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Anatomy of a heart attack, Part 2: ‘Exceptional medical talent’ at Royal Jubilee Hospital

This is the second in a series about experiencing a heart attack and recovering from one. If you have to suffer a heart attack, one of the best places for it is in Greater Victoria, and the closer to the Royal Jubilee Hospital, the better.

This is the second in a series about experiencing a heart attack and recovering from one.

If you have to suffer a heart attack, one of the best places for it is in Greater Victoria, and the closer to the Royal Jubilee Hospital, the better.

Two weeks before my heart attack, I was happily swatting mosquitoes on Las Cruces Trail, a 500-year-old oxen track cut through the steaming, poisonous jungles of Panama by Spanish conquistadors, who used the trail for getting gold stolen from the Americas to the Caribbean coast and then on to King Phillip II’s coffers. I mention the trail only for comparison purposes, as this would have been one of the very worst places to suffer a heart attack.

From my perspective, there are three reasons Greater Victoria is such a good place to survive a heart attack:

1. Exceptional medical talent; with

2. Plenty of experience; and

3. Proximity to my house.

David Sovka in the recovery room at Royal Jubilee Hospital, after elective surgery to have three more stents put in his heart. - David Sovka

The good folks at the Royal Jubilee Hospital are some of the best in the world: cardiac surgeons, anesthesiologists, perfusionists, GP assists, cardiologists, specialized nurses, cardiac pharmacists and an army of people you don’t see, but whose professionalism and expertise help keep you alive just as much as the ones with their fingers on your pulse, assuming you still have one when you get there.

Like everything else in life, this mostly comes down to practice. Whatever you do — piano, times tables, cardiac surgery — the more you do it, the better you get at it. Victoria has a lot of older people, who are more prone to heart problems. (Victoria does not actually have Canada’s oldest population; as of the last census, that title is jointly held by Thunder Bay and St. Catharines, Ont.)

This year, Island Health’s Cardiac Surgery Program at Royal Jubilee Hospital completed its 25,000th heart operation. The first cardiac operation was performed in 1973. Since then, the Cardiac Surgery Program has grown to include four cardiac surgeons and completes about 15 procedures per week, each of which takes three to five hours, for a total of 725 life-changing procedures every year.

Two of those surgeries were performed on me, so I feel sufficiently experienced to say that these people really know their onions when it comes to stringing a thin wire with a camera and assorted repair gear through the radial artery in the wrist, wriggling it up and into the correct position and getting the job done. From memory, they also smell like an alpine meadow in high summer, although that might have been the fentanyl talking while I lay on the operating table.

My point is that I want to kiss all of these people for helping save my life.

The importance of good pharmaceuticals

My junior high school shop teacher, Merle Pickett, was fond of telling us: “Wup-wup, read the book!” He would say this several dozen times every shop class, while in the background, heavy industrial machines whirred blades and showered sparks and generally created the most dangerous learning environment possible for goofball adolescents.

In Pickett’s aphorism, “book” referred to a series of photocopied manuals that laid out the precise steps for 13-year-old knuckleheads to follow as they constructed various shop projects, despite being primarily focused on making ninja-throwing stars on the sheet-metal cutter when Pickett was not looking.

As a life rule, “wup-wup read the book” is probably good advice. I say this, despite a lifetime of almost never actually “wup-wup reading the book.” About the only thing I wup-wup read is the advice my cardiologist gave me, which in a nutshell is: “Take these drugs.”

In fact, he prescribed five drugs to make sure my heart will go on, which, according to Céline Dion, is a good thing.

The five drugs I take are as follows:

1. Metoprolol, a beta blocker

2. Ramipril, an ACE inhibitor

3. Atorvastatin, a cholesterol-lowering chemical

4. Ticagrelor, a platelet-aggregation inhibitor

5. Crystal methamphetamine, a potent central-nervous-system stimulant

Ha! I’m kidding about that last one. The actual drug is baby aspirin, which acts as another kind of platelet aggregation inhibitor and also relieves headaches caused by babies.

As anyone who watches cable television knows, every medication comes with a long list of possible side-effects. Unfortunately, these side-effects are never along the lines of, say, causing six-pack abs or gleaming white teeth or hair growth in the right place.

If side-effects were universally positive, they would be called Special Effects, and the price of prescription drugs would go even further through the roof.

For example, I take baby aspirin and Ticagrelor to make my blood less sticky. The intended effect is to protect my blood vessels and stents from blood clots, which would otherwise kill me, or worse. However, less-sticky blood makes for a more bleedy Dave. So shaving is much more exciting than it used to be.

Another side-effect of the Ticagrelor is breathlessness. Walking across the living room makes me breathe like Katarina Witt after landing a triple salchow. And I now sound like Marilyn Monroe singing happy birthday to JFK. Another weird side-effect of the drug is that I keep comparing myself with beautiful, famous women.

Beta-blockers such as Metoprolol protect the heart from stress and abnormal heartbeats. It also helps lower blood pressure and slows the pulse, which in my case, makes me feel dizzy when I stand up. Or even think about standing up. While mildly disconcerting, it’s not as bad as some of the other possible side-effects, which include fatigue, swelling of the feet or ankles, and — I swear I’m not making this up — depression and nightmares. Depression and nightmares sound a little too much like high school to me.

My favourite drug is Atorvastatin, which slows or stops plaque formation inside blood vessels, which is the problem that almost killed me.

Everybody carps about changing your diet to eliminate the bad kind of cholesterol in your body, but get this: 80 per cent of cholesterol is made by your own body; only 20 per cent comes from your diet.

Atorvastatin can cause muscle aches and cramps, which can be fixed by switching to a different kind of cholesterol-lowering medication. What can’t be fixed is that Atorvastatin and grapefruit juice do not mix — somehow sour, awful grapefruit juice interferes with how the drug works in the liver. I don’t see this as a bug, so much as a feature.

There are many other kinds of heart medications, depending on exactly how your dodgy ticker let you down. Many of them come with the disquieting caveat: “Usually, taken for the rest of your life.” That phrase is a clear reminder that I am so … limited.

However, thank God — and I mean it — for each of these medications, and also that I happen to live in Canada. It might be cold in the Great White North, and we did unleash Céline Dion on an unsuspecting world, but our dirty red socialist state still has a functioning health-care system. It’s not perfect, and it’s not equitable across the provinces, but it’s pretty good.

Big Pharma is here, of course, because medication is big business and always will be. Canada’s drug prices are the third highest among the Organization for Economic Co-operation and Development countries. According to a 2017 investigation by the CBC, prescription drugs cost $1,086 per Canadian per year when averaged across the population, making up 16.4 per cent of total health-care costs. And prescription-drug costs are expected to grow by 4.2 per cent per person.

Every three months, the cost of my own drugs is $394.15. Because both my wife and I have health-care benefits through our employer, every three months I actually have to pay $0. That’s right, Donald Trump and other angry orange idiots out there making disparaging noises about Canada: I pay nothing for the medicine to keep my heart going on and on. And on and on …

This might kill you, but you’re going to die anyway

I think I understand the concept that all men die. This is because, like everybody else, I illegally download the popular HBO television program Game of Thrones.

The United Nations’ Worldometer — a real-time estimate of the number of births and deaths on planet Earth — says there are about 7.7 billion human beings at the time of this writing, which is 2:50 p.m. on a Friday in case you are wondering. Two hundred and eighty-seven people died while I typed this paragraph.

Probably I don’t actually understand that everybody dies. Despite part of my brain knowing that everybody dies, I mostly walk around not thinking about it. I mean, OK, everybody dies but surely not, you know, ME?

I am reminded of a saying that my first boss, Dan Peters — owner/operator of the south side Dairy Queen in Lethbridge, Alta. — used to say: Quit goofing around! He said that a lot. But the actual saying I am thinking of is:

From the day of your birth,

To your ride in the hearse,

You’ll never get out of life alive.

Inspiring words to teenage idiots, mostly concerned with a) zits and b) girls’ reactions to zits; and who are psychologically incapable of believing that they will ever die.

I suspect the reason that Peters often quoted this depressing ditty is because he often thought about his own mortality. Running a successful fast-food business founded on the principles of sugar and cholesterol might do that to a guy. Also, he had a serious heart condition. There were actual tablets of nitroglycerine kept in each of the cashier tills at the restaurant, just in case.

Thinking about Dairy Queen puts me in mind of a delicious hot fudge sundae, possibly with added peanuts, although I’m sure I had a more important point to make. Oh yes! Of course: Death and dying. After a heart attack, you think about death and dying a lot. Such black thoughts have faded a little over the past nine months.

But not much.

The series

Part 1: 'Every part of me felt really awful'

Part 2: 'Exceptional medical talent' at Royal Jubilee hospital

Part 3: Risk factors and the French Paradox

Part 4: Stress test and a sweaty gym visit

Part 5: Grow up and eat your vegetables

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