This has been an incredibly busy September. September is the peak month of our harvest season, so it is probably our busiest month as well. Further, every September I typically make a trip down to Capitol Hill for Senator Kirsten Gillibrand’s Ag Advisory Panel Meeting and NY Farm Day Celebration. I typically schedule numerous meetings with a number of offices while I am down in DC. This year I was down from September 7th till September 10th. I hope to blog about that very eventful trip soon, which included:
- a number of very productive meetings on Capitol Hill and at USDA
- my getting a massive headache forcing me to leave the Farm Day reception early and vomiting in a DC cab
- my return Amtrak train striking and killing a person who committed suicide outside of Philadelphia
… amongst many other events. Look for that blog entry eventually.
But in the meantime, allow me to share what happened afterward. I finally got home about 12:30am on Friday. I went back to work on the farm that Friday morning and by 6:30 or so I was out the door. I worked on the farm (obviously) all day Friday, Saturday, Sunday and Monday. During that period I drove the forklift in the barn as we packed onions, the windrower to prep the fields for harvest and the big field forklift as we harvested. My days were pretty busy, typically working from 6 or 6:30 in the morning to 7:00 or 7:30 or later each night.
On early Tuesday morning I had an appointment with my neurologist who has been treating me for my headaches, Dr. Uri Napchan, of Middletown Medical (http://www.middletownmedical.com/services/specialty-medicine/neurology/). I brought with me a 50 lb. bag of yellow onions for Dr. Napchan and his staff. I carried the bag on my shoulders from the parking lot up to his office … no sweat. My appointment was my 3 month check-up as well as my quarterly botox shots (I get them for headaches, not for looks, though Eve says I look like a Klingon afterward).
Well, the visit went well, my vitals were fine, etc ….. After the visit I returned to the farm and windrowed much of the day into the evening.
Here are a few pics taken that day:
In fact, I even shot and eventually posted a video on YouTube of windowing:
Around 7:00pm I switched to the next field. It is a very wide field and I had to walk the width to count the beds to determine where the center is.
It’s a wide field, about 50 beds or so. And as I walked the width of the field I started to notice slight discomfort, almost a feeling of pain in my chest, around my heart. This struck me as odd because by this point in the season I’m at the peak of my physical activity and should feel any discomfort after walking a few feet. I filed away what happened, said nothing to Eve later, and continued to windrow for another half hour or so.
The next morning I woke, had breakfast, viewed my weather video, drank my coffee and got out the door at about 6:30am. The first thing I do in the morning, every morning since late April, is take care of our employees’ drinking water. The 5 gallon jug is typically left in the barn. I carry it, with whatever water is in it, to the faucet outside my house, dump the old water, fill it with fresh water and ice, and then take it to the barn.
I grabbed the bucket and carried it to my faucet. By the time I got to my faucet I experienced sharp and pronounced chest pains that dropped me to my knees. I also could not catch my breath. I literally crawled into my house. Eve was still there, had not left to work. She obviously was a bit freaked out and wanted me to call our doctor. After 5 minutes the pain subsided and I could breath no problem. I assured her that what happened was some sort of anomaly but it wouldn’t happen again. I then went outside, emptied then filled the bucket with water and ice and proceeded to carry it to the barn.
And when I got to the barn I once again was dropped to my knees by the very intense pain.
I crawled into our farm office where my dad was sitting. He nearly panicked, telling me to call the doctor. After about 5 minutes the pain subsided and I felt fine. I told him if something like that happened again I would definitely call the physician that treats me.
I then went out to the field to windrow, which I did from about 7 until about noon. Since I never experienced pain like that I decided to tweet about it. At 9:08am I sent this tweet:
Most of my tweets automatically get posted to my Facebook page. I assumed, after I tweeted and it was posted, that most of my social media friends and followers would say:
“What complaining about you slacker? Get your tail back to work!”
That’s not the overwhelming reaction I received.
Both on Twitter but primarily on Facebook my friends overwhelmingly urged me to seek medical attention IMMEDIATELY. Dozens of person told me that what I experienced was not typical or usual and I should seek help immediately.
I didn’t take it seriously. At that point I had roughly $150,000 in farming expenses for the season and roughly $20,000 in sales. i attributed it simply to some form of anxiety or stress, not physical. As I was finishing windowing I watched as my father, who is in his mid 70’s, skipped his lunch to rake onions over to prepare for harvesting.
How can I stop working over my situation when I see that? I proceeded then to drive the tractor back to our property that is between my house and my parent’s house, park it, and I then walked a few hundred feet back to my house.
And when I got to my house I felt very noticeable chest discomfort that one could characterize as pain. And at that point I knew something was up. I called Eve at work and she was adamant I had to call our primary care provider. Because of her insistence (and because of the overwhelming response on social media) I agreed to give our nurse practitioner Vicki Rheaume at Horizon Family Medical a call (http://www.horizonfamilymedical.com/locations/florida/). When we spoke I related my conditions and what I had been experiencing, including on the field Tuesday night and I asked her “don’t you think Vicki that this all might be stress or anxiety?” She paused for a second and said that she would not say that and she insisted I either go to the ER or call my cardiologist asap. That surprised me a bit. I really expected her to say it was stress or anxiety. Or maybe that’s what I wanted to hear.
I then called my cardiologist’s office. It had previously been part of Horizon but was now called the Hudson Valley Heart Center (http://www.hvheartcenter.com/index.php). When I called I detailed my symptoms to the scheduler and asked if someone could see me. The scheduler responded “we do have a space in about an hour and half if you can come in.” I sort of grimaced and replied “well … I’m all dirty and we’re harvesting now, do you have any time tomorrow?” I still wasn’t taking this too seriously. She said they did have time available at 4pm the next day. I said I would take it. I wouldn’t see the doctor I saw last time, this time I’d see Dr. John Portelli.
I then proceeded to continue to work as we harvested till about 7pm or so. I started to notice that when I would exert myself a bit I would start to feel some chest discomfort. But as Eve and I laid in bed that night I continued to insist it was obviously stress or anxiety over what was turning into a not so great season on the farm.
The next morning I worked as I normally would on the small barn lift as we graded and packed onions. Then at about 10pm a contingent of USDA employees from the Risk Management Agency came to my farm with local Cornell Cooperative Agents for a tour and discussion about crop insurance.
After they left I graded onions and then had lunch with my friend Chris Olert at the fabulous Quaker Creek Store (http://www.quakercreekstore.com). I then went back to work and worked until 2pm grading onions.
During the day I continued to notice if I moved to quickly or attempted to lift anything heavy like a bag of onions I would feel noticeable chest pain. Again, I continued to assume it was stress. i showered and drove to the heart center’s office in Chester for my 4pm appointment. After filling out some basic paperwork a nurse took my vitals and then Dr. Portelli came in to examine me. they did an EKG which I believed didn’t show anything unusual or remarkable and I believe my vitals were also good (my blood pressure is typically low). So after explaining my symptoms and examining me I asked the doctor if it was probably stress or anxiety causing my symptoms. Dr. Portelli said “no, I’m saying heart. This sounds like heart.” He diagnosed me with exertion angina and he then ordered an immediate stress test. He walked me out to the scheduler and stood by to ensure that I would be the first person seen the next day. The scheduler remarked later “he is taking this very seriously, he usually doesn’t stand and wait like that after asking for the appointment to be made.” He prescribed for me a beta blocker to slow don my heart and nitroglycerin tablets. That shocked me.
When I arrived at my pharmacy, The Florida Pharmacy, Charlie the pharmacist came out and handed me the nitroglycerin tablets and said< “this is to be taken seriously, this is life or death serious.” He then gave me the very specific instructions as to when and how to take the nitroglycerin tablets.
I still felt this was all stress or anxiety induced. I firmly believed that. One reason I waited almost two days to actually see a doctor was because I didn’t want to bother very busy people with very important jobs treating persons with very real illnesses. I didn’t want to waste their time or divert their energies and attention from where they should be directing their energies and attention.
The next morning I took it easy. A Facebook friend of mine from Long Island, Laura Di, came and visited the farm. She had a blast and it was great to meet in person someone that I really admire and respect. She has fought very hard for her community after the destruction of Superstorm Sandy.
(above pics of Laura Di. Dad wanted pics and a hug)
Eve came home from work early and she drove us to the office in New Windsor for the stress test. Very quickly we were taken to the room by 2 nurses to be set up for the stress test, which is basically running on a treadmill. As they were applying the electrodes all over my body they asked how I was feeling. I said, “well, I actually have had all morning a minor level of discomfort that feels like heartburn. I had breakfast but I don’t typically get heartburn.” I then added, “I didn’t poop this morning. Is that important?”
Eve rolled the eyes to the very top of her head and told me to shut up but the nurses just laughed and one replied “don’t worry, I have one like that at home too.” After all of the electrodes were applied I stepped on the treadmill. Dr. Portelli came in at this point to monitor the test.
I lasted all of six minutes. After a mere 6 minutes I was totally gassed and out of breath. I should have lasted longer than 6 minutes. Again, by mid September I’m at the peak of my physical activity. Even in the middle of January when I am far more sedentary I should be able to last longer than 6 minutes. The test did not initiate the sort of pain I felt after carrying the water bucket but I did feel some pain, just not as severe. I did have noticeable pain in my left arm thought the test. My right arm felt fine but not my left. I kept saying to the nurse that was taking my blood pressure during the test “I have pain in my left arm. Is that normal? Why do I have pain in my left arm?” As soon as the stress test was over the pain in my left arm disappeared. No one said a word and I had absolutely no idea what it meant until we got in the car ride home (https://www.sharecare.com/health/heart-attack/does-left-arm-pain-mean-having-heart-attack).
Dr Portelli asked his nurse to get me a nitroglycerin tablet. I said I was fine and I was really reluctant to take it. My pharmacist warned that potential side effect was a headache and I already have enough problems with a headache. I believe he said though my EKG was fine my symptoms continued to indicate some sort of cardiac problems and he ordered a cardiac catheterization early on Monday morning.
I was stunned and bummed. The upcoming Wednesday, September 23rd, would be our 25th wedding anniversary so we planned on spending the upcoming weekend in NYC, We had punched incredible seats to see “The Book of Mormon” on Broadway, planned to be joined by good friends of ours from Connecticut for dinner at Ben & Jacks and maybe check out the naked painted ladies of Times Square (http://gothamist.com/2015/08/17/naked_times_square_struggle.php). Well … maybe we weren’t going to do that as we celebrated our 25th … but we would be in Times Square. then we were going to stay the night at a very fancy hotel and have brunch on Sunday before we came back home. Dr Portelli strongly discouraged me from going and added “do you really want to have a heart attack and be stuck at some hospital in NYC?
Good point doctor!
So, we decided to follow my doctor’s advice and we bagged the weekend anniversary celebration get-away. On the plus side, I was now going to be able to watch my Iowa Hawkeyes take on the Pitt Panthers in Iowa City Saturday night.
By the way … Iowa won on a literally last second 57 yard field goal (http://www.foxsports.com/college-football/story/iowa-hawkeyes-marshall-koehn-kirk-ferentz-091915). As the game winning kick was made my son Caleb and I literally screamed and Caleb immediately turned to me “keep calm dad, keep calm.”
The reason he said that was because earlier in the day I got very angry over a couple of know-nothing blowhard idiots on a Facebook page. i got so upset I started getting strong to severe chest pains. So strong they started going into my left arm and underarm. And despite walking away from the computer and sitting on the couch for a few minutes the pain only intensified. So intense I had to actually take one dose of nitroglycerin. And after 2 minutes it actually worked and the pain subsided.
I still didn’t believe it was anything more than stress or anxiety.
Saturday afternoon my good friend Susan McDonald stopped in to visit me and Eve. She wanted to make sure I was doing okay and taking it easy. She really calmed me down and made me and Eve laugh and was a great comfort.
Another person who was a huge comfort to me was my good friend Maria Ingrassia. Maria happens to be a staffer for the Congressman for my district, Rep. Sean Patrick Maloney (http://seanmaloney.house.gov). But she has been my friend long before she started working for Sean. She is a fantastic staffer and asset to Rep. Maloney and his district team. But she is also a great friend and she gave me a great deal of information about St. Luke’s and their facility and the cardiac team I was seeing that was a huge comfort to Eve and I and source of mental relief. She made sure Eve had her cell phone number and wanted Eve to call on Monday if she needed anything at all while at St. Luke’s.
On Saturday and Sunday my father and brother harvested two of my fields of onions. It totally killed me that I could not work. My doctor ordered me not to work or exert myself at all. I love to work, I love my job, and most important … MY FATHER AND BROTHER DON’T DO MY JOBS RIGHT!!!! Boxes aren’t stacked straight or properly … no straight lines of onion bags, things placed all over the place …a argh! Eve would follow me out in the yard and chase me back to the house, literally at one point throwing stones at me.
(picture below is taken by Eve after she threw stones at me to get back in the house)
Monday morning we arrived early at St. Luke’s Hospital in Newburgh, NY (http://www.stlukescornwallhospital.org/Pages/default.aspx). The procedure would be done in their well renowned cardiac unit (http://www.stlukescornwallhospital.org/clinical-services/cardiac/about-us/Pages/the-vision.aspx). The procedure would be done by Dr. Richard Gosselin:
When we initially arrived we had to sit outside the cardiac unit in a waiting area. A very friendly and chatty man started chatting it up with Eve. I took his pic and tweeted about him, unbeknownst to him:
We were finally ushered into the unit and I was ordered to disrobe … except my socks. Now, I was officially bummed out because I love getting those little socks from the hospital. It is the highlight of your stay. As I sat and waited for the initial prep stages to start I actually Periscoped from my bed.
Eve wasn’t amused and almost took my phone away.
I must admit though I wasn’t a basket case I was a bit nervous. A funny semi-exchange resulted when the elderly man in the bed next to me, who we couldn’t even see because a curtain separated us, offered his opinion. Here is the tweet that related this:
We met Dr. Gosselin, who along with Dr. Portelli, Eve and I liked and trusted very much. He was warm and sincere and very optimistic and told us not to worry. He then had the nurse give me a Valium and a Benadryl prior to the procedure. Those pills had absolutely no effect. Pic below was taken 15 minutes after I took them:
They then wheeled me into the procedure room across the hall.
As I was set up on the table my right arm was extended out. They said that 85% of the time the catheterization (https://en.wikipedia.org/wiki/Cardiac_catheterization) are performed in the wrist, 15% in the groin area. They prep both areas in case they can’t do it in the wrist. The prepping process includes obviously shaving the region. As the nurses shaved my groin area I said “well, it’s my wife andI’s 25th next week and I was going to do that as an anniversary present anyway.” They laughed and one quipped “I guess your wife is going to have to reciprocate.” I replied, “that’s in negotiations.” They all laughed again.
They used a local anesthetic at the point of insertion in the wrist and some sort of other anesthetic. You are awake during the procedure but though you believe you are lucid, you really aren’t. I can remember watching part of the procedure on the television monitors above me (they left my glasses on for the procedure) and I think I made the nurses laugh some more, but I have no clue as to what I said. And to me it seemed like the procedure took only 10 minutes when it in fact lasted about an hour and a half.
When I was wheeled out I had pretty significant chest pains. The nurse asked how bad and I said “6.” Eve, who was waiting the entire time in the prep area during the procedure asked “okay, but what level for normal people?” I then said “8.” Eve knows I have a pretty high toleration for pain. I was getting nitroglycerin in my IV drip so the nurse then increased the dosage, At this point Dr. Gosselin emerged and told us that I had a 95% blockage in my left anterior descending artery (https://en.wikipedia.org/wiki/Anterior_interventricular_branch_of_left_coronary_artery) and that he applied a stent in the artery to open it.
I was in shock. Total, absolute and complete shock. The only blockages in my life I have ever had to deal with typically involved this device:
Even up to that point I was convinced nothing would be found and it was stress or anxiety causing my symptoms. According to the Wiki article above it was this same sort of blockage that killed former NBC newsperson Tim Russert. Dr. Gosselin gave Eve a document which had details on the stent, and it included a wallet size version I now needed to carry at all times. He then said either he or Dr. Portelli would talk to us tomorrow when I would be discharged. I forgot to mention, we were told prior that if nothing was found I could go immediately home but if a stent was placed I would need to stay in the hospital overnight for observation. Then Dr. Gosselin left.
As I was lying in the bed in the prep room the chest pains subsided due to the increased nitroglycerin in the IV, but, the increased nitroglycerin triggered a massive headache. A headache probably as severe as the headache that crippled me nearly a week before on Capitol Hill in DC. The nurses gave me a dose of cocktail of drugs I use for my acute pain relief. But they had absolutely no effect on the headache. What seemed like an eternity but probably was only a half hour or so we waited for my room to be ready. When they finally started to roll me out of the prep room to my recovery room I was hit with waves of pain in my head, chest and an onset of nausea that made me feel like I was going to vomit.
Within a few minutes we were in my room and by then I had totally sweated out my sheets. I was literally writhing in pain and I was unable to sleep or feel any relief. And this lasted for roughly 5 or 6 hours. After 6 hours my chest pains had lowered enough that the nitroglycerin drip could be shut off and I was given a 2nd dose of my headache relief cocktail. I then was finally able to get some sleep.
I awoke a couple of hours later to Eve quietly chatting with our good friend Brian who came to visit us in the hospital. His visit was so kind and it really made us feel much better.
A couple of hours after Eve eventually went home Dr. Gosselin came in to check on how I was doing. He then said that Dr. Portelli would see me in the morning and would clear me for release. I then tried to watch the Jets game on Monday Night Football but the woman across the hall was a bit of a distraction. As I tweeted:
Though her hands seemed to be wrapped up like a sock puppet she continued to set off the nurse call button every 2 minutes. It was like being in bed next to a firehouse with a arsonist on the loose.
Now, I must say this, the nursing care and related care provided by St. Luke’s was fantastic. All of the nurses were patient and kindly and extremely attentive and helpful. It was my first visit to that hospital and I must say the treatment and care was excellent.
Eve arrived as I was sleeping early Tuesday morning and patiently read a book until I awoke. She could see I still had some discomfort or pain and not a great night. At about 10:00am or so Dr. Portelli came to visit and put in motion my discharge from the hospital. He told Eve and I that my blockage was near 99%. His office had previously scheduled my initial follow-up with him for Tuesday September 29th. He said a dietician and a cardio rehab person would be at this appointment in New Windsor. Eve said she is definitely taking me to that appointment. I was put on a new blood thinning medication that I would have to take for at least a year connected with the stent and he also prescribed a high dosage of Lipitor. My bad cholesterol levels are always good but my good cholesterol is chronically low and my triglycerides are constantly high. My previous general practitioner had put me on an early generation statin drug years ago but I suffered horrible back pain as a side effect and immediately stopped taking it. I hope this doesn’t happen with the Lipitor. He also said I could not drive for a couple of days and that I should not work until the earliest Saturday. He also said there would be mild occasional discomfort due to the stent and my body getting accustomed to it. He knew it was our anniversary on Wednesday so he cautioned us to take it easy … if you get my drift.
My bed as we left:
Eve on the way home immediately entered dictator mode as to what I was and wasn’t going to be able to eat and drink. “Hold on tiger, we haven’t even spoken with the dietician yet!” She was not deterred.
The past week I was not allowed to work by my doctor, Eve and my father and brother. That was hard. And Eve has already started to impose harsh restrictions on what I can eat and do. Over the week I have experienced occasional minor chest discomfort but on a few occasions I actually had very strong chest pains. We had a brief altercation on the farm where law enforcement was called. As I was standing around I started feeling moderate to pretty strong chest pains. So strong that I was doubled over and considered taking a dose of nitroglycerin. My dad turned to be, semi-nervous and said “walk away … just walk away.” But he then turned to me and asked “but can you fill out a ticket/receipt for the tractor trailer we just loaded.”
Me … clutching my chest and doubled over in pain … “uhm … NO!”
I watched enough daytime television to last me for at least 2 months. I didn’t have enough time to catch up on what was happening in what my grandmother used to refer to as “her stories” on the soaps.
On Tuesday September 29th I had my follow-up visit with Dr. Portelli. Eve and I really like him. We brought him a 50 lb bag of onions which he gratefully accepted and shared with the office. He went over my procedure and explained exactly where the blockage was and what the procedure did. He ordered a follow-up stress test and scheduled my next visit with him as well as pre-visit blood work. He then said that he wanted me to do cardio-rehab therapy. His office would contact them and they would contact me to set up an appointment. They would also have a dietician there to address some of my eating habits. The cardio rehab would help transition back to work more smoothy, though he cleared me to do light work starting today! I can work the forklift and the like, I just can’t do any heavy lifting or strenuous activity. And he didn’t mention any serious damage to my heart so that was great non news! Eve had a list of questions which he answered and the ones he couldn’t he said the dietician associated with the cardio-rehab group would be able to fully address.
As we were leaving the office I thanked him for saving my life. He hugged me. It was a nice moment.
I just can’t emphasize enough how fortunate I am. First, that I showed pronounced symptoms of a problem, when I lifted the water bucket and experienced the severe chest pains. Second, that my wife, all my friends on social media, especially Facebook, and my primary care person Vicki, all urged me to take it seriously and seek medical attention. And finally I happened upon a doctor who didn’t just go by the EKG but actually “practiced” medicine and correctly diagnosed my symptoms for what they indicated, a serious cardiac situation. If I had gone to an ER they might have simply done an EKG and took vitals, saw there was no problem and sent me home. And I would have continued to work and would have probably suffered a heart attack.
Very fortunate indeed.