Archives for posts with tag: spontaneous coronary artery dissection

“That which we call a nose,
By any other name would smell as sweet.”

Or “sweetly,” depending which way the wind blows.

Apologies for mixing poets, metaphors and verb forms, but that’s just the kind of summer it’s been. It’s a time of mourning with lots of loss, sickness, life changes, and now my nose. It’s no longer the nose I was born with, thanks to heredity and youthful stupidity on sunny beaches years ago.

My nose has been called many things over the years. Ski slope. Kitty. Pug. But I always loved it, small and turned up as it was. When I was four years old, we were in Philadelphia getting off a city bus to see a tourist site. A woman stopped my mother and said, “If I had that little nose, I would hold it up in the air as high as I could.” To her, it was the perfect nose and deserved to be worn proudly.

With biopsies and band-aids leading up to the surgery, my secret sorrow has been on display for several weeks. But on Monday at the surgical center, grief took center stage. When the doctor began the numbing shots, I let out a wail and commenced braying like a stuck donkey while hyperventilating my way through sheer mortification. How perfect to be in the first treatment room, kitty corner to the front desk and adjacent to the waiting area. Do you apologize? Laugh it off? Keep crying? I tried a combo approach.

But wow did those shots hurt, way worse than the ones for the biopsies. My second round of weeping began after the tissue analysis. The good news was, the first two Mohs samples had removed all the cancerous cells. The bad news was, as I looked down at the diagram she drew of the recommended reconstruction, I could see the two bloody pits where nose used to be! Eeesh.

I was on board with the reconstruction plan, but then again — how could I not be? Who am I to argue with the woman who holds my hope for a complete, healthy nose in her talented grasp? Since my teeth were aching and we definitely didn’t want me braying again, it was time for more shots.

Incisions were made, tissue tugged and placed, and two rows of stitches completed for each closure. The first round of each suturing made a clicking sound; the second was good old-fashioned needle and thread. Somewhere along the way I asked if they could please just hit me on the head and knock me out, but that wasn’t an option.

As the final step in each phase, the smell of cap guns filled the air as the surgeon cauterized “for a better cosmetic result.” She was aghast at my comment but I thought everyone of a certain age had owned a cap gun as a kid. The technician agreed with me: caps, which definitely beats thinking about what we were actually smelling!

By the time I was waxing poetic about the complete Laura Ingalls Wilder series to keep myself distracted, the surgeon began sawing off my ear. Not really, but it sure sounded like it. As she cut the graft to fill in the left side of my nose, her assistant cranked up the best hits of the 1930s and ’40s. (Note: cardiology and skin cancer offices cater to a similar demographic.)

What an ordeal — for us all! I feel so fortunate the philosophy of the Skin Cancer Surgery Center is very caring, hands on, and patient centered. (But I really do wish they had knocked me out; actually, they probably wish they had too.)

I talk a lot about post traumatic stress disorder in SCAD patients, and do believe it plays a role in our recovery and future health care experiences. It was so comforting that the surgeon took time to hear my feelings about earlier scars from open heart surgery. Her reassurance that she will do whatever it takes to heal my nose successfully is heartening. At 48, I plan to have several decades left to wear my nose proudly through life.

I just hope I don’t sneeze for another year or two.

For more on the various forms of skin cancer, symptoms, and treatment, check out: Skin Cancer

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Why, yes … yes she has!

You know at gatherings, when people haven’t seen each other for a few years, generally some speculation ensues. Real or fake?  A lift or good genes? And in the most severe cases, who is that stranger?!

The Bionic Women (and friend)

Well, with great pride, the three of us pictured at our 30th high school reunion can state without a doubt, we definitely had some “work” done. Some serious work. From left to right: heart attack from spontaneous coronary artery dissection, repaired with double bypass surgery; an acoustic neuroma, successfully removed through brain surgery; and open heart surgery to graft an aortic aneurysm and perform a mechanical valve replacement. (No health issues for our lap man — he’s just a very funny accessory!)

It wasn’t by design, but we saved the shop talk until the very last. As people said good-byes and drifted out the door of the heartwarming gathering we’d enjoyed, the three of us found ourselves together. Like a last minute huddle, reliving the not-so-great highlights of our years since high school and gearing up for the time until our next reunion. By way of illness, we share a language and awareness you only gain through experience. We are well, at least for the moment, and that is truly all each of us ask. Because as we learned the hard way at an early age, things can always get worse. But day by day, they can get better too.

Thirty years have passed. It was enlivening to realize that within each of us, our 18-year-old selves still flourish. The bikini days may be gone, but I’m much happier being bionic!

[Correction: A Dose of Reality regrets our misstatement that “the bikini days” are over. Rock it, girl!]

 

I speak for those who can’t speak tonight. I speak for those who’ve been brushed under the rug by slight-of-hand. I speak for the dead.

We’d all like to believe that if we control our risk factors, listen to our bodies, and call for help when in need there would be no heart disease. No heart attack. No stroke. No death.

Yet we all know the truth, which is women do the right thing every day and die anyway.

Whether from congenital defect, unmanageable risk factors, or un-researched biological boogeyman, women die from heart disease every minute of every hour of every day because we haven’t devoted the attention, research dollars, or sweat equity to keep them alive.

Don’t insult my intelligence by telling me that awareness of heart disease will keep me alive. I literally could teach a course on Spontaneous Coronary Artery Dissection (SCAD) to med students today and die of a second heart attack from SCAD tomorrow because the data hasn’t been funded to explain my disease or prevent my death from it.

Talk to me about answers. Show me cradle-to-grave assessment, risk management, and care. Act upon my crisis.

Women die every minute of every day because death from heart disease isn’t yet lucrative or sexy enough for our health care and research establishments to act.

I’m fighting hard until I Go Dead for Women.

Spontaneous coronary artery dissection (SCAD) is a rare and poorly understood cause of acute coronary syndrome, heart attack, and sudden cardiac death. A spontaneous tear inside one of the layers of a coronary artery creates a flap, or subsequent clot, that blocks blood flow to the heart muscle.

Cardiologists typically have never seen a SCAD, but may remember the term from medical school. Twice online, I’ve communicated with women who’ve been discharged from the hospital after a heart attack with no clear diagnosis. After they’ve returned to their cardiologist and suggested the possibility of SCAD, a review of their angiogram does indeed confirm a dissection. I firmly believe the SCAD diagnosis is missed on a regular basis. SCAD just is not “on the radar” of cardiologists in our ERs.

SCAD was first documented in 1931. The following key points summarize what we know about SCAD today:

  • The vast majority of cases occur in people with no known risk factors or underlying conditions.
  • SCAD is more than twice as common in women than in men.
  • SCAD causes heart attacks and can result in life threatening arrhythmias and sudden death.
  • Pregnancy is a risk factor for SCAD; 30 percent of SCAD cases in women occur near the time of delivery.
  • Seventy percent of SCAD cases occur in people under age 50.
  • The average age when SCAD occurs is 42, but it has been documented in a 19-year-old.
  • SCAD is an emergency and requires urgent treatment.
  • SCAD can recur; up to 10 percent of patients experience two or more events.

With true research underway at Mayo Clinic, now the challenge is finding more SCAD survivors to participate in the virtual registry and DNA biobank. As you encounter stories of unexplained heart attack, please remember spontaneous coronary artery dissection. Your awareness may lead to answers for someone else.