Tag Archives: Heart

One Year Old and Counting

Turned a ripe old age of 1.

Turned a ripe old age of 1 today.

Today is my First Birthday. It is the first year anniversary of my triple heart bypass surgery. I’m one. I survived the first year. Hopefully there are many more years to come.

On this day a year ago, I was wheeled into the surgical unit before 7:00 a.m. in the morning and before I knew it after talking to a few people while on a gurney, I fell into a deep sleep and never got up again until sometime after 4:30 that afternoon.

Upon waking up, I was a new man, in some pain and discomfort, but most definitely fixed and saved from my harrowing brush with death. It was an uphill climb for there which challenges me to this very day to exercise and to eat healthy foods.

I mark this day with this short and brief entry to say “Hello, I made it”.

I will hopefully blog more in the coming new year. May you all have a great 2017.

What to Expect After Heart Bypass Surgery — Part 1

Heart and function monitors after surgery in intensive care. Photo by Mel.

Heart and function monitors after surgery in intensive care. Photo by Mel.

So you are going to have heart bypass surgery. This post will be about what to expect after your surgery as you spend the next several months in recovery.

AT THE HOSPITAL

First day you’ll be in intensive care, legs up with a number of tubes and other sensors plugged into your body. These are all hooked up to monitors that track your health condition for the time you are there. The stay in intensive care is 24 to 48 hours. It was 36 hours for me.

The stuff plugged into you are gradually removed before you move to the recovery ward.

More than likely after your brief stay in intensive care you will be moved to a telemetry ward. There the hospital staff will monitor your progress. Doctors will occasionally visit you, encourage you to start eating and walking. Nurses are there all the time and help you with just about every aspect of early recovery. Nurses are the lifeblood of most hospitals. Without them the system would probably collapse.

While confined mainly to a bed you will be encouraged to eat, and especially walk. Nurses and other personnel may / will come and visit you to work on your basic motor skills such as standing and walking. You will need help to go to the bathroom or use the bedpan. I chose the bathroom all of the time…

Before that happened though you are hooked up to a catheter which takes care of the urinary functions for the short term. Later the thing is removed and you are free to use the bathroom. I don’t like catheters, especially when it goes in and even comes out. One word: pain.

Speaking of which.

PAIN will be your constant companion for quite some time. Pain will be apparent every time you cough. The intensity of the pain shortly after surgery is high. Your pain level for every cough will be in the area of 8 to 9 on the 10 point pain scale. The pain from coughing will gradually wane. Sneezing also brings about the same chest pain.

The cause of the pain is fluid buildup in the lungs and the fact that your chest pounds against the healing wounds of your ribcage which is located just above your heart (see Wounds below). I tried to suppress my coughing but that was futile. It could have made things worse. As my doctors told me, “cough it out”. Be sure to use the “heart pillow” every time you cough.

WALKING: From early on you are encouraged to walk. You will find walking to be difficult, especially in the beginning. Your walking range after surgery will be short. A walk around the hospital ward will be considered “good”. Walking helps build your strength and gives your newly repaired heart a workout. While in the hospital you are hooked up to a heart monitor that is tracked on computers in the telemetry area. That is kind of cool I think. I used to always like to walk around the telemetry area to check my vitals like pulse and respiration that was displayed on a large flatscreen monitor.

Walking in those first days after surgery will be slow, short and maybe labored. My heart rate was between 100 to 120 beats per minute (bpm) while I walked. While idle I think my heart rate was at around 92 bpm. It gets better as time goes on.

Daily walking will be a recommended activity after your discharge.

EATING: You probably won’t have much of an appetite shortly after surgery. But that improves in time. One thing about eating is that if you were a junk food junkie like me (which more than likely brought about my heart condition) you definitely will have to change your daily menu. Divorce yourself from sugary carbonated drinks, beef, pork, sweets, candies, hamburgers, etc. Think more fruits, vegetables, water and fish. I will write more about meals later.

MEDICATIONS: You will be given a lot of medications shortly after surgery. Nurses are good at being timely in administering your medications. Some will be given through tubes while others will be given in pill form. Before you are discharged from the hospital a long list of medications will be prescribed to you for home use during your recovery and beyond. Be sure to dutifully take your medications. They are vital to sustaining your heart and life.

TUBES AND STUFF: More than likely there will be several tubes stuck into your body. All of these were inserted while you were in surgery. Thankfully you were spared the pain of the insertion since you were under anesthetic at that time. However, the tubes will have to be removed during hospitalization. Some like the catheter and the one going into your chest will be briefly painful when they are removed. The chest tube looks kind of gross upon removal… yellow/brown slime coats it. Yeah, you needed to know that.

There will be at least 1 or 2 intravenous tubes inserted into your arms for blood testing and medication purposes. These will be removed shortly before discharge. From the times you are poked with needles, you will find that your arms will become bruised.

Since you may also be on blood thinning medications, the chances of being bruised increases even after your discharge.

WOUNDS: Everyone who goes through heart bypass surgery will have two major wounds on their body. The first and most obvious wound is the large cut that go from the top of your chest to the bottom just above your tummy. Surgeons cut this area of your chest to gain access to your heart. They also had to break the bones on your rib cage to get to your heart. After the bypass veins are placed around your heart the bones have to be mended with a wire mesh that will stay inside of you for the rest of your life. Then the wound is stitched. It looks pretty gross when you first see it after the big bandage is removed a few days after surgery. Think Frankenstein’s monster… heh.  The chest wound will heal but will be a permanent scar on your body. The resulting scar is called “The Zipper” by many bypass survivors.

The Zipper.

“The Zipper” and tube wound just below that. Photos by Jerry Stanfield.

The other major wound will be on your leg at the lower end of your thigh just above the knee (at least it was in my case). Basically it is a big hole where the surgeons extracted your own veins for insertion around your heart (hence the word “bypass”). There will be a small tube coming out of that for drainage after surgery which will be removed before discharge.

Taking care of your wounds and being mindful of the condition of your healing heart and ribcage will be an important part of your recovery. The ribcage takes a while to heal. Patients have to be mindful in following instructions to prevent the ribcage mesh from accidentally dislodging itself which would probably result in a medical emergency that will probably require surgery and hospitalization to repair.

The reason for much of the chest pain associated with coughing is attributed to that healing ribcage area.

Below the chest incision wound will likely be a hole from which the gross tube was removed. It will be bandaged and will take time to heal. You have to keep it cleaned and medicated until it heals. The healing time for this wound is about 2 to 3 months.

I think I covered most of the things that happen after surgery. This post ended up being about care during hospitalization. The next post will be about home care. Fun stuff.

 

 

 

The Kaiser Medical Team

Some of the that helped me. Photos from Kaiser Permanente.

Some of the that helped me. Photos from Kaiser Permanente.

This post has been sitting on the server for at least a month. Yep, haven’t updated this blog… so I am now in catch-up mode. So here we got a short list of Kaiser doctors that helped me get through the heart attack and surgery. Was not easy but without them, I’d be pushing daisies today.

Dr. George Wilkinson, MD – Cardiac surgery – Was Dr. Wilkinson on loan from another location? Do I even have the right person. His connection to Kaiser is not listed online. I definitely met him before surgery. He is the doctor who did my open heart surgery.

Dr. Jeffrey Wu, MD – Cardiac surgery; “There is a Steely Dan song with your name on it”. Dr. Wu was also on my surgical team. As I understand it, he was second to Dr. Wilkinson.

Dr. Steven K. Kramer – My primary health care physician. Conveniently located at Kaiser Honolulu Clinic on King and Pensacola Streets. Mild mannered and listens.

Dr. Ali Z. Merchant – Cardiologist; consulted with him on heart follow-up.

Dr. John Lee – PAC – Encouraged me to cough early on; cardiology dept. Mac guy. 🙂

Dr. Timothy Skovrinski – Emergency room, 1-10-2016

Dr. Sue Lim, I liked her. “It’s okay to swallow the mucus you cough up”.  Her specialty is “hospital medicine”. She wrote some of my prescriptions.

 

Heart Bypass Surgery

Heart Bypass

Single, double, triple and quadruple heart bypasses. Art by Bruce Blaus.

DECEMBER 26, 2015: After suffering a moderate heart attack, I was admitted to Kaiser Permanente’s Moanalua Hospital for further tests and corrective action to my condition. The first few days that I was there, I was given a variety of medications in either pill or intravenous (IV) form to control the heart and whatever else was in distress.

Once I got admitted, I did tell some of my friends and relatives that I was legs up in a hospital bed after suffering a heart attack. Some of my friends like Daniel, Laura, Spencer and Jay visited over the next few days. Daniel was the person who picked up my car and drove it home from the Magic Island parking lot.

It was nice to have visitors.

DECEMBER 27, 2015: I was subjected to a few more tests including chest X-Rays, and Electrocardiograms over the next couple of days. I was also kept on a number of medications too.

The big event of this day was a procedure called a Coronary Angiography. It is a procedure  where doctors “look at the large blood vessels of your heart (coronary arteries).” A doctor inserts “a thin, flexible tube (catheter) through the blood vessel into your groin or arm.” The test is used to see if an artery is blocked.

The doctor and the medical team moves the catheter through the blood vessels into your heart. A dye is injected to see where the blockage is, if any. (Kaiser publication 1047 6161)

Frankly I don’t remember the procedure. Information on the topic say that the patient gets a medicine to help him or her “relax and not feel pain”. Well that certainly happened and I don’t remember the procedure at all. The entire thing took about a half hour or less. I certainly remember waking up and asking the doctor whether or not the procedure was over.

It was. I would have loved to see the image of the dye running into my arteries and veins. I’ll ask Kaiser if they have one and if I can get a copy of it. Everything in imaging at the hospital is digital today (which is one reason why Kodak filed for bankruptcy) and hopefully an image can be passed on to me.

They told me that they had wanted to put a stent in arteries that had a blockage. Instead they found a major blockage of about 50% in one of the big ones. It was decided that a Coronary Artery Bypass Surgery was needed.

DECEMBER 30, 2015. The day of my surgery arrived early. I was awoken by two or three female nurses in the telemetry ward where I was holed up since December 26. They got me up, took off my clothes and shaved almost my entire body except for the hair on my head. The nurses are good at nursing but I would not recommend them as barbers or hair stylists. For the most part most of my bodily hair was gone or at best, reduced to a short stubble.

Then they gave me some special kind of soap and made me take a shower… which was nice. Scrub a dub dub! No one but me in the tub… well stall that is.

One of the funny things before this all happened was my bed was labeled as a “NPO Zone”. I had no idea what NPO stood for until I looked it up, but the subtitle under the label read “Do Not Eat or Drink Anything” (see photo).

NPO

NPO Zone traffic cone. Funny!der that label read “Do Not Eat of Drink Anything.” The funniest thing is that the warning looks just like a traffic cone. See photo.

I guess they don’t allow patients to eat because (I am just guessing) they don’t want them to do #1 or #2 while on the surgery table. Maybe #1 is OK as I found out later they had a catheter inserted into that sensitive area where traffic is supposed to be only one way… down and not up!

Anyway after the hair removal and shower, I dried off and was given a new gown. Someone brought in a gurney and I was shortly thereafter wheeled out of my room (with my things in tow – cell phone, wallet, clothes, slippers, books, papers, Chromebook laptop and bag) and to the 4th floor surgical level of the hospital.

I was wheeled into a staging area for everyone undergoing a surgery that morning. Needless the say, the staging area room was busy with doctors, specialists, technicians and nurses scurrying about and talking to each other as well as patients in hushed tones. I was wheeled into a small area segregated by thin curtains from other patients.

I met my anesthesiologist, whose name escapes me for now. As I was lying in bed, we chatted and I think he put a breather thing over my nose. I think I was also hooked up to an IV. During the course of the chat, which I don’t remember now, I somehow and miraculously just faded away.

This is what I remember of my surgery:

Black Square

Surgery was several hours of unaccounted for time in my life.

Nothing.

This is a good thing. For the next 5 to 8 hours I was out like a light. Don’t remember a darn thing.

In a brief nutshell, heart bypass surgery involves cutting the sternum area of my rib cage open, gaining access to the heart, removing veins from my leg and moving them to the heart in which a bypass is created and then putting me all back together. Sounds simple but I bet it is 110% complicated.

The process also involves stopping my heart and having a machine take over pumping my blood and helping me to breathe. The heart is stopped for a period of time to which the surgical team can put in the bypass.

The possibility of death exists if something goes wrong. That I know as I had to declare my sister as my “Power of Attorney” just in case something did go wrong,

Nothing went wrong. I had an excellent surgical team, led by Dr. Wilkinson and Dr. Wu. They explained the process to me beforehand which I had already known, since my Dad had the same procedure done in 1988. I will write something about my doctors and Kaiser support staff in an upcoming post.

In the end, I had a triple bypass done on me.

If you want all of the gory details related to the procedure of Coronary Artery Bypass Graft (CAGB) you can read all about it in this article on Wikipedia.

Intensive Care Tech

Intensive care tech at my bedside. Photo by Mel.

DECEMBER 30, 2015 – Later That Day: I vaguely recall waking up hours after my surgery. The first things I remember seeing was a new room, a pretty blonde nurse (her name was Chelsea) and I think some glass nearby. I also heard the faint sounds of electronic machines monitoring just about all of my body functions.

The first thing I noticed was that I could not talk. I asked the nurse for a piece of paper to write stuff with. One of the reasons why I could not talk was that I had a breathing tube going down my throat. My body was also hooked up to a number of tubes and IV feeds going to the different machines that were managing some body functions, and administering medications. I probably looked like a sick Borg from Star Trek TNG. Lots of tech to keep me alive at that time.

I asked the nurse for a pen and paper so that I could communicate. The first things I wrote down were “What is my condition?”; “Keep this here”; “I Want to Cough”; “Chest Hurts Slightly” and “Tired”.

As I now recall, one of the first tubes withdrawn from me was the breathing tube going down my throat. That was a nice removal and it allowed me to talk…. and eat, though I was not very hungry.

I have to say that my time spent on the 5th floor intensive care unit of Kaieer Moanalua was for the most part, despite all the tubes and stuff connected to me, very pleasant. Nurse Chelsea and later nurse Pat (I think that was his name who told me about the local Jimmy Buffett Pau Hana Parotheads club) were most excellent caretakers.

I slowly recovered over the next 36 hours in intensive care before I was transferred back to the cardio telemetry ward on December 31.

Intensive-01

Various IV tubes with medications pumped into me during intensive care.