The 2017/2018 Season of Our Discontent

As you all no doubt recall, Jim had a spinal fusion August 22, 2017.  It was an arduous recovery.  He lost a lot of muscle mass and coordination and it hurt like holy hell.

If that were not enough, three weeks post surgery a mysterious pain and stiffness manifested in his hips.  A week later, it was also in his shoulders.  The pain was excruciating.  It took about five weeks for the medical team to diagnosis it as polymyalgia rheumatica.  Here is a brief description of it.

The symptoms include pain and stiffness of the shoulder and hip girdle. The stiffness may be so severe that the patient may have a great difficulty rising from a chair, turning over in bed, or raising the arms above shoulder height. Stiffness after periods of rest (gel phenomenon) as well as morning stiffness of more than 1 hour typically occurs.

The treatment is prednisone.  Eight weeks after surgery on his back, Jim was back on steroids.  The PMR responded very well to the prednisone, and within 24 hours we were able to attach the truck to the RV and leave Issaquah.  Without it, we might still be there.

One of the (many) prednisone side effects we were warned about was acid reflux.  That manifested November 2.  Mass quantities of proton pump inhibitors and H2 antagonists did not control the events.  After a couple of months, we were sent to a gastroenterologist.  The gastro we went to see was very concerned about the fact that the pain in the chest occurred during exertion.  She was less concerned about the fact that it also happened at rest, which we thought was somewhat odd.  It did put a damper on how much and how hard we could hike/bike.

So then it was off to the cardiologist.  On the tread mill it was discovered that Jim had a depressed ST segment on his EKG which means there is inadequate blood flow in the heart somewhere.  A PET scan of his heart revealed that his Left Anterior Descending Artery was narrowed.  The LAD is also known as the Widow maker.  The scan didn’t say how blocked, nor did it say if any other arteries were clogged.

On February 15 Jim had an angioplasty done.  His LAD was 99% blocked.  Dr. Tuli was going to place a stent, but could not.  He could get the wire through the plaque, but it was too dense for the balloon to go through.  The good news is that the rest of his arteries are not too badly clogged.  We left the hospital that day with orders to not hike, not bike and not exert.




This just came out of the blue, and it could have been so bad.  When you have a heart attack, the ambulance hauls you in to the catheter lab, and they do the angioplasty procedure.  The balloon is inserted in the plaque, and is inflated to squish it against the sides of the artery.  Then a stent is inserted to hold the squished plaque against the artery wall.  In Jim’s case, the balloon would not have moved through the plaque, and Jim could have died.  Depending on the hospital, they could have called in an interventional cardiologist certified in drills and lasers if they had one on staff.  If not, then there could have been a bypass right then and there.

Friday we went to the Tucson Medical Center cath lab.  It’s a good thing we went when we did.  Jim was 100% blocked.  There was a tiny microchannel still functioning, but things were dire.  Dr. Waggoner had planned to use the equivalent of a drill to clear the plaque due to its very large size.  Yuuuuuge! That was not to be, the thing was so full of calcium that the drill could not penetrate it.  So the laser was deployed and a fair amount of time was spent vaporizing the plaque.  Here is a link to a youtube animation of how the laser works.  The animation is non-gory and safe for all ages.  Basically, the Excimer laser is advanced up to the plaque, and the plaque is vaporized.

Two stents were placed due to the length of the artery that was zapped.  Recovery took awhile, there were some low blood pressure excursions, probably due to lack of food and immobility.  When I left after dinner, Jim had pinked up and was looking good.  He has gone from blocked to not blocked, and life will be better.  We still don’t know exactly what that life will be like, but it will be better.

As of this writing, the PMR seems to be in abeyance.  He’s down to 7.5 mg from 20 mg of prednisone, and the wean continues.  The back surgery was a complete success at three months and he had regained a lot of strength and muscle mass.  If it weren’t for his wretched heart, and the pain he had in his chest, things would be excellent.

So that’s how our winter has turned out.