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30 August 2007 @ 08:53 am
Sixth Surgiversary  
Mended Hearts calls them surgiversaries--the anniversaries of when we had our cardiac surgeries, whatever they were. This is my sixth and I guess I am in a pensive mood this year. I turn 49 on December 2nd, and I'd really like to at least make it to 50. Reaching another year should make me happy, and yet my heart health seems to be deteriorating lately. I need more diuretic and I'm getting out of breath more easily upon exertion. Maybe that's partly because my heel injury has kept me from walking, I don't know. But it worries me. Today I felt moved to look back at some of my LJ entries about my heart disease journey.

Dave sent out an email on the day of my coronary artery bypass graft (x 4), or what's commonly known as a heart bypass surgery. In hospitals they just call it CABG, pronounced like the vegetable. Later that day, before I was fully awake and extubated, I had a heart attack. This is a risk of both surgery and the angiogram I had the day before. Fortunately they gave me powerful blood thinners right away and the damage was mild. If you must have a heart attack, have one right under the nose of the doctors!

A few weeks later I wrote about the experience in my paper journal, which I later transferred to my LJ.

My recovery was somewhat depressing because it took place against the backdrop of 9/11 news stories and the feelings we all had about it. In July of 2002 I had a stent placed in one artery to hold it open because that graft had closed. (I didn't know this, but sometimes the veins they take to bypass the blocked part of your artery just doesn't work and collapses on itself.)

It's difficult to find clear data about mortality rates beyond the CABG procedure, because multiple studies are being done looking at this or that factor relating to it and each comes up with a different number. In one study I saw that my chances of surviving to ten years post-CABG is 48%, in another my risk factors of obesity, high triglycerides, hypertension and prediabetes indicate:

The concurrent presence of three or more members of the quartet occurs in 10% of men and 21% of women in the pre-CABG population at our institution, and among these groups one in five men and one in four women died over the course of follow up.

(That was only 8 YEARS post CABG!)

Another study showed a mortality rate of 14% for CABG at five years following the surgery. This study did not adjust for any additional risk factors, it was simply meant to compare CABG to other possible interventions.

Well, I wasn't one of those 14%! That's something, anyway.

My mother lived 12 years after her CABG. She in fact had a second CABG five years before her fatal heart attack. It is possible she could have lived longer but she refused cardiac interventions and just asked to be made comfortable. Her quality of life had diminished greatly, even at the point I am now. By this point she was on oxygen and everywhere she went she had to carry a tank with her. She could barely walk. She only got worse after that and she developed diabetes and her incision from the second CABG never healed properly. She also was never able to quit smoking, and I'd bet she had a cigarette on the way to the hospital that last night. (I have nothing but sympathy for those trying to quit smoking, it is obviously one of the most addictive substances on the planet.)

The thing is, heart disease is unpredictable. A person can do all the right things and if the plaque in their arteries becomes unstable--the surface of the plaque breaks--then a clot will form and they'll have a heart attack. If they get to the hospital in time, intervention may save their life--or may not. Additionally, a damaged heart is prone to getting out of rhythm. This can lead to cardiac arrest. Most people do not receive intervention in time to revive their heart and preserve their brain function. (4 to 5 minutes seems to be the cut off point for brain function unless the brain is cold--such as cold water drownings. Interesting studies are under way to see if artificially cooling the brain and body can give the medical team more time to revive the patient while still maintaining brain functions. A cold brain needs less oxygen and can go longer without it.)

One way to think of risk factors is that they are like lottery tickets. The more you have, the more likely your chances to "win." Or in this case, die. But all it takes is one, and anyone who has heart disease is automatically in the "high risk" category for heart attack or other cardiac event.

It doesn't help matters that the interventions themselves can kill you! There is a 2% mortality (death) rate from CABG and an angiogram can lead to an emergency CABG if the artery is ruptured in the process. The angiogram can also cause plaque to rupture and form a clot. This is why they don't just do one for anybody to see how their arteries are doing. You have to have evidence of heart disease to justify the risk of the procedure.

Will I beat the surgeon's prediction that I wouldn't make it to 50 unless I got down to my "normal" weight? I have one year, three months and three days to go. Who knows! But I do know that if I had the gastric bypass surgery I could die on the table or of complications, I could live like my mom and constantly have problems digesting food, I could suffer malnutrition, I could have yet another surgery to cut excess skin off my body, leaving me open to another risk of dying. I see no reason to mutilate a healthy, properly functioning organ of my body (two organs, in fact) as a method of managing the symptom of obesity. In the meantime, I will do my best to live a healthy life style and take my chances on having a better quality of life while I am here.

If nothing else, living with heart disease helps you get your priorities straight. If there's something I want to do, I know I have to do it as soon as possible and not wait for a tomorrow that might or might not come.

I had some reflections of the things that this extra time have brought me, here, for year 4. I have also talked about the impact of heart disease and chronic illness on my marriage. That's an ongoing process, especially lately when I've been out of work and Dave has been carrying us financially. We can both see disability looming just around the corner and I am resisting the loss of a full income and the feeling of accomplishment and independence it gives me.

Learn about heart disease and how to assess your own risk factors, review heart attack symptoms, and find out what you can do to prevent or at least delay the onset of heart disease, even if you have a strong family history like I do.


The sooner you start, the better chance you have! And remember, if you ever have heart attack symptoms, the faster you can get to the hospital the less damage your heart will sustain. Time is muscle! Those who wait end up far more disabled than the sensible folks who go in and don't worry about whether it's a false alarm. Even the doctors and nurses will tell you that it's better to come in and find out it's nothing serious than to sit at home and die of a heart attack because you're afraid to be embarrassed!
Mari Adkinsmariadkins on August 30th, 2007 06:22 pm (UTC)

My mother in law had to have a double bypass in May 2000. Preston and I didn't even know she was here in the hospital until all was said and done. His dad didn't want to scare us. :eye roll:

As for those heart attack symptoms, I've had several. But from what I understand sometimes it's hard to discern a panic attack from even a mild heart attack...:sigh:
Tapatitapati on August 30th, 2007 09:31 pm (UTC)
Yes, it is difficult to tell the difference between panic attacks and heart attacks. I have a friend who did call an ambulance because she had such chest pain and difficulty breathing. The field ekg looked good so she decided not to go to the hospital. The paramedics were great and said they'd be happy to come back.

I've had the same difficulty with my gastric pain (spasming esophagus) that feels like heart pain. So when I'm on the fence I go into urgent care and get checked out there. If I have other cardiac-related symptoms like being clammy, short of breath, nauseated, then I'm calling 911, no fooling around.
Mari Adkinsmariadkins on August 30th, 2007 09:42 pm (UTC)
If I have other cardiac-related symptoms like being clammy, short of breath, nauseated, then I'm calling 911, no fooling around.

I hear you, but when I panic sometimes I do the short breath and nausea bit, too - so it's hard to tell! Eh, it's better to dial 911 and be safe! :D
(Anonymous) on September 17th, 2007 01:33 am (UTC)
I had a cabg 11/22/06
Hi,I had a cabg just before thanksgiving 2006. I feel terrible. I never regained my strength or increased my stamina. However, it beats the alternitive. I had mine done by the Veterans Affairs Medical Center in Columbia, MO.
I had great doctors and nurses at
Columbia. When I returned home the Veterans Affairs Medical Center at Leavenworth, KS was to provide the aftercare and it was minimal. I had no structrued rehab program. I did the rehab on my own. That consisted of walking. I ran out of breath very easy and still do. I cannot exert myself at all. I am worried to tell you the truth.
If you decide to have the cabg, make sure the stuctured aftercare is in place and do exactly what you are instrcuted to do.
Tapatitapati on September 17th, 2007 03:36 am (UTC)
Re: I had a cabg 11/22/06
Cardiac rehab is vital because you can start working out while monitored by professionals and intervention is available if you get into trouble. They can show you what zone you can safely get into.

Bypass grafts can fail so if you are still having trouble, I'd get checked out and see if you need more intervention. One of mine failed and I got a stent the following year in that artery and was fine after that.

Good luck!