04/20/2014
🛌☆○●○●☆ Updated Sunday, February 26, 2017 at the bottom of this post ☆●○●○☆💉💊⚰
Introduction:
Back in December of 2000 I began having what I thought was severe acid reflux symptoms. At that time I taking Zantac on a daily basis and I thought it was just no longer doing the trick. I went to see my primary MD, internist Edward Stehlik. He changed my medication but two weeks later, my symptoms became worse. I had ultra sound tests, upper GI tests all the while figuring my problem was gastro intestinal. Eventually I was sent to my then cardiologist Dr. Chaskes for a consultation. He had already determined that I had blockage in my right leg and suggested I go for an angiogram just be on the safe side. He then told me since he was unaware exactly where the blockage in my leg was located, he thought it would be prudent to have the angiogram through my wrist. He had not at that time done an angiogram through the wrist so he referred me to Dr. Neil Dashkoff at ECMC. Back then you were counseled on what exactly an angiogram entailed. You were shown a movie and counseled on possible side effects/complications. During this time my symptoms got so bad, I remember getting in my car to go to work and the pain became so bad, I went back in the house and laid on the floor. I subsequently went to the hospital and spent a few days there to have more tests done and was actually there on Christmas day. That was quite depressing laying in the hospital, but on Christmas day I received a phone call from my niece/Goddaughter, Laura calling to wish me a Merry Christmas. That lifted my spirits like you couldn’t imagine and then she and the rest of my family who were all at my parents house began to serenade me with the Christmas song “Feliz Navidad”. It had been a bit of a running joke that Christmas and I went together with that song like peanut butter went with jelly. Laying in bed listening to that had me in tears and I then realized how lucky I was to have people that thought enough of me to do that. It was Joe’s first Christmas and I longed to hug each and every one of them. After the call had ended and for the next week or so, I was continuously grinning at the remembrance of that phone call. I was pretty good that week following Christmas until New Year’s Eve, when I called in sick and headed back to the hospital. That was when the scheduled me to go to ECMC for the angiogram. I went into the Cath lab for the procedure sure that I would be home for dinner later that day. By going through the wrist, the recovery time is a matter of like three hours rather than a minimum of eight if going through the groin. The procedure itself was pretty uneventful until Dr. Dashkoff began to remove the catheter and I could feel it kind of dragging through the arteries in my arm. While not painful in the least, it gave me the wi***es somewhat akin to fingernails on a blackboard. I was wheeled out of the cath lab into a recovery unit thinking 2 - 3 hours and I’ll be on my way home. That’s when I got the shocking news that I was going nowhere because I needed open-heart surgery because of coronary artery occlusion that showed a blockage of 95%. The procedure known as Coronary Artery Bypass Graft (CABG) took place on January 12, 2001, performed by Dr. John Bell-Thompson. It was a quadruple bypass. Hospital recovery was like 4 or 5 days before being sent home. Between a month and a month and a half later, I began to have the same symptoms. I went back to Dr. Dashkoff and he scheduled another angiogram, this time (as with all subsequent invasive angiograms) he went through my right groin. During that time, it was determined that parts of the grafts had developed scar tissue forming additional occlusion. They let me go home the next morning after scheduling another CABG procedure for March 29 and a promise that I would “take it easy” until then. Dr. Bell-Thompson again performed the procedure, this time a double bypass. After I spent another 4 days in recovery, I was sent home for about 3 months of recovery. I started back to work (part-time only, thanks to Ted and Richard) and had just worked my way back to working full shifts when 9/11 occurred. The stuff I had been through put a different perspective on that day. I woke up that morning to see that the first tower had been hit by a plane and moments later watched as the second plane crashed into the other tower. I was scheduled to work at 11:30 that morning and it took all I had to leave my family. I almost cried at work that day, because I just wanted to be home. I was able to stick it out however. Sometime before that event I had been informed by both my cardiologist and surgeon that I had recovered well and there was no reason to see them again unless complications arose. This scared me more than anything. I thought of these two gentleman as my saviors and I somewhat panicked and started sneaking ci******es (I’m sure I really wasn’t fooling anyone) until I just began smoking whenever and wherever I felt the urge. After a few years, I finally quit in September of 2007. The following winter I began having episodes similar to those leading up to my first to CABG procedures. I remember one day getting home from work and was too short of breath to get out of the car. After sitting there for about 15 - 20 minutes, Sue sent Joe out to see if I was okay. I asked him to go back in the house and bring me some aspirin. He did and I chewed a couple and felt somewhat better shortly after and finally made it back in the house. About a week later (Valentine’s Day 2008 to be exact), I had the day off which I found amusing because Sue and I never celebrated that Hallmark holiday. However, I woke up feeling extremely weak and short of breath. I spent the day in bed or sitting in the living room feeling worse as the day wore on. Later that evening I started feeling a squeezing in the center of my chest and finally relented and asked Sue to take to the emergency room at ECMC. Once we parked the car, it took all my strength to walk to the entrance and fortunately there was a wheelchair sitting there that I just collapsed into. Sue was walking ahead of me and when she realized I was not with her she came back and pushed me in the wheelchair to the check-in and told them I was a cardiac patient and the took me right in. They started an EKG and then one of the doctors came over and asked me how long I felt this way and I told him it started in the morning and kept getting worse as the day went on. He then looked at me and said “you’re having a heart attack right now”. I started to panic somewhat and told him I wanted my wife with me right now. I was also thinking that I may have seen my sons for the last time. I was left alone for a few minutes after they gave me some morphine and I think Coumadin to bring my blood pressure down. I think it went from 250/130 to something like 60/30 in a matter of minutes. That low pressure made it hard for me to breathe and I was wondering why no one was with me. Then I had a lucid thought that if they’re not hovering around, they must believe everything was under control. That was enough to ease my panic and minutes later, they escorted Sue in and she sat there and held my hand. Then I was fine. Soon they came and told me they called the cardiologist on call to come in and do an emergency angiogram. By this time it was after midnight and I was wheeled into the cardiac cath lab and began getting prepped for the angio. Then much to my surprise and delight, in walked Dr. Dashkoff who happened to be on call that night. Well, as it turned out I had more cardiac artery occlusions and would require another CABG procedure. I was able to return home and I was referred to another surgeon, Dr. Gary Grosner at Buffalo General. I was told that we was one of the only surgeons that would do a third CABG on a patient. He was very business-like during our consultation and told us that mortality rates for a third bypass operation were fairly high. I was scheduled a week or two in advance and the morning of the procedure, Sue and John drove me to Buf-Gen. Jim stayed home to watch Joe and I could see Jim crying as we pulled away. We were met at the hospital by a guy in a tuxedo who took us to a small room where I was prepped for the procedure. I ended up having a triple bypass this time. I remember waking up in ICU and hearing voices around me and then I saw a small window and the first thought that came to mind was “Hey, I’m alive. I made it.” I tried again to return to work slowly, but on September 27, 2008, I had an episode at work that forced me to leave (Jim was working with me that night, so he drove me home), and when I talked to Dr. Dashkoff a day or two later, he told me I should not be working anymore and Dr. Stehlik concurred.
But of course that was not the end of my troubles. There was the worsening condition of the blood supplies to my legs which resulted in more angiograms and eventually had a balloon angiography in my left Iliac artery and a stent placed in my right Iliac artery. When I continued having issues with my legs, another angiogram showed I had an aneurysm in my right leg and another in my abdominal aorta. But nothing was found to explain my leg pain. It appeared that I had sufficient blood flow which was not consistent with my symptoms. I had a CTA which showed that I had bulging discs in my back which was more consistent with my leg pain. During a follow-up with Dr. Dashkoff, we determined it was time again to check my left carotid artery which had previously shown some build-up and required occasional monitoring. I had a Doppler test done on both carotids and the left one showed “significant” build-up resulting in me having an MRA (a non-invasive angiogram). This too showed significant blockage, so back to the conventional angiogram which showed at least a 90% occlusion of my left carotid (half that for the right side). Dr. Dashkoff decided inserting a stent was what he felt most comfortable with. Until recently a carotid endarterectomy was the treatment of choice. This consists of scraping the plaque out of the artery. Stent placement requires a catheter with a deflated balloon inside of the stent threaded through the arteries to the problem spot. Once the stent is in the proper position, the balloon is inflated which both opens the stent and compressing the plaque against the artery wall. Once the stent is opened enough to allow the proper blood volume to flow through, the catheter is removed and you head for recovery. But placing a stent in the left carotid where the brain’s sensors for blood pressure are located, it may take a few days to stabilize the blood pressure as was my case. At this point I guess I should explain that you are always awake during the angiogram. There are screens that the doctor watches to monitor where the catheter is so he can manipulate it through a series of arteries to scope out the problem areas. However, although I can see the screen, it is positioned at such an angle that I cannot see what is being displayed. You are given a pain killer to relax you and if you become anxious they will give you more as needed. Most of my angiograms were less than 45 minutes with the majority 30 minutes or less. I did have one that lasted two and half hours and they kept me pumped full of drugs and very relaxed. As you can imagine, they don’t want you moving around during the procedure, because the catheter could puncture an artery. I always concentrate during the procedure because on occasion, Dr. Dashkoff will ask me how I’m doing or some other question and I have a difficult time hearing him. One time he asked how I was doing and I told him I was okay for the time being, but would need to urinate soon. He immediately had on of the nurses insert a Foley catheter into my bladder. Since that time, I have always made sure I was as empty as possible. Actually the insertion isn’t that bad, but the extraction, while not painful, is quite unpleasant.
Okay, I think I have given you enough background even though I condensed this introduction quite a bit.
Brain Lock Down:
On the morning of the procedure, we arrived at GVI (Gates Vascular Institute) which is behind and connected to Buffalo General Hospital at 7:00 a.m. As usual I was brought to a small room where I changed into a hospital gown (yes I remembered this time it ties in the back) and a nurse comes in to do a little (actually in my case a lot of) shaving. After about twenty minutes following the prep, I am wheeled to a kind of staging area where patients are waiting for their doctors to call for them to begin whatever procedure they are having. Family and friends are given a number of the patient they are there for and can watch a monitor showing real time status. When I was wheeled to the staging area, I dozed off and later found out I was there for 2 hours before called for. It didn’t take long for the procedure to start once I reached the cath lab. I remember trying to see if I could see what was displayed on the monitor, but as usual I couldn’t. It didn’t take long for Dr. Dashkoff to weave the catheter with the attached balloon and stent to my carotid. I could actually feel the catheter start to enter my carotid (usually, but not always, you can’t feel anything). The first time I felt the catheter in one of my arteries it gave me the wi***es. It never hurt, but I could feel it dragging through the artery. This time all I felt was fascination. This is when it gets weird. What I am about to describe may only be my imagination, although I truly believe these events occurred exactly as I am going to elucidate here now.
I believe that once Dr. Dashkoff maneuvered the stent into place, but prior to him inflating the balloon, my “mind’s eye” actually took control of my senses. I could see (or picture) a charcoal colored stent in place and it seemed to be between 3 and three and a half inches long (mind you I have never actually seen a stent). Shortly thereafter, I heard a sound that reminded me of an iron door slamming shut akin to the sound you would hear in a video game. Funny thing about that is, I don’t play video games, but I was sure that was what I was hearing. Approximately 1 second later, my vision when completely black, then simultaneously I heard what seemed to be glass shattering as though a cell phone was dropped face down on the sidewalk. I did not hear the sound of it hitting the sidewalk, just the glass shattering. That was immediately followed by an image of a cell phone size piece of shattered glass with the frame and each individual piece of glass outlined in a bright neon orange (yes, I’m color blind, but I’m still sure it was orange). That image only appeared in my left eye and faded to black in about two seconds. I looked around the room and did not notice anything out of place, but I could not remember if I had my eyes open or not when this occurred. So, I decided to close my eyes in case it happened again. This is when I realized that the stent was being opened a little bit at a time. A moment later I could see the balloon end (white) extending about three-eighths of an inch past the end of the stent and actually brush against my brain. Then it happened again exactly as before. Iron door slam sound, total blackness, glass shatter and the orange shattered glass image, fade to black. Again all images seemed to appear in my left eye only. Okay, now I was sure that I had “seen” all this with my eyes closed. Now to try it with my eyes open. Everything happened exactly the same again with the exception being I didn’t see the balloon protrude past the end of the stent. Decided to try with closed eyes again for what turned out to be the last time I perceived the balloon being inflated. Exactly the same as the second time except when I saw the balloon pass the end of the stent it took a bulbous form and again when it touched my brain the sequence of events occurred identically to the previous times.
Okay, okay, yes you can now say I’m a little touched in the head. But because of the outcome, I wouldn’t want to exchange that experience for anything. I wouldn’t mind going through it again. I believe at that point my brain went into a survival mode. My blood pressure kept fluctuating and I had become exhausted. I remembered being wheeled out of the cath lab and crossing over to Buf-Gen into a room in the SNICU (Surgical Neurological Intensive Care Unit). I must have slept for awhile, because the next thing I knew, Dr. Dashkoff was in my room with all the nurses in the unit (7 or 8 of them) as I was 1 of 3 or 4 patients. Normally there are about twenty patients on any given day, but for some reason there were no more than 5 patients in the unit at any one time. Because of the nurses contract, there was always about 2 nurses for every patient. My last day there, they had patients waiting in recovery for beds to open up in the ICU.
But I digress. When Dr. Dashkoff came to check on me that first evening it was 7:45 p.m., he was explaining what he had done and what to watch for until I was stable. Then out of nowhere he began talking about The Tonight Show when Johnny Carson was the host. He started telling us all in the room about how he would hold an envelope and recite answers to the question inside the envelope. I was the only one in the room that knew he was talking about the Swami routine he did as Carnac the Magnificent. He actually remembered some of the answers and questions and recited them and reminded him of Ed McMahon always repeating the answers and that the envelopes were kept in a hermetically sealed mayonnaise jar on Funk and Wagnall’s front porch. While we’re discussing this he is applying pressure to the pressure bandage where he had entered my groin with the angiographic catheter as is common practice following this procedure. While he is doing this he uses other hand to tap on my abdomen. He taps in one place and explains to the nurses that what they are hearing is air. He then taps another spot and says “that’s liquid”. He then feels around a bit and says to me “you must have an awfully big bladder, have you voided?” I told him no and he asked if I was uncomfortable. I told him a little, being too groggy to realize what was coming next. He told the nurse assigned to me to insert a Foley catheter to drain my bladder (with an audience of course). Meanwhile he and I began talking about how crazy Jonathon Winters comedy was, like when he dressed up in nothing but a diaper and a baby bonnet. He and I are laughing and almost crying while all the nurses just stood there trying to figure out what was so funny. Finally, after filling the Foley with a liter and a half of urine and still going strong, he excuses himself and all but my nurse left with him. When they left, they left the curtain closed so nobody could see in or out. Well, I’m kinda sitting up in bed and I look at my nurse directly for the first time and I say to her “I’m sure we’ve never met before, but you look awful familiar”. She just kinda smiled and went back to checking to see if the Foley needed to be emptied again. Then it dawned on me. This nurse was the spitting image of Halle Berry. She had really short cropped hair that kinda glittered in the low light of the room. When I asked her if she had ever been told that, she just kinda smiled and said “Sometimes”. So here I am in bed with Halle Berry and suddenly I hear a slight pop and a wet and warm feeling spreading over my lap and down my legs, pooling under my ass. I’m sitting there thinking well I’m probably the first one to pop a Foley. Either that or the catheter pulled out and I was unable to stem the flow. Turns out that was not the case at all. The popping sound I heard was actually the pressure dressing popping through the tape and my femoral artery was spurting blood all over me and the bed. Poor Halle dropped the Foley and tried to apply pressure to the now uncovered incision sight while trying to reach the curtain to pull it back. She was at least a half foot away from reaching the curtain, so while maintaining pressure (she had somehow managed to put the bandage back in place) sh called for help saying “Help, he’s bleeding out”. Well the rest of the nurses were back in the room within about 3 seconds and one was already on the phone with Dr. Dashkoff, who made it back in about 20 seconds. They finally taped the bandage in place and then used a clamp that fitted under the bed frame and was tightened down to maintain a constant pressure on the bandage. If by chance I had died while bleeding out, I would have missed all the comments (I’ve come up with dozens) about that fat old guy that died in bed with Halle Berry. Please feel to post your best.
Epilogue:
Well I am home and recuperating very nicely. I have days where I have energy like I haven’t had in over twenty years, but the next day I am tired as all get out (what does that mean anyway?). But I am definitely headed in the right direction. I am sure with limited blood flow to the brain, your brain forms an austerity budget of oxygen. I know I can once again mentally multi-task, and I can feel endorphins which have long been missing. With the carotid occlusion of over 90%, I was months if not weeks from a stroke. I am blessed to have Dr. Dashkoff and Dr. Stehlik looking out for me. On that note, I am also thankful to first and foremost my wife, Sue (no, not the other wife) and all of my recognized family, friends and friends of family and family of friends (some are complete strangers) that sent all their prayers and well wishes. It is gratifying to know that you’re cared about and I’ll do my best to reciprocate at the appropriate time.
Update December, 2016
Realizing how fortunate I have been as far as the medical care I have received over the years, I felt a need to pay it forward. After much consideration, I have decided that upon my death, my body will be donated to the State University of New York at Buffalo School of Medicine. Perhaps one student will be able to see how procedures have improved since they were performed on me and trigger ideas to develop even better procedures for patients that are dealing with issues similar to what I had dealt with. This is meant as a tribute to my team of dedicated professionals that allowed me to enjoy my family and friends for a bit longer than I would have otherwise. These include the doctors of course, as well as the great nurses that showed dedication and compassion that all too frequently gets overlooked. I felt a special bond with these professionals as well as immense respect for each and every one of them. In the same vein as James Cagney in his portrayal of George M. Cohen in the movie "Yankee Doodle Dandy", my mother thanks you, my father thanks you, my sister thanks you, my wife and boys and dog thank you, most of my friends and extended family thank you, but most of all, I thank you.
