‘So how bad was the operation?’

‘So how bad was the operation?’

My heart attack has had such a sobering impact on so many of my friends, colleagues and family that I felt motivated to write these articles. Two people have given up smoking and another is now taking statins.

I have to issue the statutory warning that I’m not qualified to recommend the use of any medication. There are vague stories about adverse effects resulting from the continuous use of statins. 

Feedback on here has been sparse to date but I’ve had a number of replies via the social media links to the file. If viral propagation takes place (one share so far on Facebook) we might just make a difference by helping others to avoid complacency and self-deception and face up to reality.

This time, for the benefit of those who are facing a bypass operation, here’s how it goes:

On the day, and I was postponed twice because of more urgent cases, the porters arrived to wheel me, bed and all, into the theatre. I now understand how difficult it is to coordinate these affairs. Some patients also have diabetes and there’s a limit to how long such people can fast, as we all have to before an operation (‘nil by mouth’). Others have defective heart valves, too, or both ailments combined. It ain’t easy!

A nurse arrived and gave me a little calm-you-down pill (and what wouldn’t I give for a bottle of those) and in I went. In the theatre anteroom, I was asked to take deep lungfuls of oxygen to oxygenate my blood. This is because they have to stop the heart and hand your bodily functions over to a machine which monitors your vital signs. Then they squirted anaesthetic into a cannula in my hand and I was gone, in an instant. The next thing I knew it was 2.30 am and I could hear a soft voice telling me to wake up.

In other words, the operation itself is a push-over, except for the 2% chance you won’t make it! The trade off here is that, without the operation, I would have lived for around 4/5 months.

I felt no pain, just a slight soreness in my chest where they ran down my sternum with a small circular saw! I was aware of my right leg, too, where they harvested the vein they required. I have no varicose veins so this was straight forward. ‘The body is a rich source of spare parts’ the surgeon told me. ‘You have twice as many veins as you need’. Sometimes they use a redundant vein in your chest. I really think they enjoy cutting people up.

I was wheeled into theatre at 3.30 pm and the operation lasts around five hours. They like to keep you sedated for six hours so my 2.30 am wake-up call was spot on. Everything must have been OK.

I’d made friends with a guy called Albert and I was vaguely aware they were having trouble waking him in the bed behind me. My wife and eldest daughter Sally had arrived by this time and we were all concerned. I’m not sure what happened to him. New Cross is like a small city.

Sleep became my biggest problem. I’ve never been able to sleep on my back and I couldn’t sleep on my side until my sternum had more or less healed (after around a month) so I slept in the comfortable chair beside my bed most of the time, and the same when I got home. A nurse asked me to get into bed at one point so I waited until she went off duty and got back in my chair.

Because I had three stents fitted (@ £1050 each!) my blood had to be just right. I needed extra anti-coagulant because the stents are a foreign body but, too thin, and the vein grafts won’t heal. The surgeon and his team have to walk a tightrope. The result of this is that I ended up with around 1.2 L of fluid (mainly blood) in my chest cavity, which caused my left lung to collapse. My blood/oxygen levels were within specifications on one lung only. I used to be a pro trombonist, which probably explains this. Added to this, there was a temporary system failure with the result that the X-Ray images couldn’t be accessed on computer for a while.

The draining and re-inflation process was pretty unpleasant. I shall say no more.

They usually get you walking about the day after the operation but the above setback delayed my stroll for a day. I then spent a day or so walking the corridors carrying a bottle of blood joined to a tube that went into my left rib cage. This caused slight inconvenience at bed time, more reason to sleep in my chair.

I stood in front of the mirror in the ensuite bathroom. I had a multi-headed cannula inserted into the main artery in my neck, a tube leading from my ribs into a bottle, another cannula in the back of my left hand, plasters on my chest and leg, surgical stockings, and bruises around my abdomen where the anti-coagulants were administered at bedtime (to guard against DVT’s).

‘Good grief!’ I thought. ‘You look as if you’ve been hit by a truck’.

Despite it all, I’m recovering well and feeling better than ever. Shortly before rounding off this blog I went on a three mile march, descending and re-ascending around 300 feet and I felt great!

Looking back to my first admission by ambulance, I’m still in awe of the skill and professionalism of all those concerned. The ambulance personnel had sent precise details of my condition to the hospital and I was wheeled straight into the ‘Lab’ from the vehicle. A smiling and confident multi-national team approached me and it was obvious they all knew exactly what the problem was and where they had to go to put it right. Access to the heart artery with the stents was via my right wrist, with a local anaesthetic. I still can’t believe it.

Their fast and efficient response minimised damage to the heart muscles cause by the restriction of blood flow. This is very important.

In no time at all I was in bed wondering what had happened. I was still as high as a kite on morphine, too. And so very tired!

At my lowest point I dreamed my grandfather, a regular soldier, was standing at the foot of my bed holding his rifle. He looked so young and so frail. His eyes looked without seeing. Heaven only knows what he’d seen. ’Chin up lad’ he simply said.

I awoke with a start, my eyes dancing around the deserted ward in the subdued light. It had all seemed so real, as dreams often do, especially in the confused state people enter following major surgery.

What I’ve been through is nothing. Nothing.

Action Heart: a follow-up

I had my first session in the superbly equipped hospital gym Monday 7 December. Everyone walks up to a bank of blood pressure machines as they enter. Because this was my first visit, I also had a portable ECG monitor strapped to my waist and a series of contacts attached at intervals around my chest. The equipment sent information by a wireless link to the hospital system during my session. The staff already had my history in their file which they had clearly studied. They finally printed out a graph which, too, goes in my file.

Everything was OK and my closing B.P. was 116/76. My opening BP was 140 over something which is as high as they wish it to go. I travel to hospital on public transport, a journey requiring two bus routes. This being my first trip, I began to think, at one point, I was going to be late. This illustrates how insidious stress can be. In my case, because I’m a punctuality freak anyway, the prospect of being late caused me extra anxiety.

I’ve got the times sorted now, so I’ll be OK next time. Unless one of the buses is late!

The session begins with a warm-up procedure not unlike those pictures we often see of old-timers (like me) staying healthy, followed by sessions on cycles, treadmills and other exercises. I’m required to register the degree of hardship on a little card I carry with me as they turn up the dials, which also records my blood pressure at the start and end of the session. It’s my responsibility to read the data to the reception staff before I leave. This is all part of a growing tendency over here to expect patients to be actively involved in their treatment. Or are they just shifting part of the blame?

On the subject of stress, I have an appointment with a counsellor 21 December. I know, because I’ve tried and failed, that I need help, here. An over-active mind is the culprit, I believe, and I was interested to read that many of our favourite physicists suffered in a similar way, many of them turning to alcohol as a solution. Not that I’m claiming to be as clever as Richard Feynman. I wish…

My heart attack and a warning to others!

On August 19 I began to experience a severe pain between my ribs as I sat in my chair. I hadn’t been exerting myself. That afternoon I’d eaten some very spicy food at a funeral wake so my initial idea, that it was indigestion, was plausible. Normally, on those rare occasions I suffered from indigestion, a glass of milk would do the trick, turning off the pain as though someone had turned an ‘off’ switch but this time nothing worked and I began to change colour slightly.

We called an ambulance and the crew hitched me up to an ECG machine which confirmed that I was having a heart attack. Within less than an hour of telephoning for assistance, I was in the laboratory at New Cross hospital, Wolverhampton, three miles away through heavy rush-hour traffic, having stents fitted as I watched the whole process on a monitor, which helpfully showed a ‘before’ and ‘after’ picture.

I then spent around three days in hospital before being discharged with a warning that bypass surgery would also be needed to repair other diseased arteries that were not accessible to stents. This operation was carried out October 7 and I am now well on my way to a full recovery.

Where did I go wrong?

I have always believed that the worst lies are those we tell to ourselves and, looking back, I can see where I went wrong. Added to this, there’s the overarching problem that we all tend to believe that bad things only happen to the other guy. To be fair (to me) during my lifetime this has generally been the case. The objective of this post is to help others avoid the mistakes I made.

There are many reasons, apart from vanity, that caused me and all those who know me to react with surprise at the news of my attack. There is no family history of heart disease – my parents both lived to the age of 95 – and I had always eaten a healthy diet and taken plenty of exercise. I have never smoked cigarettes and although I puffed a pipe, without inhaling, the surgeon informed me that the pipe had not caused my condition.

(I have not smoked it since my attack because the presence of nicotine in the blood has an adverse effect on the health of arteries, whether inhaling or not.)

I had been telling everyone that I hadn’t displayed any symptoms, because I believed it to be true but, now that I am virtually fit again, I can really tell the difference. For example, after swimming two lengths I had found it necessary to take a short rest and put it down to my age, 75 years, and the fact that I did not swim every day. I had never been a strong swimmer and water is not my natural element. Shortly before writing this, I had been on a walk lasting around an hour which involved a very steep, half-mile-long uphill stretch, without any of the ill effects I had experienced previously. Again, I had always believed that old age was the culprit.

My cholesterol level had usually tested to 5.2 which is higher than the target level but my doctor said that they don’t just look at this figure but take family history into account. I grabbed onto this information, also reminding myself that other factors, such as hormones, proteins and enzymes in the blood also played a part.

I had also read of a man in a small Italian fishing village who found, during a routine medical examination, that his cholesterol level was so high he should have been dead. In fact he was as fit as a fiddle. They are now trying to synthesise a protein discovered in his blood to use as medicine. This was further evidence to me, as I sought to believe what it suited me to believe, that my cholesterol level was nothing to worry about!

In fact, around ten years ago, I had approached my doctor with the proposition that I should take statins. Bringing up my file on computer his verdict was that I didn’t need them. The criteria have changed since then so that, with the same profile, I would now be prescribed statins.

The verdict

My opinion, for what it’s worth, is that years of stress and overwork cause my heart attack. I am informed that, under pressure, we go into ‘fight or flight’ mode. Our ancestors would rapidly assess a situation and decide whether standing and fighting or running away would be the better option for survival. Either way, the liver pumps cholesterol into our veins to prepare us for action. In our modern lives we are under different, sometimes invisible, pressures with the result that our stress is frequently bottled up. Where I live, just getting out of the end of the road into the traffic can be bad enough.

Creative people also experience stress during the agony of creation and I often tell people that writing music is every bit as difficult as it looks.

Added to all this, I lost everything in life not once but twice. Just one such experience can drive strong men to suicide.

The Heart and Lung facility

Wolverhampton’s new Heart and Lung facility has been described as the best in the world! I can believe it. A helicopter pad is under construction so that patients far and wide may ‘enjoy’ the benefits. All nurses and other staff enter data via hand-held devices resembling a cellphone which is sent by wireless to the databank whence it can be accessed instantly from anywhere. X-Ray and Ultrasound images are stored in a similar way. Every singe time I received attention I was asked to verify my date of birth, name and address. They also checked my hospital number against the one on my wrist-band.

(It is this same, rigorous attention to detail that causes Britain to be a much harder target for terrorists.)

When I regained consciousness after surgery I found myself in a large, open plan area, in semi-darkness. Shadowy figures silently went about their business. Every bed had its own set of colourful monitors. I began to think I’d been abducted by aliens.

Action Heart

But the fun doesn’t stop here. Allied to the amazing treatment and care I received is a program called Action Heart. I am attending a series of eight lectures on heart disease and related subjects such as diet, exercise and stress. Also, when I was signed off by the surgeon, I automatically received a phone call from my local hospital calling me in for a fitness assessment in preparation for joining the hospital gym. This involved a test on a treadmill, wired-up to an ECG machine. My blood pressure was also monitored and they looked for (and found) a rapid recovery of all signs when I was finally allowed to rest. When they showed me the well equipped gym my jaw dropped. It’s BIG.

And all this is free.

Much is said about the comparison between Britain’s National Health Service (NHS) and the insurance-based system in the USA. Of course, we pay for our system too. Money is deducted from our pay which goes into a National Insurance fund for state pensions etc. and part of the tax we pay goes to the NHS.

The economic arguments used to justify the insurance-based schemes are not as clear-cut as they are sometimes made out to be. Fit workers are more efficient and one of the biggest problems faced by industry is uncertain staffing levels, especially in SME’s that always suffer from ‘small team vulnerability’ (a useful American expression).

The NHS was created by the Attlee government that was voted into power at the end of WW2, which also conceived the Welfare State and began a massive program of social housing. This Labour government was arguably the greatest democratic government ever seen.

I am not a party-political animal and believe that the tendency to align oneself with closed-system ideologies – the ‘isms’ – is always a sign of mediocrity. The Universe just doesn’t work like that. Nevertheless, I am, in my ‘heart-of-hearts’ (now freshly mended), a Socialist and probably always will be so that it is totally abhorrent to me that people should be denied the care and treatment they need because of their financial circumstances.

One thing is certain; my treatment and care was so good that I cannot imagine how it could be improved upon. But it will be. You’ll see.