My Surprise Heart Bypass:

  The symptoms;

      In the middle of July 2011 while working at The Ivanpah Solar Project on the Nv. / Ca. state line, I had a lot of spare time and decided to use it to get fit. I had just quit chewing tobacco after around 34 years and chose to start jogging after work despite the temperature in excess of 105 degrees. As I left the hotel I did some simple stretches and began jogging. I wasn't able to go much farther than several 100 yards before it became very difficult to breathe. I was also experiencing a slight pressure high in the center of my chest with a burning sensation leading up my throat to just above the Adam's apple. With the combination of these symptoms, I figured that I was more out of shape than I had earlier believed, but it would just take a little longer to get in shape again. I would walk it out until the symptoms would subside, (about 5 minutes) then try jogging again. I went through this battle twice before I decided to see my family Dr. before proceeding. I firmly believed that he would tell me I was experiencing some kind of asthma problem aggravated by the desert heat. The symptoms even persisted to simple tasks such as carrying my luggage up 2 - 3 flights of stairs and even walking around 1/2 mile to dinner with friends. As I was going to find out after the fact, these are classic stable angina symptoms. At this point, let me paint a better picture of myself. I had just turned 47, have a moderately active job in construction with good work ethics and not afraid of getting as physical as necessary when something needs to be done. I'm 5ft. 10 inches, and just over 190 lbs, so physically I wasn't an easy candidate for what was to follow. I strongly urge everyone to learn the symptoms of angina as they are simple and I believe commonly misunderstood. (See previous "stable angina" link.)

  The almost missed diagnosis;

     Upon reporting my situation to my family Dr. he listed a couple of possibilities but suggested that since I complained about a pressure in my chest we should have a  treadmill stress test done to eliminate anything to do with the heart. I was confident at the time that this wouldn't be necessary as I was sure it was a lung issue. He had been my Dr. for nearly 20 years, I like and trust him so I figured why not play it safe. I knew very little about the treadmill test and for some reason had the idea it had to be done in a special clinic or lab, (in hindsight it should be able to be done at most any cardiologist office). I was only able to find one place and was instructed that they could only do this on a Wednesday. This was a big scheduling problem for me as I was working 225 miles from home and would be required to take the whole week off or have a lot of extra mileage and cost. For this reason, I postponed and basically forgot about it.

 The luck starts here:

   In February 2012 certain conditions added up which led me to the decision to quit my job at state line and take a new one back near home in the Orange County area (lucky point 1). After I had been back for a while and settled in I recalled the need for the treadmill test and scheduled an appointment. I casually went in that day with confidence I would do fine, then be able to move on to find out what was wrong with my lungs. I described the symptoms to the technician and was told to let her know if I experienced them again during the test. After approx. 7 minutes into the test I felt the very slight pressure and burning in my throat, told her and she called for the cardiologist to monitor. after he quickly evaluated the readings he demanded that we immediately stop as there was something grossly wrong (lucky point 2). He told me he felt there was a blockage and gave me a couple of options The Dr. suggested that for me, we should skip right to a Coronary angiogram . The angiogram would be definitive and as he expected to find the blockage, he would have Coronary stents  available and have them installed before I was really aware, then be able to go home the same day. I liked the idea of a quick finish all at once and agreed with him. We scheduled the procedure for a week later at Hoag Memorial Hospital in Newport Beach.

 Check in at the hospital and the angiogram;

   The hospital offers preregistration and that seemed to be a time saver. I was able to show up without much wait I am told that usually you can see the whole process on a monitor, but for me, I wouldn't be able to do this as I suffer from anxieties and requested to be as unconcience as possible.. This process seems very slight as the access incision is only the size of the tip of a pencil lead. I needed a little anxiety medicine so I wasn't aware of very much. When I regained awareness I was in the cardio recovery unit. Everything was fine until my cardiologist told me that he wasn't able to stint and that I had to have bypass surgery. He further stated that my blockage was 98%, 95%, 95%,50% and I can't recall the percentage of the 5th artery. This caused me a very high anxiety level and while the nurse was checking the dressing, I passed out. when I passed out I actually flat-lined, I'm not sure why, but I believe that due to the blockage. I'm told that it took 5 syringes ( of adrenaline? )to bring me back around and that I was out for around 45 seconds (lucky point 3). After flat lining, my cardiologist stated that I had earned a pacemaker too. In preparation for the angiogram, I had to be on a blood thinner to prevent blockages and stroke during the procedure. My cardiologist said I couldn't go home until I either received the bypass surgery or the pacemaker installation. Both of these surgeries would require a totally different blood thinner and the change would take 4 days so I had to stay in the hospital from Thursday till Monday waiting for the bypass surgery which was scheduled for 6 a.m. Monday may 7th  2012.

 Waiting,  and the bypass surgery;

    The wait was pretty basic with a couple of exceptions. I was given a breathing aid called a coach 2. After the bypass, my lungs would have to be re-inflated so I needed to get a baseline as to my lung capacity prior to surgery. This is used by expelling all of the air from your lungs then inhaling through a tube at a steady rate and watching a sight gauge. The second exception was the stress level. I wasn't too concerned until Sunday evening, I began to get a little stressed. I was still on anxiety medicine and I spent a fair amount of effort counting the clock backward to time it out so that I would have a full dose when they came to get me in the morning. Lastly, I had to be wiped down with sterile wipes and largely shaved just prior to the surgery. At this point, I was very stressed. Between the fear and cold from the wipes, I was shaking pretty well. Let me take a moment to explain the fear a little better. I never did consider the possibility of dying but was concerned for pain and difficulties during the upcoming recovery. In the past, I had seen My father in law at approx. 58 years, and his father at approx. 78 years go through this and it looked pretty tough. There seemed to be a strong chance of pneumonia conditions and if you can imagine coughing with a cut sternum..... well I was scared.

 CABG x5 (Coronary Artery Bypass Graft) ;

    Most of this span is a blur, but I'll include what I can, I'll only say what I know from first hand and include links for deeper information. Here is a link from my surgical group with descriptions of the surgery (Coronary Artery Bypass Surgery). My night nurse rolled me down to the O.R. promptly at 6 a.m.Which just before entry was the last chance for my family to see me. I remember very little at this point, just that this is when they shaved me. I was very anxious to meet the anesthesiologist so I could knock out, they must've been there soon cause that's all I remember till I woke up. There is one slight memory of being told that they were going to remove the trachea tube, then out again till around 11p.m.. When I was waking up in the Cardio I.C.U. unit the first recollections that I have basically are that I was very groggy, had a mild temperature and was breathing out of my mouth which kept it dry. It seems as though every 5 - 10 minutes I was calling the nurse for water. It didn't take to long before the nurse was spoon feeding me crushed ice, this was pure heaven at the time. I also was asking the nurse what time it was in around 10-minute increments. I'm not sure why I was so obsessed with time, other than maybe the faster time passed the sooner my upside-down world would be back to normal. They had strapped some sort of inflatable ball to the bottom of my feet (about the size of a racquetball) which would inflate, drain the air, then re-inflate. These were to aid the blood circulation in my legs. One other important item was the air bed that I was in. This bed seemed to have several chambers that would allow air to move around regulating pressures in different chambers to aid in comfort and to prevent cramping and I suppose bed sores. I really liked this bed a lot especially considering that I had developed bad back pains in the regular bed prior to surgery, I hated the thought of leaving this mattress upon going back to a room on the telemetry floor so the nurse suggested asking for an air mattress topper which actually helped during recovery.
 I was blessed with having what I imagine about had to be the 2 very best nurses in Cardio I.C.U. that I possibly could have. They truly took such good care of me that I have since gone back and thanked them. I also am convinced that I had the best surgical team possible. The Thoracic surgical group has 5 surgeons in it, I had 3 of them working on my chest and their assistant harvesting veins from my inner legs. My lead surgeon was thoroughly professional and respectful. I think extremely highly of him. The incisions made were simple. Obviously, there is one cut straight down the center of the chest. This main incision used to be cut the full length of the sternum but now is usually started approx. 4 inches below the top of the sternum so as not to show in the shirt collar after surgery. The incisions in the legs for access to harvest the veins used to be pretty much full length of the legs. Mine were very reasonable, I had 6 very small cuts, 2 near each ankle, 2 just below the knees and 2 at the top of the thigh. Then there are 2 cuts about 1 1/4 inches long just above the knees. There were also 2 cuts in my abdomen for drain tubes to be inserted, one in the center of my abdomen and one in the left side.

Before I was allowed to leave the CVICU (cardiovascular intensive care unit) I had to accomplish a few basic goals. I had to be able to eat some simple foods such as jello. I had to be able to get up with help and walk in place for a couple minutes holding a walker and be able to sit upright in a chair for a while.

Back to the Telemetry floor;

  The next 4 days of my hospital stay was on the Telemetry floor. The Telemetry floor is an entire unit dedicated to closely monitoring you and your heart every minute of the day with a remote unit. The goals that were set for me at this stage were simple. 1, walk around the unit twice per day and utilize the breathing aid (coach 2) to aid in full re-inflation of my lungs. Some of the simplest things now became cumbersome. After the catheter was removed I now had to figure out how to evenly roll out of bed (without sliding clear to the floor) by myself to go to the bathroom. The walks around the unit were very exhausting but gave me a great sense of accomplishment. I was accompanied by a nurse for each walk. The first couple of days I used a walker and after that, I just walked my I.V. stand. Another obstacle that I had to deal with was the drain tubes and a box that the tubes went into, this was usually carried by a nurse. The shower was a slightly scary concept and I just utilized wipes for around a week, until I mustered up the courage. On Wednesday the drain tubes were removed and I would have been cleared to go home on Thursday, but I was required to stay on a little longer for another reason.

Invited to stay on for a pacemaker installation;

 Due to the fact that I flatlined after the angiogram, I was now required to have a pacemaker installed. This was scheduled for Thursday and my release scheduled for Saturday. The pacemaker surgery was simple and easy on my end but required skill for the surgeon. The pacemaker is placed just under the skin above the left collarbone due to my being right handed. It would be reversed if I were left-handed. I had 2 electrical leads threaded into an artery then down into my heart. Sometimes they will install a 3rd lead for a defibulator.

A few complications with the recovery;

The first compilation had begun in surgery but not known to me until after my return home. Approximately a week after I returned home I received a letter from the hospital stating that an item used during surgery had been causing infections. This may explain the temperature that I had been running beginning in Cardio ICU, and my thirst and constant need to be fed ice. 

The second complication was my developing congestive heart failure symptoms. As I would lie down I began having extreme difficulty breathing. The sack around the heart (the pericardial sac) was building up fluid which in turn caused fluid to fill my lungs. Now to this point, I believe that all of my heart symptoms were reflected as a problem with my lungs.

Work in progress, more to come.