Heart Disease
by Chuck Cronan
A List Member's Experience
Sorry that this is very long, but many, many of us have this in our future - diabetes is a MAJOR risk factor, especially if you ignore diet restrictions and live a sedentary life.Thanks again to the many, many friends here that wrote encouraging, spirit-uplifting notes to me personally and/or posted. I thank you all to the extreme - it was both needed and appreciated.
For those of you who are new or need a summary - I am a 52-year-old Type II requiring insulin. Diagnosed about five years ago, on insulin (90 to 100 U, split in three doses daily) for three and one-half years. I have multiple cardiac risk factors, most of which I was well aware of, 30 pounds overweight (210), low HDLs, high triglycerides, sedentary, diabetic, high saturated-fat diet.
The risk factor that almost did me in, however, is genetic. On both sides of my parents, particularly my father, there are rife reports of heart attacks and arteriosclerotic disasters. My older brother (by three years) had a minor heart vessel blocked five years ago which did not need surgery. So that this genetic factor is fully appreciated by the reader, two of my father's nephews (my first cousins), one 60 and one my age (52), and I had heart bypass surgery within a period of four weeks!
To review my timing - on 11 May I had a major angina attack, first one that was truly recognizable as heart related; although minor attacks were felt for months previous to this, I rationalized them away.
On 14 May I had a Thalium stress test in which a gamma-ray emitting Thalium isotope is injected in a vein immediately after a stress test. After 20 minutes of data gathering, while positioned on something that can best be described as an unstable ironing board, it indicated a large shadow on the left side of my heart; this meant that blood flow was extremely restricted in that area. The test was run a second time after two hours of rest to see that circulation to the heart did return. However, due to the shadow, another test was needed.
On 31 May I had a cardiac catheterization. Long (more than one), pre-shaped tubes are inserted through a temporary port in a groin (in my case) blood vessel, but could have been elsewhere depending on the cardiologist's needs. The tubes are designed to lead to the precise spot necessary to measure blood flows and vessel blockages. This test only took 45 minutes, but the conclusion was initially devastating. Incidentally, several of you had warned me about significant bleeding when the tube port is removed from the groin, with stories of heavy pressure required by means of weights, sandbags, bricks, or very strong orderlies. I was lucky, in that respect; the bleeding stopped nearly immediately, and I did not need weight on my hip/groin area, but I was still instructed not to move that leg or sit up for eight hours.
The devastating news was that I had two blocked cardiac vessels, one 95% blocked and one 60% blocked. Diabetics have poor success with angioplasty, and with a 95% blocked vessel (its position probably would have resulted in a massive heart attack if it completely closed down) it required nearly instant surgical repair (I have been told that 60% blockage is the trigger for medical intervention).
This is where I am forever indebted to all that wrote to me - I really became depressed - I'm too young for this, I have a 14-year-old daughter who cries if I need to travel on business even one night - how do I explain this to her? It was too soon, I have had a nice life, I am truly NOT afraid to die (painlessly, that is), but it is too soon, there were too many things I felt I had to know before I went; I want to know that I was a good father, that I would be proud of my daughter's future. When I thought of this I sobbed, more than once. I really was feeling sorry for myself. On top of that I had no will, no medical power of attorney for my wife, no living will. Your words helped, perhaps more than you'll ever know.
Double bypass was performed on Tuesday, 4 June (I went to work 3 June, trying to be normal). I was lucky that the 95% blocked vessel could be shunted with the left mammary artery. What is nice about that is that only one end of that artery need be moved and reconnected immediately downstream from the blockage - that it is arterial, rather than venous, is a plus, too, because it is less likely to plaque up again and designed to take high pressure. The other blockage required a saphenous vein from my lower left leg.
For that surgery, they try to not give you enough time to think about it. Check in at 6AM, at 7:45 they wheeled me into the OR, someone began shaving my chest, something was added to my glucose/insulin drip bottle. Suddenly the clock on the wall said 4 in the afternoon, and I was in Intensive Care. Multiple tubes and wires coming out of me, an airway pipe down my throat, and two breathing tubes to the lungs, jump-start wires in four locations on my chest (just in case), wires coming out of my neck to the heart, too. IVs everywhere, bladder catheterized (thank god I was unconscious at the time), and maybe more; including two chest drainage tubes, which were to give me problems later. Loved ones are asked to visit only if necessary, because the patient looks as if s/he is hip deep in their grave. My daughter chose not to visit because she was afraid she would cry - I know I would not have visited me.
I did well. I was told that I was back in ICU at noon. After complaining sufficiently (pointing and moaning and gagging, oh my!) about my respiratory tube, they took it, and the breathing tubes, out at about 5 or 6PM. I was able to call my wife at 7:30 that evening at home (she had been present most of the day, but left, emotionally drained, shortly before I came out of it). At midnight, 12 hours after the surgery was over, I was requested to stand and be weighed. I was 10 pounds heavier after surgery than when I checked into the hospital. This is due to the use of artificial blood, used liberally, and other liquids pumped into me. No transfusions were used even though I was on a heart-lung machine. This hospital has a policy of using blood transfusions only if absolutely necessary. Because of the extra liquid weight I was on a fluid-restricted diet, and all of my urine needed to be collected and measured, and I was weighed daily - I had to loose that excess weight before they'd let me go home.
Sometime the morning after surgery, many of my remaining tubes (not the chest tubes, yet) and my neck wires were removed, and I was transferred to the Intermediate Cardiac Care unit - but I had to walk! That is amazing, you have to agree, less than 24 hours after a double bypass, they walked me down to my new room pushing a wheelchair ahead of me for support. My instructions were to walk around the hospital floor every two hours. I had to demonstrate also, 1) that I could pee, and 2) that I could have a bowel movement.
The third requirement to get out of there (other than the weight loss) was to demonstrate an improvement in breathing. There is a little gadget that you inhale through and it indicates your lung capacity. I was doing OK until Thursday when it was time to remove the final jump-start wires and to "yank" the chest drainage tubes.
Ah! The chest tubes. With all the cutting, snipping, and sewing of blood vessels, there is some normal leakage of blood and fluids into the chest area above the diaphragm. These tubes drained into little bottles on the floor - visually they could see if there was excessive internal bleeding. Well! I am informed it is time to remove the chest tubes.
"Most patients feel only minor discomfort. In fact, some don't even feel their removal at all.""Minor discomfort," she said. This is probably a true statement for most patients, however. The patient in the bed next to me didn't even feel their removal, and my two cousins said there was only mild discomfort! YEOW! NOT ME! All of my ribs spasmed simultaneously and I was only able to breathe in shallow gasps - they had to slap the oxygen nose tubes on me. (Note here: my breathing difficulty was finally diagnosed three weeks after the surgery - I have a broken rib!) For at least three or four hours I was unable to move. A pulmonary specialist was brought in. Thinking it may be related to my asthma, they began to give me an aerosol to inhale - tasted strangely familiar - every couple of hours.At 3 or 4 Thursday morning they came in to weigh me. Getting back into bed, my rib muscles again cramped up - and then I realized what they were giving me in the aerosol. Years ago, my doc had prescribed an asthma medication called Ventolin. It caused me near-paralyzing rib muscle spasms that were listed in the literature as an infrequent side effect. At this time the respiratory nurse comes in to give me another dose - I asked what it was and I was right! Same stuff, different name. I literally told her to get away from me - I would not take it. I was given a different asthma medication that worked fine, and by that afternoon my lung capacity was much improved. However, this episode cost me an extra day in hospital.
I was allowed to leave the hospital after breakfast on Saturday, 8 June.
I still have a broken rib that does not let me get full breaths, but I am assured it will go away.
Since I have been home, I am supposed to walk 30 minutes/day, usually around the block. I asked and got permission to ride a bicycle rather than walk, if I wished. Two weeks from the surgery date, I asked for and received permission to drive. It is very tiring, as I have very little muscle strength in my shoulders right now. Cardiac rehab classes began that week - treadmills and exercise machines for the next several weeks to rebuild my stamina.
The one warning I have been given is not to lift more than 10 pounds (about 4.5 kg) for at least until the end of July, when I may return to work, and probably for a month or two more. This restriction is due to the healing of the sternum, currently wired into place.
I am too young for this. My leg healed fairly well, and my nurse, looking at the scar and lack of swelling in my ankles says: "You are too young for this". In my cardiac rehabilitation classes I am the youngest, by at least 10+ years. This, friends, bothers me the most - I am too young for this!
But - I can look at the whole event as an opportunity. I've been given a chance to start over. I am relatively young - my heart was not damaged (thank God), nor any other organ, before surgery, and now that a few body parts have been rearranged, I consider this as a cardiac engine rebuild. It's up to me now. I MUST incorporate diet changes and get off my fanny. I have already lost about 15 pounds, and my insulin needs are down to about 40 U (from 90 to 100) daily and dropping every day. That part of this adventure I find personally exciting.
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