I had no idea I had blockages in my heart. No idea.
Yes, I am overweight, and yes I have diabetes, and yes, I know I can eat better and exercise more. But I am an active executive who hops on and off airplanes, travels, works hard, and enjoys life without too much issue.
I did not have any chest pain, I did not have a heart attack, I did not feel pressure in my chest. They tell me I had 'silent ishemia.' Basically, blockages in my heart arteries were preventing my heart from getting enough blood, which was then reducing my heart function. Turns out people with diabetes are more likely to have silent ischemia.
Essentially, part of my heart was starving for blood, and I had no idea. But then something weird happened in October of 2023.
"Maybe I'm just sitting too much."
I started a new job in August of 2023, and by October I was traveling to clients, working on projects and fully into the hustle and bustle of an exciting new company. I recall walking across a bridge to the office one morning, feeling a little more tired than usual as I got to the top of the bridge, and a little out of breath. "Whew!" I thought to myself, "maybe I've been sitting too much. I need to get back to my workouts!"
Over the next week or two, I was in and out of 4 airports, and I noticed that climbing the jetway off the planes with my suitcase and workbag was similarly causing more fatigue and breathlessness, and I finally also noticed that my heart rate seemed to be a little high.
Even being overweight, all of this is unusual for me. I tend to take extra laps around the airport before boarding as exercise, so this was NOT normal, and was definitely something new. I called my doc and scheduled a video visit for the next week.
Stress Test & Bloodwork
The doctor ordered a stress test and had me get some some blood work. The next day she called me - my hemoglobin was 7.3 (which is dangerously low) and she told me to go to the ER immediately. I have had anemia my whole life, but I take iron every day and I had not had a problem since college. My hemoglobin had also been 12.3 in July — so this was a very big drop.
I went to the ER with my husband, and — I will cut to the chase here — I have a rare hereditary bleeding disease called HHT that my Mother had and brother has. As soon as the cardiac team came to see me they said “this is symptomatic anemia - you’re bleeding somewhere internally.” This is what caused my drop in hemoglobin, which was causing the fatigue and the elevated heart rate.
To find where I was bleeding, they ordered a colonoscopy, endoscopy and pill endoscopy (which was very cool, but that’s another story for another day!) They found the problem and I was diagnosed - I do indeed have HHT.
But there’s another problem. And it's with my heart.
The cardiology team came by again and told me they had found some things in my tests that were worrisome and once gastroenterology cleared me, they wanted to do a angiogram. They thought I might need a stent for an artery that had some blockage, and my ejection fraction was 35%. Which is low - way too low. And I was walking around in the world with no idea.
Fast forward so I can get to the point - I did have blockages, and they did not want to do stents because I’m too young, and I also can’t be on heavy blood thinners with my new HHT diagnosis (which are required after a stent) and they want me to talk to the cardiac surgeons.
I was beyond scared - I was terrified. One of the cardiac fellows came by and reassured me that I was going to be ok. He said that they always want to be aggressive to get ahead of these kinds of things, and that I had time to go home, talk to my family and prepare for surgery. I was 'stable' and 'low risk.'
I was released from the hospital with an appointment to get a surgical consult four weeks later.
How serious can it be? They say I am low risk and stable.
Because they gave me a blood transfusion and iron in the hospital, my hemoglobin was back up, so I felt pretty good a week after leaving the hospital.
So .... maybe I don't need surgery after all. I had just started a brand new job I liked, and hey -- they said I'm stable.
They let me go home and didn't seem too worried. Maybe they are being overly dramatic? I mean - OPEN HEART SURGERY? That's barbaric. Certainly medicine has come a long way. Isn't there a minimally invasive method?
I spent the next few weeks checking out info from Cleveland Clinic, Mayo Clinic, even the minimally-invasive CABG options at University of Chicago. But in all of my conversations and research the words that hit me the hardest were that CABG is the "gold standard" in repairing blocked arteries. Full stop.
I desperately wanted a different option because I was afraid of what I understood to be a very major, invasive and horrendous surgery. Googling it was scary and thinking about my chest being opened, and being on heart and lung bypass machines -- I mean COME ON!
Meeting with the surgical team.
A month after I was admitted to the hospital for the HHT episode, I was sitting in the surgical team's office with one of the surgeons and their nurse practitioner. I was scared, and nervous, and asking questions about all of the risks I had read about online. They told me to stop Googling and to listen to them instead.
When I asked about the 1 in 100 people who has a heart attack during surgery? He told me that those statistics are national statistics covering wide age ranges and situations — and their practice had far lower incidences than that. Plus national averages don't apply to low-risk people like me.
He was explaining I needed 3 bypasses and that it was a pretty 'textbook' surgery. I was told I am young and low risk and that this was a surgery they do hundreds of times a year. "I just did one of these this morning," the surgeon said.
When I continued to pepper them with questions that were clearly based in fear, the NP finally said "I don't say this to be mean, but you are unremarkable. Technically we could have a junior surgeon do this."
Fortunately - they don't have junior surgeons at the hospital I was at, so I would get one of the big guns.
The surgeon I was meeting with was persistent and asked me to pick the date - either 12/12 or 12/18 was available. "Be home by Christmas!" he said.
Can't this wait until spring?
I was hemming and hawing and I could tell he was getting irritated. "If I am so low risk, and healthy and young - can't this wait until summer? Or spring?"
He said, "you're asking me about risk percentages of having the surgery - but the unknown is the risk of you waiting and having a cardiac event in a week, a month, six months -- and then you won't be healthy and low-risk."
I scheduled an elective CABG that very day for December 18, 2023. I now had about 2 weeks to prepare.
