Cracking me open

“A nasty poison in my heart, yet my heart has been given wings in the long run,” the author says.

By John Knapp

My birthday is July 24. I have gloried in the fact that every year since I was aware of such things it had never rained on my birthday. The exception was last year, my 60th birthday. For the first time ever, it was definitely raining. Not drizzle, not misty fog, but real rain. It gave me pause. I do believe in signs and omens. Looking back I had no idea how ill the omen was for the year that lay ahead.

Though I have very good eating and exercise habits, I have had a hard time as I have gotten older sustaining vigorous exercise. I have written before in this blog about going deep into the Raw Vegan wilderness. It was all in an effort to cure a bewildering set of issues, including fatigue that was occasionally severe. I was told it was depression. I was told “adrenal fatigue.” I tried acupuncture, raw vegan resorts and all told me that my heart rate and blood pressure were quite good, as did my regular doctor.

I gave up “the search” sometime in the last year. I was getting too old to chase the dream of finding the cure for these vague ailments. “Just chalk it up to getting older,” I told myself. Yet, I would continue to have incidences of running completely out of gas on quite easy walks. Those bewildering incidences drove me to the offices of Dr. Kathryn Retzler.

John Knapp

John Knapp

I met with Dr. Retzler, who interned for a year with famed heart specialist, Dr. Mark C. Houston. She had an impressive treatment protocol that was unlike any I had been through before. I was given an extensive questionnaire about my health, and my family’s health history. I had blood work done that looked at types of cholesterol I had not heard of, and even included a look at my genes. Given my family’s health problems and my genetic background, I found I was at high risk for many things, particularly Alzheimer’s and heart disease.

Dr. Retzler ordered a heart CT scan so that she could get something called a “calcium score”. I had never heard of it. When and if cholesterol plaque builds up in your coronary arteries, calcium will eventually attach to it. A CT scan cannot see soft tissue or cholesterol plaque, but it can see calcium. Based on the amount of calcium that the scan finds, a score is given for the major arteries on the surface of the heart, the ones that supply the heart itself with oxygen. If you are in your forties, they would like to see a score of “0”. Scores up to 100 put you in varying categories of risk. A score of 400 puts you in the very high risk category.

On April 13th Dr. Retzler called me at work to talk to me about my scan. I had a calcium score of 3, 136. I had advanced coronary artery disease, she said. She referred me to Dr. Michael Shapiro at the heart clinic at OHSU Hospital in Portland, Oregon, and asked that I be given the highest priority, and I was scheduled to see him the next week.

The news was disquieting to say the least. My fraternal twin brother, Mark, had died of advanced coronary artery disease at the age of 46. I had assumed I had dodged that bullet. I searched the internet looking up calcium scores, hitting all the blog sites with frantic people wanting to know what their score meant for them. But I found no one with a score anywhere near as high as mine. The highest that I’d seen was one score of 1,000. It was only later that Dr. Retzler told me that Dr. Shapiro, a cardiologist for over 10 years, mentioned that he had never met anyone with a score as high as mine. His visit summary said it all. “Patient has a profoundly high coronary calcium score.”

Dr. Shapiro arranged for me to have a stress EKG test, which showed my heart was having to work too hard to pump blood. Then it was on to a coronary angiogram, which was over quickly. There wasn’t enough room in my arteries to cleanly navigate the little catheter that takes a picture of insides of the arteries.

I was scheduled for a triple bypass 5 days later, on Monday May 11th, four weeks to the day that I received the results of my heart CT Scan. I had three working days to put my affairs in order, file my disability paperwork and arrange for others to take over my work duties during an unknown amount of time off.

During the bypass procedure, your entire sternum is opened, except at the very bottom where they tie it together to ensure your chest doesn’t butterfly. They call it “cracking” your chest. A heart/lung machine pumps your blood and breathes for you while your heart is completely stopped. More than likely they will be lifting your heart completely out of your chest cavity. (In my case, they harvested veins from my right leg and used them to bypass the blockages on three arteries). When they are finished, they use stainless steel wires to stitch your sternum back together, and small plates to reinforce and stabilize the incision. The entire procedure started at about 8am and was over by 1pm.

The procedure is now so commonplace that the surgery is coded as “routine”. It hardly feels routine when it happens to you.

Recovery from the surgery is different for everyone who goes through it. 99% of the people who have the surgery survive, but recovery can be very slow, sometimes up to a year, and some aren’t made better from having the surgery. Most of the post-surgical complaints are problems sleeping, neck and back problems, depression, trouble thinking clearly and fatigue. More serious complications are stroke, grafts closing after the surgery, and problems with the stainless steel wires and plates used to hold the chest together.

If you’re reading this in early August (and I’m not dead), I’m barely three months in and have had most of the minor problems to varying degrees, particularly fatigue and sleep issues. Returning to work has been very hard and I wish now that I had waited longer. It has been difficult keeping up with my previous pace. People have been kind and helpful, but don’t always understand that you can’t instantly bounce back from a surgery like that. Some expected that I would feel better and be more youthful almost immediately. The fact is, I feel worse than when I went in, but the risk of having a heart attack or stroke has been reduced significantly, and that’s something to be thankful for.

By August, my birthday will have come around again, and I will have turned 61. I received the gift of my beating heart. It’s stronger now, and I can feel it lustily pumping the blood in and out. I probably felt it before, but I never gave it a second listen. It will count out the beat for my happy birthday song, and maybe the rain will join in. Whether or not the rain comes again, I will count it a happy birthday, indeed.

John Knapp lives a quiet life in Vancouver, Washington with his rescue cat, Abby. “I’m not sure who taught her how to rescue people,” John says, “but she did an excellent job with me.”


Editor’s note: John is a gem. I met him through The Oregonian’s Community Writers program, which allowed readers to nominate themselves to write regularly for the Opinion section. His contributions to this blog run the gamut. He writes with intelligence and humor. He comments on others’ work with sincerity and empathy. At our VOA meetups, he dominates the conversation (no, wait, I’m confusing him with someone else). But, seriously, he is the kind of person the world needs more of.

Tomorrow: “Song in darkness” by Lynn St. Georges


8 thoughts on “Cracking me open

  1. John – First let me say I am glad to hear you are still with us, a sentiment undoubtedly shared by you and others.
    I have to echo George’s words here about you – your posts are always filled with strong insights and honesty, and your comments to others show a softness and kindness. I did smile when George referred to you as the person who dominates the conversations … it seems much of your empathy comes from paying attention and listening rather than being the life of the party. All good things. As I said on Nike’s post, I only know you via the VOA community and I’m grateful for that. Be well!

  2. John – can’t imagine what it must have been like to be operated on with a chisel, hammer and nutcracker but maybe your bone structure is as tough as your writing style is vibrant.
    Glad you’re still with us!

  3. Whoa, what an amazing event in your life and, now, mine. As I read this, I immediately thought back to my very recent annual physical three weeks ago. I got an excellent report from my doctor and the lab, but……, what if?
    Thank you, John for writing this. Obviously, a physically traumatic and mentally draining experience for you. I was anxious just reading it. I’m so relieved that you are in recovery mode. Best wishes and Happy Birthday.

  4. John,
    I’m so glad you’re “not dead yet” (Monty Python moment) and I now want to know what a “raw vegan resort” is. AND I love that I get to know you and benefit from your perspective on so many things.

    • Raw veganism is being a vegan, but only eating raw, uncooked food. The place I went to is kind of a Mecca for vegans in Florida. It was a resort in that it is set in Florida, otherwise it’s just a nice clinic. It’s very expensive and they have a lot of unconventional treatments. People who go there usually are sick. A lot of people go back many times, and some even choose to spend their vacations there each year. It wasn’t for me. Too dogmatic, too many rules, and it isn’t an easy lifestyle. In the end, I just don’t buy that it will benefit a lot of people. It didn’t do a thing for me, but has helped many people, especially people with cancer. If I got cancer, that’s the way I would try to eat.

  5. Was scary just reading this – I can’t imagine what it must have been to go actually go through the process.
    I echo other people’s sentiments. You are so full of empathy and authentic in your interactions – one of those people everyone likes having in their corner. So glad you are alive and well and healthy!
    I was very young when I saw my father having a heart attack and taking his last breath – this was in the days before bypasses and stents. Last year I signed up with for a heart-wellness program in Palo Alto that does this extensive blood test (that is not usually done in routine physicals) and education, coaching on lifestyle changes. I would recommend it for anyone young or old.

    • Sorry to hear about your experience with your father. It must have been very traumatic. The test I had is tailor made for someone like me: high risk (family with heart disease), but asymptomatic. I’m exactly the kind of person they like to find. Once of the arteries that was most clogged is called “the widow maker” for its propensity for causing fatal heart attacks. So many stories on the blogs I visit of people who were diagnosed and flat lined before they even got them into surgery! Luckily they lived. Thanks for all your kind comments. I really treasure them!

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