Sunday, December 28, 2008


I've been thinking about anatomy a great deal lately, particularly about the anatomy of that central region of human bodily existence and perceived import, the heart.

For reasons of metaphor alone, the heart is well worth thinking about. In terms of physiology, however, the heart and the brain are organs of primary interest to those of us who value thinking because they're integrally connected to the processes that, ultimately, keep us chugging along.

I've never worried much about my the health of my brain, and for most of my life I was only vaguely aware of the fact that most of my ancestors had died of heart disease. But nearly fourteen years ago, I was discovered to be inflicted with really bad genes--an unfortunate combination of potentially lethal gifts from both of my parents. The disease is officially called familial hypercholesterolemia, a long, nearly impossible to pronounce name for genetically high cholesterol. After testing, my primary care guy discovered that my total was somewhere in the neighborhood of 500, at a time when the goal was below 200. My good cholesterol was abysmally low, and my bad outrageously high. But the doc's nurse hooked me up with a female cardiologist (the nurse was aware that women and heart disease were still little explored territory in those days, and she thought a woman would be better informed), whose first words to me after an initial exam, which began at my ankles, were "Poor baby; it's not your fault."

What my ankles told her was that I had long been depositing excess cholesterol onto my achilles tendons, forming what are called xanthomas. I had noticed years earlier that I was developing something that looked like "surfers' knots" above my heels, and chalked it up to bad shoes in my more fashionable youth. But the xanthomas told her that my difficulties, which by then included episodes of debilitating angina that masqueraded as tension in my upper back, had been bequeathed me by the peculiar combination of parents that resulted in my very existence on the planet.

I made an appointment for a catheterization to discover the extent of the damage to my arteries. In the interim I proceeded to take off across country by myself in a rented van to help my father distribute the contents of my grandmother's house after she'd moved to a rest home. I stopped off at Chaco Canyon, where I got a touch of heat stroke, and drove sick as a dog to Kingman, Arizona. The rest of the trip was relatively uneventful, but I look back on it now as a consummate folly. I was ready to pop, I found out after I had returned and kept the appointment, with four arteries clogged up nearly completely (80 to 90%). I was immediately sent upstairs to pre-op, and underwent a four-vessel coronary artery bypass graft (commonly called a "quadruple bypass") later that day. I was 47 years old at the time, and only a year into my first full-time teaching job. I was still young enough, and stupid enough, to feel invincible.

Now, all these years later, my cholesterol levels are well-controlled by drugs and diet, and my arteries are probably pretty clear. But age is now taking its toll, and my aortic valve has silted up ("calcified" is the more technical description) and I'm facing another chest-cracking, tentatively scheduled for March. Angina has returned, familiar and unfriendly, and I'm feeling terribly delicate. I can't exercise or over-exert myself, and when I suggested waiting for surgery until next summer my new (male) cardiologist looked at me as if I'd completely lost touch with reality (I seem to remember his saying, "Are you nuts?").

So now I'm consumed once again with the workings of the human heart, and that's led me to wonder about how we've visualized this particular organ through time. This has led to an exploration of images, which will be featured on the Cabinet (recently spiffed up, by the way). But since the Farm focuses on heart (in the metaphorical sense), home, hearth, and place, I thought I'd post a warning here for those who haven't yet twigged to the possibility of disease, and who just might want to hang around a bit longer in whatever place they call home.

Had I been tested in my twenties, I'd have avoided the atherosclerosis that nearly doomed me before my fiftieth birthday. My children were tested when they were sixteen and nineteen, right after my initial surgery, and my daughter was discovered to have the gene--or at least a similar combination of genes. As a result, she's on appropriate drug therapy, is physically active, and takes better care of herself than I ever did.

The benefits of living in moderation cannot be overstated. Although I couldn't have avoided the genetic component of my afflictions, eating more thoughtfully, exercising more conscientiously, and not letting stuff get to me as much as I have done throughout my life might have ameliorated the bad genes somewhat. I've done all of the above some of the time; I needed to be doing it all of the time. And, of course, following the latest adjustments, I'll do better. But it shouldn't take any of us this long to learn.

Image credit: A closeup view from above looking down on the aortic valve of Peskin and McQueen's computational heart during ejection from the left ventricle. Valve leaflet fibers are white. The red blobs are blood markers, and the red streaks show the recent paths of the blobs. From the Pittsburgh Computing Center's page, Heart Throb, on blood circulation and the heart. The page contains stunning computer models of heart functions, and I'm hoping that my using this one constitutes fair use.


Esther said...

What a great post Mom! Just for the record, I wouldn't trade the bad genes for anything in the world because they mean you're my mom. You will make it through March better than ever. I can't wait to hear that mechanical tick coming from your chest because each tick is more time with you. Love you and can't wait to go on that hike with you!

Geoff said...

Or maybe David Cronenberg was right: we shouldn't rely on fashion magazines and beauty contests alone to form conceptions of perfection. We should have contests for best spleen or kidney.

I'm so glad he's Canadian even if there are more than a few unerstandable reservations.

You should be glad he didn't give me a recipe.