Heartache

Several months ago, during a routine medical check, it was revealed that my cholesterol levels were abnormally high. I was measured at 9.0. The average is about 4.5 (that's expressed in mmol/L. Some countries report results in mg/dl - to convert, divide by 0.02586). I was so far over to the right hand side of the bell curve that I was single-handedly increasing the national average. I got three stars on the report that came back from the path lab. Something, it was made clear to me, would have to be done.

I reported the test results to a friend who thought she had high cholesterol until she heard my Olympic record breaking figures.

"Gosh," she said, impressed. "You’re the only person I’ve ever met with solid lard circulating in their veins. Did it clog up the syringe when they took the blood sample?"

I had to confess that there had been no such effect. The blood was still liquid with a distinct absence of lumpy bits. Mind you, the rainbow effect as the sunlight glinted off the layer of oil on the surface tended to give the game away. I think I might be a national resource. They can attach my circulatory system to the inlet valves of the Marsden Point oil refinery. New Zealand will never have to import crude oil again; we can be completely self sufficient. Perhaps I’ll get a medal.

A daily pill was prescribed and a strict low fat diet. Much of the savour left my dining table and I began to live on chicken and fish, cooked in sauces based on fruit juice and cornflour. Surprisingly these turned out to be tastier than you might think and mealtimes perked up a bit. I investigated interesting things to do with vegetables. I ate breakfast cereal that claimed to be 99% fat free and I anointed it with non-fat milk. I drank my tea and coffee black (this was no hardship – I’ve always done that). I stopped spreading grease on my bread. The only taste on my toast was a thin layer of jam, the only lubrication in my sandwiches was pickle, the only fillings fat-free ham, salad and fruit. When I went away on business I lived exclusively on raw fish from Japanese restaurants. I grew a dorsal fin and had to strongly resist the urge to swim home rather than fly.

Exercise (yuck!) was highly recommended and so I bought a second hand exercycle. The advert was irresistible ("late model, low kilometres"). I pedalled every day. Not surprisingly, I lost weight.

But I didn’t lose any cholesterol.

Initially the levels dropped slightly. But then they climbed up again as my liver, appalled at the lower levels it was finding, began manufacturing cholesterol at ever increasing rates and pumping it into my blood. My body, it appeared, was determined to die of a heart attack, and there didn’t seem to be anything I could do to stop it.

An appointment was made to see a cardiologist and an ECG examination was scheduled so that we could all find out how much damage had already been done. I was instructed to bring shorts and running shoes for they intended to put me on a treadmill and measure all the different ways my body didn’t cope with the pressure.

Fully equipped, I turned up at the appointed time.

The lady in charge of the ECG equipment told me to get changed. "Bare chest, shorts and running shoes, please."

When I was ready, she took my blood pressure. It was normal. Then she produced a razor. "I have to shave your chest, so that we can get a good contact for the electrodes."

"OK," I said.

"I’ll try and keep the pattern symmetrical," she said, "so that nobody will laugh at you when you take your shirt off in public."

I brightened up a bit. This began to have possibilities. "Can you write your name instead?" I asked. She gave me The Look – you know, the one that means they are beginning to have serious doubts about your sanity. I was starting to enjoy myself.

"Now we have the sandpaper." She scrubbed vigorously at the freshly shaved areas then she dabbed an electrically conductive adhesive on the patches of bare skin. I began to feel like a plank of wood that had been planed square, sanded smooth and smeared with glue. Perhaps I’d end up as part of a coffee table. These ambitions died as she attached electrodes to the adhesive. She hung wires on the electrodes.

"Oops," she said.

"What’s happened?"

"I stuck one too many electrodes on you," she said. "I thought they looked a bit unsymmetrical." She pulled the extra one off and threw it away and then she rearranged the wires, frowned and rearranged them again. The wires came together in a belt which hung loosely round my waist. A single, rather fat cable led from the belt to a machine that stood by the treadmill. A screen showed the peaks and troughs of several graphs that marched implacably across it from right to left in response to mysterious electrical activity inside my body. In the top right hand corner of the screen was a glowing green number.

"That’s your pulse rate," explained the technician. We stared at it. It was normal.

There was a keyboard attached to the machine and she typed a few commands on it. The graphs changed shape slightly as the scale altered. "I’ll go and tell the doctor you are ready," she said. "He has to give you the once over before we put you on the treadmill. We don’t want you dropping dead on us."

The cardiologist came in and listened to me with a stethoscope. He read my notes and said, "Hmmm. You’ve been referred to me by your GP."

"Yes"

We discussed my complete lack of any symptom other than the high cholesterol itself. "I feel remarkably well, in fact. That’s what makes the whole thing so ridiculous," I complained peevishly. "It wouldn’t be so bad if I felt ill, but I don’t."

"I’ve never had a patient who complained about not feeling ill," he said thoughtfully. "I wonder if it’s a new syndrome?"

"It’s probably all my GP's fault," I explained. "I think she must have put the cholesterol in there when I wasn't looking"

He agreed with me that it was a distinct possibility

He turned to the keyboard and played with it for a while. A window opened on the screen and displayed mysterious figures and the graphs ceased their stately progress. Something went beep. "I think I’ve broken it," he said. "Damn computers. I hate them."

The technician glanced across. "Press Escape," she said.

He looked puzzled. "What?".

I decided to intervene. "Top left hand corner of the keyboard," I said. "It's a key with the letters ESC on it."

He found it and pressed it and the machine started working again. "Thank you," he said, greatly impressed. "How do you know so much about computers?"

"It's what I do for a living."

The technician stood me on the treadmill and attached a blood pressure cuff to my left arm. "The test will last for 12 minutes," she explained. "Every three minutes the speed will increase. I’ll be taking your blood pressure at each increase. We’re going to get your heart rate up to 144 and then work you hard for a little while. If you feel faint or get chest pains, tell me and we’ll stop immediately."

The treadmill began to move and I started to walk.

"Relax," said the technician in soothing tones. "Stop being so tense. You’ve got a poor technique. Don’t grip the handlebar. I don’t want to see any white knuckles." In the top right hand corner of the screen, my pulse rate began to increase. The ECG machine began to excrete paper as it made a permanent record of the graphs that marched in such a stately fashion across its screen.

"Three minutes," said the technician. The blood pressure cuff gripped my arm briefly and the treadmill got faster. The belt around my waist that all the wires led to felt loose. I wondered if it would fall off. I hoped not. I’d hate to have to start this all over again.

"Six minutes." Again my blood pressure was taken and the treadmill increased it’s speed. I was starting to feel it now. My legs were aching and I was beginning to pant. My pulse rate was up to 140. As I watched it reached the magic figure of 144. "Oh good," I thought. "Maybe we can ease off now." No such luck.

"Nine minutes." This time the speed increase seemed out of all proportion to the previous ones and I really had to hurry so as not to fall over. My body was leaning at a 45 degree angle as it fought against the treadmill that was trying to make it fall over in a heap. Try as I might, I couldn’t get vertical. Looking in the mirror on the wall, I could see that I had turned distinctly pink. I was panting quite hard now and my pulse was racing at 168. The technician was looking anxious.

"Are you feeling OK? Any chest pains? If it gets too much, just say and I’ll stop immediately."

"I’m OK," I said, in between gasps. "Let’s keep going." My thighs were on fire and I was sucking air deep into my chest. Apart from a hammering heart that was giving the distinct impression that it wanted to leap out of my chest and go for trip to the seaside where it could eat fish and chips, drink beer and attempt to pick up women, I felt great.

I watched my pulse hit 183 just as the technician said, "Twelve minutes." The treadmill decelerated and soon came to a complete stop. I hung on to the bar and panted and listened to the rapid thumping inside my chest. "Come and lie down for a moment," said the technician.

She led me to a trolley and I stretched out and looked at the ceiling while she removed the electrodes. There were several cartoons stuck to the ceiling. In one, a sorry looking man lay on a bed. He was covered from head to foot with enormous zig-zag surgical scars crudely sewn together with huge Frankensteinian stitches. A doctor was saying, "You’ll be pleased to hear that the exploratory surgery found nothing wrong."

Another showed an enormously fat man swimming in the sea. Two sharks circled below him and one was saying to the other, "I was tempted, but I thought he might contain too much cholesterol."

Once everything had calmed down and I was slightly less pink, I got dressed. The technician took the huge roll of paper that the machine had regurgitated off to the cardiologist. After a time, he summoned me to his office.

He said, "Regrettably…"

(Oh shit!)

"…your ECG is completely normal. I can’t find any evidence of damage at all." He looked glum at the thought of all the money I wasn’t going to pay him.

We examined a chart that correlated my age (ancient), blood pressure (normal), whether or not I smoked (no), and whether or not I had diabetes (no). It seemed I had a 5% to 10% chance of a cardiac related event (heart attack or stroke) over the next 5 years. The longer I continued with a high cholesterol level, the greater the chances of fatty deposits blocking the arteries to the heart, and the higher the likelihood of such an event. I had been lucky so far. This probably wouldn’t continue.

Given the nature of my new diet, and the fact that I’ve always eaten a fairly low fat diet anyway, it seems likely that I have a genetic predisposition to high cholesterol. It is a completely symptomless disease, apart from the rather extreme symptom of the heart attack that appears one day out of the blue and kills you. However some people with astronomically high cholesterol start to deposit fat in unlikely areas of the body and often they will have a white fatty circle around the iris of the eye. My father had such circles around his eyes. I remember noticing them as a child and thinking how odd they looked. At the moment my body seems quite tolerant of its high cholesterol and that too is probably genetic. But I can’t continue to rely on it for protection.

The doctor and I decided that I was a prime candidate for one of the new statin drugs. These, he explained to me, would cut through my cholesterol like a hot knife through butter (apt analogy there, I thought). I will have to take the drug every day for the rest of my life.

In the short term (i.e. the next few months) I probably don’t have much to worry about. In the long term I should be able eventually to reduce my chances of a cardiac related illness to something more reasonable. The future looks hopeful, as long as I continue to eat sensibly and generally take care of myself.

"What I suggest you do now," said the doctor, "is go and have a celebratory lunch. Perhaps a cheese and cream sandwich. Deep fried, of course."

As I left, he shook my hand. "I hope this handshake guarantees that a large part of your computer expertise will rub off on me," he said.

"Oh yes. But you have to WANT to change…"