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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