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 I'd like to welcome you to my podcast and videocast station and I'd like to welcome you to part three of my interview with Dan sharing his journey as a 44 year old man who went through coronary artery bypass grafting. Hi Dan, welcome back. Hi Warrick. Look, for those who may have missed the first two parts, I encourage you to go back and listen. But if you don't get the chance, Dan's 44 years of age, fit and well. a surfer in the local area where I live, an engineer with two kids under 15 years of age, married, with a raised cholesterol. And one thing led to another. He came to me where he organised a cardiac CT scan which showed significant buildup of plaque. He had a stress test which showed significant lack of blood flow to his heart. We went on and did an invasive angiogram and he got booked in for coronary artery bypass grafting. Major but routine surgery, but somewhat unexpected for Dan. He talked a little bit about that apprehension and the two weeks that felt like an eternity. So we're going to jump into what actually happened when surgery came around. So Dan, after that two weeks, which must have been... Just a suck, sitting at home, sitting on the couch, waiting, wondering what was going on. Tell me about when you actually had that day of surgery arrive. What happened? Yeah, so the surgery, I went into the hospital the night before because I was first cab off the rank the next day. And I remember going into surgery and the nurse came in to see me. And she said, okay, tomorrow we'll get you up at 5am because we need to shave you down for the surgery. And I was like, oh, what's that for? She said, oh, well, we need to, we're probably going to take an artery out of your left arm and a vein out of your right leg, but we'll shave the full body just in case we need to get a few more veins or arteries from elsewhere. And I was like, so you're just going binding, aren't you? I was like... I think I was going to sleep that night, but then I couldn't sleep. And I remember actually, I remember watching six episodes of Breaking Bad in a row. Started at about 11 because I couldn't sleep. And I'd never seen the series, but I'd had, I just got a Stan account. And that's all I did that night. And then finally it was 5am and the lady came in and choked me down. And I was like, you know. I was ready for the surgery, I was ready for the surgery, but just that it dawned on me when she's shaving my left arm, my right arm, my left leg, my right leg, going to take veins and arteries, yeah, chest, whatever it took, and I was like, this is real. Anyway, scrubbed down, washed down, and then she gave me two Valium, I think it was, for pre-surgery, and relatively healthy. Five minutes later, I don't remember another thing. I don't remember seeing the surgeon in the morning. I don't remember seeing the anaesthetist. The next memory I have is waking up in ICU. Significant period of time later and the ICU nurse was looking after me and all I remember is I had a green button. I think it was for the fentanyl where I could self-administer. And I just... got in this regime of if I press the button every time it goes green, I can keep track of time. So I was loaded up on the fentanyl. The fentanyl, by the way, is a painkiller? Yeah, on the pain relief. And suddenly it was almost a challenge just to press the button on the fentanyl. And I just remember six hours later, she says, oh, you've been through quite a lot of your fentanyl. We'd better slow up. that's my real my surgery experience and so it was it was quite quite blissful in some ways yeah and I am then got moved moved from ICU up to the actual bed in the cardiac ward and then that was the process where the I guess the recovery began I remember getting the hiccups just the day the day after and if you've ever had open heart surgery and your rib cage is tied back together with tie wire and you've got oxygen up your nose you can't even hold your breath and you've got the hiccups and it was the most excruciating thing that i could ever um come up and i'm trying to hold my nose to because i knew that's how i um how you got rid of the hiccups but i've got oxygen flowing in there And, yeah, I just remember that. That lasted for probably the first couple of days. I just had this excruciating pain from that. So where did they take the grafts from, Dan? So they took an artery from my left arm. They took a vein from my right leg. I believe somewhere in my chest they would have taken something, but I'm not sure exactly which graft they took. So what Dan is alluding to is the artery that runs down. The inside of the breastbone, there's one on each side of the breastbone, about a centimetre just to the side of the breastbone plate. It's called the internal mammary artery. And that's the artery that we take down from where it comes off on the subclavian artery, which is the big artery that runs out towards the arm. And we plug that artery... literally into the coronary arteries. So it goes down and gets stitched into the coronary arteries. And if you've had an artery out of the arm and an artery out of the inside of your chest, then that's a very good start because we know the arterial grafts tend to last longer and more effectively than the vein grafts. So that's a good outcome. Yeah. So tell me the pain that you had after the surgery. Obviously, the hiccups were a pain. in the chest but what other aches and pains did you have did the graft sites hurt did the sternal or chest wound hurt not the there was a there was it was very um you you were very um i guess the chest didn't overly hurt as much as i thought it would but i was very immobile like you really couldn't move about or even sit up and i remember trying to even just sit up in bed to or they try and get you in a chair. If you turned or if you wiggled, then there was the sharp pain. The arm was quite sore. The leg where they took a vein out of the leg was sore. And just the lack of mobility. The lack of mobility that even getting to sit in a chair was such a struggle and such an effort. The deep breathing. I couldn't feel like I had anything done to the heart. Like I didn't know, oh yeah, I've had my heart surgery, I've had work done there. There was never any pain trigger or any receptor that said my heart's been touched. It was the leg, the arm and the actual rib cage. That's what I noticed. So how long would you have been in hospital for, Dan? I mean, is there anything more notable in that hospital? There's a couple of notable ones. I don't know if you want the... the funny stories from hospital or the story so with all the medication comes constipation and comes constipation comes laxatives and I remember having physio and there was a physio lovely lovely bloke who was helping us through there and my first session with him where it was the first time I basically got out of bed and this was five days four days after surgery I'd been out of bed, sorry, but the first day I was actually walking, the laxatives started to work. And I'm walking down the hallway and I'm squeezing his hand and he says, you don't have to hold my hand. And I'm like, I actually do. And he says, just walk slowly. And I said, no, I've got to walk. And so, yeah, so I've suddenly realised that, yeah, with my, in my condition and my... lack of bodily control i was leaving a trail of mess down the uh down the corridor but did finally get to the toilet and uh that was the first time in five days that i'd managed to get to the toilet and um that was quite embarrassing incredibly embarrassing but um you're very hard to keep dignity when you see there's no dignity there was no thing oh my goodness here i am i've got absolutely no dignity that's what it is a realization when you're crook you're it was unbelievable But I also, yeah. Bodily functions take priority. Yeah, shortly after that I also developed a, and I was having daily blood tests. It was showing that my liver was having some issues. My ALT, I don't even know what the ALT is, but I know the ALT count was through the roof. It should be under 50 and it was somewhere near 1,000. So they kept me in hospital for two or three more days. In fact, I didn't get home. I think it was nine or ten days in hospital. And they only let me go home if I had daily bloods. So every day I had to go from home, down the stairs, get driven to the local doctors, have blood tests, which lasted two or three weeks. If I recall, it was a trigger for you to come back and see me early because there was some concern that your cholesterol-owning tablets may have been... central to that abnormality. That's right. I think I put to you that it was probably antibiotics. Yeah. We'd just wait and see. That's right. So as a precaution, I stopped the cholesterol tablets for about a week. We got the ALT back to normal levels and we reintroduced the cholesterol tablets and had continued blood tests. I'll add in there for anyone who's listening, Dan stopped those cholesterol tablets under doctor's instructions. Oh, absolutely. It was definitely controlled. Whereas sometimes I think of people who just stop their tablets because they think it's a good idea. No, no, no, it was definitely controlled. Very controlled. We basically stopped a lot of the medicines, even Panadol, any medicine that could affect the liver and then reintroduce them. I found that the ALT got back to normal levels. Coincidentally at the same time I got a leg infection from a bug that they tried some new antibiotics for which the infection resisted. That put me probably two or three weeks on the couch. I couldn't walk for three weeks. I think it was those antibiotics, in fact, that probably played up the liver. They did, yeah. But that cleared up in the end. It did clear up in the end. Yeah. Yeah, and, yeah, I'd probably say the first four weeks after surgery was very immobile. With the leg infection especially, I couldn't really walk, so the rehab was stalled. What about the mental state for you, for Kate? And the kids did that all I actually think the mental state improved The day that I knew that I was having surgery or on the day of the surgery from any everything from from that day on I had a physical injury to recover from so before that I had a Life-threatening surgery to prepare for with no known outcome. Yeah, and as soon as I woke up as soon as I woke up from that surgery With physical issues I had a bone graft or the grafts, I had a rib cage that was cut open. I knew I could fix that. But before that, open heart surgery, which was such a traumatic thing that you don't really know what's going to happen. That was like, I hope I come through the operation. Dan, we've talked for over 10 minutes again in what seems like a blink of an eye. I think this idea of moving from the fear of uncertainty to the task of recovery is a perfect time for us to just pause here. And we might come back for episode four and I'll ask you a bit about rehab. So thanks for sharing again. Yeah, thanks. No problems. I'm going to wrap up there for those listening. Thank you so much for tuning in. I really hope you're getting as much out of Dan sharing as I am. And it's, for me, a privilege to... have a patient share their own personal journey and get a feel for, well, a beginning of a feel for what it must be like on the other side of the consulting desk. So till next time, stay well. I wish you the very best from the Healthy Heart Network, hoping you live as well as possible for as long as possible. Take care and bye for now. 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.
