How Can You Mend a Broken Heart?
I was caught between two levels of consciousness, starting to wake up but still dreaming. I was not yet aware of where the dream world ended and the real world began. All I knew was that I couldn’t breathe, and I was suffocating. I reached with my hands to remove whatever it was that obstructed the flow of air--maybe an alien facehugger baby--but there was nothing there. Even more confusing, I realized that I was in fact breathing. My lungs were working vigorously, my mouth was open and gasping, but I was still suffocating. As the waking world came into focus I sat up a little in bed, and slowly the oxygen seemed to return to the room. Within a few minutes I was breathing normally again.
I haven’t had another episode quite so dramatic, but a few days later I dreamed that I was in bed, and my dog was sitting on my chest. I couldn’t take in enough air to yell at him to move. Since then I haven’t had any more weird dreams. It is no longer so strange an experience that my sleeping brain has to create an explanation. I just wake up, realize that I’m breathing really hard and fast, and I roll over and go back to sleep. The symptoms of heart failure have become routine.
When I got back from my hiking trip in Japan, I felt pretty fit. I didn’t want to lose it, but continuing to walk all day was no longer sustainable. I got back into a serious running program, thinking that would be a more efficient way to keep things rolling. I did this with the full support of my cardiologist. At first my running stride felt awkward, but gradually things smoothed out. I charged up hills like an animal. Sometimes when I first started a workout I felt a little pain in my glutes, but it usually went away after I loosened up a little. Sometimes it took a couple of miles to loosen up. In terms of distance, what used to be a long day was now a short day. Once a week I went longer, topping out at 16 miles. On days that I didn’t run, I walked a few miles with my pack, still crammed full of 40 pounds of gear. On some days I did both, a run and a weighted walk. I made unexpectedly good progress on this program, showing consistent improvement in both speed and endurance. I was running better than I had in years, maybe decades. I thought I had discovered a secret weapon. I signed up to compete in a major half marathon, and with three months still to train, I thought I could perform pretty well in my age group.
The glute pain started to be more persistent. My yoga teacher gave me some stretches and poses to help iron things out. The pain started moving to different places; my left hip got cranky, my right quad cramped. Both got worse, to the point where I could only run slowly or not at all. But I could still walk, and I kept walking, with a loaded pack. Then one day, miles from home, the pain forced me to stop. I had to call Ann to pick me up.
After several weeks of resting, frequent visits to a chiropractor, intensive yoga sessions , polishing off a bottle of Aleve, and reluctantly stashing my backpack in the attic, I was able to start running again, tentatively at first, then with confidence. I had three weeks left to train before race week, and that was going to have to be enough.
I ended up doing as well as I could have expected, and placed 10th in my age group. I was happy with that, for about five minutes, until I discovered that had I run just two minutes faster, I would have placed 5th. Still, I texted my cardiologist: “first place among participants with severe mitral valve regurgitation” I wrote, although I had no data to support this. “Congratulations,” he replied. “I’ll take that as evidence that you’re still not feeling any negative symptoms.”
Things got back to normal again, and I continued to make improvements. After talking myself out of immediately signing up for another half marathon, just to see if I could shave off those two minutes, I focused more on speed than high mileage. Quarter mile repeats were my bread and butter, and I timed myself running the mile on a track about once a week. It felt good to run fast, and my times were improving. The glute pain was gone, the hip issues resolved. And then the breathing problems started.
They may have actually started a while ago. Our bedroom is on the second floor, and every time I climb the single flight of stairs, I feel out of breath...and something else. It is difficult to explain, but it is a distinctly unpleasant feeling. So much so that I sometimes avoid going up if it isn’t absolutely necessary. And yet, I can still run quarter mile repeats or hike up a mountain, and my shortness of breath is the normal kind, the kind you’d expect from vigorous exercise, not the icky kind I get every time I go to grab a sweater or brush my teeth. I tried to explain this to my doctor. It isn’t the climbing, I suggested, it is the stopping. He listened politely before dismissing my theory.
There was a treadmill workout I used to do regularly. I raised up the incline as high as it would go, to simulate running up a steep uphill, and got the belt moving at a moderately high speed. I’d jump on for thirty seconds, then jump off for thirty. I always felt good during the on part, but as I jumped off, I’d get a little light-headed and loopy. I took it as evidence of my willingness to push myself so hard that I flirted with passing out. I thought that made me an athletic stud, and I never considered that it might make me someone who was turning a deaf ear to the clear messages my body was trying to send. But my point is, it was the stopping, not the running that caused me to feel the symptoms.
The mitral valve sits between the chamber of the heart that receives newly oxygenated blood from the lungs (left atrium), and the chamber that shoots the blood through the aorta and into rest of the body (left ventricle). If the valve doesn’t shut all the way, some of the blood leaks backward, into the lungs. A small amount of leakage is probably normal, and I’ve probably lived with this all of my life. As I’ve gotten older, the leakage has gotten more severe. Still, my symptoms are not obvious. My doctor talks about strategies that my body uses to compensate for the valve’s inefficiency. These might include raising the heart rate, raising the blood pressure, retaining more fluid in the body, and eventually enlarging the left ventricle and thickening the ventricle wall. None of these sound good, and my doctor assures me that none of the bad ones have happened to me yet. Despite the severity of my faulty valve, I was not a candidate for surgery, as long as I was feeling good and performing well.
When I told him about my night-time breathing issues, he said without hesitation that it was time. The next step is a procedure called a transesophageal echocardiogram. A regular echocardiogram is just like a sonogram that they use to take pictures of unborn babies. There’s that gizmo that they coat with KY Jelly and use to rub your wife’s belly, and a screen where the technician points and says, “Look, there’s a foot!” and you pretend to see it too. For the echocardiogram, the gizmo goes mostly in a space between two ribs on your left side. On the screen, they take various measurements of the valve and the amount of backward blood flow. They don’t point at stuff though, and it is not the interactive kind of experience that it is with future babies. Although one time during the procedure my heart went into one of it’s wild arrhythmias, as it is prone to do fairly regularly. “Would you cough for me please?” the technician asked. Magically, my heart rhythm immediately returned to normal. I’ve used that trick many times since. But they’ve never printed a picture of my mitral valve for me, that I can show my friends at work and post on Instagram. The technician has lots of buttons and switches and a trak-ball, and her hands move quickly, and she looks like she is playing an elaborate video game. For the transesophageal version, they stick the gizmo on a tube and shove it all down your throat. Or so I’m told. This way they can get up nice and close, and not have a lot of fat and bone in the way. The result will be a more detailed picture, and, according to my doctor, will provide the information necessary to develop a surgery plan. I’ll let you know how it goes.