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Probably upcoming CABG

  • 1.  Probably upcoming CABG

    Posted 04-04-2021 12:58
    Hello all. I posted awhile back an introduction and story of my frequent flyer status in the cath lab. My original Stent/PTCA was in Springfield, IL in Dec. '19. Since then, I have had in-stent re-stenosis 4 times. First was 3 month after my original procedure, and they inserted a stent inside the first and a smaller one at the takeoff of that vessel. Then in June, I had chest pain and blockage again, this time doc thought it looked like clot and she was unable to pass an IVUS catheter, so she did multiple inflations with a balloon, again achieving 0% stenosis. Made it all the way to the end of Nov and had to go to the hospital in western Cincinnati while visiting our daughter and new grandbaby. I was 99% occluded then.There, they did multiple passes with a laser and multiple balloon dilatations, opening it to 0% stenosis again. Saw my cardiologist on return home and she added Xeralto low dose to the Brilinta I was already taking.

    In March I started having discomfort again, including twice while at cardiac rehab. Saw the doc and he added 2 anti-anginal meds, and scheduled a stress test. Stress test looked fine, but we were not convinced, and when we saw him in the office to discuss, he said stress test misses blockages about 20% of the time, and given my history, we all agreed I should have another heart cath. That happened last Wed., diagnostic cath only in an outpatient center. Again I am 95%+ blocked. He made an appointment for me with cardiac surgeon for this coming Thursday.Friday the office called and said my cardiologist had talked to him and explained the situation, so he wanted to move me up a couple of days. I will see him Tues morning to see if he feels the artery beyond the blockage is too small to do a bypass or if he feels it would be beneficial. As much as I dread the surgery, I do NOT want to keep visiting the revolving door to the cath lab every 3-5 months. My guess is if he decides to go ahead with the surgery it will be soon. If not, the cardiologist said there are a couple of other things he can try in the cath lab, including lithotripsy. I have been reading up on that and it has good success, but I have had good success with all other procedures--just doesn't last. My cholesterol has always been fantastic, but I was started on Atorvastatin a year ago due to being diabetic.

    I now have an insulin pump, so sugars are better controlled, and I'm hoping that will help going forward. I know heart bypass is almost a routine procedure, and they have perfected the technique and continue to refine it. I was unaware til recently that they now do beating heart procedures, and my surgeon performs this on about 70-80% of his patients. I was on the other side of the bed for many years, having worked for about 8 years altogether in an ICU taking care of post op open heart patients. I have been in the operating room watching the procedure, so I have a pretty good idea what to expect, though that was over 30 years ago and I know things have changed a LOT since then. Back then, patients were on the vent at least overnight, if not a second day, they were in bed until they went out to the stepdown unit, and in the hospital about 10 days. Now, I am told 3-4 days postop is not uncommon and often you are up in the chair the night of surgery!

    Just wondering if any of you had the beating heart procedure and what your experience was with this, or what your experience was anytime in the last 4-5 years. We haven't talked to the surgeon yet so I don't even know if our hospital will allow my wife to visit, which I'm liable to throw a fit if they don't! ;) They have held off on discussing surgery because it is primarily a singe vessel disease. I have other blockages but none over 30-40%. But we can't keep doing heart cath and dilatation or other procedures every few months, so I'm hoping he will say we can go ahead and get it over with.

    Any words of encouragement or sharing of experience appreciated. I have been reading this forum for several months, but many of you have had your surgeries years in the past. I was just curious to hear of experiences of surgeries recently.

    Thanks all, and Happy Easter to those of you that celebrate.

    Dennis

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    Dennis Danner
    Retired RN
    [Punta Gorda, FL
    [Phone]
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  • 2.  RE: Probably upcoming CABG

    Posted 04-05-2021 04:50
    Hi Dennis,

    Having read your story, I am once again astonished by the amazingly diverse experiences we can have with coronary artery disease.  On the one hand, you have had what sounds like a horrible time with angina and restenting of a single blocked artery deemed by your doctors worthy of treatment.  On the other hand, I had not experienced a single symptom whatsoever prior to suffering a so-called "mild" heart attack three plus years ago and being told I had major blockages of five coronary arteries and required immediate quintuple CABG surgery despite having good collateral circulation.  Now, 38 months after the surgery, I feel exactly the way I felt before and after the heart attack and surgery; perfectly fine. By the way, I had a recent nuclear stress test and echo cardiogram in January because my cardiologist had detected an extra or skipped beat during a routine visit, but was told that all my grafts remain clear.

    Moreover, I learned from my uncle, after my surgery, that he had failed a routine stress test when he was 75 and his doctor determined that he had major LAD disease but plenty of collateral circulation and therefore did not require any treatment other than hypertensive medication.  He is now 86, feels perfectly fine and has never had a heart attack or angina despite his major blockages.

    My experience, and that of my uncle, led me to research the CABG scholarly literature, and I learned that there have been at least two relatively recent studies (I can supply the names and citations if anyone is interested) concluding that there is no distinction in morality between non-anginal patients who have had CABG surgery and patients who received non-surgical medical treatment, and that CABG is warranted (and highly effective) in relieving angina, but is not otherwise generally necessary in non-heart attack cases.  I am not a cardiologist or physician of any kind, but I do have a scholarly disposition and would love to hear the views of any cardiologist on this forum about these and/or other studies, including whether I may be missing some important information.  None of this directly applies to you, of course, given your angina history, but I still find it fascinating that there are some people with less severe blockages who require or may benefit from CABG, while CABG may not be indicated for others with more severe blockages but are asymptomatic.

    Anyway, I hope you will forgive my rambling musings, but I hope I have at least conveyed how different our different our coronary artery disease experiences and treatment can be.

    Wishing you all the good luck and pain free health in the world, and good luck on your upcoming treatment.


    Ira

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    Ira Reid
    Hoboken NJ
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  • 3.  RE: Probably upcoming CABG

    Posted 04-06-2021 15:08
    Hello Dennis

    Perhaps you've had your appointment by the time you get this.  My CABG in September was "beating heart" and I preferred that to the alternative older method of stopping the heart and using bypass perfusion.  As a surgical nursing instructor in the 1970s to late 80s, I followed the debate between "surgical" and "medical" approaches to CAD and obstructions.  The studies, then and now, show about equal outcomes.  It's good to have a variety of options because other factors also figure into decisions.

    Besides having beating heart surgery, my saphenous veins were spared.  I had a 95% obstruction of the left main artery extending into both the left anterior descending and circumflex arteries.   Stenting was not an option because of the Y shaped obstruction but I was a candidate for using the left and right mammary arteries as grafts bringing their own blood supply and more sturdy walls than saphenous veins.  Dream surgical plan.  I signed on the dotted line.

    Complication one:  The right mammary artery (RIMA) was found not to be long enough to reach the circumflex after they had already "skeletonized" it so they removed it and used it as a bypass graft.

    Complication two:  I did poorly after going home on Day 4.  But I didn't know how I was supposed to feel.  Shell shocked, PTSD. Short of breath, weak, unable to stand without help. BRAIN FOG.  Had a one month appointment with the surgeon who didn't seem concerned but the home health nurse said after two weeks to get help and to go to Cleveland Clinic.  There they found that the RIMA was totally occluded.  In an elegant strategy, they put a stent in the obstructed left main to the obstructed circumflex artery which the RIMA was supposed to bypass.  Thought I was done and dusted.

    Complication three:  Angina appeared two weeks after the stent in Cleveland.  I limped through Christmas and was back in Cleveland mid-January.  This time a diagonal branch of the LAD was found to be compromised yet too small for stenting leading to unstable angina.​​
    Present day reality:  My chief problem is CAD and my treatment now is "medical." I am on a "cocktail" of angina meds and I exercise faithfully.  I expect to have more visit to Cleveland and I'm getting cardiology care there via tele-health.  So far, so good. I have episodes of angina for which I take the sub-q nitro but I don't perceive this as a "crisis" but rather a need to give the involved vessels some dilation.

    My story illustrates various facets of surgical vs. medical approaches.  I'm good with it.  It is what it is and I'm happy every day.  I got counseling for the PTSD.  I still have anxious moments but it's manageable.  As a nurse for 56 years I remain awed by what can be accomplished by skillful practitioners AND motivated, determined, deliberately resilient people who undergo all kinds of treatments.  The love and support of family and friends are precious, but I was ok going "all by myself" to three hospitalization at the height of COVID.  Kind folks looked after me.

    Today I am signing up to give COVID vaccine injections as an Ohio Medical Reserve Corp.volunteer working out of area health departments. Life is good. God is good.  We can afford to be good to each other.

    Peace and be of good cheer
    DE

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    Doris Edwards
    Retired RN
    Dublin, Ohio
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  • 4.  RE: Probably upcoming CABG

    Posted 04-07-2021 13:38
    Hi Doris,

    It was very interesting to hear your educated view of the "medical" vs "surgical" debate to CAD.  I have a feeling that, one if these days (or decades), OHS will be a thing of the past and everyone will be treated by as yet undeveloped heart drugs or perhaps microsurgical procedures.  Maybe we'll see it ourselves in our next lives.

    Regarding PTSD, I have experienced it too, not through anxiety but through flashbacks.  Little things like grabbing hold of a TV stand feeling a bit lightheaded if I stand to quickly, hearing my wife ask me something, can transport me back to the hospital room for a second or two.  It's not unpleasant, but it is curious, almost like I never left the hospital.  Maybe the way I deal with traumatic experiences is through intellectualization.  I tend to do that generally.  I once saw a movie called "Jacob's Ladder" that I intend to see again because my experiences, including my ICU hallucinations, remind me of what happened to the soldier in the movie, including the questions concerning whether they were real, hallucinations, experienced right before dying in the war, or supernatural events after surviving the war.  Maybe the fabric of reality is much more extensive than what we commonly experience in our waking lives and includes our hallucinations, dreams (as certain Native American people believe(d), the expanded consciousness that some have experienced as an "awakened" state as well as our everyday consciousness.  I embrace it all.

    Ira

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    Ira Reid
    Hoboken NJ
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  • 5.  RE: Probably upcoming CABG

    Posted 04-08-2021 08:18
    Hi Ira

    I still have flashbacks too, not as horrifying as earlier. Getting a
    name-bracelet put on for a recent blood draw triggered one.?? I hated
    putting on the cardiac monitor patches in rehab. Appreciate being able
    to connect with those who've been there too.

    Doris