Sunday night update

Still kickin.

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Cardiac Follies, Part 7

Sometimes I’m so dense I surprise even myself. Case in point:
It’s been more than three months now since I had the annoying little heart attack that has provided the excuse for all of these “Cardiac follies” columns.

First there was waking up with that “this could be it” feeling; then a certain amount of hemming and hawing before I finally dragged the old carcass down to the emergency room at MidState Medical Center in Meriden, where they did a certain amount of diagnosing and stuff, followed by a code-3 jaunt up to Hartford Hospital for a bit of angioplasty and the installation of a new part from the cardiac plumbing supplies department; then three days of eating the salt-free, flavor-free food up there and then back home, followed by several weeks of cardiac rehab back at MidState.

All that hullaballoo, but not until last week did it finally dawn on me that this lifestyle-change business that we cardiac patients are supposed to do (you know, finding out that you can actually walk two blocks instead of driving, and that not all food comes from drive-up windows) provides a perfect excuse to (1) go shopping and (2) take up a new hobby that will require me to (3) buy some new tools.

So I went shopping for a bicycle, even though I haven’t ridden one since maybe 1983. But not just any bicycle would do.

Sure, I could’ve gone down to Sprawl-Mart and picked up a perfectly serviceable multispeed bike for $120 and been done with it. But that would’ve been too easy.
Or I could’ve gone to one of those we’re-so-into-it-and-you’re-so-not-that-you-won’t-even-understand-the-jargon-we-talk-which-is-exactly-why-we-talk-that-way bicycle boutiques — you know: the kind of place where, unless you’re under 30 and built like a Greek god, you’re afraid to walk through the door — and I could’ve bought something nice for, like, $700, or something very nice for, say, $1,500, or something very, very nice (like maybe that pale green Italian job in the middle of the sales floor) for only $2,600. But that would’ve been too easy. And too expensive.

And besides, the age alarm at the front door would’ve gone off, and that’s so embarrassing.

And besides, I’ve never even heard of most of the brands they have in the shops now. What happened to Peu-geot? Raleigh? How about Gitane?

And besides, my hopelessly romanticized idea of a bicycle factory is a dimly lit brick garage where some guy named Pierre attaches the Campagnolo shift levers to a Reynolds 531 frame with his own grimy hands, then spits on the floor, adjusts his beret and mutters “Sacré bleu!” before going on to the next bike. (The transport mod-ules I see in the stores now look like they were squirted out onto conveyor belts by gleaming, hissing robots.)

And besides, paring away that last gram of weight (which is what everyone who’s really into bikes is really in-to) is actually pretty much the opposite of what I should be doing; what I need is more exercise, not less.

So I opted instead for what I really wanted in the first place: a relatively clunky 1976 Motobécane (a French outfit that has long since given up the ghost, or so I hear).

Let’s say it needs some work — not unlike its new owner. It needs a new rear dumaflinchie, for starters, and the thingamajigs are pretty rusty. But the whatchamacallit seems solid enough, so it’s worth a shot.

Now all I need is lots of new tools and nifty accessories. That, or to find somebody who will take care of these things for less than an arm and a leg.

Maybe Pierre is available.

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What's a cath lab, and what am I doing here?

When you’re flat on your back in the emergency room, completely helpless, with all kinds of needles and things sticking into your arms, and the reason you’re there is that you woke up that morning with symptoms that could only be a heart attack — and then they tell you they’re going to ship you off to “the lab” — you can probably be excused if your mind starts scrolling through images from Frankenstein movies, with either Boris Karloff or Elsa Lanchester as the, um, patient.

I’m talking about Big Science a la 1930s Hollywood: great arcs of electricity crackling and dancing between polished-metal electrodes; oversized switches and dials that look like they came from the engine room of the Titanic; some kind of clanking-chain mechanism for hoisting not-quite-human beings out of vats of mystery fluid. The kind of joint that only jumps on stormy nights.

So, on the sunny morning of April 20, in the Emergency Department of MidState Medical Center in Meriden, that’s exactly what I pictured when Dr. William J. Farrell informed me that I needed a stent and I needed it stat.

I was going to be the guy on the slab in the lab.

Then they bundled me into an ambulance and hauled me up to Hartford Hospital and trundled me down the corridor — but it wasn’t anything like what I’d pictured.

In fact, it was actually rather pleasant: no sparks, no clanking chains; everything was made of the same beige plastic that all hospital décor is made of. A clean, well-lighted place where I was greeted by the clean, well-lighted face of Dr. Raymond G. McKay, who put me at ease and wasted no time starting in on my percutaneous transluminal coronary angioplasty and stenting — or, as he later explained it in arcane medical jargon, “plumbing.”

“We’re very good plumbers,” he said.

The whole business was a model of efficiency. Only later did it dawn on me that McKay already knew exactly what I needed when I got there, and when I would arrive, because Farrell and the MidState folks had figured out what was wrong, started the appropriate drugs and relayed all the pertinent info to Hartford. And since the two hospitals are part of the same outfit, I was already a patient of Hartford before the ambulance left Meriden.

Just watch that D2B time
It’s a “hub-and-spoke” system, McKay explained. Community hospitals diagnose and stabilize cardiac patients, start the proper meds and send them directly to the cath lab if that’s what they need.

And it’s all about the “door-to-balloon time” — getting the artery open as soon after you arrive as possible, which can mean the difference between life and death, or between minimal heart damage and a lot of heart dam-age. It’s about both how well you’re going to live the rest of your days and how many of those days you’re going to get.

You want this “D2B” time to be under 90 minutes, McKay said, or you could be looking at “irreversible dam-age” — which is a fairly chilling term when somebody’s talking about your ticker. Hartford Hospital’s median door-to-balloon time was 66 minutes last quarter, against a national average of 74 minutes. In a case like mine, that meant door (in Meriden) to balloon (in Hartford) time.

Hartford is also one of only 17 hospitals nationwide recognized by the feds for having a low death rate when treating one of the most common types of heart attack.

Anyway, in no time at all McKay had made a small hole in the groin area and was using a catheter to fish a wire through the femoral artery all the way up to the heart area and then he inflated a tiny balloon in the constricted part of the artery and left behind a little cylindrical, expandable, metal-mesh gizmo called a stent, smaller than the spring in a ballpoint pen. A balloon expands the stent to secure it to the arterial wall so it can’t wander around. You don’t want it to wander around.

A catheter, by the way, doesn’t necessarily have anything to do with getting rid of, you know, liquid waste ma-terials, although it can. A catheter, per Webster, is simply “a slender, hollow tube, as of metal or rubber, in-serted into a body passage, vessel or cavity for passing fluids, making examinations, etc. …” This is the tube through which the doctor inserts the guide wire, the balloon, the stent and enough dye for the X-ray to be visible.

A stent, McKay tells us, “looks like a Good & Plenty candy on the X-ray.” And so it does.

Not a bad day’s work — although, under the “conscious sedation” you’re in when they do this stuff, as Farrell explained it, the whole deal seemed to flash by in about 20 minutes.

Turns out it was more like an hour and a half, as I learned when I went back after about three months to watch another cath lab interventionist, Dr. Jeffrey Hirst, do the same thing to another patient, who had generously granted permission for me to observe. You might say this patient was an old hand; it wasn’t his first stent.

McKay and Hirst are both on the staff of the cath lab (wait a minute, let’s get this out of the way: it’s the Car-diac Catheterization Laboratory of the Henry Low Heart Center at Hartford Hospital), which is headed by Dr. Francis J. Kiernan. Had I decided to have my heart attack on a different day, my intervention might have been done by Farrell, whose cardiology practice is based in Wallingford but who spends part of his time working in the lab.

Hirst’s patient was getting a Quantum Maverick 38081 drug-eluting stent installed; mine was a Medtronic Driv-er OTW, a bare-metal job. The drug-coated stents give off medication for a month or so that helps the site heal without clogging up, and one of those babies can easily cost the hospital’s parts department $2,000 or more, compared to maybe $1,000 for the other.

No lobster for me, thanks
You can’t go through a whole lot of this cardiac stuff, though, without wondering what kind of a fix you would have been in had you showed up at the hospital door, in the same kind of shape, 20 or 30 years ago. Stenting, McKay said, didn’t come into its own until the 1990s; angioplasty a decade or so earlier.

That is, in the 1980s they would have been able to open up your clogged artery with a balloon, but it might not have stayed open. If it didn’t, that meant it was time for open-heart surgery. (“They split me open like a lobster,” as a fellow patient in MidState’s cardiac rehab program put it, offering to show the rest of us his scar.) Your oth-er choice in those days was to take it very easy, worry a lot, hope for the best and pray.

One of the best things about these less-traumatic catheter procedures (less traumatic than “lobster” surgery, I mean) is that they make lots of open-heart surgery unnecessary, McKay said. Another is that they reduce recov-ery time: 20 years ago you might have had major surgery and then spent a month in bed; today you might get a stent and be back on your feet in three days or so.

Another advantage, from an institutional point of view, is that cath labs can generate a lot of revenue for hos-pitals. And it’s a growing treatment sector: “From 1979 to 2001, actual cardiac catheterization procedures in-creased 315 percent,” according to Cath Lab Digest (yes, there really is such a publication), “making it one of the fastest-growing clinical services.”

Which is one reason for MidState to want to build a cath lab in Meriden. Another reason, according to the hospital’s testimony before the state Office of Health Care Access, is that it “fits squarely within MidState’s strategic commitment to patient access to quality cardiology services.”

Be that as it may, the proposal was turned down earlier this year on the basis that “patients already have ade-quate access to quality health care services” — through facilities including Hartford’s cath lab.

“MidState is an excellent, excellent hospital,” said McKay, “but may not be able to supply the volume to keep a cath lab going.”

Volume is also a problem at the Heart Center of Greater Waterbury, which is run jointly by two hospitals but hasn’t been able to generate an adequate amount of work and now faces possible closure. Although it’s a dif-ferent kind of facility from what MidState proposed, it does illustrate the trouble a smaller hospital may have in trying to move up to the next level of service.

Volume is not a problem, though, at the Hartford cath lab, which performs around 1,500 angioplasties a year; add in other procedures and the total more than doubles.
And there’s something else to be said for high volume. Think of it this way: Suppose your Ferrari is on the fritz; do you take it to a garage where it’s going to be exotic, a challenge, something they rarely see? Or a place where they work on so many Ferraris that they could practically rebuild them in their sleep?

In a medical crisis, the last thing you want to be is an “interesting” case, seems to me.

But just in case your case turns out to be more interesting than expected, you also want your angioplasty to be done at a location where they can always wheel you into cardiac surgery if things go badly, which is rare but does happen. That’s what the American Heart Association and the American College of Cardiology recommend.
Meanwhile, back at the lab

Why did I return to the laboratory?
Well, simply to find out what the place looks like and feels like when you’re not the patient (“Give it to me straight, Doc.”) and not under the influence of existential anxiety (“How long have I got, Doc?”) tempered by appropriate but mood-altering drugs.

Why did I choose MidState when I needed emergency care, when my home in Kensington is just as close to the Hospital Formerly Known as New Britain General?

Well, in large part because I knew about MidState’s affiliation with Hartford; I figured that if it was really se-rious, they’d send me up there.

I keep reminding myself that this is not an opinion column, which is mostly what I write; this is a news story — but it’s a first-person story, which is a little different. So I figure I can get away with this much:
I sort of cringe a little when I hear or read about the “caring” staff at any hospital. It’s as if “caring” should trump “professional” or “knowledgeable” or “competent.” Don’t get me wrong, we all want “caring,” but if I were forced to choose, I’d have to go with “competent.”

Fortunately, I didn’t have to pick one or the other.

And I thought “bedside manner” had gone the way of the house call — killed off by managed care or high technology or whatever. I was wrong.

I was impressed with both the caring and the competence of people all along the line, from the ER staff at MidState, to the Hunter’s Ambulance guys, to the Hartford cath lab people, to the cardiac rehab nurses back in Meriden. They were there when I needed them, and they done good.

The system works.

I think I made a good choice.

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Cardiac Follies, Part 6

So here I am, the post-cardiac patient. Or maybe the permanent cardiac patient would be more like it.

The way I know this is that every morning I have to face The Lineup - the five bottles of pills, four of them prescription stuff with funny names, that I have to take every day now, some of them with water and some of them with food and some of them with both.

(And, don't you know, the pharmaceutical companies are absurdly good at dreaming up names for their meds that are strikingly, even unnaturally, hard to pronounce. Case in point: METOPROLOL, which happens to be one of my Funny Four.)

And you also have to keep track of how many are left and get the prescription refilled on time.

And you also have to make more trips to the drug store than you ever figured you'd be making on a regular basis.

And you also can't help realizing that nobody has to take five different pills every day, four of them with funny names, unless they're either sick or old.

Or both.

But at least I'm almost done with Cardiac Re-education Boot Camp at MidState Medical Center, which means I'm almost done with those drill instructors - Sgt. Catherine, Sgt. Ellen and Sgt. Debbie - with all their blowing of whistles and checking of blood pressure and monitoring of vital signs and coming up with helpful hints about how to maintain the exercise at home (once you're through with rehab) without dropping dead from the effort.

However, I've got to admit, I do need the re-education.

Because I don't know a thing about fitness, never having been fit, and I have next to no experience of exercise, never having given it a shot except, perhaps, in the 1970s, when I had a couple of 10-speed bikes and sometimes actually rode them.

You see, I've always thought of exercise as something to be avoided; and I've always thought that if it makes you break a sweat or breathe harder, it must be bad; and that if you could get there by car, why on Earth would you want to walk? And I've always figured that any place worth seeing could be seen just as well, and maybe even better, in a movie or on TV.

(BEGIN INTERLUDE OF GRIPING.)

Obviously, this improper attitude comes from poor training early in life; from years and years of "physical education" classes that included hours and hours of the physical (entirely too much of it dodge ball) but none of the education.

Is that a complaint? Yes it is.

It seems to me that most of the "physical education" we got consisted of playing games you were supposed to already know how to play. But if you were the occasional kid who somehow hadn't gotten that information at home - if, for instance, you knew hardly any of the basic rules or terminology of baseball, football, basketball or soccer, and had never played any of them before you arrived at school, but were expected to know all about them when you got there - then you were ignored by the teacher (who never seemed to have considered the possibility that anyone in his class could be so ignorant) and you were treated like some kind of a geek by your classmates (who, of course, knew all about sports.)

Do I blame the schools? Yes I do.

I just hope that nowadays there's more to Phys Ed than there was for me, because I think it's fairly crappy to be developing something like an appreciation for regular exercise as a regular part of life - at the age of 59 - that could have, and probably should have, been acquired by the age of, say, 12.

(END INTERLUDE OF GRIPING.)

OK, I'm done now.

And I'm learning.

Reach Glenn Richter at grichter@record-journal.com or (203) 317-2222

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Cardiac Follies, Part 5

Some people have been puzzled, or worse, by the title of this series of compositions, of which today's episode is the fifth - which is satisfying (from the standpoint of efficiency, if nothing else) in that I've been able to squeeze five whole columns out of one teensy-weensy little heart attack. And chances are I'm not done yet.

Well, the "cardiac" part is because it's about heart attacks in general, and mine in particular, with an emphasis on (a) how not to have one, (b) what to do if you do have one, and (c) what to do afterward - if there is an afterward, which, in my case, there was.

Others, like the Record-Journal's Ken Robinson (age 49) and NBC's Tim Russert (age 58), were less fortunate. I got a second chance; they didn't. Which I'll take as a strong suggestion that I not screw it up.

As for "follies," well, those have been all mine - from living for 59 years in such a way as to be a heart-attack-waiting-to-happen, someone who had all but one of the major coronary danger signs without necessarily knowing it was quite that bad; to idiotically trying to brainwash myself into not going to the hospital when it became perfectly clear that I was having a coronary (maybe it'll pass if I just sit down, or something); to foolishly driving myself to the drug store for aspirin, after foolishly failing to have some on hand at all times; to rashly driving myself to the hospital when I would have been far better off arriving in style - that is, on a stretcher. The list goes on, and looking back now, it's just one egg-on-facey stunt after another.

Be that as it may, I'm in another phase now: Cardiac Re-education Boot Camp at MidState Medical Center (although that might not be the official name, exactly) where Catherine, Ellen and Debbie try their level best to whip fitness nincompoops like Yrs Trly into some semblance of shape and to drill heart-healthy concepts into our thick skulls, all the while torturing us with boring bouts on the treadmill and the recumbent bicycle and the infernal Nu-Step contraption - interrupted only by their frequent attempts to detect our vital signs, if any.

Anyway, here are a few of the things I've learned so far:

1. Smoking is bad. Period.

2. Stress is bad, too, but there are allegedly ways of managing it - short of massive infusions of Jack Daniel's, that is. Short of quitting your job, selling your house, getting a divorce and moving to Timbuktu, too. They're having a class on this stuff at the hospital next month. Maybe I should go.

3. Fruits and vegetables don't actually grow in cans. In fact, many people believe they grow either on trees or in the ground, and that if you catch them before they get put into the cans, they're likely to be fresher and more nutritious and not saturated with salt and sugar and stuff.

4. Exercise is good, within reason. But you should warm up first, and cool down last, and not get carried away in between.

5. Exercise is also boring, so if you survive cardiac boot camp, you should plan on transitioning as soon as possible to more-fun stuff - like walking, f'rinstance. Besides, that way you get to snoop on the neighbors and they'll be none the wiser.

But maybe I'm overdoing the boot-camp bit. Think of it, instead, as Club Mid - kind of a cardiac Club Med, presided over by gentilles organizatrices Catherine, Ellen and Debbie, where you wear a heart monitor around your neck instead of the pop-beads that are the official wampum of that other place.

That's it! Club Mid! They'd better order the new stationery right away.

And I won't even charge for the idea.

Reach Assistant Managing Editor Glenn Richter at grichter@record-journal.com or (203) 317-2222

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Cardiac Follies, Part 4

As threatened last week, here are a few more pointers on what not to do during a heart attack - gathered from recent personal experience when I woke up having what turned out to be a heart attack, at the first sign of which I hemmed and hawed for a while, trying to talk myself out of it, then futzed around, trying to convince myself it would soon pass, then drove to the drug store to get some aspirin, then drove to MidState Medical Center in Meriden to get some treatment.

When you think you may be having a heart attack and can't figure out what to do:

Don't hem and haw about whether or not to get help. If it feels bad (and like nothing you've ever felt before - duh!) don't try to convince yourself it's routine and minor.

Don't futz around, doing the dishes or watching TV while you try to convince yourself that it'll pass. By the time you figure out that your symptoms aren't going to go away all by themselves, it may be too late.

Don't call your sister-in-law or your buddy from work or your college roommate to get their advice - unless they happen to be cardiologists or something.

Don't waste time primping for the emergency room. If they can handle stabbings and broken bones, they can probably cope with a fashion disaster.

Do dial 911, take some aspirin and wait for the medics to arrive.

If you get to the hospital some other way, don't think you're out of the woods yet:

You may find, if you drive there yourself, that all the parking spaces anywhere near the emergency entrance are taken - many of them by cars with handicapped permits. You may think this is weird, since a handicap is a chronic condition, after all, and here you are, trying to get treated for an emergency.

You may also notice that there doesn't seem to be a security guard around, so you can either ditch the car right there and let somebody else worry about it, or you can park it out in the lot and walk.

You may find that the place is not designed for people who manage to stagger in under their own steam. Unless you're bleeding on the carpet (or lying on it, or both) there's going to be a certain amount of red tape.

You may find, once you do manage to get inside, that everyone assumes you're perfectly OK to sit down and answer routine questions and present your insurance card and stuff - even if the first thing you said was, and I quote, "I think I'm having a cardiac event." This is why it's better to arrive by ambulance.

You may think you detect a little constructive criticism here. If so, you're right.

But once you get past all the obstacles, you'll find you're in good hands after all.

That is, once you get seen by medical staff, things finally start to happen - and before you know it you're flat on your back and people are sticking needles and tubes into you and putting stuff in and taking stuff out and doing an X-ray and pretty soon a cardiologist is talking to you and in no time at all you're looking out the back window of an ambulance and then you're being wheeled into a big room at Hartford Hospital where a very nice guy gives you some happy juice that really mellows you out and then he shows you the wire thingamabob he's planning to fish through an artery to within a couple of inches of your heart so he can install what looks like the spring from a ballpoint pen and then he does it and you get to see the before and after on the screen and how that river of an artery had shriveled down to a scrawny little creek but now it's back to being a river again so everything's fine. The end.

Or rather, not the end. Which is an altogether better outcome.

Reach Assistant Managing Editor Glenn Richter at grichter@record-journal.com or (203) 317-2222

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Cardiac Follies, Part 3

Ken Robinson got a big kick out of my heart attack.

And I mean that in the best possible way. OK, maybe it sounds a little strange, so let me explain.

For a lot of years, Ken was the principal teacher in this newsroom as well as the chief maintainer of standards and the keeper of the institutional memory and the hirer of quite a few cub reporters and the chewer-out of a good many of them. Years ago, that might have meant informing some young writer that he can't get everything from the newspaper files but might actually have to leave the building once in a while and go out and talk to some actual people. More recently, that might have meant informing some young writer that he can't get everything off the Internet but might actually have to leave the building once in a while and go out and talk to some actual people.

That was another kind of news that sometimes needed delivering, and Ken had no problem delivering it.

But he was also the humorist-in-chief.

Work in this business long enough - as Ken did for 31 of his 49 years - and you can hardly help catching the kind of gallows humor that comes with the job. So much bad news flows through a newsroom: The car crash that kills five, the children trapped in a house fire, the stabbing, the shooting, the lost soul who falls down (or lies down) on the tracks just before the train comes through.

And that's just the local stuff; nor is there ever a shortage of bad news from the rest of the universe.

So, amid all that storm and stress, you tend to develop a macabre take on the sometimes tragic, sometimes comic, often absurd antics of so many of the people who find their way into the news.

Anyway, as soon as it became clear that my medical misadventure of April 20 was going to be very annoying but not very fatal, I started polishing my anecdotes so I could feed Ken the details that would reinforce my carefully cultivated image as the paragon of dysfunction that I obviously had been for quite some time - the heart-attack-waiting-to-happen whose grease-and-salt-laden meals tended to come from drive-up windows, the guy who never wandered more than a few feet from the car unless it became absolutely necessary - with a special emphasis on my outstanding capacity for stubbornness and stupidity.

But I could only do that because I survived my cardiac event, and with very little damage.

No such luck for Ken, who collapsed and died, right here at the old word factory, a couple of Tuesdays ago.

Which means he's not here to joke about it - and, believe me, he would have. I can just imagine the Letterman-style Top Ten List he might have come up with, just for starters.

And that, to me, is the single strangest, most abnormal, most unnatural thing about the mood of this place since May 27.

Ken didn't get a second chance; I did. So I guess my top job now is to make sure I don't waste it.

Which is why I now find myself in cardiac re-education boot camp at MidState Medical Center, where drill instructors Catherine, Debbie and Ellen try their level best to whip wellness reprobates like Yrs Trly into shape.

If I play my cards right - if I listen to those gals, make a few lifestyle changes and stick to it - I don't have to have another heart attack. Ever.

Next time: How what at first seemed like it might be The Big One turned out to be more of a ho-hum-so-that's-what-it's-like little heart attack. And how I don't expect to enjoy such dumb luck twice.

Reach Assistant Managing Editor Glenn Richter at grichter@record-journal.com or (203) 317-2222

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