vadimstudio.com Blog

August 10, 2009

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 11:03 pm

Paul Jason Paul Jason

A little more about the exercises: For those of you not familiar with the concept, a lunge is performed by placing one foot at a long stride in front of your other foot (and slightly to the side for balance), pushing up slightly on the rear toe. The front leg is bent so that the ankle-knee plane is at 90 degrees. The back is arched and the head is tilted slightly towards the ceiling. Then, keeping that front leg at 90 degrees, you slowly bend your rear knee and lower it to the floor. Then you slowly bring that knee up to its original position. Do that six times with each leg in the front position. When you’re comfortable doing that, increase the number of repetitions, and then start holding free weights in your hands while you’re doing the exercise.

I also learned how to do squats, standing with my feet about fifteen inches apart, arms at my sides, back slightly arched, and head slightly tilted towards the ceiling. You slowly lower yourself (derriere thrusting backward) into a sitting position, with the plane of your ankles-knees as close to 90 degrees as possible (i.e., you can’t let your knees protrude forward). Once you reach what you perceive is a sitting position, you slowly stand back up again, keeping your back arched and your head slightly tilted upward. Then you do it over again, ten or fifteen times!! It’s great for your quadriceps.

Once you are comfortable with this exercise, try doing it with free weights. After three months, I was doing it holding up to forty pounds in each hand (the heaviest dumbbells they had at the rehab center).

After awhile, I was taught how to do squats while standing on balance discs. Balance discs are made of a strong, flexible, plastic-like material. They are shaped like little flying saucers, about twelve inches in diameter. They’re smooth on one side and have blunted spikes on the other. They get inflated to about two-thirds of their capacity so that they are soft when you stand on them. To do the squats I mentioned, you place the discs on the floor, smooth-side down, stand with one foot on each disc, back slightly arched and head tilted upward. Then, slowly lower yourself (derriere thrusting backward) into a sitting position, with the plane of your ankles-knees as close to 90 degrees as possible.

Of course, the lower your rear-end goes, the better. And, also, of course, the fact that the discs are soft makes them unstable, so you really have to concentrate on your balance while you are doing the exercise. You can hold your hands out in front of you to assist in the balancing act. Once you reach what you perceive is your lowest possible point you slowly rise to an erect position again. Then you do it over again, five or six times!! It’s great . . . for your quadriceps, for your body core, for your balance, for your concentration and, most of all, for your confidence.

Balance discs are also great for enhancing simple exercises. For example, if you are comfortable doing biceps curls with free weights (10, 20 or more pounds), then you should try doing them while standing on the discs. It adds a whole new dimension. Now you not only exercise those arm muscles, but you have to contract your body core (for better balance) and your leg muscles get into the act as well.

April 24, 2009

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 10:28 pm

   Paul Jason

The Recovery. Part IV.

In early July, about a month after I started the rehab program (and three months after my surgery) I asked the young men working at the rehab center if they thought it would be possible for me to conduct my annual Fifth Avenue Walk in September. I explained that I had started the walks to celebrate my fiftieth birthday and had already enjoyed the experience for ten consecutive years. I really didn’t want to skip this year.  They were cautious in their evaluation, but didn’t rule out the possibility.  The goal of being able to extend the unbroken string of consecutive walks became an added incentive to me to enthusiastically participate in the cardiac rehab program. The twelve-week program would conclude at just about the same time as my anticipated annual walk; with any luck, I could achieve my goal. I also consulted with my cardiologist, who was encouraging.
 
            Imagine my exultation when, on September 17, 2000, just five short months after my surgery, I lead a group of approximately twenty invitees down the four-mile route  early on a Sunday morning .  As in the case of the prior ten walks, I completed this one in less than one hour. I was ecstatic. The Annual Paul S. Jason Invitational Fifth Avenue
Four-Mile Walk was intact !!!
 
            But I didn’t deem this to be the crowning glory of my rehabilitation.  I made what I think was my next important decision by determining that I would continue to exercise at this facility. I had gotten to know the people there, including the physicians, and I was comfortable doing any type of exercise there, even if I looked foolish sometimes. The way I looked at it, an exercise program for a CAD victim is a life sentence.  I had to be committed to this for the long haul, and I might as well enjoy the workouts in a conducive, stress-free environment.
 

            Once again I must confess that I was a late convert to any regularly scheduled, structured exercise program. If you learn nothing else from this treatise, I urge you, whether you have undergone cardiac surgery or not, to try it.  In retrospect, one of my biggest regrets is that I didn’t start years ago. I always had excuses. Not enough time.  Too many other appointments. And on and on.  Well, once you have had cardiac surgery there will be no more excuses, and you will always find the time.  Why not start now and try to avoid the surgery.
 

            After twelve weeks in the rehab program I was feeling better. Now I was amenable to trying new types of exercise and the exercise physiologists were willing to teach me a number of increasingly more difficult routines, including weight training and balance exercises.  They had excellent gymnastic skills and I was inspired by their willingness to teach me how to improve my strength, flexibility and balance. 
 

Within a matter of months, their prophecy began to materialize.  I not only regained my pre-operative strength, I started to exceed it.  As the months went by, I was able to exercise with weights I hadn’t lifted in at least twenty years.  I was rolling and twisting and turning in ways that I had forgotten since my teenage years.  And while some of the exercises were hard, they were also fun.  They required concentration on correct form and execution.
 

            Soon I was performing lunges to strengthen my legs.  And squats.  And balance exercises.  For those of you who may be interested in a description of some of these exercises, I have reserved space at the end of this chapter.  They are just a small sample of the exercises and skills that I learned within a year after my surgery.  I tell you about them because I want you to see that it is possible to rejuvenate yourself.  If I can do it, anyone can do it.  That became my motto at the rehab center.  Other patients (I wish there were another appellation I could use because none of us was currently sick), some of whom had been coming there for years and sticking to the standard routine of aerobic exercise equipment and stretching, thought I was a little bizarre in my efforts and told me so. Nevertheless, I persisted, and, slowly, many became converts and the results were astonishing.  Some are older than me, and some younger; but all of us  came to enjoy our workouts a lot, and became physically fit to boot.  We continue to do our aerobic exercises, but we do these other exercises also. In my case, I have maintained my body weight, my muscle mass has increased, and many people who know me tell me that I look great.  I’m happy to accept their judgment in that regard.
 

            In March, 2001, I finally took that postponed and long-awaited trip to Costa del Sol, Spain. Every morning, at 7:00 a.m., I walked three miles along the beach.  I couldn’t help but rejoice at my good fortune to be alive, to feel well, and to be in beautiful Marbella, Spain.
 

            In May, 2001, I had a one year follow-up nuclear stress test. I was psyched for it and worked out hard for weeks prior to the test. The nuclear images showed normal myocardial perfusion. In other words, the blood flow through my coronary arteries was good. I also completed the 4th stage of the Bruce Protocol and achieved a MET level of 12.9.  My maximal heart rate was 165, which is greater than 100% of the predicted maximal heart rate.  My blood pressure rose from 120/70 to 180/90 at peak exercise. I was described as having a “very good level of cardiopulmonary fitness.”

To be continued…

February 10, 2009

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 4:05 pm
  Paul Jason
   

 

  

   

The Recovery, Part III.      

  

Eight weeks after my quadruple by-pass surgery I had to make another critical decision. Slowly but surely during the eight-week recuperation period my body hair had re-grown. I no longer felt like a naked ape. And the issue of my missing moustache and goatee had been overshadowed by more pressing concerns. 
  

However, as the day approached for my anticipated return to work I had to make a decision as to whether or not I would re-grow my moustache and goatee. My return to the workplace was actually going to present an image dilemma for me.. For the past thirteen years I had worn a full beard and/or a mustache and goatee.  This facial hair had become part of my personae. My family, my friends, my clients, my employees, my neighbors, as well as acquaintances large and small, important and insignificant, had come to recognize me by my facial hair (and my sparkling personality, I suppose). Could I now face them (no pun intended) without these accustomed accessories?  The prospect made me uneasy.
 

I finally decided to let the reactions of these aforementioned people constitute the unscientific survey by which the final decision would be determined. At first, some people in the neighborhood, shopkeepers and the like, didn’t recognize me. Some walked past me in the street as though I were a stranger.  But slowly the opinions started to emerge and, surprisingly, they were impressively in favor of my remaining clean-shaven.  Many people expressed the opinion that I looked ten years younger without the beard.  I soon began to wonder why, if the beard had made me look ten years older, they hadn’t said anything to me years before.
 

Well, vanity beating out sanity, I have clung to my newly-acquired clean-shaven image to this day, taking some satisfaction in knowing that my grandchildren can see my face.
   
In addition to conquering the facial hair challenge, exactly seventy-one days after my surgery I began a cardiac rehabilitation program approved by my cardiologist.  For the next twelve weeks, on Mondays, Wednesdays and Fridays, I left my office at 3:30, retrieved my gym attire, drove to the rehab center, and began an exercise regimen.  I had never before (school physical education classes excepted) worked out in a health club or gym and this was going to be a totally new experience for me. But, as far as I was concerned, exercising at least three times a week for the rest of my life amounted to a life sentence, and I figured that I might as well make the best of it.
 

The particular rehab program I enrolled in was recommended to me by two local merchants and choosing it turned out to be the best decision I made . . . next only to the choice of my surgeon, I suppose.  It was the best decision, I think, because the facility had more than just adequate equipment; more importantly,  it was staffed at that time by a well-qualified and dedicated staff.  It was in existence for about twenty years and, as I learned later, some of the “patients” had already been coming there for almost all of those years.
 


The Program Director was a gentleman in his fifties with a Doctor of Education Degree in Applied Physiology from Columbia University.  He was a Fellow of the American College of Sports Medicine and a Fellow of the American Association for Cardiovascular and Pulmonary Rehabilitation and had taught college courses in exercise physiology, kinesiology, cardiovascular fitness and cardiovascular health and nutrition, amongst others.
              

Three young people with college and post-graduate degrees in exercise science and cardiac rehabilitation manned the place at that time.  I learned that they had Masters of Science Degrees and had taken graduate courses in subjects such as aerobic fitness, the physiology of human performance, electrocardiography and non-invasive evaluations, cardiac pathophysiology exercise and pharmacology, testing evaluation and exercise prescription. They had also participated in clinical laboratories  emphasizing diagnostic stress testing, echocardiography stress testing, telemetry monitored exercise, geriatric fitness, diet analysis and pulmonary rehabilitation.  Aside from their college degrees, these exercise physiologists are independently certified as exercise, strength and conditioning specialists.
 

This was no commercial health club or gym operation populated by body builders or weight lifters. Rather, it was a place where victims of coronary disease were rejuvenated in a stress-free and protected environment. There was no endless waiting for the availability of exercise equipment (a common complaint of many health club members).  No conflicts between uptight yuppies and the slower-moving geriatric crowd here.
 
Also present during the three days a week that I attended were one or the other of two physicians in charge of monitoring people like me.  During the first  twelve weeks my exercise program was carefully structured, and reports of my progress were forwarded to my cardiologist. Each time I came to exercise I was obligated to attach three electrodes to my chest so that the staff cardiologist could follow my activities through telemetry. The physician on duty sat behind a desk at the front of the exercise room.  On that desk was a bank of computers and screens gathering information on each monitored person in the room. The physician continuously printed out electrocardiograms and other data.  Additionally, he could visually see everyone in the room and observe their physical exertions.
 

The twelve-week monitored program was strictly regimented.  The Program Director had devised a system of six-minute stints on various pieces of aerobic equipment, punctuated by one-minute interludes.  Each patient was given a chart to track his/her exercise record. On the chart were notations indicating the level of difficulty to be undertaken on each piece of equipment. Periodically the exercise physiologists would upgrade the exercise levels. After each exercise, the patient noted his/her perceived level of exertion on the chart.  Exertion levels are assigned numerical valuations, and range from “very, very light” to “very, very hard”.  In this manner a continuous record of progress is established.
 


Additionally, at least once a week the patient’s blood pressure was taken before, during and after the exercise program to measure the relative effects of the exercise performed.
              

To make sure that there was a continuous physical flow in these workouts, the aerobic exercise equipment was arranged in five rows, each consisting of seven pieces of apparatus: a stationary bicycle, a treadmill, a rowing machine, a Stairmaster, an arm-leg bike (like a stationary bike, but with poles that you move back and forth), a recumbent bike (the leg motion is circular like the stationary bike, but your legs are out in front of you instead of below you) and a recumbent stepper bike (like a recumbent bike, except the leg motion is back and forth instead of circular, and there are poles like the arm-leg bike).  The general rule was that each participant started on the first piece of equipment in any row and moved progressively up the row.  Since there were thirty-five exercise machines and rarely more than twenty-five people in attendance at one time, the ability to move from one piece of equipment to another was unimpeded. After I had been there about a year and a half, an elliptical trainer apparatus was added.
 

Every session began with a six-minute warm-up exercise on the first piece of equipment.  For obvious reasons, this was performed at a lower level of exertion than the balance of the routine and was designed to gradually get the muscles moving, to elevate the heart rate and to increase the blood flow.  This was followed, at first, by three other exercises, and concluded by a cool-down exercise, similar to the warm-up exercise in intensity, but designed to gradually reduce the heart rate.  Over the weeks the number of intervening exercises was increased from three to five.
 

A session consisting of a warm-up, five exercises, a cool-down and six one-minute interludes took forty-eight minutes to complete.  This was followed by a few stretching exercises while the muscles were warm and pliable.  Emphasis was on the hamstring, thigh and calf muscles.
 

There were also twelve strength resistance training pieces of equipment: two pullover apparatuses for the latissimus dorsi (back) muscles; two leg extension apparatuses for the quadriceps; two leg curl apparatuses for the hamstrings; two arm curl apparatuses for the biceps; two chest press apparatuses for the pectoral muscles; one back extension apparatus for the erector spinae, the glutimous maximus and the hamstrings; and one cable column apparatus, which can be used to do a wide variety of exercises benefitting a whole bunch of muscles.  There were also barbells of various weights, the heaviest of which was forty pounds.
 

However, the most important element of this rehab center, as far as I was concerned, was the personnel. I found them to be encouraging and challenging, especially a young man with a strange accent named Vadim Vilensky. I began the rehab program full of trepidation and definitely not feeling like my old self. My legs still felt weak, I was hunched over a bit (from the chest incision) and I still had a dull pain in my back (near the shoulder blade).  However, after two or three weeks, my mobility began to return to normal and my posture improved as well.  The exercise physiologists constantly assured me that I could not only return to my former physical condition, but I could surpass it.  And I believe that Vadim set out on a mission to prove it to me.
 
The intensity level of my workouts began to increase.  And, with each improvement, I began to believe that I could come all the way back . . . and, maybe more.

To be continued…

 

 

 

 

  

   

 

 

 

    

     

 

 

 

January 6, 2009

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 7:38 pm
    Paul Jason       

                                                                         The Recovery – Part II.
    

The physical therapists (I say therapists because two different people attended me)  visited about three or four times and gave me some simple exercises to help regain some strength for everyday activities, and to stretch out major muscle groups.  They also supervised me as I practiced ascending and descending an interior staircase.


On top of all of this, my appetite was not good.  I hurt too much to consume much food, although my significant other made sure that my meals were low fat, low sodium.  She’s an enthusiastic, as well as competent, cook, so the meals were a lot tastier than the hospital meals. I had always enjoyed her cooking, but my usual capacity for food was missing . . .  at least for the first three or four weeks.
  
Also in Weeks Three and Four the pain began to subside somewhat, and the swelling in my left leg receded a bit. But I still could not climb into the bathtub to take a shower without assistance; and, for the first time in a long time, I missed not having a stall shower I could just step into.  My appetite slowly improved, but my breathing was shallow.  I was still using that little plastic lung-exercising device (the “incentive deep breathing exerciser”), but it felt as though my deep breathing would never return.  I was discouraged.
                

My ability to negotiate the interior staircase and the series of steps leading from the front of the house to street level slowly progressed, but after walking twenty steps or so I felt tired and needed to rest.  I learned something that I had never really had occasion to contemplate before: that when your lungs are not functioning correctly, not introducing an adequate oxygen supply into your bloodstream,  your fingers, toes and other extremities don’t work very well either.  I guess that’s a major problem for emphysema victims that I never thought about before.  All I know is that I became obsessed with a  longing to take one deep breath, but the weakness of my chest and lungs made me too afraid to attempt it.

Perhaps the most agonizing part of this recovery was that the days dragged on at a piteously slow pace, and I had no ability to concentrate on anything that could have filled those endless hours.  Normally an avid reader, I could not bring myself to read any book or magazine for more than a few minutes at a time.  I also enjoy watching movies on television or video.  Now, at a time when I begged for any diversion from my misery and my inactivity, I found that my attention span was more limited than at any other point in my adult life.
    
   

   

   

  

To make matters worse, every workday morning my significant other would leave for her office and I was totally alone.  The only redeeming feature was that she worked nearby and came home every day at lunchtime to check up on me.  Of course, she was there every evening and the entire weekends.  Occasionally a relative or friend would stop by to see me, but, to tell the truth I wasn’t too enthusiastic about having visitors.  I looked dreadful, I felt dreadful, and I’m sure I wasn’t much of a conversationalist during those first few weeks.
 

One person who unexpectedly communicated with me regularly was the very same client who had arranged the surgical second opinion.  He called me at least two or three times every week to ask me how I was getting along, and more importantly, to ask me if there was anything that I needed or that he could do for me.  Kindness like that is unforgettable.
 


In any event, about two weeks after I returned home I was scheduled to visit my thoracic surgeon for a follow-up examination.  Of course I couldn’t drive a car at this point, so I was driven to his office.  Merely getting into and out of an automobile continued to be a hassle. I was apprehensive and uncomfortable.  This was the first time away from the security of my home since my return from the hospital.
 

I arrived at the doctor’s office at the appointed hour and proceeded to wait a half hour for him to see me.  Parenthetically, this is one of my pet grievances – - waiting for doctors.  Over the years, I have found them, almost to a man (or woman, as the case may be), to be intolerant if they have to wait more than a few moments in my office.
 

When the doctor did finally did see me, I was amazed that he spent less than five minutes looking at my wounds, which were still somewhat covered by the surgical strips that had been affixed in the operating room.  He announced that my recovery was proceeding normally and that barring any unforeseen problems there would be no reason for him to examine me again.  I was stunned.  That was all?  This man, who had held my life in his hands in the operating room, needed no more than five minutes to determine that the surgery had been a success?  I didn’t know whether to be angry or amazed.  Didn’t he want to know how I was coping with the results of his handiwork?  Apparently not.  The patient survived, the patient will heal, bring on the next patient.
 

The fact of the matter is that I have never seen that man again.  Thus, in the span of approximately three weeks, this stranger entered my life, saved it and walked away as though we had never met.
 

Nevertheless, I now had the assurances of my thoracic surgeon that I was on the road to recovery, and I left his office with no alternative but to make it a self-fulfilling prophecy.
 

Easier said than done.  The recovery was sluggish and maddening.  Slowly, with each day’s shower, one after another of the surgical strips pulled away from my wounds, exposing the scars I was hesitant to observe. Previously, my body had been moderately muscular and unscarred.  Now, the nine-inch incision down the middle of my chest, and the series of incisions down the length of my bloated left leg, riveted my attention and played havoc with my psyche.  Would I ever be the same?  Could I ever be the same?

To be continued…

 

 

 

 

 

 

 

 

 

 

December 11, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 8:51 pm
  Paul Jason  

The Recovery – Part I.

I had been told that the recuperative period for the by-pass surgery would be about eight weeks. Eight  weeks!!  I had never been away from my office for more than nine consecutive days (one work week sandwiched between two weekends) in thirty years.  Since entering the hospital, I had already been out of the office for twelve (eight working) days.  How could I possibly stay away for another eight weeks?
 
Now, the second great reality began to set in.  The first great reality was that I was mortal.  The second reality was that I was not indispensable.  Much as many of us tell ourselves during our career-building years that we are essential cogs in the machinery of this or that success, the bottom line is that we are replaceable.  Perhaps the sooner we accept that notion, the healthier our mental outlooks will be.
 

Other people stepped in to fill the void created by my absence.  My secretary ran the day-to-day operations of the office, communicating with clients, advising them of my physical condition and the prognosis for my return.  Other local practitioners helped to breach the gap created in the commitments I had made prior to the onset of my illness.  My loving daughter visited the office regularly and lent her very structured organizational skills to ongoing operations.  And when my secretary and my daughter called me,  they told me not to worry, and that “everything is under control.”
 
For the first four weeks or so, I was buoyed by these reassurances and made no attempts to contact the office.  Thereafter, I advised my secretary and my daughter that they could phone me in the event any matter arose concerning which I alone might have personal information or knowledge.
 

Relieved of the stress of worrying about the operation of the office, I was left to cope with the overwhelming issue of physical recovery.  The first two weeks were pure agony.  I was taking pain killers for some relief, especially at night, but the difficulty of finding a comfortable place for myself was dominant.  I could not get into, or out of, bed without my chest feeling like it would pull apart.  So instead of sleeping in bed, I usually wound up falling asleep on a sofa, or in an easy chair.  However, no position would remain comfortable for more than an hour or so; I was supposed to keep my legs elevated, too, to control fluid collection.  After awhile, my left leg would start to ache and my breathing would become labored.  Therefore, I was only able to rest for short spurts throughout the day and night, and was literally exhausted for most of those two weeks. My security pillow was a constant companion because any sudden move – - – any cough or sneeze – - – was an exercise in torment. In those moments, the only thing I could do was grab that pillow and hug it firmly to my chest.
 


I was constantly wearing a full length surgical stocking on my left leg. Invariably, at the most inopportune times my leg would start to itch. Even worse, the forced inactivity, coupled with the unorthodox sitting positions I found myself in,  gave me generalized dull aches in my upper and lower back (distinguished from the sharp pain in my left shoulder blade), and my behind hurt as well.  I can assure you that nothing is more frustrating than backaches which can’t be massaged, and an aching backside which cannot be relieved.  After all, I couldn’t sleep on my side or my stomach.  And I couldn’t load up on analgesics either.
 

Getting out of bed was an adventure. . . . a painful adventure.  First I had to inch my way to the edge of the bed.  Then I had to bend my knees and start a slow rolling movement onto my side, pushing my body upright using my elbow and trying simultaneously to swing both of my legs to the floor.  All the while my sternum would be repositioning itself with each motion.  Of course, once I got into a sitting position I had to remain there for a few seconds to allow my blood pressure to adjust so I wouldn’t get dizzy and fall down. Cardiac medications have a way of doing that to you; remember that the next time you see an elderly person who is unsteady on his/her feet.  Then I would put both of my hands on my thighs, bend forward slightly and thrust upward with my legs, not my arms. If I was lucky, I would wind up in a standing position. . . well, almost a standing position.  The incision in my chest made me hunch over a bit. Getting back into bed was a somewhat reverse procedure.
 

Sitting down in a chair involved similar techniques, with emphasis on the leg muscles.  First I would try to straighten my back and then slowly lower myself onto the front edge of the chair; then, using my legs, I would slither backward an inch at a time.  A miscalculation could result in me plopping into the chair, an unintended event accompanied by pain.  To stand up, I would inch my way to the front edge, plant my right foot a little bit ahead of my left foot, place my hands on my thighs, bend forward and thrust upward with my legs.  
 

Fortunately, the hospital social worker had been very cooperative and had arranged for the Visiting Nurse Service of New York to call on me.  Twice a week a nurse would come to see me for a few minutes, check my vital signs, my incisions and the girth of my left leg. As far as I know, the nurse’s report reached the desk of my cardiologist.
 

The first nurse, in turn, authorized the services of a home health aide and a physical therapist. I say the “first” nurse, because three different nurses visited me over a four week period. Therefore, as I said, as a result of the actions of the first nurse an aide came three times a week for three weeks, each time for a couple of hours, and helped me into and out of the tub so that I could shower myself sitting on a bathtub bench.  Of course, I had to use a hand-held spray because I wasn’t supposed to let the full force of the regular shower head hit my chest.  
 

The aide also rubbed body lotion into me to try to help alleviate some of the muscle soreness that had cast its pall over me, especially in my back.  After each massage I felt better for an hour or two, and I was thankful.


To be continued…

November 6, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 10:38 pm
     Paul Jason
 

 Chapter 16:      The Wonder Drugs (continued)
    

Having described my regimen of post-surgical drugs in the last installment, my commentary on that subject would be incomplete if I failed to address the one last “wonder” about these drugs: their cost. 
  

 The monthly retail cost of these medications is over $200.00 (a little less if your pharmacy has a “senior citizen” rate).  By far the most expensive medication of the group is Lipitor. Fortunately, my medical insurance plan covers a significant portion of these expenses so that my actual out-of-pocket cost is less. Of course, the plan costs me over $5,000 a year in premiums and covers me alone.  Is it any wonder that so many moderate-income, retired and elderly people are desperate to receive financial deliverance from the impossible costs of their life-preserving prescriptive medications.
 
I find it incredible that any individual in the United States who can afford to own his/her own home is entitled to deduct every penny that he/she pays in interest on his/her mortgage loan, thereby receiving a subsidy towards the capital appreciation of the value of that property,  but that no individual can deduct the cost of his life-saving or life-preserving prescriptive medications unless they, together with his medical and dental expenses, exceed 7.5 % of his/her annual adjusted gross income.
 

 Thus, for example, in spite of the relatively expensive health insurance plan that I pay for, the out-of-pocket co-payments that I am generally obligated to expend for medical services and prescriptive medications amounts to an additional  $2,500.00, more or less. I am unable to deduct one penny of that expense on my income tax return.
 

 Can there be any question why these inequities engender outrage amongst many Americans, both young and old?  If Congress has assisted some citizens to achieve the American dream, it has also condemned others to suffer the American nightmare.  It is a national disgrace, and Medicare Part D is not the answer.
 

Finally, I would be remiss if I did not comment on the fact that in spite of the reality that these wonder drugs have been proven to reduce the necessity of hospitalizing patients suffering with episodes of congestive heart failure and myocardial infarction (the pharmaceutical companies claim that for every dollar spent on prescription drugs $3.65 in hospital costs are avoided; that 50,000 heart-related deaths could be prevented each year in the U.S. if high-risk patients received statin drugs; and that deaths attributable to heart disease and stroke have been reduced by 50 percent in the past thirty years due to drug therapy), such hospitalization is essentially covered by Medicare, while the drugs are an added expense.
 


Congress’ efforts to provide drug coverage at prices the average American can afford has  been inadequate at best. I subscribe to the notion that the medical/drug needs of the American people will not be properly served until they receive the same coverage their elected representatives, the members of Congress and the President, do.  I challenge you to name one other milieu in which the employees (our elected officials) receive better health care benefits than their employers (the voters).

To be continued…

 

September 19, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 12:32 pm

   Paul Jason

Chapter 15:                                         The Wonder Drugs
   

I guess it’s common knowledge that advances in medicine have managed to increase life expectancy in the United States over the past hundred years.  In 1900, the average American lived to the age of 48 years .  By 2000 , that life span had soared to over 70  years (80.0 for white females, less for others;  74.5 for white males, less for others). Of course, part of that increase is attributable to the manipulation of numbers.
 
Early in the last century, diseases like tuberculosis, pneumonia, dysentery, influenza and diphtheria stole many young lives, thereby skewing the statistics.  Even then, men and women lucky enough to advance beyond their adolescence and ultimately reach the ripe age of 50 years had a fairly good chance of surviving to the age of 70.  Now, thanks to major advances in immunization and child care in general, the number of infants who survive their twentieth birthdays has vastly improved.  Thus, the average life expectancy has risen accordingly.
 

But, that is only part of the story.  Modern medicine has also learned how to deal much more effectively with the ailments which accompany advancing age.  Today, many people are alive who would have succumbed to their illnesses if we turned the clock back twenty or thirty years.
 

The critical issue has become, however, not whether modern medicine can keep us alive, but rather, what kind of quality of life can we expect from modern medicine if we are allowed to remain alive through the benefit of incredibly sophisticated surgical techniques and “illness-specific” drugs.
 
As I mentioned in the Preface, during the ten-year period prior to my bypass surgery, I used prescription medication to reduce my total serum cholesterol level, which in 1989 was discovered to be 254 mg/dl (milligrams per deciliter).  In 1987, authorities in this field had announced that the maximum acceptable serum cholesterol level was 200 mg/dl, regardless of age or sex.
 
My Primary Care Physician at that time prescribed the medication Lopid to accomplish that goal.  I also read Robert E. Kowalski=s New York Times bestseller “The 8-Week Cholesterol Cure”.  Kowalski scared the hell out of me and had me baking my own low fat oat bran muffins and eating them by the gross which, at times, was “gross”.  However, my own body was simply manufacturing too much cholesterol and Lopid and oat bran together could only bring my level down to around 220 mg/dl.  And that, in spite of the fact that I walked, as I discussed previously, nine to twelve miles a week during approximately seven months out of the year.
 
To make matters worse, my “low-density lipoprotein cholesterol” (LDL, the so-called “bad” cholesterol) was always too high, and my “high-density lipoprotein cholesterol” (HDL, the so-called “good” cholesterol) was always too low.  The end result was that the ratio between my total cholesterol and my HDL always exceeded the number that Kowalski said was critical:4.5.


 

Thus, when the newer medication Zocor came onto the market, I discussed with my physician changing to that medication.  He advised me that there was, at the time, a dichotomy within the medical community as to whether or not Zocor should be taken together with Lopid, or whether it should be taken alone.  His position was on the side of the dual medication; therefore, sometime in 1993, I began a regimen of both Lopid and Zocor.  That combination brought my total cholesterol level down to around 200  mg/dl, the level deemed to be the absolutely maximum acceptable level.  However, the ratio between my total cholesterol and my HDL remained unsatisfactory.
   

Of course both of these medications had side effects and I had to have my blood drawn and tested periodically to confirm that I was not experiencing any negative liver function disorders.
 

Also, somewhere along the way my doctor suggested that I commence ingesting a quarter aspirin (81 mg) every day as a heart attack preventive.
 
Then, in mid-1998 , I heard about the newest cholesterol drug, Lipitor.  I questioned my new Primary Care Physician about it and he agreed that I should try it and see what positive (and possibly negative) effects it might have on me.  Thus, in October, 1998,  I ceased using Lopid and Zocor and began using Lipitor. The effects turned out to be all positive.  My total cholesterol dropped to around 180 mg/dl and the ratio between my total cholesterol and my HDL improved as well.
 
Nevertheless, as you now know, all of the progress I made in my battle against Coronary Artery Disease as a result of these medications did not prevent the necessity of my having to undergo quadruple bypass surgery in April 2000.
 
In the years leading up to Y2K the only regular medications prescribed to me were Lopid/Zocor/Lipitor, which I took together with one-fourth dose of a regular non-prescriptive aspirin.  Since the surgery, on the other hand, I have been on a regimen of six prescriptive medications, plus aspirin.
 

Let me give you the names of the drugs first and then I will describe them and their side effects in greater detail.  I do not mean to imply that all post-coronary bypass patients take these same medications or even any of them; I only mean to tell you that my physicians, in whom I have confidence, have recommended this menu of drugs for my short and long term welfare.
 
The drugs, in alphabetical order, are: Altace , Atenolol ,  Colchicine , Folic Acid , Furosemide  and Lipitor.
 

All of these drugs (including the aspirin) are “wonder drugs”: it’s a wonder that I can remember to take all of them every day (except for the Furosemide, which I take every second or third day); it’s also a wonder that I can keep track of when each prescription needs to be re-filled, since I seem never to be able to get all of the prescriptions to expire on the same day of the month.


 

My pharmacy encloses a computer-generated sheet entitled “Patient Prescription Information” every time I have a prescription filled.  The sheet provides the common brand name(s) for the drug; how to use it; its side effects; precautions; drug interactions; and actions to take in the event of an overdose or missed dose.  Using that information, and with the aid of some additional research, I thought I might attempt to give you some insight into some of the medications used by post-bypass patients.
 
Enzymes are a group of specialized protein molecules that control biochemical reactions in the body.   Altace is a member of the class of drugs known as ACE inhibitors,  which are designed to inhibit certain enzymes in the body from narrowing the blood vessels, thus helping to lower blood pressure.  The good news is that it seems to work very efficiently to accomplish its stated mission.  The bad news is that Altace seems also to have the ability to produce rather undesirable side effects like dizziness, headaches, diarrhea, constipation, nausea, fatigue and/or dry cough.  The user may also develop chest pain, tingling of the hands or feet, yellowing of the eyes or skin, persistent sore throat and/or fever.  In the event the user turns out to be allergic to the medication, reactions could include rash, itching, swelling, dizziness or trouble breathing.  Sounds like fun, doesn’t it?  I began with a dosage of 5 mg per day (one small capsule).  After a year, that dosage was reduced to 2.5 mg a day.
   

Aspirin (acetylsalicylic acid) has been available commercially for over one hundred years.  But it was not until the early 1970s that it was discovered that aspirin inhibits the body’s production of hormone-like substances called prostaglandins,  which assist in the contraction of vascular smooth muscles and the dilation of blood vessels.  Thus, aspirin can prevent blood clots by preventing platelets from releasing  thromboxane, a member of the prostaglandin class, which causes the platelets to clump together in a blood clot; that is, aspirin serves as an anti-coagulant.
 

In 1985 the U.S. Food and Drug Administration approved the use of aspirin to prevent heart attacks in patients who had either suffered a previous heart attack or suffered from unstable angina.  Aspirin may also serve to reduce inflammation in the blood vessels.  Current research indicates that blood vessel inflammation can lead to hardened and narrow arteries, thereby precipitating heart attacks.
 

However, with long term use, aspirin can have some unintended side effects.  Even at low doses, aspirin can cause gastric irritation, increased occult blood loss and, occasionally, serious gastric bleeding.  There is even a relatively minor increased risk of cerebral hemorrhage from sustained use of aspirin and, at high doses, dizziness, ringing in the ears and vomiting has been known to occur.  To counteract some of these side effects, it is recommended that the aspirin tablet used be of the coated variety, designed to eliminate stomach distress and/or damage.  My cardiologist instructed me to take one 325 mg (full strength) Ecotrin tablet every day, indefinitely.  Ecotrin is an enteric-coated aspirin.
       


 

Atenolol is part of a group of medications known as Beta Blockers.   Beta Blockers can control angina (chest pain), high blood pressure and irregular heartbeats.  Atenolol slows down the intensity of the heart=s contractions and reduces its oxygen requirements and the volume of blood it has to pump.  It also serves to increase the diameter of the blood vessels, thereby reducing the pressure needed to move blood through the vessels.
   

Atenolol can cause the user to experience dizziness, lightheadedness, drowsiness and/or blurred vision. Because it reduces blood circulation to the extremities, the patient’s hands and feet may become more susceptible to cold temperatures.  In addition, the patient could experience easy bruising or bleeding, swollen hands or feet, confusion, depression or sore throat.
 
Allergic reactions to Atenolol may include rash, itching, swelling, dizziness and difficulty in breathing (difficulty in breathing!!).  Women are cautioned that this drug should be used during pregnancy only after consultation with their physicians regarding the possible risks involved.  I started with a dosage of 25 mg per day (one tablet).  After one year, that dosage was reduced to 12.5 mg per day.  The only problem is, there is no generic 12.5 mg tablet on the market.  Therefore, every month I bring home thirty 25 mg tablets and diligently cut each of them in half.
 

Colchicine  is  used  to  prevent and/or  treat gout, a  condition characterized  by the sudden onset of severe pain in  the joint  of the big  toe, or, sometimes, in the ankle,  wrist,  knee or elbow.  The pain  intensifies and  the joint becomes very sensitive to  the  slightest
external pressure.  As I explained in Chapter 6,  I experienced gout for the  first time in  my life  during those few days I spent in the hospital prior to my surgery.  I suspect it may have been precipitated by the introduction of thiazide or a thiazide-like diuretic into my IV as a blood pressure medication. Thiazide diuretics are recognized as a cause of hyperuricemia which, in 70 to 95 per cent of all cases, is the result of the underexcretion of uric acid rather that the overproduction of uric acid.             
 

Colchicine has the ability to produce the following side effects: nausea, stomach pain, vomiting, diarrhea, yellowing of the eyes or skin, sore throat, easy bruising or bleeding, muscle aches, numbness or tingling of the arms or legs, fatigue, rash and/or itchy skin. Oh, and one more happy note: alcohol can decrease the effectiveness of Colchicine, so the patient should “limit” alcohol consumption while taking this medication.  I take one 0.6 mg tablet every day.
 

Folic Acid is a vitamin.  It is found naturally in leafy green or yellow vegetables, beans and orange juice.   Folic Acid helps to regulate levels of homocysteine in the blood.  A high level of homocysteine is an independent risk factor for arterial disease.  A usual dosage of Folic Acid, contained in many non-prescription vitamin supplements for example, is 400 mcg (micrograms). I consume two 1 mg tablets a day.  That’s 5 times the amount of Folic Acid contained in the vitamin supplement.  At 1 mg  (the standard therapeutic dosage), it requires a prescription. Fortunately, Folic Acid has minimal side effects; but some patients do suffer allergic reactions like rash, itching, swelling, dizziness or trouble breathing.
 


 

Furosemide is a member of that group of drugs known as “water pills” or diuretics.  It is a potent diuretic , which means that it acts to decrease the amount of water retained in the body by increasing urination.  Thus it counteracts edema (fluid retention and swelling of the hands and feet caused by heart failure or other diseases) and high blood pressure.  Its side effects are interesting, if not familiar by now: dizziness, lightheadedness, increased sensitivity to sunlight, blurred vision, loss of appetite, itching, stomach upset, headaches and weakness, muscle cramps, pain, nausea, vomiting, dry mouth, thirst, unusual bleeding or bruising, rash, yellowing of the eyes or skin and/or ringing in the ears. 
 

And whereas the effectiveness of Colchicine is decreased by the consumption of alcohol, the side effects of Furosemide may be intensified by the intake of alcohol.  Women are cautioned that this drug should be used during pregnancy only after consultation with their physicians regarding the possible risks involved.
 

During the first year after my surgery I took one 40 mg tablet of Furosemide every other day.  After one year, I reduced that intake to about every third day.  During the first six hours or so after ingestion, the drug induces sudden, strong urges to urinate.  This will occur repeatedly during that time frame.  It is a highly unpredictable phenomenon.  Needless to say, you will want to be sure that a toilet will be accessible and available to you at all times during that six hour period once the pill has slid down your throat.  If you don’t follow this advice, then don’t say I didn’t warn you.
 

Finally, Lipitor is one of the statin group of drugs which are being used to help reduce cholesterol and triglycerides (fats) in the blood.  It works by inhibiting cholesterol synthesis in the liver. Lipitor, too, can produce some of the nasty side effects I have alluded to above: headache, nausea, diarrhea, constipation, gas, stomach upset, joint pain, muscle pain, weakness, fever, unusual tiredness, chest pain, swelling in the arms or legs, dizziness, yellowing of the eyes or skin, dark urine, vision problems and black stools.  As if that wasn’t enough, allergic reactions can include rash, itching, severe dizziness and/or trouble breathing. Frequent ingestion of alcohol may increase the possibility of serious side effects.  Also, as with all statin drugs, liver function must be monitored periodically through blood tests to be sure the medication does not have a negative impact. 
 

Lipitor does have one idiosyncracy, however: you cannot eat a grapefruit or drink grapefruit juice while using this medication.  I don’t know why; you just can’t do it.
 

Finally,  this drug cannot be taken during pregnancy since it may cause fetal harm.
 

There, that’s the whole of it.  Based upon an orderly cataloging of the side effects I have described, you may have surmised that I walk around lightheaded; am unable to focus on the world around me; run to the bathroom at least once every hour; have yellowed eyeballs and rashes all over my body; appear slightly swollen; am prone to nausea, with ice cold hands and feet; given to scratching myself in the most intimate of places; chronically tired, slightly feverish, possessing no appetite and complaining constantly of muscle cramps.
If that’s your conclusion, I’m here to tell you that you are . . . wrong (. . .or at least I think you’re wrong!).

To be continued…
 

August 8, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 6:20 pm
  Paul Jason  

Chapter 14: “Get Out and Stay Out”
 
By the fourth day after the surgery, Saturday, April 8, 2000,  I could get on and off the hospital bed myself, but with great difficulty and pain.  My left leg was swollen to a girth one and a half times the size of my right leg, from the inner mid-thigh down to the ankle.  My breathing was shallow, and my wired chest was very unstable.
 
You may remember that I said in an earlier chapter that the thoracic surgeon told me that, barring unforeseen complications, I would be discharged from the hospital four and one-half days after the surgery. Well, on that fourth day one of my physical therapists came to visit me. She said that her mission was to be sure that I could walk, and that I knew how to negotiate steps.  She explained that since my left leg was temporarily incapacitated, I would have to go up and down steps one at a time, leading always with my stronger right leg.  So, for example, if I were to go down a flight of stairs, I was to descend from step to step by lowering my right foot to the step first, and then bringing my left foot down.  Conversely, to mount a flight of stairs   I was to ascend to each level by stepping first with my right foot, and then bringing my left foot to that level. Sounds easy enough (a child can do it), until you take into consideration the feeble breathing, general weakness and aching chest factors.
 

I believe that it was sometime during that fourth day that a PA (Physician’s Assistant) appeared in my room and announced that he was there to remove the tubes that were still protruding from my body.  I had tried to ignore them during the past couple of days, while the inevitability of their removal buried itself within the recesses of my mind. Moreover, they were camouflaged amongst the millions of little surgical strips that covered my wounds.
 

To the best of my recollection, I still had two tubes right below my breastbone which had served to drain the fluid that collects around the heart after this surgery, and a third tube located just below and to the left of my breastbone, in the rib cage area, to drain any fluid which collects in the chest cavity.  What these tubes drained into I cannot tell you.  In fact, that’s the very point: there are so many things hanging from your body during those first days; so many debilitating things going on with your body and mind; so many thoughts and pains darting back and forth,  that simple, probing questions that curious minds usually entertain, such as where those drains empty, are blotted out from conscious thought.   
 

Up to that moment it never occurred to me that anyone other than my surgeon would be removing from my body anything that had been inserted during surgery.  But that PA was on a mission and anything I had to say on the matter was of no concern to him.  Not knowing whether I should brace myself, I asked him if this was going to hurt; “Not much” he replied. Easy for him to say.  I was laying on my bed. With aplomb, he grabbed hold of one of those tubes and started to pull. I couldn’t look.  From the sensation it felt like he withdrew two feet of tubing, although I’m sure it was much, much shorter. Then he went on to the second tube, and then the third.  I couldn’t believe what was coming out of me.  He dressed the wounds and left. The whole procedure probably lasted five minutes.


Well, it was becoming apparent that they really were determined to discharge me on the next day.  I couldn’t believe it.  Could I really function outside the confines of this hospital so soon?  Given the state of my mobility, I questioned how I would be able to get home and into the house.  My “significant other” was making arrangements to come to the hospital with a friend and to drive me home.  How would I get to the car?  How would I get into it?  How would I get out of it?
   

Sunday morning, April 9, 2002,  it started to snow.  That’s right, snow. A little late in the year for snow in New York City, but you can look it up.  I limped out to the hallway window (remember, the dividing curtain in the center of the hospital room was never drawn back,  so I could never see the room window) and watched the flakes coming down… slowly at first, and then more frequently.  By 11:00 a.m., snow was beginning to accumulate on the ground.
 

“They’ll never release me on a day like today,” I thought to myself.  “How can they expect me to go outside, as unsteady and unstable as I am, and travel home? What happens if the car gets stuck in the snow?  I’m not physically capable of maneuvering myself out of any  situation.”  These thoughts raced through my mind.
 
My significant other had the same thoughts, and she called me to express them.  Should she drive the long distance to the hospital in this weather?  Should I be exposed to such harsh weather so soon after such critical surgery?
 

I hobbled to the Nurse’s Station and made inquiry regarding my impending discharge. “Oh, yes” I was advised, “you are scheduled to leave the hospital as soon as your cardiologist arrives to examine you.”  My cardiologist?  Well, thank God . . . I can’t imagine that he’ll let me out in this weather.
 

How wrong I was. In fact, it was not my cardiologist, but one of his partners, who appeared that day.  I expressed my concern as he was examining me.  He declared me fit for discharge, downplayed my fears, and told me to go home.  He wrote prescriptions to be filled at an outside pharmacy that day, wished me well, and left.  Boy, I wished I was as optimistic as he was.
 

I guess the moral to the story, if there is any, is that modern American medicine is controlled by the insurance companies, HMOs, managed care services, etc., and that, short of a catastrophe, my post-operative days in the hospital were pre-ordained and carved in stone.
 

The “Discharge Plan/Instructions” sheet that was delivered to me by an RN indicated that my blood pressure was currently 102/60, my body temperature was 99.4 degrees F. and my pulse was 84.  All of my medications, their dosages and frequency of ingestion were listed there.  It also advised me to call for medical assistance if I experienced chest pain, palpitations, dizziness, redness or discharge on my incision sites, fever, “etc.”  In case of an emergency, call 911.  An emergency?  How the hell would I know what an emergency is.  To me, this is an emergency!!!


Tired, weak and faced with the inevitable conclusion that the insurance company bean counters would dictate my exit from this medical facility, I phoned my significant other, told her what had happened, and asked her to please come and get me.

To be continued…

July 28, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 6:55 pm
  Paul Jason

Chapter 13:   ” Sponge Bath . . . What Do You Think This Is, a Spa ?”
  

 

The remaining days and nights of my hospital stay prior to discharge were filled with restlessness, discomfort, loneliness, apprehension, fatigue and depression. Various members of the “medical team” dropped by intermittently to examine me, but most of the time I was left to contemplate my condition and cope with my pain. 
 

I found that unless I asserted myself, little attention was devoted to alleviating my pain.  For example, from the moment the endotracheal tube was removed the morning after the surgery, my throat was sore – - – very sore.  They had given me ice chips to suck on soon thereafter, but nothing further.  The soreness persisted over the next days.  It was not until the fourth day, when I was complaining about the situation to a nurse I had not seen before, that she offered to bring me some lozenges to suck on.  Lozenges?  “You mean you have throat lozenges to alleviate the pain?”.
 
 ”Nobody offered them to you before?”
 

Well, no.”
 

Sure enough, the lozenges were numbing and soothing.  Why hadn’t anybody brought them before?  After all, every surgical patient who has had general anaesthesia has had an endotracheal tube shoved down his/her throat.  The throat and windpipe react to the intrusion and irritable soreness inevitably results.  Why not provide lozenges as a matter of course?
 

Nevertheless, it is this sort of general indifference which undermines the hospital experience.
 

Lozenges, of course, are just a small indication of this indifference.  Another one of my pet peeves is the fact that once that aide in the CCU had gently cleansed me the day after surgery, no one else ever washed me; no one ever offered to wash me.  As I have described in a prior chapter, lying in a hospital bed can be a perspiring experience.  My ability to get on and off the bed was somewhat limited, and painful.  The first couple of days I was using a bed pan, and I didn’t have enough solid food in me to require use of the toilet.  But, surely, I needed to be washed down, if not for my cleanliness, at least for my dignity.  I always thought that patients in my condition received “sponge baths” in or at their beds.  But there were no sponge baths to be had.  I guess they’re no longer part of the union contract!!
 

Fortunately, my domestic partner came to visit me every day and she washed me down using  wash cloths that she commandeered from a nearby corridor supply closet. (This is but one very small example of what I was talking about in the Preface when I said that  I could not imagine the hardship one would undergo to face this ordeal alone.)
 


Also, by the fourth day, I was able to struggle off the bed by myself, shuffle over to the bathroom a few feet away (when it was available, there being, of course, two other room occupants to share it with, and more when there were visitors), and attempt to wipe myself down with the wet corner of a towel.
 

I understand that there is a nationwide nursing shortage.  I also know that my experience in one hospital cannot serve as the basis of a generalization.  However, I have now taken the time to speak  to other people who have been hospitalized in the New York metropolitan area, and their comments have been similar to mine. Comments to the contrary have been the exception rather than the rule.  And, after all, The Motel Monte is not some backwoods infirmary; it is a major player on the metropolitan New York medical scene.  And it doesn’t require the services of a registered nurse to sponge bathe a post-surgical patient.  Something is wrong, terribly wrong, and I suspect that not enough is being done to address the matter.
 

In a similar vein, I discovered that no one was particularly concerned about the pain I was experiencing.  Unless I persisted in my requests for pain medication, I received no attention or sympathy in that regard.  Now, don’t jump to the conclusion that I’m some pampered wimp, incapable of tolerating a little pain and, therefore, was whining for relief every five minutes.  Quite the contrary.  As one example of my pain toleration, a few years ago I had a lower rear wisdom tooth prepped for the installation of a crown . . . without any anaesthetic.  However, that pain lasted for an hour and then subsided.  This pain would last, unabated, for several days.
 

Since the surgery, I have read about hospital-based programs in pain management in which patients are given limited control over the introduction of pain medication into their bodies.  Whatever the status of those programs, and the medical philosophies that buttressed them, was in April 2000,  in my experience The Motel Monte was not implementing them.  Certainly this is an area of care that requires more consideration, and every prospective surgical patient should make inquiry regarding the status of pain management in the hospital of his/her choice.
 

When I first organized an outline for this book, I considered naming two of the chapters  “You Have Throat Lozenges?” and  “May I Have My Pain Medication Before I Die?”  This was reflective of the anger I felt during the recuperative period whenever I contemplated the hospital experience.  Ultimately, as you can see, these individual ideas became melded into a more generalized statement of dissatisfaction.

To be continued….
 

June 3, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 7:48 pm
   Paul Jason
    

  Chapter 12:   “Whoops!  We Have a Visitor”
 
Approximately thirty hours after I left the operating room I was wheeled on a gurney up to the “Intermediate Cardiac Care Unit” on the sixth floor.  Unlike my first visit there (prior to the surgery), I was now placed in a semi-private, as opposed to a private, room.
    

It was after midnight when I was wheeled into my new room. The overhead lights were out.  The light on the wall behind the bed was turned on and I was assisted from the gurney onto the bed with considerable pain and discomfort. At my request, the nurse brought me a couple of pillows to prop me up in the bed. My IV was checked, I was hooked up to some monitors, the light was turned off and I was left to my own devices.  The hallway lights, peering into the room, created an eerie environment. 
 

It was a standard type of room that I had been in many times before as a visitor. Upon entering, on the left, was a bathroom.  Beyond the bathroom was the bed reserved for me.  A movable curtain separated that bed from a second, parallel bed, which itself was parallel and adjacent  to the windows. At this time the curtain was drawn, and I could not see who occupied that other bed.  This was probably going to be my roommate for the next couple of days.
 

The ability to find a comfortable position in which to rest abandoned me and I spent the next couple of hours restless and perspiring. . . perspiring so much that I finally felt impelled to ring for the nurse and to request that my bed sheets and hospital gown be changed.  Whether this was precipitated by the emotional anxiety generated by my relocation from the CCU, or the sheer physical exertion of that transition, was unknown and not particularly important at the time.  The fact that I was wet enough to feel very uncomfortable was enough.
 

One of the things that you come to recognize after laying on a hospital bed for a short while is that vinyl liners reside immediately beneath the bed linens.  I’m sure they are there for sanitary reasons; however, they also serve as unwanted captors of body heat and are capable of fomenting linen-drenching perspiration in patients whose body temperatures can fluctuate continually for any number of reasons.
 
Of course the mere changing of bed linens became for me another exercise in pain and discomfort, requiring as it did that I shift myself around the bed to assist in the process.  Nevertheless, having temporarily achieved a drier sense of myself, I managed to fall in and out of sleep repeatedly as the next few hours passed.
 

Then, all of a sudden, at what I estimated was perhaps four or five o’clock in the morning judging from the quietness of the hallways,  the separation curtain rustled, and a short, squat figure appeared from the far side of it. The figure walked right past the foot of my bed, headed straight for the bathroom, and never even looked at me.
 


At first, in the dim light, I couldn’t decide whether I had just seen a man or a woman. A woman? I didn’t know they have co-ed hospital rooms.  I mean, I know that many colleges have had co-ed dormitories since my kids went to school.  But, even then, that sometimes means that alternating floors within a dormitory building are designated for girls only and for boys only and, at other times,  that rooms occupied by girls are located on the same floor as rooms occupied by boys.  I never heard of situations where one girl and one boy are assigned to the same room.  Hmmmm.  But, then again, in those college dorms, on those co-ed floors, I also know that some (maybe all) of the bathrooms in the hallways are co-ed.  Hmmmm.   But, I still didn’t think that hospitals have co-ed rooms.  Never heard of it; never saw it. 
        

The bathroom door opened, the figure trod back in front of my bed, never looking at me, passed to the other side of the curtain and got back in bed.  This time I was convinced – - – it was a woman!
 

And then another thought hit me.  This person was walking without any difficulty. How could that be?  I was in the ICCU.  I had to presume that all of the other people on this floor have undergone some type of cardiac procedure.  When that happens, you walk around with an IV dangling out of you, or some sort of monitor hanging around your neck, or bent over from the stitches they put in you, or something like that.  But this person had none of those impediments.  What is she doing here?
 

Before I could ponder the situation much further, I fell asleep again.
 

I was awakened by soft voices.  As I became coherent, I realized that the voices were coming from the next bed.  I looked towards the bed, but the curtain was still drawn.  However, the sun was starting to filter through the windows and the opaque separation curtain, and I knew that I had made it through the night.
 

The voices were Spanish voices.  Soon there was rustling again and the short, squat figure appeared, dressed in a bathrobe.  She plodded past my bed without a glance or a word and disappeared into the bathroom.  After some time, she emerged and then disappeared behind the curtain. 
 

Again, Spanish voices.  Now the curtain rustled a second time.  A man, dressed in a different bathrobe from that worn by the woman, appeared this time.  He glanced at me briefly as he passed my bed, but said nothing.  He, too, entered the bathroom. After a few minutes he  retraced his steps, and went behind the curtain.  It sounded like he got back into bed. Back in bed?  Wait a second . . . I didn’t know they had double beds in here!!  Curiously, as with the woman, there was no IV dangling out of him, and he wasn’t bent over either.  What’s going on here?  Who are these people?
 

Shortly, a nurse entered the room to check vital signs and the daily hospital routine began.  The woman reappeared from behind the curtain dressed in street clothes and went out into the hall.  Neither the nurse, nor anyone else, as far as I could discern, said anything to her.
 


The nurse checked the man in the next bed; there was some language difficulty.  He spoke very little English, and she spoke very little Spanish.
        

When she finished, I fully expected that the curtain would be drawn back so that I could not only see my co-habitant, but so that a little daylight be allowed to shine into my side of the room.  However, my expectations were dashed.  In fact, from the moment I entered that room, until the moment I checked out three and a-half days later, that curtain was never drawn back.
 

And with good reason. This couple had set up housekeeping in that portion of the room.
 
I have good reason to believe that the food service department delivered two meals to that bed at every meal.  The woman spent most of each day there, and slept there every night, sharing the bed with the man.  They spoke only Spanish to each other, so I could never understand anything that they said.  They never demonstrated any interest in speaking to me.
 

I can tell you that no matter how many visitors you have while you are a post-operative patient, there will be many hours in each twenty-four hour day when you will feel alone, isolated and depressed – - – depressed, even if you don’t know it.  Spending those moments in the confines of a private hospital room may provide the sanctuary in which to cope with your inner thoughts and to contemplate the future. But spending those moments within a semi-private room provides the opportunity to share your misery with a fellow human being who is faced with the same feelings of self-doubt.  However, being confined in a semi-private room occupied by three people, as I have described the situation, is demoralizing and demeaning: it lacks the quietude of the first alternative, and robs one patient of the camaraderie inherent in the second.
 
On my second day in that room,  one of their visitors asked me, in English, how I was doing.  I used the opportunity to pursue my natural curiosity.  It turns out that the man had been admitted to the hospital about two weeks earlier to undergo coronary bypass surgery.  However, he had other neglected health problems which rendered him a high risk candidate until they could be controlled.  Therefore, he had been laying around the hospital receiving some medications, being visited by his primary care physician and other doctors, and waiting to be told that the surgery could be performed.  Thus, his wife had moved in with him.
 

Also, by the second day in that room, I was starting to use the bathroom.  Now, instead of sharing it with one other patient, I was sharing it, on a full-time basis, with a non-patient as well. The room began to feel, well . . . crowded.
 


To my surprise, and chagrin, no one on the staff seemed to be concerned about the situation. Not the Administrative Nurse Manager; nor the Associate Administrative Nurse Manager; nor Patient Care Coordinators; nor the Registered Nurses; nor the Licensed Practical Nurses; nor the  Nursing Attendants; nor the Clinical Care Coordinators; nor the Monitor Technicians; nor the  Attending Physicians; nor the Residents; nor the Interns; nor the Physician Assistants; nor the Nurse Practitioners; nor  the  Unit Secretaries; nor the Service Associates; nor the Unit Manager.  No, not even the Registered Dietitian cared.  Nope, not one of them was concerned that three people were co-existing in a semi-private room designed for two patients . . .  and one was a very sick post-operative patient.
 

And so the old saw addressed to good-doers everywhere was visited upon me: “Let no good deed go unpunished.”  This was my fate. Voluntarily leave the CCU one day early, at the request of my surgeon, and join a menage-a-trois!!
 

My reaction to this scenario turned from negative to very negative. I felt as though I were trapped  in some fictional tawdry roadside motel of yesteryear, where rooms rented for one wound up being occupied by two, with curtains drawn and  profiles kept low in the hope that no one would say anything. Befitting the administration of the place, as viewed from my vantage point, I decided, right then and there, to dub it “The Motel Monte” and to use that descriptive name as the title of any document I might later generate about my hospital experience.

 

 

 

 

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