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 station. Today I've got the opportunity to speak with a patient who is called Bruce and Bruce has just had a journey through cardiac health care and it's been a new experience for him and he's been good enough to offer. to share it. So I have Bruce's permission. Can you confirm that, Bruce? That's correct, yes. And I'm going to have a bit of a chat with Bruce and hopefully he can give you some information that may be helpful for you in the future. So thank you very much for giving me the opportunity to record this, Bruce. I genuinely hope it'll help someone who's listening. I hope so too, yes. So just a quick overview. How old are you? I'm 74 years old. And I recall that we met, I think it was last year. That's correct, yes, about 15 months ago. About 15 months ago. And if I recall, you came along worried about your cardiovascular risk because your brother had had bypass. Do you want to just give me a little bit of detail around that? Well, my brother, living in Victoria, had a bit of ill health. He's three years older than me. Ended up going to a local hospital in the country, Victoria. When he was admitted, he had a mild heart attack, so they sent him down to one of the major hospitals in Melbourne where he had a cardiac arrest. So he fortunately survived that and had a triple bypass. He recovered extremely well. A guy that was not all that fit, he had weight on, he was a smoker. But when I was there in the hospital, his surgeon said to me, you should get yourself checked. This is a family history. My father had a triple bypass in the 60s. My younger brother at 52 had a heart attack. And I've been the healthiest of my siblings. So when I came back, I went to my GP who referred me to Dr Bishop. And we proceeded to do some tests, stress testing and so on. I did it six months ago again in the last week, and there was a difference between the one six months ago and the one this week. So from there, we went on to having a... So I might just jump in there momentarily, Bruce, because the sequence, as far as I recall, was a little bit different, and it might be a valuable bit of information. Okay, yes. You came to me... to get checked out. Correct. Why was it me? Was there a reason why it ended up being me? My GP suggested you because of the technology you were using at the time. Great, okay. So you did scans and so on. Fantastic. So when you came to see me, if I recall, the first thing we did was organise a CT scan. That's correct, yes. And the reason I did that was I wanted to, because for the benefit of the people who are listening and can't see you, you're a pretty fit, active-looking fellow who had no symptoms whatsoever. None whatsoever. So I thought, well, why would we put you on a treadmill test? Because you already look fit and well and you've got no symptoms. Why don't we image your arteries and see if there's a problem? So I thought you were a great candidate for getting a CT scan of your heart done to look at the health of your arteries. to try and evaluate what was going on. Now, again, if I recall, and your notes are in front of me, but I haven't looked at them. If I recall, we found a lot of plaque in your arteries. I think your comment was, there's a bit of rust in the pipes. My recollection is there's a lot of rust in the pipes, but I didn't want to be alarmist. You're being gentle to me, I think. So the advantage of that was we knew there was a lot of stuff going on and we could immediately put you on preventative agents like cholesterol-lowering tablets and aspirin. And then I said to you, there's a couple of spots that look like they might be narrowed. We should follow that up with a treadmill test. And you're quite right, we did do serial treadmill tests. The first treadmill test didn't show any problem at all. And I think I said to you, even though there's a lot of rust in the pipes, the first treadmill test is telling us that we can't make you any better because you exercised very well. You made the comment that my heart worked under stress better than did without stress. And that was the first indication that it was reasonably good. Yeah. And we got you on the right therapy, we educated you, and I said, look, come back in six months or 12 months and we'll do another treadmill test just to see if things had advanced. Do you want to walk me through what happened then? Well, we did the second one, which indicated similar to the first. But this one, a week or so ago, he showed me the images and there was a change. And that's when the alarm bells rang. and I suspected it slightly working with my son who coaches rowers at the school and I was helping him carry boats from the water back up to the sheds and doing it and I thought I'm just puffing a little bit that normally I didn't. And I thought, oh, it's probably just stress and all the rest of it. So I was suspicious of it. And after you confirmed that I've got a problem, I mentioned it to my wife, and she was not very happy because I had not said anything previous to that. She said, you're being secretive. Yeah, so there's an important learning there. I think there is, yes. For all blokes listening to this, if you've got a change in symptoms, you've got to tell your doctor. Or at least tell your wife and she'll make sure you tell your doctor. Yes, I wish my wife would. But as I say, it was only subtle. It was not to any great degree. But that was the warning sign. It does sound like we set the follow-up treadmill test at a good time. You did. Because we caught things before they'd gone too far. I think I said to you, you needed an invasive coronary angiogram so we could get the highest resolution images of your arteries so we could plan exactly what to do. Tell me about the invasive coronary angiogram, because that was a new experience. Well, I've never been to hospital before. I've never broken a bone. The only time I've had stitches was a spider bite on the lip where it wouldn't heal, and that's the only time. So I'd never been to hospital, so I didn't know what to expect. Came in, put in a ward and so on, and it was easy. I mean, I went into the theatre, you did the procedure, I had no pain anywhere at any time. Even after the procedure, everyone was delightful. So where did I stick the needle in, Bruce? At the groin. And I wasn't aware of it. And even afterwards, there was no pain, no bruise, nothing. As if it never happened, apart from the results that you got, which were the important things. I can assure you they're your pictures. I'm sure it was the case. It was me. They're not stock images. So did you see the pictures on the screen? Yes, you showed me the pictures that day. All right. No, sorry, next day I think it was. And, yes, it was quite obvious. It was quite bad, actually. So we've decided that we think the best way to get... more blood to your heart is by coronary artery bypass grafting and i've sent you to a surgeon to talk about that already how did that go that went really well the surgeon was brilliant explained it all you'd already outlined pretty well for me and the surgeon just followed that up told me the procedure and so on and i mean and i've since looked on the net to see you know the procedure and what's required and all the rest of it i mean it looks a little bit daunting but It's not worrying me at all because I know the end result will be so good. It's like having your car fixed. If you've got a problem with it, you've got to have it fixed. If you don't have it fixed, you end up with more problems. It's the same sort of thing. The really nice situation is that we're going to... I mean, landing the plane is always a problem, isn't it? Yes, I used to fly. Always the tricky bit. But for you, we're landing the plane 9 to 5, Monday to Friday, in fair weather conditions, which is not... the situation your brother originally went through. Oh, no, he was in a terrible situation. So from my perspective as a preventative cardiologist, I have no issue with you going on and needing bypass surgery. Oh, yes. I have every issue with that being a consequence of an out-of-hospital arrest like your brother had or a heart attack out of the blue with loss of myocardial function. So I'm actually very... very pleased with how this last 18 months has gone for you. We've done an evaluation, instituted therapy, put you under surveillance, demonstrated a change, acted on that. Now we've got a plan in place to get you sorted out. I think you'll be January or February in my next patient calendar, actually. I mean, it's silly. People have asked me at school where I'm working, the teachers that will say, how do you feel about it? And I say I'm looking forward to it, which is not quite right. I'm not looking forward to the procedure, but I'm looking forward to the end result. As I say, I'm active. I want to stay active. I've got 10 grandchildren that I want to be involved with and so on. So it is important. I think it's also fair to say that your understanding of the pros and cons and the reasons why we're doing it and the lead into it is giving you plenty of information so that... Of course there's fear with surgery, but you understand the whys. That's right. Oh, you've got to do it. Look, my father, he had ill health from when he was about 35. He had back problems and this and so on. His attitude was if the procedure gives you a bit more time on this earth, go for it. And he had that positive attitude all the time, as my brother did. After his procedure, he had that positive attitude. A glass half full person as well. You look forward to, all right, these things happen. You look forward to what's in the future. So I've got you between having seen the surgeon and your time of operation. When is your operation booked, Bruce? It's a week away. Oh, that's exciting. I go into hospital next Wednesday. Oh, fantastic. And so Thursday, the operation. Well, obviously I'm going to wish you the very best for that, and we're going to wrap up in a second. From your own journey, have you got any pearls of wisdom for anyone who's listening or anything you just want to share that you think you wish you'd known or what would you like to say? Well, as you say, my brother's situation, he was lucky he was in hospital at the time he had his cardiac arrest or he wouldn't be with us now. And I think if you have symptoms, you've got to have it looked at. You've got to do something about it. And as I say, I probably would not have if my brother hadn't had the cardiac arrest, if his surgeon hadn't turned around and said, you need to get checked. Otherwise, I wouldn't have thought about it until I got to a point where I thought, there's something really wrong. So if you think there's something wrong, have it checked. Yeah, look, I think that's great advice. If I could add one other thing, and this has now happened to me several times, if you have a brother or a sister who has a problem, I think the next step is to check out the other brothers and the sisters. I've now had two or three patients who I've seen who've had bad arteries. I've said, please get your family checked. And they haven't. No. It's crazy. And a couple of those people have had heart attacks and one of them died. Yes. And honestly, Bruce, if your brother hadn't prompted you, you could have been busy carrying a boat. Chest pain and drop dead. Yeah, exactly. And I've since, you know, I have another brother and sister, and I've told them both to be checked. The sister's, you know, 16 years younger than me. Doesn't matter. That's right. I said, you've got to get yourself checked. And they said, oh, we should do it. So... Yeah, just do it. You've got to do it. Please, go and get checked. I'm going to wrap up there. Last, just to draw a line under it, Bruce, you're comfortable if I share this with the public? I don't have a problem with it at all. Thank you so much. I'm going to wish you the very best for your surgery. I'm going to thank those who are listening and I hope you got something from that. And until next time, take care and 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.
