Seriously uncomfortable, barely able to move, often sleepless, I was unable to take more than shallow breaths because my lungs had collapsed (a result of the surgery) and its air sacs had filled with mucus. I was dosed with a liberal pharmacopia – blood-pressure elevators, blood thinners, cholesterol reducers, fluid reducers, stool softeners, hemoglobin boosters, heartbeat slowers and, of course, painkillers, including morphine. The latter I can recommend.
My aching left leg, from which the vein had been extracted, was a purple blotch from groin to knee. Swollen on dopamine, my feet resembled the gnarled limbs of some ancient oak. I could not feel them. I needed help getting to and from the washroom. Every step was tentative and painful.
The level of care extended was extraordinary – an endless parade of solicitous cardiologists, anesthetists, respirologists and nurses. They not only read my chart, they also stopped to chat and offer encouragement. One therapist gave me a small heart-shaped pillow to hold against my chest when I coughed, sneezed or, god forbid, laughed. It proved no match for the pain. Another brought me something called an incentive spirometer, a long horizontal tube fitted with a mouthpiece. I was to suck air out of the tube, trying to suspend a small white marble in a vertical cylinder for three seconds or more. By breathing deeply, you force air into the lungs, and open the air sacs.
Alas, I sucked at sucking. For several days, I could barely keep the marble suspended for one second. My ability to walk was equally impaired. A single circuit around the ward was taxing. In my head, I wanted to push myself, but my body rebelled.
I had survived, and was thankful, but didn’t really like that I was part of a grand success story.
The big decline in Canada’s cardiovascular death rate stems both from improved surgical techniques and from new drug therapies.
More concerted prevention efforts also play a role. Cardiologist Matthew Sibbald of Toronto’s University Health Network says lifestyle changes – regular exercise, smarter diets and, most significantly, the decline in smoking – are beneficial.
But the key factor, he maintains, are the drugs, so-called statins such as Lipitor and Crestor, which reduce “bad cholesterol” (LDL) levels in the blood.
“Drugs like Lipitor,” Dr. Sibbald says, “have changed the burden of disease in this country.”
The numbers certainly support the argument. Since the big push for controlling cholesterol began a decade ago, there has been a dramatic, 30-per-cent decline in rates of heart attack and bypass procedures. (In the United States, bypasses have fallen even farther, by 38 per cent, since 2001.) As well, there are fewer stent procedures, and fewer patients with blockages are turning up in hospital emergency wards.
Controversy still surrounds bypass surgery
My own need for surgery had never been up for discussion. My angina had been categorized as unstable – the pain could appear at any time, even at rest. I had already suffered one heart attack and was at serious risk for a second. Given the arterial blockages, Dr. Sibbald, who assisted on my angiogram, told me that, if I had experienced another cardiac event, I probably would not have survived the trip to the hospital.
In the medical world, however, a good deal of controversy still surrounds the efficacy of bypass surgery. Many cardiologists maintain that patients with stable angina (mild, occasional chest pain) do not need it. What causes heart attacks, they insist, are not cardiac blockages per se, but plaque that somehow loosens from the cell wall and stops arterial blood flow. That can happen inside new grafts as well.
Moreover, about 10 per cent of bypass patients do not survive more than 24 months – typically, the elderly, the obese, the diabetic or those who can’t or won’t change their lifestyles.
“There’s no real debate about the statins,” Dr. Yau insists. “It’s one thing if you’ve never had artery disease. But anybody with a history should be on medication to control cholesterol levels and drive them lower.”
Still, statins can cause a range of pernicious side effects, including muscle pain, mental confusion, constipation, headaches and impotence. Beta blockers, which slow the heartbeat, may induce fatigue, upset stomach, dizziness and loss of libido. Given that I now have “a history,” I’m on both, as well as a daily dose of blood-thinning Aspirin. Many bypass patients also take pills to control blood pressure.