation that my aortic valve, with two of its three leaflets fused (a congenital disorder known as a congenital bicuspid valve— just another thing I could blame on my parents), had stopped working. It was at this point that I realized that I wasn’t returning home today and that my life was about to change forever.
* https://www.insider.com/events-90s-2000s-2018-3
* https://newsinhealth.nih.gov/2016/01/blood-pressure-matters
