Five Kids, Hockey, Swimming and a SCAD

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by Micaela Fassina

Since February is Heart Health month, here’s a story for you. My name is Micaela and I survived a heart attack.

 

I was 44 years old, with 5 children between the ages of 5 and 13. I was relatively healthy, and trying to get into better shape. I was doing aquafit 4 times a week and learning to play hockey in a weekly mom’s clinic offered by our local hockey association. There is no history of heart problems in my family, I don’t smoke, or drink excessively, and I try to eat as healthy as 5 kids and a busy schedule let me. I’m a stay-at-home (or in-the-van) mom: at the time of the heart attack we were in the middle of a kitchen & 2 bathroom renovation and had 4 kids in soccer, 3 kids on swim team, 2 kids in diving and one in synchronized swimming. (Before you say anything, we do not force our children into any activity they don’t want to do – this was all their choice.)

On July 18, 2017, it was business as usual. The kids and I were at our community pool for their daily lessons and my aquafit. However, a child (not mine!) had been sick in the pool and it was closed while it was being shocked with chlorine. So lessons were dry-land, and the moms decided to do “land-fit” instead. I set aside my iced coffee, fully expecting to finish it in half an hour, and sat down to do some sit-ups. Except I couldn’t pull myself up for even one! Ok, on to lunges. Three lunges in, I experienced the strangest thing I’ve ever felt: an explosion radiating out from my chest going down both arms and up my neck into my jaw, and at the same time, a vice clamping down on my chest, all of it painful. I figured it was heat stroke, or sun stroke, or dehydration, or something. I went to sit down, but was now feeling nauseous and I knew something was very wrong. We had just recently lost an acquaintance to an undiagnosed heart attack, and my symptoms mirrored his. So I called my mom to come get the kids and then lay down in the grass. In the 10 years we’ve been members at our pool I never once lay down, so next thing I knew I was surrounded by concerned friends and lifeguards. They called 911, while my sister-in-law called my husband. Other moms were trying to keep my kids occupied and out of the way; apparently one of my kids was swinging a baseball bat around! Two of my kids refused to be distracted and sat watching me at my most helpless. I tried to reassure them, but was so sapped of strength that I could barely talk.

I never lost consciousness and my heart never stopped, but my memories of that time are disjointed and surreal. I remember trying to crack jokes to lighten the mood, and being disappointed that the firemen that answered the call weren’t better looking. I kept on eying my iced coffee hopelessly, wishing I could finish it. A friend rode to the hospital with me, and I made sure that she had grabbed my cross-stitch to bring along, just in case. By the time I was going through triage, I was already feeling better and was hoping it was just an embarrassingly strong case of indigestion. In fact, when my husband arrived at the ER, he didn’t have to ask where I was; he just followed the laughter.

Tests after tests were run: blood work, multiple EKGs, CT scan, ultrasounds and X-rays. Everything was coming back negative, except for one item in my blood work: my troponin levels were rising. Troponin is an enzyme released when the heart has been damaged – proof that I had suffered a heart attack even though I was perfectly healthy according to all other test results. After a night in the ER, it was decided that I would be admitted and sent to have an angiogram, which is a procedure where a catheter is fed through an artery in your wrist (or groin) into your heart. Dye is then injected through the catheter while you watch live X-rays images of your heart pumping. If necessary, this is also the time when stents would be inserted. It took a while, but the cardiologist finally found the remnants of a 30% tear in a secondary artery, which had already scabbed over and was healing by itself. Two days after the actual incident, I had an official diagnosis: Spontaneous Coronary Artery Dissection or SCAD.

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#HeartHealthMonth

SCAD affects mainly, but not only, otherwise healthy women of child bearing age. There are no specific or consistent symptoms or warning signs. Some people experience the same pain I did, while others compare it to severe and lingering heartburn. SCAD can be a minor tear like mine, or a full-blown rupture requiring bypass surgery, or instantly fatal. It can recur, but why in some and not others is a mystery. Because SCAD is a rare diagnosis, there is currently not much research or information.

I’m currently on a daily regimen of blood thinners, beta blockers and baby aspirin for at least one year. But there’s nothing I can really do to prevent another SCAD from happening, since no-one can tell me why it happened in the first place! They have ideas: it might have been stress from the reno or over-exertion, or the heat, or my not having had breakfast that morning, or Mercury aligning with Pluto, or Zeus arguing with Poseidon on Mount Olympus… I sometimes wished I had been a smoker or morbidly obese, because at least then there would be a reason for the heart attack, and something concrete I could do to prevent another one from happening. And that is another source of frustration: trying to make people understand that SCAD is different from a “traditional” heart attack. My mother is still trying to rationalize what happened; she remains convinced that there must have been something in my life I could have done differently.

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My life since SCAD has been different, but the same. It took a couple of months for me to feel “normal”. I was not allowed to exercise for 3 months, after which I did a stress test (12 minutes on a treadmill) and got the all clear for everything except heavy lifting and isometric exercises. I’m seeing a psychologist for my PTSD, and thanks to social media, there is a great on-line community of fellow survivors offering support and understanding from around the world.

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My latest cross-stitch project

 

The initial recovery combined with the medications left me exhausted for quite a while. I have to watch myself and my stress levels, and make sure I have more “me” time and that I don’t over-extend myself – too much. With 5 kids currently in hockey, swimming, music and drama, there are days when I have to be in multiple places at the same time and I don’t know which way to go. But that’s what family, friends, a good support system and carpooling are for. And when I’m having a bad day, it’s ok to say, “I can’t do this” and go hide under the covers for as long as I need. Every time I hear of a woman my age passing away suddenly and for no known reason, I wonder if it was SCAD (Dolores O’Riordan springs to mind). But ultimately, I’m learning to not dwell on the what-ifs and the what-might-be. The most important thing is that I am alive and well right now, and still rocking the mom-wife-daughter-sister-friend thing.

 

Micaela Fassina, Supermom of Five Montreal, Quebec

Staying Active With Persistent Pain

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by Dr. Maureen Allen

Getting active with persistent pain can be a huge challenge.

Persistent pain or long term pain is a common condition experienced by 1 in 5 Canadians. It can feel similar to acute pain but the two conditions are very different.

 

Acute pain or short-term pain occurs when you have damage or possible damage to your tissue. Once your body repairs the damage your pain alarm should shut off.

Persistent pain on the other hand occurs long after tissue has healed. This pain is less about damage and more about the central nervous system which is part of your pain system.

The following post answers some frequently asked questions and contains tips on how to stay active with persistent pain.

Can persistent pain be cured?

There is no cure YET for persistent pain but our understanding of this life changing illness is growing. Unfortunately there is no blood test or X-rays that can confirm you have persistent pain. It’s because your pain has persisted more than 3 months and has never gone back to normal that it has received this diagnosis.

Persistent pain can also be found in illnesses like fibromyalgia, back pain, Crohn’s disease, migraines and irritable bowel disease just to mention a few. Despite the fact that these occur in different parts of your body the cause of the persistent pain is still the same: an amplified pain system.

Will activity help my pain?

ABSOLUTELY!! Our tissues are designed to move. When we stop using them they get weak and deconditioned. Because persistent pain is caused by a sensitized or amplified pain system, attempts to move your tissue may be painful and sometimes can result in a flare-up of your persistent pain. The important thing to remember is you are not causing damage by moving. It’s how you move that matters most. Activity needs to be done in the right way to minimize pain flare-ups. If walking is an activity you like to do, here is an example on how you might approach walking.

It’s good to plan a time for your walk the day before and be sure it’s on a surface that is flat with no hills. This calms the pain system and helps make life more predictable and less chaotic. Remember it doesn’t have to be perfect, the important thing is that you try.

Finding your activity tolerance

Activity tolerance is the amount of activity you can do on a good pain day and a bad pain day that will not cause an increase in your daily pain intensity.

Your daily baseline pain is the intensity of pain you experience on a daily basis that is not a flare-up. In other words it’s the average or typical amount of pain you live with every day.

A flare-up however is an increase in your daily baseline pain that can leave you debilitated for hours, sometimes days. When this occurs the intensity of pain you experience may go off the 10 point scale.

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Tips on staying active

 

1. Pay attention to the pain intensity
As you begin your walk, pay attention to the pain intensity you are experiencing. If your pain intensity is 5 on 10, how far can you walk before it starts to creep up to 7 on 10?

2. Calculate your activity tolerance
If you start to feel the pain intensity increase at ten minutes, calculate your activity tolerance or starting point by taking half that time or 5 minutes and plan your daily walk once or twice a day sticking to the 5 minutes. This may not seem like much, but it will be a safe amount of time that can be gradually increased over time if you do not experience any flare-ups.

If you prefer not to use time; distance or land marks may work better. In this situation the land mark you choose which caused an increase in your baseline pain should be cut in half.

It doesn’t matter if you use time or distance to find your activity tolerance. It’s whatever works for you. There is no right or wrong way.

3. Plan ahead
Now that you know the ideal time or distance to avoid a flare-up, plan the best time of day for your walk. On the day of your walk do not let pain sabotage your plan. It is important to try. Remember you’re not causing damage by moving.
It may seem like you’re not doing much at this stage, but research shows that using activity in this way can help to re-train or re-boot your pain system. Minimizing flare-ups are essential to calming pain. Be patient and gentle with yourself.

4. Plan your progression
If you were able to walk for 4 days at the distance and time you picked then you can add a minute to your time. If you use distance, pick a new target on your route that feels safe but still challenges you to nudge the edges of your pain.

5. Don’t get discouraged
Sometimes despite your good planning a pain flare-up may occur the next day or a few days later. Don’t panic or get discouraged. When this happens your time or distance may need to be adjusted or you may need to look at how your day is structured.

You are not alone

Remember you are more than just a person living with pain. You have dreams and aspirations like everyone else.  Begin to take the steps to help you move forward.

Talk to your health care provider to see if a referral to a pain self-management program may be beneficial for you. It may help you explore other activities that could be more suitable for you and your abilities. Be open to trying different things. Look at what your community has to offer.

 

Maureen Allen, MD
Director of Emergency Services
St. Martha’s Regional Hospital
Antigonish, NS

 

Source: Understanding Persistent Pain:Finding calm in chaos, a guide for patients and their families, Dr. M. Allen, 2017.

(images by pixabay.com)

By the same author:

 

Understanding Persistent Pain

by Maureen Allen, MD

Pain is a universal experience that can feel scary and worrisome at times. As much as we dislike the experience of pain it has an essential role to play in our body, which is to protect and warn us of potential harm. Without our ability to respond and pay attention to pain our life would be in danger.

Think of your pain system like the security system we use in our house. When the alarm is triggered it calls us to action to pay attention and seek out the problem until the “all clear” has been signaled or the problem that triggered the alarm system has been addressed. It seems clear and straight forward most of the time but occasionally there will be a glitch within the system that fails to feed-back accurate information despite the volume of the alarm or the intensity of that experience. If the glitch occurs in our home security system, we call the repair man to come and “fix” the problem but for 1 in 5 Canadians repairing the glitch in our pain system can be difficult but not impossible. This is called persistent pain.

Persistent pain or chronic pain is a complex illness which can feel similar to acute pain, but the two conditions are very different. Acute pain or short term pain occurs when you have damage or possible damage to your tissue like a broken wrist, whereas persistent pain occurs long after tissue has healed and is less about damage and more about your central nervous system.  It is often described as a volume control issue where the intensity or volume of pain you experience is left on moderate to high and never returns to the “off” position.

Persistent pain can take over your life.

sad-505857_1280We are not sure why some people get persistent pain while others do not but health professionals with the help of science are beginning to understand the nervous system changes that cause persistent pain and find more effective ways to help patients manage this life changing illness.

Learning to live with persistent pain can be challenging especially when told everything is healed and you need to get on with your life. It is similar to being told you have a condition like insulin dependent diabetes. Without help, support and new knowledge of the illness you would feel overwhelmed and frightened.

Don’t wait for your pain to get better before you start to make changes. Reach out to your local Pain self management clinic to get more information and how you can be referred.

stethoscope-1584223_1280My next blog post will touch on some important principles, such as how to get active with your persistent pain and whether medications can play a role in your recovery.

 

Maureen Allen, MD Director of Emergency Services St. Martha's Regional Hospital Antigonish, N.S.Maureen Allen, MD
Director of Emergency Services
St. Martha’s Regional Hospital
Antigonish, N.S.

Definition of a Supermom

by Micaela Fassina

First of all, I have to say that I have never, ever called myself a Supermom except in the most derogatory manner. Other people call me Supermom all the time, which made me uncomfortable because I think that I’m just surviving, treading water, trying to keep from drowning under all my various obligations. But let’s take a closer look.
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If sheer quantity of children defines a Supermom, then I qualify. I am a mother of five children, ages 12, 10, 7 and 4-year old twins.  But that wasn’t planned.  We had already gotten rid of all our baby stuff after kid #3 when we found out we were expecting twins and had to get it all back times two! Don’t get me wrong; I love every single one of my children and couldn’t imagine my life without them.  But being a mother of five was not part of my game plan when I graduated university.  I know a mom of seven (yes, seven – no multiples!) who was trying to convince her husband to go for #8. I would call her a Supermom, because she actively pursued this life and thrives on it (at least in public).

Maybe it’s volunteering that makes a Supermom.  All my children attended the same co-op preschool, of which I am now the treasurer after doing a stint as the co-chairperson.  I also do my assigned duty days (doubled now because of the twins) helping the teachers in the classroom.  When my oldest was on the competitive swim team, I was a timer at her meets.  I spend one afternoon a week in the elementary school’s library.
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If kilometers logged while chauffeuring children to activities makes a Supermom, then I guess that’s me as well. This year, all 5 kids are playing hockey, the eldest started an after-school drama, the 10- and 7-year-olds are also in Kung Fu, and the twins are taking winter swimming lessons. We just finished a summer of soccer for 4 of the 5, and swim team and diving at our local pool.  I rarely have to drive more than 50 km away from our house, but I’m always in the car.

Is the ability to multitask like a boss the ultimate Supermom qualification? Well, as I am writing this, one of the twins is coming to me crying because the eldest “pulled my dress”, so now I’m typing with one hand as I comfort & snuggle a preschooler. Oh, and the oven is preheating so I can cook dinner.

Reading this overthe-twins, I still don’t think I’m a Supermom – not unless I consider that I am surrounded by other super people: my husband who coaches hockey and soccer, and both sets of doting grandparents as well as aunts and uncles, who are willing to lend a hand whenever necessary (which is often).  That, and my jumbo kitchen calendar (if it’s not on the calendar, it doesn’t exist), keep me afloat enough that I look like I know what I’m doing.

But if there’s one thing that makes me feel like a Supermom, it’s the fact that my kids love me & think I’m the best mom ever (even if I yell too much, and am often the worst mother in the world).  When they tell me that I’m the best cook, or look to me for validation, or come to me when they are hurt or need their tears wiped, that’s when I know I’m a Supermom in their eyes.  Ultimately, that’s the only label that matters, no matter what other people might call me.

So, no matter how you are living your life, with one kid or seven, single mom or with a huge support system, if your kids love you (and they do!), you are a Supermom!

Micaela Fassina, Supermom of five Montreal,Quebec