Five Years--What a Surprise!

Before discussing my latest Miami adventure, I need to mark an important anniversary.

I try to keep Daily Affirmations from turning into some sort of online journal. Maybe you'd enjoy reading more updates about such incredibly important things as the dream where I was chasing a marshmallow across the English Channel, or laments that people don't speak more clearly, or whether I had a good nap the day before. Personally, I couldn't care less about how your naps go, so I figure, you know, likewise. My view is its far important to write posts about generally inane things we all confront, and to liken them to Star Trek, Top Gun, Dirty Dancing, or one of several 70s sitcoms. This is my calling. Law is something I do in between quoting from Caddyshack.

Today's post breaks that rule. Five years ago tomorrow (January 10, 2006) I had heart surgery, which probably saved my life. Or at least lengthened it considerably and dramatically improved its quality. Some of you may remember it, though most of you didn't know the details. I intend to celebrate by drinking beer and eating sausage queso. Well, ok, not really.

All my life, even now, I've had a condition known as "hypertrophic cardiomyopathy." Basically, this is an enlarged heart. Specifically, the walls of my heart are excessively thick. So for all of you convinced that I'm heartless, well that's just way off the mark.

Hypertrophic cardiomyopathy (HCM) is the result of an inherited genetic trait predisposing the heart to become enlarged. My mother had it (and likely passed away from it), and we believe others in her family had or have it. Though somewhat rare, its the most prevalent cause of sudden cardiac death in athletes. Houston Rockets star Cuttino Mobley had to retire prematurely after being diagnosed. American marathon runner Ryan Shay died during the US Olympic Marathon trials from HCM. Most people who have HCM don't have any complications from it, but for those who do, like me and mom, the thickening can obstruct the flow of blood exiting the left ventrical. The result is the heart has to beat faster to supply the body with sufficient blood. Symptoms include chest pains, dizziness, fainting, extreme fatigue, and the like. Some people, however, experience no symptoms (or at least, nothing they attribute to a heart problem). Unfortunately, some people experience no symptoms until they die or suffer a heart attack. In extreme cases, HCM can cause sudden cardiac death, as the genetically mutated heart cells disrupt the normal electrical current which causes the heart to beat. This leads to arrhythmia, which if not arrested by a defibrillator, causes death even in otherwise very healthy people.

In my case, I knew I had HCM around 25 years ago, when in college (or maybe law school). Mom was being treated by a cardiologist for cholesterol problems who happened to be conducting an HCM study. She participated, and was diagnosed. Back then, there was almost no treatment other than beta blockers to slow the heart. Mom never experienced any blockage or obstruction, so the medicine was largely preventive. I was diagnosed as part of the study. My brothers were tested but found not to have the disease.

I experienced no symptoms at all for many years. Every few years, I would visit Mom's cardiologist for an examination, be declared "negative," and go on my way. In retrospect, however, I was experiencing symptoms for many years that I attributed to growing older. I would experience fairly profound lightheadedness when climbing stairs or sitting up from a chair. Occasionally when running, I would experience a severe and overwhelming fatigue that would prevent me from running more than a mile. These episodes would last a week or two, and after backing off would go away. Through the years, however, my ability to run long distances gradually eroded, as my weight steadily crept up. I attributed all this to sitting behind a desk most of the day and to growing old. That all changed in the particularly hot summer of 2005. All summer long, I could barely run a mile, even at night. I tried running indoors at the Gregory Gym track, with the same result. I tried swimming in the fairly cold Deep Eddy pool, but had the same problem. But I kept pushing, convinced I was just out of shape and needed to force myself to break through. Sometime in August, when about a mile and a half into a run, I noticed that my chest was hurting. That's something I'd never experienced before, and thought maybe I should go to the doctor. He referred me to a local cardiologist, who found the obstruction I'd begun to experience.

Returning to my cardiologist at the Methodist DeBakey Heart Center in Houston, they confirmed the results, and put me on a beta blocker. They'd had some success in treating symptoms with beta blockers, which slow the heart. They didn't hold out a lot of hope though, for a long term solution, saying the beta blocker typically warded off obstruction for only a year or two at most. In my case, it was about three months. I was able to resume running, albeit at a slower pace (and with a cardiac monitor). One very cold night in November 2005, I was running on the three mile loop at Memorial Park in Houston. Two miles went just fine. After I stopped for water and then resumed the run, the obstruction was back at full strength. As if though someone had flipped a switch. I tried to make it back to the tennis center at the three mile mark, where I'd parked. Eventually I had to walk it in. At that point, I knew the only option was surgery.

Through the years, two types of surgical procedures had been developed to treat HCM. The first, and probably still most prevalent, was an open heart procedure in which the surgeon goes through the aorta to slice away part of the thickened heart wall causing the obstruction. Recovery is about three months, and risks include all the risks of open heart surgery--infection, memory loss, brain damage, pulmonary failure, etc. Fun times. The other procedure is a septal ablation. The surgeon goes into the heart by a catheter procedure (as if though putting in a stint or conducting an angiogram), but injects an alcohol solution into the thickened tissue contributing to the obstruction. This kills the tissue at that point, causing it to contract and shrink, which eliminates the obstruction. Its not an open heart procedure, but it had only been utilized eight years before I had it done, so they lacked a long-term post-procedure database. Also, this process has a higher risk of causing the heart not to restart on its own, necessitating an implantable defibrillator/pacemaker. Recovery time, however, was generally only two to three weeks. You can watch an animated video illustrating both procedures by clicking here.

Mom and I went to the Cleveland Clinic for a second opinion. Its regularly rated as the best heart institution in the country. That was quite an adventure. As ever, she took copious notes of everything that was said, and never left my side. They wanted to do the open heart procedure, saying the ablation technique was still too new to recommend. Our doctors at Methodist, however, were confident, and related that the pacemaker risk was largely confined to much older patients. So I chose the ablation route, and waited for a month and a half for the procedure.

That part was harder than the actual procedure and recovery. As the day grew near, I became more and more freaked out. The surgical nurse told me that they do not administer anesthetic, and patients were awake at all times during the procedure (though they administered pain medicine). She said some experienced severe pain at the moment of injection. Also, I began to grow very fearful of my heart not restarting and being relegated to a pacemaker. All the running I've done through the years wasn't just for fun, it was a lifestyle, and one which I despaired of losing. But there was no choice. Had I done nothing, my heart would continue to beat excessively fast. Basically, it would prematurely wear itself out. I would be at a very elevated risk of heart attack, or other complications from fainting and having to live a sedentary lifestyle. That simply wouldn't do.

As I got my affairs in order and arranged to spend the recovery at home with my parents, the holidays were very difficult to endure. All I could think of was my own pitiful little problem, viewing it as a danger rather than an opportunity to restore and preserve the quality of life I'd experienced before. As the day wore on, I became extremely anxious and in retrospect started acting like a little kid about to get a shot.

About a week before the procedure, Mom suffered a heart attack. This was quite a shock, as she had been so closely watched by her cardiologists. The doctors found absolutely no arterial blockages, and declared it caused by extreme stress. Ironically, the same doctor who did my procedure performed her angiogram. I've posted about this before. Mom was always extremely over-extended. Even in the cardiac intensive care she was making calls to church volunteers she coordinated. But as was her manner, she viewed it as a "test run" to see how everything would work at that hospital for my procedure.

The procedure itself was not so bad. The whole thing is conducted while the patient is on an x-ray machine. They looked within my heart for just the right spot to make the injection. I remember the nurse pointing the spot out to me as I looked overhead at the x-ray image. I remember her saying they were going to make the injection now, but don't remember anything after until the team was winding up. I remember being wheeled out and back to post-op. I went past some sort of greeting line with a number of people I knew but can't for the life of me remember. I experienced absolutely no pain at all.

Recovery was worse than the procedure, but not because of my heart. I had (and continue to have) no problems with my heart whatsoever. It restarted just fine, without the need of a pacemaker. I couldn't roll over on my side in bed, however, for a couple of days, and after the first day my back was killing me. They gave me pain medicine for that. Dad stayed with me the entire time in the hospital. Mom was there every day, but as she'd had a heart attack the week before we insisted that she sleep at home. I'm still not sure how we were able to win that argument. There then followed two weeks at home, which I basically spent sitting outside on our back patio while Mom fussed over me all day. I slept downstairs on a bed that Dad had drug down from upstairs. I was overwhelmed at how many people came by to visit, many from Austin. The number of cards and flowers and so forth were also surprising. Kimberly was also a God send, having come for a week from California to help me and Mom. We couldn't have made it without her. I couldn't drive or walk up stairs, so I had to be driven each day to my brother's house to take a shower (in his ground floor shower). It was the highlight of each day. Well, that and my afternoon "walk," which basically consisted of going up the block to the greenbelt on Woodland Hills Drive. After two weeks I had a follow up visit to the doctor, who cleared me to begin slightly more physical activity. Stupidly I went to the gym, and promptly contracted the flu. So I had about another week's worth of staying at home while Mom continued taking care of me. Eventually, however, I was able to go back to Austin. At first I worked only part time, which was the greatest thing that ever happened. Being able to leave for the day at 1 was fantastic. For some time thereafter, they kept me from stressful assignments, which eased the transition back. By my April 2006 follow up appointment, I had begun running and exercising, and was given a very promising outlook for recovery.

Now, I go to the cardiologist once a year for follow up testing. The first few tests showed an extremely minor amount of blockage, but only under pressure (bearing down on the abdomen). I have few restrictions. The doctors advised me not to engage in competitive sports (too much start/stop activity) or to lift heavy weights (pressure on the chest cavity). For that reason, I work out with a personal trainer who has consulted with my doctors on the specific types of weight training that I can perform, and who can watch over me just in case something happens. The doctors say there's nothing I can do to make the blockage return. Though in light of Mom's passing from sudden cardiac death, they have advised me to have a defibrillator implanted (which I've decided for many reasons not to do, at least for now).

This whole episode turned out far better than I could ever have imagined. Basically, the procedure gave me my life back. My heart condition was far worse for many years than I knew. I believe that I was experiencing obstruction in an on and off way for many years before 2005, and just attributed it to old age or being out of shape. With the obstruction, I was facing a sharply reduced lifespan spent sitting in chairs and staying within a 30 mile radius of my home. Now I can do things that seemed highly unlikely before. For example, I've run three half-marathons since the procedure. Before then, I'd despaired of ever running more than six miles. I've lost maybe 20 pounds since then, and just generally feel a lot better. I tell people I immediately felt five years younger. I've been able to go on all kinds of trips and have really incredible experiences I would have had to forego if I were still afflicted with a heart obstruction. It also enabled me to continue practicing law. I'm not sure I could have continued in such a high-stress profession with HCM. And in rejuvenating my life, its allowed me to have experiences, such as travels, and to develop friendships and relationships I may never have had otherwise. In many ways, its been a second chance at life.

This whole thing also taught me a number of lessons. It made me realize I had far more friends than I realized, and that these friends were much better to me than I'd expected. It also taught me the value of friends and family. Though I generally like to live like an island, I'll never again minimize the positive impact that friends and family have on one's disposition and welfare. This affair also showed me the positive power of prayer. People all over, primarily at my parents' notice, were praying for me. This clearly made an impact. Everything that could have gone wrong, instead went right, and I felt the support of so many people. The procedure and recovery also made me focus on physical health and vitality. You only have one body, and it has to do you your entire life. The prospect of a minimized, sedentary lifestyle proved completely unacceptable. Keeping my body in as good a shape as possible (though with donuts and cheesy bread every now and then) seems even more important. Being able to run and swim and hike and travel is so much more rewarding than I ever knew. Finally, I've realized I won the parents lottery. They never failed me, not once. Mom had a heart attack the week before my procedure and still was there for me the whole time. Dad never left my side. They calmed me down and ran "interference" for me when stress ran too high. They catered to my every need. They anticipated everything I could have wanted. I cannot imagine how I could possibly have had better parents.

So anyway, if you were among the many who prayed for me, sent messages of support, visited me, or covered for me while I was away, I thank you. It meant quite a lot. No thanks to those of you, however, who joked that my procedure was "micro-surgery." Ha, ha, very funny.

Next-OK, I'll tell you about Miami over New Year's.