A very Cardiac Christmas tale

It's been quite a journey recently - and not much of a fitness one either!
In December 2018 I was in Paris for work when I noticed I was struggling for breath as I walked up a hill chatting on the phone. Quite unusual for me (the breathless bit rather than the chatting), but maybe just a cold or 'something' getting to my chest, I postulated.

Returning from my business trip I was greeted with the news that my younger brother had died suddenly, just 2 months shy of his 45th birthday. It would be fair to say that over the years we have taken very different approaches to our health and he had required some emergency surgery in the summer to resolve Perforated Duodenal ulcers, which he had allowed to go untreated for too long. Nevertheless, he should have been on the road to recovery, but some questions over his attitude towards the lifestyle changes he was going to need to make for a full recovery. There remains an unresolved concern that he may have suffered some kind of cardiac issue, but in the absence of a post-mortem for whatever reason, we shall never know.

The following weekend, the kids were playing rugby at East Kilbride which has a bit of a steep climb to get from clubhouse to pitch. By the time I'd jogged up to the pitch and across to join the team, I realised I wouldn't be able to speak to them. At this point, my fellow coach who also happens to be a pathologist warned me that they had seen quite a surge in Pneumonia cases in Glasgow recently. He urged me to see my doctor asap, which I guess I thought was a good idea, but I've slipped into a pretty shoddy way of expecting to be told that "it's probably a virus come back in 2 weeks if you're still ill".

On Monday whilst I wrestled with how complicated December was turning out to be with Christmas, a family wedding, now a funeral and my own health somehow letting me down, Craig once again texted to urge me to see my Doctor. I realised this was the one thing I could actually do something about, so called the GP and was invited to the surgery that morning after a phone call to discuss my symptoms. On meeting my GP, he checked the lungs and said they were clear, but given a poor family cardiac history and the fact that I live in Glasgow, where our record of cardiac ill-health is second to none, he decided to refer me to the cardiologist, put me on aspirin and beta-blockers in the meantime. 3 days of Beta Blockers and I was in the position that despite feeling grand normally I had to stop for a rest halfway up the stairs and could not quicken my pace to cross the road without stopping to catch my breath after. Strange days. Totally ok on the flat, but knackered as soon as I hit any incline.

Decided to make use of the work insurance plan and see a cardiologist privately - so on the last Friday before Christmas, just after 6pm, I get an ECG with the diagnosis that I've suffered a significant heart attack recently... Here's how the system works in the UK. Your NHS doctor can prescribe drugs which you get for free from the Pharmacy. Private consultants can not prescribe out-patients drugs - normally they write a letter to the patient's GP and make a recommendation. They can also write a private prescription, which the patient takes to the Pharmacy and pays for the medication at market rate. With the ECG suggesting 'significant' Myocardial Infraction (MI), it's straight onto extra some blood thinners to complement the aspirin I'm already on, something to address the high blood pressure I'm exhibiting and Statins to deal with the elevated Cholesterol level detected by the GP blood test (which also showed the presence of some proteins that could be indicative of heart issue). Fortunately for me I'm in the position where an extra £24 the week before Christmas is manageable, but it got me around to thinking about how much I agree with the Scottish government policy of free prescriptions and why it's important.

Quite an amusing discussion with the consultant followed where he agreed with me that even light housework might be too much of an undertaking at this time (I was only joking, but he was stressing how easy I should take things) but disagreed with my wife that I should avoid alcohol altogether, recommending that a wee glass of red wine might be just the thing to help me relax, so long as I didn't overdo it. R&R was the key!

1 week later in between Christmas & New Year and I'm back at Ross hall for an Echo Cardiogram and cardio stress test. I've done my best so far to stick to the instructions and my wife has been a superstar in making it possible. First up is the cardiogram and I sense some frustration from the Cardiologist. In the end he reveals that he's not seeing anything like the damage that he's expecting to find. The stress test goes pretty well too. In my mind I'm readying myself for the Drago lab scene from Rocky IV, as the nurse manscapes my chest and attaches the electrodes. The mood is somewhat ruined by the nurse checking everything is attached before asking me whether I've used a treadmill before - Everyone's a comedian these days! Anyway, it's quite an easy start before the incline increases and the speed steps up to a brisk walk. Although I'm way more breathless than I would expect, my heart is responding exactly as it should to the changes in stress and it's not getting out of kilter at all. In the end the doctor sees that I'm more breathless than I should be but declares that I'm fit enough to be an HGC driver. With all due respect, I've seen some of those boys and I set my bar a wee bit higher than that, so we need to look at something else.

An MRI and a cardio angiogram are next on the list of tests. The MRI (the gold standard of scans) turns out to be something of a claustrophobic yoga class, as for 90 minutes I'm trapped on a gurney in a tunnel doing breathing exercises. Each scan is taken at the end of an out breath. There's no indication how many pictures it will take (you get a beep per picture), but it ranges from 1 to 24, with 6 being pretty typical. The result is a full 3D image of the heart working and blood flow. The end result of my scan is that I am showing a perfectly functioning heart with no indication at all of any damage. The subsequent consultation with the cardiologist turned into something of an episode, with him expecting this news to be greeted euphorically. He hasn't counted on my wife working back in her mind how many times she has gone our of her way to make me as comfortable as possible on the couch with a glass of wine whilst she dealt with our unholy brats on a Christmas sugar rush. As I accept his view that this could have been some kind of myocardial virus with what I consider good grace, I note with some concern that my wife appears to be raging that I've somehow managed to malinger through the festive period and this cardiologist has been complicit in facilitating it. He points out that blood tests and ECG are still indicative of an issue, just that we're discounting Heart attack now and looking for another cause, hence why I've to get back for the Cardio Angiogram, where they will check out the state of my arteries.

 We're now into mid January, and I'm actually feeling noticeably better. Also pleased to know that I can drop the blood thinner (Clopidogrel) and blood pressure pills (forgotten already). Really starting to buy into the Myocardial virus story and feel like there has been a sudden vast improvement, although I'm still not feeling like I'll be going for a run anytime soon, but my Fitbit, which I've started paying much more attention to is showing that my resting heart rate which had suddenly stepped up to 75 from 60 in December, is now showing signs of lowering back towards that original level.

For the Angiogram I'm back at Ross Hall and the requirement is that I need to get my Heart rate constantly below 60 for the test to proceed - again there's a bit of manscaping and some electrodes connected up. Sitting just on 60bpm in the relaxed pre scan position with beautiful cherry blossom tiles looking down, they decide to apply some beta blockers to get me down a bit, soon sitting at 54bpm and the test begins. Much quicker than the MRI, but halfway through there is an injection which helps build up some contrast for the analysis. Quite a strange wee experience with a cold flow up the arm before the feeling that I'm wetting myself, although not as unpleasant as that sounds... 

Sliding out of the machine I notice that my eyes are wee bit itchy and the nurse notices too. An allergic reaction isn't unknown, so they decide I should hang about for a wee bit and they make a cup of tea. Finish my tea and I'm ready to go but the nurse says the Dr. would like a word - that's not good news thinks I, but she says something about the allergic reaction. I don't believe her, but let's hear what he's got to say.

In the background of the cardiac scan, where initial impression is that heart and arteries are in good nick, he's spotted what he thinks might be a Pulmonary Embolism - Blood clot on the lung. After a bit of discussion, where his first thought is that I should take my scan directly to A&E, they agree that I should just get a full lung scan and see whether Ross Hall can treat me. Full lung scan reveals Multi-Focal Pulmonary Emboli (blood clot on each lung) and hospital Admin have rules that as its discovered on site I should be treated immediately. Very quickly meet a new Cardiologist, who explains just how dangerous this situation is and its straight upstairs into bed to be attached to a Heparin drip 24/7 until the Warfarin Therapy becomes effective. The easy explanation is that the Intra-Venous (IV) Heparin is very quickly effective but not long lasting, whilst the longer lasting Warfarin pills are not immediately effective and require some fine tuning as the effectiveness is seriously affected by diet and metabolism. The not so easy bit to handle is that I've got some blood clots on my lungs which could dislodge and kill me or at least make me seriously ill.

The explanation for my apparent recovery is that the blood clots appear to be fragments of a much larger clot, with the theory being that the larger clot was initially blocking a major artery - making me feel really crap - before splitting to block less major arteries - making me feel less crap.

Pulmonary Embolism (PE); that's a world of trouble that you don't want to hear your doctor saying at any time. You really, really don't want to hear - Multi-Focal Pulmonary Emboli. On the other hand 5 days in a private hospital is a pretty decent way to get the headspace required to move into recovery mode and that's where I am right now.