My Heart Surgery Story 1: The Almost Angiography
It began in the hills of San Francisco when my wife and I were visiting my daughters. My youngest daughter and her boyfriend wanted to take me to brunch. We walked from their apartment. Walking was a new experience for me since I’m from LA and drive everywhere. We walked across the park. We walked through Haight Ashbury. We walked up the hill. We walked around the corner. We walked down the street. By the time we got to the restaurant, I was short of breath.
All weekend, any time I had to walk a block or climb a flight of stairs, I was gasping for breath. There was no pain so I had no thought of heart attack. What I thought was, “Boy, am I out of shape.” And, “If I lost a few pounds, it would all be better.”
The Primary Care Physician
After three days, my daughters and wife convinced me that I needed to see a doctor. Monday morning, before we began our drive home, I called my doctor and was able to get an appointment for that afternoon. Considering it was a 7 hour drive to the appointment, we hit the road, pedal to the metal.
Even stopping for a quick lunch, I made the appointment time. My doctor listened to my symptoms and listened to my heart. She told me I had a heart murmur and would give me a referral to a cardiologist. As I geezer, my insurance is Medicare Advantage, which is an HMO. That means a world of waiting for each referral in the next step of the process – whether that process is heart surgery or toenail fungus.
Visiting the Cardiologist
Two days later, I was still short of breath, but I had my referral. Two days after that I was in my cardiologist’s office. She also listened to my chest and confirmed a heart murmur. That’s not a disease, but an abnormal murmur is most often caused by a defective heart valve. The next step was a carotid ultrasound. This non-invasive test is used to take measurements of the heart and aortic valve from outside the body using ultrasound.
The test showed that my aortic valve was smaller than normal size, but not in the danger zone. (To keep it simple, a normal aortic valve opening is over 2.0 centimeters. Below 1.0 centimeters is a problem. Mine was 1.4.) Based on the results, the doctor decided I did need angiography (Also referred to an angiogram, or angio for short.) This invasive test uses imaging to look inside the heart, its arteries and veins.
Approval for the procedure came quickly. There was not a lot of arguing about a questionable heart valve. (For more about aortic vale replacements, see this hub.)
Before doing the angiogram, the doctor required an X-Ray and a blood test. I was never clear about what information an X-ray would provide, but I had it done. I had to go to a different office, but also had the blood work done.
My angiography was scheduled for the morning, which was fine by me. Get the cardiologist while she’s fresh, I thought. So my wife and I arrived at the hospital bright and early at 7 am for a scheduled 8 am procedure. Of course, there was plenty of paperwork to fill out and a medical card to be copied to be sure everyone would be paid the amount the insurance company had negotiated with the hospital. [For my thoughts on medical insurance companies, go to this link.]
At 7:30, as I was lying there in my hospital gown with an IV in my arm, the cardiologist walked in and said, “We can’t do the procedure today.” Say what!. She went on to explain that I had iron deficiency anemia. The normal hemoglobin value for a man my age was over 13. My hemoglobin was 7.
Does lack of iron cause shortness of breath? Why, yes it does. The heart has to pump harder to get the little iron it has to your body. This results in shortness of breath.
So the angio was off. But not me. I was wheeled up to a hospital room for “an overnight stay.” For the next twelve hours, I was pumped full of blood. Every time a bag of blood was emptied into me, they started another one.
Four bags later, when my blood test showed my iron back up to 12, I was released with instructions to start taking iron pills and return to my cardiologist in 6 months.
So the good news was that there was no need for angiography. And that iron pills can be bought over the counter – so they don’t cost an arm and a leg.
But the story was not over. See My Heart Surgery 2.