Yesterday, I was thinking of canceling the operation on June 4th. When I was in the hospital I was so out of it because I was on Fentanyl, Valium, and Verset. So when the surgeon came by to explain things, I couldn't understand what he was saying. So yesterday, I called him.
I told him I was having second thoughts about doing the surgery. I did some research online about what it involves. It's gruesome. They will put a 4-6 inch incision in my chest, break through my sternum to expose my heart, stop my heart and put me on a machine that will warm, oxygenate, and circulate my blood while my heart is stopped. They will then run two graphs to my heart with arteries from other parts of my body. I will be in the ICU for 5-6 days, and home from the hospital for 4-5 weeks for recovery. And of course, a LOT of pain.
So, I thought, maybe I can live with this. This is the question I posed to Dr. Surendra Chawla, my cardiologist. He is very kind and patient. His answer to me was pretty much word for word, this...
Me: Doctor, I'm having second thoughts on doing this procedure. If I don't do it, what are my chances of survival?
Dr. Chawla: If you don't do the procedure, life will go on. You are in no immediate danger of a heart attack because your heart has already done the bypass for us (see diagram below). So, if we do not do the procedure, all that will happen is that you will have diminished capacity that will be a chronic condition. You will have to live with being limited to what you can do. You have a decreased blood flow of 30%, and you can expect that blood flow to become somewhat worse over time, making it more difficult to do even what you can do today. You have the blood flow of the general 75 year old man. The heart itself is healthy and the bypass that it created is plenty for the heart, but not enough to feed other organs for increased activities. If you are ok with that, there's no problem. The only danger is that everything depends on the health of the arteries that did the bypass. If they become compromised in any way with an obstruction, it will be extremely serious and the heart would most likely suffer damage. Our options at that point become limited.
Me: So, if I think I can live with this, I won't have to go through the recovery and putting my family through this?
Dr. Chawla: Correct. And I won't lie to you. The recovery is difficult and painful. You will be in the hospital in ICU for 5-6 days. We will then release you and you will have a one month home stay. After that, you can start to build up your stamina and build your life again. And there is a risk of pneumonia.
Me: It's so much to take in.
Dr. Chawla: Yes it is. But what if I told you that a man your age should not have to be in this condition? Right now, you go to your mailbox, and when you get back, you have to rest for 10 minutes to get your breath back. What if I was to tell you that after this is over, you will fell like you are 20 years old again? Over a long period of time, your body has done extraordinary steps to protect you. And because it has been such a gradual progression to this point, you have become used to it. After the operation, you will realize blood flow that you haven't had in years. So, the real question you have to answer is this: Is one month of recovery worth getting that back? How much do you want it, and are you willing to risk a compromise of the blood vessels that are keeping you alive? Only you can answer that.
Me: Well, you've clarified this very well. Thank you.
Dr. Chawla: So, should I cancel the scheduled operation on June 4th?
Me: No. I'm going forward with it. I want back what I once had, and now that you've explained it, I don't think one month of what I have to go through is too much to ask.
Dr. Chawla: Good! I'll see you bright and early on June 4th then, and we will do this together.
In a more technical explanation, this is what is happening with me:
What is collateral circulation?
This is a process in which small (normally closed) arteries open up and connect two larger arteries or different parts of the same artery. They can serve as alternate routes of blood supply.
Everyone has collateral vessels, at least in microscopic form. These vessels normally aren't open. However, they grow and enlarge in some people with coronary heart disease or other blood vessel disease (such as in the case of stroke). While everyone has collateral vessels, they don't open in all people.
How does collateral circulation help people with heart disease?
When a collateral vessel on the heart enlarges, it lets blood flow from an open coronary artery to an adjacent one or further downstream on the same artery. In this way, collateral vessels grow and form a kind of "detour" around a blockage. This collateral circulation provides alternate routes of blood flow to the heart in cases when the heart isn't getting the blood supply it needs (myocardial ischemia) (mi"o-KAR'dede-al iKE'meme-ah). (source: American Heart Association)
This shows a bit what is going on.
Image source: Cleveland Clinic
The Left Anterior Descending Artery (LAD) has a blockage. Collateral vessels have opened up and grown around the area from the Right coronary artery (RCA) to form a bypass of the blockage to protect the heart. I'm one of the lucky people that this has happened to. It doesn't happen in all people.
So that's where I'm at today. I have to make some arrangements the best I can and go from there. I want to say what is most important to me now:
I have an amazing family. My folks are flying out to be with us during this time. Kent is cutting his trip short to South Africa to be here when this happens. My friend Austin and his wife Carole have spent many days with me getting me to the hospital and bringing me home. Austin stayed with me in the hospital the first time. I don't know how I can ever repay that.
I've had so many emails, posts to my website and my Facebook page from well wishers. I've had flowers delivered to my home from friends afar. I've receive so many cards in the mail that I've lost count. I feel so loved and I've taken so much of this and my friends for granted in the past. That stops now.
I know it's pretty overwhelming, but my Mom had the bypass surgery and once she got through the recuperation time, she felt great.
Think about it, you've got like a country lane giving blood to your heart right now, after the surgery, you'll have a highway.
Hang in there, anything related to your heart scares you like crazy, I know.
I guess that's true Jeff. What really makes me scared is my lack of control over my life. It all seems like other things are in charge now. Work knows, so there's all kinds of things happening that basically says, "...how are we going to do without Bill...." and....
I read on the Internet possible complications... God, it's awful. I know that they are saying this because it COULD happen, but then I think, "...what if it HAPPENS TO ME...?"
It makes me crazy.
Why do I write all of this? Because if I am to be no more, someone will know that I was here.
I know... sounds crazy, but that's the way I feel. And at work, I have people giving my hugs that have long be adversaries. WTF is up with that???
It makes me feel that maybe I'm going to a place that I won't come back from. And then my boss tells me that I won't be back at work for at least 8 weeks, when I'm telling my boss it will be 4-5 weeks... when I read on the Internet that he may be right.
I don't know man. I just don't know what to think.
I think that feeling is only natural. When something like this happens, it really is out of your control. When they were doing an ekg on my chest and then announced that I was having a heart attack, I didn't even have a chance to call Moe. They had an ambulance waiting for me at the doctor's office, which I was carted out to and then in 10 minutes I was in the ER getting totally worked over and then I was told I was being med-flighted to another hospital where they could do the cath. Thankfully the doctor had called Moe for me like I asked and he was able to get to the ER before I got in the hospital, but my one real thought the entire time was "I don't want my life cut short like this." Then I got med flighted and cath'd and after I woke up in intensive care, discovered they couldn't get rid of the blockage so I had to live with the damaged heart. Now, over three years later I'm on several different meds and I've had my share of various problems from them, but I'm still around and I make the best of what I have and try to take one lesson away from the whole thing - and that is to try to treat each day as your last so I don't waste it and I don't get upset about the little things that don't really matter.
You need to have this done and everything else will work out eventually and you'll come out better for it, you'll feel like a new person.
My Mom was out of work for about 8 weeks when she had the bypass. I was out of work for 6 weeks after I had the heart attack and then could only work part time for about a month after that.
I know it's all scary, but it will work out - just worry about making yourself better for now.
Jeff,
Very insightful and thought provoking. You are right. I have to just think about getting better. It will take time and I have to just let that happen. I thought our folks coming out was an overreaction at first when Kent asked them to come out. I didn't want them to go through the travel because they are in their 70's. But now, I think it was a good idea.
The amazing thing for me has been how many people care about me. I honestly had no idea. One night, alone at home, surrounded with over a hundred cards, emails, and flowers around me, I just sat down and cried for a good hour. I was very humbled at it all and I realized how so lucky I am to have so many care about me.
I must be doing something right in life. I've always cared for people a great deal. I've always tried to be there for others often times at my own expense. Now, I have to be there for me - just me. It all happens one week from today.
I'm going to start setting goals for myself when I get home. A little more each day. It will be awhile before I'm ready to do that 15 mile hike again, but I'll get there. I know I will. I'm determined. Who knows... maybe someday we can take a hike together. That would be awesome.