It was Monday, October 27, 2014. I woke up feeling “pretty good”. At least good for me given my chronic illness and the various symptoms that I live through each day. The week before I had started a new protocol for IVIG. This was the protocol recommended by the doctors at the Mayo Clinic back in the early summer. When I first arrived home, I told my home neurologist of their recommendations and he had already started me on his own treatment regimen after stopping the Cytoxan therapy that I had been on for about two and one half years.
The IVIG therapy was to treat a paraneoplastic neurological syndrome that was triggered by Stage IV metastatic melanoma first diagnosed in 2008 and 2009. Since that time, I have suffered from a variety of neurological and physical symptoms that have left me totally disabled and in constant pain.
The previous week for three consecutive days (Tuesday, Wednesday and Thursday), I was given IVIG at 0.4 gram per kilogram of body weight (the Mayo protocol). This dose was about three weeks after receiving IVIG for the third consecutive month in accordance with the protocol typically used by my home neurologist (1 gram per kilogram of body weight divided into two doses on consecutive days).
Recent (2009) research done at Wake Forest University School of Medicine identified how the presence of cardiovascular risk factors serve as an indicator of how likely it is that a patient who receives intravenous immunoglobulin G (IVIG) treatment will have a stroke or heart attack.
Cardiovascular risk factors include coronary artery disease, cigarette use, high blood pressure, previous stroke or arterial thrombosis, diabetes and high cholesterol. From this study, it was found that having just one or two cardiovascular risk factors does not result in a significant increase in risk for heart attack or stroke after treatment.
***But, if the patient has three or four risk factors, the chance of having a serious complication is substantially higher.***
Now, what risk factors did I have?
- Coronary artery disease
- High (and/or variable) blood pressure
- Previous arterial thrombosis
- Previous findings of high LDL cholesterol
So, it looks like I would have had a substantially higher risk of serious complication. This does not necessarily mean that the IVIG directly led to arterial thrombosis that caused my heart attack but it does lead one to suspect a very close association between the two events. This potential cause/effect relationship is further bolstered by the fact that I had had a thallium cardiac stress test one week prior to the IVIG treatment that showed normal blood flow in the cardiac arteries and no reaction to the drug-induced stress during that portion of the exam.
***On that relatively good Monday, symptoms began to develop around noon. At first, I thought that it possibly was just the overwhelming fatigue that I feel most days in the afternoon. But it very quickly was much more than that.***
I had severe chest pain right on my sternum and it was getting difficult to breathe. My wife retrieved our pulse oximeter and blood pressure machine and it was clear that my oxygenation level was low and my heart rate and blood pressure were all over the board. I felt myself blacking out but my wife and friend kept me awake during the wait for the ambulance and EMS to arrive. The response time was at least a full 20 minutes. I don’t think that meets their contract requirements. But that’s a story for another time.
When EMS arrived, they put me on the stretcher, hooked up monitors, began oxygen and started the transport. They wanted to take me to Blount Memorial Hospital, which they said was closer, but I knew was not only further away than three other hospitals but did not have open heart surgery backup. I instructed them to take me to Parkwest Hospital, a Top 100 Heart hospital and the closest hospital to my home. In the ambulance, I was given aspirin and nitroglycerin and an IV was started. The pain and other symptoms seemed to ebb and flow but never went away. I don’t know the protocol, but the ambulance drove very slowly, observed traffic lights and stop signs and did not beat my wife and friend who drove on their own and even stopped for gas on the way.
Upon arrival at Parkwest, things moved quickly. Labs were done stat, another IV line was started, a heparin drip was initiated and the on-call cardiologist was right there in a matter of minutes. His last name was “Brewer”, which happens to be the maiden name of my mother, so I suspect that we are related in some way, even if distantly.
We went straight to the Cath Lab where the finding was a 100% blockage of the left anterior descending (LAD) coronary artery (the “widow maker”). The doctor was able to restore blood flow with balloon angioplasty. Previous stents in that artery were intact. Echocardiography would reveal minimal heart damage with an ejection fraction of about 50%.
I had no “out of body” experiences but I swear I saw an angel standing in the Cath Lab. But that was after a lot of morphine and versed so it could have been a hallucination. However, I am certain that a guardian angel was looking over me that day and saved my life. It was not my time and God still has a purpose for me to fulfill before I leave this old world.
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