The Bypass

The phone buzzes with a notification. “Chest is open. She is on pump now. Everything progressing normally.” The Wife is undergoing open heart surgery. I sit in the waiting room alone, mercifully mask free because of this.

I remember the first time I heard open heart surgery used as a phrase. My grandfather had undergone a quintuple bypass back in the seventies. The surgeons had marveled at the complexity and his near-miraculous survival at the time.

The doctors and nurses now refer to these kinds of procedures as routine. “We do them all the time.” My heart doesn’t know this, refuses to accept that the opening of that beloved chest could be anything less than a near imminent death event. My all too active imagination can paint the scene in Technicolor for me, if I allow it.

I don’t allow it. I don’t want to see, to think of her that way. A piece of meat on the cutting table. Instead I will fill my head with classical music and meditate on the reunion we will have in a few short hours. No other outcome will be entertained no matter how many times those ravens of doubt perch over my mental doorways. I will see her again. We will embrace and she will chide me for being a silly sentimental old man.

That is the picture I will paint in my head instead of those other nightmares. Time enough for the nightmares afterwards.

Featured image: NucleusMedicalMedia

Postscript

The cardiologist remarked that he had never heard of a fever-induced trip to the emergency room being used as a detection method for cardiological issues, but we had known about the heart valve deformity for years by that point. The fact that she would need surgery at some point in the future has been a known quantity since the day we started regularly going to the cardiologist, at least twenty years ago. It was her blue fingers that freaked me out that night. Her fingers had never been that color before.

She was diagnosed with an ESBL infection in addition to the heart valve blockage. They didn’t even know for certain that she had the infection, it was just on the plate that they used to culture bacterial growth, to try to see what was causing the fever. She got the special antibiotic drugs anyway, and the nurses had to gown up for the entire time she was at the hospital. Visitors and guests were expected to gown up as well. This earned her a private room later in her stay, so she wasn’t going to complain about the extra drugs she had to take.

I insisted that they run tests to determine if she was still infected with the antibiotic resistant strain of e-coli before they released her, and the tests came up negative. That was all I was worried about. I didn’t want her to be released only to have the fever recur and me have to take her back to the ER a second time. Her attending physician didn’t think it was the ESBL causing the fever anyway, she thought it was a allergic reaction to a Botox outpatient treatment done the day before. That is the most likely culprit in this little medical drama, the antagonist that triggered open heart surgery for the Wife.

She starts outpatient Cardiac Rehabilitation next week. Ah, I remember those days fondly:

The Wife has complained repeatedly that her renewed heart beats too fast. When she airs her complaints, I quietly thank her cardiologist for making sure her heart continued to beat regardless of pace. I would have missed her presence, her voice, if he hadn’t. It would have been difficult to find a reason to go on without her heart beating next to mine. Hopefully that predicament has been postponed for another twenty years. Here’s hoping we both make it to our fiftieth anniversary.

Friday July 30, 2021 – She got up and got her pills today all on her own. She’s been home for a week and relied upon me for everything until today. The Wife is coming back to herself. It is a good sign.

Normal Saline Causing Vertigo?

I learned something new. I love it when that happens. When I was hospitalized for the night after having my angioplasty last year,

…I started to experience vertigo. I didn’t think too much of it, other than the irritation that I felt while trying to wheedle a Xanax out of the nurse because of the vertigo. The stress of having to argue with the nurse about a medication that the hospital could see on my charts as being a medication I have been prescribed adding to the anxiety of an approaching vertigo spell. Yeah, that was fun.

But still. I couldn’t figure out why I had that sudden bout of vertigo. No warnings, none of the normal patterns (not that surgery is normal) But then I remembered that they had me on an intravenous drip of normal saline for most of the day and the night, about 16 hours of normal saline by the time I started to feel the spinning. For a lot of Menerieans salt=vertigo and saline is definitely salt. I have been on a reduced sodium diet for decades now because reducing salt is also what they recommend for people with hypertension, another chronic illness that I enjoy.

Sixteen hours of saline fluid introduced into my system. Surely that wouldn’t cause vertigo, right? I mean, normal saline is the same sodium levels as blood, right? Why else call it normal saline? It turns out that this is not the case. Normal saline just means the saline solution most frequently used in hospitals, and the salt levels are not the same as the levels in the blood.

Each bag of saline contains the same amount of sodium as 20 snack-sized bags of potato chips.

webmd.com

I haven’t eaten an entire bag of salted potato chips in… well, it has to be at least a decade. I occasionally (once a month or less) get a snack bag of air-fried chips from Schlotzsky’s (another Austin original) along with my regular original sandwich (hold the cheese and add the guacamole, please) and unsweetened iced tea, and that is almost more salt than I need in a day. I know they changed that bag at least twice while I was there, which is a lot more salt than I needed.

The assumed harmlessness of introducing normal saline into the bodies of all of their patients has been a point of worry for many doctors. So much so that there have been trials conducted using other replacement fluids than saline solution,

For more than a year, the emergency room and intensive care units at Vanderbilt rotated the IV fluid used to hydrate patients. On even-numbered months, they used saline, and on odd-numbered months, doctors could choose between either lactated Ringer’s or Plasma-Lyte-A. Both Ringer’s and Plasma-Lyte have less sodium than saline, along with other electrolytes. Most of the patients on balanced fluids in the study got lactated Ringer’s.

webmd.com

When I read the phrase lactated Ringer’s I heard it in one of the voices from the show Emergency! from way back when. That was the show that first got me interested in medicine and emergency care. My mother would probably be horrified to learn that I was indoctrinated into the evidence-based medical system by a TV show that she let me watch as a child.

Facts VerseEmergency! Behind the Scenes Facts & Secrets – Aug 26, 2020

Lactated Ringer’s or the Plasma-Lyte appears to be the better way to infuse fluids into patients. Not world’s better, but statistically measurable improved results from not relying on normal saline for all the patients admitted into the hospital. If you also need lower saline you might ask for one of those two the next time you find yourself needing surgery. Here’s hoping that time isn’t in the near future.

Fish Oil

I was prescribed fish oil in the last year of the last millennium. Fish oil was supposed to treat my triglyceride levels that had topped 300 at the time. This was back in the days when there was just fish oil, and you took a lot of it. There was little understanding of what was desired in the supplement, but the doctors back then were pretty sure that you should be taking fish oil on a daily basis to lower bad blood cholesterol. I was prescribed nine 1400 milligram softgels, to be taken every single day. That meant that everything tasted like fish oil for several years. Everything tasted like fish oil until they started enteric coating the softgels. I got pretty creative with how I took them, so as to limit the flavor and gas that the fish oil imparted to everything. There was no mention of what kind of fish oil in that original script. Omega 3 might have been a known thing at that point, but it wasn’t on my radar.

As we scrolled past 2000 and headed for the middle of the next decade, researchers started to get a better understanding of what kind of fish oil was desired. That was when Omega 3 fish oil became a thing. Omega 3 was what they were finding made the difference. When I learned this fact I did the math and figured out that I could cut my dosage to two or three softgels if I bought the right kind of fish oil, a reduction that was grudgingly okayed by my GP of the time.

But then the next set of research results came back, and it looked like the researchers were backpedaling on the benefits of fish oil in avoiding heart attacks. I tried to get the doctors to let me stop taking the stuff because I hated having to work around the taste of the oil in the back of my throat all the time. At every visit, the general practitioner and then the cardiologist kept insisting that I had to keep taking the nauseating stuff. I humored them and kept taking it, but I stopped worrying about how much and how often.

Fresh Air – The Science And Environmental Hazards Behind Fish Oil Supplements – July 9, 2018

I stopped worrying until the last of my current keg ‘o fish oil from the warehouse shopping club started to run low, and I went looking for a replacement bottle. It was when I checked the Omega 3 content of the brand I had been taking against the new bottle’s Omega 3 content that I realized that I had been slacking off the one thing that might have been keeping my cholesterol at bay. That my recent adventures with angioplasty might have been partly of my responsibility. The brand I had been taking had about a third of the Omega 3 of the brand that I had just purchased. Which meant I should have been taking 9 of the damn things just like I had been doing at the beginning. So the bottle that I had been dipping out of for over a year probably should have only lasted about 3 months, and there is no telling for how long I haven’t been meeting the minimum dosage of Omega 3 that the cardiologist expects me to take.

Healthline – 17 Science-Based Benefits of Omega-3 Fatty Acids

How much is that? you might well ask. I had no idea, so I asked the cardiologist today and they said EPA over 660 DHA over 60, twice a day. I had to look on the bottle label to find out what EPA and DHA were references for, and only then realized that EPA and DHA are two different kinds of Omega 3.

1400 mg of fish oil is a completely misleading measurement, and a straight reading of Omega 3 isn’t enough to know whether what I’m taking is the right stuff or not. Nope, now I need to be taking those two specific variants of Omega 3 (EPA and DHA) and those are the minimum numbers, twice a day.

If I die from a heart attack, it will be obscure nomenclature that kills me. You can put that on my tombstone.

Angioplasty

It’ll all be fine.

That’s what they always say. Medical professionals. They’re always keen to reassure their patients that all will be well. They don’t want the patient to freak out and do anything crazy like killing themselves or canceling the procedure out of fear of the procedure. That is so not me; and I am way, way beyond the ability for comforting words to assuage any fears or disquiet.

Nope, I’m already certain that the end has come. I’m gonna die on the table. That’s the worst possible outcome. The next most likely outcome is that I’m going to wake up with a zipper chest like so many of my relatives have. Of course, I don’t tell anyone else that, not even the Wife. At least I don’t say that in those specific words. The Wife knows my mental acrobatics. She helpfully exclaims to the cardiologists nursing staff,

See what I have to put up with?

I know my own genetic history. I know what is in store for me because it is what happened to my direct genetic ancestors. My maternal grandfather had a heart attack when he was about my age. They cracked his chest open and sewed six bypass arteries into his heart in order to keep him alive. The procedure was successful. He lived for another thirty years before his gut killed him. When I started getting that weird sensation in my chest, I knew what that feeling meant, I just couldn’t jump to conclusions about what it was. No, I had to go through the experts and ge their opinions. I could have been wrong, but I wasn’t wrong. This time.

The feeling? It was like two solid objects rubbing against each other in the area around my heart. I’d never felt anything quite like it before in my life. After the sensation repeated itself several times during exercise, I decided I probably should take it seriously. So I did. I cancelled the physical therapy appointment I had the next day and booked an appointment with my cardiologist for as soon as he could see me.

He’s the one who offered the platitude it’ll be fine after saying the word angiogram and then watching me pale. What he didn’t know was that I have had nightmares about things crawling through my veins for most of my life. it’s part of my fear of needles and why I nearly faint every time someone sticks me with something. An angiogram is exactly that fear come to life.

I cringed every time an older relative would go in for one of the procedures. The Wife’s foster father had one done back in the dark ages, back in the 1980’s when an angiogram was still experimental. His was the first one I had ever heard of being done. They went in through his groin. They went in through that artery in the thigh that if cut you can bleed out in a matter of seconds. Not minutes, seconds. That artery. The femoral artery.

The catheter that they introduce into the blood system through the artery allows them to run a camera up through your arteries to study blockage from inside your body, and they can use it to introduce dye into your blood system, near the heart, so that they can use x ray imaging to study blockages. Which is what they wanted me to agree to. We’re going to slice open an artery and run tubes through your bloodstream. But don’t worry, we do this all the time.

They don’t know that worry is what I do eighteen hours a day, every day. If I’m not worrying about something, then I’m probably not actively thinking at the moment. I even worry when I dream. This is why driving a car every day of a working life is a special kind of torture for me. Anything more than a half-hour of driving, and I’m already worrying a hole in my stomach. I gave myself an ulcer inside of six months when I briefly flirted with driving for a living, bringing to an early end any kind of career driving trucks or test cars.

Over the course of the next week, while waiting for the procedure to happen, I say my goodbyes to everyone and make sure my karmic debt is paid off. I don’t want to be surprised in a potential next life by being reborn as a cockroach or anything. Just covering my bets. When the day finally arrives I’m under so much stress that if you scared me I would probably have a heart attack on the spot. That’s me trying not to worry.

Luckily I wasn’t going to be awake for the procedure. I made sure of that before agreeing to it. No, I do not want to be awake. I want the good drugs. The kind of drugs that keep you from remembering anything. I definitely do not want to be reliving the memory of crap crawling through my veins when I go to sleep for the rest of my life, if there is a rest of my life. Knock me out, or as close to out as I can get and still be responsive to commands or questions.

The doctor showed up early. He checked my wrist to see if it was large enough to get into easily. He was planning on accessing the radial artery rather than the femoral artery. I was initially thrilled at the notion that I wouldn’t have blood shooting out of the artery next to my junk the first time I went to the bathroom after the procedure. Then he left the room to allow the prep nurse to get to work. They prepared both the femoral artery area in the groin (so much hair!) and the right wrist as possible surgery locations. Had I known they would need to shave my groin anyway, I could have used the trimmers on it beforehand. Manscaping is a foreign concept to me. If hair grows somewhere on my body (on your body, even) it probably grows there for a reason. I see little need to trim hair that no one sees but me and the Wife. If she doesn’t like the hair, it usually gets snatched out by the roots anyway.

Talking to the surgery nurses is the last thing I remember before the procedure. I remember that both arms were strapped down (we don’t want you moving. Yes, I understand) The surgical shields were put in place. They were cold, but in place. The nurse said they do these kinds of procedures eight times a day on a normal day. They wouldn’t be doing eight of them on that day because the cardiologist I had been referred to had already dealt with two emergency procedures before he got to me in the mid-afternoon, and I had been scheduled as the first cardiogram of the morning when I walked in that day. He’s a busy guy. He earns his pay, without a doubt. He definitely earned it working on me that day.

The good drugs started when the doctor entered the surgery and verified everything I’d agreed to for about the fourth or fifth time (the thoroughness of modern medical procedure is reassuring if slightly tedious) and I don’t remember much after that. I remember the imaging system suspended over my chest like the upper hammer in a forging hammer press. I remember voices, but not words. I do vaguely remember something rounding the corner in my shoulder at one point, but I definitely do not remember the amount of work they had to do once they had done the initial scan.

…because it was as bad as I imagined it was. I didn’t die, so the worst outcome was averted. They didn’t have to crack my chest, something that would have been required had I been undergoing the procedure even ten years ago. Second worst outcome avoided by simply being born in the place and time that I was. No open heart surgery. Just three stents. Three stents, in three different arteries, and then the second set of tests to make sure that blood flow was restored to the blood starved areas of my heart.

What would have been weeks of bed rest and a lengthy hospital stay reduced to overnight observation and three months of cardiac rehabilitation. I’m a big fan of science-based modern medicine. It has once again kept me alive to see another day. From that perspective, what is there not to like about it?

I start remembering things after I’ve been in the recovery room for a bit. I remember the Wife’s usual amusement at my slowly dwindling confusion. I remember the cardiologist (now my favorite person in the world) visiting to let me know what they found while crawling through my arteries. He also let me know that I needed to stay for observation for at least a day to make sure that there were no complications. I also remember sitting in the recovery room until they had a hospital room ready for me, sitting there waiting until the cleaning staff was impatiently waiting for me to leave so they could clean up and shut down the surgery wing for the day. At least I had Looney Tunes to keep me company.

The pressure bandage was removed from my wrist at some point during the wait, and then there was a brief panic while I bled through quite a bit of gauze before the nurses got the bleeding to stop. Nurses pressing on the fresh surgery site to stop the bleeding, that was the most intense pain I endured that day. A mercifully brief pain considering the amount of pain that open heart surgery entails. Pain for months on end.

Spotify
NPR – Invisibilia – The Fifth Vital Sign

I could bitch about the inability to get my betahistine cleared through the hospital administration while I was laid up at the hospital for the night, but that seems pretty trivial in the scheme of things. We’ll just pretend I didn’t take the betahistine anyway because that would be against the rules. Did you know you aren’t allowed to bring your own drugs into the hospital? It was news to me. If you have drugs that aren’t available in the US unless they are compounded, you probably should get your drugs approved by the hospital you might be staying in before you find yourself stuck there with no treatment for your weird diseases. It will save you the frustration. In my case, it would have kept me from requesting a Xanax from the staff in order to keep the vertigo at bay. They didn’t want to give it to me, but I convinced them they didn’t want to see a full blown drop attack in the middle of the night. Really, I’m not complaining, I’m just a problem patient. Ask the Wife.

The only real surprise I experienced post-recovery was that I didn’t expect to be one-handed for such an extended period of time. Had I realized that the bruising would hang around for as long as it did, I would have told them to go in through the groin. I would have missed a wedding anyway, as it turned out (thunderstorms will do that) But I could have done everything else I normally do while laid up in bed for forty-eight hours. Not having two hands meant I missed raiding in World of Warcraft for two weeks. But the worst part was not writing. Not writing much of anything for nearly three weeks. Slow torture for anyone who loves to write. As I said previously, I watched a lot of television.

This brings us to today in this little story. Today, where I’m stuck in the near-endless repetition of cardiac rehab three times a week. Exercising while wearing a heart monitor with nurses always hovering nearby. Me and a whole lot of people twenty years my senior sweating as a group and wishing we could be somewhere else. I’m beginning to understand what it means to be handed the short end of the genetic stick now. What it means to have a cholesterol problem that can’t be treated with a Statin because of dangerous side effects. I hope to survive my genetic handicaps long enough to see a crispr application that will fix what is ailing me, whatever that is.