vadimstudio.com Blog

July 29, 2008

From Flab to Fab

Filed under: By Ellen Bittner — Administrator @ 6:26 pm

  Ellen Bittner

Chapter 4.  Overcoming Obstacles - Part 1: Fear 

As a child, I was considered a “dare devil” and often got myself into situations that would lead to injury.  On one occasion, I decided to slide down the support pole of the slide in the playground.  This resulted in a gash on my chin.  (I still have the scar.)  There were also several instances when I fell off my bike.  Chances are, if I had been riding it in the conventional way I wouldn’t have cut my foot open (which also left a scar), or broken my front teeth.

My daring ways were not limited to dry land.  I also enjoyed exploring and playing at the beach and in the lake, undeterred by the fact that I didn’t know how to swim.  That adventurous spirit continued until one day when I was playing at the lake and almost drowned.  I had jumped off the pier and a passing speed boat created a wake that pulled me under the pier, where I was caught in the undercurrent.  Not knowing how to swim, I panicked.  The more I struggled, the deeper I went into the dark, murky mass of seaweed.  That experience left me with a fear of water that lasted nearly four decades.

As I wrote in Chapter 3, my high school had a swimming pool.  However, although Swimming was part of the Phys Ed curriculum, I didn’t learn to swim there.  Because I had developed a fear of water, and was a “non-swimmer”, I was a part of the class that was “taught” by a student assistant.  This meant that while the teacher taught the “swimmers”, the student assistant supervised the “non-swimmers” in the shallow end of the pool to make sure none of us drowned.  In order to pass the course at the end of the semester, the “non-swimmers” had to jump into the deep end of the pool and grab onto a pole that had been inserted into the water.  The teacher, who was holding onto the pole, pulled us towards the stairs and we climbed out of the pool.  Not only did I not learn how to swim, but this experience exacerbated my fear of water.  And so, for most of my life I shied away from water, unless I was in a swimming pool where my feet touched the bottom and I could stand along its edge.

As I neared retirement and was looking for ways to become more physically fit, I wished that I could swim.  I knew that swimming was good exercise.  It was aerobic and there was no impact on the joints.  However, the few times that I did try a water aerobics class, my fear of being swept away into deeper water kept me from fully participating in the class.

Then, one day I saw an article in the newspaper about a program for people with aqua phobia - a fear of the water.  The article described a new course, SOAP (Strategies for Overcoming Aquatic Phobias) and Water (www.waterphobias.com) created by Jeff Krieger (jkrieger@WaterPhobias.com).  Jeff, who was a guidance counselor and Red Cross certified swim instructor, had originally designed the program for children, in anticipation of the summer camp season.  His unique approach made use of his guidance background to deal with the phobia, before beginning to teach swimming techniques.  I called the number provided, and was impressed with Jeff’s compassion and understanding when I told him about my swimming history and near-drowning experience.

When anxiety took over, and I missed the orientation meeting, Jeff called to encourage me and persuade me to join the first class.  When I arrived, there were four other middle-aged adults.  (To Jeff’s surprise so many adults signed up for the program that he had to divide the class into three groups.)  We sat in a classroom and talked about our experiences, our fear of water, and our expectations of the program.  The pool, the focus of our fears, was nowhere in sight.  After about a half an hour concentrating on our fears we went into the pool area, where there was a large metal tub with five yellow “rubber duckies” floating in the water.  Jeff had us sit in the tub and choose a rubber duck.  We used “our” duck as the focus of a “positive” water experience.  Then, keeping that image in mind, we put our face in the water and blew bubbles.

During the ensuing five weeks, Jeff took us from that large metal tub, and taught us how to be in control and feel safe in the water.  Using foam noodles, he showed us how to relax and float; then he taught us to float and tread water without the aid of a noodle.  A major accomplishment for me was being able to put my face in the water and learning how to breathe.  Jeff also dealt with the emotional aspect of our fears by having us write about our experience in a journal after each class.  (I still have that journal.)  His responses to my entries and his encouragement were very powerful, and played a major part in my progress.  One of Jeff’s favorite sayings was: “Setbacks, no matter how large are temporary; Progress no matter how small lasts forever.” 

Jeff eventually had me feeling comfortable enough in the water that I could swim to the bottom of the pool to retrieve water toys that had been scattered around.  At the end of the six-week program there were several of us who wanted to take the next step and actually learn how to swim.  Jeff put together a “post-graduate” course and created another six-week program for us.  During that time, Jeff taught me a variety of basic swimming strokes and how to dive from a diving board.

It’s been five years since Jeff helped me overcome my paralyzing fear of the water and gave me the tools to be able to “take care of myself” and enjoy the experience.  Since then, a fellow graduate of his SOAP and Water program and I have been swimming regularly at a local Y.  I look forward to meeting her each Monday morning to swim laps.  We continue to motivate each other, as we try to swim faster and further each time.  I have not only overcome my fear of water; I have learned to enjoy swimming and now reap its fitness benefits. 

   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 25, 2008

From Flab to Fab

Filed under: By Ellen Bittner — Administrator @ 11:32 pm

  By Ellen Bittner

Chapter 3. Using Weights, Losing Weight

Growing up in New York City, I went to school in a pre-Title IX era.  (Title IX, enacted in 1972, was the first comprehensive federal law to prohibit sex discrimination in educational institutions.  Its major impact was on high school and collegiate athletics, providing girls with equal access to physical education and sports activities.)

My high school phys ed classes consisted of calisthenics, which included doing sit-ups while a partner held your feet at your ankles; and exercises with mantras such as “I must, I must, I must increase my bust.”  Folk Dance, Jazz Dance, and Swimming (that’s another chapter) were some of the other courses that were available to women at the time.  Girls who wanted to participate in high school sports could become cheerleaders, which emphasized learning chants and dance routines.  This was also a time when women with muscles were considered “unfeminine” and sweating was thought to be “unladylike” (I still have an aversion to sweat.)

The gyms that I joined in later years were not that much different.  These women’s oriented fitness centers emphasized cardiac fitness (which is very important) over strength training, once again conveying the message that women should avoid developing muscles.  Fitness schedules at these gyms included step classes (beginner, intermediate, & advanced), and aerobics classes (low impact, high impact, dance, and hip hop).  I often felt uncoordinated and became discouraged with all of this choreographed activity.  Keeping up with the instructor and the music in these large group classes was frustrating, and I easily became bored with the repetitive routines.

As I aged, so did my body.  Along with peri-menopause came the usual weight gain and other physical changes associated with this “change of life” phase.  In order to avoid the characteristic loss of bone density and diminish the negative affect of my family’s genetics that I wrote about in Chapter 1, I decided to take action to improve my health and extend my longevity.

I had already tried the large fitness centers and knew they hadn’t worked for me.  I also knew that I wanted a fitness program that would help me counter the loss of bone density & metabolic changes that came along with menopause - a program that would involve resistance training.  I came to the decision that these needs would best be served by a personal trainer.

After doing some research on the internet, I went to visit several one-on-one fitness centers.  I spoke with the trainers there to get a sense of their fitness philosophies and approach.  I also wanted to be sure that the trainer I ultimately chose would take my current physical condition into consideration, and not use a “one size fits all” packaged routine.  When I met with Vadim Vilensky at his Fitness Studio, I explained my goals, and told him that I wanted to be healthy, not become a “weight lifter.”  His slogan “Fitness for the Real World” and his experience working with cardiac patients were contributing factors in my decision to work with him.

Most of the fitness centers that I had visited were full of machines.  But, the walls of Vadim’s studio were lined with resistance bands, free weights, kettle bells, barbells, stability balls, and mats.  There wasn’t a machine in sight.  These objects were all so new to me.  At first, I found all of this apparatus intimidating.  Before long, I realized that my body was the machine, and that I would be using my own body’s weight, strength, flexibility, and stability with the equipment.   Once I learned how to use them properly, I bought my own set of free weights and a stability ball so that I could “practice” what I was learning at home.

It’s been 4 years, and I have become much more comfortable and skilled with the equipment.  I have also become more fit, flexible, and athletic.  In terms of “Fitness for the Real World”, some of the lifestyle changes that I am enjoying are:

Then, I would take an elevator, no matter how short the trip;  Now, I bypass the elevator and routinely use the stairs.

Then, I had difficulty reaching my own feet to tie my laces;  Now, I easily squat down (& get up again) to tie the laces of 4 year olds.

Then, I needed to use a shopping cart to carry even a few shopping bags;  Now, I easily carry several shopping bags, or a case of water, in my hands.

Oh, and the business of not wanting to become a “weight lifter”, there have been times when I’ve considered entering a Power Lifting competition.  Who knows, maybe some day I will.

          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.

 

 

 

 

May 13, 2008

From Flab to Fab

Filed under: By Ellen Bittner — Administrator @ 1:42 pm

   By Ellen Bittner

Chapter 2. The Battle of the Bulges


I knew I would need help in beating the odds of my genetics, and creating a longer lifespan for myself, so I decided to find a personal trainer.  I met with Vadim Vilensky, and told him what my goals were.  I liked his philosophy - “Fitness for the Real World” - and began working out with him.  I also adopted what I considered to be a healthy diet.  I ate sparingly (small meals with small portions), used artificial sweeteners, ate fat free and salt free products, and replaced the diet soda I was drinking with water.  (I made this last change after learning that carbonation in soda could be detrimental to bone health.)  


After working out with Vadim for several months I began to notice some very pleasant changes in my body.  My waistline was beginning to reappear and I could look down at my feet and see my toes again.  These changes also led to smaller clothing sizes, a welcome turning point because I now fit into a “Misses” size and no longer had to pay more for “Women’s” size clothing.  I also felt different – I had more energy and, as friends noticed, began to develop a “spring” in my step.   With all of these positive changes, I was disappointed that the scale wasn’t reflecting the amount of work and effort that I was expending.  I rationalized that this was partly due to my increased level of fitness.     Regular fitness assessments showed that I was gaining muscle mass, and bone densitometry tests showed that my bone density had increased.  Nevertheless, I was feeling frustrated and wanted to know why I wasn’t seeing a more dramatic weight loss.    

  Vadim suggested that I make an appointment to meet with his nutritionist.  She told me to keep a food journal for one week, and then we would meet to analyze it.  Imagine my surprise when she told me I was eating too little!  Although the formula for losing weight requires that you take in fewer calories than you expend; she explained to me that, by eating as few calories as I was eating, I was putting my body in a defensive “starvation” mode.  This meant that I was actually holding on to more calories than I needed, rather than metabolizing the calories I was taking in.  She also explained that I needed to incorporate some fat, healthy of course, in order for my body to properly absorb the nutrients it needed.  She made a few more adjustments to my daily food plan and recommended that I add two small snacks to my daily intake.  This discussion also left me with a better understanding of how to read food labels more effectively, in order to create a more balanced food plan (note that I’m not using the word diet).

 

I was eating more healthfully and the scale was beginning to show the results.  In the first few months I saw substantial weight loss, but then it stopped.  While I wasn’t gaining weight, it seemed to take forever for the next drop to occur.  Then, I’d hit another plateau.  As much as I was frustrated, and tempted to give up, I continued with my exercise routines and followed my food plan.  Why?  I still felt better and could move more easily; so I figured as long as I wasn’t gaining weight I was ahead.  Interestingly, I recently read an article in the Mind & Body section of The Journal News (May 9, 2009) that explained what was going on. The article, by Nanci Hellmich, actually recommends that you “Reach a ‘set point’ to set yourself up for dieting success.”  She wrote that it’s healthier and more effective to try to lose 10% of your body weight and then stop losing for a while.  The article suggested that you try to keep that weight off for at least six months so that your body could adjust to this new “set point” before attempting to lose the next 10%.  Imagine that, my body was doing this – much to my frustration – all by itself; or maybe that’s what my healthy eating plan is all about.


To be continued…
                                                            

                            

             

    

May 2, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 2:04 pm

 Paul Jason

Chapter 11:  You Want Me to Volunteer to Do What?
     

The exultation which accompanied  the confirmation of my continued existence on Planet Earth was soon replaced by the reality that I hurt.  I mean every part of me hurt.  As soon as I was released from the restraints that had prevented my earlier movement, I discovered that my body ached.  My left leg felt very swollen and weak.  My back felt sore.  My chest felt like an eighteen-wheel truck had run over it.  An IV and a urine-collecting catheter were hanging out of me and I suspected that a few other tubes and/or wires were projecting also. I was sure the IV was feeding me pain-killers, as well as some saline solution.  In addition, a nasal prong was inserted into my nostrils to supply oxygen and assist my breathing.
 

To tell the truth, I wasn’t too anxious to survey the damage.  Dealing with blood and bloody wounds has never been one of my strong suits.
 

After the endotracheal tube had been removed, a nurse brought me ice chips to suck on to alleviate the soreness in my throat.  That soreness would continue for the next two or three days.
 

Some time thereafter, a young woman appeared at my bedside and announced that she was a physical therapist and that she was there to assist me from the bed onto the floor.  I retorted (with whatever energy I could muster) that I seriously doubted that she, at  about one hundred pounds, was going to be able to sit me (at about two hundred pounds and feeling like a dead weight) up in bed and then assist me into a standing position.  I guess she had second thoughts because she  left the room for a few moments, only to  return with a second one hundred pound young woman.  Well, I thought to myself, at least we have improved the odds.
 

Their first attempts to get me into a sitting position on the bed were filled with agony (for me), fear and a little disbelief.  I hurt in all directions.  Additionally, I learned for the first time that my dissected chest was very unstable.  At the least little movement, it felt as though my breastbone would pull apart.
 

I knew, prior to the surgery, that the patient’s chest is pried opened.  But, to tell the truth, I never understood the full reality of that statement.  My dismantled breastbone was literally held together with wires. It was unstable and would not begin to recover its stability for eight weeks or so.  To make matters worse, the surgery had very quickly depleted the major supporting muscles of their tone and strength, and I felt something like a marionette dangling loosely on its strings, incapable of creating assertive motion.
 

Nonetheless, these two young women were determined to get me out of bed, like it or not.  So slowly, and very painfully, they propped me into a sitting position, then maneuvered my feet and legs over the side of the bed, held me under the arms and lowered me to the floor.  There was not much that I could do to assist in the process and, as my feet hit the floor, I felt my rib cage quiver.
 


But the agony was not over.  After getting me to take a few assisted steps, they sat me down in a hospital armchair (the firm, vinyl upholstered, wooden arms type).  During these few moments, I discovered three other things: one, my left leg felt stiff and it was not working very well; two, it hurt just as much trying to sit down as it did trying to stand up; and three, I couldn’t breathe very well.  My breaths were short and shallow.  The anaesthesia was still working on my lungs. Every attempt to draw in air was resisted by a pair of protesting lungs and a protesting chest, both of which felt as though they were about to explode.
     

Coughing had become an excruciating experience.  I had learned, however, from cardiac patients I knew or had previously met, that CCU patients are generally given a “security blanket” to hold onto, and to hug against their chests, as assistance in those moments when unexpected coughing or body turning becomes inevitable.  In some hospitals, this companion comes in the form of a large-size Teddy bear, or some facsimile thereof.  Often it is decorated by the nurses with words of encouragement, the patient’s name and/or the date of the operation. When I asked for one at this hospital, what I got was a blank white pillow case stuffed with some bedsheets!! . . . my “security pillow”.  I knew right then and there that I was either dealing with a very dispassionate nursing staff, or a nursing staff that was undermanned and/or overworked and/or undersupplied.
 

I believe it is worth digressing at this point to mention that the American Nurses Association has been saying for years that most hospitals are understaffed.  Often these institutions supplement their regular nursing staffs with temporary nurses who may be unfamiliar with all of the particular facility’s routines, mission statement and medical staff.  We’ve all heard about this nursing shortage, but I believe that most of us don’t pay much attention to it . . . until it directly affects us.
 
I also believe that people become nurses for the best of reasons and intend to provide the best possible care for their patients.  I, therefore, gave my nurses the benefit of the doubt.  Nevertheless, when you are overwhelmed with post-surgical despondency, you really are not in an appropriate frame of mind to rationalize  why some RN is seemingly ignoring you in your time of need.  .
 

To overcome the breathing problem, I was soon introduced to a diabolical little plastic lung-exercising device, sometimes referred to as an “incentive deep breathing exerciser.” It consists of three enclosed vertical cylinders, five inches in length, each holding a small plastic ball.  The three cylinders are attached to a base which has a projecting flexible tube, at the end of which is a mouthpiece. The goal of the device is to get the debilitated, anxiety-ridden patient to suck on the mouthpiece hard enough to make the balls rise in succession to the tops of their respective cylinders.  Thus, on the first feeble attempt, the patient may be able to get the first ball half way up its cylinder while his lungs scream for relief. Sooner or later, the patient will hopefully improve to the point where all three balls will rise to the tops of their cylinders. With this surgery I immediately knew that it would not only be necessary for my lungs to improve, but my chest would have to heal as well.

 

This breathing exerciser was to become my nearly-constant companion for the next six or more weeks, until my breathing resumed its pre-surgical norm.  However, during that initial introduction to it,  I was convinced that this device had been created solely for the purpose of becoming my personal nemesis - - - my sworn enemy.
     

While these seemingly exhausting activities were going on, and in no particular order, an aide came into my room and announced that she was going to wash me while I was sitting up in the armchair.  I had detected earlier that my left leg and most of my chest was swathed in bandages, and my body had the telltale signs of various fluids (antiseptics, blood, etc.) all over the portions I could see.  Ever so gently, she began the first post-operative clean-up and I was most appreciative of her efforts.  While I thanked her profusely at the time, I never saw her again and was never able to fully express my gratitude for her kindness in momentarily returning to me some sense of dignity.
 

Later in the day a handful of relatives came to visit me.  Of course, visiting hours in the CCU are limited, but their presence was a psychological reaffirmation of my existence.
 

Also, the two physical therapists returned.  This time they got me out of the chair, assisted me while I shuffled twenty excruciating feet up and down the hallway, and got me back into bed, IVs, hanging tubes, wires, and all.
 

The inability to walk was psychologically devastating for me.  Walking had been my primary form of exercise during the prior twelve years; and I don’t mean strolling.  Sometime around my forty-eighth birthday I had set a goal of four-mile one-hour walks as a yardstick for measurement of my physical well-being.  Every time I went out onto the streets (and that averaged three times a week during the approximately seven months of agreeable weather in New York) I would aim to walk four miles in less than an hour.  I had devised a series of measured routes in my neighborhood so that I could walk with abandon, enjoy the scenery, and be assured of the distance I was traveling.  All I needed was a pair of sneakers and a wristwatch.
 

After awhile, the routine became sacrosanct and, to memorialize it, I decided, in celebration of my fiftieth birthday, to establish the “Paul S. Jason Annual Fifth Avenue Four-Mile Walk.”  I invited some friends and family members to join me at 8:00 a.m. on a Sunday morning in the Fall at 86th Street and Fifth Avenue in Manhattan.  We then proceeded to walk down Fifth Avenue (with the cross streets empty of most vehicular traffic at that hour on a Sunday morning) to the Washington Square Arch, a measured four miles.  This was not a race; but I encouraged all walkers to set a goal to walk the distance in one hour or less, if possible. Then, when everyone reached the Arch, I took them all out to breakfast.
 

I chose a walk in Manhattan because I was born and raised in New York City and I wanted to simultaneously celebrate my life and my lifelong attachment to this city. I chose Fifth Avenue because (i) it runs in essentially a straight line for the required four miles, (ii) it is lined with a great array of wonderful New York landmarks, and (iii) it concludes with a very visible goal line, the Washington Square Arch.


 

By April, 2000, I had already conducted ten of these annual events with a somewhat varying group of participants.  And, always, I had  managed to complete the walk in less than one inspiring hour.  Thus, it had become a source of joy, renewal and friendship for me.  Would that now be jeopardized forever? I had no way of knowing.
 
I forget whether or not I ate any solid food that first day. I was receiving nourishment intravenously.  I did, of course, slip in and out of sleep.
     

One of the other lessons I learned that day (I guess I should have known this before) is that hospital gowns are designed so that the patient’s rear end pokes out every time he gets out of bed or rises out of a chair.  No article of clothing has yet been devised by the mind of man to more quickly rob a middle-aged man (or woman for that matter) of his dignity than the hospital gown.   As my two young, female therapists assisted me with my first, feeble steps I didn’t know whether to cry (from the pain) or to feel embarrassed.  But I learned very quickly that when the body is broken and in pain, dignity dissipates straightaway and survival takes over.  For the balance of my hospital stay I was never again concerned with personal modesty; practicality ruled at all times, and that’s all I have to say about that subject.
 

Eventually, night settled in and I was thankful that I had survived the initial post-surgical trials and tribulations. My body ached, but somehow I knew I was going to get through this passage of my life.
 

Then as I lay in my bed, just minding my business, my surgeon suddenly appeared.  It was about 10:30 at night and I was surprised that he was still in the hospital since I was under the impression that he operates during the day time.
 

“Mr. Jason, I have come to ask a favor of you.”
 

(”A favor of me.  What could I possibly do in this condition to assist anyone, let alone a cardiothoracic surgeon?”).
 

“We have a critical emergency case who is being rushed into the operating room.  When the surgery is over in a few hours he will have to be moved into the CCU, and we have no available beds for him tonight.  Of all the patients in the CCU you are in the best condition to be moved . . .”
 

(”Best condition?  I’m half dead.  I’m just glad that my heart is still beating . . . and I can hardly breathe.”).
 

“I’m hoping that you will volunteer to leave the CCU tonight to make room for this patient.  If you agree to do so, you will be moved to the sixth floor ‘Intermediate Cardiac Care Unit’ tonight.”
 


 

(”Tonight?  I thought I was supposed to be in the CCU for two days after my surgery. I just had a quadruple coronary bypass operation. Should I question the evaluation of the man who, ostensibly, had just saved my life?”).
 

Well, now I was not only physically debilitated as never before in my life (and clinically depressed I might add), but I was being presented with a moral dilemma.  Do I respond to the doctor’s request as a decent human being concerned about the welfare of others less fortunate than myself, or do I play the role of the very sick patient and plead my own cause?
 

I don’t think that anyone appreciates having to deal with a moral dilemma, under any circumstances.  But I do think that this was a special circumstance. . . a time when I was not operating with all of my reasoned faculties.  Yet, to my subsequent amazement, my spontaneous reaction was to agree to the proposition that was presented to me.
 

To this day, I still mull over in my mind whether that request was ethical or not, and whether my response was emotional or rational.  In hindsight I can see that I suffered no ill effects from that decision; but, at the time, I had no way of knowing what the outcome of that precipitous action might be.  
To be continued….

April 30, 2008

From Flab to Fab

Filed under: By Ellen Bittner — Administrator @ 11:05 am

   Ellen Bittner
 

Chapter 1 – Nature vs. Nurture


The lyrics in the opening scene of the Broadway show Wicked (by Cristy Candler) pose the question - “Are people born wicked or do they have wickedness thrust upon them?”
 

This “nature versus nurture” debate concerning the relative importance of an individual’s genetics & innate qualities (”nature”) versus environment and personal experiences (”nurture”) in determining a person’s physical and behavioral traits has been going on for years. 


For me, the conflict between “nature” and “nurture” has to do with my physical health & life expectancy.  Although some of their ailments were the result of life style choices, both of my parents suffered from heart disease and had experienced multiple strokes and heart attacks.  My father, who also had glaucoma & emphysema, passed away when he was 73.  My mother, who died at the age of 77, also had high blood pressure, high cholesterol, & lung cancer.  Based on this family history and my genetic make-up, my quality of life and life expectancy would most likely be limited.  


Since I had reason to be concerned that I may have inherited a predisposition to some of my parents’ life threatening diseases (I also had several aunts and uncles who passed away in their 70s or early 80s), I decided to adopt what I considered to be a healthy life style.  I wasn’t a smoker and I followed a diet that was low in calories, and was salt and fat free.  I also followed an exercise routine that included walking & swimming.

Wanting to know more about the way “nurture” can affect life expectancy, I attended a lecture given by Dr. Nir Barzilai.  Dr. Barzilai is the Director of the Institute for Aging Research at the Albert Einstein College of Medicine.  His lecture focused on how behavior & environmental factors affect (“nurture”) longevity.  Some of the aspects he discussed related to spirituality, physical activity, interest & involvement in the arts, and participating in social situations.

At the conclusion of the lecture, one of Dr. Barzilai’s colleagues asked me if I would be interested in being a part of his research.  Since I was curious and wanted to learn more about these studies I said, “Yes.”  I later learned that I would be a part of the study’s “Control Group” because of my parents’ relatively short life spans.My real wake-up call occurred a few weeks later.  After I completed a survey, which included questions dealing with life style activities and choices, I was given a medical screening.  This screening included blood tests, height & weight measurements, and physical response tests. 

Despite what I had considered my “healthy” lifestyle, these tests showed that the hereditary factors were winning, and at 56 years of age I was at “high risk” in a number of categories.

After receiving these results, I became even more determined to shift the balance by “nurturing” myself more effectively and beat the odds dealt me by my genetic make-up (“nature”). 

To be continued…

 

 

April 10, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 10:42 pm

  Paul Jason

Chapter 10:  Help!!!  I’m Drowning and No One Can Hear Me
   

I was in the operating room for six and a half hours.  It was in the CCU, about nine hours after I was wheeled out of the operating room, that I learned that I had survived the operation and remained a mortal being on Planet Earth.  However, I didn’t know that immediately.  My first recollection of a conscious moment occurred  when I opened my eyes and realized that I was laying in what felt like a horizontal position, perhaps a little elevated, and everything around me appeared to be white.  I couldn’t see too much because I couldn’t really turn my head to the left or the right.
 
 ”My head must be propped in place”, I thought to myself.  “And I don’t seem to be able to move my arms or my legs.  It feels like there’s some kind of tube inside my throat, and I can’t swallow.  That must be the tube I heard about that assists your breathing during surgery.  But, I thought they take it out when the surgery is over. God, I don’t even know how I’m breathing. I can’t talk … I can’t even call out.  Help, someone.”
 

It’s not dark in here, but I feel paralyzed, and everything is white.  Oh, my God, maybe I’m dead and I don’t know it.  I can’t hear anything.  But wait, there is one thing I can see that isn’t all white - - - right on the wall directly opposite me.  It’s a clock - - - and I can see it, even without my eyeglasses on. I can read the numbers, and I can see the hands.  It says 3:30. 3:30!!  Is that a.m. or p.m.? What day is this? The surgeon told me the operation would take between six and seven hours.  They wheeled me into the operating room at about 11:30 a.m. on April 4th.  That would mean that I left the operating room around 6:30 p.m . on that day.  Is it now past midnight and into the wee hours of April 5th??  I can’t tell in here - - - wherever I am  - - - there doesn’t seem to be any natural light.”
 
“Wait a minute.  This is crazy.  I don’t even know if I’m dead or alive and I’m worrying about the time. Maybe this is a delusion.  I can’t move any of my limbs; I can’t talk: I don’t hear anything. How do I know I’m alive?  Maybe I’m in a suspended state of being, floating somewhere in the netherworld, somewhere between Heaven and Hell.  The clock.  Maybe it’s not real; maybe it is symbolic.  Maybe the time that I see on its face is illusory.  Maybe it’s there just to force me to come to grips with the fact that my time on Earth was but a  fleeting moment in the eternity of the Universe.”
 

My mind continued to race with thoughts of mortality, and then, without warning, all conscious thought ended. . . . .
 

“Wait !! - - - I’m conscious again.  Was I gone for a moment, an hour, a day, a week, a year?  I still can’t turn my head; my arms and legs still feel like they have heavy weights on them.  That damn tube is still stuck down my throat.  And the clock is still there on the wall - - - and it says 4:05.  I can hear voices in the background, but I cannot comprehend what they’re saying and I can’t yell out to them.  Oh God, am I dead or alive? Help, someone.”
 
And then, from out of nowhere, a thought occurred to me - - - if I am floating in the netherworld,  then this is all an illusion.  If that’s true, I shouldn’t be able to feel anything tangible.  But, there is one portion of me that I can move - - - and that’s my fingers.
 

  

So, I scratched at the whiteness around me and felt my fingernails rake the starched crispness of the bed linens.
 

“God, I must be alive.  I can feel the nub of the sheets and hear the frantic sound of my  fingernails digging into them.  I must be alive.  This is no illusion!!  This is tangible, and every fiber of my brain is telling me that I’m alive.”
 

And then, just as quickly as I made this discovery, I slipped back again into unconsciousness. . . . .
 

“Wait.  I’m conscious again.  And that clock on the wall says 4:35.  Why doesn’t anyone walk over to look at me?  I can still hear their voices out there.”
 

“Wait a second. Something’s wrong.  I think I’m alive, but I still can’t move anything but my fingers - - - and I can’t call out to anyone because I have a damn obstruction shoved down my throat.  And something is happening to that tube . . . that hose.  It feels like there’s something dripping down that hose. Drip, drip, dripping - - - with no let-up.  Oh, no. That post-nasal drip I inherited from my mother - - - the drip that comes and goes at its own whim - - - the one that never gives me serious trouble - - - but just enough trouble that I feel impelled to clear my throat, or cough, or blow my nose, to alleviate it . . . even take over-the-counter medication sometimes to dry it up real fast . That same nasal drip has just decided, at the most inopportune time in my life, to start acting up.  And its discharging mucous right onto that hose - - - and I can’t clear my throat (for God’s sake,
I can’t even swallow with that hose stuck down my throat); I can’t blow my nose; and there’s no way that I can communicate to anyone that I’m in distress.  What am I going to do?  How come no one warned me about this possibility? I feel like I’m going to choke.”
 

“Wait a minute: I’m not going to choke - - - I’m going to drown!!!  I’m going to drown right here in this damn hospital  - - - right here in this damn Cardiac Care Unit. I’m drowning and no one can hear me . . . and nobody’s going to know about it until I really am dead.”
 

“Don’t panic.  For God’s sake, don’t panic!!”
 

Unconsciousness. . . .
 

“I’m awake again.  The clock says 5:10.  Well, at least time isn’t standing still.  It must be 5:10 a.m. on April 5th.  But I can still feel that mucous dripping. . . dripping . . . down the hose in my throat. God, how big is that hose anyway?  It feels like a garden hose.  It must be  an inch in diameter. I really feel like I’m going to drown.”
Damn, I’m sure the nurses are checking on me periodically.  Why is none of them ever standing by my bed when I’m conscious?  Even if one of them were standing right there, I don’t know if I could communicate my anguish.  Oh God, is this the final retribution - - - allowing me to survive that horrendous surgery (itself a testament to the intelligence and creativity of man), only to allow me to ironically succumb to the lowliest of man’s ills? . . .  Unconsciousness.
 

Consciousness.  “The clock says 5:50.  I’m still alive. I didn’t drown while I was out, but I can still feel the mucous drip, drip, dripping down that hose. Voices.  Female voices.  Sounds like two nurses standing right outside my room.”  I hear one of them say: “John will be here soon.  As soon as he gets settled in, he will remove the tracheal tube from this patient.”
 

“Soon.  How soon?  Every moment feels like an eternity and that damn dripping isn’t stopping.   I hope I haven’t drowned by the time John gets here.  Wait.  Here comes a nurse. She’s coming right here to the bed.  She’s looking right at me.  She sees that my eyes are open.”  She says: “Take it easy, Mr. Jason.  Someone will be here in a little while to remove that tube from your throat.  You’ll feel better then.”
 

“Then?  When is “then”?  Can’t you see the terror in my eyes? . . . .   I guess not.  You’re walking away.” 
 

I doze off again.
 

“I hear voices again.  This time it’s a man and a woman.  The same nurse who told me that someone would be coming in a little while.  I can see that it’s 6:20.  My God, it must be morning, and the morning shift is coming on.  That hose must be in my throat at least since I left the operating room almost twelve hours ago.”
 

John and the nurse are exchanging some pleasantries, and he’s telling her about his social activities of the prior night.  “Oh God, don’t they understand that I”m about to drown.”  The seconds feel like hours. “I hope John is wide awake this morning and ready to go.”
 

Then, suddenly, John is at my bedside, doing just what he is trained to do.  Before I know it, the hose is removed and I really begin to feel alive.
 

Alive . . . Alive!!!

To be continued…
     
 

April 7, 2008

Meal Replacement Bars

Filed under: By Tamra Rosenfeld — Administrator @ 2:59 pm

  Tamra Rosenfeld

Meal replacement bars are geared towards athletes who need quick energy or people on the go who do not have time to have a meal. 

Pros to meal replacement bars: They are better than stopping at McDonalds or Burger King.  It is also better to have a meal replacement bar than to skip a meal.  Skipping meals can slow metabolism. 

Cons to meal replacement bars: They can be high in calories, sugars, and fats (including saturated fat).  Many people use them as snacks which can be detrimental to weight loss and weight maintenance.  These bars may contain anywhere between 150 and 350 calories.  A serving of fruit is 60 calories; Dannon Light N Fit yogurt only contains 60 calories.  Combine a fruit and a light yogurt and you still have fewer calories than a meal replacement bar.  Meal replacement bars also do not contain all of the nutrients a well balanced meal would provide.

Other comments: Meal replacement bars are usually high in protein.  The average person in America consumes more protein than they need from their diet.  If being used for a meal replacement the high protein content can be beneficial, but if used as a snack it is probably not needed.  Many meal replacement bars are fortified with 100% of the RDA for some vitamins and minerals.  With a well balanced diet this fortification is not necessary.  In addition if you have 2 meal replacement bars a day and a bowl of fortified cereal in the morning you may be getting 3 times what is recommended for some vitamins and minerals. 

How should you chose a meal replacement bar?  If you are going to have a meal replacement bar here are the things to look for:

  1. Read the labels and look at the calorie content.
  2. Check the amount of fat and saturated fat on the label.  Look for under 30% of the bar coming from fat.  Look for 1 gram of saturated fat or less.
  3. Look for added sugar. 
  4. Look for stimulant such as caffeine that you may not want.
  5. Check the fiber content – the higher the fiber, the better.

Meal replacement bar examples: 

Below are examples of some protein bars that are very high in calories, fat, or sugar.

 

High calorie bars (over 300 calories per bar) –

American Body Building Extreme Body Peanut Crunch Bar,

Detour Caramel Peanut,

Meso-Tech Caramel Nut Crunch,

Myoplex Storm Chocolate Peanut Caramel,

Tri-O-Plex Peanut Butter Chocolate Chip.

 

High fat bars (10 grams of fat or more):

Atkins Advantage Chocolate Peanut Butter Bar,

Carb Solutions High Protein Bar Creamy Chocolate Peanut Butter,

Detour Caramel Peanut,

Myoplex Storm Chocolate Peanut Caramel,

Tri-O-Plex Peanut Butter Chocolate Chip.

 

High sugar bars (25 grams of sugar or more):

Advant Edge Complete Nutrition Energy Bar Peanut Butter Caramel,

American Body Building Steel Bar Crunchy Peanut Butter,

GeniSoy Southern Style Chunky Peanut Butter Fudge,

Promax Chocolate Peanut Crunch.

 

Here are some better options:

 

If you are looking for a lower calorie (under 200), lower fat (5 grams or less), and lower sugar (15 grams or less) option:

Doctor’s CarbRite Diet Chocolate Peanut Butter,

Kashi Go Lean Crunchy Chocolate Peanut Bliss,

Luna Nutz Over Chocolate,

Pria from Power Bar Chocolate Peanut Crunch,

Rapid Results Diet System Soy Protein Bar Chocolate Almond,

Slim Fast Succeed Chocolate Peanut,

 

If you are an athlete looking for quick energy these are high in calories and carbohydrates but low in saturated fat which can raise cholesterol levels:

Biochem Ultimate Low Carb Bar – Creamy Peanut Butter

Cliff Bar Chocolate Chip Peanut Crunch

Power Bar Chocolate Peanut Butter

Revival – Peanut Butter Chocolate Pal

Tri-O-Plex Peanut Butter Chocolate Chip

 

 

March 29, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 5:42 pm
  Paul Jason
 

Chapter 9                    Anesthesiology and Anesthesiologists
 

Tuesday, April 4, 2000, was the big day.  It could be my last day if things didn’t go well in the operating room. I know that they were feeding me tranquilizers intravenously.  Otherwise, I would have been bouncing off the walls.  
 

At 9:05 a.m., an aide came to my room to get me. I was transferred to a gurney and brought to a holding area on the surgical floor of the hospital.  The holding area was cool and I felt cold.  A nurse put a blanket on me.
 

At first, the staff couldn’t find my surgical consent form.  But soon it was located.  A Physician’s Assistant came by to check my chart.
 

And then . . . a female physician with an Eastern European  accent came.  She told me that she was the anaesthesiologist.  The anaesthesiologist??   What happened to whatshisname??
 

Oh, God!  Is this a bad sign?  A part of the team has been changed and we haven’t even started yet.
 

Again I expressed my apprehension, and requested that I be rendered unconscious before being brought into the operating room.
 

“No problem.”
 

Now, for the first time, I began to think about the paradox created by the fact that I had chosen my thoracic surgeon, but  I apparently had no say in choosing my anaesthesiologist.  What if my operation was about to be performed by the best cardiosurgeon  in the hospital, assisted by the worst anaesthesiologist in the hospital?  Why is it that patients get to pick their surgeons, but they don’t get to pick their anaesthesiologists?
 
Obviously, I didn’t have time to resolve that dilemma prior to my surgery.  The tranquilizers were kicking in.  Why hadn’t I thought about this before?
                                                                             
Anesthesiology is apparently one field of medicine (similar to obstetrics) that lends itself to group practice.  I don’t know the history, the economics or the politics of this situation, but it is a fact.  As I indicated earlier,  I tried to interview two anesthesiologists after the surgery to get some answers to this and other questions.  Perhaps, had they been willing to grant those interviews, I could be speaking from knowledge, rather than conjecture.
 


It appears that anesthesiology groups contract with one or more hospitals, providing services on an as-needed basis. It seems logical, therefore, that every time a surgical procedure is scheduled at a hospital, an available anesthesiologist from the contracted group is designated to cover the operation.  Whether one or more anesthesiologists are in attendance during any one surgical procedure is unknown to me.  Also, whether anesthesiologists specialize (e.g., in head surgery, thoracic surgery or obstetrical procedures), is also unknown to me.  What I do know from speaking to people, however, is that most patients do not get to choose the anesthesiologist who will assist their selected surgeon.
     

In my case, the surgeon was recommended by two of my attending physicians.  Additionally, as I described elsewhere, I was encouraged by the recommended surgeon and by my cardiologist to obtain a second opinion and I did receive that opinion, regarding both my condition and my surgeon, from a cardiac surgeon affiliated with another major medical institution in New York City.
 

However, at no time during the pre-surgical process did anyone inform me that I had any choice whatsoever in the selection of the anesthesiologist.  I repeat my earlier question: what if my surgeon is the best cardiothoracic surgeon at the hospital, but is being assisted by the worst anesthesiologist in the group providing services to that institution?
 

            I knew that I would be subjected to general anesthesia during my surgery.  But, what exactly is “general anesthesia”?  Does it simply mean that they would “put me to sleep”?  Obviously a general anesthetic state is much different from sleep.  I can’t imagine anyone being able to remove or repair one of my body organs while I am simply asleep. 
 

Actually, general anesthesia is about as different from ordinary sleep as a snooze is from a coma. It is essentially composed of four elements: hypnosis (unconsciousness), amnesia (lack of memory), analgesia (lack of pain) and muscle relaxation.  Not every surgical operation requires all four elements.  On the other hand, no one drug or technique can address all four elements at the same time. Therefore, being able to choose the correct combination of drugs and techniques is at the core of anesthesiology.  Dosage, of course, is also important.
 

Amongst the drugs used to achieve the desired results are barbiturates, narcotics (opioids), volatile anesthetics, anxiolytics and muscle relaxants.
 

Barbiturates produce hypnosis and are used to induce unconsciousness.  They provide virtually no analgesia, amnesia or muscle relaxation.
 

Narcotics or opioids, on the other hand, provide potent analgesic effects, but are not effective in producing either hypnosis or amnesia.
 
Volatile anesthetics are liquids that vaporize and are administered through breathing apparatus.  They are very effective in producing hypnosis and amnesia and, at some dosages, produce good muscle relaxation.  However, they provide no significant analgesia.
 


Anxiolytics are used to relieve anxiety and are usually given to patients prior to surgery to calm them.  They are also helpful in ensuring anterograde amnesia (i.e., lack of memory regarding events going forward in time).  They produce hypnosis only at high doses and do not provide any analgesia or muscle relaxation.  Versed, which I discussed in conjunction with my angioplasty, is an anxiolytic.
     

Muscle relaxants do exactly that.  Therefore, they are never used alone.
 

In a typical surgical procedure, an intravenous infusion is established and an anxiolytic drug is introduced to calm the patient and to induce amnesia.  In the operating room induction agents are introduced through the IV to quickly establish the anesthetized state.  Most of these agents are short-acting.  They are utilized to allow the placing of the endotracheal tube through the patient’s mouth, past the vocal chords and into the trachea (windpipe).  Once this has been accomplished, the anesthesia for the surgery is begun by introducing combinations of the  barbiturates, narcotics, volatile anesthetics, anxiolytics and muscle relaxants discussed above.
 

Interestingly, muscle relaxants, when they are used, are not selective, i.e., they weaken all of the muscles of the body, including the muscles used for breathing.  That is one of the reasons the endotracheal tube is used.  It provides a means of assisting breathing by connecting the patient’s respiratory system to an external, mechanical ventilator.
 

The anesthesia is continued until the completion of the surgery, at which time introduction of the agents is discontinued and the effects of the muscle relaxants are reversed with intravenous medications.
 

Most persons are awake enough to be responsive shortly after they arrive in the recovery room, even though they cannot remember these moments.  The sensation of “waking up” occurs when the patient’s memory returns (the ebbing of the anterograde amnesia), even though he may seem, from all outward appearances, to be awake before that time.
 

Are there risks associated with general anesthesia?  Of course there are, and we have all heard about them in some general way.  A human being, with human frailties, will be making critical decisions regarding our lives while we are defenseless to fend off his or her  errors. The number of potential complications are extensive.  One source I came across claims that death, as a direct result of anesthesia, occurs about two or three times out of each million anesthetics.  However, I wouldn’t take too much comfort in that statistic, assuming that it is true, because the emphasis is on death, as opposed to permanent damage to some body organ or system.
 


Another issue I had never thought about before is the possibility of waking up in the middle of the operation.  I assumed, as I would think most other laymen have assumed, that once they put you to “sleep”, you stay asleep until the surgery is completed and you’re in the recovery room.  Up until very recent years, while it was an exceptional occurrence, there were recorded instances when exactly that worst nightmare happened. To understand how it happened, one must appreciate the distinction between unconsciousness (lack of awareness) and amnesia (lack of memory).  An inebriated person, for example, is not unconscious, but he could be amnesic.  Therefore, in spite of the fact that his speech and motor coordination may be impaired,  he can still be aware of his surroundings, although he may not later remember anything that occurred while he was in that state.
 

Are patients unconscious from the time that the initial sedation sets in until the surgery is over.  Not necessarily.  They may have no memory of the events that occurred while they were under the influence of anesthesia, but whether they were unconscious at all times is sometimes hard to tell.  There have been some studies that suggest that many patients may have awareness, at least for sound, during anesthesia.  It appears that very few have any recall.
 

During the surgery, as I discuss in the next chapter, the patient’s vital signs (pulse, blood pressure, etc.) are closely monitored.  If there are any signs that a patient is beginning to awaken from the anesthetic, the anesthesiologist is alerted to this fact by telltale signs such as increases in blood pressure and heart rate, changes in respiratory patterns and a variety of other vital signs.  Therefore, action can be taken to remediate the situation. Nevertheless, there have been cases where patients have actually experienced recall of events which occurred during anesthesia, even though above average doses of anesthetic agents were introduced or because their bodies failed to signal the telltale changes in their vital signs.  Again, variable factors such as  differences among individuals regarding their tolerances to medications can result in unexpected events.
 

The worst possible case scenario could occur when muscle relaxants are used. In that event if the patient becomes aware or feels pain during the surgery, he is incapable of communicating that to the operating team because he is essentially paralyzed. 
 

Fortunately, however, in 1996 a new technology known as the Bispectral Index (BIS)  became commercially available.  It is a noninvasive monitoring system consisting of a sensor attached to the patient’s forehead and a monitor. It can directly measure the effects of anesthesia on the brain by analyzing the brain waves recorded in the electroencephalograph (EEG), translating them and producing readings on the monitor ranging from zero (no brain activity) to one hundred (the patient is fully awake).  By continually indicating the patient’s level of consciousness during the surgical procedure, the anesthesiologist is able to adjust the amount of anesthetic agent the individual requires.  The result is that there are fewer cases of under-sedation or over-sedation and patients are waking up faster after the surgery.  I do not know if this device was used during my surgery.

To be continued next week…

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