Apr 23, 2024 4 min read

By Nick Jacobs

In December 1996, I had a thallium stress test. I ran full speed without any discomfort, jumped off the belt, and high-fived the medical professionals in the room. Three days later, my doctor, who had never visited our home, was knocking on my front door. He made a courtesy call to let me know there had been a significant finding in the stress test.

Immediately after the new year, I went for a cardiac catheterization and had two stents placed in my right descending coronary artery. As it turned out, those stents were what is referred to in the vernacular as “full metal jackets” because, unlike the newer generation of drug-eluting stents, these devices were not medically coated, a protection that helps keep your body from forming scar tissue or stenosis around the metal.

About 18 months later, I had the beginning of a heart attack which presented itself as toothaches in the back of my mouth. Plus, according to my family, I turned gray. I again went to the hospital and, because I had been injured by the insertion of the first stents, I needed to have two more stents placed in the corner of the right descending artery. The invasive cardiologist who placed the new stents said, “The fish were biting, but there was no heart damage.”

About seven years later, I experienced some discomfort and had to have those first stents re-stented. That’s what happens when you have re-stenosis. Then, again, seven years after that, while walking through an airport in Milwaukee, I felt that same chest tension, went to Pittsburgh and had another stent placed below those original two stents.

In May 2019, my cardiologist told me I’d need a new aortic heart valve. There was something new in trials at that point called a TAVR, transcatheter aortic valve replacement with an artificial, bovine heart valve which was placed through the groin instead of through open heart surgery.

No one was doing that locally at that time, so I went to Cleveland to see if I qualified for the minimally invasive surgery, and I was rejected because guess what? The original full-metal jackets were once again clogged. I had an 80 percent blockage and was told I needed open heart surgery.

I went home and decided to have the TAVR placed as soon as it was available for my age group. It was then I also decided to once again avoid open-heart surgery if possible and, fingers-crossed, wait for the next wave of technology.

Luckily, that seems to have worked. After experiencing an extreme lack of oxygen on a Canadian glacier last fall, I went through a series of tests and, once again, headed for Cleveland where, at the clinic, a young, incredibly talented physician, Dr. Amar Krishnaswamy, simultaneously employed all of the new technologies to clean out those antiquated stents.

First, he used high-pressure balloon angioplasty, then cardiac lithotripsy, followed by cardiac lasers, and finally brachial artery insertion of radioactive isotopes for six minutes to keep the cells from growing back over the stents.

If you want to know why I chose this path to heart health, I was lucky. The technology was coming on the market as I was aging, and my family’s high cholesterol which I had fought my entire life, was being addressed by brilliant doctors and scientists across the world.

If, for whatever reason, this series of treatments doesn’t hold up, in May, Cleveland will be getting medically coated balloons that will help open blockages, possibly without stents.

Yes, there are great invasive cardiologists and open-heart surgeons locally, but if you find yourself in a complicated situation, there may be alternatives. My dad died at 58, and at age 49, my heart journey began. Consequently, I’ve looked at these decades as a gift of time to accomplish some good things to make this world just a little better.

Nick Jacobs is a Windber resident.