Cracking Me Open - by John Knapp

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By John Knapp

My birthday is July 24. I have gloried in the fact that every year since I was aware of such things it had never rained on my birthday. The exception was last year, my 60th birthday. For the first time ever, it was definitely raining. Not drizzle, not misty fog, but real rain. It gave me pause. I do believe in signs and omens. Looking back I had no idea how ill the omen was for the year that lay ahead.

Though I have very good eating and exercise habits, I have had a hard time as I have gotten older sustaining vigorous exercise. I have written before in this blog about going deep into the Raw Vegan wilderness. It was all in an effort to cure a bewildering set of issues, including fatigue that was occasionally severe. I was told it was depression. I was told “adrenal fatigue.” I tried acupuncture, raw vegan resorts and all told me that my heart rate and blood pressure were quite good, as did my regular doctor.

I gave up “the search” sometime in the last year. I was getting too old to chase the dream of finding the cure for these vague ailments. “Just chalk it up to getting older,” I told myself. Yet, I would continue to have incidences of running completely out of gas on quite easy walks. Those bewildering incidences drove me to the offices of Dr. Kathryn Retzler.

John Knapp

John Knapp

I met with Dr. Retzler, who interned for a year with famed heart specialist, Dr. Mark C. Houston. She had an impressive treatment protocol that was unlike any I had been through before. I was given an extensive questionnaire about my health, and my family’s health history. I had blood work done that looked at types of cholesterol I had not heard of, and even included a look at my genes. Given my family’s health problems and my genetic background, I found I was at high risk for many things, particularly Alzheimer’s and heart disease.

Dr. Retzler ordered a heart CT scan so that she could get something called a “calcium score”. I had never heard of it. When and if cholesterol plaque builds up in your coronary arteries, calcium will eventually attach to it. A CT scan cannot see soft tissue or cholesterol plaque, but it can see calcium. Based on the amount of calcium that the scan finds, a score is given for the major arteries on the surface of the heart, the ones that supply the heart itself with oxygen. If you are in your forties, they would like to see a score of “0”. Scores up to 100 put you in varying categories of risk. A score of 400 puts you in the very high risk category.

On April 13th Dr. Retzler called me at work to talk to me about my scan. I had a calcium score of 3,136. I had advanced coronary artery disease, she said. She referred me to Dr. Michael Shapiro at the heart clinic at OHSU Hospital in Portland, Oregon, and asked that I be given the highest priority, and I was scheduled to see him the next week.

The news was disquieting to say the least. My fraternal twin brother, Mark, had died of advanced coronary artery disease at the age of 46. I had assumed I had dodged that bullet. I searched the internet looking up calcium scores, hitting all the blog sites with frantic people wanting to know what their score meant for them. But I found no one with a score anywhere near as high as mine. The highest that I’d seen was one score of 1,000. It was only later that Dr. Retzler told me that Dr. Shapiro, a cardiologist for over 10 years, mentioned that he had never met anyone with a score as high as mine. His visit summary said it all. “Patient has a profoundly high coronary calcium score.”

Dr. Shapiro arranged for me to have a stress EKG test, which showed my heart was having to work too hard to pump blood. Then it was on to a coronary angiogram, which was over quickly. There wasn’t enough room in my arteries to cleanly navigate the little catheter that takes a picture of insides of the arteries.

I was scheduled for a triple bypass 5 days later, on Monday May 11th, four weeks to the day that I received the results of my heart CT Scan. I had three working days to put my affairs in order, file my disability paperwork and arrange for others to take over my work duties during an unknown amount of time off.

During the bypass procedure, your entire sternum is opened, except at the very bottom where they tie it together to ensure your chest doesn’t butterfly. They call it “cracking” your chest. A heart/lung machine pumps your blood and breathes for you while your heart is completely stopped. More than likely they will be lifting your heart completely out of your chest cavity. (In my case, they harvested veins from my right leg and used them to bypass the blockages on three arteries). When they are finished, they use stainless steel wires to stitch your sternum back together, and small plates to reinforce and stabilize the incision. The entire procedure started at about 8am and was over by 1pm.

The procedure is now so commonplace that the surgery is coded as “routine”. It hardly feels routine when it happens to you.

Recovery from the surgery is different for everyone who goes through it. 99% of the people who have the surgery survive, but recovery can be very slow, sometimes up to a year, and some aren’t made better from having the surgery. Most of the post-surgical complaints are problems sleeping, neck and back problems, depression, trouble thinking clearly and fatigue. More serious complications are stroke, grafts closing after the surgery, and problems with the stainless steel wires and plates used to hold the chest together.

If you’re reading this in early August (and I’m not dead), I’m barely three months in and have had most of the minor problems to varying degrees, particularly fatigue and sleep issues. Returning to work has been very hard and I wish now that I had waited longer. It has been difficult keeping up with my previous pace. People have been kind and helpful, but don’t always understand that you can’t instantly bounce back from a surgery like that. Some expected that I would feel better and be more youthful almost immediately. The fact is, I feel worse than when I went in, but the risk of having a heart attack or stroke has been reduced significantly, and that’s something to be thankful for.

By August, my birthday will have come around again, and I will have turned 61. I received the gift of my beating heart. It’s stronger now, and I can feel it lustily pumping the blood in and out. I probably felt it before, but I never gave it a second listen. It will count out the beat for my happy birthday song, and maybe the rain will join in. Whether or not the rain comes again, I will count it a happy birthday, indeed.

John Knapp lives a quiet life in Vancouver, Washington with his rescue cat, Abby. “I’m not sure who taught her how to rescue people,” John says, “but she did an excellent job with me.”

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