Coronary Artery Bypass Surgery: All's Well That Ends Well (Part 2)
Last month, I reported the events leading up to having coronary artery bypass surgery for treatment of newly discovered coronary artery disease. Also mentioned was the sudden role reversal of a 40-year care giver to a care receiver. There were lessons in this unwanted new experience.
As uneventful as the diagnosis, surgery and early convalescence were, including the hospital discharge five days after the operation, this did not mean that the patient was OK. There was still some pain, a great deal of weakness (major surgery like cardiac operation is a huge stress on the system, no matter how well things go), and there was the whole process of having everything work properly like eating, bowel function, walking and, in the case of heart surgery, not being able to lift anything more than 10 pounds. These are all annoyances but in very rare cases there are complications after the surgery that go beyond these issues.
As too often it seems in the case of physicians as patients, we seem to be magnets for things to go wrong. However, with all patients in all operations there is a measurable and predictable incidence of complications. They range from slight, a rash from one of the many medicines, to calamitous, such as a stroke, heart attack or as in my case, multiple lung emboli from clots that formed in my legs secondary to a rare reaction to heparin.
Three days after discharge from the hospital I rather suddenly had great trouble breathing and felt ill. This was a Sunday and I decided to give myself a day to see if things would get better overnight (an unwise decision). Things didn't improve and I awoke with significant ankle edema to go with my shortness of breath. I had my wife, Jenny, take me to the cardiac surgery clinic and within a couple of hours and after two major diagnostic tests, I found myself back in the intensive care unit with the diagnosis of heparin induced thrombocytopenia thrombosis (HITT) with pulmonary emboli.
The diagnosis struck fear in me since I knew exactly what was going on and how badly things could still go. This is probably one of the unfortunate things about being a physician active in the field -- in fact, we had feared HITT at Duke where I worked and had written about it and explained it to the medical community. It was a dreadful complication for our patients and now I was a patient with it! This was a true role reversal that frankly was most scary.
My physicians as we say "jumped all over it" (I am sure they were as concerned as I was) and had me getting a continuous infusion of a different anticoagulant to prevent further clots. Within three days I was stable enough to leave the ICU and gradually improved in breathing and walking and everything else. The treatment involved gradually switching over to oral Coumadin from the intravenous drug and I was discharged after 10 days in the hospital.
As with the uncomplicated hospitalization there are lessons for you gentle readers to learn from my experience. First, there are complications that commonly occur after surgery and are discussed with you as part of the informed consent that your surgeon goes over before you consent to an operation -- try to pay attention to the list and ask your surgeon how you will know if you have any of the complications. It is best to have your spouse listen intently as well, since complications are part of every procedure and your spouse may be the only one who really hears what the surgeon is telling you. (This is because you, the patient, just want to know what is going to be done and the overall chances for success.) Complications fortunately do not occur in most people. Second, when being discharged you are given a list of symptoms to watch for -- my watch list after surgery included shortness of breath, return of heart pain, fever higher than 101, and weight gain of more than four pounds in a week. The list also included watching the surgical site for redness, swelling, pulling apart, and pus drainage. This list is very important and every patient must be on the alert for any of these symptoms. (In my case I had severe worsening of shortness of breath that meant something untoward was going on.) Finally, remember if anything -- anything at all -- seems amiss or unexpected, call your surgeon. Even though you have probably never had the surgery before, you still will be able to sense if things are going as hoped or not, and you must call your surgeon if things seem abnormal. Never worry that you are bothering the surgeon. Your welfare is the surgeon's top concern and anything that bothers you will be important: Let the surgeon decide whether it is a serious problem or not.
As this report is filed exactly six weeks after the surgery, I conclude : All's well that ends well!
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