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The High-Tech Heart: A Neurologist Talks about His Own Bypass Operation

separator When the inner linings of arteries become so clogged with cholesterol that the heart cannot get the blood and oxygen it needs for normal functioning, your cardiologist may recommend coronary artery bypass surgery. This surgery creates new routes for blood to travel to the heart.

During bypass procedures the surgeon typically uses part of what’s called the internal mammary artery (IMA), which is also in your chest, to make the new passageway for blood. Sometimes, they use veins from the legs to create the new passageway. Whether they use the IMA or the leg vein depends on where the blockage is.

It’s common for patients to need more than one bypass. That’s what is meant when you hear terms like “quadruple bypass surgery,” “triple bypass surgery,” etc. Bypass surgery usually takes from three to six hours to perform.

A doctor’s recovery from bypass surgery
We spoke with Praful, a neurologist originally from India who’s lived in the U.S. for nearly 30 years. He came here when he was in his early 20s. Praful had bypass surgery in November 2006, after learning that one of his coronary arteries was completely blocked and that two others were about 60 percent blocked.

Praful says he was “pretty astonished” when he found out he had to have a bypass operation. He had been experiencing mid-chest discomfort, a feeling of heaviness in the chest and a burning in the stomach for several days. But, he says, he had had episodes like that, especially the burning in the stomach, off and on for 10 years. In 1996, he had a treadmill stress test that showed no abnormalities.

He managed his feelings of indigestion over the years by taking Prilosec and by cutting back on spicy foods, which have been a common part of his diet.

Now, a new treadmill test was “long overdue” he says. The pains in his chest were a little different than what he had experienced previously. And, he says, he was noticing that sometimes a little bit of exercise would cause shortness of breath. “My wife was forcefully telling me ‘You have to go to the doctor about these pains, period.’ So I went for the second stress test. I said to my wife, ‘I can assure you it will be negative.’ ”

This was on the Wednesday before Thanksgiving. Praful was surprised to learn that the stress test was abnormal “When I had my first stress test,” he says, “I was able to keep going without a problem. This second time, I had to tell the cardiologist to stop the machine.”

That same day, Praful had a cardiac catheterization, the test that confirms whether arteries are blocked or not. “They found that I had a total blockage of the main left anterior descending artery. That’s an extremely important artery,” he says, “because it supplies the left ventricle. The left ventricle pumps blood to the rest of the body. The test also revealed that two other arteries were 60 percent blocked.” Praful’s cardiologist showed him the test results. “I was completely convinced that I had to have the bypass operation,” he says.

If arteries aren’t completely blocked, surgeons are often able to decrease the blockage by inserting a stent in the artery. The stent is a small tube that props up the artery and keeps it open, so that blood can pass freely. In Praful’s case, the total blockage in the left anterior descending artery meant that bypass was necessary. “The stent wouldn’t work because the blockage was complete,” he says. “The stent could rupture the artery and cause instant death.”

The next day, Praful had his bypass operation. He says that going in for the testing, finding out he needed surgery and entering the operating room the next day was “like a Disney World roller coaster ride.” But he says he felt calm and relaxed the night before and even the morning of the surgery. “I relied on God and technology,” he says. “I knew that the chances of mishap were small, because these procedures are done all the time.”

After the surgery
Praful says he began to wake up several hours after the surgery. “I started becoming aware of where I was. I was experiencing sharp belly pain, I was trying to tell the nurse about it, but I couldn’t talk, because I had a tube in my throat [this is normal after bypass surgery]. I had to gesture,” he says.

The next thing he remembers is waking again at about 3:00 the next morning feeling rested and in no pain. “The first hours after surgery are often painful,” he says. “But they generally give you pain killers for 48 hours, so the pain is manageable. But those first days are difficult. There can be complications. And you have tubes in place—one in the pleura [the chest area] to drain fluid from the lungs, one in the pericardium [the lining of the heart] to drain fluid there and the tube in the throat.”

For Praful, “the most troubling part in the early days was trying to move. You need total help at first to sit up.” He says that on about the third day, he was up and walking. “They have you put a pillow against your chest. This makes it easier to move,” he says.

But in the beginning, the walking is hard, he says. “You can take only baby steps. In fact, babies can go faster. And coughing and sneezing can be painful”

Recovering at home
But gradually, you feel better and better, he says. “At first you feel week and tired. But you get stronger every day.” Praful went home five days after his surgery. “They tell you not to drive for two weeks, because your wound needs to heal. But I started driving within 10 days. I had to practice moving the steering wheel first though.”

Praful says his doctors said he could go back to work in two to four weeks. He started back to work, part-time, after two weeks. “My heart itself was strong,” he says. “It hadn’t been damaged from a previous heart attack, so I was able to get back into things fairly quickly. Even in the days right after I returned home, I did a little work around the house. I’d pick up a broom, rearrange things in cabinets, just to get my arms and legs moving.”

It’s common for people to experience emotional ups and downs after bypass surgery. Praful says, “I had a little phase when I was irritable. And sometimes I felt down. I sometimes felt smaller. I had lost my vigor and the strength I had. I would wonder why this had happened to me. But then I would look at it positively. I would say to myself, ‘God saved your heart and your life.’ ”

Making changes in lifestyle
Praful says he feels stronger now. In retrospect, he says that before his surgery, he had much less energy than he does now. But the loss of energy happened so gradually that he hadn’t noticed it.

He says he’s doing more vigorous exercise now, walking every day. He’s changed his diet as well. “I don’t have regular milk anymore,” he says. “Now I drink only the no-fat milk. I avoid fried foods now, while before I ate whatever I wanted. And I eat oatmeal a lot. I never liked it before, but I’ve learned that you can make it taste good when you add spices to it.”

Praful says that after someone has heart surgery, family and friends rush to the cardiologist to make sure their own hearts are okay. And for several days after you get home, he says, everybody changes the way they eat. “That’s a natural anxiety,” he says. “But then they go back to their routine habits and their routine foods.”

Praful’s reassurance to those needing bypass surgery
These days, Praful says, “surgery isn’t really so bad. The technology is good and the pain management is good. People who have to have this surgery shouldn’t worry too much. They need to know they can rely on science and technology.”

A personal interview with Praful.
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