By Rita Jane Gabbett
This is a cautionary tale for all the women I love, which, as it turns out, includes all women. It might be worth consideration for you guys too.
When you are having an angiogram (cardiac catheter procedure), they don’t knock you out all the way. This is because they might have to wake you up and discuss your options with you in the middle of it. I couldn’t exactly follow what they were saying, but I could catch bits and pieces. And these are three phrases no one wants to hear when their cardiologist is up inside their heart. “This isn’t going to,” “We are going to have to,” and “Let’s try…”
Don’t worry. This story has a happy ending. After all, I am typing this two days later. But there was some luck involved and that’s where the cautionary tale comes in.
Whether you have heard this or not, it bears repeating that women’s heart disease symptoms can be vague. Mine were. So much so that even on the morning of my procedure I was questioning myself. Why am I doing this? I feel fine. I can walk a mile and I only get chest pains occasionally. Everyone gets out of breath sometimes. Stairs are hard. I’m 66. This is just aging. They will probably find nothing. And then I will be labeled a hypochondriac.
Cautionary tale advice: Sometimes, probably all the time, the best thing to do with your inner critic is to thank her for her input, then tell her to sit down and shut up.
As it turns out, I am probably the antithesis of a hypochondriac, and I am going to venture a guess that I am not alone. Many of us like to see ourselves as strong, capable, healthy, damn near invincible. I did.
There is also this: with apologies to all the wonderful doctors out there (including my cardiologist for whom I am forever grateful) some doctors tend to poopoo women’s symptoms. Several studies bear this out, including one that shows women complaining of legitimate heart disease symptoms are twice as likely to be diagnosed with mental illness as men reporting the exact same symptoms. It occurs to me that even the word hysterectomy sounds suspiciously like hysterical.…Enough said.
When I told my primary care physician that I had racing heart palpitations and some shortness of breath at the top of the stairs he told me I was prone to anxiety. I am? I don’t feel anxious. Then he had me hold out my leg while he pressed down on it. He said my thighs were weak and if I exercised more, I wouldn’t be so out of breath.
Maybe he labeled me “prone to anxiety” because I had complained similarly two years prior. That time, he had me wear a heart monitor for two weeks, which showed only slightly irregularity and he told me I was fine. I felt foolish.
But the shortness of breath had gotten worse and the “weak thigh muscle” theory did not sit right with me. I am a life-long exerciser who watches her diet and up until these recent months hardly missed a day on my 10,000 steps regimen. I wanted to push back on that diagnosis but didn’t. After all, he went to medical school; I didn’t.
Cautionary tale advice: Doctors are not magicians, and they are not in your body. Many are also pretty overworked and exhausted these days.
He then listened to my carotids (arteries between the heart and brain) and heard a prominent bruit (pulsing sounds like blood pushing through a narrow channel). To his credit, he ordered a sonogram and referred me to a cardiologist.
I passed the sonogram with flying colors – only slight calcification in my carotids. I was elated. See? Nothing wrong with you. Maybe you are a hypochondriac, my inner critic chided. Still, I kept the appointment with the cardiologist. Thank God.
A former journalist, I like to go into any interview prepared. I constructed a one-page document outlining my symptoms over the past 18 months, and a detailed family history. The exercise of preparing that document was a good one. It forced me to be honest and look objectively at my reality. Over those months, I had gone from daily three-mile walks to five days a week, to three days, to two miles, to one mile, to, “Oh hell, I’m tired, let’s watch Netflix.” I also talked to my older sister to flesh out family history.
Cautionary tale advice: Do this. Like the Boy Scouts, be prepared.
That document alone, which I handed to my cardiologist when we met, pretty much set his hair on fire. He ordered a stress test for the next day. I was sure I had passed. Even the staff cardiologist conducting it said I did great but added that we’d have to wait until my cardiologist reviewed the results, as he tended to see things others did not. Well, God bless him, he did. But even he was on the fence about whether to proceed to an angiogram. My test results were mixed – the echo cardiogram looked great. My heart was pumping strong. But the EKG showed some slight heart irregularity upon exertion. He said we could look the other way, but given my family history, he’d like to proceed to an angiogram.
Cautionary tale advice: Make sure you know and share your family history with your physicians because that’s probably what saved me.
In my case, super-high genetic cholesterol (with an inability to tolerate statins), an uncle who dropped dead at 42 of a heart attack and a mother who had a quintuple bypass and valve replacement were enough to tip the scale for him.
Even as I was quick to point out (and rationalize) I was unlike my mother in many ways. She was a smoker, I was not. She had high blood pressure, mine is low. She was sedentary, I am extremely active.
But I liked this guy. He listened carefully. Asked questions. My first appointment was 45 minutes long. He called me between surgeries to go over my stress test results. I trusted him. I’m glad I did.
Cautionary tale advice: In almost every aspect of life, follow your gut instinct. We were given that “gut brain” for a reason.
So on to the angiogram we went. Sure enough, the main artery that supplies blood to the right side of my heart was 95% blocked. He inserted a stent which he says is now working beautifully. As for the chatter I heard while I was only half under, turns out my 4’11” stature also came with pint-sized veins and arteries. The blockage was in a tricky spot (where the artery curved) and so occluded that he had to insert a second tiny wire to perform a sonogram inside the artery to be able to place the stent correctly. Isn’t medical science grand? Amazing. I am so grateful for every researcher, every manufacturer of medical equipment and every doctor, nurse and technician who took out student loans to save my life! Thank you. Thank you. Thank you.
Cautionary tale advice: Take the victory but learn from it and pay attention.
It is going to take me a minute to get my brain around the fact that I have coronary heart disease. The artery that supplies the left side of my heart is also starting to clog, but it’s not bad yet. I have smaller blockages in others, but also not too bad. Yet. The operative word is yet. I am now on blood thinners and will go on a new cholesterol treatment for people like me who can’t take statins. I will have yearly stress tests and if I have symptoms, I will be honest with myself and my cardiologist about them.
I won’t brush it off next time the walk to the far end of the soccer field for my grandson’s game looks like a lot of work (as it did a few months ago). I will not blow off chest pain as heartburn. And I will pat my inner critic and my oversized “I’m OK” ego on the head and send them both into a time out if they get too loud.
Final advice: Smell those roses. They are the reason we are here.
Janie Gabbett is a journalist who spent the bulk of her career working for the international news agency Reuters in Washington, D.C., Los Angeles, Hong Kong and Chicago. Now she processes life by writing about it. Her essays have been published in Faith, Hope and Fiction, McSweeney’s and the Christian Science Monitor. When not writing, she is either working in her art studio or creating pillow forts and dinosaur menageries with her grandsons.