An Open Letter to Coronary Artery Disease
Dear Coronary Artery Disease,
I know you’re the one who “broke” my heart.
I know who you are and what you represent to millions of people. The World Health Organization states you are the “number one cause of death globally.” It is not something you should be proud of. I know genetically you are a big part of who I am. Yet, my life’s goal is to not allow you to impact my children and grandchildren’s lives like you have interrupted mine.
You have taken me down a path I would have never taken. You have given me a unique perspective into the saying that “every setback is a setup for a comeback.” You have impacted my life and changed its course.
Life has become inherently challenging.
I remember when you first entered my life. My father’s fight against heart disease began in his early forties. He had his first coronary bypass surgery in 1971 when heart surgery was in its beginning stages. I watched my father’s struggles with an intense apprehension.
I remember him resting in bed, reading, reading and reading – he had to rest after his first coronary artery bypass surgery. That was the regime back then. He had stacks of magazines – Time, Newsweek and National Geographic.
I remember him boasting that “his cardiologist” – the one who just did his bypass surgery – was featured in one of those magazines. I sensed a certain pride and strength in his statement. I so wish I had that magazine today. I would love to know more about this doctor and his contributions to cardiovascular surgery.
I remember seeing rows of pill bottles lined up beside his shaving cream and razor in his bathroom, thinking how sick he must be having so, so many bottles of pills.
I saw him try to improve his diet. Our family meals changed from roast beef and mouthwatering potato dumplings with buttery, caramelized onions to fresh watercress salads and fish. I remember his infamous breakfasts of dry toast with spinach and milk. I remember trying it too and actually liking it! But I still longed for the breakfasts of homemade frosted cinnamon rolls with fresh butter even more nostalgically!
I remember his long, long walks through the highways and byways of our small hometown village. Walking was both prescription to better health even then.
My father succumbed to all his efforts in 1980, following hours of his second coronary bypass surgery at University Hospitals in Madison WI. This was ten years after his first CABG (coronary artery bypass graft) in Milwaukee, WI at St. Luke’s Hospital. I like to think he was a true pioneer of heart surgery and gave his life to help others find answers and discoveries in the field of cardiovascular surgery.
When these events come into our lives, we have a strong desire to make sense of them so they apply to our own daily lives and world. They bring a deeply personal message that permeates my very being and my relationships.
I remember the first time you became more personal with me too. It was in 2007, in the wee hours of the early morning, when you caused that heaviness and pain in my chest. I remember how unrelenting you were.
There were days – perhaps more like months – that I wondered: “where did I go?” You have left me with an epiphany. Heart disease and chronic angina has been a major life event. It has taken me years to understand this and move forward. I now see that it is all, just simply “my life”, my path to follow – the journey that makes me who I am. “Just my life” has meant ending my career years before I expected to. When you go through a life-altering experience, you have one of two choices to make. You can come out as a stronger version of the person you were before, or you can let it destroy you.
It took years to find my “new normal” and to accept that there is a distinct difference between now and then. You have given me a broader knowledge base of words like yourself, microvascular disease, atherosclerosis, chronic angina and lipoprotein(a). Perhaps the most frightening words were being told that even though cardiologists love to “fix people”, that they could not “fix me” because some of my coronary vessels were too small. It reminded of:
“All the king’s horse’s and all the king’s men
Could not put me back together again.”
You, coronary artery disease, comprise the impairment of blood flow through my coronary (heart) arteries. It is atherosclerosis’s formation of plaques that impede blood flow and blockages. The typical presentation of coronary artery disease is much like I experienced with chest pain. Prevention is by modifying risk factors such as physical inactivity, obesity, smoking and high blood pressure and high cholesterol. Treatment is by improving blood flow to the heart, with surgery or medications or EECP.
I know your friend, atherosclerosis too well. He is often found with “other friends” such as plaques, atheromas, lipids, cholesterol and inflammatory cells. I try to avoid him and his friends, but they constantly seem to confront me. I antagonize him with Lipitor and Zetia but family history keeps him re-appearing, even when I avoid all the other risk factors!
Chronic Angina is a way of life that I have perfected. I know how to cope. I know my limitations. I know where my nitro is when I need it. Pain is simply my body’s way of getting my attention. I stop and listen to my body and know how to respond.
Chonic angina is best described as a:
“prevalent manifestation of cardiovascular disease and is most commonly due to insufficient oxygen supply from fixed epicardial lesions in the coronary arteries. In addition to increasing the risk of cardiovascular death and recurrent myocardial infarction, chronic angina has a significant impact on functional capacity and quality of life. All patients with cardiovascular disease should be closely questioned to determine the functional and symptomatic limitations attributable to ischemic symptoms.”
I must admit, though, CAD, your companions microvascular disease and liproprotein(a) are more complicated and difficult to defend myself against. I know they are related to that genetic make-up factor, but sometimes I just wish I would have never met them! I am aware of the Lipoprotein(a) Foundation to tackle this dilemma.
An elevated Lp (a). is a causal factor for heart disease. An individual may have an a normal cholesterol reading and still have elevated Lp (a). Knowing Lipoprotein (a) levels may give the cardiologist. a more accurate indication of risk. Each child born of a person with it has a 50% chance of inheritance.
Microvascular disease is typically found in women. The Harvard Medical School, in their pamphlet: “Harvard Health Publications” explains it well:
“The coronary arteries and smaller vessels feeding the heart muscle do not dilate properly and thus couldn’t accommodate increased blood flow — a condition known as vascular dysfunction. Vascular dysfunction occurs both in women with clear arteries and in those with obvious coronary artery narrowing. Moreover, it was not a problem of the large coronary arteries alone, but involved stiffening of the network of smaller vessels that also nourish the heart. This condition has been dubbed coronary microvascular dysfunction, or microvessel disease.”
“To some cardiologists, the discovery of widespread microvessel disease came as an epiphany. It helped explain why so many women with coronary artery disease were misdiagnosed and undertreated: The standard protocol identified only coronary artery obstructions. Microvessel disease could also help explain why so few women have the classic crushing chest pain that signals coronary artery disease. Instead, they feel diffuse discomfort, exhaustion, or shortness of breath under stress or even during daily routines.”
Where I once “thrived” on stress, and gravitated to high stress positions or taking on two jobs at once, I now accept and move forth at a more acceptable pace. Teaching, journal articles, advanced practice categories, meeting accreditation standards and completing paperwork and criteria to maintain high quality – were paths I took with great pride and commitment. I am certain my career echoes others with the same diagnosis – I recognize, now that I became an employee who gave my time and talent for my employer, sacrificing my own health and happiness at all times.
A good day today is a brisk walk without shortness of breath and the endurance to walk as long as I want without the nagging fatigue and overwhelming angina. YOU taught me to never take my health for granted. You lead me to follow my passions: I keep my spirits up even as new bottles of pills line the kitchen shelves (much like my father before me) and the pharmacist knows me by name. My diet grows more restrictive, and yes, coronary artery disease, you do bring pain and sometimes an unrelenting fear. Yet I no longer spend time grieving. I’ve since come to consider all moments as gifts, even those marked by frustration, fear, and despair. Time is truly precious. Happiness comes not from the avoidance of pain and suffering and despair, but in the healing from it.
These are the facts that make up my life. I accept them and vow to make the best of the life I’ve been given. Part of making the best of this life has been creating a new life.
The writings of Zen teacher, Joko Bec contain one of my favorite quotes, she said: “Our life is always all right. There’s nothing wrong with it. Even if we have horrendous problems, it’s just our life.” I find great solace in these words. Not everything can be fixed—perhaps not even my health. I am in awe of physicians, the giving of their time and talents to help others, but I know they cannot “fix” all the problems presented to them. They, too, are only human.
This letter has rambled on longer than I anticipated. I wanted to make you aware of my feelings. I wanted you to know that I am left with hope, with patience and that you have a revealed a new path to me. You have rebuilt my identity. As I live life to the fullest, I sign this letter with a meaningful and heart-healthy quote, once uttered by the 40th president of the United States, Ronald Reagan.
Love Generously. ♥
Leave the Rest to God.
P.S. Please feel free to add any postscripts to my letter to coronary artery disease. I know there is so much more he needs to hear.