In September of 2007 I was training to climb Mount Chirripó the following February. I actually felt pretty good and had put in at least one 16k hike with Bob, but it was time for my annual pacemaker checkup so I scheduled an appointment with Dr. Lopez at Hospital Cima to make sure it was working properly. I didn’t want to get to 10,000 feet above sea level and have a pacemaker problem.
Dr. Lopez found my PM to be working properly but noticed some irregularities with my heart and recommended that I see Dr. Arce, my regular cardiologist, for a stress test. Dr. Arce suggested we do an echo stress test as it would give him a better view of my heart. I still wasn’t worried as I have had a strange heart for many years and have had many EKG’s that showed minor abnormalities, but never anything serious.
Imagine my surprise when he diagnosed me with Congestive Heart Failure, put me on an alpha and a beta blocker and recommended that I not try to climb Chirripó. He suggested that after being on the medications for a while and with a moderate exercise program that if my heart improved I might be able to attempt the climb at a later date.
For those of you not familiar with CHF, I had an enlarged left ventricle and a low ejection factor. Normal or good ejection (the strength your heart pumps) was around 50-60 and mine was down to 40. Very low is in the low 30’s. This meant that my heart was not as efficient in pumping out my lungs as it should be. This explained why I was having so much congestion and was finding it difficult to get in shape.
He explained that even normal hearts were susceptible to pulmonary problems at higher altitudes and at my age, 70, with this heart condition I would be in danger at this time. He wanted me to come back in a couple of months for another test before I made any plans to climb a mountain.
This bummed me out as I had been planning this for some time, but I was not looking forward to leaving my body on the side of Mt. Chirripó.
In November I went back to Texas to run the Rock Ledge Rumble and the Ultracentric so I decided that while I was there I would see my stateside doctor and see what Dr. Markus had to say. He is a brilliant diagnostician and knows my history for the past 30 years. He took one look at the test results and said that there was something else going on. At my level of fitness I shouldn’t develop CHF and that he thought I may have had a heart attack in the past. He made an appointment with my cardiologist, Dr. Weingarden at The Heart Place, for another echocardiogram. When he got these test results he said they were inconclusive and he really felt the only way to make a definitive diagnosis was to perform an angiogram to see if there were any heart blockages. So the following Monday I went in for an angiogram.
When they got in there they found a small 75% blockage in bottom part of the right cardiac artery and thought that I may have had a small heart attack sometime in the past, but that the artery had opened up after the attack.
I thought back two years ago, about two months after we had moved to Costa Rica, when I woke up one night with severe heartburn. I thought I was having a heart attack so we went to the Clinic in town where they diagnosed me with acute gastric upset and gave me some medicine. In a few minutes I felt Ok and went home.
I guess I was right and that probably was the heart attack that caused the damage they were seeing now.
While they were in there they installed a stent to take care of the blockage and that problem was pretty much under control. Unfortunately, they spotted another problem. They detected an atrial flutter that while in itself it didn’t represent any dangerous problems, did open the door for pooling of the blood and subsequently posed a danger of blood clots. The clots could go to the brain, kidneys and lungs or even cause more heart attacks. To protect me against this possibility they put me on a heavy duty blood thinner, called coumadin or in it’s generic form warfarin, the main ingredient in rat poison .
Having heard of the dangers of this type of blood thinner I was not excited about it but decided I would like drooling out of the corner of my mouth
less, so I started taking the warfarin.
There was also the possibility that I night be a candidate for an ablation of the alternate pathway that was causing the flutter, kind of like having an extra sparkplug that you don’t need. This required another procedure wherein a radio-frequency catheter would be inserted up through my groin into the heart and then turned on to burn and seal off the extra pathway thereby doing away with the flutter.
I couldn’t do this until January so I went back to Costa Rica to spend Christmas with Mary and wait until January.
This seemed like a simple enough plan to follow. Be careful and don’t do anything stupid until this was fixed. For your information when you are taking warfarin every little bump or bruise turns horribly black and blue and takes a long time to clear up. So in two weeks I was black and blue all over. It was like living life walking on eggs. I had to watch every move I made.
Two events happened in late December that scared the daylights out of me. First I was trying to back my land cruiser down the driveway, got befuddled, and backed off into our neighbors coffee field. (There will be a separate blog on that, so hold your laughter.) As it happened I could see my coumadin-laced blood splattered all over the hillside and just then it was not very funny.
Second, two days later, I turned my ankle on the driveway and fell, banging up my knee in the process. Within three days my leg was black and blue from my thigh to my toes. My local Doctor, Dr. Cerdas, immediately took me off the thinners and had me elevate my leg for three days, pretty scary stuff.
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