I've had some questions about why I was off-line from mid-October until recently. There's really a rather simple reason: I had a myocardial infarction (MI, or in lay terms, a heart attack) on Monday October 18, and I've been slowly recovering since then.

Sunday, October 17 was beautiful, and my wife and I took our sailboat out into Charleston harbor and the Atlantic Ocean, ate supper out afterwards, and had no problems. Monday morning, I walked our two dogs as usual, then sat down for breakfast.

During breakfast, I had chest pain. Not exactly crushing, but located below the breastbone (in medical terms, what's called substernal), and definitely different from anything I'd ever experienced before. It didn't settle down, and I asked Steph to call the paramedics. The pain continued, and at some point started up in my left arm and jaw also, and I was sweaty and scared.

The paramedics and their ambulance arrived promptly (as did  also a fire engine!), took my blood pressure and what-have-you, and a few minutes later, I was being transported to the nearest big hospital. The first electrocardiogram (ECG) was normal. The first blood tests also were normal. But several hours later the repeat of the blood tests started showing an upwards trend, and the trend continued. I was now largely pain-free, and my heart rhythm never changed from normal, but it was clear that something was haywire. Cardiac cath was scheduled for Tuesday morning, and showed three areas where my coronary arteries needed bypass. Open-heart surgery was scheduled, and I now have a scar on my chest, some new medications, and a changed outlook on the vicissitudes of life.

That's the story in brief. As of now, I'm back at work full-time, but as of yet haven't been out sailing again. Partially since it's uncomfortably cold in winter, even in Charleston, and partially that my physical endurance is still subpar.

Why discuss my story at all? Well, for one thing, it points out that those of us with diabetes, even on insulin pumps, CGM devices, and with normal A1C levels (mine was 5.4 during the hospitalization) are at risk for what's called macrovascular disease (heart attacks and strokes). Macrovascular disease, where the larger blood vessels in the heart or brain or elsewhere are partially blocked or sometimes totally occluded, is minimally affected by glucose control, and needs additional treatment. Quitting smoking, lowering cholesterol (lipids) and controlling hypertension (high blood pressure), are equally important. It's also widely thought that taking aspirin is an important therapy. I had thought I had my cholesterol and BP under control, and have been on aspirin for years, but I still had a cardiac event.

Another point: although myocardial infarctions are traditionally associated with crushing substernal chest pain radiating to the left arm and jaw, and an feeling of impending doom, they do not always follow this pattern. Indeed, there are cases with no symptoms at all, and the diagnosis of an MI is made retrospectively based on findings on routine electrocardiograms. In such a case, the patient is assumed to have had what is called a "silent MI."  In other cases, a MI may occur with minimal or unusual symptoms; such an MI is called an "atypical MI." Symptoms that might occur with an atypical MI include shortness of breath, cough, fatigue, abdominal pain, nausea and vomiting, fainting, and palpitations.