Dr. Giannotto’s Stroke Part 2

In the meantime, blood studies were normal except for the lipid profile. My cholesterol was 303 with the HDL (good cholesterol) at 100 and LDL (bad cholesterol, plaque forming cholesterol) was at a very elevated 205. My primary care physician stated that I had been dealt a bad hand of genetics. He also stated that if it were not for my lifestyle choices, the situation at hand could have been much worse, even fatal. I was placed on a statin drug, Lipitor 40mg daily, Plavix 75mg daily (thins the blood), continued on my daily aspirin and my blood pressure medicine. Now I have always written that prescription drugs like this were never to be taken chronically. All sorts of nutritional deficiencies and medical problems can ensue. Again, my regimen of vitamins, mineral and supplements guard against this. I also made it clear that the medicines need to be temporary until healing occurred. The physicians agreed.

An EKG showed a mild first degree heart block likely caused by one of the blood pressure medicines that I was taking. The first degree block was not serious or symptomatic but we would watch it. The echocardiogram shows several minor abnormalities. My left ventricular function (pumping action of the heart) was excellent with an ejection fraction of 65-70% (exceptional, especially for a 64-year-old). However, a had a mild aortic stenosis and a mild dilatation of the ascending aorta probably secondary to the stenosis. I asked a cardiologist I trusted, Dr. Linda Tao at NYU Medical in New York to look at this and spoke with the radiologist. These changes were for the most part, age related and probably would never amount to anything, especially in the absence of any symptoms. We would follow these changes yearly. Yet I was so upset when my primary care physician interpreted these results saying I would eventually need a valve replacement and treatment for an aortic aneurysm. I left the office despondent and as I was awaiting my UBER, he ran out and apologized. He admitted to over-interpreting the results. I never want to see that man again. He never looked at me, never asked about symptoms or how I was feeling and had no beside manner at all. He only looked at test results and made lists. What is medicine coming to?

Now I had two weeks to think about surgery and every possible complication that could occur. It was a mental game. I prepared myself by reading every medical article I could find about my condition. Complications of surgery included stroke, post-op myocardial infarction, arrhythmias and even death. But the risk of these was extremely low- less than 1%-but being the physician that I am I worried about them. And as the day approached, I became more anxious and depressed. Dylan and Matt stayed with me each step of the way and really became calming influences in my life at that time. What I did know is that despite my worry, I was doing everything I could via lifestyle choices to minimize any complications and maximize healing.

March 24th arrived. I was up at 4AM, showered and packed a bag. My surgery was scheduled for 7:30AM and I was told to be at the hospital by six. Dylan drove me to the hospital that morning. Needless today I was extremely anxious. The lesson learned here is that I will never, ever underestimate a patient’s fear again. The fear is real and is not mitigated by anyone, not even the physician performing the surgery. As a physician, you ask the patient to place trust in a very system that he knows nothing about. The media doesn’t help the situation with certain stories they cover. And advertisements by lawyers literally can scare the crap out of you. So why would a patient trust his/her doctor and the medical system? And yet this is what is expected.

I found myself in the pre-operative unit. Various IVs were placed and an anesthesiology resident needed to place a line in my radial artery (artery in wrist for accurate blood pressure monitoring and ease of drawing blood if needed). The resident was visibly nervous because he knew that I was a physician. I found myself having to calm him down so that he could proceed. It took three attempts but he did a good job. The anesthesiologist came and talked about sedation while under local anesthesia, but I declined. I wanted to be fully awake during the procedure so that I could speak with the physician and monitor myself for signs of stroke. Finally, Dr. Mukherjee arrived and we went over the procedure again. I was ready. I told the staff and the doctor that since family was on the way but not present, they should speak with Dylan about everything. He was and is the closest thing to family I have. I said my goodbyes to Dylan and Matt and was wheeled into the operating room.

Immediately, my anxiety dissipated. The staff was awesome, conversant, friendly and helpful. They made certain that I was comfortable. The procedure lasted a little less that two hours, I spoke to Dr. Mukherjee constantly and was happy to find myself in the recovery room by 9:30AM. Vital signs including blood pressure were normal and I felt great. The doctor reaffirmed that my blood vessels were strong, like that of a nineteen- year old and that the plaque was completely gone. I had a clean carotid artery. He even joked that with the increased blood flow to my brain, I may make a lot of money trading on Wall Street and that if I succeeded, he deserved 50% of the profits!

Dylan and Matt were allowed to be with me and my sister Beth arrived shortly. She had driven in from New Jersey earlier in the morning. Within several hours I was transferred to a telemetry (monitoring) unit in the hospital and discharged early the next morning. I was constantly told by the nursing staff, the medical staff and the ancillary staff how healthy I looked having undergone a major surgery. Dr. Mukherjee reaffirmed this sentiment the next morning as he discharged me. He couldn’t get over how quickly I had bounced back. He told me I should live another 60 years!

I spent the next five days recovering at home and resumed a full schedule six days later. I came to the conclusion that I may have been dealt a bad genetic hand of cards, but my lifestyle choices had seen me through successfully. I cannot overemphasize this point. Yes, some of us may have genetic tendencies toward stroke, cancer and myocardial infarction, but we can minimize the damage done by these problems by lifestyle choices. I believe this now more that ever. Genetics is not an excuse to give up. Rather it should be a motivating factor to stay as healthy as you can so as to negate the full genetic effects of a disease you may have inherited.
So please, learn from my story. Exercise wisely, eat well but nutritionally, decrease stress and put a leash on your bad genes!

Two weeks after surgery, I saw Dr. Mukherjhee. He was elated with the healing and the state of my left carotid artery. He released me to exercise. I had a serious discussion with him about trying to be proactive with my heart. Plaque in one area is an indication of plaque elsewhere. Although I have never had any cardiac symptoms such as pressure, pain and shortness of breath, I decided that an evaluation might be in order. I am seeing a cardiologist next to discuss the possibility of a nuclear stress test and evaluate the condition of my coronary arteries. Only after this work up is complete will I rest easy again! In the meantime, I have faith that my lifestyle choices will have a beneficial effect on any pathology that may be uncovered.

Leave a Reply

Your email address will not be published. Required fields are marked *