My Tip for Easing Your Angioplasty/Biopsy

Roasting tomatoes from the bounty of a lingering summer is one of my most favorite things to do in autumn. This year, tomatoes were piled at the farmers’ market well into late October—unheard of here in western Maine. I put-up these beauties in freezer bags just before leaving for Boston for my annual heart transplant check-up—my most dreaded thing to do during this otherwise glorious season. I really should not complain because I have lived to experience 11 years of good results from post-transplant check-ups. Let’s begin with celebrating the important part, right? Roasted tomatoes are just one of the many benefits of being alive.

During the early years with a new heart, angioplasties are the core of frequent and annual check-ups and involve catheterization through the neck, groin, or wrist. The heart is usually biopsied as part of the catheterization. Patients fresh out of transplantation go through these checks weekly, as I did. Over the years, the cath schedule tapers to a routine annual, and then only every other year. Today, my annuals alternate between two procedures: an echo cardiogram and coronary angiogram one year followed by an echo and dobutamine stress test the next year. This year I returned to the cath lab for an angiogram.

Year five of transplant survival is cause for celebration among graduates and their clinicians for a number of reasons. First, the graduate is alive and thriving! When I received my lovely new heart in 2006, the data showed that half of us might not make it to five years, largely because of infections or cellular rejection. The data has improved since then, but I never forget that every year is a triumph. I was also very happy to learn that in the fifth year, the biopsy part of angioplasty was over for me unless it is needed, which is the norm. Also, the angioplasty schedule reduced to once a year, every other year—meaning, fewer trips to the cath lab! Finally, year five is generally regarded as the end of cellular rejection risk, which is high in the early years while our bodies adjust to having a foreign organ in our biochemical system. Leaving that risk pretty much behind is a big relief for all of us, as well as an important marker in a heart transplant patient’s progress. By year five, the graduate and her lovely new heart have usually proven truly compatible. An added bonus for me: I felt fantastic, even with complications. A good life was possible. I was living it every day.

We must all remember, however—as every doctor has told us—a heart transplant is a treatment, not a cure. After five years alive, the graduate enters the second period of risk, that of vascular rejection. You see, the vascular system experiences a lot of wear and tear from a denervated heart that pumps blood through the body at a constant rate of roughly 90 beats-a-minute. It can cause a little, oh, let’s call it erosion, though that metaphor is not accurate. You get the idea. The good news: vascular rejection does not happen to everyone and generally makes slow progress in an otherwise much-improved life.

As we celebrated the great, good fortune that I had made it five years, I secretly, guiltily, celebrated the end of angioplasties and biopsies sprinkled throughout each year. They are torture for me—despite the inexaustable kindness, love, and competence of my friends in the MGH cath lab. You see, I am small-boned with veins that are deep and narrow. Picture the poor cath clinician who has to cope with Lilliputian vessels in a grown woman.

It has been a difficult dance, filling me with trembling dread akin to the dread I felt as shy and tragically gawky Gordon Mills made his approach during seventh grade dances because no one else had picked me and he knew I was too kind to refuse him. (Maybe he thought he was rescuing me from humiliation, now that I think about it. If you are out there, Gordon, thank you and I apologize.) I remember shaking with cold and feeling ashamed at my repulsion because even then I recognized my uncontrollable response as colossally unfair. No one should be defined by who they are as a pre-teen or teenager. The same is true of cath lab clinicians, who are really nice people when they are not doing the deed. Despite this knowledge, I am horrified  every time I am wheeled, already shaking, into the chilly cath lab.

Hydrate extra well before the procedure to bring the most plumped vascular system you can muster to your Gordon Mills, the perfectly nice cath doc who wishes, as you do, that there were some other way. But as yet there is not. The simple trick of extra hydration will make the going less rough on you because the tiny catheter’s entry and removal are easier in juicy vessels (think ripe summer tomatoes) than in dehydrated, desiccated ones. Makes sense, doesn’t it?

I have learned to drink 8 to 10 full, 8-ounce glasses of water for 2 days prior and right up to the hour that clinical instructions say to stop all fluids before catheterization. It really works. My cardiologist thinks it is a brilliant solution and wishes that he, a veteran of the cath lab, had thought of it. Never continue hydrating beyond the clinical requirement to stop. Hydrating too close to the procedure may prevent accurate readings.

I often think of children who have to cope with this procedure… If you are the parent of such a child, maybe this will help ease their discomfort and terror, but check with your transplanting physician first, of course. Kid bodies are not adult bodies.

Back at home and drained from the three-hour drive to the lake following several days of testing at MGH, Jack and I relaxed in front of the fire with pasta and fresh tomato sauce from the roasted tomatoes that I did not freeze. It’s easy to make.

First, you roast (350 for about 45 minutes) the tomato halves or quarters that you have tossed generously with enough extra virgin olive oil (EVOO) to make them glisten, salt, pepper, and fresh or dried herbs. In this batch, I threw in a small fistful of dried Herbes de Provence, a gift from my sister Callie’s trip to France. Sometimes I add slivered garlic. When the tomatoes are collapsed and browned (caramelized) at the edges and their released juices have reduced and thickened a bit, haul the roasting pan out of the oven.

Cool the tomatoes to room temperature, if you are packing them into sturdy bags for freezing and defrosting for dinner on cold winter nights. Otherwise, toss hot or warm fresh roasted tomatoes, with pasta, just as they are. I love to puree the roasted mess first (fresh or defrosted) and pour it into a skillet to warm through. It will be creamy—as if you had added cream, which you can do, but it is not needed and takes away from the fresh sweet/tart flavor of just tomatoes, herbs, and olive oil. Add to the pan of pureed, roasted tomatoes: drained, almost-cooked pasta with a little (1/4 cup?) of its cooking water. Simmer pasta in the sauce until it is al dente and has absorbed some of the sauce. Serve with fresh basil leaves (or parsley, or?) and more EVOO drizzled on top—as Jack and I did by the fire that night. With good results from MGH and good red wine, it was a fitting feast of life in full color. xox Deborah