“You didn’t do anything wrong”, he said. I looked back quizzically. And, he repeated again, “You didn’t do anything wrong!”. This is not reassuring me though.
How did I get here? I tried to be good. I assessed my family genetics at an early age and tried to make a significant course correction. I exercised regularly. The marijuana was thrown out. Drinking alcohol was cut way back and eventually eliminated. No processed foods graced our pantry.
One day riding my mountain bike up a beautiful trail in Mount Shasta, the Garmin displayed a heart rate (HR) up in the 150’s (~ 90% of max) near the beginning of the ride while not really going that fast. Being in the middle of reading Peter Attia’s book, Outlive, and just finishing the chapter on heart disease made me think a visit to my Primary Care PA was in order. My total cholesterol had been just over the top limit of 200 the last three years and I am 69. Attia recommends knowing AP0B and Ca+ to get a better picture and my thinking was let’s get those tests done. My PA said OK but first let’s make sure you don’t have anything else more severe going on so she ordered a Stress Test and Echocardiogram.
The Stress Test was like being interrogated by the detective. “Has anyone ever told you that you have left branch bundle block?” said the attending physician reading the EKG as I walked on the treadmill under the influence of a drug that made everything feel taxing and with some kind of dye running through my blood vessels and heart. “No, never and I have never heard of it before” was my answer. “Well, you do” said the doctor and out of the room he went. The technician who hooked up the EKG electrodes, managed the test, and took the images of my heart said “not to worry”.
My PA was not so sanguine about the 35% left ventricle number when talking with her. And, she said “the Echo will tell us more”. The technician that did the Echo didn’t say much and I didn’t walk away with any feeling one way or the other. My PA though was real concerned about the left ventricle 31% ejection fraction. “You need to see a cardiologist. And, I don’t think you should ride your bike until then. And, here is a prescription for Nitros. If you have chest pains, take one and get to emergency.” When I told her I had ridden over 2500' vertical feet that morning on a 18 mile single track mountain bike ride she shook her head saying that I should be getting out of breath walking up the stairs at my house.
Fast-forward a couple weeks and my wife and I are in a room with the cardiologist. “You have Congestive Heart Failure [CHF]”, the doctor says. The words hit like a ton a bricks. “That means you have the all-cause mortality rate of someone diagnosed with cancer” he continues. “I believe the best course of action is a cocktail of drugs including a beta blocker, blood pressure meds, a diabetes drug, baby aspirin, and statin which means you will take six drugs per day”. And, looking at my wide-eyed and blank face, he continues, “You didn’t do anything wrong”.
We talk about some further testing including a catheter angiogram to look at the heart with a tiny camera from inside. And, he asks if I want to start the drugs now. It will take at least 30 days to get the blood pressure meds dialed so I don’t feel light headed when standing up. The beta blocker will stop my heart rate from going up so he says I will feel terrible every bike ride until I can push through that HR limit. Then I should feel OK.
At this point, I am somewhat in shock. It feels like a judge sentenced me to death and I’m on death row. So now I am going through the stages of grief. Denial, anger (fear), bargaining, depression, acceptance are all swirling around at once because my previous self-image took a big hit. So, I decide to do nothing until there are more tests and go out for a sushi lunch. After all, my bargaining and denial self says, the tests are “only” 80% accurate. Yep, I’m grasping at straws.
I had always planned to live a long life and now in about 20 minutes my place in the centenarian olympics is gone. The idea of seeing grandkids someday and growing old with them is fading. Riding bikes off into the sunset with my main social group of friends and acquaintances dims. The reasons for living feel like they are being pilloried.
A bike riding friend told me of being on a beta blocker and how the terrible feeling of no energy or oxygen did not go away once he got his heart rate up. He felt lucky to make it back home doing a short ride without falling off his bike and ditched that drug. And, I seem to get sick to my stomach from all kinds of things like antibiotics, Norco (after hernia surgery), two different statins, and even baby aspirin sometimes. It makes me think the 30 days the cardiologist said it would take to optimize dosages is crazy optimistic and I’m really looking at six months to feel crappy-OK and not terrible. And, even at optimized levels what is my quality of life?
My dad had a heart attack at 44 and quadruple by-pass at 68. Then he had several stents, angioplasty, pacemaker, pacemaker w/defibrillator, and so many drugs including his personal nemesis, the hated diuretic that made him pee constantly. At the age of ninety, he had had enough and while in the hospital for back pain had the physician take him off everything and died twenty-four hours later when his lungs filled up with liquid because his heart couldn’t pump enough to clear them anymore. I am starting to really understand his final decision. Having seen this story already, I did everything to write a different ending. It seems genetics are strong with this one.
The trade-offs of longevity and quality-of-life seem impossible to quantify. And, that feels like sitting on death row all by yourself with no execution date. But you know it is coming.
If you found this interesting and want to know what happened next check out Part II here at this link.
