Episode 49: From Heart Nurse to Heart Patient-Jen Shetler’s “Unroofing” Journey.

SPEAKER_02 0:00

It went from something's weird to oh my god, I'm dying. It was a minute max where I felt something in my chest to this is the worst pain I've ever had. I'm 45 years old, I'm healthy, I'm not overweight, I look in shape, and I knew anyone looking at me saying, I have kind of something going on, would be like, it can't be hard. So I walked in and said, I'm having chest pain and it is severe. And I think it's important for us to say those words and not cover up what we think it could be. Because if you say the word chest pain, immediately they have to take action.

SPEAKER_01 0:47

Welcome to Imperfect Heart, a place for you to join me, Jeff Holden, in conversations, discussions, and dialogue about our hearts and the impact myocardial bridges have on them. We'll talk with healthcare professionals, those in related fields that support our condition, and others just like us with stories of their myocardial bridge experiences. It's my intention for this content to inform, educate, entertain, and even motivate or inspire you in your personal journey on dealing with a myocardial bridge. Most importantly, is to have you leave each episode with hope, knowing you're not alone and that what you're experiencing is real. As you all know, every guest, every myocardial bridge, every journey is unique. It's not often we hear from a marathon runner, but we have a couple we've spoken to. It's not often we have a nurse or a doctor with the condition we have. But we have a couple we've spoken to. And it's clearly not often that we have a guest that goes from diagnosis to surgery in a period of about a month. As a matter of fact, I'm not aware of that ever happening, with the exception of the unicorn situation we'll talk about today. No, our guest is not a unicorn, but the situation surely is. She's not only a marathoner, but an ultramarathoner. She was not only a nurse, but a cardiovascular nurse working in interventional cardiology, and she went from presentation of symptoms and diagnosis to surgery in a month. It helps to know what you're dealing with, and Jen Shetler not only knew what she was dealing with, but she wanted to dealt with immediately. And she had her unroofing done on her explicit and detailed description of the process to the cardiologist she chose to perform the surgery in North Carolina. Her story is a candid explanation from start to finish from a patient and a professional perspective. So get your notebooks out. She gets a little technical. A mother, a wife, a healthcare professional, and now a myocardial bridge unroofed patient. Jennifer Shetler, welcome to Imperfect Heart.

SPEAKER_02 3:01

Thank you. I'm glad to be here.

SPEAKER_01 3:02

And I'm so excited to speak with you. You may hold the record for one of the quickest diagnosis to surgery times of any of us. We'll hold that part of the conversation for a little bit later, because I'd like to get everybody an opportunity to know you a little bit better. Like most of us, you were good until you weren't. You're a big-time runner, a marathon, or a full-time employee, a mother of four, and a former cardiac nurse. You're going to bring something really special to the conversation that we haven't had before because you are both the doctor side of it, the medical side, and the patient side. Tell us when you first realized something wasn't right.

SPEAKER_02 3:55

And that's kind of what happened with me. So I run. In fact, I ran a hundred miler last April with no problems. It was a 30-hour race. I ran through the night. That's a crazy side point. So I run. I run 5Ks, I run fast sometimes, I run slow sometimes. This is something I do. So I was out on just a normal run, warming up with the light jog. And as soon as I started running, the moment I started running, I had a squeezing in my left chest, a tightening, like a belt was just tightening on something in there. And it kind of alarmed me at first. And I was like, What is what is this? And started to slow to a walk. The pain went away. And immediately I said, I know what this is. But how can it be? I'm I'm healthy. I basically do a stress test on my body every weekend during my long run. This can't be chest pain. Started ranging again. The same feeling came back, that tightening squeeze in my left chest, slowed to a walk, and I stopped there. And I actually thought about it for a second. Like, is this real? I have a great watch. It tells me my heart rate. It can give me actually one lead of my EKG. I pulled that up and looked at it and said, crap, this is real. That was November 16th of last year.

SPEAKER_01 5:11

November 16th of last year. We're not even six months ago.

SPEAKER_02 5:15

No, no. November, December, January. Yeah, two and a half months ago, not even.

SPEAKER_01 5:19

Isn't it amazing the denial we all seem to find in our conditions? Because we can't be wrong. Yeah. Of course this can't be happening.

SPEAKER_02 5:30

Well, and and for me, I've had, I work with cardiologists all over the country all the time. I have friends that are cardiologists. And I think as nurses and healthcare professionals in the field, you get a little nervous every time something falls loose, or you, you know, like you just get a sense, oh yeah, check me. I want every ultrasound and every Doppler and every echo you can possibly give me. So I've had I've had cardiologists check me out because I had an inkling or a feeling that turned out to be nothing. And every single one of them has said, your carotid ultrasound's great. Your you know echo looks great, your EKG's fine. You have nothing to worry about. You're in great shape, Jen. You run. So when this happened, all of those sentences flooded back into my mind. And I said, this can't be it, but I know enough to get checked out to rule it out to give a better idea of what it could be. That was my mindset. This isn't my heart, but let's check the box so that we know when I go to the GI doc or the neurologist or whatever, we've done our due diligence and ruled out the things that could possibly kill us.

SPEAKER_01 6:31

I want to say something here for the benefit of the people who are not athletic, they're not runners, cyclists, paddlers, whatever that sport may be. They just maybe are in in average shape to know that normal people. Yes, normal people. That often we've heard from athletes about their symptoms. And athletes tend to maybe be a little bit more in tune with their bodies. And I would suspect, although there's certainly no proof of any of this, that maybe because of that athleticism, maybe because of those elevated long duration, high heart rates, we exacerbated our conditions. So that what maybe would would have been benign, as so many people are over the course of time, is exaggerated because of the beating that artery takes. And so we experience symptoms. So to the point of people saying, Well, I I'm not an athlete, that can't be me. Yes, it still can be. It isn't predicated on the fact that you are or are not athletic. It just happens to be that in our case, we might have really exaggerated that particular situation.

SPEAKER_02 7:39

So what I think has happened is we've probably precipitated it early in our life. If you think about these bridges causing damage to the lining of the artery that it's overlying, maybe it takes a certain number of beats versus years, and we've just beat faster or longer. So we hit that threshold faster than someone who was maybe diagnosed in their 60s who didn't run as long as we did or bike as hard as we did. So, you know, I again, none of us know why some people can live with a myocardial bridge and never know it and be fine and die of cancer at 94. And then some of us happen to be symptomatic. It doesn't matter whether it's a deep bridge, it doesn't matter if it's a long bridge. We don't know why. And that's the weird thing. But I think what I tell women, and I've been I've been advocating now for three months, women especially present differently. We always have, it's not a bridge thing, it's a heart thing. We have cardiac issues, but we don't equate the symptoms we're having to cardiac pain. And we say, oh, it's anxiety, I'm getting older, maybe it's my hormones, I just had a baby, this, this, that, and the other. And healthcare professionals do that too. And the fact is that healthcare providers don't recognize cardiac issues in women because they dismiss it as, well, no, you you're you can't be. It's anxiety, it's depression, it's your hormones. So I think what what is important to recognize is that it can happen to anyone healthy, unhealthy, diabetic, not diabetic, young athlete, older person who's never had anything wrong, it doesn't matter with heart issues, especially with ENOCA and Minoca, they they don't know some of why it happens to some people and why it doesn't. So I think it's important for everyone to be aware. It can happen to your happen to your healthy 21-year-old son, which is what we're trying to rule out now and and and look at. So you never know.

SPEAKER_01 9:36

And to your point of ENOCA and NOCA, go ahead and explain for us.

SPEAKER_02 9:41

So coronary artery disease is typically thought of as blockages in your arteries that feed your heart. So when you see someone on TV having a heart attack and they clutch their chest and they fall to the ground, that's the big bad one. But what that usually means, if someone says, I have coronary artery disease, it usually means a stenosis or a blockage caused by plaque. Atherosclerosis, fatty buildup of cholesterol and calcium, that's usually what does it. Now, in things like ENOCA, which is ischemia in non-coronary occlusive disease, which means it's not an occlusive plaque blocking the artery. In fact, the arteries are great. Now, in our case, it's aside from the bridge. But if you looked at my vessels, they look fantastic aside from this one section of bridging. And in enoka or anoka, which is angina, or minoca, which is myocardial infarction with non-obstructive coronary disease, all of those are cardiac problems that we don't know, we don't really fully understand why they happen. Clean coronaries, beautiful wide open vessels, but something downstream perhaps is clogging up the pipeline. And the analogy that I love is looking at it like a road. And if you think of your three main coronary arteries as the highways, whatever town you live in, it's I-40 or I-5, whatever, it's the big one, right? And then you have little branches, and those are like your feeder highways, I-440, what have you. And then downstream, you've got the tiny roads, maybe two-lane roads. Further downstream, you got the dirt roads, right? You don't want to have a blockage in your main highway because that just messes everything up, and downstream is completely traffic jammed. If you have a blockage on a dirt road, usually won't cause a big problem. But what we're finding out is people have pain with that. And they have pain with the two-lane road, and they have pain with the teeny tiny feeder highway to the big highway. So, what we're looking at is we've always looked at the big epicardial vessels. Those are your right coronary, your left man, your LAD, and your left circumflex. We look at those, and if for a while, and even in some places now, if you don't have a blockage there, you're good. But what we're realizing in that is some of these smaller vessels that you can't even see in a calf lab when they have problems that you can't detect, they are problematic. And people do have pain, and they can even have an infarction, which is a heart attack.

SPEAKER_01 12:15

And not to mention, myocardial bridges are one of those possible causes for any one of the three, Enoca, ANOCA, or minoca.

SPEAKER_02 12:26

Yep. Because it's not, it's not a typical obstruction caused by plaque.

SPEAKER_01 12:30

Right.

SPEAKER_02 12:30

It is an obstruction, and we have to remember that you know, with a bridge, we're compressing that artery and we are occluding flow at times. With every heartbeat, for a lot of us, we have at least a temporary blockage or sluggish flow there. Yes. And those of us that are symptomatic absolutely have some sort of flow problem.

SPEAKER_01 12:51

So now let's get back to Jen.

SPEAKER_02 12:54

Enough teaching.

SPEAKER_01 12:55

No, no, no, that's fine.

SPEAKER_02 12:56

I was a teacher before I was a nurse. It comes out.

SPEAKER_01 12:59

And I love this. This is excellent because we're going to weave in and out of the conversation into medical terminology back to the symptoms. Something happened mid-November, late November. You ended up in the ER.

SPEAKER_02 13:13

So that first event where I had what we call exertional angina, I had pain that presented when I was exerting myself and exercising, that went away when I relaxed. So that that sent me to urgent care. I don't, I honestly, this is why I did this is the silliness that I made it in my head. I knew it wasn't cardiac, so I went to urgent care. If it's cardiac, you should go to the ER. Urgent care generally can't do what we need them to do. Now, what they need, what we needed them to do is yes, an EKG, they can do that. Yes, a check x ray. But the number one thing we need is troponin. And that's a cardiac enzyme. It's a lab draw, a blood draw from your arm. And why we need that is because that detects myocardial injury. I knew it wasn't heart, so I went to urgent care just to see, like, yeah, do a chest x-ray. Let's make sure I don't have any major issue. Let's get an EKG. Now, the reason why an EKG didn't show us anything is because it by the point, the time I got to the urgent care, I had calmed my heart rate down. I wasn't running. I drove there. It was a five-minute drive. My heart rate had come down. I was no longer exerting myself. My EKG looked fine. Now they were smart and they said, you know, it can't be cardiac. You look so healthy, but you need to go to the ER and get a troponin. And I said, nah, think I'm good. Went home, said I'm fine, planned my run for the next morning, called a few of my friends saying, Hey, I had this weird episode today. Would you guys maybe run with me just in case it happens again? And they said, sure. The next morning I went for a run. It was supposed to be a 16-mile run. And about a quarter of the mile in, I said, you know what, it's happening again. And they turned around with me and walked me to my car, and I drove straight to the ER. Because at that point I knew I need a troponin. This is this might be real. This might be real. So yeah, I landed in in the ER.

SPEAKER_01 15:01

And are you telling them? I don't need all the you know, forget the EKG. I already been there, done that. Just give me a troponent test. Did you stop?

SPEAKER_02 15:08

Um I try very hard not to be that nurse.

SPEAKER_01 15:12

Okay.

SPEAKER_02 15:12

Right? Now, what I did do because I wanted to be taken seriously, and I know anyone looking at me, I'm 45 years old, I'm healthy, I'm not overweight, you know, I look in shape. And I knew anyone looking at me saying, I have kind of something going on, would be like, it can't be hard. So I walked in and said, I'm having chest pain and it is severe. And I think it's important for us to say those words and not cover up what we think it could be. Because if you say the word chest pain and you go like this, immediately they have to take action. And they have to do an urgent stat EKG meaning meaning right away. They have to get you lab draws, they have to do a chest x-ray in most facilities, and they have to give you four-baby aspirin. It's their protocol. This is in the US for sure, and in a lot of other countries as well. They have to do that. They're timed on it, they're paid on it. So I went in and very specifically said, I'm having chest pain. I was just running. It happened at most when I was running. It's a little bit better now. It's there. And so they sprung into action. I didn't have to ask for it. This was, you know, we have great facilities here. I'm in Raleigh, North Carolina, and there's several really big teaching institutions here. So they knew. They knew exactly what I needed. But troponin was one of the first things they did.

SPEAKER_01 16:27

And what was the outcome? What did you find?

SPEAKER_02 16:30

It was a high sensitive sensitive troponin. I, if I recall correctly, and I have notes here, but they're they're scribbly because they're my ER notes. My first troponin was within normal limits. My second troponin was 19, which at this facility their threshold was 18. I was the lowest possible positive troponin they could have, but I had it. And then I think my third one came down. So my third one was 12 or so. But I had a positive troponin. So I was at an ER, but it was a non-cath lab hospital, no CT surgery, no cath lab. So they wanted to ship me out to their main hospital. And of course, I have friends at the other hospital. So I said, no, no, we're going over here. So I went to the other hospital, which was a big to-do. But I think it was very helpful that number one, I had friends on the inside. And number two, that I knew what I needed. And at that point, when I had that positive proponent and I said, Oh my gosh, this is actually cardiac. I called my good friend who's a cardiologist and said, I need to be admitted. Can you admit me? He was in Minnesota at a conference speaking, and he left the conference to admit me. So I did have the inside hookup, but I think anyone else could have gone to the ER and said, I need a cardiologist to see me. They need to know this positive troponin. I need to be admitted. It's my heart, and I need these things done. And I think, you know, the rule is echocardiogram and stress tests, and you just keep going. If anything's abnormal, you have to go to the next step. It's like a choose your own adventure, right? Like, oh, you checked the box, you got a positive, you're going this way. So that's what happened.

SPEAKER_01 18:08

What what date are we at about now? Maybe mid-November or late November 2017.

SPEAKER_02 18:13

So this was all the same day. This was November 17th. So my first episode happened on Friday, November 16th. I went home that night, said no, it's not cardiac. The next morning on the 17th, it's a Saturday, went for my long run, said nope, going to the ER. They admit me, I'm transported. I have an echo and a PET scan on that same day. They they they knew. So transferred about midday on the 17th and had an echo that looked great. Echoes normally do, unless you had a lot of damage. My echo looked fine, it looked great, perfect. Everything's working well. My valves are functioning normal. My ventricles are doing great, blood's going where it needs to go. Awesome. Jen, you should be good. PET scan, which is a type of nuclear stress test. Nope, abnormal. At that point, they knew that something was going on, weren't quite sure what. PET scan came back positive with abnormal coronary flow. And at that point, we knew that we we needed a calf. Now, this is a weekend, and in most facilities, at least most small facilities, you wouldn't be able to get a calf until Monday. This hospital happened to be open all weekend. Again, I called my buddy. I said, Dude, my PET scan was abnormal. He said, I'm calfing you tomorrow. Don't eat after midnight. We're getting you in tomorrow. And he calfed me the next day. So less than, I want to say less than 50 hours after my very first episode of exertional angina, we had our answer. We were in the calf lab looking at my bridge.

SPEAKER_01 19:48

So you were able to diagnose it from that very first angiogram.

SPEAKER_02 19:53

Yeah, and the interesting thing was I'm laying on the table and I'm I'm used to working in this environment. That's where I came from. So I asked for no sedation. It's not going to scare me. I know what to expect. They said, Are you sure? And I said, You can sedate me if I get belligerent, but no, I want to watch. The thing about the cath lab is the camera moves around you to get an image because we're looking at a three-dimensional object in two dimensions, and you can't see what's on the other side unless you turn. So the camera moves, and the very first shot was up here towards my head. It's on the left side of my head. And usually you get one picture. If it looks great, you move the camera and they took three pictures in the same spot. And I knew then they found something. Now, what they were looking at was my left man had spasmed, and my left man had tightened so much because of this bridge that it looked like severe left man disease, which is the worst obstructive coronary artery disease you could have. That's when you're flying to the CT surgery, calling the OR, putting in a balloon pump, which is a more mechanical stuff to help keep you alive, and saying, this lady needs to go now. It wasn't that, it was a spasm. But because they took three pictures in the same spot, I knew they found something. So as soon as he shifted the camera and he took a picture, I was looking over at the screen, and I think I called out the word myocardial bridge before anyone else in the room did.

SPEAKER_01 21:21

So you were already familiar with the possibility of bridges being something you may have, which is really foresight for many, many, many people. Because usually it's symptomatic first, then you go down the rabbit hole of X, Y, Z, don't get there, and the CT shows finally that you've got a bridge. And you caught it on the first anjo because you had that spasm. It's almost fortunate.

SPEAKER_02 21:45

Yeah. Well, I think it what was great about the spasm, it sucked, you know, they usually hurt, and I get them still. You give nitro to relieve it.

SPEAKER_00 21:53

Uh huh.

SPEAKER_02 21:53

That's the only way to relieve a spasm, especially in your epicardial vessel. There's other medic medications. They can give you to relieve spasm, but it's it's 99% of the time relieved with nitroglycerin. Nitroglycerin's a cheap medication. Every cath lab has it on the table. They gave nitro, which is great, it relieved the spasm. It potentially made the myocardial systolic compression a little worse because that's what nitro can do. When everyone says nitro is contraindicated in bridges, it's not contraindicated. When patients have spasm because of a bridge, it can be very, very helpful. If you don't have spasm and give nitroglycerin and have a myocardial bridge, what it does is it expands the healthy artery. And so it gives more of a compression in your bridge. And that expanding or vasodilation of your healthy artery before and after your bridge creates some turbulent blood flow because now you have a wide open gate trying to go through a little teeny garden hose of your myocardial bridge. That's a contraindication. You're flooding a floodgate that's closed. That's the issue. But if you have spasm, you need things like nitroglycerin. But the the benefit of giving vaso or a vasodilator like nitroglycerin was that they were able to see the compression of my bridge clear as day. I mean, anyone who was trained in looking at a normal angiogram would know something was wrong, even if they didn't know what it was. They'd be like, that looks weird. What's going on there?

SPEAKER_01 23:23

So it's not quite a home run from that point to your next visit to the EER, correct?

SPEAKER_02 23:31

Now you You know, at that point I thought it was great news, like many of our physicians do. Oh, it's just a bridge. You don't need a stent. This is great. Have some atopolol, and you'll you'll be fine. Now that was problematic for me right away, and I I knew it seeing my bridge because my blood pressure normally is 95 over 55. I run low, I always have. Who knows why? Maybe it's the bridge. You know, we don't know. I've always run low. So on the table, I'm thinking, well, I can't get beta blockers. My resting heart rate's 47 because I run. I can't walk around with a heart rate of 38. That's just that's not great. So I knew even on the table, this is gonna be tricky. I got back to my room. My doctor's telling me, no running for you for a minute. We got to figure this out. And that that was the big hit in the chest. It wasn't the chest pain. That was the that was the brick wall I hit. Like, oh, no running? Are you kidding? I mean, that's like telling my kids no dessert, right? Like, no, that's not happening. So I get back to my room at 5 o'clock at night, and I had some friends there, and I was crying. I can't run, guys. I can't run anymore. That was, you know, the big kicker. And so immediately I started Googling myocardial bridges for patients who can't take metoperol, myocardial bridging treatment for patients with low blood pressure. And I came to the Facebook group. That's how I found it. And in fact, I want to say someone somewhere on Facebook recommended this group. And that night, even again, this is just the day after I had my first symptom. That night I'm researching how bad myocardial bridges can be and thinking, what an idiot. I've we've been treating these wrong for so long. I was one of them. I was in the cath lab telling patients, great, you don't need a stunt. You just need metoprolol, you'll be fine. And maybe not.

SPEAKER_00 25:19

Right.

SPEAKER_02 25:20

So at that point, we knew, yeah, we've got to figure this out. Let's let's give you some meds. So they gave me all the right meds. I can't do a beta blocker. My heart rate and blood pressure are too low. We'll put you on calcium channel blockers. The nitrates worked really well. We're gonna send you home on nitrates too. That's great because the calcium channel blockers are doing their job relaxing my heart, except for the headaches that nitrates can cause. So about 11 days into taking isosorbide, which is a nitrate, a long-acting nitrate, meaning you take it once and you're good for the day. I finally said, I can't take this headache anymore. They said, Okay, well, we'll try something different, change things up a little bit. The day we change things up again, I had a heart attack. And it was caused by a vasospasm, a severe vasospasm.

SPEAKER_01 26:05

Right after Thanksgiving-ish, heading into the Yep.

SPEAKER_02 26:09

That was December 6th.

SPEAKER_01 26:10

Yeah. Okay.

SPEAKER_02 26:11

So right after Thanksgiving, two days after my 45th birthday, I go to bed at night. And these are when vasospasms typically happen, early in the morning or at late at night. It's without exertion, usually. For some reason, vasospasms don't occur as much with activity or during the day, and maybe it has something to do with the good things in your vessels like nitric oxide being stimulated by exercise. Who knows? The docs know, I'm sure. What I know is that it happens for me at rest. And I went to lay down. This is the first vasospasm I had that I felt. I laid down and kind of felt funny and even debated elbowing my husband, who was already asleep. I debated it. I said, This is nothing. But I elbowed him anyway and said, Hey, babe, I think something's up. And the time it took him to arouse from sleep, between when I elbowed him and he actually woke up and realized what was going on, it went from something's weird to, oh my God, I'm dying. It was a minute max where I felt something in my chest to this is the worst pain I've ever had. I think I'm dying. And it was, believe it or not, a small heart attack. It was very small. I did have obviously a positive troponin. It peaked at 246, which is it's positive. That is an MI, but that's nothing compared to an MI in your left man or LED or circumflex or RCA. I mean, it's it's nothing. It's a small heart attack, and people have bigger heart attacks every single day with troponins in the thousands and tens of thousands.

SPEAKER_01 27:51

So no damage, but enough.

SPEAKER_02 27:54

Thank goodness.

SPEAKER_01 27:55

Yeah, but enough to to now really get your attention that this bridge is something you're gonna have to deal with.

SPEAKER_02 28:01

Yep. So I did have a CT surgery consult, but even I was okay with let's try meds first, which I think is reasonable. Let's try meds first. Yeah, let's try meds first. I'm happy with that. But in the in the background, my cardiologist had reached out to a friend of his who is one of the best cardiothoracic surgeons in my area by far. And he had reached out to him and said, Hey, I've got this this young gal. Can you maybe take a look at her? And between my first admission and my heart attack, I'd actually met with him and he said, Yeah, I think it's reasonable to keep, let's do meds for a while. That's great. But in the meantime, let's get you a coronary CTA, which is a CT angiogram. It's a picture of your vessels that's non-invasive. You don't have to get stuck or prodded or poked. It's a picture from the outside. Give some dye to inject in your in your arteries. You can see it's a big, beautiful 3D image almost. It's it's it's gorgeous. And you can get a really great idea of what your coronary arteries look like, but you can see if there's muscle overlying the vessel. And so you said, let's just get that, let's schedule you for it. So they scheduled it. It was the end of December. Sure, no worries. And then I had my heart attack. And in the hospital, the first thing I said to them was, I have a coronary CTA that I have scheduled in three weeks. You're doing it now. And that was the one thing I did demand was I'm not leaving this hospital without a coronary CTA because I need it for surgery. And now I know I need surgery. This heart attack proved it.

SPEAKER_01 29:29

You're not wasting any time. You have the benefit of people behind you. So not everybody is as fortunate to be in this position, but you're also in a system, a healthcare system that isn't known for unroofing bridges. You are gonna push through to have somebody correct your situation that isn't necessarily somebody who's been doing this on a regular basis.

SPEAKER_02 29:54

This isn't Stanford, this isn't Memorial Herman in Houston, this isn't Chicago or Atlanta, this isn't one of the guys. Right. This isn't one of the guys. But what I think is important, and and I there's obviously different opinions on this, but what I think is important to share is myocardial bridge on roofing is the easiest cardiothoracic surgery there is. These guys are used to harvesting a vein from a leg or rerouting an artery from your chest and tying it into your coronary arteries past a blockage, which you can't see from the outside. These guys are really good at opening up a pericardial sac, which is the sac that surrounds the heart, without damaging it, because I gotta put it back together. They're really good at cutting through the layers of fat and tissue, and everyone thinks that a heart looks beautiful. When you open up a heart inside a body, there's fat, there's fluid, there's junk there, and they've got to find that artery to tie in a bypass. Or they have to open up a heart to fix a valve without cutting these arteries that are running all over it. So they're really good at knowing how to cut a heart and how to make sure they don't interrupt the blood flow to the heart. So an unroofing is actually the easiest thing they can do. Now, my surgeon is a heart transplant surgeon. He takes hearts out and puts a new one in. That's the that I mean, you can't get better than that. So when I met with him and I said, I want this unroofed, this is problematic for me. He said, I don't do a lot of them, but I can do them. And the reason is because when he ties in a bypass graft, he has to make sure he's tying it into an artery, not a layer of muscle. And if there's a layer of muscle over that artery, he's got to get it out of the way anyway.

SPEAKER_01 31:39

Yeah, and we hear from so many of the doctors when they do bypasses, more often than that, they see, oh yeah, it's going into the heart tissue, muscle tissue. We'll just cut that open a little bit so it's easier to get access. So it's not something that they're unfamiliar with. It's just the procedure, making sure they unroof it completely. And of course, it gets a little complicated if it goes into a ventricle or something like that. But for the most part, they don't.

SPEAKER_02 32:01

And even when they do, again, there's surgeons that are used to cutting into hearts and occasionally having complications. Even in an easy coronary artery bypass graft, you're going to have complications if you do enough of them. So they're used to having to tie up an artery or close something that shouldn't be open, or open something that shouldn't be closed. That's what they do. So, you know, I had a I had a CTA, so we we thought mine probably didn't go in the ventricle, but we all know that you don't know until you get in there. And angiograms are good for obstructive coronator disease, they're not great for bridging, they underestimate the presence of bridges a lot. CTAs are a little bit better, they're not picture perfect, it's not even the gold standard for obstructive disease. They're not the best. The best is opening up and looking and saying, well, darn it, there's a layer of muscle over this artery. It shouldn't be there. And so we know that even when you get in there, a lot of times physicians are surprised at how deep it is or how long it is or at how difficult it was to unroof it. Because you can't count on the CTA or the angiogram in the cath lab being 100% accurate.

SPEAKER_01 33:11

Right. And they may give you the indication that, yes, this is a severe bridge, but that doesn't tell you what the significance of it is in the tissue until they get there.

SPEAKER_02 33:19

Yep.

SPEAKER_01 33:20

Be it robotic and or sternotomy, they'll find it either way once they get in there.

SPEAKER_02 33:24

Yep. And that's that's a good point, that there's really no way of knowing if your bridge is causing the symptoms if you haven't interrogated it. And what I mean by that is testing it to see if it's hemodynamically significant, which means does it interrupt blood flow at rest or with exertion? Does it hinder blood flow at all? And any kind of pain from your your face down your arms to your belly button can be cardiac pain. When people say, my left arm tingles, my jaw hurts, I have a pain here, I have a pain here, I have a pain here, it can actually all be cardiac. It can be a thousand other things too. And the only way to know with myocardial bridging, unfortunately, is to interrogate that that myocardial bridge. Now I never had that because we knew minus causing spasm. We saw that in the cath lab, we saw that on angiogram. I had a heart attack because of it. So we didn't have to interrogate it. It was boom. We know it's problematic. Let's not have you have another heart attack.

SPEAKER_01 34:19

And for the benefit of those who are wondering, well, what do you mean you interrogate? You can't talk to it, you can't ask it, the person can't explain it. It's the provocative test that we just recently had Dr. Fowler from University of Pittsburgh explain beautifully. So visit that episode. You'll understand exactly what we're talking about. Interrogation of the Aaron.

SPEAKER_02 34:38

You're provoking the artery to do its worst. You're making it you're making it angry. You're saying, give me your best shot. You make it angry enough, and it's going to show you its face. And with bridges, they squeeze too hard and interrupt blood flow, or they don't relax enough to allow it through.

SPEAKER_01 34:55

So you had that that second heart incident, which wasn't MI, myocardial infarction. That was December 6th, 7th, 8th-ish. December 17th, you're having surgery. It's hard to get people in for months in some of our other institutions. You were able to get in in just a little over a week because of the confidence that you knew, and you even had to convince your surgeon to do the procedure.

SPEAKER_02 35:21

He was, I don't say I had to convince him. When I met with him before my MI, he was reluctant to do it without giving me a shot on meds, which is what I think most surgeons, most responsible surgeons should say. Let's start you on meds and see how you do. We don't, you know, they like cutting, they're surgeons, but I think the responsible thing to do is say, you might be okay on meds. Now, I think for most cardiac injuries or some a lot of cardiac problems, that could be true for a while. But what we know about myocardial bridges, especially, is that they get worse over time. And if they are causing the problem, the problem's not going away. If they are causing endothelial dysfunction, which is messing with the lining of the artery and making it not want to do its job, if it's causing that, it doesn't get better. It only gets worse. So I think he was maybe reluctant to do surgery without a medication, optimal medical therapy first, which are all the good things that we should be on when we have these bridges. But after the MI, he was like, Nope, this is causing you problems. Let's take it out. I was lucky that he had, he called me himself. He's fantastic. He called me himself and said, Jen, I agree. I saw your CTA. And they, in fact, they had sent it from the hospital before I was even discharged for my MI. He had it. He said, I looked at your CTA. I'm confident I can do this safely. I'm not sure it's going to resolve all your problems, but it's going to allow you to run again without exertional angina. Is that good enough for you? And I said, Yeah, absolutely. He said, Great, I got an opening in January. It's after the holidays. I said, We'll take it. His assistant called his scheduler the next day, and she's fantastic as well. And she said, I got an opening next Tuesday. Can you take it? And I looked at my husband and I said, Yep, I will absolutely have surgery next Tuesday. I'm giving him the eyeballs from across the room. Like, are you hearing what I'm saying? And his eyes shut up and he said, Okay. And we talked about it briefly afterwards, and we had chatted, obviously, about this whole thing from the get-go. Hey, this might not solve all of my problems, but it's going to allow me to run without exertional angina or the fear of a heart attack from this bridge. What do you think? Cool, we're doing it.

SPEAKER_01 37:35

And all this is occurring. You're just moving forward as opposed to, oh, let me investigate the opportunity for robotic. Maybe I'll look at somebody in Houston or I'll look at somebody in Chicago. No, you're just, I'm going to get this done right now, sternotomy. I don't care. I want to take care of it.

SPEAKER_02 37:51

I did look at, you know, I listened to some podcasts that you guys have. I listened to Dr. Boyd. I looked at Stanford's history of their 200-plus patients Avon Roof. I looked at Dr. Ramsey in Houston with his success with robotics and Dr. Guy. I've looked at all of them. What made me decide to go with the astronomy, which is the only approach the surgeon was willing to do, because again, he doesn't do many of them and he wanted to be able to see everything, and this is what he's comfortable with. Does he do minimally invasive thorachotomies? Yeah, he does, but he preferred astronomy for this. And in my mind, I would rather have the physician, the surgeon, be comfortable doing what he does 19 times a week than have him do something he does once a month.

unknown 38:39

Yep.

SPEAKER_02 38:40

So I think it's important to recognize there are three approaches. Now he doesn't do robotic. Robotic is very specialized. You need equipment and the physician needs training. And not a lot of folks have both. So we knew that was out. Why I wanted to not travel was because I didn't I didn't want to be far from my family. I have a really great support system here with my run club. They all wanted to help. They wanted to be there. They wanted me to shuttle, shuttle me to appointments and bring my family dinner. And I knew that my family needed as much support as I did. So I elected to stay close to home at a facility 30 minutes from my house with one of the best cardiothoracic and heart transplant surgeons there is. He just didn't happen to do a lot of unroofing. But that was okay with me knowing how easy a procedure it is for these guys.

SPEAKER_01 39:27

Well, I'm talking to you almost two months out. People listen to us almost two months out, and I'm fairly convinced that he knew what he was doing.

SPEAKER_02 39:39

You know, CT surgeons don't last long if they don't.

SPEAKER_01 39:43

The outcome is if the outcome isn't what is expected, you're not going to be around for long.

SPEAKER_02 39:47

No. And there, you know, there are some CT surgeons that for sure take on the most difficult cases and obviously therefore have more complications. But I think when you're when you're looking for a surgeon, knowing that you have to look for your surgeon, but for the facility and for the staff as well, he is the main guy, he is the you know, the mamma jamma, but there's a whole team of people that you meet when you go into the OR. And I was wide awake going into mine, and I met every single one of them because I wanted to make sure they knew how happy I was that they were there taking care of me. There's a team, and I think most surgeons will say, well, yeah, I do the hard stuff, but I couldn't do it without my team. So knowing that this hospital I went to is consistently ranked in the top 10 in the country for cardiac surgery, I knew that, yes, he's a great physician, but he also has a great team.

SPEAKER_01 40:36

You know, and something you're saying too, Jen, I think it's really important for people who are struggling to find a doctor who will do this. Any good CT surgeon, cardiothoracic surgeon, is going to understand this process. They've seen it, they just haven't done it in its full entirety as the unroofing procedure, but they've done bits and pieces of this. So if you're in one of those situations, if you're somebody who's suffering from this situation, you've got a cardiothoracic surgeon that you're at least talking to, share the information that you can find online with them. There's a lot of the information in the Facebook group, certainly in the podcast. There's enough there now for people to take to their doctor and say, Can you just do this? And we've now had people who have done it because they couldn't get their insurance to cover out-of-market, out-of-work-working.

SPEAKER_02 41:23

Network network, thank you.

SPEAKER_01 41:25

They couldn't get it done. And they had to find somebody, and they have. It's now becoming a familiar enough situation that the doctors are recognizing it. We still have a long way to go, but to your point, you know, you're in North Carolina, you're in Raleigh, and you did it, and your doctor understood perfectly what was going on. So most people I would say, let's fast forward to where we are today. For you, it's where we are in real time. There's no fast forwarding. It's only been almost two months.

SPEAKER_02 41:57

I will be eight weeks post-op in a few days.

SPEAKER_01 42:00

Yeah. Sternotomy. And how are you feeling?

SPEAKER_02 42:04

I feel fantastic. I do still have vasospasm. That's something we have to work through. Who knows whether it's the endothelial dysfunction? Because we never tested for it at this point. It doesn't really matter because the treatments will be the same. So could I go into the cath lab and have some provocative angiogram? Could I get some testing for endothelial dysfunction? I could. But we know it's there. Without knowing, we know. So I'm I'm being treated the same as I would for a vasospasm anyway, because that's a symptom of the disease. The disease is endothelial dysfunction. The symptom is vasospasm.

SPEAKER_01 42:36

Which can heal over time after the compression stops beating up the artery.

SPEAKER_02 42:40

Sure can. And with taking your meds and changing and modifying your lifestyle that should be modified, you stop smoking, you get your hypertension under control, you get your diabetes under control. Now, for me, I never had any of those things, which is what complicated all of this from the get-go. But yeah, endothelial dysfunction can heal over time. So I'm taking my meds. It's not perfect. And I think the important thing we all share about recovery is that it's not linear, it's a roller coaster. And it's not even a day-by-day thing. For me, the very best piece of advice I got from the hospital was a nurse who said, take it hour by hour. It's not day by day, because you're gonna wake up feeling great, and then by noon you're gonna feel like crap. And then one day you're gonna feel like crap, but by noon you're gonna feel good. Hour by hour for the first few months because it's a roller coaster. And you can't even say, Oh, the first week was the worst. The first two weeks are the worst. It it sometimes hits you seven weeks out that man, I'm still dealing with this. We all move faster than we should. We all think we should be able to do more than we can. And your body's still healing, even if you look great, your scars healed, you feel good, your body's still healing on the inside. There are things healing that you can't see, like inflammation. So I I feel good. I I have I have the downs just like if. Everybody else. I think what helped me very much was being as healthy as I was going into it, which is why I didn't want to delay the surgery 10 years, 20 years.

SPEAKER_01 44:09

And for you, it's still fresh. I recall my days of those first few months. When you really look back and you go, I'm a mortal human being here. And I I could have not been here had I done something. How are you dealing with it? How's everything going right now? And I understand that you even done some things with your running group as a result of all this. So share that with us, would you?

SPEAKER_02 44:34

Yeah. It's terrifying to come to grips with mortality and to see the reason you might die written on a piece of paper. It stinks to know that this might be what does it. But none of us know. You can get in a car wreck in your driveway. You can, who knows, right? So none of us know. But it is disturbing having an option be there in place, right? So that that's something I've been dealing with. That's kind of my very, very downhill of the roller coaster. That's the scariest part of it, was realizing that, gosh, this could be it. Whether it's 10 years or 30 years or 40 years, who knows? But this could be it. But I think it's important, and I truly believe this. I have seen it with patients that I've taken care of, that having a positive attitude really helps your body heal, fight, whatever it needs to do. Having a positive attitude affects healing. I really believe that, and it does affect your health. So I am lucky enough that I have a run club. I actually started my run club in April of 2023 for different reasons. I started it to complete a very hard race, my 100 miler, that I was struggling with finishing. I started my run club to have a group of people to support me through what I thought would have been my biggest challenge and hurdle ever. And then a few months later, I actually figured out what the biggest challenge and hurdle ever was, and it was this. So over the last almost two years that I've had my run club, we have over a thousand members now. And so many of them reached out to send me a meal or a gift card, bring my family dinner the night I had surgery, visit me in the hospital. I have very many healthcare friends. Some of them stayed with me in the hospital. I had one friend who stayed with me overnight because she's in healthcare, and I was like, I just want someone making sure they don't, you know, give me dextrose when it should be morphine or they give me nitro when it should be this. Like just read the labels, right? My one of my best friends sat with my husband in the waiting room. They're on, they're all my run club buddies. So having a support system, whether it's a club or a church or a Bunko group or your kids' teacher's message board, whatever it is, I think it's important to have a support system. And I was really lucky that I had a group of a thousand that they were jumping.

SPEAKER_01 46:59

Yeah, and to think at some point that the odds are good that somebody in that thousand group, since 250 to 300 of them have myocardial bridges, is going to go through the same experience and need that same attention, and the awareness will be there today that wouldn't have been prior.

SPEAKER_02 47:17

So And if not, if not a bridge, then some other form of ANOCA or cardiac disease. It's important to have a support system. And that was definitely the way that helped me get through this 100%. It was tough run club.

SPEAKER_01 47:33

And important for people to understand don't try to do this alone. Have people around you. Reach out. Don't there's nothing proud. Don't. Just don't do it.

SPEAKER_02 47:42

Don't yeah, there's no reason to be proud. And I think I recognized really early, and and part of it was having been through other things in life. We all have gone through things we shouldn't have to go through. We all have trauma. We all have bad situations. I've been through a few of those too. This actually was easier because I knew enough to say when people offer help, take it. And if people say, What can I do for you? Give them an answer. Hey, I have laundry. Can you do my laundry? Well, no, I can't be there. Great. Can you send me dinner? Can you order pizza for my kids? When people offer, they're not doing it with the intention of you saying no. I think sometimes they expect that we say no because we usually do. But when people want to help you, they want to help you. And so I didn't say no to anybody. In fact, I had so many folks wanting to help. I gave that job of saying yes to other people to say, here, plan this for me. Plan the meals, plan my visits in the hospital, you plan my visits at home. And I even had people doing the work of planning the work because I knew enough. You guys take it. You guys want to help? Great. Everyone can help do something. I don't have to worry about a thing. In fact, I didn't have to worry about a ride home from the hospital because I had a friend who happened to be visiting me when I was discharged early, third day post-op, not even 72 hours out of surgery.

SPEAKER_01 49:05

With a sternotomy.

SPEAKER_02 49:07

From a sternotomy. Now, here's the the the caveat to that is I was never on cardiopulmonary bypass, which means my heart was never immobile. It was beating the whole time, which is another testament to how fantastic my surgeon is. Now they they stabilize it, so there's you know little a little holder keeping it nice and still, but it's still beating. So I never needed cardiopulmonary bypass. And his rationale for that was as soon as I was put under anesthesia, I had ST elevation. And so he wanted to get in and get out as soon as he could, and he didn't want my heart stopped because he was worried about ST elevation and worried about my myocardial damage and ischemia. And what if it doesn't come back like it should? So when I when I had basically a very large heart attack, the beginning of one, a STEMI, an ST elevation MI, as soon as I was put under anesthesia, they reversed it very quickly. It was fine, no permanent damage. But it could be, it was very scary for a moment. At that point, he said, you know what, we're not putting her on bypass. Let me let me get in, get it unroofed, get out. So because I wasn't on bypass, I healed a lot faster. I was able to be extivated in the OR, which is very unusual. So I was better off than a lot of folks who need open heart surgery because of that. So yeah, I was I went in for surgery. My surgery was late on Tuesday afternoon. It was about 3:30, and I was discharged at 9 a.m. on Friday morning.

SPEAKER_01 50:35

Lucky you. Right?

SPEAKER_02 50:37

In ways. In some ways.

SPEAKER_01 50:58

I mean, we we present with nothing that should be causing it, but we really have it.

SPEAKER_02 51:03

Yeah. And it's funny you say that. I was just asked today if I could speak at an event geared towards nurses, advanced practice practitioners, like physicians' assistants, and nurse practitioners and paramedics. And it's on bridging because they knew of me and because I have connections in the hospital. They said we really want to teach people about bridging. So I I know, I know what I want to say. And I think in addition to knowing the facts we know about women in heart disease, I would say when patients come in complaining of pain, things that are subjective, things that we can't measure and we can't see, we have to believe them. And if they say it hurts in their chest, we have to rule out cardiac. And to rule out every cardiac problem, we have to do invasive testing or at least provocative testing. We have to get them, yes, EKG, chest x-ray, echocardiogram, yes. But a lot of times those tests are gonna look normal. We've got to get them in stress tests. We have to stress their body and see what their heart does under stress. We have to be able to see perfusion. So we can't just do an echo or a CTA. We've got to get things like an MRI or a PET scan. We've got to get images. And if things don't look right, and if the patient's still complaining and you send them home on meds and they're not doing well, I really think definitely with patients with myocardial bridging, but even if we're not quite sure, I think being able to do provocative testing is going to be the key for a lot of patients. Now, the trick is getting there because you do need with insurance, especially in the US, you do need to prove that there's a need for it. So things like abnormal stress tests are very important. And if we can catch to abnormal EKG, if they happen to have pain when you're putting the stickers on for their EKG, let's get that screenshot. But sometimes we can't always do that. So I think it's important to look at every single piece of the puzzle. And if there's one abnormality, in my case, it was abnormal coronary flow on a PET scan. That was it. That was the only abnormality. And I went for a heart calf, a left heart calf in the calf lab. I think a lot of people would have overlooked that.

SPEAKER_01 53:19

Yep. And three weeks away, three weeks later from that, you were having open heart surgery.

unknown 53:24

Yep.

SPEAKER_01 53:25

And I think in this situation, that has been done successfully.

SPEAKER_02 53:30

Yep. I think recognizing that myocardial bridges are not as benign as we used to think, and I used to think that. I was one of them. In some patients, and we can't predict who and we can't really tell why. In some patients, it does cause problems. And the only way to test for a myocardial bridge is with a stress test measuring hemodynamics before and after the bridge. And that's something that's rare. It's not done on anything else except bridging. But we've got to put a wire past that lesion, past that bridge, measure pressure under stress, and see what it does during diastole as well as systole. We've got to see if there's a big difference when the coronaries refuse. And that's gonna be something that I think will be very tricky, at least in the US, to get cardiologists to understand because we don't test this way for anything else for an obstructive coronary lesion. We're gonna do an IFR and we're not gonna use debutamine. We might do an FFR, but we're gonna use adenosine. And what we know about bridges is that an IFR with debutamine works the best. It doesn't make sense as a healthcare provider because an IFR is a test that you don't usually use, a medication, a chemical stressor. You don't usually use that. That's just measuring pressure when the heart's relaxed. You don't need a stress chemical, but for bridging, you do.

SPEAKER_01 54:53

And for those of us in the lay side of things, what she's talking about is really specific to the medical field. They will understand all this terminology. It's not necessary for us to understand it other than what she's talking about is flow through that particular artery and measuring it and understanding what's happening before and after the bridge. But I'm glad you shared it that way because for the benefit of those who are in the medical community, who the statement is for, is believe your patient. Don't dismiss them. If they keep coming back, something's wrong. And go go further. Give them the benefit of the doubt and keep looking until you're absolutely certain there's nothing there. And in some cases, there may not be. But in many, under the now that we know that one out of four, one out of three people may have one of these bridges, the likelihood is there's something there.

SPEAKER_02 55:43

Yep. Even if you have a patient with a myocardial bridge that has other coronary diseases, pathologies, obstructive disease, I think you have to say the bridge could be part of the problem.

SPEAKER_01 55:54

Yes.

SPEAKER_02 55:54

It might not be all of it. And certainly there are 90% lesion in their proximal LED, the higher upstream LED, yes, that lesion is a problem, but you can't tell me it's all of the problem. If there's a bridge there, you have to consider it could be part of the problem. We kind of need to figure this out. We need to at least look at it a little bit more closely and with more testing and with more research.

SPEAKER_01 56:19

Yeah. And one last question for you. For the people who are in the space today, you know, you were fortunate, you knew, you moved, and you were rectified. For the benefit of those who are sitting there, they're stuck, they're scared, they're afraid. What would you say to those people?

SPEAKER_02 56:37

It's normal to be afraid, number one. I think this is a scary thing. And when someone tells you there's something going on in your heart that's not normal, but you'll be fine, that's terrifying because it's not normal. Maybe I won't be fine. But I think it's important to know that there's research going on, there's so much literature, especially by Stanford, but in other parts of the world, there's a lot of case studies that show we had a patient who had a bridge, we unroofed it, he was better. So I think it's a matter of getting that research and putting it in front of your team and saying, look, I know what I'm talking about here. I've done some research. And in fact, when I when I met with my CT surgeon for the first time and shared with him what I knew and what I had learned in a very brief period of time from Stanford and from Ramsey and from physicians all over the all over the world, and I'm spouting out these facts. Stanford's done over 200, and we're looking, here's one case study, and they actually have a few case studies of people who have passed away, they've had cardiac arrest because of bridges. There's nothing else they can find wrong with them. And I'm spouting out all this information that I learned myself just in a short period of time. My surgeon looked at me and said, I think you've read more about this than I have. And I hope that maybe, you know, I sparked a little chain reaction in the team that took care of me, you know, going in with as much ammunition as I have. But yeah, I think it's important to realize that there's there's support out there, there's knowledge out there, and anyone can learn. It's easier for me because I'm a nurse and I can speak this language. 100% I'm not taking that for granted. But I I think we've seen on our Facebook group that lay people without medical background have really dug into this and they know what needs to be done. They know the tests that need to be done. They have the data that proves these can be malignant and not benign. They can cause problems. And if you go in armed with confidence and positivity without being combative or aggressive, I think that will move things in the right direction. It's one thing to walk into the office of your surgeon and say, hey, I've got a myocardial bridge. I get that you guys, it's not treated a lot. But I happen to have some research that shows in a small percentage of patients it can be really dangerous. Here it is, versus, why haven't I had my heart cath yet? Ugh. I think we have to be very cognizant of medicine is a science, but it is also an art. And we're constantly learning. Medicine is changing, evolving every single day. If it wasn't, I wouldn't have a job. I'm grateful that we're learning more and patients are living longer, right? We're always learning, and I think the really great healthcare teams will recognize that they can't know everything. And sometimes their patients are able to educate them.

SPEAKER_01 59:25

Well, and for the benefit of all of us, and I say all of us in the medical community, all of us as the patients, every one of us that had successful unroofing impacts many others around us. All those people who thought it was benign now realize, oh my gosh, it's not on the medical side of things. All the people who saw you or me or whomever else go through the process, if they know somebody that experiences it now, they can move them to a successful outcome over the process because it may be a bridge. And we just have to keep advocating. And to your point about the positivity of it, yes, we are all responsible to make sure that we're telling the story and that we're telling the story that gets heard about the success. Our quality of life has improved. If it's not 100%, it's 60, 70, 80, 90. And that's better than where you were. And I think that's the the main thing we have to convey. You have been so generous with your time. I really appreciate it. And not only your time, but your knowledge. You've been a cardiac nurse, which really gave some credence to this conversation in a way that we haven't had before. And I can't tell you, I thank you from the bottom of my imperfect heart for the benefit of the listeners, myself, and the medical professionals who are gonna listen to this and go, okay, there's there's one of us not only talking about it, but who's gone through it and skipped a few steps because she was so confident in what the situation was for herself.

SPEAKER_02 1:00:55

And a little persistent.

SPEAKER_01 1:00:56

A little bit.

SPEAKER_02 1:00:57

A little bit.

SPEAKER_01 1:00:58

I can see that. And to think that we are not two months out yet from your surgery and the energy and the presence that you've got.

SPEAKER_02 1:01:07

I'm very lucky. I'm very fortunate, I'm very blessed. A lot of things that wouldn't have gone the way they've gone had it not been for the knowledge I had and the connections I had and my the confidence and knowing what I know and knowing what I don't know, but definitely from what I've learned from the Facebook group, from this podcast, from Stanford, from Memorial Herman, from all these other facilities doing this procedure. If any one of those pieces of the puzzle weren't there, I don't think I'd have a clear picture. So it all just I'm very blessed that everything happened to fall in line very quickly, and I was able to glue the pieces that didn't quite fit together because of my persistence.

SPEAKER_01 1:01:46

And that little bit of history you had as a cardiac nurse.

SPEAKER_02 1:01:49

That, you know, I'm I'm going on 18 years. I'm still in the business, just not taking care of patients. But yeah, it that probably had a little bit to do with it.

SPEAKER_01 1:01:57

Thank you so much. Thanks for your contributions to the Facebook page and the way that you deliver the messaging. Really appreciate it, Jen. Thanks.

SPEAKER_02 1:02:06

You're very welcome. Thank you.

SPEAKER_01 1:02:08

Thank you for listening to Imperfect Heart. It's my hope that this information help in some way to improve your situation or will help you better understand this condition. More importantly, that it gives you hope through stories that there is help and you most certainly are not alone. If you've been diagnosed with a myocardial bridge, please be sure to join the private Facebook group Myocardial Bridge Support Group. For more information about our program or to reach me directly, visit the website myimperfectheart.com. If you like what you heard today, please give a positive review. Thumbs up, high five, whatever your app likes. And be sure to share with everyone important to you so they understand what it is you're dealing with. Please subscribe as well. Welcome each day with gratitude and positivity. Imperfect Heart is a production of Hear Me Now Studio.