Mi Corazon, Medellin Colombia 2017. Photo by Nora Múnera Fotógrafia. http://www.noramunera.com/biografia.html
In part 1 of this epic blog post I wrote about the technical, medical issues my wife and I confronted during my recent heart attack, the physical, physiological, and psychological aspects of the experience. In part 2 I discussed the metaphysical, the spiritual & ethereal reality of confronting my own mortality, and the affect that experience had on me now and going forward.
In part 3, I must recognize the woman who saved my life. No hyperbole involved, no overblown, exaggerated expression aimed at self aggrandizement or patronage, Mariah loves me unreservedly, despite my annoying habits and many quirks, my inability to leave a cabinet door standing open, and my irritating habit of putting things away in the kitchen before she's finished with them. She ignores all (most) of that, and still soldiers on with me.
So this is an honest and frank acknowledgement that during the biggest crisis of my life my wife's advocacy and interventions likely saved me. I owed her a lot before the event; now my debt is deeper than I can repay. I may even have to start leaving the paprika and pesto out while she cooks, maybe leave one or two drawers open for a time. This will be difficult for me, but she's worth it.
In espanol, the word 'Corazon' means 'Heart.' From time to time, as we study and learn Spanish together here in Medellin, I refer to Mariah as mi corazon. It is now more true than ever.
Here's just a peek at what a spouse can expect if your very own Corazon is ever challenged by a medical crisis, and here's how you should respond in thanks. You see, when I had my ataque de corazon, my wife, mi Corazon, had her very own attack, from the unknowns of what might happen to me, from the daunting burden of responding to directives, procedures, drug and device challenges, and from the psychological aspects of such crises, the part that's too often ignored. In our case all the above was compounded by a language barrier. Through it all, Mariah rose to the challenge, and met every bump, rattle, and jolt, and brought us out the other side. I don't say it often enough, Mariah, I love you 'con todo mi Corazon.'
Going through all we did over the past month or so was tremendously difficult. The initial emergency, the race to the wrong hospital the first time, then getting to the right one. The never ending intake paperwork, insurance details, emergency room procedures. The truly critical period when I lapsed into V-tach, and nearly into V-fib, and the subsequent heart catheterization & stenting that bought me a critical care bed for four days. During this time Mariah watched, and waited, and anticipated, her past career as a cardiac RN critically useful, while that knowledge and experience gained over thirty five years was almost too much information.
As I mentioned in part 2, though I knew beforehand that she and I are in this leaky little boat named the SS Expat together, it was never more clear until afterward that every decision and experience of mine had a direct and lasting impact on her as well. Far more than shutting cabinet doors and stowing the mayonnaise jar, my actions to stabilize, maintain, and improve my health affects Mariah in direct and measurable ways. If I'd died during my heart attack, or if I neglect to prevent another one, she'll lose much more than my companionship and the financial resources I add. She'll lose a bit of her own agency as well, in addition to a portion of her self-esteem as a medical professional, because she will, rational or not, always think she'd forgotten something. Sure, she'd be able to cook and bake without losing sight of the yeast and the flour canister, and she'd know right where the paprika & pesto are, because I've not put them back in the cabinet and then shut the door, a slightly infuriating event for her that's happened a time or two. But she'd be faced with an unknown that can never be rectified. A what if..? This is my cue to fill in parts of the what if.
What does a mate require of a spouse when one of the other is injured, ill, debilitated in some way? I'll ask my wife, and then try in my feeble efforts to put myself in her position.
Our kitchen counter now resembles a CVS Pharmacy
1- Be a compliant patient. Take the drugs prescribed, on time, in whatever dosage and with whatever instructions accompany them. It helps to know what you're taking, and why. It's too easy to take scripts to the local farmacia, get them filled, then schlep them home and start popping pills. Take the time, make the effort to know what each drug is, what it does and why, what possible interactions it has with other drugs and/or food items. What's the dosage, and the various quantities remaining? Don't assume filling the scripts is your spouse's responsibility. Make an effort to match up the drugs with their effects. In other words, are they doing what they're supposed to? In my case, they were not. I've been hypotensive my entire life, with a challenge of blood pressure that's often too low. This is an enviable situation in some ways. But when certain drugs like statins & ACE inhibitors drive BP down, the result, for me, was alarming. Being a compliant patient might mean informing the physician that your prescribed regimen is wrong for you.
They're not trying to run your life; they're trying to save it
(BTW, this is NOT the lowest BP we saw)
2- Stop it with the kvetching already: Your spouse isn't trying to belittle you, or baby you, or take control of you. They're trying to save your miserable life, that's all. It will seem, and feel, and sound at times like they're running the show, and calling all the shots. Especially if your spouse happens to have some inside knowledge, like 35 years as an RN, for example, it will feel like you've lost control to their dictates and directives. But what they're doing is for your own good. It just happens to come at a time when you feel that your life is no longer your own. Your illness has taken away big parts of your liberty, and latitude. You're restricted, and maybe homebound in ways you've never been. It sucks, quite frankly. Now your very own spouse is demanding that you do this, read this, take this pill, take your blood pressure, drink this magical potion. It's a tough time for both of you. Here's the bottom line: swallow your ego, listen up, tell the little egocentric asshole screaming inside your head to shut up, and do what your spouse is telling you to do.
When life hands you lemonades, squeeze your spouse, you'll feel better.
3- Addendum to the above: Put yourself in his/her position. If your spouse were injured or ill you'd rise to the occasion, take charge, rally the troops, and become the field general who orders what's needed to protect your own Corazon, just as they're doing for you. Don't forget, they've sustained an injury, too, it just doesn't show like yours does, and they don't get half the sympathy from others. There are no get well cards for those charged with tending to us. Maybe there should be? People who love and care for us are every bit as restricted and limited by our medical challenge as we are. They have the added burden of keeping the ship afloat and the jib in trim, paying bills, maybe throwing a biscuit or two to the rugrats, providing transportation, meals, entertainment, and clean socks and undies. For them, real life goes on, and they have you to look after into the mix. So do what they say. You'll get better, and when you come out the other side they'll be smiling and waiting for you.
In closing, I have a message for those in my age group, potential expat or not, about being your own health care advocate. Below you'll find some light reading that contains good medical information, and some ways to avoid the experience we confronted. This is especially relevant for my siblings, and anyone who's had a parent or sibling with a heart, or other genetic condition. Here's the thing about family members, you may not like them very much, but you share their genetic makeup, so don't be precious about the differences. Read this stuff. It may be valuable to you, and even to your offspring at some point. I should also add that being female is no get out of jail free card. Heart disease is the biggest killer of post-menopausal women in the U.S. and elsewhere. And by the way, women exhibit very different heart attack symptoms than men do, and those differences can be significant.
Don't worry if the papers and studies cited here are dense & jammed full of medicalese. You'll get the important points, just keep reading. All recommendations are based on research my wife and I did during and after my heart attack. Some of what we found was astonishing, and a bit irritating. Did you know, for example, that cholesterol is good (and necessary) for us? That if cholesterol levels drop too low we can be susceptible to various other bad stuff, like Diabetes? Did you know there's a simple lab test that can predict with some accuracy if you're a candidate for a first heart attack? That physicians often treat the disease, and not the patient? I'll explain how these items affected my own medical profile, and how my wife and I are protecting ourselves going forward. Disclaimer: I'm not a physician. I don't play one on TV. In fact, I don't even watch TV. None of this info is gospel, so do your own research. The data come from reliable on-line sources, so they're all subject to change.
Cholesterol: This life vital chemical has been maligned, condemned, vilified, and sanctioned. Its eradication and/or diminishment in our bodies has been the primary focus of cardiac health studies for at least a generation. But one thing we rarely read is that our bodies manufacture cholesterol and its variants. The so called LDL 'bad cholesterol,' and the HDL 'good cholesterol' are mentioned only in terms of their beneficial or deleterious affects. From the research we've done, it's obvious that there must be an optimal cholesterol level for every person, depending on many factors. Lower is not necessarily better. There are people with very high LDL levels who live long, uneventful lives. There are those with very high HDL levels who suffer heart attacks. Much more research on cholesterol is needed, especially on the effects of cholesterol levels that are too low. The literature on this aspect of cholesterol management is meager at best.
For one thing, recent studies have shown that a cholesterol level that's too low can make us susceptible to diabetes mellitus, DM. In my case, with a strong family history of adult onset diabetes, recent efforts to diminish my cholesterol level for heart health could have had serious side effects. While I don't wish to have a second heart attack, I don't want to develop diabetes, either.
A lab test that's gaining prominence examines blood serum levels of what is called C-Reactive Protein. This chemical found in our blood is a marker for inflammation, and its value in a lab test can indicate ones susceptibility to a first myocardial infarction, a heart attack. Medical science is more and more considering atherosclerosis an inflammatory disease, and a high C-Reactive Protein level flags that quite well, very easily, and at little cost. For those with little or no family history of heart attack, this simple test can prevent an out of the blue occurrence of MI, such as the one I experienced. If I'd had a test of my C-Reactive protein earlier, it may well have predicted the MI I had in January.
Another reason to monitor and understand your drug regimen is that physicians often treat diseases, not people. What I mean is, with little time for in depth contact with patients, and often no history available to them of a patient's lifestyle and/or family background and genetic profile, physicians rely on standards of care that dictate rigid prescription medicine assignation & dosing. There are also legal liability issues forcing doctors to follow inflexible guidelines when writing medical prescriptions. Patients with MIs are, therefore, the beneficiaries of a set, well known, and widely prescribed drug array. Especially when a stent is deployed, the drug regimen is almost sacred: It consists of ACE Inhibitors, Beta Blockers, Statins, and Aspirin. However, here's where the patient profile comes in. In my case, as an example, some of those rigidly assigned drugs lowered my blood pressure, at times to alarming levels. Though my wife and I had indicated to the physician staff that I was commonly hypotensive, the drug slate was assigned, and the medicines did exactly what they were designed and formulated to do. They dropped my BP even more. After several weeks of trial and error, with my cardiologist changing drugs, and consulting with an internal medicine doc, my dosages and drugs were adjusted and reached a happy medium that keeps my systolic BP consistently above 100. Be persistent, know your own body, understand the drugs you're taking, and speak up for yourself.
This is not meant to be a definitive guide to pharmaceuticals, and/or a life-style aimed at preventing heart attacks. All I know is what happened to me. There's a lot of literature and evidence based medicine indicating that certain practices can prevent heart attacks and strokes, and reduce morbidity after them.
Studies: In no particular order, here are links to the research articles we found, plus a few Pdfs you may find useful.
NIH Study on Cholesterol & the diabetes connection: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513492/
A lab test to predict heart attacks? C-Reactive Protein. https://www.sciencedirect.com/science/article/pii/S1110260814001173
U.S. MI stats (NIH): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504336/
About ACE Inhibitors & Beta Blockers: https://mail.google.com/mail/ca/u/0/#label/Health+Care/161a5af7a6ac2f06
More MI Info:https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/coronary-artery-disease-unstable-anginanstemi
Home rehab:http://bmjopen.bmj.com/content/2/6/e001820 Also: http://openheart.bmj.com/content/3/2/e000463
The heart manual, UK:http://www.theheartmanual.com/Pages/default.aspx
Post MI Kindle book: https://www.amazon.com/Life-After-Heart-Attack-Lifestyle-ebook/dp/B00FRL765E
AHA guide: http://www.heart.org/HEARTORG/Conditions/HeartAttack/Heart-Attack_UCM_001092_SubHomePage.jsp
And finally, here's a lost of research studies looking for volunteers. Your particular genetic, or health, or social profile may be of interest to the research community. Check into these studies, and your contribution may saves lives.