Twelve Weeks After Bypass Surgery

An Optimist at Heart

My recovery has proceeded slowly but surely over the last couple of months. Nothing terrible has happened to me in that time — and that’s good, considering increasing COVID–19 cases in New York. I continue to “mask up” and to do all that I am able to avoid catching The Virus. So have the vast majority of New Yorkers.

I am able to carry heavier loads around now. That has really made a difference — 25 pounds of groceries carried home last time I shopped and seven (count ‘em — seven!) dirty loads of laundry shlepped downstairs to the laundry room and then seven loads of clean clothes shlepped up the stairs. My legs were fine, but my chest muscles still needed some loving care and consideration, so I waited a couple of days to put half of them away... and slept in the interim.

As both my cardiologist and I say, “Listen to your body.”

Up until a couple of days ago, I was spinning on my bike at home to get some exercise, keeping my legs and my breathing in decent condition. On Christmas Day, I gave myself a nice gift: I took my bicycle outside and rode a few miles. That felt soooo good! Now, today, I rode 11.6 miles, wearing my heart monitor. Gobsmacking good!! It was interesting to see how my heart rate varied throughout my ride. Good to see that my heart rate slowed by 20 beats per minute in only a short time when I was stopped at a traffic signal. My breathing never got labored. Only a little of “the burn” in my legs and no tiredness after riding. No chest pain. No heart pain. But I couldn’t really put out; that will have to wait until sometime in the New Year when I can allow my heart to beat as fast as it wants — within reason.

As it has been said: “Listen to your body” — with the aid of electronic devices...!

I’m hopeful. I wonder how much faster I can ride. I want to be able to attack hills more aggressively. I would like to do another Escape New York! century ride (100 miles) this September — and faster than I did a couple of years ago. I wish to take a few more long bike trips — well before I get too old to do so. Knowing more about my body, what stresses it out, and how well it can recover from that stress with the right care will inform me how far I can go, how fast, and how long.

I say it again:

Listen to your Body!

It would have been nice not to have followed in some respects a relatively unhealthy lifestyle for a number of years, driven by mental disorder. It would have been nice to not have had to take for seven years a medication that probably deposited a good deal of the plaque that clogged my left coronary artery. To be sure, I couldn’t dodge the fact that there was coronary disease in my family tree. But regret will only slow me down and, even though it has been difficult in the past for me to shake off a regret-driven depression inducing state of mind, I will surely be able to live more fully in the future, knowing that health professionals and I have teamed together to give me a good chance of achieving a number of my desired goals before I’m done with this world. What those goals are is still in the process of being reckoned — but at least I have the cycling part of it outlined!

Oh — well... then there’s music. I’m so psyched about having found the more athletic side of myself that I think less about making music. I’ve not touched a keyboard but a few times since around Ides of March time, when the church I was working for closed and musical performance in New York all but disappeared. But I kept on cycling. Then came July and my coronary artery disease diagnosis, and I became intensely focused on getting my heart fixed. But I still kept cycling, including to most all of my pre-surgery appointments!

I don’t doubt that the exercise provided by my avid habit helped keep me in a good state of mind, as well as in good fitness to handle the rigor of major surgery. Listening to my body and mind has done me good.

It’s much more difficult right now for musicians to express their artistry, except in the privacy of their homes or in an empty building. However, now that I’m able to get around, carry heavier loads, sleep less(!), and commute by bicycle(!!!), I have the bandwidth to add music practice to my To Do list. By May, I could be playing organ and directing a choir again and maybe even planning a concert or two. I look forward to that; the increased music making will help me achieve an even more healthy state of mind.

Both music and exercise are healing activities, and I intend to continue doing both. Then there’s good food. Drawback: I’ve gained 20 pounds this year — most of it from my own cooking!

I feel good about what’s to come just around the corner — many challenges, but also much satisfaction (as long as I listen to my Spirit... and my body). I’m thankful to all who have stayed in touch, seen me through surgery, and offered me emotional and material support during my recovery. In that spirit, I sincerely wish all of you Peace and Fulfillment in the coming year.

Have a Happy New Year!

Mark Victor

Heart Has History, Too

Family History...!

I had a great talk with my Auntie Ann today. She filled me in on cardiac issues that existed in two branches of our family tree — Tedlock (Uncle Victor and cousins all died of heart attacks and Bertie [nee Marshall], my grandmother, had angina) and Smith (three generations back, both branches, and Aunt Trudy). So genetically, I am disposed to heart problems. Oddly enough, my father does not have coronary artery disease, but he did suffer twice from rheumatic fever, leaving him with a heart murmur that has not slowed him down (he’s 93 y.o.). He gets periodic cardiac ultrasounds and EKGs. Genetic dispositions can skip a generation; I suspect this has happened in my case.

At least in these times we have wonderful medical diagnostic techniques, mitigation protocols (drugs, knowledge of good lifestyle changes) and fine invasive interventions. I should live a long time — just like my Dad — with good health management — both by myself and health professionals.

The family history is essential to my being able to stay in good health. Knowing this is very helpful. It indicates to me that I will probably be having regular cardiac ultrasounds and catheterization/angiograms. Note that there is a 30% occlusion in my right coronary artery — not too terribly bad, but it needs following. (Dr. Boateng mention it during my presurgery consult.) I do need to change out my statin, though; Lipitor (atorvastatin) makes me dizzy and has more interactions than the newest one (the name of which escapes me right now).

I had such a wonderful experience at Mount Sinai that I'm going to try and get my psychiatry there. WNYC featured a half-hour segment (don't remember what the show was) on research that had been done on the possible psychiatric benefit of three psychedelic drugs (ketamide, LSD, and a popular marijuana derivative). What I heard indicates to me a psychiatric section at Mount Sinai that is willing to think "outside of the box" — very important as regards the treatment of Adult ADD.

I might even consider transferring all of my care to Mount Sinai. That way, I could get the benefit of their fine Attending Physicians, rather than just their rotating residents and fellows (for the most part) that come from their medical school programs through Elmhurst Hospital Center. I'm getting more frustrated with the administration of this particular NYC-HHC hospital. Their policies are unhelpful and, I think, becoming unhealthy to deal with, especially mentally. Too many apparatchiks.

Knowledge is power — in medicine, too!

Lotsa Heart...

Wednesday and Thursday, October 14-15

I had my one follow-up appointment with Dr. Boateng and the follow-up surgery team. I am doing incredibly well; we all came to the conclusion that I’m in about the 90^th percentile of good recovery of heart surgery patients. This is only two weeks and two days after bypass surgery!

I’m going to miss all of the medical professionals at Mount Sinai. I’ve never had such a wonderful experience in hospital. The level of knowledge and skill, the kindness and appropriate firmness with which they treated me, the fine attention to infection control — all contributed to my being able to head home and continue what is a fine recovery.

I was able to nail down some concrete limits for heart rate, weight limits to bear on my arms, and a better timeline of recovery. I am going to have to rein myself in a bit and be especially careful of stressing the chest pectoral muscles and the sternum before they are ready to bear more of a load. This is something I have experienced before, with my hip, but my hip was screwed together. My sternum is held together with glue...!

Also, there is extensive healing going on under and in each pectoral muscle, necessitated on the left by moving a large artery and repurposing it to feed my heart and on both sides with the need to open my chest to access the heart. The total timeframe is about three months (probably a bit more) with possible additional physical therapy once the chest has sufficiently healed. The idea is to get blood moving without stress in the upper body, and using the lower body to deepen breathing and gradually get the heart beating faster over a period of several weeks.

One more PT visit, then I’m on my own. I see Dr. Sternheim, my Cardiologist, at Elmhurst on 10/20. Check shortly after that for another post.

You Gotta Have Heart... Lots and lots and lots of heart...

Out of the Hospital and Into Recovery (10/1 to 10/15)

10/1 — Second day with the physical therapist. Today, a pain volume control decided to click down a few notches. I had to tell the PT to let go of the device (a more robust version of the four-legged walking aid, with wheels) so that I could push it along on my own. Surprise! We got along well after that.

Both of my roommates watched Fox. I watched a good deal of MSNBC in retaliation... :-o Now the bed is empty. Wonder if it will be filled?

Later on — Got a new roommate. Watches sports. African-American guy who called me out in my reaction to a patient in another room yelling for assistance. He rightly asserted that I don’t know what this lady (also African-American) was calling for and how she was feeling, and that I was prejudging her. We discussed this a bit, and I apologized. After that, we had a great relationship. I do know that my reaction was too much tinged by my prejudice about young, “loud-mouths”. It’s always best to stop and think before reacting when you do not know all of the facts.

10/2 — Don’t really remember much about the day. The food is still good, but I’m having trouble eating because of constipation (normal after a major operation). Had a couple of good dumps today, and ate like a horse, getting hungry overnight.

During the day, the social worker and another PT came by (different person) to assess my needs at home when discharged. I waved off the walker which was offered; I felt (rightly) that my balance and strength were such that I could walk without any assistance. I did so a couple of times when evening came — to the bathroom, and taking a good walk around the hallway outside the room.

10/3 — Discharge. In a way, I’m sad to leave, but I’m ready and well-prepared to go home. Ray and his wife picked me up, we stopped by the pharmacy, and then Ray helped me by bringing my heavy backpack (items inside that I never used — five books!) into the apartment and setting it on my freezer. Shame he had to see my dirty nest, but maybe I can get some cleaning done in the next few months.

10/6-8 — Woke up and got up after two days of sleep, punctuated by bathroom runs followed by snacks and bowls of cereal. Actually had chili with Parisi’s bread for a good meal. Got outside to pick up groceries (o.j. & milk). Started a log of health measurements recording temp, pulse, walks, bike spin, and comments. Keeping the comments mostly clinical. Want to have this as a tool for visiting nurse and visiting physical therapist.

Over the next several days, I slept from 14-16 hours every day, leaving not that much time to reply to email and phone calls, eat, and get a decent walk (usually to the grocery). I’m not bored, but I do get concerned that I can’t get back to everyone in a more personal manner. I only ask that everyone be patient; father and sister get priority as does my recovery — food and sleep (14 hrs/day) included!

You Gotta Have Heart

Wednesday, September 30

Well, I had my “procedure”. Why I use that word instead of “major operation” reflects the skill and smooth transitions that I made from operating room to recovery to ICU to the cardiac care unit.

Like the doctor’s said, they took an artery from under my left pectoral muscle and redirected it to the left ventricle of my heart. There was no need to graft or redirect any other vessels.

My heart was stopped for about an hour. They wanted to make sure that my right atrium had sufficient blood supply. Apparently, there were some marks on the right ventricle which could have appeared as a result of lack of blood. However, when the doctors took the clamps off the arteries, the right atrium appeared to look quite healthy.

I was pretty fortunate not to have had more than superficial damage to the heart. Around the areas of the occluded portion of the left coronary artery, there was some surface scarring, but not too thick. Yes, I did have an infarction, a “heart attack” — but I don’t know for sure when that happened. I do know that there was enough blood redirected through the right coronary artery to really minimize any damage to the heart muscle and to promote healing of some damage that did occur.

Recovery has been quite painful. And I don’t know what gets into these physical therapists; mine was absolutely brutal. I know he needed to have me walk, but the way I was feeling, I didn’t need to make a full circuit around the central desk on the floor! Outside of that, I have pain in around my chest, my back, and my shoulders, primarily.

Most of the pain seems to be muscle pain. I’ve been successful in avoiding pulling on the sternum — which was the “access” point to my heart once they sawed it open...! And Mount Sinai has been pretty good about pain management. Today, Wednesday, I was in horrible pain in the morning; I had not kept up with the meds, and my roommate had the television on all night, keeping me awake. Well, I slept some this afternoon, and I’ll probably fall right off when I go to bed.

One of the main bothers has been the amount of mucous accumulating in my throat. I am unable to get it out, and it builds up until I finally am able to expel it. My lung capacity is fairly low right now, because the lungs collapse and don’t fully reinflate for a while. And it hurts to cough!

In fact, it was hurting when I made any motion with my body. I expected that and was somewhat prepared for it, but it was still a bit more pain than I thought I would have at this point. Also, the body’s reaction to the major, big-time surgery that I had is as extreme as the surgery itself. Wrenching the sternum apart and spreading the rib cage open is pretty serious stuff!

With that, I wish you Sweet Dreams and a Good night!

You Gotta Have Heart...

Heart Surgery, Part the Third

Last Friday (9/18), I cycled over to Mount Sinai Hospital, Guggenheim Pavillion, to meet with my surgeon and a Nurse Practitioner. It was the first rather cool day in a long time, and the trip was mostly uneventful and quick with only a hint of angina pain.

Armed with a fistful of questions and items I wanted to cover in my discussions, I of course first had to make it by the person taking my temperature and quizzing me about my possible exposure to SARS–CoV–2. Soon, I was going through the double glass doors into the Coronary Surgery Department at Mt. Sinai. Quite impressive on first sight.

My meeting with the N.P. went quickly. After checking my blood pressure, we discussed some things, mostly about what happens after surgery. I gave him my meds list and list of “questions”, which he took to the surgeon. Not long after that, I was led to a conference room and I sat down to wait for the surgeon. In the next half-hour, I was able to answer some of my questions by reading about open heart surgery in the textbook that was on the table. One would think it was left there on purpose, eh?!

Percy Boateng, M.D. is my cardiac surgeon. He is well experienced, doing many procedures on the heart during any week at Mt. Sinai. Dr. Boateng is a “man of color” — originally from Ghana! We had a wide-ranging conversation, about heart surgery, running, and cycling, among other things. And, of course, we talked about my upcoming surgery.

I was able to view the angiogram, taken during the cardiac catheterization procedure I had. On angiogram, there is little evidence that a left coronary artery even exists — it is either completely occluded or my body has gotten rid of it! Dr. Boateng (and also Dr. Sternheim) concluded that the left coronary artery gradually closed up over a period of time. This allowed the heart to build new blood vessels and reverse the flow of blood in parts of the left ventricle and other places in the heart. As a result, I never had a heart attack, only angina (which I didn’t recognize as such until after I was first diagnosed with coronary artery disease in August). Being active and cycling for moderately vigorous exercise helped.

Our human body is an amazing organism. Its capacity for self-healing and adjustment to injury and dysfunction is equally amazing. But equally amazing is the ability of skilled health care professionals to intervene when the body is unable to self-repair. I have the greatest respect for health professionals; it also helps that I worked as a secretary and word processor for some in the not too distant past at New York University Medical Center. This work has helped inform and guide my decisions about my own health care and feed my ample respect for those who take care of me.

So — I am scheduled for coronary bypass surgery on Monday, September 29. The surgical team will open my chest, hook me up to a heart bypass machine, and redirect an artery under my left pectoral muscle onto the proximal surface of the heart (right on top), replacing the occluded (and possibly missing!) coronary artery. My heart will probably be stopped for all of 15 minutes. (Dr. Boateng mentioned that they could do this with the heart still beating, but I decided, for more accurate placement and suturing of the artery to the heart, that I would like my heart to be stopped during this part of the procedure.)

I am certainly reassured by the skill and knowledge of Dr. Boateng. I’m also assured of a quicker recovery than I thought. My breathing tube will be taken out about an hour after surgery ends. I will be out of bed and sitting in a chair by evening of the same day. The hospital health care professionals will have me walking the next day, Tuesday. And I should be out of the hospital on Friday, or Saturday if they determine that I need one more day of hospital care.

Although cardiac bypass surgery has become quite routine since it was first successfully performed in 1969, this procedure still has its risks. But in my case, death (0.45%) or morbidity (<5.0%) are rather rare. I have confidence that the team from the Cardiac Surgery section of Mount Sinai Hospital are very good at mitigating risks like post-op infection, stroke, aneurism, and others. I am in good hands.

Once I get home, I’m told that I will be able to do a good many things, just as long as I don’t stress my sternum, which is cut through and separated to access the heart. I know from experience with my femoral neck (hip) fracture that major bones take six to eight weeks to heal sufficiently so that they may carry heavy loads again. I can reach, but not stretch. I can carry loads under 5-10 lbs. I can exercise on my bicycle indoors (I have a spinning stand for that), but only put light weight on my hands and arms. I’ve already been advised to begin taking walks every day immediately upon returning home. A physical therapist and a visiting nurse will stop by to check up on me, and they will give me more direction and advice.

It helps that I’m a well-informed patient, asking detailed questions and doing my own research. By doing so, I have been able to clarify issues regarding medication and pre-existing conditions with my surgeon and cardiologist. I am fairly confident that we’ve “covered all the bases”.

Next step is pre-op testing and intake. More about that in my next blog post.

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You Gotta Have Heart...

Heart Surgery, Part the Second

I tolerated the cardiac catheterization procedure very well. Interesting that I hardly felt any sedative that they may have used; I was quite alert during the whole experience.

The angiogram(s) showed that my main coronary artery is completely occluded. However, blood flow has been shifted to the "back door" — collateral vessels now supply 70% to 80% of my heart. I got the sense that there is no apparent necrosis or scarring, only that, because of limited blood supply, the heart muscle isn't moving properly. Their analysis is that I had somewhat gradual occlusion of the artery, allowing the heart to shift the flow to the collateral vessels without undue damage to the heart muscle. However, the flow is not sufficient, and heart-muscle damage is probable in the future. My heart needs fixin'.

There are two procedures that can be done:

►         Another cardiac cath, performing angioplasty + stent insertion. Both doctors told me that there is not a great chance of success and that it probably would only last 5 to 10 years. To me, the integrity of the main coronary would be in question anyway, not having handled any blood flow for possibly a year, maybe longer.

►         Replace the artery by coronary bypass surgery. This would graft an artery from the pectoral muscle area onto my heart, Serious surgery, three- to four-month recovery period, some serious pain but, with a good lifestyle, it will last me much longer and allow me to remain a rabid cyclist. (I intend to live at least to 90 y.o., like my Dad...!)

Guess which one I immediately chose? Yup — coronary bypass surgery. I don't really have any mitigating factors any more that would count this option out. And — they told me I'm still young. Great guys!

Dr. Sternheim already gave me one chance to chicken out, in the recovery room after the procedure. The surgeon will give me another opportunity on 10/20. The surgery would be done at Mount Sinai Hospital, Manhattan (Fifth Avenue). I'm not going to chicken out.

And MetroPlus, my insurance, damn well better not get in the way! If so, they'll have a rabid cyclist, at least two doctors, an N.P., and a fine nurse comin' after them... eh?! New Yorkers: Wear your masks, so I don't have to delay this surgery due to COVID!!!

I have to thank my primary care N.P., Yalto, for her thoroughness, though which she noticed the dysfunctional heart rhythm on EKG.

I'm in good hands with Dr. Sternheim, and I trust him a lot. The doctor heading the surgical team is very experienced in coronary bypass surgery. Dr. Sternheim mentioned that the surgeon probably does ten or so of these per week at Mt. Sinai.

It'll be a great adventure...! As far as pain goes: I'll make sure that I have good pain management in place before the operation. I have experience — my hip fracture and surgery. I had a pain specialist who did good for me. The eventual meds were 2, 3, or 4mg hydromorphone + 75mg Lyrica, which lasted the entire time between doses and relieved serious level 8 pain. Only took a bit of opiate once I got home, and then only occasional OTC pain reliever after that.

Next: A visit with the surgeon and a nurse practitioner in the Coronary Surgery section at Mount Sinai.

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You Gotta Have Heart...

Heart Surgery Time, Part the First

Well, I have problems with my heart. I found out late last year that I had an abnormality in my EKG, which we take regularly because of a medication’s effect on heart rhythm. Because of our current COVID-19 crisis, I was unable to follow up on that until July, when I scheduled a transthoracic echo-cardiogram and a visit to my cardiologist, Dr. David Sternheim.

I might mention that Elmhurst Hospital Center, at which I get my primary medical care in the I.D. Clinic, was the “epicenter of the epicenter”. They were slammed by the COVID-19 crisis, taking more than their share of critically ill patients. By mid-April, the entire hospital was devoted to taking care of COVID-19 patients. I had to reschedule appointments, cancelled during this time, and some of my appointments were (and are still) moved to telephone consultations. Fortunately, by the middle of June Elmhurst was able to resume some sense of normalcy. My heart goes out to all who lived through that crisis, taking care of so many who came down with COVID-19. I did what I could to support the health professionals with encouraging words and some humor as well.

However, I resumed my regular care at Elmhurst, and rescheduled (among many other appointments) the echocardiogram — a type of ultrasound.

On the ultrasound, the "apex" of the heart (bottom of left ventricle) showed that it was not functioning properly. After discussion, Dr. Sternheim and I concluded that it was probably a "silent" coronary event, which occurred some months before the EKG that showed an abnormal heart rhythm. I can still do moderately vigorous exercise; he told me "just don't push it". That, in itself, is encouraging.

I’ll be having cardiac catheterization/angiogram, during which a dye will be injected to show blood flow through my coronary arteries and into the smaller vessels. It’s possible that I’ll also have a stent or two or more inserted to widen a partially blocked coronary artery. The wait won’t be too long — just a couple of weeks.

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