The "Cabrito al Pastor" Syndrome - The inside story of Heart Surgery.

 

One of my favorite things to do when I travel to Monterrey is eat "Cabrito" the local and regional dish.  Whether I have it at the "fancy" restaurant like the "El Rey Del Cabrito," or at the city market, "El Mercado Juarez"  It is always delicious and I can never have enough.   Cabrito has been a regional dish in Northern Mexico for over 420 years.  It is a kid (young goat) still milking and usually less than 45 days old.  The original dish was probably brought over from Spain but it has evolved in the northern regions of Mexico to a culinary specialty.  Cabrito al Pastor is grilled over charcoal and prepared by splitting the chest and pacing it on a steel  spit so it can be placed over the coals. 

 

It is the splitting of the chest that has brought me to this analogy.  Although the kid has been butchered and cleaned by the time the "Splitting" of the chest occurred, but I can just imagine what the cabrito must feel like when that happened.  In fact, I cannot say that I "know the feeling" of having my chest cut opened and spread since I was under anesthesia when all that happened, but I can tell you how it feels after the procedure.  Poor cabrito, I'm glad he was dead when his chest was split.

 

My body has been a natural generator of bad cholesterol all my life, influenced by an almost uncontrolled consumption of delicious food (food with lots of grease) and a hereditary trait of the Garza family to heart problems, my destiny  to have clogged heart arteries was sealed.  Unfortunately I was somewhat asymptomatic to this heart condition and it took a bit of effort to find the problem.  fortunately the clogged arteries were serendipitously discovered during a routine test to look into other symptoms.

 

After two heart catheterization, where they went through the arteries in my arm to monitor and explore the situation of the heart,  and a stress test on each individual arteries - apparently a fists in medical testing - it was determined that at least one of the arteries was over 90% blocked and the other three were blocked 70% to 80%.  After a conference of five cardiologists and surgeons, it was decided that because of the unique pattern of the branching of the arteries and the location of the clogs, the artery with the most severe blocking could not be corrected with stents and at least one bypass had to be performed.  I agreed and surgery was scheduled for July 9th 2020.

 

I registered at the hospital at 6:00 a.m. on the 9th of July.  My clothes were taken and I was given this gown that completely exposed my backside and a nurse came in to shave the whole front of the body, including my "private" parts and put an IV in my right hand for Intravenous therapy to deliver fluids directly into a vein.  They asked me questions that seems to be directed at making sure I knew who I was, where I was and why I was there.  After a while they rolled me into the surgical prep room.  There were several other people there awaiting surgery and I got to overhear some of the conversations and concerns of the other people ready to go under the knife.  At this point I still felt that I could still get up and run away from this place, but it was either facing a 40% chance of surviving a massive heart attack or a 98% chance of surviving the heart surgery.  I'm not a gambling man, but the odds of surviving a heart attack were not in my favor, so I stayed on the gurney.

 

While in the pre-surgical prep room I was visited by the anesthesiologist .  He asked me some questions about allergic reactions, but his main point was that he was going to make certain I felt nothing.  A couple of nursed were attending me and I made sure that they covered my legs and feet with warm blankets to avoid the cramps and the "restless leg" syndrome I get when my legs get cold.  I also had a "wild toe nail" that I asked them to clip and they did.   They told me hey would put two or three more IVs in my hands and one in my neck and a direct arterial tap in my wrist.  They started to tell me about the drainage tubes they would place after the surgery and several other things, but the elevated readings of the monitor indicated that I was getting stressed and she told me "I'm going to give you something to relax."   That is the last thing I remembered that morning until about 6:00 p.m. when I remember someone saying : "He seems to be coming out, let's prepare  to remove the tubes."  I went back under and the next thing I remembered , about 12 hours after the first nurse told me "I'm going to give you something to relax,"  were two nursed trying to take my vital signs and drawing blood.

 

I had three drain tube coming out of my chest, two IVs in my right hand, Two on my left hand and one in my neck with fluids dripping into at least on and possibly two of the IVs.  Throughout the evening and the following day they kept injecting medication into some f the IVs in my hands and in my neck.  I also had an arterial tap in my right wrist.  But, to me, the most practical thing was the catheter to drain the urine, that is one of the best medical tools invented, although taking it out a couple of days later was the most uncomfortable and disgusting things ever to be done to me.

 

The following day they took out the second drain tube.  This was buried deeper and yanking it out was a little more distressing that taking out the tube near my heart.  However, the minute it was taken out the pain in the back of my rib cage disappeared - I could move, sit, up walk and bend over without any pain.  During this whole time I was given oxygen through my nose to  keep the oxygen level in my blood above 90.  The rate (or possibly the quantity) of oxygen  was slowly reduced from a 16 to a 2 over a five day period and my blood oxygenation stayed at about 95.  The doctor said I could be released on the sixth day and on the fifth, the nurses began to take off the IVs in my hands and neck and remove the arterial access port on my right hand.  That was liberating.  Also, I had been bathing every day for the last couple of days and felt almost human.  The last criteria I had to meet before being released is to have a bowl movement.

 

Now, knowing that I would not eat well for a while, I had some hardy meals the day before the surgery.  That proved to be a questionable decision.  For six days, all that food slowly moved through my intestine, hardening and possibly fossilizing a bit on its way to being "discharged."   Needless to say, it was a massive amount of body waste acting like a cork in a vintage bottle of wine.  My job was to extract that cork using only gravity and other natural movements since I could not "push" or have any stressful contractions.   Adapting the "think" technique that Harold Hill (Robert Preston) in the movie the "Music Man" used to teach music - the "think System," I began to concentrate all my will power to the task at hand.  Forty five minutes of concentration began to show results with very slow movement.   I was on the verge of success , when the Doctor came into my room as part of his rounds and called my name.  Instantly all the concentration was lost and the progress that was made retracted.  It was very disappointing!   After another forty minutes of more intense concentration, some rhythmic body motion accompanied by some minor pain, I met the final criteria for being discharged from the hospital - a somewhat disgusting but very satisfying sight to see.

 

Just before the time I began to apply the "think system," it was decided that I still had too much water in my body; my hands and feet were a little swollen.  I was given some drug to extract it.  For the next 24 hours I had to measure my urine.  I measured almost two liters of pee. in that 24 hour period. 

 

The following morning, all my discharge paperwork was completed and signed before 9:00 a.m.  I was dressed and ready to go.  Unfortunately, the rules are I had to be taken out in a wheel chair.  But the transportation people responsible for wheeling me out  where nowhere to be found.  I began to complain after over an hour of sitting in the room.  Finally, around 11:00 a.m., a technician found a wheel chair, without one arm rest or foot rests, and wheeled me out to the front door.   

 

The Heart MRI

I went to the Beaumont Hospital in Royal Oak, MI for the MRI of my heart.  The Dr. wanted me to have this test in an effort to determine why my heart showed extra muscle thickness in the upper part of the heart and maybe determine why I was having these off-timed contractions.  The hospital is about 20 miles away from my house and traffic at 6:00 a.m. was almost nonexistent.  Van Dyke, a six-lane avenue was almost empty and normally it is stop and go traffic at that time of the day. 

The first thing I faced at the South entrance of the hospital was an army of nurses asking me questions, spraying me with disinfectant and giving me anti-bacterial foam for my hands.  I then had to go to the information center where the desk clerk kept me at least six feet away as he asked me and I answered questions.  Another staff member came to get me and escorted me to the MRI facility all the time keeping at least six feet away from me.  I felt like someone who had the plague.  When I got to the MRI facility another staff member continued querying me trying to determine if I was a high risk of having been infected with the coronavirus.  Finally, after all the paperwork was filled and checked, another technician escorted me to a dressing room (in this case undressing room) and I was asked to take off al my clothes and get into a scrubs-like outfit.  I then proceed into the actual MRI machine and asked to lie down on the sliding table in front of this "tube."

She prepped me by inserting an IV, put something heavy over my chest, put a headset and the table moved into the "tube."  She provided instructions to me over the headset and told me that the software would give instructions on when to breathe and when to hold my breath.  the test took about 45 minutes with pictures being taken 8 to 20 seconds at a time.  If it wasn't for the constant instructions to "breathe normally," and take a breath and hold it." I would have fallen asleep in that tube.  In fact, I think I did a couple of times because the technician would interject herself in the programmed cycle and tell me that I did not hold my breath and she would have to take that "picture" over again.  It was annoying having to awaken.

When she was finished she disconnected me, asked me to get dressed and told me that I could go.  I asked her about the results and she said that my doctor would get in contact with me.  I told her the doctor's office was closed for a couple of weeks.  She said that the doctor had access to the computer files and that he would contact me when he evaluated the MRI.

I drove home about 9:30 in the morning and it was an eerie feeling with all shops, stores, gas stations, fast food places were all closed.  In the 20-mile ride on the busy avenues I did not see more than ten cars.  I got home and the first thing I did was to dip my hands in a bleach solution that I have in a deep dish in the sink and then washed my hands with soap.  I made some chile con queso and refried beans for brunch and about noon the doctor called me with the results of the MRI.  I told him I did not expect a call for two weeks.  He indicated that that the muscle build-up on the top of my heart did not seem as severe as it was indicated in the echocardiogram.  He did indicate that the MRI showed a lot of scarring if the heart similar to what it would show after heart attacks.  I told him that as far as I knew, I did not have any heart attacks.  So the scarring was not a mystery. 

He indicated that he still does not know what was causing the sensations of heart "flutter,"  But that he wanted me to add another medication to the regimen I was already taking.  This new medication, "Metropolol extended-release 25 mg" is supposed to eliminate the arrhythmia.  I went and got the medication and read through the description. DAMN!  After reading all the possible side effects, I don't think I want to take this.  It is worse than having what I have.  I may feel dizzy or pass out, it affects blood pressure and heart rate, may hide signs of low blood sugar, other medication such as cough or cold drugs, diet pills, stimulants, ibuprofen, and some natural product aids cannot be taken when taking this drug.  I cannot have alcohol and it may have an allergic reaction.  Taking this drug may result in a rash, hives, itching, red skin, swelling, blistering or peeling skin, fever, wheezing, tightness in the chest or throat, depression, chest pain, abnormal heartbeat, slow heartbeat, shortness of breath, big weight gain, swelling in the arms or legs, feeling tired, feeling dizzy and weak, diarrhea, upset stomach, and vomiting.  Although it all sounds horrible, the one that caught my eye was the "Big weight gain."  Hell, I'm already in the largest size clothes I have ever worn.  I don't want to buy larger ones. 

The doctor says that some people don't have any of these side effects and that drug companies have to put these for disclosure purposes.  I'll give it a try for a couple of weeks and see how it goes.  If it does not help or causes any of these side effects, the drug is out of here.

The Mystery of the Heart Flutter

Over the past several years, maybe four, I have been feeling a strange sensation in my chest.  It feels as if one is squeezing a small balloon full of water in a hand, and the feeling of the water squeezing through the fingers and "popping" back into the balloon as you open the hand.  That rushing feeling is what I feel in the chest.  It started as an occasional sense, maybe occurring one every few months and it began to be more frequent.  I got a little worried about it a few years ago and I went to a cardiologist to get tested.  Unfortunately, the sensation never occurred during the tests and all the tests came out normal.  On several occasions, I have motioned this to my regular doctor, Dr. Blanchet, but all ECGs that have been taken have come out looking normal.  Last Fall, after another normal ECG, Dr. Blanchet suggested that it may be something else, possibly gas coming out of my stomach.  He asked me to try some medication for gas but I did not take it because I am certain that it was my heart and not the effects of gas.

In November and December 2019, the frequency and intensity of these sensations increased to a point that I became concerned enough to seek another cardiologist.  I called Dr. Blanchet's office for some recommendations and made an appointment to see a third cardiologist in five years.  We had scheduled a trip to Mexico over Christmas and I traveled with these intense sensations in my chest.  These sensations were not painful, nor were they debilitating, I just felt the fluctuations as if my heart were pumping the blood "backward."

I went to see the cardiologist and I was very disappointed in my initial meeting with him.  Again the ECG was normal since I did not have the sensations I described to him.  although I told him that the chances of feeling them were much higher if I lay on my left side.  I had noticed when I lay in bed that if I lay on the left side the feeling is more likely to happen and it would be more intense than when I have them when I am sitting or standing.  His comment was that he needed to make a series of tests.  That in itself did not bother me.  What bothered me was his follow up comment was that he needed the tests to determine what I "did not have."  I indicated that given my symptoms could he direct the tests to see if he could determine what I did have instead of trying to eliminate what I did not have.  He did not seem to be happy at my challenge of his testing procedure and he indicated it was a scientific approach to understanding the problem.  I indicated to him that scientific research, as I understand it is formulating a hypothesis and then test to see if it was true.  He did not respond and proceeded to schedule an echocardiogram and the installation of a monitor for a month to see if they could catch these "sensations" I was feeling.

When I went to have the echocardiogram performed and the monitored installed, the sensations in my chest were quite frequent and dominant.  The technician, doing the echocardiogram was not a very good observer and I asked her if she had noticed the fluctuations that I felt in her monitoring of my heart.  She indicated that she had and she called them "Premature Ventricular Contractions (PVCs).  It seems, however, that she was only trained and interested in the echocardiogram test and was not interested in the PVCs, and in fact did not report them to Dr. Edouard R. Daher, the cardiologist.  I refused to have the monitor put on me for a couple of reasons:  First, to me, the purpose of the monitor was to show that the "fluctuations" in my chest were not in my imagination and were detected by the technician performing the echocardiogram.  It was the first time they were detected by an instrument.  Second, the monitor was to be attached for a month and I had scheduled a trip to Mexico for three weeks and I could not see the sense of being wired and of carrying a monitor all over Mexico.

During the follow-up visit about a week later with Dr, Daher to review the results of the echocardiogram, he indicated that the muscle in the upper chamber was extremely developed and he had no idea as to why that was.  I asked him if it was related to the PVCs that the technician had detected during the echocardiogram and it was the first time he had heard that I had PVC.  The Technician never reported it.  He asked me why I did not have the monitor installed I told him, My purpose was to demonstrate that PVC existed and they were shown during the echocardiogram.  since he did not have any of that information he insisted that I have the monitor installed.  He also asked me to schedule a Heart MRI.  Again I told him that I would do it when I got back from my trip.

Meantime, the fluctuations or PVCs have become more frequent and more intense and I feel them about a fourth of the time that I am awake.  I'm scheduled for the heart MRI on Wednesday March 25th at 7:30 a.m. at Troy Beaumont in Royal Oak.  I am also due to have the heart monitor installed that same afternoon.  But I am only going to keep it on as long as it is necessary to detect and get a measurement of the PVCs - a lot less than one month.  In fact, I believe it should only take a day or two of monitoring at the rate and intensity they are occurring.

My Son's 18th

My son, Adrian, turned 18 last week.  I am so happy that he is beginning the next and greatest phase of his life and on his way to new and exciting adventures, facing new challenges, opening doors to new learning opportunities, and to developing new relationships.  True, this can be said of any new day of one's life, but turning 18 officially marks the end of childhood.  I love watching him grow from a little bundle of life to a mature, rational, intelligent and sensitive young man.   Turning 18 brings legal responsibilities but I am confident he has developed the common sense and knowledge to handle this new phase of his life.  

Adrian had an extremely difficult period at the beginning of his teenage years.  He was diagnosed with ADHD when he was about nine years old.  I believe now that it was a misdiagnosis.  He might have suffered from some ADD, but in retrospect, I do not believe that was a key issue.  Nonetheless, we agreed to treat him for it, but the medication did not seem to help much.  It helped somewhat but it did not relieve the underlying issue of his variable mood.  It wasn't until late in his twelfth year that his main condition began to emerge, and in the most painful and drastic ways.  After several medical episodes and after getting rid of several different psychiatrists, and having to intern him several times in several hospitals, he was finally diagnosed as having a bipolar condition.  Given his personality swings, over a two year period, that diagnosis should have been obvious by psychiatrists who initially saw him, however, it took a fourth doctor to understand the problem and start him on a more appropriate treatment.  This treatment continued for a couple of years but he was still not "out of the woods."    It turns out that Adrian also had another underlying condition, in addition to his bi-polar situation, that triggered severe depression episodes.  This was finally recognized and additional medication was prescribed, and the correct dosage was identified to allow him to stabilize him.

It has been almost a year since he overcame that battle against the darkness that was consuming him and he is now facing life with a positive attitude.  It had been almost a four year battle of diagnosis, many trials to find the correct medication and the appropriate dosages to get him stabilized.  However, I feel he has reached a stage of stability.  Unfortunately, the years when this condition dominated his life were formative years for school and relationships.  Because of his hospitalization and absences from school because of his inability to function, his grades suffered tremendously.  Moreover, the period of school from 8th to the 11th grade is when students not only learn the basics of Mathematics, English, Science as well as other basic subjects, it is the period when they develop the skills to study, to succeed in school and learn how to learn.  Unfortunately, he missed most of that.  He now realizes his educational weaknesses and for a year he has been working extra hard to catch up.  He is driven to succeed in high school and attend and succeed in a four-year university.  He attended summer school and is taking extra classes in his attempt to catch up.  I am very proud of him, his effort and his drive.  He has gone from a "D" average student for four years to an all "A" student this year.  

Life will not always be kind to him and he will face many difficult challenges, but we will always be there to support him when he needs us.  Happy birthday, son, never lose faith in your abilities and remember that you are loved today, tomorrow and always.