A few weeks ago, I woke up at 3 a.m. with excruciating chest, arm, neck, and back pain. It was the kind of pain that resembled everything I’d ever read or heard about the pain which precedes a heart attack. I don’t know what the typical response is for a man who senses that he’s experiencing a cardiac emergency, but my response was probably a textbook example of what not to do: I stayed in bed and let my thoughts run wild.
This can’t be a heart attack. I’m not breaking out in a cold sweat. I’m a healthy and well-controlled type 1 diabetic. I’m not short of breath. I exercised last night and felt fine. I had carrots and celery for my nighttime snack last night. I can’t afford to have a heart attack. What does a room in the cardiac ICU cost, ten thousand dollars a day? What if I die? What will my wife and son do without me? Why did I neglect my diabetes in my 20s? I ate too much pizza in college. God, I really can’t miss work today. I wonder if I can get to the emergency room and be out in time to get to work.
After about 30 minutes of panicking and waiting for things to get better, I vomited. I remembered that my father-in-law had experienced the same symptoms when he’d had a heart attack two years ago – chest pains then vomiting.
I woke my wife, Theresa. “I need to get to the hospital,” I said.
We dressed quickly and as we were walking out the front door, my compulsive need to know my blood glucose level at all times (which apparently persists even under threat of cardiac arrest) forced me to test. It was 180 mg/dl, quite high for the middle of the night.
Before we were out of our neighborhood, my chest pain had worsened. So had my state of mind. I was trying to convince Theresa to drive faster, but she was thinking clearly and decided we should stop at the firehouse up the road and hitch a ride in an ambulance. She figured it would be a good idea to be hooked up to an EKG sooner rather than later. We called 9-1-1 and when we pulled up to the firehouse, the gate attendant yelled out to us, “Are you the heart attack?”
“Am I the heart attack?” I asked myself.
As is typical for paramedics, the men who met me were professional, fast, and smart. They hooked me up to the EKG and took my vital signs. The EKG indicated a normal heart rhythm. My blood pressure and heart rate were normal too. The paramedics asked a series of questions and decided that it was still best to get me to the hospital. They sprayed nitroglycerin, a drug that lowers blood pressure and alleviates chest pain, under my tongue, loaded me into the ambulance, and pulled onto the highway. Theresa wasn’t allowed to ride with me, so she followed us to the hospital.
A few minutes into the ambulance ride, I felt nauseated and threw up again. To calm my nerves, the paramedic named Kevin explained the EKG readings to me. Kevin talked about sinus rhythms, p-waves, t-waves, QT intervals, PR intervals, and ST Segments, all of the things that indicate whether your heart is beating to the rhythm of the right drum. He joked about how the EKG patterns on TV shows look like they are heart rhythms of amphibians, not humans.
Since I was incredibly anxious, I asked Kevin to test my blood glucose, which always skyrockets under stress. Blood glucose might not have been on Kevin’s top ten list of things to monitor, but I knew that high blood sugar could lead to high ketones, and the last thing I wanted was to have a heart attack and diabetic ketoacidosis at the same time. My blood sugar was up to 280. I bolused 5 units of Humalog.
Although by the time I arrived at the hospital my chest pains had subsided, that didn’t lessen anyone’s sense of urgency. In fact, arriving at the emergency room with a suspected heart attack was like having front row seats above the home dugout at Yankees stadium. I moved right to the front of the line ahead of the broken legs, stab wounds, neck injuries, 3rd degree burns, 103 degree fevers, dog-maulings, and baby deliveries. No waiting, VIP treatment.
One doctor and three nurses peppered me with questions, poked me with needles, and x-rayed my chest. My blood pressure had dropped to 70 over 20 because of the nitroglycerin, so I lay flat on my back while they pumped fluids into my arm. After 30 minutes my blood pressure normalized, and within the hour the doctor came to me with some initial test results. He said my chest x-ray looked good, my EKG seemed normal, and the first cardiac enzyme test was negative. But, as 39-year-old type 1 diabetic, he said I was at a much higher risk for cardiac events. The initial tests were a good sign, but there could be underlying problems that these tests might not detect. He felt the best course of action was to hospitalize me for a few days so I could undergo a complete cardiac workup. The choice to stay or go was up to me. I didn’t want to walk out of the hospital, collapse and die in the parking lot, and then have the doctor say, “I told him he needed more tests, but he just wanted to go to work.” So I opted for a sleepover at the hospital.
The Cardiac ICU wasn’t too busy that week. My room had two beds, but I was the only patient. It was a plain-Jane room: a bed, a moveable tabletop, and a tiny little TV with 65 channels, static and fuzz at no extra charge. My nurse, Jeff, explained that I needed to have three more cardiac enzyme tests over the next 24 hours, and after that, if things looked okay, I would take a stress ECG. He said all of the tests would give a fairly definitive report of the state of my heart.
I spent the day in the hospital, hooked up to a half dozen wires and at the mercy of the lab tech who came every 6 hours to draw blood. I tried to watch TV, but nothing really interested me until Oprah’s infamous diabetes show came on. That show made me thankful that my doctor’s name was Browning, and not Oz.
I had a lot of time to think about diabetes and my health. In so many ways, I’m lucky to be alive. I spent many years in denial about diabetes, and made bad choices during my 20s. It’s easy to make bad choices about diabetes because the consequences usually don’t hit you immediately. But when you’re sitting in a Cardiac Unit in the hospital, every bad choice you’ve ever made, every skipped shot of insulin, every Krispy Kreme doughnut, and every bag of Doritos come back to haunt you.
You would think that the hospital would be the one place on earth where you wouldn’t have to explain your diabetic needs, but that was not the case. This is the most important thing that a diabetic needs to understand when entering a hospital. The people working in a hospital have a theoretical, textbook understanding of diabetes, but they may not have a practical sense of your diabetic needs. If you are a patient with diabetes, it is your job to make sure that the medical professionals know what they’re doing when they’re making decisions that will affect blood glucose, food intake, and insulin levels.
For instance, the food service people forgot feed me, and I had to remind them that I was a type 1 diabetic on an insulin pump and that I would create quite a scene if my blood sugar dropped much below 50. The hospital’s diabetic meals – based on an ADA approved diet, had 60 grams of carbohydrate per meal. In a typical day, I rarely consume more than 40 grams of carbohydrate. This forced me to make a choice between not eating very much or making a huge adjustment in my insulin intake. I chose to just eat the protein portions of the meals.
Late in the evening I was finally able to speak to my doctor. He told me that the first three enzyme tests were all normal, and that I was scheduled to do a “treadmill test” first thing in the morning.
First thing in the morning is hospital-speak for 10 a.m., and at 7:30 a nurse told me I wasn’t allowed to eat until I’d had my stress-test. I reminded them again that insulin waits for no man, and that they needed to get me some breakfast. They called the cardiologist and got permission for me to eat what was easily the worst meal of my hospital stay. For reasons that are still unclear, they chose to serve me a “Low Cholesterol” breakfast. Eggs, Malt-o-Meal, two pieces of toast with sugar-free jelly, eight ounces of apple juice, and a carton of milk. Over 70 grams of carbs!
After the stress test, the cardiologist said that there was no indication anything was wrong with my heart. He said I had “a pretty good pump under my sternum.” He warned me that heart disease is the leading cause of death for people with diabetes, and that I needed to take my heart health seriously. He speculated that my chest pain might have been caused by GERD (Gastro-Esophogeal Reflux Disease, a fancy name for indigestion), since the nerves in the esophagus are closely linked to the nerves near the heart. GERD is a frequent cause of severe chest pain, he said, but since the main goal of my stay at the hospital had been to rule out heart disease, he wasn’t going to attempt to make a diagnosis. He did mention that since the esophagus has a smooth muscle lining, it’s common for nitroglycerin to calm the painful symptoms of GERD.
I’m not happy that I spent two days in the hospital due to indigestion with a funny name, and I’m not entirely convinced that I had GERD. My family doctor had recently taken me off some anxiety medication, and when I looked online for withdrawal symptoms, I found that many people reported suffering chest pain.
The good news is that I haven’t had any repeat of the symptoms. Part of me wishes they’d found an alien growing inside of me, or something that would have warranted a twenty thousand dollar hospital stay. The rest of me is relieved to be okay. And while overall, the experience was frightening, I did enjoy seeing my heart at work during the stress test, like a fist expanding and contracting, over and over again, the little valves opening and closing like taxi doors. Forty to 160 times per minute. All day. Every day. For a lifetime.
Sorry, I meant coronary artery spasms.
Not only can withdrawal from anxiety medication result in chest pains – one of the most prevalent symptoms of anxiety and panic disorder is chest pains of mysterious origin. In addition, anxiety and panic disorder can cause angina due to coronary heart spasms in an otherwise healthy heart. I assume a heart monitor would catch any spasms.
Awesome article. Thank you very much.
Great read I’m also a type 1 diabetic who has been in denial for years. It’s hard but I have to get my health under control.