Thursday, 21 August 2014

Straight from the Heart (V) : (Déjà vu) The Story of My Tryst With My Heart Ailment - Part V of VII

Straight from the Heart :
The Story of My Tryst With My Heart Ailment

Straight from the Heart (1) : The Story of My Tryst With My Heart Ailment
Straight from the Heart (2) : “Rational” Thinking, Irrational Acts
Straight from the Heart (3) : When the Unthinkable Happened : Angioplasty, 1999
Straight from the Heart (4) : Back to Life as Usual, with a Minor Throwback
Straight from the Heart (5) : Déjà vu
Straight from the Heart (6) : Opening Up to Open-Heart Surgery (CABG)
Straight from the Heart (7) : Post-Operational Recovery
Straight from the Heart (8) : One Year After

Part-V of VIII

Déjà vu


Since College, my last 47 years (1967 to 2014) of good health were punctuated by about 3 months of ill-health (December 1999 to February 2000) that included heart-problem and Angioplasty. A minor heart-related health-event occurred in January 2007, but it lasted barely 3 days. Otherwise, it had been life as usual with fairly active (though not intensive) physical life that included daily walks, swimming about twice a week, and occasional gym for short periods. Smoking I had left in December 1999, and my food-habits have been fairly healthy, involving NO junk food or soft-drinks.

For many months leading up to June 2014, I had been going daily for an evening walk in a BMC ground, with a good walking track, not too far from my residence in Borivali-East in Mumbai. I normally took five rounds of the ground. However, when absorbed deep in some topic or immersed in music with ear-plugs on, the rounds would climb up to 10 or even 12. At times I felt a little exhausted after 2 or 3 rounds, but discovered that if I persisted without halt, the comfort-level would return and I could easily take more rounds.

On 21 June 2014, as I was walking towards the BMC ground, I suddenly felt breathless. I halted; stood resting for some time; then resumed. After another 5 minutes of walk, I felt the same, halted, stood resting for a while, then resumed. Finally, I reached the ground. However, I had to stop for breath after each half-round. Disappointed, I terminated the walk session after two rounds and returned home, halting periodically to gain breath. I wondered what had gone wrong. I had been taking medicines regularly, still...

Next day, on 22 June 2014 evening, I again went for a walk, and I again encountered similar problem.

Thinking it was a transitory phenomenon, I persisted the next day on 23 June 2014. But, it became worse. I had to return home without even reaching the ground.


I visited Sanchaiti Hospital, Kandivali-E on 24 June 2014 along with my wife and consulted my doctor, Dr Sejao Vidyasindhu, MD. The doctor was of the opinion that what I was experiencing was “Angina-equivalent”. He advised we must lose no time in getting ECG, 2D-Echo and Angiography (CAG) done; and till that is done I must forget about walks, do no exertions and take complete rest.

His cryptic declaration of the state of my heart and the immediate-next-steps-advice left me no room to fool myself that “things might not be all that bad” and provided me no scope to “to further kick the angiography-tin down the road” buying more time, hoping, God willing, things might turn out okay even otherwise.

Dr Sejao Vidyasindhu had been treating my wife, and had ably handled my father’s case too in the past, and I knew him as a no nonsense thorough professional who always offered the right advice.

Dr Sejao advised I get Coronary AngioGraphy (CAG) done at the earliest at some really well-equipped centre through a cardiologist of proven competence, honesty and integrity. He suggested, as top option, Dr Sunil Wani at Kokilaben Dhirubhai Ambani Hospital (KDAH), Mumbai, and gave me his mobile number.

Initial Diagnostics : ECG & 2D-Echo

Knowing Dr Sejao as a thoroughly competent professional of high integrity, I did as he advised on Tuesday, 24 June 2014.

Not being able to get through to Dr Wani on the phone (most doctors remain busy with patients and can’t pick up phones like you and me), I sent an SMS. The response was prompt, and an appointment with the cardiologist Dr Sunil Wani at Kokilaben Dhirubhai Ambani Hospital (KDAH) & Medical Research Centre, Four Bungalows, Andheri-West, Mumbai was fixed up for 4pm on Thursday, 26 June 2014.

I went alone for the appointment, not wanting my wife to confuse the doctor with her inputs, although my wife wanted to accompany me.

I met Dr Wani at his cabin in the Cardiology OPD on the first-floor of KDAH. After discussions with me and check-up, Dr Wani sent me for ECG and 2D-Echo-Doppler, facilities for which were on the same floor. Dr Wani asked me if I had come unaccompanied, and appeared a little surprised when I responded in the affirmative. Similar was the reaction of the technicians who did ECG and 2D-Echo-Doppler, and of staff who wanted the person accompanying me to go make the payments for the tests. An unaccompanied heart-patient appeared to them to be an abnormality. They didn’t realise I wasn’t regarding myself as one till the tests proved otherwise; and after the breathlessness of 21-23 June, I was no longer in a similar state and was feeling normal.

The ECGs had been done before, so there was nothing new in it for me. However, 2D-Echo-Doppler was new.

Two-Dimensional Echocardiogram (2D-Echo)
2D-Echo uses ultrasound to picture out the heart. It displays a cross sectional “slice” of the beating heart, including the chambers, valves and the major blood vessels that exit from the left and right part of the heart. Doppler is a special part of the 2D-Echo that assesses blood flow (direction and velocity) as it makes its way through and out of the heart. One hears “swishing” or “whooshing” sounds during this part of the procedure.

Apart from information on the size of the chambers, dimensions, volume and the thickness of the walls, and details on valves, 2D-Echo determines if the pumping power of the heart is normal or otherwise, and if reduced, to what degree.

You are asked to take off your shirt and vest to bare your chest, and to lie on your left side as the technician moves the transducer head (microphone-like gadget that takes a “picture” or video image of the heart) across different parts of your chest to get different views of the heart.  A gel is applied to the chest or on the transducer. You may be asked to breathe slowly or to hold your breath.  A connected monitor shows the images, which are preserved. A cardiologist reviews and interprets the recordings. It is a painless non-invasive procedure that takes less than 30 minutes.

Our heart is a pump. At rest, our heart causes about 5 litres of blood to circulate to our body per minute, by some 70 rhythmic contractions. Our heart pumps blood twice. First, it pushes the blood returning from the body through vena cava into our lungs for oxygen. Returning from the lungs, oxygenated blood flows into the heart, which routes it into the aorta and onwards to our body.

Often, a term pumping rate as a percentage is used for the heart, although it is actually the Ejection Fraction(EF). EF determines how well your heart pumps with each beat, and is usually expressed as a percentage. A normal Left Ventricular EF (LVEF) ranges from 50% to 70%. LVEF of 65 means 65% of the total amount of blood in the left ventricle is pumped out with each heart-beat. LVEF may be lower when the heart muscle has become damaged due to a heart attack, heart muscle disease (cardiomyopathy), or other causes. An EF of less than 35% increases the risk of life-threatening irregular heartbeats that can cause sudden cardiac arrest (loss of heart function) and sudden cardiac death.

After my 2D-Echo was done by the technician by about 5.30 pm  on 26 June 2014, I showed my curiosity to know the result. She told me the doctor would come, study the images and let me know. Upon my persistence, she only asked if I had experienced an even in the past (heart attack) that might have damaged the heart’s pumping capacity.

She phoned Dr Wani, who instructed her to ask me to wait there only at the 2D-Echo location. Dr Wani came by about 6pm, had a close look at the images, and asked me to come over to his cabin.

In his cabin, Dr Wani asked me the same question that the technician had asked. He then informed me that there was a definite deterioration in my pump rate. He put the figure of LVEF at 40%. Other than that, my 2D-Echo indicated near normal status.

That figure of 40% disheartened me. So, there was indeed something wrong with me!

Déjà vu : Angiography Again

Looking to the ECG and the 2D-Echo results, Dr Wani advised the necessity of Angiography (CAG).

Knowing I couldn’t any more claim otherwise on the state of my heart, after the 2D-Echo results, I realised I had no further leverage and that I could not kick the angiography-tin further down the road and buy time.

I enquired from Dr Wani all the relevant particulars about the proposed CAG. He gave me a printed sheet of options (type of stent and ward) and corresponding costs.

He told me that if CAG is done in the afternoon, I would have to stay overnight and could go home only the next day. However, if CAG is done early morning, I could go home by the evening. I promptly chose the early morning option, never wanting to stay at any hospital more than the minimum necessary. Morning slot was not immediately available—the earliest slot was on Thursday, 3 July 2014, which I unhesitatingly grabbed.

Reluctance to Inform Others
I was not in favour of informing others—even my two daughters, Manasi and Manini, at Hyderabad and Germany respectively—for I considered Angiography to be too minor a thing, and a possible Angioplasty after that (if at all warranted) to be not a big deal.

However, my wife confided in the daughters. Upon learning of the same, I dissuaded them over phone from taking the unnecessary trouble to come over. Yet, both landed at Mumbai on Wednesday, 2 July 2014.

To KDAH on Thursday, 3 July 2014
Dr Wani had advised me I should take just a cup of tea in the morning with two biscuits, and should be at the hospital (KDAH) by 7.30 am to 8.00 am in the morning of Thursday, 3 July 2014.

We all got up early by 5.30 am, got ready, and proceeded for KDAH by 6.30 am. First was the payment and registration on the ground floor, which we completed by 8.15 am.

Thereafter, we proceeded to the third-floor where the “Cath. Lab.” and the facility for CAG (Angiography) were located. We waited for a while. I was called in by 8.30 am, while my wife and the two daughters waited outside in the “waiting area”—a clean, well-furnished place.

I was shown my bed. Then, a hospital staff took me to a room. He asked me to take off all my clothes to facilitate shaving of all my body-hair, except, of course, the head. I was given hospital-clothes to wear. So dressed, and looking like a patient, I very self-consciously walked back to my bed.

To Cath. Lab.
At about 9.15am I was wheeled into the Cath. Lab. for Angiography. The staff got busy in necessary preparations and adjustments of instruments.

I didn’t feel abnormal or anxious or nervous. I complied with whatever were the demands of the staff—which were not much. I had to only lie on my back—comfortably. I didn’t have to stretch my arms above sandwiching my head and ears, like I had to do in my previous CAG in December 1999—which was uncomfortable and painful.

Dr Wani arrived around 9.45am after preliminary preparations were over. He wished me and reassured me everything would be fine.

A small hole was made in the artery of my right wrist. It was slightly painful. No anaesthesia is given for Angiography. Dr Wani then pushed a catheter up my artery through the hole. I have already covered the technical details of Angiography in my previous blog (Part-III), hence I won’t repeat them here. I could see a wire dangling and struggling up on the screen, but it couldn’t make much headway. After repeated tries, Dr Wani informed there appeared to be a cramp up inhibiting the further movement of the catheter. He, therefore, withdrew the catheter from the wrist.

We would have to do it from the groin, said Dr Wani; and the staff got busy blocking the wrist hole and making preparation for CAG through the groin. Finally, a small hole was made in the groin into the femoral artery up which the catheter was inserted. It was painful.

CAG through the groin was successful. It took a total (including the first CAG attempt through the wrist) of about 90 minutes, including preparations.

I have a funda or a technique or what may be called a formula to beat the pain or to divert attention from the violation of my body: I repeat to myself internally a long string of names of Hindu gods and goddesses, and the process of doing so helps me forget the immediate material environment even as I try to rise above the mundane. This technique helped me comfortably sail through the Angiography.

At the end of it all, while still lying in the Cath. Lab., Dr Wani came up to me and said briefly in subdued voice: “There is blockage. I would appraise you of the details later.”

Blockage? Angioplasty?
That put me down, but I tried to console myself with: ‘Ok, some blockage. Won’t go away with medicines? At the most Angioplasty then! And, maybe, not one, but two stents. Still, perhaps a week or less in hospital. That’s fine, I can handle that.’

I was wheeled out and taken to a ward just outside the Cath. Lab. I was told to remain in reclining position, and not to move my right leg or bring any pressure on it. Groin-hole and the surrounding area on my right thigh were firmly bandaged, so also the hole in my right wrist.

After a while I was given some refreshment. Meanwhile, Dr Wani had met my wife and daughters waiting outside and had appraised them of the status with the illustrated map of the coronary arteries of my heart.

Not Angioplasty; Open-Heart Surgery
Dr Wani later came to my bed, smiled, showed me the Angiogram, and indicated to me on the same I had 5 blockages between 85% to 100%. He then said Angioplasty was not possible, the only remedy being Open-Heart Surgery, and sooner the better.

Open-Heart Surgery was something I had never even once considered as a possibility (earlier, I had taken details and rates for only Angiography and Angioplasty from Dr Wani, never having queried him on open-heart surgery); and now it stared me brutally in the face. How what you never expect happens?

Onward to Open-Heart Surgery in the next blog...

* * * * *
Rajnikant Puranik
August 21, 2014
91-22-2854 2170, 91-98205 35232

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