Tag Archives: heart attack

Quick Update

I flew back to the United States from the Philippines on October 22nd. On the 24th I had an ultrasound on my heart and I met with my cardiologist on October 26th to go over the results of the ultrasound. (For those who may be new to my blog I had a heart attack last year… you can read about my journey back to diving in the archives) I continue to improve and the good news is that my heart function is back within the normal range. I have some minor valve leakage which he is not concerned about. He’s cleared me to start exercising again so maybe I can start dropping some of the weight I’ve gained now!

I’ve decided to go back to work after being “retired” for 3 years. I need to supplement my income a bit to feed my scuba addiction 😄 (will teaching scuba diving qualify as “work”? 🤔) I’m in Hawaii now where I’ll be for about 2 1/2 months. (those of you who follow my Facebook page already know I’m here). I’ll be attending my IDC, EFR Instructor, and MSDT courses with Dive Oahu.

The tentative plan after Hawaii (plans are always subject to change) is 2 months in the Philippines. I’m guiding a couple of buddies on a dive trip around the Philippines in February. In April I should be heading to Guam where I’m planning to teach scuba diving and spending at least a year. It’s a good location. Guam is less than 4 hours from one of my favorite dive destinations (Philippines), and part of the world-class diving of Micronesia! What’s not to like?

I had the usual distractions when I was home taking care of business and visiting family and friends so as usual I’m a bit behind but there are no deadlines other than self-imposed ones 😀 My next blog post will be on Anilao, then I have another short one on my second visit to Puerto Galera this year. It’s coming up soon so stay tuned!

Cleared to dive! Travel to Puerto Galera…

On Wednesday, March 8th I met with my cardiologist at Medical City-Clark here in the Philippines. Doctor Payumo confirmed that I’d done very well on the exercise stress test which was good news! I had achieved 15.1 MET’s well above the 13 MET’s minimum, recommended by DAN. Additionally all my labs were within normal range. She gave me a clearance to dive and recommended I have a followup in 4 months.

The following day I left for Puerto Galera!

I took a bus from San Fernando, Pampanga to Cubao in Metro-Manila. From there I took a JAM Bus to Batangas Pier (175 pesos). We left around 3:45 PM and arrived at the pier 2 1/2 hours later. I expected to miss the last ferry and planned to either spend the night at a hotel near the pier or see if a private boat might be available. As it turned out, a private boat was available.

This was my first time taking a private boat and it turned out to be a learning experience. I was approached near the terminal and told I could hire a boat to go across for 5000 pesos. My reaction was to laugh! Then they said they could take me for 1500 if they could find 2 other people. I agreed, reasoning that would spend a good percentage of that amount to get a room for the night. Two other people did show up, a guy from Ireland and his Filipina girlfriend, but did not want to go for 1500 pesos stating they would just get a hotel room instead. After further negotiation, an agreement was reached that they would take us for 3000 pesos, so a 1000 pesos each. Even better I thought!

We were led to another area of the piers. I paid 50 pesos for a port fee. The guy who was organizing the crossing said he needed the money before we got on the boat as he needed to pay the people who pointed us to him. As I had entered the terminal area there were men standing near the entrance who were asking everyone coming in if they were going to Puerto Galera. I admitted that I was and someone walked with me to the terminal and pointed me out to the guy coordinating. I didn’t ask him to walk with me and certainly didn’t need him to show me to anyone, but I’m sure he got a few pesos for walking with me.

Without giving it much thought I handed a 1000 pesos (around $20 bucks at the current exchange rate) to the coordinator. The Irish guy said he would give half and give the rest in Puerto Galera which the coordinator agreed too. We got on the boat and then sat a few minutes waiting to leave. After we were on the boat 3 more people came and got on the boat (locals). My Tagalog is somewhat limited. I understand a lot, but I’m far from conversational. The Irishman’s girlfriend didn’t have that problem and overheard everything being said. It turned out the 3 locals had only paid 500 pesos each! Then the Irish guy was told he had to pay the balance of another 1000 pesos before the boat would leave!

He said no! We had been told that the 3 of us were hiring the boat for 3000 pesos. Now they had 3 more people who are paying half what we were! He told them flat out that he’d already paid the same amount that the 3 late arrivals had paid and as far as he was concerned that our agreement had been broken. If it were a problem, then they could give him his money back and he and his girlfriend would just spend the night in Batangas. Of course the coordinator didn’t want to do that. The boatman wouldn’t leave because he’s not gotten his money yet. Everyone is pretty calm but now we are at an impasse.

I’m on the Irish guys side, but other than offer verbal and moral support, there isn’t much leverage on my side as I’ve already paid in full. We saw it as being scammed. I couldn’t do much beyond laugh! They went back and forth for a good 30 minutes (the coordinator left a couple of times and came back). Finally an agreement was made that they would pay another 600 pesos (not 1000) and we could go! It was a small moral victory at least. What I learned from it was that someone can get a small bangka boat to make the crossing for 4100 pesos minimum. No one is going to be happy though! 4500-5000 pesos is reasonable to hire the boat, but not if they are going to put extra passengers on the boat. Then they are just making extra profit at your expense.

We finally got underway around 7PM. The crossing was pretty nice. A little slower of course than on the ferry, but weather was good (else the Coast Guard would not have allowed us to go) and the moon was almost full and visibility was good. We arrived around 9 PM at Sabang. I was able to get a room at Mermaids Resort and Dive Center. The main resort is up the hill on the main road from the pier, but they also have rooms over the dive shop. I was able to get a room for 1450 pesos a night. I got checked in, went and grabbed a bite to eat, then went back to my room to get some rest.

To be continued…

Stress Test

I went in for lab tests and an exercise stress test on Friday, March 3rd. It took about 3 hours for me to get there from where I’m staying on Subic Bay near Olongapo City. The labs had to be done in the morning since they’re doing a blood lipid panel to see where my cholesterol is. I have to have blood drawn between 9 and 12 hours from my last meal. Trying to make it at 9 hours would have given me no sleep! I finished eating around 11 PM the night before so I needed to have blood drawn before 11 AM.

I caught a bus at 7:30 AM that was going all the way to Dau, near Angeles City. 158 pesos. I got to Dau at 9:45 AM. A short walk and I was able to catch a jeepney to Clark Main Gate where there is a jeepney terminal. Less than 10 minutes. From there I caught a second jeepney to Medical City-Clark. After checking in downstairs with TriCare, I arrived at the lab right at 10:30 AM with only 30 minutes to spare!

After getting my blood drawn and providing a urine sample, I caught the shuttle to SM City Mall-Clark and had some lunch. I walked around the mall for a while. I normally would have had coffee, but I wasn’t allowed to have any caffeinated beverages before the stress test. I had a mango shake instead!

When I checked in for my stress test around 2:30 PM they took my height and weight. A little surprisingly I’d gained 10 lbs in the last month! I’d been told to take it easy by my doctor, but perhaps a “little” more exercise might have been good! Probably didn’t help that the local VFW, where I spend a lot of time due to their free WiFi, started serving “apple pie ala mode”! I started having this almost every day… probably not very helpful in keeping weight off!

After taking my height and weight I was escorted to the room with a treadmill and an EKG machine, where the test would be conducted. The tech left the room while I changed into a pair of gym shorts. After I changed she came back in and placed a chair on the treadmill for me to sit on. She then started hooking me up to leads to the EKG machine. They got a “resting” blood pressure and pulse. 110/70 for my blood pressure with a resting pulse around 70. My blood pressure was very good as it has normally been. My resting pulse was a bit higher which I attribute to loss of conditioning over the last few months. A more normal resting pulse rate for me would be a little lower at around 65 bpm.

Sitting and waiting while they take my readings at rest before starting my exercise stress test.

A doctor came in and introduced herself and explained how the test would go. Basically the goal was for me to reach 85% of my maximum heart rate which is calculated as 220-58 (my age) while they monitored my heart. My blood pressure would also be monitored throughout. The doctor explained if it became dangerously high defined as 220/110, the test would be stopped. The treadmill would go through a programmed series of steps where speed and elevation would be gradually increased in order to stress my heart. If I were unable to keep up or began to suffer symptoms such as severe chest pain, extreme shortness of breath, leg pain, weakness, or dizziness, then she would also stop the test. Each stage was 3 minutes and I did a total of 7 stages before going into a cool down.

I showed her a printout of an article from Divers Alert Network website showing that I needed to achieve 13 MET’s at Level 4 of a Bruce Protocol in order to be cleared to dive again. I let her know that my goal was to exceed that level.

As it turned out, I had no problems exceeding it. The test is designed to gradually increase the stress. It took over 18 minutes and Level 6 for me to hit 85% of my maximum heart rate. I still wasn’t working that hard at that point and was at only 10.3 MET’s! As I approached a 100% she slowed things down a bit to keep my heart rate up but so I wouldn’t exceed the maximum. My blood pressure topped out at 140/90 so never even close. I ended up at 15.2 MET’s at level 7 so well above the minimum I needed to meet! (at least as I understand it)

They also measured how long it took my blood pressure and pulse to return to normal. I had 6 minutes of cool down on the treadmill. My pulse had dropped to a 100 by then. In fairly short order I was fully recovered. Truthfully I was surprised at how well the test went and how quickly I’ve seemed to recover, but I’m not going to complain!

I have an appointment with my cardiologist on Wednesday and we’ll go over my test results. I’m only a layman, so possibly there was something in my EKG which will be a contraindication for me to dive, but I’m pretty confident of being cleared to dive!

I’ll keep y’all posted!

Another update…

I went back in the hospital on January 26th (yes I know I’m way behind on my blog!). This time I was at The Medical City-Clark, which is one of the best hospitals in the Philippines. Also, important to me was that they would bill my insurance, so I only had to pay my deductible, which saved me several thousand dollars this time! Unfortunately I’m still waiting to be reimbursed for the hospital bill in Singapore!

On Friday, January 27th my cardiologist here in the Philippines, Dr. Elaine Payumo, performed another angioplasty, to clear the 80% blockage that I had on another branch of my left coronary artery. After clearing the blockage, she inserted another stint. Unfortunately, I had scar tissue on my wrist where they performed the previous angioplasty when I had my heart attack in Singapore 3 months ago, so they were unable to go in there this time. Instead they had to go in at the groin, which was a lot more uncomfortable and required more recovery time. I spent the rest of Friday in ICU and most of Saturday. I again had issues with my blood pressure being too low and required support for that. By Saturday evening I was in the low normal range and was moved back to a regular room. I was discharged around lunch time on Sunday, January 29th, with instructions to take it easy for a week and then come back to see my doctor. A big part of that was because of going through the groin. An incision was made in my femoral artery and I needed to make sure it had a good start on healing.

On February 6th I went back to my cardiologist. She told me I’m doing well. I have very little scar tissue. My resting heart function has recovered to over 60%, both of which are good signs.

She renewed my prescriptions for my medications. Right now I’m on DAPT (Dual Anti-Platelet Therapy). I’m taking ticagrelor and aspirin as blood thinners. That’s recommended for at least 12 months. I’m also on atorvastatin for cholesterol. I take omeprazole in the morning as a precaution against internal bleeding due to the blood thinners.

I was instructed to take it easy as far as exercise. Walking and stretching only. I’ve been recovering in Olongapo where I have a place on the beach. I have a very nice view of Subic Bay from the balcony at my hotel. This has been torture at times because conditions have been excellent and I can’t help but think about all the diving I’ve been missing! My doctor told me to come back in a month and to have my labs done again and a stress test before coming to see her. I’ll be doing those this Friday. The results of the stress test should be ready by Tuesday and I’m scheduled to see Dr. Payumo again on Wednesday, the 8th.

Although I feel I’ve had a lot of improvement, I’m not sure if I will be cleared to dive next week. I’ve a feeling that I will only be cleared to exercise harder and will have to come back once again to be cleared to dive. I hope I’m wrong, but that’s what I expect right now. I still hope to be diving again by mid-April but we’ll see.

In the meantime, I’ve finally finished my eBook on diving in Puerto Galera! I know I’m way behind schedule on that! I started working on it in August. I was a bit optimistic in thinking I’d have it done sooner. It’s not a long book (most e-books aren’t). Just 48 pages. I’d finished most of it prior to my heart attack in November. I had a couple of chapters left to write and I’ve been procrastinating. Finally got back to work on it last week.

In it I’ve tried to distill the information one would need to plan a dive trip to Puerto Galera on the island of Mindoro in the Philippines. It’s aimed mainly at people living in the United States, but anyone traveling from anywhere I think can find some value there especially at the price point that I’m going to offer it at.

Puerto Galera has a reputation as one of the premier dive destinations in the Philippines… a well deserved one in my opinion. The book is available on Amazon now! “Underwater Adventures-The Ultimate Guide to Diving the World: Book One-Puerto Galera, Philippines” by Bill Stewart.

I think you’ll find some good information there and it’s only $0.99 cents! Check it out!

Heart Attack

“The first sign or symptom of cardiovascular disease can be chest pain – or your first heart attack. DAN diving fatality statistics reveal many cases of sudden death due to cardiovascular disease with no prior history of it.”-Dr. James L. Caruso on Cardiovascular Fitness and Diving from the July/August 1999 issue of Alert Diver

Sometimes when you least expect it, life throws you a curve ball…. I was on my way back to the Philippines after spending 2 months in the US. I was changing planes in Singapore on Thanksgiving Day for the final leg of my trip  which had started in Houston.  When my flight landed, my connecting flight to Manila was already boarding.  I ran from the terminal where I landed to the terminal where my connecting flight was leaving from.   A few minutes after reaching the gate I suffered a heart attack!

I’m very fortunate that it happened on the ground and not in the air (or even worse while diving). Given that I had a 100% blockage in my left coronary artery I’m lucky to be alive. I was told it’s not uncommon for someone with a 100% blockage to essentially drop dead on the spot. In spite of the pain, (picture your chest being crushed in a gigantic vise and your left arm going completely numb) I stayed conscious through the whole ordeal.  A paramedic came to the gate and then a doctor.  I was rushed by ambulance to Changi General Hospital.

“Cardiovascular events cause 20 to 30 percent of all deaths that occur while scuba diving.”-Dr. James L. Caruso on Cardiovascular Fitness and Diving from the July/August 1999 issue of Alert Diver

I spent 5 days in Changi General Hospital here in Singapore.  Upon arrival they confirmed that I was having a heart attack.  When they found the 100% blockage that was causing the heart attack, they also discovered that I have 2 other blockages. One is 50% and the other 80% which will require later treatment. The priority obviously was to clear the one that triggered the heart attack.  They inserted a catheter through my wrist and into my heart.  They then performed an angioplasty and inserted a stint.

Shot in the Cardiac Ward at Changi General Hospital in Singapore 4 days after my heart attack.

My cardiologist told me the day I was released from the hospital that I shouldn’t be in denial and that it was unlikely that I would ever dive again. I think I’ll be getting a 2nd opinion on that though! The damage was extensive I was told, but it will be a few months before we can see how much I can recover.  I’ve had conversations with two friends who were able to come back to diving after a heart attack.  I know every case is individual, but I’m hopeful that I’ve not made my last dive yet!

I was told to expect to be on blood thinners for at least a year.  After that I can probably get by with taking a daily aspirin.  I will need to pass a pretty extensive physical and stress test before I can be cleared to dive again. No guarantees but I’m going to give it my best shot!

My case was a bit unusual. I’m an active person. I had completed over a 100 dives in the Philippines between October 2015 and September 2016.  My cholesterol was high but my blood pressure was in the normal range and I’d had a checkup earlier in the year and a normal ECG.  I’m a non-smoker. I had a stress test 10 years ago, but was told my heart was fine.   I did suffer occasional chest pain but I’d put this down to reflux (I have GERD and have been on medication for it off and on for years).  Because of the stress test I had a tendency to write off chest pain as reflux.  With three blockages, apparently at least some of that chest pain was not GERD!

The other thing was my weight.   In 2012 I was 185 lbs.  By the time I left for the Philippines in October 2015 I was 222 lbs!   At the time of the heart attack I was around 193 lbs at a height of 5′ 11″.  Heavy, but within the height/weight standard I had to meet when on active duty with the Navy.

One of my close friends who is also a diver told me it’s a wake-up call for all of us (especially “Baby Boomers” and a big chunk of “Generation X”).  The importance of regular checkups and staying fit becomes even more important as we get older.  I’ve discovered this the hard way!

For now I’m killing time here in Singapore until I go back to the doctor to see if they will clear me to fly. That will be on the 13th. I’m still adjusting but I’m thankful that I’m here to be able to go through that!