On November 1, 2009, my heart attacked me.
It was a sneak attack, as six weeks prior I was informed by my general practitioner that a physical exam showed me to be in good health. Over the succeeding years I modified my diet but never really followed anything strict.
Eight-and-a-half years later, I entered the University of Michigan Cardiovascular Center for a triple bypass coronary procedure, an attempt to prevent any further disease. The problem was spotted a few days prior to the surgery, thankfully caught in time before another heart attack.
The next few months are now devoid of conducting activities. So instead of the usual music diary, I will be writing about many different topics, most related to health but also a few things that swirled around in my mind during convalescence. Perhaps my tale might help others in recognizing the signs and preventing problems in the future. If not, I hope this makes a decent story.
How did I get to this point between the two surgeries? What did I learn along the way?
First, some background and context.
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The History
Like many of you, one of the first questions I get whenever visiting a doctor is, “Do you have a history of coronary disease in your family?”
Invariably I always answered in the negative, even though my father, mother and grandfather died as a result of heart attacks. The reason I did not feel it constituted part of the history is that there was no awareness that there were problems prior to the event that took their lives. A heart attack to me was like appendicitis, or tonsillitis, not really a disease like something as simple as a cold or as complicated as cancer. There were few screening programs back in the mid-fifties, and all you could do was hope that you did not fall victim to a heart attack. It was considered one of the worst ways to go, as there was not much that could be done.
My dad was 47, his father 56, and my mother 78. It appears that longevity is not on the Slatkin side of the family. I was very happy to have passed the first two milestones, and I have almost five years to go in order to match mom. My brother, who is 71 years old, seems to have genes from my mother’s side of the family.
As a child I was actually considered underweight, even to the point where I was supposed to drink a glass of malted milk every day. Butterscotch was my preferred flavor. By the time I got to my forties, the pounds started to accrue. The battle of the bulge has continued to this very day. I did not pay attention to my girth unless I started to feel uncomfortable. Then it was a binge diet, once so severe I had to be taken to the emergency room.
Over the years my health has had a few setbacks. There was prostate removal, a couple urological surgeries and cataract extraction, as well as the whole heart thing. I am a combination of missing and additional parts, sort of like the six-million-dollar man but reduced to maybe seven thousand. But generally, I don’t get sick and have rarely had to cancel conducting engagement due to health issues.
The heart attack occurred in Rotterdam, at the end of a five-concert stretch. Those of you who read my first book, Conducting Business, may recall that I wrote extensively about that time. I was on the podium when it occurred, and the only signs that something was wrong were a sense of fatigue walking over to the hall, and feeling dizzy and out of breath on the podium. By the time I finished the Second Symphony of Rachmaninov, I did not know where I was.
In the dressing room I collapsed on the couch, drenched in sweat. The medical personnel on hand at the auditorium got to me quickly and said, “You are having a heart attack. An ambulance is on the way.” Ten minutes later I was at the Erasmus clinic, a feeling of great weight upon my chest. The only thing I remember saying was, “Make it stop.”
Cindy came from Dallas the next day. It took a few days for me to be able to speak, as I had very little strength. What I learned was that one artery had been almost completely blocked, stemming the flow of blood and backing up enough to cause the event. The doctors put in three stents. They said that my heart was actually very strong, and that this should help prevent future problems. Nine days later I was back in Detroit.
And two weeks after that, I was in Miami. Through a good friend, I was scheduled for an evaluation by the medical specialists at the university. They concurred with the Dutch but wanted me to go to the Pritikin Longevity Center, an institution that formerly was referred to as a “fat farm” but is now a life-enhancement resort and spa. For two weeks I was put on a regimen of moderate exercise and a heart-healthy diet. I’ll never forget the first item on the menu, a truly unappetizing concoction called “broccamole.”
Returning home eleven pounds lighter and in decent shape for the first time in years, I gradually got back to my regular routine. There were no epiphanies—religious, spiritual or physical. The only sign that something had changed was my desire to drink the wines I had stored up rather than let them sit on the shelf.
Did I mention that I also have sleep apnea? No? Well, I do, and as with many people it manifested itself primarily as snoring. Apnea is when you stop breathing while asleep, and it is linked to a number of heart conditions. The lungs don’t get the air they need, and you never feel like a full night’s rest has happened. Wearing a mask at night was grueling, and it was hard to tell if it helped. But it was certainly preferable to just trying one of those annoying products advertised on TV and satellite radio, which do not help get the needed oxygen into your system while you doze.
Over the last fifteen years or so, I would nod off suddenly. It could be at a movie, even a loud one such as Transformers. I took my son to the first one, and he kept poking me to stay awake. I thought I was just sleepy. Although they were reluctant to tell me, I learned that musicians who attended auditions with me noticed that occasionally I appeared to fall asleep while a violinist took a shot at the Mendelssohn Concerto. Again, my belief was that I was tired and that this was not related to the apnea. How wrong I was.
Let’s jump to January 15, 2018. Cindy and I had just boarded a plane on the way to Amsterdam. Prior to departure, I found myself short of breath and perspiring, with my pulse rapidly beating. I did not think it was a heart problem and promptly fell asleep early in the flight. Upon arrival, we went to visit the medical facility at the airport (always good to know that there is such a place when traveling). They checked me out and said I was okay, and we continued on to Poland. But I should have listened to my ticker in the first place.
In February, a very strange thing occurred during a rehearsal in Detroit. For a fifteen-minute stretch of the Symphonie fantastique, I completely blanked out. But I did not stop conducting. It was a form of musical sleepwalking. That quarter of an hour was completely erased from my mind. I know that members of the orchestra noticed and were concerned. This time I knew something was not right.
I spoke with my cardiologist, who wanted me to wear a heart monitor for two weeks. The device was simple enough, and I seemed to have no problems during that span. However, upon examination of the results, it turned out that twice I had events during which my pulse had jumped all the way to 187 beats per second! One happened while I was asleep and the other during a rehearsal. In neither case was I aware of a problem. How was that possible?
The answer was delivered to me on April 3rd, when I went to see a different cardiology expert. He indicated that I had something called atrial fibrillation. It sounded scary, but also like some flutter-tongue effect that the flutes can do. Basically, AFib is a set of electrical charges running around the upper chambers of the heart. If they get out of control, they can lead to stroke, heart attack or other heart-related diseases. It also turns out that sleep apnea can be one of the causes.
The doctor gave me a couple options, including a wait-and-see approach. But ultimately, he recommended catheter ablation. I knew about catheters from problems south of the border but had never even considered that one could be used to solve a heart issue. In this case the device is inserted in the leg and sent up to the heart, and electrical impulses create hot spots to control the rate of fibrillation. A lot of people have had this procedure and seem none the worse for wear. And you are home that day with only aspirin to take for a couple weeks. At the most, I would only have to cancel one week of work, if that.
I wasn’t convinced that this was right for me, so I sought a second opinion. Good thing, too. This doctor recommended a few more tests and said that ablation surgery only should occur when the frequency of rapid heart rate gets shorter and shorter. During the first week in May, I went through a battery of tests and found out that my coronary arteries were damaged, with a 90% blockage in one artery. Of course, this is what can lead to a heart attack. The two cardiologists were in touch with each other, and after yet another day of tests, I went in for bypass surgery on May 8.
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In the next installment I will write about the actual procedure, my interesting stay in the hospital—which resulted in some new thoughts about music—and my return home. These entries may occur during the next few weeks, so keep checking in regularly rather than once a month. And please heed your doctor’s advice and be sure to get full check-ups and quality follow-up. Most of all, listen to your body. It tells you what is going on all the time.
See you soon,
Leonard