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Cardiac Vascular & Thoracic Surgery. The concept sends chills down my spine since it inevitably conjures up images of white gowned surgeons sawing open the chest cavity and dipping their hands into your core. This is in fact what actually occurs and there’s no denying that one is facing their own mortality when undergoing such a procedure.

Luckily, in the case of bypass surgery the success rate is better than 99%. By success I mean surviving the actual surgery itself. I haven’t delved into the long term survival rate after the surgery in terms of heart failure. Maybe in a later post after I do some research at the Library of Medicine I’ll post something about that. In my case I’m sure they think that by grafting new arteries onto my heart I will avoid a fatal heart attack in the short term in any case.

My appointment with the surgeon is the thursday following the catheterization procedure. Since there are about  dozen surgeons in the surgical practice at Fairfax Inova Hospital I wound up choosing my surgeon sort of randomly. Dr. Lucas Collazo was the first one who had an appointment opening so I took him. Lucky me. This guy has a resume a mile long and fixes the hearts of little babies. I’m guessing he can probably fix a big baby like me.

So Thursday rolls around and I show up for my appointment. The Nurse does all the poking and prodding and paperwork and then Dr. Collazo walks in. Nothing like I expected. I thought he’d be brusk and businesslike and no nonsense. Say a few words and off we go. Not so. He walks in and introduces himself as “Lucas Collazo” with a warm friendly smile. We sit down to talk and he explains that he’s seen all the data from the catheterization procedure that Dr. Garg sent over and thinks he’ll need to do a triple bypass but is not 100% sure that will be all until he’s in there. I explain that I work at the National Library of Medicine and have done a lot of research on the procedure and talked to several people who have undergone it or whose spouses did and described the recovery pretty thoroughly.

I also have a friend at the library who’s a retired cardiac surgeon and who has described everything about the procedure. He’s impressed. We chat for awhile about dogs and iphones and Macs and then he says by way of wrapping up the conversation – “How about next wednesday?”

Duh. Man that quick? I thought I’d have a couple of weeks to get ready. I still had a lot of stuff to do around the house that I wouldn’t be able to get to after surgery and I was counting on that couple of weeks. Still, the sooner I get it done the sooner I get back on my feet.

So I said sure, “Let’s do it”.

So the last time Dr. Garg worked on my heart in October, he told me that the locations of the further known blockages made the prospect of using stents to prop them open untenable. He would just be pushing this nasty arterial plaque out from one location into another at a junction of arteries,  possibly causing more damage than it would fix.

So I’m hoping this bypass thing can be put off as long as possible. At least I had until the next stress test in June (09) and then I was hoping he’d tell me another 6 months. This was not to be.

I took the Stress test on June 1. It’s called a nuclear stress test because they inject you with a a radioactive trace dye and then put you on a treadmill.  The treadmill starts off slow and then gradually builds to a fast walk up a sharp incline. Your heart is beating at it’s max rate and you feel the pain starting to creep up your left neck to your chin and around your shoulder and down your left arm. I made it all the way to the highest level and am hardly breaking a sweat but I am breathing hard. I can feel the pain.

Next they put you on a table and take pictures of your heart. The nuclear dye will show areas of the heart where the blood flow is diminished. So they have done this twice, once at rest with no strain on the heart and once after heavy stress.  The news is not good. I felt it during the test and now it’s confirmed. Dr. Garg is not pleased with what he is seeing.

Friday rolls around and I’m back in the Cath Lab at Fairfax Inova Hospital. I’m becoming an old hand at this and know the drill;  I tell the nurses who come to prep me for the catherization procedure. When I had these done before I was not exactly awake. They use a drug called Versed. Versed has the property of letting you be awake but totally unaware of the passage of time. You think you’ve been only laying there for a few minutes and are asking when they’re going to get the ball rolling when in fact they’ve been done for 5 minutes and are just wrapping things up. Cool.

Dr. Garg saw what he feared. The blockage was progressing and could not be stented. He suggested I make an appointment to see the surgeon as soon as possible.

I’ve had Coronary Artery Disease (CAD) for some time. This means the arteries in my heart are slowly narrowing due to plaque buildup. I first had a near miss with a heart attack in 1998 when I was living in San Diego. I was 49. The Cardiologist who treated me, Dr. John Gordon, noticed that my Left Anterior Descending Artery  (also known as the Widow Maker) was 90% blocked and also that another main artery was 100% blocked and had been for some time. He noticed that I had grown my own bypass called a collateral. Whew! He stented the LAD and left the other alone. All was well for 10 years.

Then in 2007, I was out walking my dog at 10:30 pm on the friday before Labor Day and boom, a lead weight fell on my chest. The pain was pretty intense and did not stop when I stopped moving. Somehow I made it back to the house (about a 1/4 mile) and called 911. I spent the Labor Day weekend in ICU and then got a few more stents on the next tuesday including opening up the original stent which had closed down.

All was well until a year later when I woke up in the middle of the night with severe angina. I took some nitroglycerine tabs and waited until first thing in the morning and then had a neighbor drive me in to the hospital. Two days later I had another stent put in.

This disease was progressing and nothing was stopping it – not diet, exercise, statins or any other medicine. My Cardiologist , Dr. Jayat Garg, told me that there was another blockage that would not be stentable and the only eventual option was a Coronary Artery Bypass Graft – in other words open heart surgery. Oh shit. Chest cracking time.