I am 70 years old. In my adolescence and young adulthood I smoked, both cigarettes and from time to time a pipe. I have eaten far too much meat over the years. There have been periods where I was insufficiently active in physical activity. I enjoy salted foods. I have an intense personality. I have often driven myself hard, get insufficient and irregular sleep. All of this is contributory to where I now find myself.
It all started with my recent physical, where my personal care physician, a physician’s assistant in an internal medical practice, detected some anomalies with my heart which concerned him, and referred me to a cardiologist. He upped my medication for blood pressure, changed what I was taking for my regular problems with allergies.
Without revisiting every single step along the way, in the midst of all this I had major trouble with my digestive and excretory systems, and while these have been stabilized, it made for several difficult weeks as far as what I could eat/drink, and my ability to get sleep. I am also due for my quintennial colonoscopy in about 2 weeks.
Meanwhile back to the heart and the cardiologist. I have always had a systolic heart murmer, but it never affected me. For a number of years I have been on medicine for hypertension (high blood pressure) and high cholesterol. I have at times been very active — at one point doing 7-12 yoga classes a week, for example — at others getting very little physical exercise. In the last 15 years my weight has ranged from 170 — 205, and currently is around 194, which is too heavy.
I have in the past few weeks been through multiple tests ordered by the cardiological practice. A stress test cleared me to continue walk for exercise, jogging as I felt comfortable. But I was found to have leakage from all four coronary arteries, and my heart muscle was stiffening — both of these probably the result of a long period of hypertension, perhaps for a number of years before I went on medication. Further testing was ordered for a closure examination of my aorta and aortic valve with a focused echocardiagram, and what was detected there led to a CT scan with contrast of the area.
I have an aneurysm in my aorta, on the abdominal side, that is 5.4 x 5.6 centimeters. At the average of 5.5, that means intervention is necessary, and I am being referred for a referral to prepare for insertion of what is known as a T-bar stent to cover the aneurysm, which extends over part my my aorta, but also to my illiac arteries.
This is probably a result of my having been a smoker, as well as my extended period of hypertension, about which more in a few minutes.
That is the immediate major issue, but unfortunately that is not the entire story.
In the process of the testing a small nodule was detected on the lower lobe of my left lung. As it happens, when I had my 6 month dental checkup yesterday, my very thorough dentist noted some discoloration at one place one the lower left side of my mouth. For right now, both of these will just be monitored, but both will need to be rechecked within 4-6 months to see if there is any change, precisely because I was a smoker, even though I have not used tobacco for about 4 decades.
In addition, over the past few weeks I have suddenly and for no apparent reason fallen asleep in mid afternoon with a certain amount of regularity. It has not mattered how much sleep I had the night before (I am pretty good at keeping track of symptoms). It is quite possible I now have developed sleep apnea, although we will not address that immediately either.
My consultation will be on October 11. The procedure, which is necessary because I am at some risk of the the aneurysm bursting at some point, particularly if my BP gets too high, will occur sometime after that, and will require me to be hospitalized overnight. I was given my choice between a man at Washington Hospital Center, who has done the most of these procedures, another at Fairfax, which is about a 15 minute drive away, or at Virginia Hospital Center which is a couple of blocks away, is where my wife has gotten almost all of her treatment for her cancer (except for her stem cell transplant, which was at Fairfax), and where all of our medical practitioners except for her opthamologist are based. I am opting to be closer to home, to make it easier on my wife.
I will have the colonoscopy on October 11. Hopefully that will be normal, or at most will have some polyps that can be simultaneously addressed, although the way things have gone recently on the medical front, I go into that with no particular level of confidence.
The way things currently look, I will probably not have the stent put in until the 2nd half of October. It is quite possible that as a result I may have to be on a blood thinner for several months. And of course both my diet and my exercise will be somewhat restricted.
In the meantime, I have to get my blood pressure under better control. My base medication was already increased. I have a standby that I have been taking when my upper number was over 180 or the lower number over 110. As of now those numbers have been lowered. If the upper number is over 150 or the lower number is over 90 I am to take it. This is intended to lessen the risk with the aneurysm. I should note that since this extended medical situation began, I have been regularly monitoring my blood pressure regularly. In the past two weeks I have seen both numbers start to rise, and there has been real concern about the lower (diastolic) number.
I am without the standby medication, I am already up to ten pills of one sort or another daily.
As it happens, I was not able to obtain a teaching job for the start of this year, and so far have not found other employment. I have a tutoring service prepared to hire me on a contract basis that could provide some income as soon as I submit the paperwork. I might be able to go ahead with that, but as of right now wonder how I can be applying for a new job, teaching or otherwise, when I know up front I am going to have to miss some work at the beginning of my employment, and when there is no guarantee of how my medical procedures will go. That is something else we have to consider. It is less the question of the medical bills: we have excellent insurance. But we do have other bills and our margin of error really requires me to bringing in an income. We will have to consider that and decide how to proceed.
It would be wonderful if I could earn an adequate amount of money, even on a contract basis, by working from home or a nearby cafe online, perhaps as a writer or an editor. I suppose that could also include tutoring online. So far I have not found such opportunities, but perhaps I will get lucky.
As I reflect back on my life, I have always been able to be physically active.
For much of my life the worst I encountered after childhood was the occasional serious allergic reaction — to a bee sting, to food or drink. I had my share of bumps and bruises, including one serious concussion playing soccer in my late 20s. My then girlfriend, now wife, was there when that happened, which was a bit scarey to her. I have had several episodes in the past that led to testing on my heart, and each time no underlying problem was found. These had come from stress tests in the past, when there were some anomalies, but I was never required to restrict my activities. In 1984 and again in 2011 I had surgeries, first for a large cyst on my neck that only after the fact the surgeon told me he had never seen something that big that was not malignant, the other to repair a double hernia. I had a scare in March of 2014 when they thought I might be having a stroke, but after 27 hours in the hospital and several referrals to specialists afterward, as best as we could determine was that I happened to have an ocular migraine at the same time my blood pressure was too high.
I am not carrying any fear of what I am confronting medically, at least not in the near future, but recognize that I have to be careful until the aneurysm is controlled by the stent: there is always some risk of it bursting, in which case death would be near instantaneous. So long as I keep my blood pressure under control that should NOT be a great risk. There is nothing I am confronting that will, except for very short periods of time, interfere with my primary responsibility of caring for my wife in her continued treatment for a cancer that remains incurable, but which can be managed.
But there is no doubt how I go forward with my life is changed yet again, just as it was when my wife was diagnosed with her cancer more than three years ago.
I consider myself lucky.
I try to be open, and to be willing to accept the well wishes and emotional and spiritual support others are willing to offer.
That is why I wrote this.
Peace.