Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr Warrick Bishop and welcome to part two of Dan's Journey. Hi Dan, welcome back. Hi Warrick. Look, a quick recap for those who may have missed the first part. In fact, I encourage you to go back and have a listen to the first part. But in summary, Dan's a man who at 44 years of age with raised cholesterol came to see me because his GP sent him along to find out more about his cardiovascular risk. Well, the long and the short of it is he had a cardiac CT scan, it showed high risk features, and my staff rather gently and subtly invited him in for an early consultation so we could put him through stress testing. So do you remember the phone call when my girls gave you a call, Dan? Yeah, I do actually. And I was thinking, that's very quick. Very quick to get that call, but I thought at least it's proactive if nothing else. And I think it was the Wednesday that I had the scan and I got booked in for Friday for the stress test. So I turned up with my runners and thought, I wonder where this leads to. Yeah, so I can, quick reminder, Dan is a tall, fit-looking fellow and he turned up on the Friday with his sand shoes, running gear, looking like he was ready to do a 10K and we put him on the treadmill. Look, the rest is history, and without going into too much detail, there was no question that when we exercised Dan, there was evidence of lack of blood flow to his heart, which showed up through the changes on the electrical monitoring, the ECG, and changes on the ultrasound that we did of his heart before and after, showing us a part of his heart wall just wasn't contracting properly. But on top of that, Dan was short of breath and realised he just didn't have the exercise capacity. he'd had previously do you remember finishing that treadmill test well i think i remember it was over before it really started well i've done i've done one actually with you in 2012 for an insurance um requirement and it lasted 20 minutes and i think i clocked the machine and uh i remember you putting it on full bore so that i could get my heart rate up and on this one my I think I was on 135 beats per minute and three minutes in when you were boarded. And I thought it's either a very good sign or not a good sign at all. And seeing as I felt like I could hardly breathe, I knew that it wasn't a good sign. So a quick recap. I'd actually put down on a bit of aspirin and cholesterol-lowering therapy just as a protective manoeuvre, a bit like an airbag or a seatbelt, until I had more information. Well in retrospect that turned out to be a good call. The exercise test was compelling and we moved as quickly as possible to make arrangements for further evaluation and really what that is in the setting of coronary disease is looking at the arteries with as much detail as possible and that requires an invasive coronary angiogram where we literally stick a tube inside the body. pass that tube right up to the arteries of the heart and squirt a contrast or dye into those arteries so we can get the best possible pictures and plan what should be done, whether it's a stent or a bypass and the details around that. Well, that's what we did for you, Dan. And I think we'd organised it all pretty quickly. So do you remember how that unfolded? Yeah, so... The Friday was when I had the first test with you, or the stress test, and I was booked in for the angiogram on the Wednesday, so four or five days later. I actually remember talking to you about it because there was a point surf, which is one of these things that don't happen very often down in Hobart where there's very good waves and I wanted to take my kids surfing. And I said, oh, do you reckon I can just go for a surf because you told me to rest? And you said, stay on the couch. This is not like half, you know, it's a proper thing. And so I said, OK, I've got to respect this and the angiogram, this is serious. And the night before the angiogram, I did get a call from you where you informed me that my private health didn't actually cover the angiogram because being 40, 40-something, I'd excluded heart from my private health cover. So I'd have to fund the angiogram myself. which meant moving it to the Royal Hobart, which would take about two weeks to get in. Fortunately, I do have a close friend who's a vascular surgeon, and I actually called her for some advice and said, hey, I'm supposed to have an angiogram tomorrow, but it's not covered. They're not a cheap thing. I think it was over $5,000. And I said, what do you think? Should I wait two weeks? to go in the public system, and she was able to look at my scan results, and she said, just do it tomorrow. And I think Warrick was kind of alluding the same thing to me, that if I could afford it, it was worth doing, but if I couldn't, the alternate was to wait for the public system. So I thought, no, I've got to fund this myself, so funded the angiogram, and that was on the Wednesday. Had the angiogram, got the results very quickly. All I know is that four 95% blockages isn't good. Warrick can probably explain that in more detail than that, but I knew things were up before that, but when I saw how bad it was, I was like close to a state of shock. So the advantage of the angiogram is actually it gives us the clearest information in terms of what we're dealing with. What we tend to do is if there's one localised blockage, we would consider trying to stent a single artery to open a single narrowing. But if there's multiple blockages, a lot of our thinking is that we can do better by putting grafts in and bypassing each of those problems. So very quickly, we got you seen by the cardiothoracic surgeon and you were whisked off to surgery pretty damn quickly. Yeah. Because I was seen at the Calvary, but the surgery was going to be at the Royal because I was a public patient. I was put on the, not the emergency, it was the prompt waiting list, I'm not sure what they call it. So there was still a two-week window from the angiogram before my surgery. I think they tried to put me in within about 10 days, but that first... that first booking got moved because of other emergency needs. So it was about two, two and a half weeks before I actually had my surgery. And in hindsight, that was probably the worst of the whole, of all of the rehab, of all of the post-surgery, pre-surgery kind of, you know, time and situation. That was probably the most traumatic. Just sitting there knowing exactly how... how my blockages were, the risk factors, what could happen, and I'm just sitting there not exercising, unable to do anything, gathering my thoughts, knowing that sometime very soon my chest is going to get cut open, they're going to open up my heart and, you know, get grafts from my leg, get veins and arteries from my leg and my arm and stick them in and hope that there's a good plumber on site. It's scary. Look, there's a couple of things that I just want to comment on there. The first is that I think, this is a personal bugbear and it comes up a bit, I think it's remiss for insurance companies to offer people health insurance that doesn't include their heart. And I know it offers the chance to reduce your premium, but the number of times something can go wrong with your heart, it doesn't seem like... It seems like false economy. And your heart's so important that I don't think insurance companies should be offering that option and the number of times people get caught out. You're in no way the first person I've seen caught by that. And I can completely understand when someone says you could save a bit on your premium and look at you, you're young and fit and healthy. You go, yeah, OK, that's for me. But I think it's a bit remiss and they probably should take that out. cover everything for everyone yeah i i would strongly agree with that i i think i was uninformed or definitely was uninformed um i think elective things in should be like um hospital for having a child or something something that you can actually control not an actual risk factor um or a health or a situation that is that is something you can't control I think so. So look, think about your own insurance, your own health insurance if you're listening to this. Look, the other thing that I think is really important is there are many times where I have patients who are getting ready for surgery and they're relatively stable in the scheme of things, but obviously very keen to get it done. And they can be quite caught up if their surgery gets postponed or moved. Now, you weren't in this category. You obviously had enough to worry about thinking about getting your surgery done at a young age with a young family. But some people miss that if they're relatively stable and their surgery is being bumped, it's because someone is really sick and really unstable and taking that place. So there's a bit of shifting and shuffling. And obviously we call that triaging. If they're being postponed, it's not because we don't want to do them. It's because someone is more needy and if they're in that person's position, they'd want us to be acting the same way. Yeah, and I remember you actually called me when I was, I call it bumped, the first time and reassured me. So, yeah, I was grateful for that. And I was, yeah, fully aware that there are emergency situations. Unfortunately for me... I was bumped because there wasn't enough ICU beds in the Royal. We had the surgeon ready to go, and he actually had no patient the day that I was supposed to go, but there was nowhere to put me after the surgery. So that's a disappointing thing for the public health system. The irony for that, of course, is that there would have been space through the private system. There would have been, so it would have got done at the time that was scheduled. And yeah, I fully understand the triad system. I guess it's slightly comforting, but when you're sitting at home preparing for that, it's still very challenging mentally when you get bumped. Those minutes and hours and days along. Well, that's it. Four weeks earlier, I was fit and healthy with zero chance of heart disease and less than halfway through my life. And then suddenly you've got a life-threatening illness. So your world's turned upside down. And anything that changes or any challenges that come, you are a heightened kind of emotion. So I met your wife, Kate, through the process. How did she cope through that weight? Because I can't put myself in your shoes, but my guess would be, to a large degree, the whole family shares that. angst and apprehension how did yeah she um everyone took it on board it was very traumatic um my parents took it really badly katie um katie with her personality and her persona um was very very supportive um not dismissive but she she didn't mollycoddle me or um like say oh you poor thing she's very down the line well okay well this is what we're challenged with this is this is the um this is the situation, this is how we'll face it, I'll organise the kids, I'll take these days off work. And she was very structured in her approach and that's how she deals with the challenge. She's quite, you know, she prepares herself, plans around it. But deep down it was, you know, really hard for her. And it was really hard for the kids too, when the kids suddenly, you know, they... They were 11 and 13, and my son's ASD, so anything outside the ordinary is challenging for him. And so for him, he was like, why is Dad on the couch all day? And, you know, he's not taking me for a walk on the beach. We're not going for a surf. So it just threw everything out. Look, we've talked for well over 10 minutes in what seems like just a blink of an eye. I'm going to wind up. this particular interview now and invite you back for part three, Dan. For those who are listening, I hope you're enjoying this story as much as I am. It's an absolute privilege to have an insight into someone's journey through this process. Thanks for sharing. Thanks for sharing, Dan. You can say no worries. And we'll be back with part three. Thank you for listening. Thank you for your attention. Until next time, I wish you the very best. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
