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On a cool autumn afternoon in November, my wife Ursula and I took a casual stroll that involved walking up a small hill. The slope wasn't great, but as we proceeded I began feeling a tightness in my chest. Gradually it became a sore feeling, almost like the sore chest you get from bronchitis. "This is not right," I thought, but I didn't say anything about it to anyone.
This is possibly the most dangerous symptom of all for heart disease: denial. I knew what it probably was. My father had struggled for decades with heart disease. My youngest brother died with a sudden heart attack when he was just 41. My maternal grandfather had died from a heart attack when he was only 55--a year older than I was in 2001. These were just the family members who came to mind that November afternoon. Later, I was to discover that my genetic odds were stacked against me far worse than I'd dreamed, but it probably wouldn't have made much difference. I didn't want to believe it could happen to me.
There was too much at stake. Ursula and I were dedicated to the green turtles of Honokowai, the honu, and we weren't ready to quit yet. There was still too much to do, so much more to learn. If I really had angina, I believed that I would never dive with the turtles again. I didn't want to face that possibility. So instead, I began a series of little "tests" that would prove that I really didn't have angina, that what I'd felt was--something else. What that could be wasn't something I wanted to think about, because deep down I knew there was no other cause.
We were renovating our house, and this gave me ample opportunity for physical tests. For example, we had an extensive collection of vinyl LPs that had to be carried up three flights of stair. I can do that, I thought, and I did--carefully watching for any chest pain. Sure, I was a bit short of breath, but who wouldn't be? My job requires that I sit in front of a computer all day, and at home, well, I sit in front of a computer all night. Not too active, so not in great shape. We ate pretty well too, so I was carrying a few extra pounds. Naturally carrying heavy loads upstairs would make me huff and puff.
Sometimes carrying loads like groceries caused a soreness in my left arm. "Muscle pain," I rationalized. It went away when I put the load down, so no worries there, right?
I kept this up for almost two months. I'd take stairs quickly--and our house as a lot of stairs--looking for chest pain. Nothing. Well, nothing I couldn't explain another way. Then, a few days after Christmas, I went out to mail a letter.
December 30, 2001, was bitterly cold in Mississauga. I dressed up warmly and started for the mailbox. It's about 100 metres from the front door, but first I had to get out of our driveway. Our driveway is about 8 metres long and has a 10 degree slope. Before I reached the top, there was a dull pain in my chest. I kept going until I reached the mailbox, but the pain didn't go away. The walk back was among the most dreadful times of my life. The denial was over. This was angina, big time. The only thing now was how I'd deal with it.
My plan was to go see my family doctor after New Year's. Until then, I'd pretend nothing was wrong, so as not to upset the holiday. I'd managed to keep it to myself this long, a few more days should be easy. Wrong.
The difference was that I'd admitted to myself that something was wrong. When I got back to the house, I went upstairs, lay down on the bed, and let the realization sink in. The despair I felt was too much. I truly thought I'd be an invalid for the rest of my life. I'd seen what heart disease had done to my father, and now I expected that to happen to me. Certainly it meant I'd never see the turtles again. I began to weep quietly.
Ursula was in another room, working away on her computer, but somehow she sensed something was happening. She came into the room and immediately knew I was upset. She sat down beside me and asked me to tell her what was wrong. I didn't want to tell her, because I knew she'd feel the same despair I was feeling, but I had to say it. It took several deep breaths before I could get it out: "I have angina."
Of course she wanted to know if I was certain. I told her I was, and we talked. Like me, she feared that it would mean the life of an invalid. I hadn't been completely in denial over the previous two months, so I had done some research on angina on the net. I told her about the optimistic possibilities I'd read about, that there were well-known effective treatments for angina, and that often it could be defeated, at least in the sense of being made pain-free. The problem was convincing her--and myself--that my outcome would be one of the favourable ones.
I convinced Ursula to stick with my plan to see the doctor after the holidays. I knew she was reluctant but she was also in shock, not sure how to deal with the news. For now, she'd go along with me. That night there was a family gathering, and I treated myself to the condemned man's last meal: steak, french fries, and wine. I knew this was the kind of food that got me where I was, but I figured one last kick at the can couldn't make things any worse. I was, after all, on borrowed time.
The next morning, I tried a little physical activity and the pain returned immediately. Ursula spotted this right away. She wanted me to go to the hospital. I responded that I was not having a heart attack, and that if I didn't exert myself I would be fine until I got my doctor's advice. What I thought he'd tell me aside from, "Go to the hospital!" I can't imagine.
We argued a bit, and finally I agreed on a compromise. We'd try to walk to the mailbox and decide what to do based on that. We got dressed up and went outside. I couldn't walk out of the driveway. It was time to head to Emergency.
When you walk into Emergency at Credit Valley Hospital and tell them you're having chest pains, they don't mess around. Despite the fact it was crowded, within two minutes--I know this because they give you a little yellow paper with a timestamp--I was seated with a triage nurse, describing my symptoms. After making sure that I was not having any pain at that moment, she took my blood pressure and got a blood sample. A scant few minutes later, I was on a gurney, hooked up to an ECG and blood pressure monitor, with an aspirin to swallow and a nitroglycerine patch on my shoulder. These people were taking this a lot more seriously than I had.
An intern came by and asked my family history. I told him about my father, my brother, and my grandfather, and I could see in his eyes that this was Not Good. He told us that we'd have to wait for a specialist to see me. Ursula was worried at this point, not because she thought I was in immediate danger, but because she thought that they might send me back home. Now that I was here, she didn't want me out of there until I'd been treated. As it turned out, there was no chance of me leaving at all.
I was admitted to the Cardiac Unit and assigned a cardiologist, Dr. Strauss. He came to see me and while he couldn't give a definitive diagnosis, he said that it was most likely that I had unstable angina. He prescribed blood thinners, a beta blocker, and something to control my cholesterol. He gave me a nitroglycerine spray and forbid me to walk around, except to go the bathroom. Then he set up a treadmill stress test for the next morning.
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I was admitted to the Cardiac Unit. 40K JPEG |
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The treadmill was a complete disaster for me. They hook you up to a monitor and start you at a casual stroll on a level surface. I actually could do this without trouble, but after three minutes the speed increases and the slope goes up to ten degrees. I lasted 21 seconds, and before they could get the treadmill stopped I was feeling some of the most severe pain I'd ever had. I was so dizzy I had to be helped to a seated position, where they administered nitro, relieving the pain. Dr. Strauss expressed no doubt at all now: unstable angina. The only questions were which arteries were blocked, and to what extent. He scheduled me for an angiogram.
An angiogram is not the most pleasant procedure in the world, but it's not too bad. They insert a catheter (in my case through the groin) and inject a dye that shows up on the display. As soon as Strauss saw the picture, he spotted my problem: two arteries were blocked, one at about 80% and another at 90%. No wonder it hurt.
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Two arteries were blocked, one at about 80% and another at 90%. No wonder it hurt. |
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When I was admitted, the intern needed my weight in order to determine the dosage for a particular medicine. When they got me on the scale, I was about 200 pounds, or 55 pounds over my so-called ideal weight. (I think those ideal weights are calculated for super-models and Callista Flockhart, but whatever.) I hadn't exercised at all, and the last real physical activity I'd engaged in was my last SCUBA dive of 2001, some four months prior. My cholesterol was through the roof. All this had to change.
We agreed that Ursula would take charge of my rehabilitation. She'd been doing a lot of research and had a definite plan in mind. The goal was easily determined. While I was in the hospital, we'd asked Dr. Strauss about the chances of diving with the turtles again. He'd said that there was a good chance that I'd be able to dive again. The normal procedure for an angioplasty was to conduct a treadmill stress test in about 5-6 weeks, and then a thallium stress in five months. If the thallium test didn't show any blockages, I'd be able to dive. So our goal was simple: pass that thallium test.
Frankly, we couldn't believe our luck. Five months would put us at the end of May, just in time for our annual summer trip to Maui. In recent years, we'd gone from summer to summer, hoping that we could still manage the diving. Both of us were getting more and more out of shape and of course, we weren't getting any younger. Now we had no choice: get in shape for this year's diving, or never dive with the turtles again.
There were two simple components of our plan. The first was to change our eating habits. We didn't want to deprive ourselves (Ursula resolved that we would both eat the same diet) but we knew we could no longer eat certain foods. Butter was out, pizza was history, deep-fried foods were off the menu. We either eliminated or drastically cut back anything with saturated fat or cholesterol. We reduced fat in general, while whole grains and vegetables became staples. We started to eat a lot of fish--three times or more a week. We didn't count calories as such, but we did avoid empty calories as much as possible.
In quantity, we ate as much as we ever did. Every once in awhile, we allowed ourselves a treat. I like steak, so we ate a small filet once a week. (Hey, filet is the leanest cut!) Ursula knew I loved chocolate, so every day in my lunch she included a Hershey's Kiss. It was things like this that allowed us to stick with the plan and not resent the changes.
This sort of diet automatically reduces calories and helps you lose weight, but the real weight reduction happened only because of the second component of the plan: exercise. We joined the gym at the Rivergrove Community Centre, operated by the City of Mississauga. I started out walking slowly on the treadmill, then graduated to a brisker walk and a bit of a slope. Soon I was expanding my routine to include other cardio-vascular machines: first the elliptical cross-trainer, then the StairMaster, the Life Cycle, and the torture device they introduced later, the FreeRunner.
By steadily increasing the intensity, we started to drop the poundage. We knew what the treadmill test would be like, so we simulated it on the gym's treadmill and I tried to see how far I could get with it. I bought a Polar heart rate monitor to make sure I was keeping in the cardio-vascular zone, and for curiosity, to see how many calories I was burning daily. By the time the first stress test rolled around, I'd dropped 18 pounds and knew I could reach Stage 5--running at 5 MPH on an 18 degree slope.
We knew what the treadmill test would be like, so we simulated it on the gym's treadmill. 42K JPEG |
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After the test, we knew I'd done well. The technicians aren't allowed to say anything, that's for the doctor, but we could see that they were impressed. They were encouraging and seemed genuinely happy for us when they passed along the answer to the only question we'd had for Dr. Strauss: yes, I was allowed to start swimming in the pool! A breakthrough, which we celebrated with a no-restrictions restaurant meal. Well, one restriction: Ursula adamantly forbid pizza.
I also had a cholesterol test at this time, and the results were excellent. In fact, my HDL level (the "good" cholesterol) was too low. The doctor recommended drinking a modest amount of alcohol regularly. It was a terrible hardship, I know, but I thought I could manage it.
We felt encouraged. We seemed to be on the right track, although we both knew that diet and exercise could easily be undone by something we couldn't control: my bad genes. No matter, we couldn't change that so we had to work on the things we could control. Back to gym and the new eating habits. The weight continued to come off. I started feeling much better, and certainly more energetic. By the time the thallium stress test was due, I was more than ready.
A thallium stress test is simply a treadmill stress test with an added twist: they inject thallium, a radioactive dye, into your bloodstream and take a set of images of you at rest before the test, then another set afterwards. The two sets are compared and if there are blockages forming, they should show up.
I knew I could ace the treadmill part of the test. I was already up to running for three minutes twice a day at 6 MPH on a 15 degree slope (the highest our gym machine would go). To get through Stage 5, I only needed to run for three minutes at 5 MPH, although on an 18 degree slope. Ursula was eager for the test because she knew I could reach Stage 6, something usually reserved for athletes. At test time, therefore, we were a bit disappointed. About halfway through Stage 5, the ECG leads started to come loose, so while it was clear I could have gone on to Stage 6, they stopped the test. They had everything they needed anyway.
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To get through Stage 5, I only needed to run for three minutes at 5 MPH, although on an 18 degree slope. 37K JPEG |
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Again we celebrated with a no-holds-barred meal, but we still were not sure whether I'd get the green light to dive. For that, there was an agonizing ten day wait while Dr. Strauss analyzed the images. Finally, the big day arrived. I was nervous, to say the least. We knew we'd done everything we could have done. I was 40 pounds lighter and in better physical condition than I'd been in for 25 years. What we couldn't be sure about was whether the blockage had come back anyway. I'd felt no sign of it in the gym, but still...
Dr. Strauss relieved us of our worries instantly. He started to say that everything was normal, then caught the look on Ursula's face. "What are you looking so worried about? Your husband has the test profile of an athlete!" he thundered. At that moment I was 40 pounds and a whole world lighter. The words "normal" and "completely clear" were all I could absorb. Ursula asked the all-important question, "Can he dive?" but I knew the answer. Of course he can dive, said Strauss, he can do whatever he wants--unrestricted diving. There's no reason to expect I'd have any trouble for at least ten years.
After we left the office, I thanked Ursula for what she'd done. I could not have done it without her. She was my personal trainer and dietician, and she'd faithfully done what I had to do and eaten the same things I'd had to eat. Together we'd turned ourselves from out-of-condition, overweight, and frankly dangerous divers into two people who are prepared and capable of diving for several more years--all because we are committed to the honu. The honu saved my life.
On July 2, 2002, my odyssey was completed. At 3:20 in the afternoon, Ursula and I descended beneath the waters of Honokowai. Five minutes later, I was gazing tearfully at three honu, only one of whom I recognized, but it didn't matter who they were. I was with the honu again.
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I was with the honu again. 40K JPEG |
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Summer of '02 at Honokowai | ||||
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The Epilog--2002 | ||||
Turtle Happenings
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Who's Who Underwater at Honokowai | ||||
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Table of Contents | ||||
