Episode 10

Published on:

21st Mar 2023

Two open-heart surgeries: HCM, mitral valve prolapse, and myocardial bridging

#10 Paul Fasse shares his miracle story with Boots where he overcame hypertrophic obstructive cardiomyopathy, mitral valve prolapse, and myocardial bridging corrected in TWO open-heart surgeries at the Cleveland Clinic. The main theme in this episode is the importance of patient advocacy.

Website: The Heart Chamber (theheartchamberpodcast.com)

Transcript: Joyful Beat | The Heart Chamber (theheartchamberpodcast.com)

The Heart Chamber (@theheartchamberpodcast)

Thanks to Michael Moeri for being my right hand man. Michael Moeri - Audio Editor, Podcast Producer and Marketing Director


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Then in 2019, he had another heart surgery, which included the Lima bypass due to myocardial bridge. Since then, he's also been diagnosed with endothelial dysfunction as well as microvascular disease. Then in 2022, doctors found that his ramus artery was 90% occluded, so he had a stent implanted.[00:01:00] Paul is an incredible heart warrior who has so much wisdom to share.

This conversation was so heartfelt from beginning to end, and I hope that you find it helpful. If you do, I'd appreciate it if you would subscribe and leave a review. You can go to the Heart Chamber podcast to drop me a note or leave me a voicemail and you can also make a donation, which keeps this podcast going.

Thank you so much for spending your time with Paul and I today. Let's get to it.

Boots Knighton: Paul Fosse, thank you for coming on the Heart Chamber today. Paul, tell us where you are


snowmobile or none of that, [:

As a matter of fact, today it's like around 50. So with that said, uh, it's dry and, and I can't say green grass, but brown grass is out there. But, uh, I, I've full-time for, uh, almost 37 full years for all Teamster Union. They were in the trucking and food industry, and I had no problem at all, through my years. Uh, as far as, uh, you know, going about my daily, work and brought up two children with my wife. We've been married, 31 years. Name is Pamela. my ch my oldest child is Vanessa. She is a teacher and 28 years old. I have a son, Jonathan. He's 26 and he is a computer engineer. And so now we're kind of empty nesters here, just my wife and I.

all that said, getting back, [:

And until probably in my mid thirties, I started feeling kind of subtle, symptoms, pbcs, if you will, you know, the premature, ventricular contractions, kind of felt like a fish was flopping around, you know, and I was pretty aggressive in my health, so I always sought out help and, you know, they would just do the typical EKGs and echoes and, and, pretty much put me on my way. But when I would exercise, uh, to a level, like, uh, for instance if I had a hand shovel a big snowstorm or do a big, big, uh, yard in the summertime and, and after a couple three hours, I would feel, pain, if you will, [00:04:00] not an, not, not so much angina cuz angina, I guess is kind of subjective too. Some people say, well, I feel it in the middle of my chest.

continued on with my life, in:

The, um, you know, I was going about 50 miles an hour, so this is in 2005. And [00:05:00] after that, I immediately knew something was wrong in that I had so many PVCs, thousands, went to the, you know, went through ambulance. My son, my son, he was a little hurt in the backseat. He had something with his shoulder or back, but it turned out to be okay.

My, my kids were in a backseat. my daughter was, okay, my son, they just checked him out and they released him. They kept my wife for a day and they kept me for like three, and I went on a telemetry floor and I had like 43 or 4,400 PVCs in a period of like 13 or 14 hours. So while they,

Boots Knighton: that's

a lot.

Paul Fasse: it is, and, and, and I, I, you know, I would typically have a PVC here and there, but not thousands. And so after all the

ind of told that things will [:

I had more PVCs in my life from that point forward. Not thousands, but certainly enough to be aggravated, you know, so they put me on a beta blocker. That was the first time they put me on beta blocker therapy. toprol. Metoprolol is the generic form,

Boots Knighton: Mm-hmm.

l went, and all was well from:

As far as, you know, I continued on with my life, worked 50, 60 hour weeks. I was big into sports and so I would, uh, instead of play them at my age, uh, what I did is I umpired baseball I used to do about a hundred and to 125, actual baseball games in the little league on top of my 50 to 60 hour work week and take care of my family as well. So nothing really stopped me. But at the same time, I never, never felt all that. Well, I mean, I, I felt okay, but it didn't stop me. [00:07:00] But I, I, I felt, well, maybe I'm getting older, this, that, the other, until 2013 and my, I can recall my, my two kids were actually on track. They're a couple years apart. They were in track and they, and so my wife and I, we met them over there and, and whatnot.

y abnormal. So I took my own [:

took my own pulse and, and while it was regular, it was also 180 beats per. And I immediately called my wife. I said, Hey, you know, something's wrong. It's now been five minutes and I'm in some kind of a regular rhythm, some something, and I don't know what exactly is uh,

going on. So she says, I, are you driving? I said, well, unfortunately I am, I'm going home, but I, do you feel lightheaded this, that?

And I said, no, I'm I, I, I, I, I just know something's really off. So she says, okay, hurry up and get home. Got home. And then she took me to the hospital. I was an atrial fibrillation. And the atrial fibrillation, they couldn't figure out why I was an atrial fibrillation. Now this is a local hospital and you think the first thing they would do is at least an echo.

ight for that, and they were [:

about 10, 15 minutes prior, uh, because they were giving me an IV carig, I had, I felt the conversion on my own.

r Toro. I then declined, from:

A matter of fact, twice I did, and, and many, many, many times close to it. So all they did is up my to Toro, uh, that I was taking. They, they put me to from 100 to 200 milligrams of Toro. All the while Now, they said, well, let's just take a look at your heart through an echo, then into a stress echo.

They said, well, they see a little bit of hypertrophy, which is thickening on the left side, but nothing to be crazy about. So paranoid Paul said, you know, and hey, what if this medication doesn't work? Cuz they're gonna up me up from 100 to 200. And he says, well, there's always surgery. But he never noted, never told me.

And I guess I wasn't as curious as I thought because I never asked them, well, what, what do you swimming left ventricular hypertrophy? What does that all equate to? But

Boots Knighton: Mm-hmm.

Paul Fasse: it got to [:

So my mitral valve was actually getting sucked into my septum, my heart muscle. And that's what Holcomb does. Hypertrophic obstructive cardiomyopathy I was diagnosed with. And the Holcomb was so severe that it, uh, they had to reconstruct my entire mitral valve, the A one. A two, a three leaflets. They had to shorten them, and they had to work on my aortic valve. My aortic valve was, was outta whack. And then they had to, what happens is on the exterior part of your heart, it looks normal. It doesn't look, it doesn't look enlarged. But interior with, with hypertrophic cardiomyopathy, in my case, the obstruction, hence the o letter O, [00:12:00]

Boots Knighton: Mm-hmm.

Paul Fasse: um, it thickens so much inside, like muscular that the blood can get out through the aortic valve to profuse into your organs. So hence the syncope and passing out. And then the next step is cardiac arrest.

And often, I can't say often, but I can say in, in some cases for sure, that your first ca for your first symptom is sudden cardiac arrest. So you're dead, or, so it was, it was a lot to, was a lot to swallow. They told me they, I have no options.

I have to go through the false sternotomy and, and, and they can't do it here. Well, they were, they're, they thought about doing it here at this local hospital, but they had only done like two or three of them. So I did a little research,

Boots Knighton: Oh, that's not, enough.

Paul Fasse: not, not by any stretch of imagination. I did a little

ughout the United States and [:

Boots Knighton: Mm-hmm. .

Paul Fasse: They did. They

al fibrillation, but ventric [:

cardiac appendage out, they put a titanium clip in. They, um, they did a whole array of things to my heart. Huge operation deemed it a success. again, I was good as far as healthy-wise, everywhere else except my heart. So good going in. I did the spirometer incentive spirometer with the lungs, and I, I did all that and my wife made sure that I took care of that, keep my lungs strong, no pneumonia.

Didn't have any really complications.

And about two years after that, I never really felt great.

so far, the resounding like [:

So you are telling me that your local cardiologist. made you sign, like they were like, we want you on the, in the or like right now, and you're like, Uhuh, I need to go to Cleveland Clinic. Like, that's a really important window because I, I wanna hear about how did you initiate Cleveland Clinic relationship and the timeframe it took to get from Doctor who made you sign the AMA to you getting on the OR table in at the Cleveland


ly it was a matter of, hours.[:

mitral valve. zero to zero to 10 is normal. Just for the sake of

Boots Knighton: Okay. Yeah. I was

Paul Fasse: for the

list, for the

listeners out there, zero to 10 is normal and I was

one 60. So I was, um, critical. Not, not just, you know, severe. I mean, I was, it was life or death and that's how Cleveland Clinic told me.

here in Michigan, I'll, I'll [:

We're doing it as we speak. Uh, less than 15 minutes passed. And they said, you need to come in through the er now how far away are you? And I said, well, I'm like 250 miles away. I'm in Michigan. And of course you guys, all y'all are in Cleveland. And they, they, they said the same thing. They agreed that, you know, you need a myectomy, you need, which is the surgical res, everything what I talked about thinning out of my heart.

They had it going through the aortic valve, but backing up, they said, come in now, or they, they shouldn't have, gimme a choice. You can come in on Friday the 13th. And come in right through the er and we'll admit you at that point. We'll do all your MRIs. We'll do, but there's no getting away from surgery.

I said, you know what, I've [:


Boots Knighton: uh oh.

Paul Fasse: I

s. In this case, your brain, [:

this is what can cause sudden cardiac death. So while it wasn't the probably the brightest thing for me to do and wait till Friday, It all did turn out. It, I, I went in on Friday the morning and they immediately took me in, and, and did the mri. They did a CAT scan and they said, you're very, very critical. And I says, what's my options? And they said, you have none if you do not get it. Our estimation, and we're not, God, I'll never forget them saying this.

We're not God, but we would think in a, in a week to maybe two weeks left of life. And what's, if I get the surgery, can I look for for prognosis? And he says, well, we do a, we're a high volume center, which, so you pick the right hospital. We do them often, and, more than likely you can get your life back.

Well, of course, I, I, I couldn't wait for the open heart, but this just, that's just it. This is

th. The [:

cardiothoracic surgeon. Unbelievable. He has got like, I wanna say, near nine or 10,000 surgeries in a, in a, in, in roughly half of them, or possibly more are because of Holcomb. So he's been there, done that. He can do it blindfolded with his hands behind his back. I mean,

he's just, he's the man.

So if there's faith and there's God, or, you know, and I'm not gonna, I'm not gonna touch base on that, I certainly was in the right place at the right time and I found the right person. Had, I've gone here to a low volume center, things would've been much, much worse cuz it's so intricate. Remember, they're thinning out your inside of your heart besides doing the valves. So it's, it's, it's, it's quite, it's very, it was

a big overhaul in my heart. So

Boots Knighton: But he was on

Paul Fasse: was on

vacation. So so he came [:

Finally, he, they said, we have a standby cardiothoracic surgeon who has done a few of them, but we really want Dr. Nicholas Madeira. So we are gonna up your Toro from 200 milligrams to 400 milligrams. Remember, you're in the hospital, so you're gonna be watched. And so I was in I C U the whole time and he finally,

Boots Knighton: how long was that


Paul Fasse: several days, several days on the 17th, he came back in town and seen me. And then he said, I will do you first thing in the morning. You're, you're my first case. So on February the 18th, I had my, um, my surgery. It was, it was Ash Wednesday. So I went from Friday the 13th in, you know, and, and to Ash Wednesday. And, and speaking of Friday the 13th, and I'll just add this little thing here.

th, different years. So [:

They said, you're strong enough, Paul. You'll make it through the surgery Friday. The, uh, on, on the Wednesday rather the 18th. did a big, huge surgery and about five hours later, what it was completed, I was breathing above the ventilator within two hours. So they removed my ventilator. Again, my lungs were great. My heart was the, was the culprit.

After the ventilator was removed, then they soon removed my chest tubes. And, I stayed there a total of 12 days because remember, I had to wait several days for the cardiothoracic surgeon to do that surgery

e best of the best. However, [:

Boots Knighton: Mm-hmm.

Paul Fasse: awesome awesome man. Awesome cardiologist. I mean, fantastic. Well, I never felt 18. I didn't feel 20. I still felt, I felt like I was 70 and I never, I couldn't run anymore. I had to give up baseball. I couldn't work. It was more physical, so I went on disability. I had already worked 37 years. I'm sorry.

Boots Knighton: well, I just wanted to ask like, did you, before we get to that next piece, like, did you do cardiac rehab or

Paul Fasse: it all

Boots Knighton: change anything about your life? Okay. And it just didn't, it didn't


Paul Fasse: No. The, the surgery, the surgery saved my

life and, you know, the gradients returned

back to normal. uh, was like three or

four on the gradient scale. Zero to 10 again is normal.

at. I really wasn't short of [:

So all looked. From their standpoint. but, for, but for,

me, and we're our best advocate. We know our bodies better than any doctors, better than anybody.

Boots Knighton: Mm-hmm.

Paul Fasse: I felt just outta sorts. I just, I didn't have enough, stamina. I, I went to cut the grass, I'd have to stop, you know, a quarter of the way my wife would finish up. And the frustration, the depression, the anxiety all came full circle where I ended up, you know, not in a nervous breakdown or nothing like that, but really, really down on my luck, down on life, down

to the point where, you know, is life even. Why did I make it through, you know, if this is the way I'm gonna be and, and that well give it time.

ld traditional pension. They [:

oh, you're retired It's not, it's not that you, I'm, I'm, I'm a person that can't sit still and I'm, and, and while I was active in, you know, if it's fishing, if it was going on a, on trips, if it was, I had to, I, I just couldn't. I just couldn't sit and I realized I have to at least exercise. So I would, I would do my walks, but it wasn't nothing to the level that I used to Not even close.

Boots Knighton: And so, you know, what I'm hearing you say is, you know, cuz cardiac depression is real, and I am hearing that you were lacking


time. And the reason why is [:

breakdown when I was 30. Um, right before I got married, I was building

a house. I was, you know, planning this and I was an anxious person. And despite, you know, knowing in your mind you said, people say, well, just, you know, think good thoughts. You know, just relax, take it all in. It's not that easy. It's not that easy.


Boots Knighton: no, it's not.

ance, and this is way back in:

It just, it's just that way.

Boots Knighton: Mm-hmm.

Paul Fasse: I [:

You know, I'll be okay and try to tough it out and you really shouldn't. Nobody should do that. Nobody.

Boots Knighton: You don't have to like, can we let, let go of that idea that we have to be tough anymore?

Paul Fasse: Right. Right. I, I I couldn't be tough. And so therefore, I, I ended on a different antidepressant, an S S R i, a serotonin selective re-uptake is what they are. I take a small amount of that

and, it, it's, it's like a minimum dose, but it was enough to get me out of that.

hing up. I'm an advocate for [:

They said, well, let's, um, you I, he says, I don't know, you've had a, you had the Holcomb and everything looks good on your echo. You had a stress echo. That looks good. We can, we can go to the next [00:29:00] level, which is angiography heart cath, or, and I says, well, how about before we do that, how about do a CAT scan with contrast?

Could you, could you put that in, in, in, in the computer now and set it up? He said, I actually, I can do it right now. And we could, we could do it. So we did it that day. I was in Cleveland Clinic. We did it that

day. And, you know, naturally a radiologist has to read it and all. So I left on my way with my wife.

We drove from McComb, Michigan, where we live, MCC McCall, Michigan to Cleveland. So I, I got about an hour away from home and he's got my cell phone number and he calls Dr. Collier and he says, um, They found a lesion that's 50 to 60%, uh, blocking your L a d. it is serious. It is serious.

And I am sorry.

it wasn't gonna be that day, [:

ivus, the, the whole thing. And they put me in with,

you know, to get the heart cath. And he says, I, I don't know how to break this news to you, Paul, but you need another huge operat. when I say, you gotta be kidding me.

And he says, your l e d is inside your myocardium as what a myocardial bridge was. And when I first found out, I had never heard of it. But now, of course, through research and whatnot, I'm, I'm well versed on ho on myocardial bridge. In hypertrophic obstructive cardiomyopathy. Unfortunately, we had to learn the hard way, but go through that. But, he, he said, um, the only thing is surgery, and that's the only thing that can fix it. And we have a Dr.

ecialize in that. Well boots [:

it. So I, I, I'm, I'm not putting them on the hook at all, but it was never noted that I had this myocardial bridge in 2015. My aortic valve was messed up, my mitral valve was messed up.

They took the cardiac appendage out, they did the mace

ing out, you know, really So,[:

which is, which is fair, fair and square. But I, I was frustrated because, and, and scared because a reoperation means, you know,

you know yourself. They're gonna go back into this. And it's not the little going in between the ribs or where they can do it, you know, through your groin. No, no. It was, take all my hardware out and I had the big long sternotomy thing. Huge, eight inches or so, I don't

know, big one. They had to take all that out and it becomes very vascular.

That's what they told me. becomes very dangerous anytime you go, you know, on a virgin chest, it's one thing. When you've already had all of that done and you're going back in there again, I was in the right spot. Cleveland Clinic, they specialize in Reoperations.

Boots Knighton: Oh,

Paul Fasse: specialize



Why if I was to do over again, would I have had this operation at Stanford? The clear answer is absolutely not in that I've already had an operation, huge one. They had to take all that titanium, all that stuff. That's you so well know. And, and I, you know, the plates,

wanted me in, um, January of:

S Madera, who did my first open heart, spoke out in front of everyone. Anne said, more than likely I would not make January of [00:34:00] 2020. I would pass away before that. It that bad. So could you come next week, come Monday?

Boots Knighton: And what date was this?

Paul Fasse: this?

gistered October the first of:

this is probably like September

27th, 28th of the week. Can you come next week? I said, sure. And come on Monday. And again, I'm not feeling well at all. I had the worst symptoms, but a different symptoms that, again, it wasn't about passing out or nothing like that. It was just the, pressure on my heart. It felt like the hardest grip on my heart and that I

wasn't gonna make it.

I could, I could feel death. I could feel death. I could, I felt death on

, the, um, pa, the physician [:

Even if we don't get compensated, we need to do the surgery. So I said, thank you so much. God bless.

Boots Knighton: That's incredible. Like what hospital

Paul Fasse: hospital will

Boots Knighton: that


Paul Fasse: Un unbelievable. Tho tho that

is something that, that's why I talk so highly of Cleveland Clinic. They're, they're, they've been fantastic. I love all

operation October the second,:

think it's

Boots Knighton: almost all

Paul Fasse: all the time.

It's, it's unfortunate, but, uh, it's

almost all the time. I am [:

though. That they took me serious and that they did the proper thing and they did not stent Cuz for you myocardial bridge people out there that are listening do not, do not stent the bridge. No matter what a Dr. May

tell you, or interventional cardiac, do not do that. That's the wrong approach. You it, it will become very fragile and, and it deadly. So once that's done, that's a, a horrific thing. you can't go

back. There's no going back.

So, thankfully they were a

aware of all this and they took me serious. depth of it, they were vague. They just said was very deep on the OR report, but it was 3.5 centimeters long. So they unroofed. and again, I had a 50 to 60%. As it turned out, it was 50%. Once they got in there a lesion, which still was there,

Boots Knighton: and can we, uh, can you educate us on what a lesion

Paul Fasse: a lesion

is a form of plaque. Basically, the, it's, it's al it, it, i, i,

a lesion [:

A k a heart muscle. Every heartbeat. Every heartbeat of, it's kind of like a straw, where if it's a brand new straw, you can squeeze that straw and let it go. It will open up. Well over the course of six decades, it doesn't wanna open up too much. So even whether you're in systole or diastole, it doesn't matter.

You're not getting proper blood flow. Hence the headaches. Hence the pressure in your heart, hence the feeling of death. just know, I mean, you just

know something is awry in really, really bad,

g about that deep feeling of [:

And once that, once you've had the operation to correct whatever is going on in your heart, and that feeling of death leaves, it's like, it's a whole new world. And I call my life now bonus life, cuz I mean, it really feels like it is a whole

Paul Fasse: Rebirth.

Boots Knighton: brand new life than before. Would you


Paul Fasse: Totally. Spot on Boots. That's a great point. I don't know how many times I told my family, my friends, neighbors, everything else, the quote. I'm running out of time. I knew it. I was running out of time

g down in the shower before, [:

I was in the hotel, yeah, I

stayed in the hotel on October the first, October 2nd in the morning. It was to go in there and get all registered and get ready for the afternoon o operation. As it turned out, it was evening, but I told my wife that evening, I told my wife during the night, one o'clock, two o'clock in the morning, my kids, you know, were, we were all in this.

We had two beds. So it was me and my son in the one bed, my wife and my daughter in the other bed. And none of them, nobody could get sleep because of. and two o'clock, three o'clock in the morning, my daughter, God bless her, she, you okay, dad, you okay? I said, no, honey, I'm not good. Uh, I, I, I feel I'm, I'm not gonna make it.

Well, we only got a few more hours till you get to Cleveland, and we were, we stayed 20 minutes away from Cleveland area, so we were right there. But, uh, nonetheless, I still felt even in the morning, I says, we, let's, let's get there. Let's get there. Now. It was more, it's it's the pain, the anxiety, the knowledge boots, what I'm going

about to go through [:

Well, I've been there, been there,

done that, been there, done that, and it felt like, feel like you've been hit by a truck. you know that everybody that's gone through open

heart. But my thing was, I, I'm welcoming a second open heart because I can't stay like this. This is no life. My quality was not, there was no quality. So getting back to the surgery, when they did the surgery, they had to make a decision. Of doing a Lima bypass, A Lima bypass, all of us are born with mammie arteries. There are roughly the

size maybe your little finger, or in your case you're kind of petite on petit two s. I don't know, maybe your ring finger say, and they're always atherosclerotic free no matter what.

as, which was, you know, his [:

We talked

about that. The pressure of the, for six, almost six decades, 58 at the time, pushing that blood through the platelets stick, and then the plaque sticks to the walls in nine out of 10 myocardial bridge patients in about 10%. One out of 10 it, it will be distal, which is on the other side of the

here else. this plaque was in:

they do this surgery? Yeah, I, I understand through, even Rob, they, they have attempted it in the 1970s, even as late as ear, you know, [00:42:00] early eighties or early as that they, they've attempted it and done it, whereas it successful, I don't know. But they, they've known about this stuff, but to actually have a procedure that was, I won't, well, as safe as can be that they felt comfortable with, it wasn't until the end of probably six, 2016, so this is prior, again, I'm in 2015. So they left it, they let it alone and they didn't address it. I guess leave a sleeping dog lie. It's not, if it's not barking

and biting you leave it alone. Well,

Boots Knighton: And that's typically how the medical field rolls because it's like, why? Because there's just so much trauma to the body. But unfortunately for you it was two times this,


Paul Fasse: they took, so

they took the le,

they did the, the, they took the left interior mam artery, A k a Lima. They, they, they transplanted that and grafted it alongside my native

was born with. So now I have [:

Boots Knighton: Mm-hmm.

Paul Fasse: I had a two-way highway, which is in all, in all regards, great.

You know, you say, wow, you got two. Now you know it's gonna feed the myocardium your heart muscle. Great. only thing with that is competitive blood flow. Competitive blood flow will always happen. One wants a fight with the other. Typically. if your native L a D, the one you're born with is still op operable, that will win. and almost all the time. So my la

ds, I guess. they, you know, [:

Boots Knighton: Oh,

Paul Fasse: but

it's still lip,

but it's still a pig. The lipstick is kind of concealing that. So

I was out of physical danger in terms of heart attack and all that. As far as that goes. I was getting proper blood flow, but damage has been done, you know,


Boots Knighton: And

that competitive blood

Paul Fasse: it's happening. now

Boots Knighton: I, I also think your heart

Paul Fasse: In the Lima In the, in the Lima now is

getting smaller, so it's still patent. They, they call that still opened, opened enough, but originally when first bypassed, it's, it's wide open, you know, beautiful big in their bigger arteries than through your, the best arteries in your veins or your legs. I mean, this is a, this is a mammary artery, it's not a vein. So the, they're big. Well now it's getting

the lima is getting narrower [:

It's, there's so much to to talk about, but. They wanted me to have, uh, you know, uh, because I still had symptoms, not to the degree of, uh, what I was before my operation, cuz I'm leaps and bounds better. But I still have issues of spasms, endothelial

dysfunction, microvascular disease, and I'm still on dal. I, I take, uh, that st you know, for, for spasms. And I still feel,

I, I, I feel okay to, you know, go out to eat once in a while, jump, jump in a car, go to the store. But I often still have symptoms. So they said, let's do a heart cath. So they did a heart and they says, I'm gonna put you with the guru of angiography again, all he's at Cleveland, because I can't really go anywhere else. And I went with him

there just shy of two hours, [:

it's still, I still get spasms at times. I take nitro sublingual, but it doesn't really help much.

It's, I call it the poison pill it, all it'll do is kind of gimme headaches and, and that, so I, I, I tend

to try to stay away from it unless I, feel like there's no other straw to grab. And then I'll go ahead and take one, but I don't take it often. But the endothelial dysfunction. According to Dr.

Gobrial, and I've seen her now because she is, you know, head, uh, of myocardial bridge at, at the Cleveland Clinic and seeing her in person, fantastic expert on all things myocardial bridge, and she basically said how much it will heal naturally. It won't heal if it was not unroofed. So Rob's what, what, what Rob

professes is a hundred percent, for people say, well, I'll take

medicine and stuff.

ah, I mean, it might buy you [:

But know, it is what it is. It, it took a beating. That's, that's, that's what it did. It took a beating.

Boots Knighton: Mm-hmm.

Paul Fasse: And

the endothelium cells that line, the artery can heal, but cheat, like Dr. Gobrial said. To what extent, we still don't know. There's insufficient data and it's just, you know, it's, it, it could heal 25%, 50%, 75.

any better than you are now. [:

are, had the surgery boots that are saying, you know, Paul, I can kind of relate this, I still don't feel on, on top of my game. I guess there's some hope that, you know, time is on our side now that we're on roofed. And I'll be, well, it, it turned three, it was three years, October 2nd, when I had the operation for my second open heart. So I'm going on four.

Boots Knighton: Mm-hmm.

Paul Fasse: And again, I don't wanna, I'm not gonna sugarcoat one thing or say I, I'll, I'll tell it right from, from right from the heart. I still don't feel like Paul Fosse. However, I don't feel like I'm gonna die. I don't feel like I need to be in the hospital. I can still do my things. I'm just not my, I'm just not myself like I used to be and maybe never will be.


oots Knighton: And that's a, [:

Paul Fasse: Yes,

Boots Knighton: and on the other hand, okay, but I am not myself. And I've been thinking a lot about how in your case, twice, like I was saying earlier in our conversation, our soul is touched when we have heart surgery, it's not, it's not just a, you know, a joint replacement or a ligament, you know, damage surgery where they go back in and repair it.

This is like the essence of you is literally handled and it. , it just changes you and, and in a lot of ways for me, the better. but at the same time, I don't know if you've seen, have you seen the movie The Princess Bride?

Paul Fasse: I don't believe so. Um, no.

for those who have seen it, [:

And the torture scene is even kind of like precious. He's like laid on a table and the king orders to have years of his life taken away and. And it's like all, it's just this incredible stage of, of, uh, what's the word I'm looking for? Or like all these different machines working together to take years of this guy's



Paul Fasse: You see why you

Boots Knighton: ultimately Yeah. And ultimately he goes, and sees this wizard, uh, that's played by Billy Crystal and it's hilarious. He gets

Paul Fasse: I'll [:

Boots Knighton: back to him, but Yeah. But I, I feel like yay, I'm alive yet I really feel like years of my life are taken away because how like our, our myocardium was cut into, our heart was cut into, and in your case twice.

Right? And it's, it's hard to walk around with like this dualistic thinking of, I'm so grateful,

Paul Fasse: but at the same

Boots Knighton: and how much time do I have left?

Paul Fasse: I just don't wanna suffer. I'm okay with, you know, obviously, you know, I, I've been told this too, you know, we're all gonna die. I get it. But we're, we're high risk. I mean, and, and I'm, and I'm still young. I'll be honest, if I, well, I shouldn't preface with that because every time you say, I gotta be honest, like you're almost dishonest.

g word. But if it wasn't for [:

It's not about It we're our best advocate. Again, as I mentioned earlier in the conversation

in this podcast, we are our best advocate. We know what we feel like. And now I finally, but it took. All these horrific things to happen to me. Not one doctor ever looks at me and says, oh, it's anxiety. Oh, don't worry about it.

rd, but, you know, it's like,[:

and, and, and, and, you know, I, I just can't understand why in two, in 2023, now that we have, you know, so many, almost 2000 members here, that these cardiologists don't realize, Hey, this is a real thing. This, this can't be taken lightly. And again, while we may be in the minority without someone actually coming forward and and accepting what we're we're saying and, and, and having an [00:55:00] operation, we would be dead. I mean, it's, it's,

it's so frustrating. I, I just wish more and more would be believers. But my former cardiologist, who I, of course fired after my second open heart, the myocardial bridge operation, I had to see one here at my hometown. A week after Cleveland Clinic, they said, you can come all the way to Cleveland, or you can see your own one here.

So I went to the hospital, and again, I'm not gonna mention his name or nor will I mention the hospital, but the very first thing he did, and my wife was in there with me, waiting for him to come into the, and knocked on the door. And he said, the first thing he said was, Paul, one open heart wasn't enough for you.

e medical books and, and see [:

Boots Knighton: There was

no telling

Paul Fasse: And I'm telling him this, I says, you know, I I obviously they didn't open, I did tell him this. Obviously they didn't open me up just for the sake of, you know what, I think this is a good time. Let's, let's give him a second open heart surgery and let's, let's, let's go for it. My l a d was trapped so much being compressed so much. I had this 50% plaque lesion, if you will, and all of that due to the myocardial bridge's severity. So without the operation, I'm sorry you feel like that. And I said, with that said, I feel we, we can't go on any further. I then got up and I left, you know, and,

Boots Knighton: for you. Did he follow up or try to

Paul Fasse: he, they didn't know.

in total disbelief. I wasn't [:

try to, try to prove it to him. I mean, Duh. I had an operation as you know, obviously he's smart, but what, what made him so, dismissed?

Dismissal this dismissal. Like, no, it can't be that they're always benign. No, they're not. No, they're

Boots Knighton: No, they're

Paul Fasse: And

the vast majority of

Boots Knighton: I'm so sorry

Paul Fasse: So I, I've been going through, I've been going through a lot of crap in my life and my quality has gone way down. I'm happy to be alive. I'm not happy with feeling the way I still feel.

But again, it is better than I was before the operations, plural, Operation one. And, and certainly if I didn't have the Ma Cardi Bridge, um, surgery on roofing, I, I hate to even, I hate to admit this, but I, I have to be this frank. If I couldn't get help, I was gonna have to find a way of taking myself out. I thought of it. I, I had passive

on like this. The, the, the [:

So I'm thankful that I got the operations. I'm thankful for Cleveland Clinic. I'm thankful that they, I had great, great physicians, and I do not hold them responsible for them not doing anything in 15 again, because it was primitive in 2015. But, I, I

still am, I'm scarred, if you will. I'm still, I'm, I'm not, I'm not myself.

I'm not exactly

myself in every way.

emotionally and physically. Yes,

Boots Knighton: Mm-hmm. . Mm-hmm. .

Paul Fasse: yes. Boots. It's, uh, it's been a

it's been a


e that it brings you a, even [:

You know, we don't have to do this alone. And even though you have two surgeries behind you, and hopefully that's the end of it, and that you can continue to heal, like you still don't have to be alone, even though it's a problem

Paul Fasse: you.

Boots Knighton: still, you still don't have to do it alone. You don't have to be alone in this.

Paul Fasse: Thank you so much. Boots, uh, you know, You just saying that it touched my heart. I really, uh, that, that's, that's, that's very comforting. And with that said, you taking the next step and I wish you all the best. I know you've gone through a whirlwind of problems too, and you know, infections and putting a titanium plates in you and, and just horrific, horrific things.

It's not just me. We're all, we're, like you said, we're all in this

her. But I, I, I wanna first [:

you for getting this podcast, asking me on this podcast. And I also wanna thank Rob for the wonderful Myocardio Bridge site that you know, he is, he's, he's a wonderful man and you're a fantastic person, yourself, boots.

And God, may God be with all of us, not just us heart, heart patients, but may be God, may God be with all of us and give us the peace in the comfort. And that's, that's, that's, that's my main, um, that's my main idea in my mind. If I can have peace in comfort, then I feel, I ha I've, I've won this game of life, regardless what happens.

Boots Knighton: Yeah. It's like, you know, you're out in the middle of the storm in a dinghy and still finding the peace while in the dinghy, and 40 foot waves. Right? It's, and you don't have a choice. It's like, well, I'm out in the middle of the storm and a dinghy, so I can either, I can choose my attitude about it,

Paul Fasse: Yes.

Boots Knighton: Um, [:

And then, oh, no surprise, you have this pori of heart issues and it's, it takes a long time. I'm talking years of

Paul Fasse: I can't agree

with you.

Boots Knighton: that.

Paul Fasse: Yeah. So it, it, it, it, messes with you and we'll make this, uh, we'll, we'll get this. I know I'm, we're way past, uh, a horse or something, but it's, it, it affects the psyche as well. Yes, it does. And I, but I, I

. I try for it not to define [:

because my symptoms, although they're not as devastating, they are enough to throw me off my game if I let it.

And, and sometimes

Boots Knighton: Mm-hmm.

Paul Fasse: in a, in a dark, if I'm in a dark area, it, can win. And I don't want it to win, so I gotta muscle it.

I have to mu.

Boots Knighton: So I, as I close this out here, I wanna remind listeners to go back and listen to my interview with my physical therapist, Cassie Fuller. We actually talk about this in depth, the mental aspects of heart surgery, and I really go there with how I worked with my mental health therapist before, my heart surgery and after.

end, unfortunately. So bear [:


So, Paul, thank you.

Paul Fasse: No, I was just gonna say

it sounds like a, a, a something that I'd be very interested in listening to. Absolutely. Very entertaining



Boots Knighton: really profound. Mm-hmm.

Paul Fasse: Thank you for everything

Boots Knighton: thank you so much for coming on the show today.

Paul Fasse: you having me. pl. It was a pleasure to be on your show

Boots Knighton: And that's the show for today. Thank you for spending part of your day with me. The heart chamber exists because of you. If you find value in this podcast, consider donating to this cause. Go to the heart chamber podcast.com and go to the donate link. And hey, while you're there, feel free to leave me a voicemail.

I want to [:


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About the Podcast

Open Heart Surgery with Boots
A podcast for heart patients by a heart patient
Formerly called The Heart Chamber Podcast, Open Heart Surgery with Boots airs every Tuesday for conversations on open-heart surgery from the patient perspective. Boots Knighton explores the physical, emotional, mental, and spiritual experiences of surgery with fellow heart patients and health care providers. This podcast aims to help patients feel less overwhelmed so you can get on with living your best life after surgery. You not only deserve to survive open-heart surgery, you deserve to THRIVE!
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