For the last few of you who read this blog and didn't see a notification elsewhere, the bypass surgery went fine--I was done "off pump" (which means that my heart continued to beat the entire time they had my chest cavity opened) and it was fairly quick, as I was wheeled into the ICU around 10:30am after last remembering the anaesthesiologist saying something to me around 7:45am.
What they don't tell you about bypass surgery is all the extra things they have to do to you, like a port in your neck that has a catheter down your aorta, or the two chest tubes that you have in your upper abdomen that drains the fluid created by your body during the surgery and recovery. I had been warned about the breathing tube, which I don't remember much about even now, although I know it was still in when I woke up, as well as the catheter in my uretha. I also knew that I would have some pain from wherever they decided to harvest some blood vessels to use in the surgery. In that last respect, I got off lucky, as they were able to use one of the mammary arteries (we males don't need blood to that part of the body as much as females), and the vein they used from my right leg they took out using endoscopy, so the incisions are small (an inch near my knee and a small hole where they snipped it near the groin).
I'm recovering quickly, about as quickly as allowed. After only three nights in the hospital, I managed to get discharged on Thursday morning, which was a good thing, as it's impossible to get a good night's sleep in a hospital. They're constantly, even when you're out of the ICU period, coming by to take some measurement: blood pressure, blood sugar, temperature, etc. And that's not to mention that they keep you hooked up with a heart monitor, blood-oxygen monitor, and an IV. The only thing decent about it all is that the pain medication is slightly stronger, but not as strong as some think; i.e., I didn't have a button to press for more meds as soon as I felt any pain. In some ways, handling the pain to me is part of the recovery, and the general fatigue and aches with having your chest sawed open I'm not having too much problems dealing with. The sutures where the chest tubes were are probably my biggest hangup, especially since they still will need to be removed when I visit the surgeon for a follow-up next week. That's the kind of sharp little pains, like being stuck with a needle, that I don't handle as well.
But everyday is better, and I'm already up to walking about 2 miles on Friday, and will probably do as much or more on Saturday. We're making arrangements for Jill to return to Malaysia without me, expecting that my quick recovery will allow me to return earlier (say on the 25th of the month) rather than later. I've got appointments to meet with both the surgeon and the cardiologist in the next weeks, which my parents will still be here to take me to, and it's been wonderful to have a great bunch of friends here who have been visiting and offering to provide us with things that we needed like air mattresses (we rented an actual bed for me) and some pots and pans to cook with. I'm still having a little trouble sleeping all night, unfortunately, for while the house is quiet and much more appealing than the hospital, I still am required to sleep on my back for the next week (my normal position is on my side). That explains why I'm writing this at 5am.
In the Hitchhiker's Guide to the Galaxy, Arthur Dent's house is demolished to make room for a bypass just as Earth is similarly demolished to make room for a hyperspacial bypass. The highway construction argument from both sets of construction managers is, "Well, you have to build bypasses."
When we last left our intrepid hero, he was feeling pretty good, having finally recovered from both the tonsillitis and the hospital stay that it had thrown him into. In fact, his most common statement was, "I feel as good as I did before the tonsillitis." But, following the wishes of the local cardiologist as well as his cardiologist of the past three years, he scheduled a follow-up cardiac catheterization to see how far his triple-vessel disease had progressed since the initial diagnosis of stable angina four years before. To do this, he would return to the U.S. Even before getting on the airplane, things began to go sour, as a common cold was contracted that led the entire 24 hours of travel to be less than optimal (and it's not that much fun without being sick). He managed to keep all social and business engagements, however, and arrived in DC on Tuesday night at the same time as his parents, who had expressed a desire to be present for this catheterization (the first one had been scheduled so quickly there hadn't been time for them to arrange travel before it was all over).
The consultation with the cardiologist in his offices on the 24th of September went well, as both patient and doctor seemed to be in agreement that any treatment would depend upon what was seen on the monitor as the medical pigment revealed the extent of blockage in his coronary arteries. The slight lingering cold was no barrier to the procedure proceeding, either, so the next afternoon remained set.
Okay, enough of the third-person narration. I can only keep that up so long outside of the 19th century.
You know it's not good when they get quiet, and they got quiet pretty much as soon as the first bit of dye showed up on the monitor. Rather than having made any progress over the last four years, all the areas where I had blockages had just increased their blocking, kind of like how a river can continue to deposit years after years of silt and debris in places until eventually there's a bit of a natural jam. Oftentimes, when that happens in nature, the river finds a new route, and my body had also been trying to do so by building a collateral network of fine arteries to keep the heart muscle replenished with blood. Unfortunately, that network had based itself off of one major trunk line while the other two were threatening to shut down completely. This is where a graphic can really help save some text.
Your coronary arteries divide into two, left and right. The left also divides into two again, the circumflex (which covers the back of the heart) and the left anterior descending artery. In my case, the right and the circumflex arteries have sections that are nearly 100% blocked (from 4mm to 8mm in length), with the left anterior descending artery squeezed to about 80% in one 12mm section.
That kind of blockage requires some urgent cabbage. Or CABG, as the term is written, standing for Coronary Artery Bypass Graft, known more commonly as "bypass surgery." In my case, I'll have a double. On Monday morning.
And since they haven't proscribed alcohol yet for me, I may have a double before the double.
There's lots of little silver linings in all of this. That heart attack in Malaysia in August could have been much--MUCH--worse. Our home in Silver Spring hasn't sold yet, so I (and Jill and my parents) have an inexpensive place to stay while I recover (and given hotel prices in this city, that's no small thing). After the surgery (well, not right after, but maybe a month later), I should expect to feel a heck of a lot better, with a lot more energy than I've had in years. And, given the length of recovery period, I may have the chance to see my niece compete at a big equestrian show in Pennsylvania during the second week of October.
Okay, so it's not the outcome that I desired, but you have to take the cards dealt to you, and my hand is full of clubs instead of hearts. Given the advances of bypass surgery over the years, while it still has risks, they are entirely reasonable compared to the most likely alternative of my having a massive heart attack if I don't do anything.
The first thing that Dr. Oskoui said to me yesterday was, "I haven't been in your blog recently." My response should have been, "That's because I haven't seen you recently," but I was so surprised that he remembered that I blogged that I simply laughed and asked, "So, you've been reading it?"
For those without a scorecard in front of you, Dr. Oskoui is my cardiologist. Because of my job change this past year, and the resulting move from one insurance plan (ASHA) to another (J's) and then, finally, to the one through my new job, I hadn't visited either my primary care doctor or Dr. Oskoui as neither of them were in-network for J's health plan. I could have visited them and paid out-of-plan rates, and I would have if I had thought something was serious enough, but I kept putting it off, thinking that I was going to be added to the full-time benefit rolls at my job any month. That, of course, stretched out to six months, and then getting enrolled in the health plan took another, and getting an appointment for a physical with Dr. McBreen took another month. That appointment was at the beginning of the month, and was uniformly positive. My cholesterol was down to 170, albeit the LDL was at 99. Dr. Oskoui and I discussed this yesterday, although with the current medical "cocktail" I'm taking (a combination of six medicines). My goal, as I explained to him, was to try and see some progress. I've been feeling that I'm simply treading water with my angina, that the medicines are keeping me afloat but that I'm no nearer the shore than I was when they first put me on them following my cardiac catheterization. Since my blood pressure has never been a problem (if anything, I've always had low blood pressure), we decided to replace the isosorbide and atenelol with a new medicine that does a combination of both but doesn't affect cholesterol. In addition, Dr. Oskoui told me to drop five-to-ten pounds through exercise, six days a week on a treadmill set at a 3% elevation for 30 minutes a session.
I'm to return in 60 days to do a new Stress/Echocardiogram test.
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