Health Matters: Pericarditis & Anaemia

At the beginning of November 2021, I picked up a nasty viral infection which lasted for approximately two weeks. Shortly afterwards, I began to experience a sharp pain in the left side of my chest – this was accompanied by chronic breathlessness. I was left feeling as though the air was unable to rise up through my chest – and the only time I was able to fill my lungs with air, was when I yawned.

It is difficult to quantify and qualify pain and discomfort. How much breathlessness is a cause for concern? How sharp should chest pain be before action is taken? The sensation of breathlessness is a frightening one, particularly for someone who has previously been blessed with good health. One night as I stood in the kitchen cutting vegetables, I could barely draw a full breath. On the evening of Thursday 2 December, I drove myself to the emergency department at the John Radcliffe Hospital. I presented my symptoms. I spent approximately four hours at the hospital and had some blood tests done, as well as a Chest X-Ray, an ECG and an ultrasound. I was diagnosed with acute pericarditis, not myocarditis as I had been fearing. Both myocarditis and pericarditis are inflammatory conditions of the heart. I was told to take ibuprofen thrice daily for two weeks. I returned home late to find my heavily pregnant wife sitting on the floor of our living room, assembling a cot. She looked exhausted and crawled onto the sofa. Our soon-to-be three-year-old son Leonardo immediately sat beside her, gently stroking her cheeks. “Mamá, estoy aquí” he said. I felt overwhelmed with emotion.

Looking back over 2021, there might have been some warning signs about impending cardiac irregularity. During exercise there was minor breathlessness and fatigue – something which I had never before experienced.

The week of my trip to the hospital, the UK Government had published guidance for healthcare professionals on myocarditis and pericarditis following COVID-19 vaccination and infection by the virus itself. There had been a number of reports of cardiac involvement following vaccination with both Pfizer/BioNTech and Moderna vaccines, as well as reports of myocarditis or pericarditis being caused by coronavirus (COVID-19) infection. As a prison healthcare worker, I had been one of the first UK citizens to have been given the vaccine, receiving my first and second doses in January and April 2021 respectively. Given the length of time that had passed between my receiving the second dose and falling ill with pericarditis, it appeared unlikely that my cardiac condition was related to the vaccine. That being said, there were clearly reported increases in cardiac involvement – and the data was disturbingly vague. Given that the government booster campaign was about to be ramped up to the level of “England expects that every man will do his duty”, and the recently published guidance relating to myocarditis and pericarditis following COVID-19 vaccination and infection by the virus itself, there was a question that I wanted answered to my satisfaction: “Given that I am currently recovering acute pericarditis, do the risks of further cardiac inflammation outweigh the risks of my remaining without my booster shot over the coming weeks and months. Also, do any of the current booster shots available carry more risk of cardiac inflammation than the others?” Over the coming weeks I asked that question to five or six doctors, none of whom appeared willing or able to answer me with any real, unambiguous conviction.

After a week or so, the ibuprofen seemed to be working. The chest pain lessened and then in the course of an afternoon, mysteriously shifted to the right side of my body.

I booked an appointment with a consultant cardiologist at the Manor Hospital in Oxford on 17 December. Here is the letter that was sent to my GP afterwards:

It was a pleasure to meet Julian today. He presented with chest discomfort some weeks ago. He remembers having a viral illness for a couple of weeks and then developing chest pain and a sense of breathlessness. He felt like he couldn’t get a full breath and there were sharp pains around the left side of the xiphisternum which migrated towards the right-hand side a few weeks ago. He was seen in Casualty and prescribed ibuprofen and this has helped the situation and things have gradually got somewhat better. He is healthy generally and exercises regularly. He is a non-smoker with no family history of ischaemic heart disease. He is not diabetic and has lost some weight recently. His current medication is ibuprofen 400mg tds. Examination today revealed a pulse of 60 sinus rhythm. Blood pressure was 120/70. Cardiovascular examination was unremarkable otherwise. The resting ECG is within normal limits. There is T wave inversion in V1 and V2. The PR interval was at the upper limit of normal and there is borderline left ventricular hypertrophy on voltage. The echocardiogram is reassuring. Normal left atrial size with left ventricular wall thickness at the upper limit of normal. Normal left ventricular systolic function. Normal aortic and mitral valves and a normal right heart. No evidence of pericardial effusion. I discussed the diagnosis with Julian. I think it is likely that he has pericarditis and things are obviously improving. I think he should continue with the ibuprofen for a couple of weeks further and I have cautioned him about exercising too strenuously at the moment. I think it is likely he will make a full recovery but it is also likely this will take a few weeks to complete. I haven’t scheduled further routine review but would be happy to see him if things aren’t progressing well after Christmas.

On 8 November (prior to my experiencing any cardiac issues) I had attended a Bluecrest Health Examination in Bicester. The recent passing of my uncle Tony from prostate cancer had prompted me to schedule a health MOT at the age of 41. I had blood work done and an ECG. When the brochure containing my results arrived in the post, I had studied it somewhat superficially – focussing on the information relating to the prostate and blood sugar levels. In the wake of the pericarditis diagnosis, I examined it carefully. It stated that a slight abnormality had been detected in my ECG results – and that I should contact my doctor if I experienced chest pain or breathlessness. I showed that ECG to the cardiologist and was reassured when he appeared to think that it was nothing to worry about.

The Cardiologist also explained that pericarditis can be ‘a bit of an emotional rollercoaster’, sharing symptoms as it does, with the legendary heart attack. ‘Some people find themselves constantly in and out of A&E, so the fact that you’ve only been there once is quite impressive, really’. I could see how I might easily be quickly overwhelmed by health anxiety. The breathlessness was very frightening. It was also possible that I didn’t actually have pericarditis – because the symptoms of chest pain and breathlessness can be caused by myriad conditions that have nothing to do with the heart.

I asked the cardiologist if there might be any risks involved in my taking the Covid booster shot. He paused and considered the question carefully. His response was something along the lines of: “You will probably be fine if you have your booster shot. That being said, it might be better to wait for a few weeks and have it after Christmas.” Perhaps tellingly, or perhaps not – because the consultant felt it irrelevant to the matter at hand, there was no record of our conversation regarding the booster in my consultancy notes.

I was starting to feel better, even going out for a few gentle jogs. I avoided chest exercises in case I injured myself in a manner which might provoke health anxiety later. Whilst I had resigned myself to potentially having to take it easy for a couple of months, I appeared to be on the mend.

My wife gave birth to our second son at 20:23 on the evening of 19 December. We were discharged from the hospital on Tuesday 21 December. Little over twenty-four hours later, having collapsed at the East Oxford Medical Centre, I found myself in an ambulance returning to the John Radcliffe Hospital.

So, what had happened?

The morning of what was destined to be Sebastian’s literal birth day, I had taken a photo of my poo, observing that it was extremely dark. My stool darkened over the next forty-eight hours and I began to experience bouts of dizziness and weakness in my legs. I also began to hear my heartbeat loudly in my head – an unusual sensation I had no recollection of experiencing previously. I felt tired and light-headed simply walking up the stairs. I attempted to go for a run and was unable to get further than the end of the street. This had never happened before. I tried once more with the same result. Normally when I exercise, I feel a sense of clarity and focus. This time I felt dazed and muddled. My legs, normally strong, felt incredibly weak. Undeterred, I attended my regular Men’s 12 Step group in the early evening. My friend John commented that he had ‘never seen me looking so yellow’. Returning home, my wife suggested I call 111. I described my symptoms and was invited to attend an appointment at the East Oxford Medical Centre, just off the Cowley Road. Whilst I was obviously concerned about my health, the last thing I wanted to do was leave the warmth and comfort of my house. I had planned on sleeping on the mattress on the floor of Leo’s room. I had been looking forward to bonding with our soon-to-be three-year old whilst my wife cared for our new-born.  There was also part of me that was attributing my weakness to the sheer intensity of witnessing the birthing process, adrenaline, stress, lack of sleep etc. I told Leo that I had to ‘go and get some vitamins from the doctor’ but I would be return later that night, whilst he was sleeping. But life made me a liar – and I did not make it back that night.

My wife drove me to the Health Centre. Ask any new mum how they feel about having to leave a new-born baby less than 72 hours old. Fortunately, my mother-in-law was on hand to look after our sons.

We arrived at the Health Centre where I presented my symptoms to the duty doctor. She examined my pallid skin, looked closely at my eyes and then performed a rectal examination. She quickly made the connection between my use of ibuprofen and my darkened stool and light-headedness. She also ascertained that I was not ‘yellow’ as several people had stated – but I was disturbingly pale. She suggested that my haemoglobin levels were dangerously low and asked if I could provide a urine sample. I had just taken a leak in the car park before entering the health centre – but I said that I would try. The doctor left the room in order to call the JR to seek guidance regarding next steps. I sent my wife a brief update via Whatsapp. It was 22:16. I went to the bathroom and squeezed out a few drops into the urine pot.

Then I collapsed on the floor of the bathroom.

One of the clinic staff would later report having heard a loud thud when I hit the deck. I can vaguely recall feeling dizzy before my legs gave out. I did not lose consciousness – but I was disoriented. I knew I had to get out of the locked bathroom and back to the consultancy room. I think I rose to my feet – but I might have crawled back there. Either way, I somehow made it back there and curled up on the floor and shouted for help. Two nurses quickly arrived, followed a couple of minutes later by the doctor. They helped me up onto the physician’s couch. Everyone was very kind. I thought about my sons at home and broke down in tears. The tears were a strange mixture of tiredness, shock and relief. My left leg kept spasming. The doctor told me that an ambulance was on its way to take me to hospital. In truth, that decision had been made before I collapsed – the doctor had already seen enough with my presenting symptoms to recommend I visit the JR. I told the healthcare staff that my wife was waiting for me in the car park. I sent her a Whatsapp message telling her that I had collapsed. It was 22:28. A few minutes later my wife arrived and held my hand. I was very relieved to see her.  My wife is a dispassionate woman, rarely influenced by strong emotion and so able to remain calm and rational. She is a calm and reassuring presence in situations such as the one in which I found myself. I started crying again. Other than shock, the overwhelming emotion was one of relief and sweet surrender. The words Eddie Futch spoke to Joe Frazier at the end of the Thrilla in Manila rang inside my head: “Sit down, son. It’s all over.”

The ambulance crew arrived and strapped me to the gurney. The two men were good blokes and they chatted and joked with me as they wheeled me to the ambulance. I waved goodbye to my wife and they loaded me into the vehicle. I arrived at the John Radcliffe Hospital, where my wife and new-born son had been discharged from twenty-four hours earlier.

“Unless I miss my guess, we’re in for one wild night”

Leonidas – 300

It was a long night although I did manage to get some sleep. I was informed that my haemoglobin levels had dropped from 150 to 55. In case, like me, you were wondering, for men the normal haemoglobin (Hb) reference range is between 130–180 g/L. Anaemia is defined as a haemoglobin level two standard deviations below the normal for age and sex: In men aged over 15 years — Hb below 130 g/L. No wonder I had collapsed. Over the course of the next sixteen hours, I had two blood transfusions, intravenous iron, and intravenous omeprazole. I also gave several blood samples. The nurses struggled to locate my veins which meant I would often be stabbed and pricked – and then told that the procedure hadn’t worked so it would have to be repeated. I was told that I would be given an endoscope the next day so I was to be nil by mouth until then. Fortunately, I had eaten a good dinner.

Prior to the endoscope in the afternoon, I was given 100mg of Fentanyl Citrate, a potent opioid agonist with a potency approximately 100 times that of morphine. As a drug and alcohol recovery worker I was well aware of what Fentanyl was. ‘Try to enjoy it’ the doctor said before shooting me up. ‘Oh, we will, doctor’, my inner addict responded, as I sank into blissful narcoblivion.

I awoke approximately half an hour later – still drugged up and groggy. I mumbled incoherently at the nurses. There were loads of them, it seemed. They were smiling and laughing at my stupor. They wheeled me back to the private room. I was pleased that I would finally be able to eat something and I was brought a plate of turkey, gravy, sprouts and potatoes. It was, after all, three days before Christmas.

My wife and son entered the room. It was lovely to see them. My son ran around the room, trying to touch the medical machinery. My wife lifted him up onto the bed and I gave him a hug. The doctor came and advised me to rest for the next week or so. Needless to say, I was to stop taking the ibuprofen which had caused the bleeding. Instead I was prescribed colchicine, which I was to take twice a day. I was also to take two omeprazole first thing in the morning. It was wonderful to leave the hospital. That night I slept on a mattress on the floor of Leo’s room as my wife nursed Sebastian in our room. I was filled with gratitude and relief to be reunited with my family.

After a few days I started to feel better. My stool returned to normal colour, a cause for celebration my Argentinian mother-in-law proudly attributed to the Christmas Day turkey she had prepared for us. The doctor had advised me to wait for a week or so before going for a run. I did so but had to stop after half a mile. I tried again a few days later with the same result. On New Year’s Eve I had a telephone consultation with my GP and informed her that I was feeling somewhat better. The GP advised me to stop taking the colchicine when it ran out as I had previously taken ibuprofen for three weeks. Unfortunately my assumed pericarditis symptoms (chest pain and breathlessness) returned the next day – and I found myself back in the hospital on Sunday 2 Jan. This time, mercifully, I was able to arrive there under my own steam. Same procedure as my first visit: blood tests done, a Chest X-Ray, an ECG. My haemoglobin levels were increasing but were still too low – around 110. I was therefore given another dose of intravenous iron, as well as a fresh colchicine prescription – to be taken, of course, with omeprazole.

My concern at this point was that my having collapsed was getting all the headlines. I was less concerned about my anaemia than I was about the pericarditis, if indeed, I did have pericarditis and not some other condition. There appeared to be a logical explanation for the anaemia – and it appeared to be improving. The return of chest discomfort and breathlessness concerned me though.

Gradually things started to improve and I started exercising again: a twice-weekly five mile run. This was perhaps more exercise than was wise – but the doctors had advised me to do ‘less than I wanted to do’, which it was. I had read somewhere that I should keep my bpm under 100 but that would mean only walking. I read an excellent article by a doctor and triathlete who was recovering from acute pericarditis, many aspects of his account matched my own.

#MyTri: How 2020 Threatened to Squeeze My Heart to Death

I decided to do re-introduce press-ups into my workout routine which might have been the cause of some discomfort and tightness in my chest. Then the dreaded breathlessness returned. I did start to wonder if I might have the fabled ‘Long Covid’, sharing some of its symptoms as I did. I had never actually tested positive for Covid – but that, of course, did not necessarily mean that I had never had Covid. I had a telephone consultation with a GP on 3 Feb. We agreed that I would reduce my medication to one Omeprazole table and one Colchicine table per day. I was keen to not take medication for any longer than I had to. I began to realise that I was probably just going to have to learn to live with occasional bouts of potentially severe breathlessness – for weeks, months, or maybe forever. Who knew? It’s still too early to know whether or not I will have to live with recurrent pericarditis and what that might entail. There are people with far worse medical conditions though. Turning forty and becoming a father had focussed my mind in terms of health and looking after myself to ensure that I was able to love and guide my sons for as long as humanly possible. The arrogance of youth had often meant that my ego had far too often taken credit for the relatively good health I had previously enjoyed. I had also previously been far too blasé about too many aspects regarding my physical health – particularly my diet. I will address my weight issues, sugar addiction and carboholism in another article – but for now I will endeavour to look after myself, hopefully with more humility and gratitude for the gift of having a body and being alive.

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