The Appointment

Well, I finally had a chance to visit with my Cardiologist. I posted back in November about how I haven't feeling very good these last couple months and how I figured it was time to catch up on that missed appointment from August. I had booked an appointment to see Dr Boyne for Dec 20 and that day has finally happened.

Unfortunately the news wasn't all pleasant. It turns out that in the last six months, new research has been published regarding drug eluding stents. I happen to have a drug eluding stent. So you can imagine I was on the edge of my seat listening intently to what the Dr had to say. The short of it is that although initially it was believed that drug eluding stents were thought to be better than bare metal stents, there is a small percentage of the candidates that receive them that have complications. It is a small percentage, less than 1% (actually 0.6%), that can suffer these bad complications.

So let me back up a bit and give you a bit of background first. If you have a blockage in one (or more) artery of your heart and it is not completely blocked, then you might be a candidate for Angioplasty like I was. Angioplasty is basically a procedure that uses a balloon to inflate the artery at the blockage. A catheter is inserted, and the balloon is directed to the site of the blockage and is inflated, re-opening this artery. However, in a fair percentage of heart attack patients, this previously blocked area can collapse again after surgery. The artery wall can be weakened by the procedure and oops.... there it goes. Of course the artery not only risks collapsing, but it also has a good chance of re-blocking, whether from scar tissue, as the artery heals itself, or from other means. The re-blocking of the artery is called restenosis.

To help combat restenosis, doctors found a way to wrap the balloon in a metal stent (looks like small chicken wire). This tube of metal wrapped around the balloon, is inserted into the artery and when the balloon is inflated, the stent expands to prop up the artery wall. This stent is sometimes referred to as scaffolding. The balloon deflates and the stent is left behind. This stent was found to reduce the occurrence of restenosis quit considerably, but many patients still had a 1 in 4 chance of having the artery reblock itslelf. The down side to this bare metal stent, was that the body didn't adapt very well to it and often times blood platelets would collect around it forming a clot (I think its called Thrombosis). If you get a clot in your heart you have a 1 in 3 chance of dying as a result. Very fatal. So, to help prevent clotting, a drug is used to make your blood slippery. Quite often Plavix is prescribed as it was in my case. Very often Plavix and Aspirin are prescribed together. Works like a hot damn. So, patients with a blockage these days can expect to get Angioplasty and a bare metal stent inserted to improve their survival rates. The medication that is prescribed usually only has to be taken for about 3 months. Then the risk of clotting goes away but there is still a decent chance that the artery will reblock.

To improve your chances even more, doctors developed a stent that is drug eluding. It is basically the same bare metal stent, but it is coated in drugs that help prevent scaring around the stent and the formerly blocked area of your artery. The scaring is probably what causes restenosis to happen the most often. The way the drugs work, is to slow down the healing process so that scar tissue doesn't form, but instead you get smooth skin cells. You still need the Plavix after surgery to keep clots from forming, but because the healing process is slowed down so dramatically to prevent scarring, you have to take the Plavix for a much longer period of time after the surgery is complete. Instead of being healed in 3 months, you now have a period of up to a year before the body has adapted to the stent without scarring. Now your chances of restenosis go from 1 in 4 to about 1 in 100. Yaaaay for drug eluding stents.

Initial studies showed that if you had a bare metal stent or the drug eluding stent, then your chances for scarring or getting a new blockage were about the same. If you didn't get it within the first three months then you weren't likely to get it at all. Now the studies are seeing that there are actually 2 periods post surgery where you can be at risk for restenosis - right after surgery, and about 9 months to a year after. So just when you think you clear the first hurdle, the 9 month mark catches up to you, and then suddenly you are at risk again.

Well... I am at the 9 month mark. Oddly enough I am suffering some chest discomfort too. Hopefully it is just coincidence. I really hope it is just side effects from the medication I am taking. When my doctor saw me yesterday and heard about my recent discomfort, he immediately booked me in for a Thallium Stress Test. Basically, this is a test that pumps radioactive die into your blood so that they can take pictures of your blood flow to see if you have any new blockages. It's possible that I may have suffered from restenosis or that I have a new blockage in another place in the artery or even in a different artery altogether. The worst case scenario is that I have a blood clot. Yikes! That thought makes my bladder want to release. A clot is a hard thing to fix. You don't want to mess with a clot... if it moves you're dead. I think the only way they can treat a clot is with medication to try to reduce and shrink it. I think the risk of it moving during surgery is just too great so they don't try to operate on clots. If it is a blockage, well then that is serious enough all on its own. You still have the risk of another heart attack (potentially fatal too), but they might be able to stent the blocked artery (possibly with just a bare metal stent this time) or they can always try bypass surgery. A blockage has options, and a clot doesn't (usually with only one outcome).

None of those options is very appealing to me. Quite frankly they all scare the shit out of me. The last time I was in this situation I was faced with 2 evils for my condition. They didn't know what I had when I first went to the hospital and they were trying to figure it out. It was either a heart attack or paricarditis. I was hoping for paricarditis which is a serious condition but much easier to treat. Pericarditis doesn't usually require any surgery and can be helped with medication. All signs pointed to paricarditis but when the final ballots were cast, it turned out I had the heart attack and 90% blockage in one of my arteries. Thus I am sitting here with a drug eluding stent in my heart pondering my luck and the chances that I am just being paranoid. I wasn't that lucky the first time (lucky enough to still be alive though), so although I am hoping for the best, I am already fearing that I might have another blockage. Shit.

I don't want to face the prospects of another blockage (or worse - a clot). My life is just getting back on track. These options just suck. I hope it's just the medication. On the plus side, the ECG that the doctor did on me yesterday didn't show any irregularities (a good sign), and my blood pressure was even better than my last visit with him. He said my heart sounded good too - no irregularities in my beat. I hope there is more good news like this when I have my Thallium Test done... I want to live - I choose life!